Inspection on 29/08/06 for Old Barn Close (5)

This inspection was carried out on 29th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Old Barn Close (5) 24/07/07

Old Barn Close (5) 06/12/05

Old Barn Close (5) 20/07/05

Old Barn Close (5) 20/07/05

Old Barn Close (5) 11/03/05

Old Barn Close (5) 19/10/04

Old Barn Close (5) 16/09/03

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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 Old Barn Close (5) Gawcott Bucks MK18 4JH Lead Inspector Mrs Maureen Richards Unannounced Inspection 29th August 2006 09:40a Old Barn Close (5) DS0000023076.V302121.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 Old Barn Close (5) DS0000023076.V302121.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. Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Barn Close (5) Address Gawcott Bucks MK18 4JH 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) 01280 824799 01280 824799 5oldbarn@muldrom.co.uk Hightown Praetorian & Churches Housing Association Miss Fiona Hull Care Home 5 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 5 residents with learning disabilities/physical handicap The home is able to continue to provide care and support to two Service Users who have been diagnosed with Early Onset Dementia. This variation applies to the two specific Service Users named in the Variation Application of June 7th 2006. 6th December 2005 Date of last inspection Brief Description of the Service: 5 Old Barn Close is a small care home that is registered to provide care and accommodation to five service users with a learning and physical disability. The home is managed by Hightown Praetorian and Churches Housing Association. 5 Old Barn Close is situated in the village of Gawcott, which is a small village on the outskirts of Buckingham, but it is accessible to Aylesbury and Milton Keynes town centres and amenities. Access to amenities is via the homes own transport. The home is on a bus route to local villages and towns. 5 Old Barn Close is a single storey building, which has been refurbished and adapted to meet the needs of the service user group. All of the bedrooms are single. There is parking at the front of the property and an enclosed rear garden. The current weekly fees are £1445.29 as indicated on the pre inspection questionnaire. Old Barn Close (5) DS0000023076.V302121.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. No comment cards were received from service users, relatives and professionals involved with the home. The inspection involved discussion with the manager, individual discussions with two staff, a tour of the communal areas of the home and four bedrooms, examination of some of the required records and observation of practices and staff interactions with service users. Two recommendations were made at the previous inspection, which, have been complied with. This inspection has resulted in a number of requirements and recommendations which maybe as a result of the high number of staff vacancies and the admission of two service users with higher care needs. What the service does well: The home keeps a record of all visits to the home by prospective service users, which include their reactions and responses to staff and service users and assists in giving an indication if the prospective service user is happy with the proposed move. Service user plans include a pen picture of service users likes and dislikes and this information is used to assist staff in service users choices and decisions. Service user plans include a series of up to date risk assessments. In house activities are being promoted and this needs to be further developed with more access to activities out of the home being provided. Family involvement is supported and encouraged. Service users personal and healthcare needs are met and monitored. Medication is well managed. Polices and procedures are in place to ensure the protection of service users. The home is clean, homely and welcoming. Safe recruitment practices are in place. Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 6 Systems are in place for the organisation to monitor this service. What has improved since the last inspection? What they could do better: The assessment documentation for all prospective service users should be fully completed to ensure that the home is able to meet individuals identified needs and that the individual is compatible with other service users. Service users plans must be further developed to include guidelines for staff on the management of specific medical conditions to ensure continuity of care for service users. Service user plans should outline the level of support required by individuals in managing their post and should indicate service users involvement. A risk assessment must be put in place to indicate why individual service users are restricted in their wheelchairs and discussed and agreed as part of a multidisciplinary decision to safeguard the service user. Activities out of the home must be developed on to ensure that service users are given the opportunity to participate in their community. The manager should look at ways of further promoting service users involvements in tasks and consider other options of how service users can be supported to make choices and decisions in relation to areas of their lives. The pictorial complaints procedure must be developed and explained to service users. A log to record any complaints should be set up and made accessible to ensure that all complaints are logged and dealt with. Adult protection refresher training must be made available to staff to safeguard service users. The grass should be kept mowed to ensure the garden area is accessible and safe for service users. Specialist training must be made available to staff to support them in their roles. The manager must ensure that agency staff have the required up to date mandatory training to ensure the safety of service users. Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 7 Staffing levels must be reviewed to ensure that the home is adequately staffed to meet the assessed needs of individuals. Some recommendations are made to health and safety practices to safeguard service users. 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. Old Barn Close (5) DS0000023076.V302121.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 Old Barn Close (5) DS0000023076.V302121.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 adequate. This judgement has been made using available evidence including a visit to the service. Assessment documentation indicate that prospective service users are assessed prior to admission, some of this documentation was incomplete which could result in service users being admitted whose needs cannot be met and who are incompatible with other service users. EVIDENCE: The home has had one admission since the previous inspection. Assessment documentation was in place to indicate that an assessment had been carried out by the service manager and the registered manager. However the skills section of the assessment documentation was incomplete and did not give an indication of the individual’s current skills and abilities. The assessment included records of the outcome of all visits to the home and evidence of discussion and review with relevant professionals. Service user meeting minutes indicate that service users were informed of prospective new admissions but due to their limited verbal communication there was no evidence to indicate they were consulted with on the suitability of individuals and on the compatibility of those admissions with the existing service user group. Old Barn Close (5) DS0000023076.V302121.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 need to be developed on to provide specific guidelines for staff on the management of medical conditions and which takes account of guidance from other professionals to ensure service users identified needs are met and promote 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 promotes the health, safety and welfare of service users. This needs to be developed to indicate why individuals are being restricted from getting out of their wheelchairs. Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 11 EVIDENCE: Three service user plans were viewed at this inspection. Each service user had three files, a personal file, a daily use file and a finance file. The files seen were informative and well organised. Service user files included personal details on the individual with reference to their spiritual and cultural needs, things that are important to them, how people get to know them, important people in their lives, communication needs and communication profile, mental health needs, health and support with appointments, support with medication, support with personal care, support and involvement with household tasks and laundry, getting up and going to bed routines. Service user plans made reference to specific medical conditions but did not provide clear guidelines for staff on the management of those conditions. Service user plans included guidelines from other professionals for example the dietician and speech and language therapist but those guidelines were not referred to or incorporated within the service user plan in relation to staff management of those issues on a daily basis. This must be addressed. Service users plans and support plans showed no evidence of discussion with service users. Some service users plans included a comment to say that the service user cannot sign. Service users plans outline service users likes and dislikes in relation to food choices and activities. Service user plans include a communication profile, which outlines how individuals communicate their choices and decisions. The home has advocacy involvement and advocates facilitate service users meetings. The last service user meeting minutes on file are dated for April 2006. The manager confirmed a meeting has taken place since then and the advocate will make the minutes available to the home at the next meeting. Meetings are now scheduled to take place quarterly. Staff support service users to access their finances and service users plans makes reference to this. However this information is brief and lacks clear instructions for staff on supporting service users with their money. Service user plans include individual risk assessments, which were up to date and reviewed. The home has separate moving and handling risk assessments, which are filed in the homes risk assessment folders as opposed to in service users file. During the inspection it was noted that one service user was restricted from freedom of movement by the use of a seat belt whilst sitting in the wheelchair. The manager confirmed that this was to maintain her safety. A risk assessment needs to be put in place to support this decision and agreed as part of a multi disciplinary decision. Old Barn Close (5) DS0000023076.V302121.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 adequate. This judgement has been made using available evidence including a visit to the service. Service users access to activities out of the home is limited which potentially do not promote 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 limited, this should be further developed 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. Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 13 EVIDENCE: 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. Service users are supported to participate in their local community but tend to have to access Buckingham, Aylesbury or Milton Keynes to access amenities. Service users plans include a lifestyle plan of programme of weekly activities and a separate record is maintained of what activities they actually participated in. This indicates that service users have participated in some out of house activities mainly food shopping, occasional lunch out or a trip out in a wheelchair in local area. The manager confirmed that the opportunity for activities out of the home has decreased due to staff vacancies and a lack of staff who can drive the homes vehicle. This must be addressed. In house activities are supported with service users having access to an aroma therapist who provides aromatherapy sessions and hand massages.Staff facilitate art and craft sessions with evidence of this being displayed around the home. The home has its own vehicle and this is being upgraded to a larger vehicle to accommodate more service users. However at the time of this inspection only two staff could drive the vehicle, which limited its usage and opportunity for, trips out. The manager confirmed this is being addressed as part of the recruitment drive. Service users plans outline family involvement and service users are supported to maintain contact. Visiting arrangements are flexible. No feedback was received from relatives and therefore no issues have been highlighted with regard to the arrangements for visitors. Service user plans outline individuals’ ability to be involved in specific tasks to promote their independence. This indicates that service users have limited involvement in tasks, which promote their independence. Staff were observed knocking on service users bedrooms prior to entering. Service users were given keys to their bedrooms but the manager advised that most of those keys have been lost or misplaced. 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. Service users have limited involvement in household tasks and the manager should consider reviewing this to further promote service users involvement and independence. It was observed during the inspection that one service user is restricted from freedom of movement as outlined in standard 9. Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 14 Service users plans outline service users likes and dislikes in relation to meal choices. Service users have three meals a day and have a choice of cereals and or toast for breakfast. The menu for lunch and evening meal is planned weekly and a record is maintained of how service users have made those meal choices. Other options for making meal choices should be considered for example food tasting, sensory responses and pictorial menus. The menus seen were varied and showed an alternative meal being provided for service users as required. Service users plans outline the level of support required by individuals with their meals and some service users are assisted with their meals. Service users have the appropriate eating aids provided as assessed as being required. Old Barn Close (5) DS0000023076.V302121.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 and by staff of the same gender as only female staff are employed to work at the home. Service user plans outline the getting up and going to bed routine. 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 by the Occupational Therapists. Service users have access to a wide range of professionals through the Community Learning Disability team based at Manor House. Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 16 Service users have a designated key worker at the home and service users plans outline service users preferred routines, communication profile, likes and dislikes. All of the service users are registered with local General Practitioners. Service users have access to chiropodists, dentists and opticians as required. 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. Service users are supported by staff to attend appointments and the manager confirmed that the Community Learning Disability team is responsive to changes in individuals. The home has one service user who requires to have a blood glucosemonitoring test done alternate days. The service users plan made no reference to this. The training records seen indicate that some staff at the home have been trained in this procedure. The manager must ensure that all staff responsible for blood glucose monitoring have received this training and establish with the district nurses the frequency of this training for staff. None of the service users self-administer their medication. Staff at the home administers all medication. The medication administration records seen showed no gaps in the administration of medication. The senior is responsible for ordering and receiving the medication and a record of disposal of medication is in place. The home has detailed guidelines in place on the use of all as prescribed medication. These were filed at the back of the medication administration records. The manager was advised to file them behind each individual medication administration record to facilitate cross-referencing. The medication administration records indicate where medication has been discontinued. A note should be made to indicate the date the medication was discontinued and by whom so that it can be cross-referenced to the health appointment record. New staff confirmed that they are inducted into the medication procedure and assessed prior to administering medication on their own. Induction records seen support this. Training records indicate that staff have attended care of medicines training. Old Barn Close (5) DS0000023076.V302121.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has a complaints procedure in place, which should be explained to service users to ensure service users are supported to address issues. Policies and procedures are in place to safeguard service users however updates in adult protection training must be made available to staff to support this and to ensure the protection of service users. EVIDENCE: The home has a complaints procedure in place, which indicates that all complaints will be responded to within 28 days. Service users have been given a pictorial complaints procedure. The sample seen was not completed with the relevant information and photographs of key people as required and no record was made to indicate if the complaints procedure had been explained to that individual. This must be addressed. The pre inspection questionnaire indicates that no complaints have been received within the last twelve months. The home has a quality-monitoring folder, which includes a section for filing compliments however there is no section for filing complaints. This should be set up to ensure that all staff are aware of how and where they record and file complaints. The home has an adult protection and confidential reporting policy. A recommendation was made at a previous inspection that the home should access a copy of the Bucks Interagency Adult Protection policy. The manager confirmed this is available at the home and was filed in a filing cabinet. Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 18 Staff spoken with were clear of their role in reporting bad practice and abuse. Training records indicate that two staff had abuse awareness training in 2005.The remainder of the staff team had abuse awareness training in 2003 and an update in this training must be provided to safeguard service users. Old Barn Close (5) DS0000023076.V302121.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home is maintained, clean and homely to benefit service users. EVIDENCE: The home was refurbished and adapted to meet service users needs. The home is generally well maintained with areas of the home having recently been decorated. A programme of maintenance and refurbishment is not in place to indicate what future improvements and decoration is planned. Handrails have recently been fitted to the corridor to specifically meet the needs of one service user. The home has a specialist bath and a walk in shower. The home has an enclosed rear garden. Staff are responsible for maintaining the garden. At this inspection the grass was becoming overgrown. Due to the staff shortages this has not been attended to. Four bedrooms were viewed at this inspection. The bedrooms seen were nicely decorated and personalised. The carpet in one of the bedrooms seen was stained and in need of attention. The manager advised she had already made arrangements to address this. Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 20 Staff are responsible for the cleaning at the home and this was generally well maintained. The home has a separate laundry with a washing machine with sluicing facilities. The home has systems in place for the management of clinical waste. Old Barn Close (5) DS0000023076.V302121.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, 33, 34 & 35 Quality in this outcome area is poor. 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 by the organisation to support this to ensure that service users are supported by suitably qualified staff. Staffing levels are inadequate to meet current service users needs, which potentially put service users and staff at risk. Safe recruitment practices are in place, which promotes the safety of service users. All staff do not have the required mandatory training, which could affect the safety and well being of service users. EVIDENCE: Staff were observed to be comfortable with service users. Due to the needs of the current service user group and the current staffing levels their accessibility to some service users at times during the shift was limited. Staff on shift appeared to have a good understanding of service users communication needs and appeared committed to their roles. Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 22 Some staff have had training in Dementia in response to the needs of two of the service users group. The manager confirmed that staff have had a recent in house training on epilepsy but this was not recorded on staff’s training logs. None of the staff have received any other specialist training in specific disabilities and conditions to support them in their roles. The manager confirmed that the home has built up professional relationships with other professionals. No comment cards were received from professionals involved with the home. The pre inspection questionnaire confirmed that three staff have an National Vocational Qualification. The home has three full time project worker vacancies and one part time fifteen hours project worker vacancy on day shifts plus a full time project worker vacancy on nights. The home has an agency worker contracted to work one of the full time vacancy posts and a full time project worker has been appointed to commence work on the 4th September. One of the project workers is scheduled to go on maternity leave in October. The manager and senior have allocated administration days and work on shifts two to three days a week. However due to staff vacancies the amount of administration days available is reduced. The rota indicates that there is two staff on each daytime shift with a waking night and sleep in on nights. The home has had two recent admissions who appear to have high care needs although the pre inspection questionnaire indicates that all five service users have medium needs. The pre inspection questionnaire indicates that two service users require two or more staff to undertake their care during the day but not at night. The home has not increased its staffing levels to take account of the needs of the new admissions which has also impacted on the activities on offer. As two staff are required to support two service users at times during the day that leaves three service users with no supervision and staff input. The organisation is required to review the current staffing levels on day and night shifts based on service users needs and ensure that adequate staffing levels are provided. Five staff files were viewed at this inspection. The staff files seen including files for bank staff contained an application form, confirmation of two references, confirmation of POVA first and CRB clearance. Some files did not include photographs and none contained a copy of passports or birth certificates. The home uses agency staff to cover vacancies and have received confirmation from the agencies that individual staff have two references on file and a criminal records check including a criminal records bureau check disclosure number. Staff files confirm that new staff, agency and bank staff are inducted into the home. The home has a thorough induction pack for new staff, which includes assessments of practice, although some areas of the induction packs seen were not signed off. Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 23 The home did not have a training plan for the year available to indicate what training is proposed and no specialist training is offered by the Organisation as outlined under standard 32. Staff training records indicate that some mandatory training is overdue and dates are scheduled for this to take place. The organisation provides fire training three yearly and this should be reviewed to ensure that staff receive an annual refresher in fire procedures. The agencies confirm that individual staff have up to date mandatory training however for some agency staff this declaration was made in 2005. The manager must ensure that all agency staff have the required up to date mandatory training and confirmation of this must be made available to the home for each individual agency staff member. Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is adequate. 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 and the quality audit tool is being developed to ensure that a high standard of care is being maintained to benefit service users. Some improvements are required to health and safety practices to safeguard service users. EVIDENCE: The registered manager has been in post for four years. She confirmed she has obtained a National Vocational Qualification level 4 and is an assessor. The manager is actively involved in the day-to-day running of the home and in providing hands on care and support to care staff. Staff confirmed that they Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 25 feel the home is well managed and that the manager is approachable and responsive to their concerns. Once the home is fully staffed to adequately meet the needs of the current service user group the manager should consider if there are other opportunities for development within the home in particular in relation to service users participation, promotion and development of service users skills and in developing opportunities for service users to make choices and decisions. The home has copies of Regulation 26 visits available, the last one on file is for July 2006. The manager confirmed that the organisation is currently piloting a quality audit tool and that a quality audit will be carried out on all of the services. All staff do not have the required mandatory training as outlined under standard 35. The home has health and safety records in place to confirm that a gas safety check and portable appliance checks have been carried out. The home will be operational for five years now and the organisation is reminded that a fixed lighting check is required every five years. The home has records in place to confirm that two of the hoists have been serviced however one other hoist was overdue for a service. The manager confirmed that this hoist was not actually in use. This should be indicated on the hoist so that all staff including agency and bank staff are aware of this. The home has a record of staff and service users accidents. The home has up to date generic and task risk assessments in place. The home carries out weekly water temperature checks and records indicate that in some areas of the home the water temperature is consistently reading more than two degrees below the safe recommended temperature for example 33 and 35 degrees. This should be addressed. Staff carry out a quarterly health and safety visual check of equipment and communal areas of the home and a stock check of first aid boxes. Records are maintained of fridge, freezer and food temperatures. The home has a fire assessment in place, which was reviewed in June 2006. Records indicate that a fire drill took place in August 2006 and that weekly fire call checks and emergency lighting checks are carried out. The fire alarm and equipment were serviced in February 2006. Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 26 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 2 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 1 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 2 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 2 x Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement Service user plans must be developed to include specific guidelines on the management of all medical conditions and to include guidance from other professionals. A risk assessment must be put in place to support the use of seat belts in wheelchairs and agreed as part of a multi disciplinary decision. Activities out of the home must be made more accessible to service users. The manager must ensure that all staff responsible for blood glucose monitoring have received this training and establish with the district nurses the frequency of this training for staff. The pictorial complaints procedure must be completed with relevant photographs as indicated and a system put in place to ensure that the complaints procedure is explained to service users. Updates in adult protection training must be made available DS0000023076.V302121.R01.S.doc Timescale for action 31/10/06 2 YA9 13 30/09/06 3 4 YA13 YA19 16 18 31/10/06 30/09/06 5 YA22 22 30/11/06 6 YA23 13 30/11/06 Old Barn Close (5) Version 5.2 Page 28 to the staff team. 7 8 YA32 YA33 18 18 Specialist training must be made 31/12/06 available to staff to support them in their roles. The organisation is required to 30/09/06 review the current staffing levels on day and night shifts based on service users needs and ensure that adequate staffing levels are provided. The manager must ensure that 30/09/06 all agency staff have the required up to date mandatory training and confirmation of this must be made available to the home for each individual agency staff member. 9 YA35 18 Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 29 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 4 5 Refer to Standard YA2 YA16 YA16 YA17 YA20 Good Practice Recommendations The assessment documentation for prospective service users should be fully completed. The manager should look at ways of further promoting service users involvements in tasks, which promote their independence. Service users plans should outline the level of support required by individuals to manage their post. The manager should consider other options and means of supporting service users to develop meal choices. A note should be made on the medication administration records to indicate the date the medication was discontinued and by whom so that it can be crossreferenced to the health appointment record. A log to record complaints and their outcomes should be set up and made available. The grass in the garden should be regularly mowed and this should be maintained. Annual updates in fire procedures should be provided for all staff. The hoist should indicate it is not in use so that all staff including agency and bank staff are aware of this. Water temperatures should be maintained as close to 43 degrees centigrade as possible. 6 7 8 9 10 YA22 YA24 YA35 YA42 YA42 Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 30 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 Old Barn Close (5) DS0000023076.V302121.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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