Inspection on 22/08/07 for Maltings (The)

This inspection was carried out on 22nd August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Maltings (The) 19/04/06

Maltings (The) 28/11/05

Maltings (The) 08/08/05

Maltings (The) 09/02/05

Maltings (The) 21/07/04

Maltings (The) 04/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Maltings (The) Brewers Lane Shelbourne Road Calne Wiltshire SN11 8EZ Lead Inspector Malcolm Kippax Key Unannounced Inspection 22nd August 2007 10:00 Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maltings (The) Address Brewers Lane Shelbourne Road Calne Wiltshire SN11 8EZ 01249 815377 F/P 01249 815377 none Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Milbury Care Services Limited Ms Sheridan Victoria Bidmead Care Home 3 Category(ies) of Learning disability (3), Physical disability (3), registration, with number Sensory impairment (3) of places Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th April 2006 Brief Description of the Service: The Maltings is run by Milbury Care Services Limited. A housing association owns the property. The Maltings has places for three people with learning disabilities who may also have a physical disability or a sensory impairment. The Maltings is situated in a residential area on the outskirts of Calne. It is a detached bungalow with a large garden. The accommodation includes three single bedrooms, a dining room, a lounge and a sensory room. One of the bedrooms has an en-suite bathroom. Other facilities include a kitchen, a utility area, two toilets, a shower and a bathroom. There is an office and a sleeping-in room for staff use. Service users receive support from the home’s manager and permanent staff team. Relief staff are also used on occasions. The fee level at the time of this inspection was £1505.90 per week. A copy of the last inspection report is available in the home. Inspection reports are also available through the Commission’s website at: www.csci.org.uk Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to the home, which took place on 22nd August 2007 between 10.00 am and 5.00 pm. A second visit was arranged with the home’s manager when feedback was given about the inspection. This took place on 30th August 2007 at 9.15 am. Evidence was obtained during the visits through: • • • • Time spent with the three service users. Meetings with Ms Sheridan Bidmead (the home’s manager) and with four members of staff. Observation and a tour of the home. An examination of records, including the service users’ personal files. Other information has been taken into account as part of this inspection: • • • • An Annual Quality Assurance Assessment (referred to as the AQAA) that was completed by the manager. Comments that were received from three relatives. These were in response to surveys that had been sent by the Commission to relatives and to a local Community Team for People with Learning Disabilities. Notifications and reports that the Commission has received about the home since the last key inspection. A telephone conversation with the manager after the visits. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. What the service does well: Staff members have good information about the service users’ individual backgrounds and their need for support. Specific needs and the service users’ daily routines are well reflected in their individual plans and records. The guidance for staff is often written from the service users’ perspectives. This includes for example, information that is provided under the headings: ‘How I want staff to assist me’ and ‘How I don’t want staff to assist me’. This approach helps to ensure that service users receive consistent and individual support in the way that they prefer. Other information has been recorded and added to over time, for example about ‘My best day’ and ‘Things I like’. This helps staff to support service users who may have limited capacity to take decisions and make their wishes known. Service users are offered choices in their daily activities and supported to be involved in the home’s routines. Staff are aware of when the service users need support and supervision so they are not at risk within the home. Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 6 The service users’ needs are monitored and support is provided with appointments so that service users maintain good health. Service users have specialist needs, which the manager and staff respond to by involving the appropriate professionals from outside the home. Assessments have been undertaken, which help to ensure that people are safe when care is being provided. Service users are protected by the way that their medication is dealt with. There are procedures in place that help to protect service users from harm and to ensure that any concerns are followed up. Service users are well supported with keeping in touch with their family and with the wider community. Staff recognise the importance of having meal arrangements that are flexible. Service users receive support that meets their individual preferences and dietary needs. The accommodation is generally homely and well maintained. There are different communal areas and also a sensory room, so that service users can participate in different activities. The garden is spacious and provides service users with a variety of outside facilities. Service users are protected by the home’s recruitment practices and benefit from the induction that new staff members receive. Staff members have a positive approach and attitude to their work. Service users benefit from a well run home. The management approach promotes their health and welfare. Audits and reviews are being undertaken, which help to maintain a safe environment and identify improvements. What has improved since the last inspection? What they could do better: Information needs to be provided about any services and goods that may be provided, but are not covered by the weekly fee. In particular, the arrangements about paying for meals outside the home need to be clarified. Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 7 This is to ensure that there are clear guidelines for staff to follow about when service users are expected to contribute to the costs from their own money. A system of cross-referencing could be used in the service users’ individual records. This would help ensure that all the relevant information in respect of the service users’ needs is linked and readily identified. The service users’ personal goals, and the action being taken to achieve these, could be better reflected in their individual plans. This would help ensure that service users make the progress that they are capable of and that the goals continue to be relevant. Changes in day care arrangements mean that service users are more dependent on staff for support with occupation and activities. It is important that there is a good system in place for monitoring the outcome of the service users’ goals and the suitability of the activities provided. Risk assessments are undertaken which highlight the hazards arising from certain activities. The benefits arising from a particular activity could be shown as well, so that the assessment process is also seen as a way of promoting the service users’ rights and independence. The quality of written information available about health and personal care differed between the three service users. A more consistent approach to record keeping and the use of forms would help ensure that staff always have good guidelines about the support that the service users need. Improvements should continue to be made to the home, so that the environment and accommodation better meets the needs of service users. The programme of staff training should be developed and implemented as a matter of priority in accordance with the training needs assessment. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is adequate overall. This judgement has been made using available evidence including the visits to the home. Further information is needed in order to ensure that service users can be confident about the arrangements being made for additional charges and payment for services that are not covered by the weekly fee. Standard 2 did not apply at the time of this inspection. No new service users had moved into the home during the last year. The current service users have lived together for a number of years. EVIDENCE: A Statement of Purpose for The Maltings was available in the home’s office. Ms Bidmead confirmed that it was being kept under review to reflect changes that were taking place in the management and staff team. The service user’s guides did not include information about the arrangements in place for charging and payment for additional services. This was discussed with Ms Bidmead, who reported that a new form had been produced for the recording of this information. Staff members had reported that service users paid for the meals that were bought when outside the home. There was no policy about this and the Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 10 arrangements were later discussed with Ms Bidmead. Ms Bidmead said that she had sought clarification about this from her manager. Service users were expected to pay for meals on certain occasions when they went out as a ‘treat’. At other times, for example, when service users went out as part of a normal day, they would not have to pay. Ms Bidmead said that a written policy would now be produced in order to give guidance to staff about the arrangements and to avoid any inconsistencies. It was agreed with Ms Bidmead that the matter would need to be followed up further in order to establish the occasions when service users had paid for meals inappropriately and therefore needed to be reimbursed. The Commission will be having correspondence with Milbury Care about this and expecting that an appropriate person investigates the matter and action is taken as necessary. Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including the visits to the home. The service users’ needs and preferences are generally well reflected in their individual plans. There is a lack of detail about personal goals, which could have an impact on the progress that service users are able to achieve. Service users have limited capacity to make informed decisions and benefit from the assistance that they receive from staff. Assessments are undertaken, which help to ensure that the risk of harm is reduced. EVIDENCE: Information about the service users’ needs was contained in ‘Person Centred Planning’ files that had been set up for each person. The files included a range of individual plans and forms that described people’s needs and daily support. Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 12 Some documentation, such as ‘Communication Passports’, ‘People Handling assessment forms’ and ‘Bathing plans’, provided staff with guidance about specific areas of need. The main areas of personal care were described in a plan for ‘Individual Support Requirements’. The files contained records of risk assessments that had been undertaken in respect of individual service users. These mostly concerned tasks relating to personal care and how to ensure that people were safe when physical care was being provided. Some risk assessments had been undertaken in respect of other activities, such as baking and being in the kitchen. The assessment forms focussed on the hazards associated with a particular activity, rather than on the benefits to the service user. Dates had been added to show when the assessments and guidance in the service users’ files had been reviewed. Information was being updated over time and a number of the assessments and plans had been reviewed in June and July 2007. There was no system of cross-referencing used to link the different records relating to a particular activity or task. The staff members spoken to thought that the files contained the information that was needed, although acknowledged that some reorganisation and archiving could be beneficial. ‘Monthly Summary Sheets’ were being used as a means of monitoring the service users’ needs and welfare. The summary sheets referred to the progress that the service users were making and staff recorded information under headings that included ‘Individual Support Requirements’ and ‘Achieved goals’ and ‘Future planning’. The latter section referred to some new individual needs and wishes that had been identified, although there was inconsistent information about how these were being followed up. Ms Bidmead said that the person centred planning documentation was being reviewed and new recording forms would be produced. This was also highlighted in the AQAA as an area for improvement. Guidance generally showed that the service users require support from staff in many areas of daily living and personal care. This included support with making decisions and with making their views known. Some forms in the service users’ files, such as ‘My Life now’ and ‘Things I Like’ helped with this and gave a personal account of their needs and wishes. During the visits, choice and decision making were evident when service users spent their time in different areas of the home. Staff said that they supported service users with making choices at mealtimes and about what to wear. One staff member said that they would show a service user two sets of clothes, from which they could make a choice. The written guidance gave staff good information about the service users’ preferred routines. Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including the visits to the home. Changes in day care arrangements mean that service users are now more dependent on the home’s staff. The provision of activities will need to be kept under review, to ensure they meet the service users’ needs in the long term. Service users are well supported with keeping in touch with their family and with the wider community. Service users benefit from an individual and flexible approach to the meal arrangements. EVIDENCE: Each service user attended a local resource centre on certain weekdays. The number of days had reduced during the last year and service users could no longer attend for the four or five days a week that had been usual. Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 14 Service users were not attending other planned day care activities outside the home. As a result, staff members spent more time with service users during the day and arranged activities at the time. This allowed for a flexible approach, but meant that there was also some uncertainty about what could be arranged on the day, for example because of the weather or the availability of a staff member who could drive the home’s vehicle. In their surveys, two relatives commented on the impact that the reduction in day services was having on service users. They felt that there was less stimulation for the service users as a result. One service user in particular liked the routine of going out each day. Staff members described the activities that were taking place, which included trips to local amenities, meals out and visits to family. Within the home, service users spent time doing art and craft activities, baking and listening to music. One service user had a collection of films on DVD that they liked to watch. Another person liked to use the sensory room, although staff said that they also encouraged this person to participate in a wider range of activities. This had been recorded as a goal in the service user’s records. Information was included in the service users’ files about the things they liked to do. This was well recorded under headings such as ‘My best … weekday / weekend’. Pictures had been used to illustrate some of the activities. The monthly summary sheets included the headings ‘Social Diary’ and ‘Activities and outcomes’. Another form was being used to record the service users’ participation in activities although these were not being consistently completed. Each service user kept in contact with their family on a regular basis. Staff members provided support with the travelling arrangements and liaised with the service users’ relatives. Information about relationships and significant people was recorded in the service users’ personal files. This was under headings such as, ‘About My Family’ and ‘How I would like my family and friends to be involved in my life’. In their surveys, two people confirmed that they were always kept up to date with important issues concerning their relative in the home. One person responded that they usually were. Each service user had the privacy of their own bedroom. The provision of communal areas meant that service users could participate in different activities and spend time apart from each other when they needed to. Menus for the main meals were written for the week ahead. These showed a varied range of meals. Comment had been added about one service user’s dislike of particular foods. Staff said that changes were sometimes made to the planned menu on the day. Alternatives and changes to the menu were separately recorded, as part of the daily recording of matters relating to food hygiene and preparation. Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 15 The evening meal on 22nd August 2007 was prepared using fresh ingredients. In their survey, one relative commented that food preparation and quantity was very good. Some dietary advice was recorded in the service users’ files, together with information about people’s individual likes and dislikes. Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including the visits to the home. The service users’ personal and health needs are being met. Service users benefit from the support that they receive from the manager and staff team. Some aspects of their care could be better reflected in the individual records. Service users are protected by the way that their medication is dealt with. EVIDENCE: Each service user had a plan for ‘Individual Support Requirements’. These were written from the service users’ perspectives and provided details of the personal support that was needed in different areas. The forms included two sections: ‘How I want staff to assist me’ and ‘How I don’t want staff to assist me’. The latter was a useful way of identifying things that may upset service users or put them at risk. Guidelines had been produced in areas such as moving and handling; and bathing. The personal files included a range of other information about individual needs that had been added to over time. This resulted in variation in the content of the files. For example, one service user’s file included Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 17 comprehensive guidance about the arrangements for support with nail cutting, although similar detailed information was not seen for the other service users. In their survey, one person commented that their relative in the home ‘has always appeared to be more than well looked after’. Another person commented that they ‘cannot fault’ their relative’s care. The service user’s records showed evidence of recent health issues and the involvement of different healthcare professionals. These were also referred to in the minutes of staff meetings. An occupational therapist had recently been involved with one service user and provided support with obtaining some new aids. During the last year the service users have also had contact with a physiotherapist and dietician. A consultant psychiatrist had reviewed one service user’s epilepsy in April 2007. As previously reported, there was no system of cross-referencing used and the lack of archiving meant that the most recent guidance and forms could not always be readily identified. This was discussed with Ms Bidmead in relation to epilepsy management plans and the guidelines for supporting service users with eating. At the time of the visit on 22 August 2007, Ms Bidmead was supporting one service user who had been admitted to hospital. The service user returned to the home later in the day and was welcomed back by staff. One staff member commented that when finishing work they always left the home feeling that the service users were well cared for and in safe hands. No service users were able to manage their own medication. Staff members provided support with its administration and safekeeping. Medication training was provided for staff. There were suitable storage and recording arrangements in place. Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including the visits to the home. Service users are dependent on others to raise any concerns and complaints on their behalf. There are procedures in place that help to protect service users from harm. EVIDENCE: Milbury Care has produced a leaflet covering concerns, complaints and suggestions. In their comment cards, each relative confirmed that they were aware of the home’s complaints procedure. Ms Bidmead reported that the home has not received any complaints during the last year. No complaints or concerns have been raised with the Commission during this time. There had been no adult protection referrals during the last year. Milbury Care had produced guidance on the prevention of abuse and the responsibilities of staff. Staff confirmed that they received training in the protection of vulnerable adults. This was included in the home’s programme of mandatory training. Staff members were familiar with the ‘No Secrets’ booklet, which gives guidance about the reporting of suspected abuse. Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate and improving. This judgement has been made using available evidence including the visits to the home. The accommodation is generally homely and being well maintained. There are good communal facilities. Work is being undertaken so that the environment as a whole better meets the service users’ individual needs. The home is kept clean and tidy. EVIDENCE: The Maltings is in a residential area and close to a range of public amenities and main roads. The home was not designed with a wheelchair user in mind and there are shortcomings in how well the environment meets the service users’ needs. One of the bedrooms measures 9.3 square metres and continues to be occupied by a service user who uses a wheelchair. Recommendations have been made at previous inspections concerning access to the home and some aspects of the environment. Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 20 Ms Bidmead confirmed that plans for certain works had now been agreed with the housing association that owns the property. This would result in a new ramp and improved access. Work is also to be undertaken at one side of the property to make this area safe for use by service users and to provide a new patio area and walkway. During the visits, service users were spending time in different areas of the home. The kitchen was not accessible to the service user who uses a wheelchair. The lay out of the accommodation limited the activities that this service user could participate in and the ease in which some rooms could be reached. There was a well established garden, which provided service users with a sun house and shaded sitting areas. Features, such as mobiles, had been hung from trees to add interest for service users. Ms Bidmead said that the new patio area would be of particular benefit to service users with sensory impairment. Plants would be chosen with fragrance to create an outside sensory area. The appearance of the garden varied, as attention and upkeep was focussed on the areas currently used by service users. It was reported at the last inspection that some of the décor looked dated. The manager at the time was keen for the home environment to reflect the needs of service users better, for example by using colour and texture in ways that will benefit service users. Some areas have been redecorated during the last year. The main communal area consisted of a spacious lounge. There was a separate dining room, which could be used for art and craft activities. Some of the service users’ artwork was displayed on the walls. The sensory room was being regularly used. The accommodation looked clean and there were no unpleasant odours. The condition of a toilet seat aid was discussed with Ms Bidmead. Tape had been used in one area that made it difficult to create a hygienic surface. It was confirmed with Ms Bidmead that an alternative arrangement should be made. An environmental health officer inspected the home in August 2005 and this was reported to be satisfactory. Staff members had received training in infection control. A ‘red bag’ system was in use for the movement of soiled laundry. It was reported at the last inspection that the manager at the time had identified some work that she wanted to take place to improve and upgrade some of the fire precautions, including the fitting of fire doors to replace ordinary ones. The manager had said that this work has been raised with the relevant parties, but a timescale had not yet been agreed. Ms Bidmead said that she was not aware of the action that had been taken in connection with this and confirmed that she would be following it up. Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate and improving. This judgement has been made using available evidence including the visits to the home. Service users are protected by the home’s recruitment practices and benefit from the induction that new staff receive. Staff members have a positive approach and attitude. The training available to staff is being developed, so that this will be better matched to the service users’ needs. EVIDENCE: There was a staff team of six permanent support workers, one of whom divided their time between The Maltings and another care home run by Milbury Care Services. Agency staff were not being used at the time of the visits. In addition to carrying out management tasks, Ms Bidmead also supported service users with their day to day needs, as was evident during the visits. Ms Bidmead said that the original documentation relating to the recruitment of staff was maintained centrally in the Milbury Care regional office. Checklists were kept in the home showing the recruitment checks that had been undertaken on new staff. These included the completion of a Criminal Records Bureau disclosure (CRB) and obtaining references and proof of the prospective staff member’s identity. Dates confirmed that the appropriate checks were Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 22 completed before the new staff member had started work. Ms Bidmead said that POVA First checks were not undertaken as it was the home’s policy that staff members would not start working in the home before a full CRB disclosure was obtained. Three support workers had obtained National Vocational Qualification (NVQ) level 2 or above. The staff members met with had worked in the home for different lengths of time. One person had achieved their NVQ and had worked in the home for several years. Two staff members had been employed during the last year; the most recently appointed person was currently undertaking an in-house induction. The other person said that they had completed their induction and was half way through their Learning Disability Award Framework (LDAF) training. Following LDAF, they were then expecting to start their National Vocational Qualification. Another staff member had recently completed their LDAF and was due to start NVQ. Staff members confirmed that training was provided in a range of topics including first aid; health & safety; manual handling; the protection of vulnerable adults; infection control; fire safety and food hygiene. Some courses were provided through external trainers and others directly through Milbury Care. The dates on which the training was attended were recorded on a matrix which was also used to identify when updates were due. One person was due to receive refresher training in first aid and Ms Bidmead said that this was being followed up. Staff members also had their own individual training records. It was reported in the AQAA that one of the improvements made in the last 12 months had been the appointment by Milbury Care of a regional training and development manager. Ms Bidmead said that there had been a focus on ensuring that the arrangements for mandatory training were well established and confirmed that it was now the intention to extend the range of training courses that were available to staff. This was identified in the AQAA as an area for improvement in the next 12 months. As part of the developments in staff training, Mrs Bidmead had received a lap top computer, which contained software in connection with training resources and records (known as an ‘electronic learning box’). A training needs assessment for the staff team had been undertaken in December 2006. This showed a number of new topics, including equal opportunities, risk assessment and some learning disability related subjects, which needed to be included in the staff training programme. Ms Bidmead said that new courses about epilepsy and autism had been set up. Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including the visits to the home. Service users benefit from a well run home. Audits, reviews and checks are being undertaken, which help to maintain a safe environment for service users and to identify improvements. EVIDENCE: Ms Bidmead has been registered as manager since the last inspection, after having been approved by the Commission as a fit person to run the home. Ms Bidmead is a qualified nurse and has had previous experience of working in a care setting. Ms Bidmead said that she had started the Milbury Care Management Development Programme in February 2007 and was expecting to complete this Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 24 later in the year. This contributed to the Registered Managers Award, which Ms Bidmead said would be completed after the management programme. The staff met with spoke positively about their experience of the home and how it was being managed. They said that they felt well supported in their day to day work. It was evident from conversations with Mrs Bidmead that she had a good understanding of the service users’ needs and gave their health and safety a high priority. As was evident during the visits, Mrs Bidmead spent time supporting the service users in practical ways. Ms Bidmead acknowledged that this had had an impact on the time that she was able to spend on administration and record keeping. An operations manager from Milbury Care was visiting the home regularly and produced reports about the outcomes. Milbury Care had produced a system of quality assurance, which included gaining feedback from different stakeholders. A scoring system was used to show people’s level of satisfaction with the home in different areas. The system included the production of an Annual Service Review and Development Plan. A plan for 2006 – 2007 was seen in the home. Mrs Bidmead said that a new plan was currently being produced. In the AQAA, Ms Bidmead has identified a number of improvements that were being planned for the next 12 months. Staff members said that health and safety was given a high priority in the home. A new member of staff confirmed the instruction they had received about how to use a bath hoist. There was a risk assessment in respect of fire and a weekly fire audit was being undertaken. Regular checks were being made of safety within the home and of different items of equipment. The temperature of the hot water was being monitored with records kept. It was reported at the last inspection that covers had been fitted to radiators, other than in one bathroom. This has since received attention. Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 N/A 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5(1)(bc) Requirement The service user’s guide must include the arrangements in place for charging and paying for any services additional to those mentioned in sub-paragraphs (b) and (ba), Regulation 5(1). Timescale for action 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations That a system of cross-referencing is used in the service users’ individual plans to show when risk assessments have been undertaken. This is so that the all the relevant information in respect of a particular need is more readily identified. That the service users’ progress with achieving their goals and future plans is more consistently monitored and recorded. This will help ensure that service users make the progress that they are capable of and that the goals continue to be relevant. DS0000036134.V340166.R01.S.doc Version 5.2 Page 27 2. YA6 Maltings (The) 3. YA9 That the risk assessment forms include a record of the potential benefits of a particular activity, in addition to the hazards and the risk of harm that may arise. This is so that the assessment process is seen as a way of promoting the service users’ rights and independence. That the service users’ involvement in activities is consistently recorded. This will help ensure that there is good information available when reviews are undertaken and the outcome of the service users’ involvement is assessed. That there is a consistent approach to record keeping and the information that is maintained within the service users’ personal files. This is to ensure that good standards are maintained across the three files. That the content of the service users’ personal files is reviewed and reorganised where appropriate. This is to ensure that up to date guidance can be readily identified in areas such as epilepsy and support that service users require with eating. That the programme of staff training is developed and implemented, as a matter of priority in accordance with the training needs assessment. This is to ensure that service users benefit from well trained staff and there is no delay in staff receiving the training that has been identified. 4. YA12 5. YA18 6. YA19 7. YA35 Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Maltings (The) DS0000036134.V340166.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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