Inspection on 17/01/08 for Moor Court

This inspection was carried out on 17th January 2008.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Moor Court Bodenham Herefordshire HR1 3HW Lead Inspector Jean Littler Key Announced Inspection 17th January 2008 11:00 Moor Court DS0000070171.V354845.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 Moor Court DS0000070171.V354845.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. Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Moor Court Address Bodenham Herefordshire HR1 3HW 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) 01568 797461 j.p.kidd@btconnect.com The Silver Rooms (Stroud) Ltd Rosemary Elizabeth Gladys Valerie Wooderson Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only to service users of either gender Whose primary care needs on admission to the home are within the following category: 2. Learning Disability (LD) 13 The maximum number of service users to be accommodated is 13. Date of last inspection N/A This is the first inspection. Brief Description of the Service: Mr Kidd is the sole director of the company that operates Moor Court and one other Care Home. Moor Court is based in the rural community of Bodenham. The service provides personal care for up to thirteen adults with learning disabilities in a large three storey detached house. Information about the Home is available from the Home or provider on request. The Service Users Guide states that the weekly fees are £500 plus an additional charge of £17.10 per week towards transport costs. The people using the service are expected to pay for their own clothes and toiletries, haircuts, chiropody, activities and day care charges. A seven day holiday is included in the fees. Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate outcomes. This inspection was carried out over 6 hours. The manager and owner both helped with the process. The inspector looked around the house and spoke with some people who live there. Mandy Warner is person who has used similar services. She is called an Expert by Experience. She visited for 3 hours with her supporter Becky Ley. Mandy’s report is included in this report. Some records were looked at such as care plans, medication and money. The people living in the Home and their relatives were asked their views in surveys before the visit. The managers sent information about the Home to the inspector before the visit. What the service does well: People are trying new activities and foods to see what they like. They are attending the daytime activities of their choice. There are now more staff and people said they liked the staff team. People are having regular house meetings to make decisions and they are being encouraged to express their views. They are being supported to have friends and stay in touch with their families. Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 6 They live in a safe place that is warm and well maintained with large gardens and nice views. People all have their own bedroom and personal things in them. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 7 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. Moor Court DS0000070171.V354845.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 Moor Court DS0000070171.V354845.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, 2, 4, 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new providers have not yet prepared all the information needed to support new people to move in. The procedures indicate that interested people will have their needs assessed and be able to try out the service. EVIDENCE: The provider submitted a Statement of Purpose as part of the registration process. This states that prospective people will have their needs fully assessed and then if a place is offered a personalised transition will be arranged that can include tea visits and overnight stays. A three-month trial period will then be offered if appropriate. No short term or emergency placements will be accepted. Mrs Wooderson reported in the AQAA (the annual quality assurance assessment that managers are asked to send to us), that she will develop an assessment tool by April 2008. No new people have been admitted since the Home changed ownership in October 2007. One person left during this period and one unfortunately passed away at Christmas, so there are currently nine residents. Now Mr Kidd knows the needs of the people currently using the service he should review the Statement of Purpose and make it clear who the service is aimed at. The document currently refers to; people having mild to moderate needs with some challenging behaviours; people needing a high level of Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 10 supervision; people having additional physical disabilities, mental health needs, personality disorders or Autism. The people currently in the Home are not used to living with people who display challenging behaviours and some are aging and vulnerable. If the accommodation continues to be provided as a large communal Home then it would be inappropriate for people with such special needs to share with twelve others. The information also states in one section that no therapy is provided, but in another it refers to music therapy, aromatherapy and counselling service, such as bereavement support, being available if needed. There is a written Service User’s Guide. Mrs Wooderson plans to develop a version of this by August 2008 that is more accessible to people with a learning disability. The guide contains information about fees and additional charges but it should also make it clear if people have to will have to pay the costs to attend their chosen day activities. People’s formal contracts are between the company and the funding authorities. Mr Kidd had not yet issued new Terms and Conditions to the people living in the Home. He agreed to make this a priority and a draft was sent to us shortly after the inspection. Moor Court DS0000070171.V354845.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, 8, 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s needs are recorded in their care plans. They are being encouraged to become more involved in planning their support and goals. EVIDENCE: Each person has a care plan that contains information about their support needs, preferences, routines and risk assessments. The level of daily recording has been increased and incident reporting forms introduced. Keyworkers are completing monthly reports to improve monitoring of issues and progress. Mrs Wooderson has added information to the plans when significant changes to someone’s needs have occurred. However, she plans to revise all the information by April 2008 with people having much greater involvement in the process e.g. setting their own aims and goals. There are also plans for keyworkers to meet their key residents every six weeks to discuss their needs and wishes. People are going to be consulted about any keyworker changes in future. Mrs Wooderson also plans to meet in private with people regularly so they can share their views with her confidentially. Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 12 The Statement of Purpose indicated that people with have their support formally reviewed at least every six months and that everyone will have a person centred plan. Two people have already been involved in planning their review meetings. People are being enabled to make choices. Examples given included people now going to the hairdressers rather than having a visiting hairdresser, what to drink during the day, choosing which toiletries to buy in shops rather than using an in-house shop, decided to try new activities and deciding whether to attend the recent funeral of someone who lived in the Home. Feedback indicated that people felt they have a say about decisions that affect them. Mrs Wooderson is aware that information needs to be provided in a more accessible way to promote choice making. A pictorial staff rota is now used so people know who is supporting them. Two weekly self-advocacy meetings started in January. Moor Court DS0000070171.V354845.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): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people using the service are taking part in activities they enjoy and are being better enabled to keep in touch with family and friends. They are being provided with more opportunities for personal development and their rights are being upheld. They enjoy the food provided and the mealtimes. EVIDENCE: Each person has an established weekly routine of attending day placements that they enjoy and benefit from. Mrs Wooderson spent a half-day at each day centre to see what each person does and to improve communication links. On the weekdays people spend at home people are being offered the opportunity to choose their own lunch, shop and prepare this, do any personal shopping they need and have a coffee in town. People continue to help around the house doing jobs such as washing and drying up. Mrs Wooderson plans to encourage people to develop practical independent living skills on an ongoing basis. She feels the range of activities needs to be extended and ways need to be found to enable people to integrate more in the local community. She plans Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 14 to review the current arrangements with each person by April 2008. Positive changes have already been made. Some examples of this are people are being enabled to choose how to celebrate their birthdays, parties being held with families and friends being invited, the new entertainment room being fitted out and equipped with a cinema system, a new bus being provided with a power step and tail-lift. A budget of £100 a week has been provided for activities and the staff meeting minutes showed the aim is for all people to benefit equally from this. Survey feedback includes some ideas for changes. One person said he likes washing up and would like to do this more, he and another would also like to go to church more often. One person said they would like to use the games room more but this currently depends on whether staff are available to supervise her. Several people said that they like living at the Home. A worker spoken with said two people choose to go to bed early but others have a flexible routine. A group stayed up to see in the New Year whereas only one did last year. She said some restrictions are in place like kitchen access when a hot meal is being served. The statement of Purpose states that visitors are welcome any time. A sevenday holiday is included in the fees. People have historically gone away as a large group, as they did this year. Mrs Wooderson hopes to offer a variety of breaks in future that may better suits people’s specific interests. One person said he had visited family over Christmas and he and his brother are looking forward to going away with their sister and see the Sound of Music. Mrs Wooderson reported that the same two weekly menu has been continued for the time being, however greater choice is being offered for breakfast and supper. She plans to review the menu in the near future and expand the variety of meals and times when a choice of meals is provided. She said better quality foods are being purchased and different takeaways tried to see what people like. Some people are now more involved in going shopping and choosing items. A worker said she felt the food was very good and confirmed that some people help prepare food and packed lunches. A pictorial menu has not yet been developed but this is planned. Photographs were being used to inform people what the main meal was, but these were not mentioned. The Expert by Experience reported:- Three people spoke to us as others were out and one person did not want to. The entertainment room is being used fortnightly for a self-advocacy group, where someone independent facilitates the meeting and encourages other people with learning disabilities to attend. Promoting self-advocacy is really good practice and also Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 15 encouraging other people to come from outside Moor Court can increase people’s friendships and relationships. I asked people what they did during the day and evenings, one person said she attends a day centre 4 days a week, which involved doing some voluntary work in a craft shop. This lady had also recently started doing yoga one evening a week, which she said she really enjoyed. Another person said he works on a local farm a couple times a week, which he thoroughly enjoys. People also attend a local church where they like to get involved in making crafts and selling them. Some people like to go the disco but others don’t, it is good people’s choices are listened to. People seem to be very active here and regularly go out and do things in the community. I asked to see the menu and I was disappointed to see the menu had no pictures with it. Although I was pleased to see people having home cooked food and people having different menu’s according to the time of year. People said if they did not fancy what was on the menu they were able to have something else. I’m pleased people have choices but people should be supported to cook their own meals as often as possible. Moor Court DS0000070171.V354845.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, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are being supported to express how they want to be supported with their personal and health care needs. Medication is being safely managed. EVIDENCE: Mrs Wooderson reported in the AQAA that people are now being enabled to buy their own personal clothes, toiletries and towels. They will be encouraged on an ongoing basis to lock their bedrooms for privacy and will be offered a front door key if appropriate by March 2008. They are being offered the opportunity to bath more regularly. Choices in this area will improve when more bathrooms are built. Keyworker meetings are due to start and these should enable people to say if they want any changes made in the way they are supported. Having three male workers on the team will increase the opportunity for same gender care to be offered to the men. One person fell in October. He has been provided with a pendant so he can call for help more easily and he has chosen to have a listening monitor in his room at night as well as the night staff checking on him. An occupational therapist has been involved and Mrs Wooderson reported shortly after the inspection Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 17 that all his advice has now been implemented. The OT has arranged to come to a staff meeting to inform staff about the effects of acquired brain injury. One person’s records showed that he had attended a dental appointment in January 08 and been to his GP surgery for a flu jab. He had had a Wellmans check and a clear record had been made of the outcome. He had a Health Action Plan however this was not dated and had not yet been fully completed. Mrs Wooderson realised that staff did not have enough knowledge about epilepsy to record seizures accurately. Further training and guidance has been provided and care plans now contain information about the type of seizures people have and protocols for how to deal with them. More accurate recording has led to the consultant changing one person’s medication with positive results. Mrs Wooderson also explained how the person who died at Christmas had been supported by staff when she became ill and visited when in hospital. Close contact had been kept with the family and their wishes respected for the funeral. The care plan had not contained information about the person’s own wishes about their death. Mrs Wooderson plans to enable people to talk about their wishes and ensure these are recorded for the future. The medication was being appropriately stored. The supplying pharmacy last inspected the system before the change of ownership. Mrs Wooderson agreed to review who had access to the keys as some staff are not yet authorised to give medication. Accredited training has being arranged for the new staff in February 2008. Others have completed a Safe Handling of Medication course. The medicines were found to be stored in a tidy cabinet and records were clear and contained appropriate information. Mrs Wooderson had been concerned that one person was managing his own medication in an unsafe way and with his agreement this is now being administered by staff. Moor Court DS0000070171.V354845.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, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people using the service are being encouraged to express their views and raise concerns. Systems are in place to help protect them from abuse. EVIDENCE: Feedback surveys showed that people knew to talk to staff or their family if they had a concern, however, some said they are not likely to do this as they do not like to complain. A new complaints procedure has been developed and this was seen on people’s bedroom walls. The local Bill of rights was also on display. A self-advocacy group is now using the entertainment room as its venue for area meetings. Mrs Wooderson hopes this will encourage people in the Home to attend and develop his or her skills and confidence. The information in the Service User’s Guide and on the Complaints procedure should include Mr Kidd’s contact details in case Mrs Wooderson cannot resolve the matter or if the complaint is about her. It currently indicates correctly that matters can be reported to the Commission but it should not lead people to think that CSCI has a role in the Home’s procedure. Resolving complaints is the responsibility of the manager and provider. Mrs Wooderson reported that no formal complaints have been received but appropriate action was taken when one worker reported a concern. Only one person currently has an external advocate involved. The advocate reported that he is appropriately involved and the service seemed clear about his role. The majority of people have relatives who could advocate on their behalf but it would be positive if the use of advocates could be increased. Mrs Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 19 Wooderson plans to develop the keyworking role to better support people to express their opinions and raise concerns. The Expert by Experience reported:- One person said she gets on with other people she lives with and likes the staff very much. I asked if she was upset who could she talk to and she said the staff are very friendly and help her sort any difficulties out. The lady had a poster on her wall with a bill of rights and the person said ‘nobody tells me what to do’, she seemed very happy about speaking out for herself. Mrs Wooderson reported in the AQAA that a procedure is in place for dealing with disclosures of abuse. This is dated June 2006 so should be reviewed. She plans to provide protection training to all staff in February 08. An incident reporting system has been set up to help monitor issues and people’s behaviours. A matter has recently come to light that has been reported under local Safeguarding procedures. Mrs Wooderson reported this promptly to us but there was a short delay before it was reported to the local Safeguarding Team. During this time Mrs Wooderson discussed the matter with the funding authority of the possible victim and took initial reports. The manager needs to be mindful that interviewing people involved can affect any subsequent official enquiries such as a police investigation. It is positive that she had completed a risk assessment and taken interim arrangements to protect people. A safeguarding matter relating to one person’s family was discussed. The care plan does not contain an agreed safeguarding plan so Mrs Wooderson was advised to refer this under the local procedures and request that a multiagency plan be developed rather than her having to take responsibility for the person’s wellbeing when away from the service. Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 20 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, 25, 26, 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home is clean, comfortable and safe and generally meets the needs of the people living there. The way the building is developed needs to reflect the type of service the new provider plans to operate in the future. EVIDENCE: The Home is situated in a rural location in Herefordshire. The detached house is set in large attractive gardens with far reaching views. The location does mean the people are dependant on staff support and the use of the mini-bus to access facilities in Hereford or Leominster. There are public buses coming through the near-by village but they do not run very frequently. The Home is registered for thirteen but there are only nine bedrooms. Previously some people have shared. Currently everyone has a single bedroom and Mr Kidd had committed that no one will share rooms. He plans to reconfigure the second floor, where the previous providers used to reside, convert the garage and change the use of current rooms to create additional bedrooms. He also aims to provide each person with en-suite facilities and to add more bathrooms, as currently there is only one and two toilets. Mr Kidd is Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 21 aware that the National Minimum Standards recommend that adults under 65 years of age should not be living in groups larger than ten. Whilst developing the building plans he agreed to consider how the living accommodation could be subdivided to enable smaller group living. Some initial changes have been made to the living space. The dining tables and chairs have been removed from the lounge and a spare ground floor room is now being used as a dining room. In the space this created in the lounge seating has been arranged to create a social area away from the television section. There is still the upstairs games room with snooker table and computer but an outbuilding has been turned into an entertainment room. This is fitted with a bar, fridge, tea and coffee facilities, seating, satellite television and music facilities. This has successfully been used for a Christmas party. The Home is currently not well adapted for people with physical disabilities. The kitchen doorway is not accessible and the bedrooms and bathroom are all on the first floor. There is a stair lift but this makes the staircase narrow. The bathroom is not designed to be accessible but a removable bathing aid has been provided. One person who uses a wheelchair has an en-suite bathroom with an accessible bath. He cannot access the upstairs games room because there are three steps along the corridor. Mrs Wooderson reported in the AQAA that the changes being planned will aim to minimise discrimination in the environment. There is no timeframe for the completion of the building developments as plans are just being developed. Some people agreed to show us their bedrooms. These were comfortable and had been personalised. People are being consulted about changes they would like to their rooms and supported to buy personal bedding and towels. Survey feedback indicated that people felt the house was always clean and fresh. Agency staff are being used periodically to support care staff with the cleaning duties as the cleaner is off sick. The laundry area is a large room fitted with suitable equipment and with lots of storage. Arrangements are in place to reduce the risk of cross infection. An Environmental Health inspection in August 06 reported that generally arrangements were satisfactory. Mr Kidd agreed to inform the EHO of the change of ownership. Mrs Wooderson agreed to ensure the Safer Food Better Business procedures were being followed. The house is reasonably well maintained and was found to be clean, tidy and at a pleasant temperature. A maintenance person is engaged to carry out repairs each month. Mrs Wooderson plans to develop a maintenance programme by June 2008. The Expert by Experience reported:- One gentleman who moved in the home last year said he liked living here and said he gets on really well with one person in particular, who was on holiday at the time and was looking forward to him returning. This person had lots of interesting and personal Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 22 items in his room and said the only thing he would change was to have a bigger bed, as sometimes he finds a single bed too small. We supported this person to tell the manager and she said they would look into getting him a bigger bed. One person showed me her bedroom and it is a good size and had lots of personal photographs, a family tree on the wall and lots of personal items, important to that person. Good to see. One lady showed us around her home with some support. The home is very grand, in need of re-decorating but I was told this will be happening soon. The lack of bathroom facilities is a concern, as the home only has one bath, one shower and one person with an en suite for 9 people. I felt the home was too big for people, it didn’t feel very homely. At the moment they have 9 people living here but the home is registered for 13 people. It would worry me if more people moved in as the home only has one kitchen with one dining room, people would not have the opportunity to be supported to be as independent as possible. Not everyone would have the opportunity to cook regularly for themselves. With so many living together it would be difficult for a person centred approach. The plans to have people with mobility problems to move onto the ground floor is a good idea, but people still may want to access other communal areas on different floors and this should be made possible. I was really pleased to see a social room had been made outside for people to use with a pool table, TV, music centre and a bar. Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 23 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, 33, 34, 35, 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people using the service like the staff that support them and staffing levels have been improved. The team is new so some staff are not fully trained or qualified yet. People are being protected by the recruitment procedures. EVIDENCE: Mr Kidd has increased the level of staffing provided. At night a waking night worker is provided instead of someone sleeping in. Another person is on call in case of emergency. During the day three staff are on when everyone is home and at times the manager is additional to the care hours. The practice of staff working two shifts split across the day has been stopped. Five new staff have been appointed, three on which have relevant previous experience. Three men are now on the team, which is very positive, as the majority of people living in the Home are men. Staff meeting minutes from October 07 and January 08 showed that the rotas were being planned in a safe way during this transitional stage to ensure staff were on duty at all times who knew people’s care needs. The limited number of staff able to drive the mini-bus was also being considered so people were not prevented from accessing their planned activities. Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 24 The survey feedback indicated that people living at the Home like the staff and feel they treat them well. All said staff listened to them but some said staff did not always act on what they said. No examples were given so Mrs Wooderson will need to look into this. The Expert by Experience reported:- My overall thought was the people and staff were very friendly, lots of good practice, people doing lots and different things, people being aware of their rights and the values staff shared were good. My only concern was the size of the home and whether a home could truly be person centred with so many people living in it. The recruitment records for one worker showed that the Home’s procedure had been followed. Mrs Wooderson agreed to make sure in future she took references from the most relevant people and established why people had left previous work with children or vulnerable adults to help safeguard the people in the Home. Mrs Wodderson reported to have used the previous providers induction pack with the new staff. Mr Kidd works with a training consultant who will come to the Home to help develop a plan for the service. The new Learning Disability Qualification will need to be considered as well as any specialist training related to the Statement of Purpose. Mrs Wooderson reported in the AQAA that staff need training in equality and disability, and safe handling of medication. Contracts are in place but job descriptions need to be further developed. She plans to hold staff meetings and provide staff with supervision sessions every six weeks. A new member of staff was spoken with. She felt her induction was appropriate, having shadow shifts, time to read care plans and procedures etc. She found the team to be positive and her colleagues and the manager approachable. She felt three staff on duty is sufficient and said the atmosphere is relaxed. She has attended one staff meeting so far that was useful and found the communication systems used to be effective. She felt the people living in the Home were treated with respect and dignity. She has watched a video on epilepsy, had a fire induction and is due to attend health and safety courses soon. She hopes to gain an NVQ award in Care in the near future. Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 25 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, 38, 39, 40, 41, 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people using the service are benefiting from the changes being made to the service. EVIDENCE: Mrs Wooderson has been working as a registered manager for eighteen years in six care homes. Five of these services were for people with a learning disability. She gained the Registered Managers Award in 2004 and the NVQ 4 in care in 2003. She also holds a Certificate in Care (Learning Disability) and Advanced Management in Care (1996). She has kept up to date in safe working practices and in best practice for people with learning disabilities e.g. she has recently attended a course on the Mental Capacity act. She is working on shift so she gets to know the people and service well. She reported that Mr Kidd is supportive and is person centred in his focus. The Expert by Experience reported:Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 26 On arriving at the home today we were welcomed by the manager, provider and some people who live in the home. Straight away I felt the manager had good values and was very respectful about the people who live in this home. Mrs Wooderson is aware that the service needs to be modernised but is aware that change needs to be introduced slowly following consultation with those affected. She aims to introduce a quality assurance system by April 2008. The changes to the keyworker role are central to this. A newsletter was sent out in December 07 to inform representatives about the new staff starting and the building plans. A party has also been held and an open-door culture is being promoted. The records sampled have been referred to under each section in the report. Mrs Wooderson has made some positive changes already to improve what is recorded. She confirmed in the AQAA that the majority of required policies and procedures are in place but these need to be reviewed and those missing developed such as moving and handling and the use of physical intervention. A sample of people’s financial records were seen. The information was clear and spending was appropriate e.g. £10 for opticians and chiropody. Bank statements confirmed that in-house records of withdrawals and deposits were accurate. Mrs Wooderson has a good understanding of current health and safety legislation and she will be supported by the company Mr Kidd uses for advice in this area. She reported in the AQAA that appropriate servicing arrangements are in place for equipment and utilities. Some positive changes have already been made as a result of her reviewing the risk assessments. Staff meeting minutes show that staff are being encouraged to join a health and safety group that will meet quarterly. Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 27 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 2 3 x 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 2 26 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 2 3 2 3 x Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Timescale for action 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 YA1 YA5 Good Practice Recommendations Review the Statement of Purpose and if a specialist service is going to be provided it should be clear what this is and how it will be provided. Issue the new Terms and Conditions to the people using the service with the involvement of their representatives. 2 3 4 YA19 Each person should have a preventative health action plan in place. Include information about the provider in the Complaints Procedure. Seek multi-agency support in developing a protection plan for one person. Seek the approval of the local safeguarding co-ordinator before making any enquiries about a possible protection Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 29 YA22 YA23 matter. 5 YA6 YA39 Implement the improvement plan that has been developed in the timeframes indicated. Moor Court DS0000070171.V354845.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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