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Inspection on 24/10/06 for New Road (33)

Also see our care home review for New Road (33) for more information

This inspection was carried out on 24th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The organisation has a procedure in place to ensure that prospective service users are assessed to ensure that the home is able to meet their identified needs. Service users are supported to make choices and decisions in relation to aspects of their daily lives. Service users have access to a range of activities. Family involvement is supported and encouraged. Visitors to the home are made to feel welcome. Service users are encouraged to be involved in daily routines and to develop some responsibility in their lives. Service users have access to a varied diet. Service users personal and healthcare needs are met and monitored. Medication is well managed. A complaint`s procedure is in place including a pictorial complaints procedure. Policies and procedures are in place to ensure the protection of service users. The home is generally clean, homely and systems are in place to maintain this to provide a safe environment for service users The home is well managed and effectively monitored. Systems and records are in place to promote the health and safety of service users.

What has improved since the last inspection?

Service users plans are being developed with all information pertinent to individuals filed in one file as opposed to three files. Risk assessments have been developed to include a wider range of risks for individuals. These must be kept updated and reviewed. The home has a full staff team and the manager has developed individuals in their roles to take on specific responsibilities.

What the care home could do better:

Service user plans to be developed to include clear guidance on the management of medical conditions and specific learning disabilities. Guidance included in service user plans should be dated and show evidence of service users involvement. The home should set up a system of recording service users responses to an activity so as to further promote choices. Service users plans should outline the level of support required by individuals` to manage their post. Staff should consider other methods to develop service users meal choices. Staff should be reminded of specific policies on a more regular basis and reassessments of specific practice should take place annually. Staff must have up to date training in adult protection. The organisation must ensure that staff roles are in line with health and safety legislation and risk assessments put in place for specific tasks. New staff must be inducted into the home and their roles and records must be maintained at the home to support this. All staff must have up to date mandatory and specialist training to ensure the safety of service users and training records should be reorganised with the information more accessible to support this.

CARE HOME ADULTS 18-65 New Road (33) Aston Clinton Aylesbury Bucks HP22 5JD Lead Inspector Mrs Maureen Richards Unannounced Inspection 24th October 2006 11:15 New Road (33) DS0000023078.V308380.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 Road (33) DS0000023078.V308380.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 Road (33) DS0000023078.V308380.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service New Road (33) Address Aston Clinton Aylesbury Bucks HP22 5JD 01296 632749 01296 632749 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) Hightown Praetorian & Churches Housing Association Sharon Ann Cook Care Home 3 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places New Road (33) DS0000023078.V308380.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 3 residents with learning disabilities, some of whom may also have a physical disability. 19th January 2006 Date of last inspection Brief Description of the Service: 33 New Road is a detached bungalow owned and staffed by Hightown Prateorian and Churches Housing Association. It has been adapted to provide accommodation for three people with learning and physical disabilities. Each person has a large single bedroom and the property has been decorated and arranged to reflect a large family type environment. There is an enclosed rear garden with lawned and patio areas and parking spaces at the front of the building. The home is situated in a quiet residential area with a pub and small shop in the vicinity. Aylesbury town centre is approximately five miles away. There are no direct public transport links. The current weekly fees are £2254.77 as indicated on the pre inspection questionnaire. New Road (33) DS0000023078.V308380.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over one day. The key National Minimum Standards for younger adults were inspected. The inspection involved discussion with the manager, a tour of the communal areas of the home and three bedrooms, examination of some of the required records and observation of practices and staff interactions with service users. Three comment cards were received from relatives, which indicated that they were happy with the care provided. Four comment cards were received from health and social care professionals involved with the home who raised no issues and were happy with the care provided. The manager has been proactive in meeting requirements from the previous inspections and have introduced new systems and record keeping to support this. What the service does well: The organisation has a procedure in place to ensure that prospective service users are assessed to ensure that the home is able to meet their identified needs. Service users are supported to make choices and decisions in relation to aspects of their daily lives. Service users have access to a range of activities. Family involvement is supported and encouraged. Visitors to the home are made to feel welcome. Service users are encouraged to be involved in daily routines and to develop some responsibility in their lives. Service users have access to a varied diet. Service users personal and healthcare needs are met and monitored. Medication is well managed. A complaint’s procedure is in place including a pictorial complaints procedure. Policies and procedures are in place to ensure the protection of service users. The home is generally clean, homely and systems are in place to maintain this to provide a safe environment for service users New Road (33) DS0000023078.V308380.R01.S.doc Version 5.2 Page 6 The home is well managed and effectively monitored. Systems and records are in place to promote the health and safety of service users. What has improved since the last inspection? What they could do better: Service user plans to be developed to include clear guidance on the management of medical conditions and specific learning disabilities. Guidance included in service user plans should be dated and show evidence of service users involvement. The home should set up a system of recording service users responses to an activity so as to further promote choices. Service users plans should outline the level of support required by individuals’ to manage their post. Staff should consider other methods to develop service users meal choices. Staff should be reminded of specific policies on a more regular basis and reassessments of specific practice should take place annually. Staff must have up to date training in adult protection. The organisation must ensure that staff roles are in line with health and safety legislation and risk assessments put in place for specific tasks. New staff must be inducted into the home and their roles and records must be maintained at the home to support this. All staff must have up to date mandatory and specialist training to ensure the safety of service users and training records should be reorganised with the information more accessible to support this. New Road (33) DS0000023078.V308380.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. New Road (33) DS0000023078.V308380.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 Road (33) DS0000023078.V308380.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Systems are in place to ensure that prospective service users are assessed prior to admission, which ensures that the home can meet their assessed needs and consider their compatibility with other service users. EVIDENCE: The home has had no new admissions since the last inspection. The manager confirmed that if the home had a vacancy, they would inform the relevant people and request referrals from care managers. On receipt of a referral the manager confirmed she would carry out her own assessment of need and as part of that would get feedback and reports from other professionals involved with that individual. The manager would also consider the compatibility of that individual with other service users living at the home. Following an assessment the prospective service user would be invited to the home to meet other service users and staff. The service user would then be admitted on a trial basis. The manager confirmed that the organisation has an admissions procedure and an assessment proforma, which was not viewed at this inspection. New Road (33) DS0000023078.V308380.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service user plans are in place. These are currently being developed and need to include specific guidelines for staff on the management of medical conditions and specific learning disability to ensure continuity of care. Service users plans indicate that service users are encouraged to make choices, which enables them to be involved in aspects of their care and life at the home. Risk assessments are in place, which promote the health, safety and welfare of service users. These must be kept updated and reviewed. EVIDENCE: Three service user plans were viewed at this inspection. One of the service users plans seen has been developed and work is currently underway to develop the other two service user plans to the same standard. Previously the home had three separate files for individuals and this has been developed into one file for each individual and includes all information pertinent to them. The New Road (33) DS0000023078.V308380.R01.S.doc Version 5.2 Page 11 service user plan include a photograph, personal details information sheet, health professionals contact details, brief reference to the individuals learning disability and health needs, reference to the level of support required with meeting personal care needs, communication, involvement in domestic tasks, involvement in making decisions and choices in relation to activities, food, clothes choices. The service user plan included some pictorial reference to assist the service user in communicating. The service user plan included the service users life story and the families have been involved in developing those for individuals. The newly developed guidance on supporting service users should be further developed to include more specific guidance on how medical conditions and specific learning disability affect the individual and how staff manage the situation. Those guidelines should include the date of implementation, name of the service user, date for review and an indication if the service user was involved in their development. The manager confirmed that she intends for the new service user format to be fully operational for all service users by the end of January 2007. Service user plans outline how service users are supported to be involved in making decisions and choices in relation to food choices, clothes and activities. and pictorial aids are being developed to further assist in those choices. The home has an advocate who facilities a quarterly service user meeting, attends individuals reviews, is involved in signing risk assessments on behalf of service users and visits the service users on an informal basis. Service user plans outline the level of support required by individuals in managing their finances on a day-to-day basis and an appointee or relative acts on behalf of service users in dealing with their benefits. Service users plans include risk assessments. A requirement was made at the previous inspection for the individual risk assessments to be further developed to cover a broader range of situations relevant to each service user. This has been complied with and a series of risk assessments are now in place, including a risk assessment on the use of restraint in wheelchairs. Service user plans now include a moving and handling risk assessment, which was previously filed with the homes risk assessments. Some of the risk assessments on file were overdue for review. The manager advised that she intends for the review of risk assessments to be done as part of the monthly summary and monthly summaries will include written evidence of this review and indicate if changes are necessary. New Road (33) DS0000023078.V308380.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users have access to a range of activities, which promotes their personal development. Family involvement is supported and encouraged to enable service users to develop and maintain family links and appropriate relationships. Service users involvement in daily routines is encouraged to allow service users more opportunity to develop some responsibilities in their lives. Meals on offer are varied but other methods of developing service users meal choices should be considered to ensure that service users are given the opportunity to try new things and to expand choices. EVIDENCE: New Road (33) DS0000023078.V308380.R01.S.doc Version 5.2 Page 13 None of the current service users group are involved in work placements or further education. Some service users attend day services or a specific one to one session. The manager advised that service users had completed a sensory garden group at Bierton Hill day centre. All of the service users attend the Winslow centre and have lunch at the café whilst there. Service users are supported to participate in their local community Service users plans include a pictorial weekly activity plan and an individual monthly record is maintained of what activities they actually participated in. The activity record for October to date included a trip to Whipsnade Zoo, Christmas shopping and lunch out. A trip to Southend is planned and the service users have had a successful annual holiday, with a weekend break being planned for two service users in the forthcoming months. The activity record includes some in house activities for example aromatherapy, massage, listening to stories and music and watching films. At the time of the inspection staff at the home were planning Christmas activities and events. The manager confirmed that service users responses to an activity gives an indication as to whether they enjoyed it and the home should set up a system, of recording those responses so as to indicate service users likes or dislike of an activity. The home has its own transport. A new minibus has been provided which can accommodate all three service users at once. This has lead to an increase in the number of activities that have taken place. A high percentage of staff at the home can drive the minibus, which support this. Staffing allow for activities to take place at the weekend and extra staffing are booked for planned activities as required. Service users plans outline family involvement and service users are supported to maintain contact and to send cards for family birthdays and Christmas. Visiting arrangements are flexible. Feedback was received from three relatives who confirmed this. Service user plans outline how service users are to be supported to be involved in household tasks for example cleaning their bedrooms. During the inspection service users were supported to answer the front door and to observe staff preparing lunch and the evening meal. Service users have keys to their bedrooms but were not observed being supported to use them, as all of the bedrooms door were open during the inspection. All of the service users have a lockable safe in their bedroom and two of the service users have a lockable drawer. The manager confirmed that staff assist service users to open their post. Service users plans should outline the level of support required by individuals to manage their post. New Road (33) DS0000023078.V308380.R01.S.doc Version 5.2 Page 14 During the inspection staff were observed engaging with the service users and appeared to have a good understanding of service users needs. Service users have three meals a day, with drinks and snacks being provided during the day. Service users choose their breakfast and lunch time meal daily and a record is maintained of what they have eaten. The main meal is planned weekly and staff take account of service users known likes and dislikes as part of the menu planning. The home keeps a record of service users responses to meal suggestions and uses this as an indication for menu planning. Other options for making meal choices should be considered for example food tasting, sensory responses and pictorial menus. Staff assist service users with their meals and appropriate aids are provided for individuals if required. The menus seen indicate that service users are offered a varied and balanced diet. The home has access to a dietician if required and a speech and language therapist in involved for some individuals with guidance on eating being provided where required. One relative raised a concern in the comment card that their relative was putting on weight. All of the service users are weighed monthly and records are maintained. Issues in relation to weight gain and or loss is discussed with relevant professionals and the home is guided accordingly. New Road (33) DS0000023078.V308380.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 at least once during a 12 month period. 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 the service. Systems are in place to ensure that service users personal care and healthcare needs are met and monitored which promotes their well being. Medication is well managed which promotes service users well being. EVIDENCE: Moving and handling risk assessments are in place for individuals as required to ensure that they are guided, moved and transferred appropriately. Personal support is provided in private. Service users are supported with their personal care needs as outlined within service user plans. Equipment is provided for individuals to maximise their independence and as assessed as being required. Service users have access to a range of professionals through the Community Learning Disability team based at Manor House. Service users have a designated key worker at the home and keyworkers have become more involved in this role in relation to the development of service users plans. Service users plans outline service users preferred routines, communication profile, likes and dislikes which are being developed in a pictorial format. New Road (33) DS0000023078.V308380.R01.S.doc Version 5.2 Page 16 All of the service users are registered with local General Practitioners. Service users have access to chiropodists, dentists and opticians as required and this is recorded in individual’s plans. General nursing input is accessed through the General Practitioner. Service users plans include a record of visits to each professional and the outcome of the visit. The manager has developed a new recording system where all appointments will be recorded on one form which she feels will enable her to keep better track of all health interventions. Service users are supported by staff to attend appointments None of the service users self-administer their medication. Staff at the home administers all medication. Each service users medication is stored in a locked cupboard in their bedroom and the medication administration records are stored in a drawer in the bedroom. The medication administration records seen showed no gaps in the administration of medication. The home has detailed guidelines in place on the use of all as prescribed medication, which was filed in each service users medication administration file. The manager confirmed that new staff are inducted into the medication procedure and assessed prior to administering medication on their own. The induction records for all new staff were not available to support this. Training records indicate that some staff have attended care of medicines training. The organisation indicates this training is three yearly and the manager should consider providing annual refreshers to staff on the medication policy and procedures and carrying out reassessments of staffs medication practices. The home has an individual record of disposal of medication and an individual stock check is maintained of non-blistered and as required medications. The medication cupboards were well organised as the home only carries a week supply of medication at a time. New Road (33) DS0000023078.V308380.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Outcome in this area is adequate. This judgement has been made using available evidence including a visit to the service. A complaints procedure is in place, which indicates that concerns are acted on to benefit service users. Policies and procedures are in place to ensure the protection of service users. This needs to be supported by more regular updates on adult protection training for staff. EVIDENCE: Service users plans include a pictorial complaints procedure, which was dated as being explained to the service user in September 2006. The pre inspection questionnaire indicates the home has had no complaints in the last twelve months. The home has a file in place to record complaints and compliments. The home has five compliments on file for this year. Two out of the three comment cards from relatives indicated that they knew how to make a complaint. The home has an adult protection and confidential reporting (whistle blowing) policy in place. The confidential reporting policy indicates the review date is May 2006 although the manager advised that this is the actual date it was last reviewed. The home has a copy of the interagency adult protection procedure which is accessible to staff. The training records seen indicate that adult protection training is scheduled to take place every three years. An update in adult protection must be made available on an annual basis and this is now overdue for the majority of the staff team. The manager advised that this was meant to take place at a recent New Road (33) DS0000023078.V308380.R01.S.doc Version 5.2 Page 18 staff meeting but had to be cancelled. The date has not been re – scheduled and a requirement has been made to address this. All of the service users have a cash box in their bedrooms and records are kept of all transactions. Those records were not checked at this inspection. None of the current service user group present with physical and verbal aggression. New Road (33) DS0000023078.V308380.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Outcome in this area is adequate. This judgement has been made using available evidence including a visit to the service. The home is generally clean, homely and systems are in place to maintain this to provide a safe environment for service users EVIDENCE: The home was refurbished and adapted to meet service users needs. The home is accessible to service users with a ramp to the entrance. The home is homely, welcoming, well equipped although some areas are in need of updating. The manager confirmed that new sofas are on order for the sitting room and this room is to be decorated. The sitting room includes a sensory area in one corner. Areas of the walls and doors are damaged by wheelchairs and this should be addressed. The home has an enclosed rear garden, which is well maintained by staff. Three bedrooms were viewed at this inspection. The bedrooms seen were nicely furnished and personalised, although were in need of decorating. The manager confirmed that this was scheduled to happen when service users were away on forthcoming short breaks. Staff at the home do the decorating New Road (33) DS0000023078.V308380.R01.S.doc Version 5.2 Page 20 but not with service users involvement. The organisation should consider if this is in line with health and safety legislation and a risk assessment put in place to support this. The home has an assisted specialist bath and walk in shower. Staff are responsible for maintaining the cleanliness of the home and systems are in place to support this. The home was generally clean and free from odour. The home has a separate laundry and a washing machine with sluicing facilities. Health and safety policies were not viewed at this inspection. New Road (33) DS0000023078.V308380.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Staff are comfortable and appear confident in supporting service users, however specialist training is not provided for all staff to support this to ensure that service users are supported by suitably qualified staff. Confirmation of Criminal Records Bureau checks and references are in place for new staff, which promotes the safety of service users, however staff files do not contain the required information to further promote this. All staff do not have the required mandatory training and accurate training records and induction records are not maintained, which could affect the safety and well being of service users. EVIDENCE: Staff were observed to be accessible and comfortable with service users. They had a good understanding of individuals communication needs and were responsive to their needs. Some staff have attended learning disabilities and epilepsy training but this training has not been made available to all staff. The manager confirmed that the home has built up professional relationships with other professionals and three comment cards were received from health New Road (33) DS0000023078.V308380.R01.S.doc Version 5.2 Page 22 and social care professionals who raised no issues and commented that staff are always helpful. The home has one carer with a National Vocational Qualification level 2 and another three care staff are currently undertaking this training. Three staff files were viewed at this inspection. The files seen contained confirmation of Criminal Records Bureau checks and two references. One of the files seen did not include an application form for the current post. One of the files contained confirmation of medical clearance and none of the files contained an up to date photograph of the staff member. Files contained copies of work permits and visa’s where required and some contained copies of passports and or driving licences. Whilst the staff files seen indicate that Criminal Records Bureau checks and references are obtained for staff which safeguards service users, all of the information as required under schedule 2 is not provided and made available to the home. The home does not use bank staff and agency staff at present. The manager confirmed that all new staff are inducted into the home, however individual induction records were not available to confirm this. The training records seen were disorganised and did not indicate that staff had up to date mandatory training. The memos with reference to training dates booked did not correspond with dates on the rota and on supervision records and no certificates were available to confirm the training had taken place. Some individual training records were not updated to reflect training had taken place and where it was completed some did not include the year of the training. There was no training records available for one of the new staff members and training records seen indicate that some staff are working without the required up to date mandatory training. It was noted on correspondence form the organisation’s head office that one of the new staff members was booked on a first aid course in August 2007. This is an unacceptable delay in providing mandatory training and must be addressed. New Road (33) DS0000023078.V308380.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is generally well managed which benefits service users. The organisation carries out monthly monitoring of the service to ensure that a high standard of care is being maintained to benefit service users. Records are in place to confirm that health and safety issues are addressed to ensure the health and safety of service users. EVIDENCE: The manager has been in post for almost a year. She is registered by the Commission and is currently undertaking her National Vocational manager’s award training. The manager has introduced new service user plans and is in the process of revamping records and ways of working. New Road (33) DS0000023078.V308380.R01.S.doc Version 5.2 Page 24 She has been proactive in meeting requirements from the previous inspection and is keen to further develop the service and introduce new ideas to benefit the home. The organisation carries out monthly monitoring visits and copies of the report of that visit is maintained at the home. The home had a quality audit carried out in August 2006 as part of a pilot scheme for the new quality audit tool, however feedback from that audit was not available in the home. This should be made available to the home and the organisation is reminded to send a summary of the findings of the quality audit for the home to the Commission. As previously identified under standard 35 all staff do not have up to date mandatory training. One of the care staff at the home is the designated health and safety person and oversees health and safety. Staff at the home carry out a quarterly health and safety audit and from this an action plan is put into place and issues highlighted addressed. This audit includes a check of the first aid boxes. The home carry out weekly water temperature checks and the water temperature is checked prior to a service user having a bath. The home has confirmation of portable appliance testing, which was carried in January 2006 and the fixed lighting check will be due in November 2006. The home has records to confirm up to date servicing of hoists, bath, gas and fire equipment. Records are in place to confirm that weekly fire points tests and emergency lighting checks are carried out and regular fire drills take place. The fire risk assessment was overdue for review. The home has up to date environmental risk assessments in place and generic risk assessments in relation to staff working practice. The home has accident records in place and those are now filed in service user plans. The manager confirmed that COSHH data sheets are available at the home but were not viewed at this inspection. The cleaning materials are kept in a locked cupboard and the key to the cupboard was not accessible as identified at a previous inspection. New Road (33) DS0000023078.V308380.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 x 2 3 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 2 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 2 33 X 34 3 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 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 2 X 3 X X 3 X New Road (33) DS0000023078.V308380.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? 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 YA6 Regulation 15 Requirement Service user plans must include clear guidance on the management of medical conditions and specific learning disabilities. Updates in adult protection training must be made available to staff. All new staff must be inducted into the home and their roles and records of an induction must be maintained at the home including medication assessments to confirm this. The organisation must ensure that all staff have up to date mandatory training and accurate records must be maintained to support this. Timescale for action 31/01/07 2. 3. YA23 YA35 13 18 31/01/07 30/11/06 4. YA35 18 31/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations New Road (33) DS0000023078.V308380.R01.S.doc Version 5.2 Page 27 1. YA6 2. YA13 3. 4 5 6 YA16 YA17 YA20 YA24 Guidance included in service user plans should be dated, include service users name, date for review and an indication if service users have been involved in their development. The home should set up a system, of recording service users responses to an activity so as to further promote choices and develop a record of services users likes and dislikes of an activity. Service users plans should outline the level of support required by individuals to manage their post. Other options for making meal choices should be considered for example food tasting, sensory responses and pictorial menus. The manager should consider providing annual refreshers to staff on the medication policy and procedures and carrying out reassessments of staffs medication practices. The organisation must consider if care staff decorating areas of the home is in line with health and safety legislation and a risk assessment must be put in place to support this. New Road (33) DS0000023078.V308380.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 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 Road (33) DS0000023078.V308380.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. 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