Inspection on 18/09/07 for New Wokingham Road 95

This inspection was carried out on 18th September 2007.

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

The inspector found 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

New Wokingham Road 95 28/12/06

New Wokingham Road 95 06/02/06

New Wokingham Road 95 09/08/05

New Wokingham Road 95 06/10/04

New Wokingham Road 95 19/05/04

New Wokingham Road 95 14/10/03

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 New Wokingham Road 95 Crowthorne Bracknell Berkshire RG45 6JN Lead Inspector Stephen Webb Unannounced Inspection 18th September 2007 09:45 DS0000050661.V345458.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 DS0000050661.V345458.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. DS0000050661.V345458.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service New Wokingham Road 95 Address Crowthorne Bracknell Berkshire RG45 6JN 01344 771369 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.new-support.org.uk New Support Options Limited Mr Jimmy Bala Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (1) of places DS0000050661.V345458.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th December 2006 Brief Description of the Service: The home can provide care and accommodation to three service users, aged between eighteen and sixty five years and one service user over the age of sixty-five. All service users have a learning disability. The home is situated within a short distance from Wokingham and Bracknell town centres. A range of local amenities and shops are easily accessible within walking distance. The home has its own vehicle and there is good access to public transport. The property is detached and accommodation is provided on two floors. Windsor and Maidenhead Housing Association own the property and the care is provided by New Support Options. The range of care needs within the home is diverse and complex. Several service users have needs, which can challenge the service. The current scale of charges as at December 2006 is £1496:05 per week. There are additional charges for hairdressing, toiletries and clothing. DS0000050661.V345458.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit from 9.45am until 7.00pm on the 18th of September 2007. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with the deputy manager, some of the staff members on duty during the day, and limited feedback from service users. Some time was also spent observing the interactions between service users and staff at various points during the inspection. Indications from the service users, both verbally and by their body-language, indicted they were settled and happy within the home, and observed interactions with staff were positive and appropriate. The inspector also examined the premises. It was evident that the service is well managed on a day-to-day basis by an effective management team. Improvements had continued to be made to the service since the last inspection, though one previous requirement, for the staff to be provided with training to enhance their understanding of residents’ communication, remained to be addressed. What the service does well: Prospective residents are assessed prior to admission, to ensure their needs can be met. The needs and preferences of the individual are then incorporated into a care plan, which with other supporting documents, informs the staff how to support them. Residents are encouraged to take part in daily routines and to make decisions and choices, wherever possible, and there are plans to develop their involvement further. None of the residents is able to manage their own finances, but the home has an appropriate system in place to do so on their behalf, and protect their financial interests. Residents are appropriately supported to take some risks, though the complex needs of some individuals lead to limitations on their community access. Work is being done to begin to address this. DS0000050661.V345458.R01.S.doc Version 5.2 Page 6 Residents are supported to take part in activities, within and outside the unit as far as possible within the limitations of their complex needs. The home is working to broaden these opportunities, and this should continue. Residents are supported to maintain and develop their family relationships and contacts by the staff. They are provided with a varied diet that reflects individual’s cultural origins, and are supported to try to ensure they enjoy their meals. The health needs of residents are met effectively by the home, and appropriate records are maintained. The home provides a pleasant, homely and safe environment, and some adaptations have been made to address their possible future needs. The staff team is stable and well qualified in terms of NVQ attainment. The staffing levels meet the current needs of residents. Staff are supported via a range of meetings and supervision forums, and an appropriate recruitment and selection system for staff is in place. The home is operated effectively in the interest of residents, and is managed by a consistent team, who are subject to regular monitoring, in their turn, by the provider. Systems are in place to protect the heath, safety and welfare of residents in the home. What has improved since the last inspection? What they could do better: There is a need for staff to receive training on understanding the communication of residents, and managing some of the behaviour presented to help them support the residents. Further work is needed to try to develop the degree of community access for some individuals. DS0000050661.V345458.R01.S.doc Version 5.2 Page 7 Some improvements to the medication storage arrangements are required and staff need to ensure that recording procedures are followed. Additional staff training is required on safeguarding vulnerable adults, and in some other areas. The overall training records should be reviewed to identify any shortfalls, for them to be addressed. A central record of any complaints should be established to provide evidence of the home’s response to these. Some areas of the patio need to be re-laid to reduce the risk of accidents, and the raising of the floor level in the dining room should be considered, to remove the need for the steps between this room and the kitchen, and lounge. Although the views of relatives, friends and others have been sought via the quality assurance system, there remains a need to identify an effective tool by which to obtain the views of the residents, and to undertake such a survey, to incorporate their feedback in the summary report of the quality assurance survey. 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. DS0000050661.V345458.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 DS0000050661.V345458.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): Standard 2: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs and aspirations of prospective residents are assessed prior to admission and relevant information is obtained from the funding authority. However, care is needed where a resident may be readmitted, to ensure that their needs can still be met effectively, and needs should be reassessed. EVIDENCE: The home had a settled group of three long-term residents at the point of inspection, so there were no recent assessment documents to evaluate. However, copies of care management and unit preadmission assessments were on file for the two current residents whose records were tracked, together with a discharge summary from a previous placement in one case. The most recent admission had since moved on to a more appropriate placement, having initially been readmitted to New Wokingham Road from hospital. Some concerns were expressed about pressure to readmit this resident despite the unit not being equipped to meet their needs. The provider should ensure, if residents are to be readmitted, from hospital, that they are reassessed to ensure the unit can still meet any changed needs. DS0000050661.V345458.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs, aspirations and preferences of residents are incorporated within their essential lifestyle, (care) plans and the associated documents, which support their care. Care plans are kept under review. Residents are encouraged to be involved in decision-making where possible, and there are plans to involve individuals more proactively. These would be supported by the provision of further training on communication skills for all staff, which had still not been provided despite this being a requirement arising from the previous inspection. (Requirement repeated later in report). Though none of the residents is able to manage their own finances, the home has an appropriate system in place to manage this on their behalf, and protect their financial interests. Residents are supported to take some risks, in the context of appropriate risk assessments, though the complex needs of some individuals lead to limitations on their community access. Some incremental work is being done to begin to address this. DS0000050661.V345458.R01.S.doc Version 5.2 Page 11 EVIDENCE: Each resident had a background, archive file and a working file where current information was stored regarding their care needs, likes and dislikes. Files contained copies of annual reviews, the care plan and copies of relevant risk assessments. The files were orderly, indexed and the papers were secured. There was evidence that risk assessments are kept under review. Each resident has an individual fire evacuation risk assessment, and there were also risk assessments around the ability of individuals to hold and use bedroom and front door keys. The complex needs of some residents present limits on the degree to which they are able to access the community, though some work is beginning to address this in particular areas. Each resident has an essential lifestyle plan, which include positives such as skills development and achievements, as well as identifying areas where care support is needed. In one case, the resident had signed their lifestyle plan. The views, likes and dislikes of the individual are recorded within the plan, under headings such as “What I must have in my life”, “Things I Like”, “Things I don’t like” and “in order to support me”, and files contained other evidence of support for residents to make decisions in their day to day lives. The deputy manager indicated that there were plans to further improve the accessibility to and involvement of residents in, their care plans, through the inclusion of more pictures and illustrations and more proactive engagement with residents. The ability of staff to further the development of residents’ skill in this area, would be supported by the provision of further training on communication skills to all staff. This was a requirement from the previous inspection, which has yet to be addressed, and staff last received this training in 2000 or 2001 apart from one individual in 2005. There were also five staff who had no record of having received this training at all. (Requirement repeated under Standard 35, later in report). Residents decide when to get up and go to bed, choose their clothing, with support where necessary, and have some choice about their meals. None of the residents is felt able to manage their own personal allowance, though they may have a role in signing for cash where able to do so. Finances for all three residents are managed under the Court of Protection. DS0000050661.V345458.R01.S.doc Version 5.2 Page 12 Each resident has a building society account, into which their personal allowance is directly paid. Two staff sign for any expenditure on behalf of residents, and individual records of all transactions are maintained within an in/out/balance system, linked to numbered receipts, which are retained. Records of building society transactions are also maintained within the individual accounts books. Examination of the kind of items purchased on their behalf with personal allowance, indicated a range of appropriate items, such as toiletries and treats. The deputy demonstrated a clear understanding of the appropriate management of residents’ funds, and information regarding their monies. There are also details regarding the individual’s communication repertoire, detailing what various communications are thought to mean, where the individual is unable to confirm this, and guidance on how to respond to specific cues and behaviours. The plans include information on the residents self-care abilities and where and how to offer support, whilst encouraging individuals to maintain and develop their own abilities. The care plans also include action-planning sheets. Copies of any accident/incident records relating to individuals were also on case files to enable monitoring. DS0000050661.V345458.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): Standards 12, 13, 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. Residents are enabled to take part in activities, within and outside the unit as far as possible within the limitations of their complex needs. The home is working to broaden these opportunities, and this should continue. They are supported to maintain and develop family relationships and contacts by the staff. Residents are encouraged to take part in the day-to-day tasks in the home as much as possible and encouraged to make decisions and choices for themselves. Residents are provided with a varied diet that reflects their cultural origins, and they are supported to try to ensure they enjoy their meals, in terms of their preferred location and timing. DS0000050661.V345458.R01.S.doc Version 5.2 Page 14 EVIDENCE: The needs and history of two of the residents mean that they have been unable to take part in holidays away from the unit, though one has recently had their first short holiday away, for some time, so there may be opportunities for this to be increased in time. There are also plans to try to increase community participation for this resident, who has two day-care supported one-to-one sessions per week, where he may go on train journeys, take part in recycling, visit a pub for lunch or go for a haircut, or a walk to town, but otherwise only has occasional clothes shopping trips with staff. One resident does not attend any activities within the community owing to his complex needs and previous experience during an external visit, though he does take some part in day-to-day events and routines within the house and enjoys barbecues in the garden. Ongoing development of the opportunities for community access should continue, at a pace appropriate to each individual, within the context of appropriate risk assessments. The third resident has two sessions of day services support in the community each week, though one of these was reported to be being cut, and also goes out at other times with staff. The resident also enjoys drawing and colouring, and listening to music, and mentioned a liking for classical music to the inspector, which had been supported through them obtaining a selection of CD’s of music which they enjoy. This resident went out for a one-to-one session with a day services worker during the inspection. The issue of community access is regularly examined as part of reviews. Individual records detail the specified religion of each resident and whether they actively engage in worship etc. None of the current residents are identified as wishing to pursue spiritual needs. The home has a multi-cultural staff team and as noted below, some items on the menu reflect the ethnicity of one resident, and the provider has provided training in equal opportunities and diversity. The manager indicated in the preinspection information, that residents are supported to celebrate key festivals within their culture. The evidence suggests that the cultural and diversity needs of residents are addressed by the home. Essential lifestyle plans and risk assessments include evidence of participation in activities and tasks, within and outside the home. For example, one resident always wishes to help mow the lawn, and a written risk assessment and DS0000050661.V345458.R01.S.doc Version 5.2 Page 15 guidelines on his use of the mower have been prepared, which enable him to engage in this task within specified parameters. It was reported that two of the residents have no sense of personal safety, so risk assessments have to be compiled in this context. The essential lifestyle plans also include information on the level of residents’ involvement in aspects of their care and daily living experience. One resident was seen engaged in vacuuming his bedroom and the hallway during the inspection, and also tidied away his clothes with staff encouragement. Another often lays the table for meals, but none has significant involvement in meal preparation or cooking. Two of the residents have helped to dig over the borders in the garden and there are plans to develop their involvement here further. As already noted, residents are risk assessed regarding whether they are able to manage a key to their bedroom and the front door. Family contact varies but includes visits, letter and phone calls for one resident, and mainly telephone contact for the others. There are plans to further develop the family contact for one resident, where contact has been reestablished with a family member. Staff also support regular telephone contact where necessary. The residents are provided with a varied diet, which tends to be planned from day to day, involving the residents in making choices, wherever possible, rather than to a set menu planned in advance. Often the meals are chosen on the basis of knowledge of those meals that have previously been popular. The actual meals provided and what has been eaten, are recorded in the home’s signing-in diary, together with details of the staff on shift. The lunch is the main meal of the day, specifically around the needs of one resident who was found to refuse to eat sufficiently at other times. This also seems to suit the other two. One of the residents is able to ask specifically for things they like, and may request items she has seen on TV cookery programmes, while another will only tend to choose preferred sandwich fillings, and otherwise eats and apparently enjoys whatever is prepared. One resident was said to not really express any preferences regarding food. Residents were observed to be offered some concrete choices regarding food, for example by showing them a choice of yoghurts, but it was not always clear that all residents were able to make explicit choices. DS0000050661.V345458.R01.S.doc Version 5.2 Page 16 One resident who was born in the West Indies had expressed a desire for specific Caribbean dishes and drinks, which have been provided at times, by the staff. The lunchtime meal was tasty and well-presented and included fresh vegetables and the option of yoghurt or fruit for desert. Two of the residents ate their lunch with the inspector and staff at the dining table. One resident tends to eat on his own in the kitchen before the others, where a table has been provided to enable him to do so. Staff interaction with the residents during the lunchtime meal and at other times during the day was relaxed and calm, and included humorous exchanges at times. A good rapport and warmth were evident, and the expressions on the faces of residents indicated a sense of wellbeing. One of the residents likes to drink a lot of tea and this is supported by the staff, who regularly offered him a cup of tea, when putting on the kettle. DS0000050661.V345458.R01.S.doc Version 5.2 Page 17 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): Standards 18, 19 and 20: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff provide personal support to residents with due regard for their needs and expressed or understood preferences as to how they are supported, and information on this is recorded within the care plans. The health needs of residents are met effectively by the home, and appropriate records are maintained. Although the home has, for the most part, an appropriate system of medication management on behalf of residents, some improvements to the storage arrangements are required and staff need to ensure that recording is always properly made. EVIDENCE: The care plans and supporting documents included details regarding the known preferences of residents regarding how support is provided to them with their care, where this is necessary, as well as details of how the individuals communicate their feelings, anxiety, pain etc. other than via verbal means. DS0000050661.V345458.R01.S.doc Version 5.2 Page 18 The plans also identify where individuals are able to meet their own needs. Routines are appropriately flexible to allow for residents’ individual preferences, and the main meal had been moved to lunchtime to address the needs of one resident, which was said also to suit the others. Following a risk assessment regarding one resident, which identified the need for window restrictors on their first floor bedroom windows, these were subsequently fitted. Risk assessments were also in place on whether individuals could manage bedroom and front-door keys. Behavioural intervention guidelines were also in place where required. The case records inspected contained relevant information regarding any health issues, hospital appointments, and included details of positive forward planning to address the anticipated anxieties of one resident regarding a possible upcoming hospital visit. The home has a good relationship with external healthcare professionals and had arranged for a consultant to visit the home to see the resident, under the circumstances, which is an example of good joint working. They were also seeking a photo of the consultant, to show to the resident in advance. “My Health” booklets were also present on individual files, which also included evidence of the active review of healthcare needs, and action plans, and there was also a record of the outcomes of healthcare appointments, which indicated that periodic check-ups took place. A medication review had also recently taken place on one resident. The home’s medication management system and records were appropriate for the most part, though one gap in the current medication administration, (MAR) sheets was noted, and the quantities of medication coming into the home were not always recorded to provide the necessary audit trail. The home’s medication cabinet was too small to hold the whole months’ supply, so the current week’s medication only, was stored there, with the balance held within a locked briefcase in a locked cupboard. This does not constitute appropriate storage and should be addressed by the provision of appropriate, fixed storage for all medication held in the home. Examination of training records indicated that the staff had received in house assessments of medication practice, in 2005 or 2006, though they no longer receive any medication training from a competent external source such as a pharmacist. Unless the in-house medication training is provided by a suitably trained, “competent” person, it is recommended that periodic training on medication be provided to all staff by a pharmacist. DS0000050661.V345458.R01.S.doc Version 5.2 Page 19 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): Standards 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 service has produced an illustrated complaints leaflet, which is in a more accessible format, but owing to their complex needs, residents are likely to be reliant on advocacy support in order to make a complaint. The service has systems in place to safeguard residents from abuse and selfharm, though additional staff training is required in this area. (Requirement made later under Standard 35). EVIDENCE: The home has an appropriate complaints procedure in place and has produced a more accessible version as an illustrated complaints leaflet. However, it is acknowledged that it would still be necessary to explain the process and the idea of complaints to some residents, and all would be likely to need the advocacy and support of someone to make a complaint as such. Nevertheless all three are able to make their feelings known either verbally or in other ways, so all of them would be able to demonstrate they were unhappy about something, though they may not conceptualise it as a complaint. Staff demonstrated an understanding of the individual communication repertoires of the residents and the care plans include details of how individuals would indicate their dislike or displeasure at something. DS0000050661.V345458.R01.S.doc Version 5.2 Page 20 Observation during the inspection indicated that staff do listen to what residents try to communicate both verbally and non-verbally. Examination of the complaints log indicated no recorded complaints since before the previous inspection, so it was not possible to assess the system in operation on this occasion. No complaints have been received by the Commission for forwarding to the service, since the last inspection. It was stated that copies of the details of a previous resident’s complaint had been filed in their case record, but no central copy had been retained and this resident had since moved to another service with her file. A central copy of any complaints and their resolution must be maintained as an ongoing record within the home in addition to filing a copy within the relevant resident’s case record. A copy of the current multi-agency vulnerable adults safeguarding procedure was available for reference, in the office. Examination of the training records indicated that though some staff had received training on “safeguarding vulnerable adults” in 2006, and others in 2005 and 2003, in several cases there was no record of receipt of this training. (Requirement made later under Standard 35). An appropriate system and records were in place to safeguard residents’ finances on their behalf. There have been no issues relating to the safeguarding of vulnerable adults within the service since the last inspection. Specific behaviour management planning was in place to address instances of self-harm, should they arise. DS0000050661.V345458.R01.S.doc Version 5.2 Page 21 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): Standards 24 and 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided for the most part, with a pleasant, homely and safe environment, with some adaptations for their possible future needs. However, the remedial work to the patio needs to be addressed and it may be necessary to consider raising the height of the dining room floor to that of the connecting rooms to remove the current steps, in the future, in order to protect residents from possible hazards. The home has an appropriately equipped laundry, and observed standards of hygiene were good. EVIDENCE: The communal areas of the home are light and pleasantly decorated. There is a long lounge diner reaching from the front to the back of the house, and an adjacent kitchen, which was well equipped in an appropriately homely style. DS0000050661.V345458.R01.S.doc Version 5.2 Page 22 Handrails had been installed in some areas to address potential future needs, but there is limited scope for further adaptation, given the layout of the building, without major works. However, the step down into the dining room extension, from both the kitchen and lounge is inconvenient and could present a hazard. It is hard to see why this was introduced when the extension was added, rather than raising the floor height to the same level as the existing rooms. This improvement should be considered in the future. The home has two bathrooms and a level-entry shower with mobile seat and has three toilets, so is well provided for in this area. Appropriate locks are provided on bathrooms and toilets, and resident’s bedrooms, to address issues of privacy, and individuals are risk assessed regarding their ability to manage a key to their room. There were no reported premises issues aside from a problem caused by water splash around the kitchen sink, where the water pressure was leading to some potential damage. The provision of a deeper sink or reducing the water pressure might be beneficial. It was noted that some of the patio paving stones had become loose and were rocking under foot. This should be addressed to remove the potential health and safety hazard, which it presents. One resident had a collection of his old greetings cards and family photos in an area of the lounge next to his preferred seat, and showed the inspector these photos, with a happy expression. There are two ground floor bedrooms and two on the first floor. One of the ground floor rooms is currently vacant and is in use as a staff sleep-in room rather than using the fold down bed in the office. Bedrooms were individualised to reflect their occupant, and were pleasantly decorated and furnished, though one resident had begun to remove a section of wallpaper, which would benefit from repair. One resident confirmed that he liked his room, and another was happy that she could listen to her music there, and showed me her CD player as she put on some music. A disused shower in one of the bedrooms could be removed to enlarge the usable space, as it doesn’t work and would be unsuitable for the resident. The home has an appropriately equipped laundry and standards of hygiene about the home, were good. DS0000050661.V345458.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): Standards 32, 34, 35 and 36: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A stable and well-qualified team of staff, in sufficient numbers, support the residents in meeting their needs. Staff receive ongoing support through various forums, though the records of these could be improved. The recruitment and selection systems in place protect residents. The provider has a core-training package to provide staff with the necessary training to meet the needs of residents, for the most part, though this is compromised by significant gaps in training in some key areas, and overdue training updates in others, which need to be addressed. EVIDENCE: The home has a stable, multi-cultural staff team, from which no members have left in the past year. The regular staffing is two staff on duty in the morning, two in the afternoon and evening, (one of whom goes on to sleep-in), and one waking night staff, DS0000050661.V345458.R01.S.doc Version 5.2 Page 24 though at times there is a third staff member rota’d to cover specific appointments or activities. In addition to the permanent staff team the unit draws from an in-house bank of three staff who only work in this home, and so are very familiar with the individual residents and the routines within the home. This works well to maximise continuity and consistency for the residents. The feedback from residents and observation of the interactions between staff and residents during the inspection, indicates positive relationships and warmth, and residents appeared to enjoy the company of the staff. The staff appeared relaxed with each other and communicated appropriately regarding residents. One of the staff described the team as supportive. In terms of NVQ attainment and previous experience, the unit has a highly qualified team, with the deputy and the three bank staff all having NVQ level 4, and the deputy also being an in house NVQ assessor. The two senior support workers have NVQ level 3, with one also having an advanced GNVQ, and the three full-time support workers have NVQ level3. The three part-time support workers are students and are not undertaking NVQ. There had been no new recruits to the staff team since the previous inspection but examination of the most recent recruitment records indicated that from the records available for inspection, that an appropriate recruitment and selection system was in operation, though the notification of CRB clearance should, ideally, include more detail. The staff receive training based on an appropriate core training package, and individual staff training records were available within the unit. Some additional specialist training had also been provided to individuals. However, as noted earlier, according to the available records, some staff had either not received some of the required training, or this training had not been attended recently. The provider had failed to address a previous inspection requirement regarding the provision of communication training, appropriate to the needs of residents. Most staff are either not recorded as having received this (five), or last attended such training in 2001 or 2002, (five). Only one staff member had attended communication training more recently, in 2005. In order to best support residents who often communicate other than via verbal means, it is essential that staff receive relevant training on DS0000050661.V345458.R01.S.doc Version 5.2 Page 25 understanding communication by residents, both directly and through their behaviour which may, at times, challenge the service, or lead to self harm. Given that both issues are relevant in this unit, as evidenced within care plans and associated documents, it is important that the provider now addresses this training requirement. It would also be prudent to provide training to all staff on appropriate behaviour management and intervention techniques within this context. As noted earlier in this report, there is also a need to update the training on safeguarding vulnerable adults, for a significant number of staff. The provision of regular updates of this training should be considered. The training records were not all up-to-date and should be reviewed by the manager to address this. Given the complex needs of the residents it is important for staff to continually review and update their skills and examine how they work to support each other, through ongoing reflection on issues and incidents as they arise. A previous inspection requirement for bank staff to receive regular supervision as well as permanent staff had been reportedly been addressed, though it was not possible from the available evidence to confirm this fully. The deputy indicated that staff were now supported through a mixture of team meetings, group and individual supervision, but the records were patchy. It is suggested that separate records of these forums, combined with an overall listing of the dates of each event, would provide clarification. DS0000050661.V345458.R01.S.doc Version 5.2 Page 26 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): Standards 37, 39 and 42: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is operated effectively in the interest of residents, and is managed by a consistent team, who are subject to regular monitoring, in their turn, by the provider. Although the views of relatives, friends and other relevant parties have been sought via the quality assurance system, there remains a need to identify an effective tool by which to obtain the views of the residents, and to undertake such a survey, to incorporate their feedback in the summary report of the quality assurance survey. Systems are in place to protect the heath, safety and welfare of residents in the home. EVIDENCE: DS0000050661.V345458.R01.S.doc Version 5.2 Page 27 The home is effectively managed, by a consistent management team. The manager has extensive experience and has a qualification in mental nursing as well as a Business and Management studies certificate. Clear guidance is provided to staff via policy and procedure documents, and the operation of the home is regularly monitored by the provider. The pre-inspection information provided, identified the need to develop an appropriate format to obtain the views of residents on their care, as part of the service’s quality assurance system. This had not yet been addressed. The provider subsequently forwarded copies of their quality assurance policy, which include the intention of surveying of resident’s views. A copy of the outcomes of the survey of next of kin, friends and carer of residents, published in November 2006 was also provided, but this collated the results from various services across the region, making it hard to identify any issues specific to this home. A regional management review of the Wokingham-based services had also been produced, as well as an annual service plan for this home, dated July 2007. This document identifies the need to survey residents and others at the unit level, regularly, as part of the quality assurance strategy. Further work to devise an appropriate system for obtaining the views of residents should be done. The provider also undertakes monthly regulation 26 monitoring visits, and copies of the reports for each month since the last inspection, apart from May, when an in-house management audit visit was undertaken, were available. Health and safety systems were in place to protect residents, and records showed that all staff had received health and safety training in either 2005 or 2006, with the exception of the deputy manager, whose training record was not in the same format as that of the other staff and was not up-to-date. Examination of a sample of health and safety-related service records indicated that these were addressed appropriately to protect residents and staff, as detailed within the pre-inspection information. The home also had an up-todate fire risk assessment in place, which had been reviewed in July. Examination of the accident records indicated that copies were placed on the individual’s file as well as being recorded centrally and copied to the provider. DS0000050661.V345458.R01.S.doc Version 5.2 Page 28 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 2 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 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 2 36 3 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 2 X 3 X 2 X X 3 x DS0000050661.V345458.R01.S.doc Version 5.2 Page 29 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 The manager must ensure that all medication is securely stored and that proper recording practice is followed, at all times, so that procedures and storage protect service users. The manager must ensure that a central record is maintained of the records of investigation of any complaints, in order to demonstrate that the procedure has been followed. The manager must ensure that the patio pavers are secured and level, so as not to present a hazard to residents and staff. The manager must ensure that all staff, including bank staff, are provided with training in communication skills, appropriate to the needs of the service users. This requirement remains outstanding from the previous inspection. Previous deadline 28/2/07, not met. The provider/manager must ensure that all staff have received recent training on DS0000050661.V345458.R01.S.doc Timescale for action 18/11/07 2 YA22 22 18/11/07 3. YA24 23 18/12/07 4. YA35 18 18/12/07 5. YA35 13(6) & 18 18/12/07 Version 5.2 Page 30 6. YA39 24 safeguarding vulnerable adults, to maximise the protection of residents. The provider must establish an appropriate system, by which to obtain the views of residents, as part of the unit’s quality assurance system. 18/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA20 Good Practice Recommendations The provider should consider providing periodic medication training to all staff who handle medication, by an appropriately trained, competent trainer. The provider should consider the levelling of the dining room floor to that of the connecting rooms, to address the potential hazard caused by the existing steps. The provider should consider providing training to all staff on behaviour management and intervention techniques, appropriate to the needs and context of the residents in the unit. The manager should review the staff training records to ensure that they are all fully up-to-date, and are maintained as such. YA24 YA35 4 YA35 DS0000050661.V345458.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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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