Inspection on 05/08/08 for New Court Place

This inspection was carried out on 5th August 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

New Court Place 28/07/09

New Court Place 08/09/07

Extracts from inspection reports are licensed from CQC, this page was updated on 27/11/2008.

CARE HOME ADULTS 18-65 New Court Place 99 Whitehouse Avenue Borehamwood Hertfordshire WD6 1HB Lead Inspector Claire Farrier Unannounced Inspection 5th August 2008 10:15 New Court Place DS0000070238.V369636.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 New Court Place DS0000070238.V369636.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. New Court Place DS0000070238.V369636.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service New Court Place Address 99 Whitehouse Avenue Borehamwood Hertfordshire WD6 1HB 020 8238 6990 020 8238 6991 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) www.grooms-shaftesbury.org.uk Livability Manager post vacant Care Home 24 Category(ies) of Physical disability (24) registration, with number of places New Court Place DS0000070238.V369636.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Physical Disability - Code PD The maximum number of service users who can be accommodated is: 24 8th September 2007 Date of last inspection Brief Description of the Service: New Court Place is a care home with nursing, providing accommodation and care for 24 adults between the ages of 18 and 65 years of age who have physical disabilities. It is owned by Livability, which is a voluntary organisation. New Court Place is a three storey purpose built building. It is located in a quiet residential area of Borehamwood, about a quarter of a mile from the town. The home has been built and fitted out to high specifications that exceed those required by National Minimum Standards. The accommodation is arranged in three units on the ground and first floor that are designed to resemble an indoor street, and each resident has a large self-contained studio, with a kitchenette and ensuite shower room. The home has a patio garden accessed from the ground floor dining room. The home is fully accessible for the people who live there. The Statement of Purpose and Service Users Guide provide information about the home for referring professionals and prospective clients. Information on the fees charged was not available on this occasion. New Court Place DS0000070238.V369636.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 quality outcomes. We spent one day at New Court Place, and the people who live there and work there did not know that we were coming. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. An Expert by Experience (EBE) took part in the inspection. The EBE is a person who has a disability, and in this case he is visually impaired. He was supported by a support worker from the National Centre for Independent Living, who took notes for him. The EBE met and talked to five people who live in the home. We also talked to some of the staff and we looked around the home. One member of staff completed a Have Your Say survey following the inspection, and we have used the information from this in this report. We looked at some of the records kept in the home and some of the home’s policies. We also looked at a sample of care plans so that we could see how people are involved in planning their own care and support. The manager sent some information (the Annual Quality Assurance Assessment, or AQAA) about the home to CSCI before the inspection, and her assessment of what the service does in each area. Evidence from the AQAA has been included in this report. The manager was on leave at the time of this inspection. What the service does well: The AQAA states, “Our service provides a tailor made individualised care package for people with physical disabilities and complex care needs. The environment is ideal to meet these needs and create as near to home as possible. Residents like living here, report that they are well cared for and happy to remain here.” The design of the home enables the residents to live as independently as possible. The home has a stable staff team of nurses and care workers, who are experienced in working with young adults with physical disabilities. The home provides a good quality of personal care and health care. There is good relationship between the staff and the people who live in the home. The staff are aware of each person’s individual needs and preferences, and they support them to make appropriate choices and decisions about their lives in the home. Everyone who we spoke to said that they are happy in their home. The Expert by Experience said, “During the interviews I observed service users supporting each other and it was evident there was a friendly positive attitude New Court Place DS0000070238.V369636.R01.S.doc Version 5.2 Page 6 within the centre. My overall opinion of New Court Place was that the principles of Independent Living were being adhered to and that service users were happy with the service being provided. Service users on the whole were happy with the staff and felt their needs were very much taken into account, and any issues are dealt with and implemented as is viable in time permitted.” What has improved since the last inspection? What they could do better: We were disappointed to observe that in some cases staff do not follow the home’s health and safety procedures. We observed two cleaning trolleys that were left unattended, with items including bleach and bathroom cleaner that may be harmful to the people in the home. An immediate requirement was made to make sure that this practice is addressed, to avoid any risk of harm to the people who live in the home. No response has been received from the home. Although the home has generally good procedures for administering and recording medication, we found that one supply of rectal diazepam is taken when people go out of the home, and it is not recorded who this is prescribed for and who it is administered to. This is against the guidelines that medicines must only be given to the people they are prescribed for. This is to make sure that there is no risk of harm to people by having medication that is not prescribed for them. There are no guidelines for administering medication for a person who sometimes has difficulties with swallowing. New Court Place DS0000070238.V369636.R01.S.doc Version 5.2 Page 7 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. New Court Place DS0000070238.V369636.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 New Court Place DS0000070238.V369636.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 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment and admission procedure provides good information for the staff so that they can meet the needs of the people who live in the home. EVIDENCE: The Statement of Purpose defines the criteria for admission to the home clearly. They provide a service for people aged between 18 to 65 with a physical disability, who wish to enter residential care. “People should have care needs that are within the scope of the staff to meet both in terms of time and skills, and do not infringe upon the lifestyle of the other residents.” All the residents who we spoken to said that the staff are competent to meet their needs. The Expert by Experience reported that people generally felt supported and listened to by their key workers. The home has a stable staff team with access to appropriate training. The survey from staff confirmed that they have sufficient information from the care plans and from training to meet the needs of the people who live in the home. The care plans are stored and maintained on computer. We saw the care plans of two residents, including one who has recently moved into the home. Both New Court Place DS0000070238.V369636.R01.S.doc Version 5.2 Page 10 contained good information, so that the staff are able to provide a good quality of care and meet each person’s needs. We did not see ant assessments during the inspection. However the Annual Quality Assurance Assessment (AQAA) states that the service has reviewed the assessment process and who undertakes the initial assessment. This has resulted in a more comprehensive evaluation of individuals’ needs and highlighted areas for individual to be involved in discussion, their own care requirements. They plan to continue liaising with residents to ensure that they are involved in the assessment process. The home has had three new residents over the last year, and each one was assessed prior to their visit to the home, then assessed again when they visited. This included discussion and meeting with other residents. The AQAA states, “The new residents transferred from existing units and the families and care managers positively commented on how the assessment process and the transition phase went, that did not have the anticipated issues arise and this down to the planning and care of those involved to welcome individuals to their home.” The Statement of Purpose and Service User Guide have been reviewed and updated following the changes in the organisation over the last year. The Service Users Guide that we saw during the inspection needs a further small amendment, to change references to the National Care Standards Commission to the Commission for Social Care Inspection. The Service Users Guide contains all the information that people need before they move to the home, and includes comments from the people who live in the home. The format is under review. The AQAA states, “At present the format for service user guide is in type, with most of the residents asking for information to be read to them, if needed. In the next 12 months we plan to review the service users guide and implement a copy in picture format that will assist several residents to access easier.” New Court Place DS0000070238.V369636.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are actively involved in their own care planning and are consulted on every aspect of community life in the home. EVIDENCE: The care plans are maintained by computer, and the care staff and nursing staff are able to add the details of the care provided each day and to update them as required. We looked at the care plans of two people, and the evidence of care provided for them was tracked through their records. The care plans provide sufficient information on all aspects of each person’s care to enable the staff to meet their needs. Everyone has a moving and handling assessment. There are appropriate risk assessments that provide procedures and safeguards to enable people to take part in the choice of activities safely. New Court Place DS0000070238.V369636.R01.S.doc Version 5.2 Page 12 As the care plans are computerised the residents do not have easy access to them. It was reported that the staff try to go through each person’s care plan with them, but most people find it difficult. The staff have recognised this difficulty, and in the Annual Quality Assurance Assessment (AQAA) the manager states, “In the next 12 months we plan to develop a person centred plan for linking into care plan. This will look at goals and aspirations in more depth than currently. We have appointed a member of staff who has recently qualified as a PCP facilitator and it is hoped to deliver specific training to staff and residents to identify strategy. Residents are involved in all aspects of their care, and are involved in formulating their care plan. Residents are asked their views and wishes and a Plan is agreed. Resident’s key nurse and head care sit with resident at frequent intervals and take resident through care plan on computer if they wish. Residents achieve the majority of tasks they wish to achieve, with support packages in place. Feedback from relatives about how we involve residents in home is reported to be refreshing.” The people who spoke to the Expert by Experience said that they feel supported to make decisions and that the decisions were their choice. They thought that staff listen and implement any changes the person wishes to make in their daily lives. One person said that he felt that staff were restricting the amount of beer he received and because he needed support to drink his beer. He said he would prefer his girlfriend or mates to help him rather than staff giving him a sip at any given time. He agreed that he could discuss this with the staff. The residents spoken to said that regular residents’ meetings take place, and they are involved in decision making. The AQAA states that they discuss any concerns either at this meeting or with key workers or unit manager on an individual basis. This main meeting is usually scheduled several days prior to staff meeting to ensure issues are followed up. Additional residents meetings are called if any issue crops up that needs them to be involved in the decision. The manager said in the AQAA, “Ideally more discussions would involve residents with aspects of unit life, but to get 24 residents’ views is sometimes difficult if decision is needed quickly. Most communication is using verbal interaction due to the range of communication difficulties individuals living in the home have. It is one of our objectives to try to source an individual advocacy service that could meet the needs of a specific service user. Due to the complex communication difficulties, the advocate would need a translator who at present would be a staff member.” The people who we spoke to said that they have choice and control of their finances and can access their money as they wish to. Each person has their own safe. Good records are maintained for personal money that is kept ion the office. New Court Place DS0000070238.V369636.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 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are supported to live full and active lifestyles. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) stated that since the merger of the company the staff have tried to maintain stability in the programme residents have currently and expand on this. The activity room is well resourced with equipment, computers and Internet links. There is a planned programme of activities, which supports the educational and leisure interests of the people in the home. Activities are organised across the sevenday week. The activities schedules include college courses, IT, pony trapping, wheelchair dancing, crafts and music. Several residents used the computers for Internet access and playing games during the inspection. New Court Place has it’s own wheelchair accessible transport to take individual service users or New Court Place DS0000070238.V369636.R01.S.doc Version 5.2 Page 14 groups to events. The activities organiser was not in the home when we visited, but the people who live there confirmed that they can take part in their choice of activities. They told the Expert by Experience (EBE) that they feel supported to access the community whether this was going to the pub, shopping, cinema, or any other activity they wished to attend. There are activities and workshops available in the centre and service users said they enjoy what they have to offer, for example Dance, Art and Music. There is an information board that displays the activities within the home. However the EBE suggested that it would be useful to also include accessible information regarding local community facilities, for example swimming baths, theatre, libraries, any other activities or clubs, local colleges and further education centres. In terms of Further Education, some people told the EBE that they have taken up courses at their local college and they were receiving support whilst attending. Two people said they did cookery and art. They were given information and supported to attend college. Another person attended a course on life skills which he said he found helpful. The residents pay for their activities and for their holidays. Most have one or two holidays a year, at Winged Fellowship holiday centres for people with physical disabilities. Some residents have also arranged their own holidays, with support from their families. However, one person told the EBE that “I feel sad that my family are so far away and I would like to see them more often, as a few times a year is not enough”. Having said this, the person did feel supported enough to take this issue up with their key worker. The EBE said that friendships and relationships (for example boyfriends/girlfriends) were evident ensuring choice and control for the individual. Meals are served in a cafeteria style area with adjustable seating and table heights to accommodate a range of needs and equipment. Residents are able to choose from a varied menu with a wide range of options. The chef cooks fresh food every day, and the menu choices include two roast dinners each week. There are at least two options for lunch each day, and a large range of snack type meals every evening. The residents who we spoke to said that the food is generally good, and they like the amount of choice that they have. There is a kitchenette in each resident’s room, and they are able to make their own drinks and snacks if they wish to. There is a hot drinks machine and a water cooler at wheelchair height in the dining room. The AQAA stated that in the last 12 months there has been a review of the catering service and flexibility for eating meals when the residents wish. This included a review of the availability of staff to support residents with complex swallowing issues. Everyone in the home requires staff support to eat their meals and due to limited number of staff available all 24 residents would not be able to be assisted at the same time if they wished. New Court Place DS0000070238.V369636.R01.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using available evidence including a visit to this service. The people who live in the home are confident that they will receive a good quality of personal care and healthcare. The care plans provide good information so that the staff know how to meet each person’s needs. The procedures for recording information in the care plans and for administering medication need further improvement. This will make sure that everyone has the care and medication that they need in a safe and effective way. EVIDENCE: The home provides a good quality of personal care and health care. There is good relationship between the staff and the people who live in the home. The staff are aware of each person’s individual needs and preferences, and they support them to make appropriate choices and decisions about their lives in the home. The staff work in teams allocated to specific residents, taking account of gender and cultural needs. People who spoke to the Expert by Experience said that they feel their privacy and dignity are adhered to and staff New Court Place DS0000070238.V369636.R01.S.doc Version 5.2 Page 16 have clear boundaries. An example of this is that people are not allowed to walk into others bedrooms without an invitation by the service user. The care plans provide appropriate details of each person’s health needs, including pressure care concerns and monitoring of epilepsy. No one currently has a pressure sore, and no one is being monitored for poor nutrition. The residents have a preferred plan of care, which sets out how they wish to receive their personal care. The Annual Quality Assurance Assessment (AQAA) states that people are consulted on all aspects of their care and encouraged to make choices. Residents’ health remains good regardless of their underlying medical conditions. The home has generally good procedures for storing and administering medication. One person looks after their own medication. New guidelines for administration of medication have been issued following the merger, and nursing staff have received updates from the local pharmacist on administration of medication. One practice is not in line with the Royal Pharmaceutical Society guidelines. One supply of rectal diazepam is taken when people go out of the home, and it is not recorded who this is prescribed for and who it is administered to. This is against the guidelines that medicines must only be given to the people they are prescribed for. This is to make sure that there is no risk of harm to people by having medication that is not prescribed for them. One person sometimes has problems with swallowing medication, and a supply of yoghurt is available to assist them when this happens. However there are no guidelines for giving them their medication in this way. We saw an example of PRN (when required) medication being given, but the reason for giving it each time was not recorded. New Court Place DS0000070238.V369636.R01.S.doc Version 5.2 Page 17 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 a visit to this service. The people who live in the home are confident that their concerns are listened to, and that they are safeguarded from the risks of abuse. EVIDENCE: The people who spoke to the Expert by Experience (EBE) said that said that they are aware of the complaints procedures. They all said that complaints are taken seriously and dealt with immediately. They also felt that they are listened to. They understand that the Care Support Manager would be the person to voice any complaints to with the support of their key worker. The home has a clearly written complaints procedure. The Annual Quality Assurance Assessment (AQAA) states that three complaints have been recorded since the last inspection. We were not able to see the details of the complaints as the manager was not present during the inspection. The complaints procedure should be amended, as it states that complaints can be raised directly with CSCI. CSCI has no responsibility for investigating complaints, and this advice could be misleading. Livability has robust policies for dealing with allegations of abuse or neglect. All the staff have training in safeguarding vulnerable people, and those who we spoke to were aware of the whistle blowing policy and who to speak to if they have any concerns. The police visited the home during the inspection due to a New Court Place DS0000070238.V369636.R01.S.doc Version 5.2 Page 18 possible theft reported by one of the people in the home. The person has since withdrawn the complaint. New Court Place DS0000070238.V369636.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, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home enjoy a high standard of accommodation that has been designed to promote independence and exceeds the minimum standards. EVIDENCE: New Court Place was purpose built as a care home for people with physical disbilities. The rooms are designed as studio style flats, each with a bedsitting room, a kitchenette and an en suite shower room with WC. Many of the fittings can be adjusted to suit individual needs. Each person has equipment that suits their needs, including hoists and environmental aids. The rooms reflect individual tastes and interests. The doors to the residents’ rooms lead off wide corridors that are planned to resemble streets. Wide doors, corridors and lifts mean that people who have to spend some time in bed can still access the communal areas. All areas of the home are wheelchair accessible. The large New Court Place DS0000070238.V369636.R01.S.doc Version 5.2 Page 20 recreation and dining area on the ground floor is a sociable space, and the cafeteria style dining area enables service users have access to drinks and snacks. The Expert by Experience reported that the access within the centre for wheelchair users was very good. “However lighting was very poor and my personal assistant who is visually impaired struggled with the lack of accessible lighting. It was suggested to the Care Support Manager that lighting in the reception area and corridors were placed on the ceilings and not wall lights. The dining area had poor lighting, particularly where people can get tea or coffee and it was deemed as a hazard. We were told that they did not have any visually impaired service users living at the centre. However, this does not detract from the fact that service users may have friends or family that have visual impairments nor that there maybe residents with visual impairments in the future. Under the Disability Discrimination Act (Section Goods and Services Provision) it is a requirement to make these reasonable adjustments. Signposting within the centre, for example where the Lounge, Arts and Computer Room, Bedrooms, Care Manager Office and Reception office, could be displayed in larger print accompanied by a picture to direct people. It was also difficult to find the button to exit the building; although it is commended that it is at an accessible height for a wheelchair user, it was placed around the corner of the wall rather than next to the automatic doors - it is suggested a sign positioned higher up would help highlight the location of the button.” The home appeared to be clean and well maintained, and appropriate policies and procedures are in place for the maintenance of hygiene and control of infection. New Court Place DS0000070238.V369636.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, 33, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are supported by a stable staff team who have the experience and training to understand and meet their needs. EVIDENCE: The people who live in the home are supported by a stable team of nurses, care workers and activity staff. The staff rotas indicate that two registered nurses and seven care assistants work in the morning with one registered nurse and seven care assistants in the afternoon. One registered nurse and three care assistants work at night. Livability is carrying out a review of the staffing structure, and recruitment has been frozen while this is in process. This means that agency staff are employed in the home on every shift to ensure that there are sufficient staff in the home. The Annual Quality Assurance Assessment (AQAA) stated that this results in higher demands on the employed staff to support these agency teams. The last member of staff was appointed six months ago. New Court Place DS0000070238.V369636.R01.S.doc Version 5.2 Page 22 The AQAA stated that all the care staff are registered and working towards NVQ level 2 if they have not already completed it. All the housekeeping team are registered and working towards NVQ level 2 in housekeeping. Seven more staff are currently working towards the qualification, and two are ready to start the course. There is an expectation that all care staff will undertake NVQ qualifications. 13 of the 20 support workers have a qualification at NVQ2 or above, and four are working towards it. All the staff who we spoke to and the survey from staff said that the training and support provided for them is very good. Livability is developing a training programme, and some elements of this are now in place. The manager is qualified to train staff in first aid, infection control and management of epilepsy; the deputy manager is a qualified moving and handling trainer; and the chef is qualified to provide food hygiene training. Several other nurses have specific expertise, for example in multiple sclerosis and epilepsy, and they are able to provide information and training for the other staff. The AQAA sated that the organisation is committed to staff training, and this is confirmed in the Statement of Purpose. Everyone has had training in disability awareness. However the Expert by Experience pointed out that this does differ greatly from Disability Equality Training, which ensures staff members are up to date with Independent Living Strategies and have an understanding of the Social Model of Disability and Disability Discrimination Act. In the next 12 months the service plans to develop the team’s knowledge base further in order to ensure that staff are appropriately trained for their role. We were not able to see staff files on this occasion, as the manager was not in the home. However during the last inspection the staff files that we saw contained sufficient information to show that the people concerned are fit to work in the home. New Court Place DS0000070238.V369636.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, 40 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well managed for the benefit of the people who live there, and their views are actively sought and acted on. Some procedures do not make sure that the people in the home are protected from the risk of harm. EVIDENCE: The manager is a qualified nurse. She previously worked at the Chalfont Centre for Epilepsy, and she is a qualified trainer for first aid, infection control and management of epilepsy. She was registered as manager by CSCI shortly after this inspection. The company has a new name, Livability, and a new set of policies and procedures are being produced. Not all the required policies have been completed, but those that we saw on this occasion were well written New Court Place DS0000070238.V369636.R01.S.doc Version 5.2 Page 24 and provide clear guidance for the staff. The Annual Quality Assurance Assessment (AQAA) stated that staff need time to absorb the changes required, and this has been useful time to reflect on practices and procedures. We have not seen any evidence of the quality assurance processes in the home. However the improvement plan following the last inspection stated that Livability will carry out a full audit including feedback from the people in the home. In addition to the monthly residents’ meetings there is a formal annual meeting where the outcomes of the feedback will be discussed with residents to consider if changes need to be made. The Annual Quality Assurance Assessment stated that the Operational Manager undertakes a monthly review of the home and audits health and safety and reviews procedures in the home. The home maintains appropriate records for the health and safety of the residents and staff in the home. The manager completed an improvement plan following the last inspection to show how the requirements on health and safety concerns have been met. It was disappointing to observe that two cleaning trolleys that were left unattended, one in access of 5 minutes and one in excess of 4 minutes. Cleaning items on the trolleys included bleach, bathroom cleaner and glass cleaner, all of which may be harmful to the people who live in the home. An immediate requirement was made to ensure that this does not happen again. New Court Place DS0000070238.V369636.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 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 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 2 X 3 X 3 3 X 2 X New Court Place DS0000070238.V369636.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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 YA20 Regulation 13(2) Requirement All medication must be administered and recorded in accordance with the Royal Pharmaceutical Society guidelines and the home’s policy and procedures. This will make sure that everyone has the care and medication that they need in a safe and effective way. All substances that may be hazardous to health must be stored securely at all times. A previous timescale of 10/01/08 was not met. Timescale for action 31/10/08 6. YA42 13(4)(a) 05/08/08 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 Good Practice Recommendations The Service Users Guide needs a further small amendment, to change references to the National Care Standards Commission to the Commission for Social Care Inspection. DS0000070238.V369636.R01.S.doc Version 5.2 Page 27 New Court Place 2. YA22 3. 4. YA29 YA33 The complaints procedure should be amended to remove the statement that complaints can be raised directly with CSCI. CSCI has no responsibility for investigating complaints, and this advice could be misleading. Consideration should be given to improving lighting and signage in some areas of the home, in order to support residents or visitors with visual impairment. Measures should be put in place to reduce the dependence on agency staff, so that people in the home are supported by an experienced and stable team of permanent staff. New Court Place DS0000070238.V369636.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 New Court Place DS0000070238.V369636.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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