Inspection on 13/06/06 for Outreach Community & Residential Services 118 Kings Rd

This inspection was carried out on 13th June 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 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Outreach Community & Residential... 14/11/07

Outreach Community & Residential... 17/01/06

Outreach Community & Residential... 24/08/05

Outreach Community & Residential... 18/01/05

Outreach Community & Residential... 14/06/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Outreach Community & Residential Services 118 Kings Rd 118 Kings Road Prestwich Manchester M25 0FY Lead Inspector Kath Smethurst Key Unannounced Inspection 13th June 2006 09:30 Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.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 Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.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. Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Outreach Community & Residential Services 118 Kings Rd 118 Kings Road Prestwich Manchester M25 0FY 0161 773 2432 0161 740 5678 Address 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) Outreach Community & Residential Services Mrs Janice Poole Care Home 4 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (1) of places Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 4 service users, to include: up to 3 service users in the category of LD (Learning Disabilities under 65 years of age); up to 1 service user in the category of MD (Mental Disorder under 65 years of age); The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. That Outreach ensure a minimum of 16 supernumerary hours per week for Janice Poole to manage 118 Kings Road. 17th January 2006 2. 3. Date of last inspection Brief Description of the Service: 118 Kings Road is one of a group of care homes managed by Outreach Care Services. Outreach is a charity that provides care and support predominantly to Jewish people with learning disabilities or mental health needs. This home is registered to provide care and accommodation for up to 4 people. The house is a large terraced property in a residential area of Prestwich, about a mile from the village centre. It is close to bus routes, local shops, synagogues, and other local amenities. The house is similar to other houses in the area and it is not distinguishable as a care home. It has a lounge, dining kitchen, and a laundry room. All bedrooms are single. Outside, there is a paved area at the front of the house, and an enclosed garden at the back. The philosophy of care, as described in the Statement of Purpose, promotes values such as independence, dignity, rights, fulfilment, and choice. Cultural needs are supported. Fees range from £467 a week. Additional charges are made for hairdressing, toiletries, activities, holidays, transport, magazines and papers. Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over seven hours. The home had not been told that the inspector would visit. The inspector looked around parts of the building and checked some paper work about the running of the home and the care given. To get more information about the home all four residents, the manager and three staff were spoken with. Carers were also watched as they went about their work. Before the inspection comment cards were sent to residents, their relatives and people such as social workers, district nurses and doctors. Three residents and three relatives returned comment cards. What the service does well: What has improved since the last inspection? The home has worked hard to try to meet the requirements that were made during the last inspection, and there have been improvements in a number of areas. The manger has looked at ways residents can have more choices, for example choosing menus, and speaking to staff about changing the times they work so residents can go out in the evening. Fire alarms are now being tested every week. Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 7 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 Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 8 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 area is good. This judgement has been made from the evidence gathered both during and before the visit to the service. The home provides a consistent and stable home environment, where residents’ care and support needs were being met. The admission procedure is satisfactory and systems are in place to ensure proper assessments are completed prior to people moving in. EVIDENCE: Residents and relatives who returned comment cards indicated they had been supplied with sufficient information prior to admission. However all three residents who returned comment cards indicated they were unaware as to whether they had been issued with a contract. This is an area the manager should address with residents individually. There have been no new admissions since the last inspection. All the residents living in the home have lived there a long time (between six and ten years). The personal file of one resident was examined. It contained evidence of the home’s own assessments, carried out in conjunction with the resident, and showed that needs and goals had been regularly reviewed and updated by the home. A copy of the care management assessment by the placing authority was also available. Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 9 During the last inspection it was noted that in the file examined the care management assessment was not available. This was discussed with the manager who indicated she was currently trying to locate any missing documents. From discussions with the manager it was evident that any future admissions would be handled appropriately. The manager said prospective residents would be offered the opportunity to visit prior to admission. Part of the process would include an overnight stay. This would allow staff and existing residents to come to a decision as to compatibility with prospective residents and whether needs could be met. The manager also advised that a new resident would not be admitted without a full assessment being carried out by both the homes staff and funding authority. Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.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 area is good. This judgement has been made from the evidence gathered both during and before the visit to the service. A good care planning system is in place, which provides staff with the information and guidance they need to ensure resident’s needs are met. Residents know about their individual plans, and they are involved in reviewing their needs and goals. Residents are able to make some decisions about their lives. The planned changes to resident’s meetings and staff duty rosters should increase the amount of control residents have over their lives. The home encourages residents to be as independent as possible, helping them to keep any risks to their health and welfare to a minimum. EVIDENCE: Two care plans were examined. Good practice was noted, as there was an extensive amount of personalised and very detailed information about residents’ health and social care needs. This included individual and risk Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 11 issues, and each resident’s daily routines and how they liked their care to be provided. For example as well as identifying preferences, the plans also highlight things or places residents don’t like and would prefer to avoid. Care plans take note of resident’s religious and cultural needs. Records showed that the resident and a designated support worker reviewed residents’ needs and goals on a regular basis. More formal review meetings, to which residents their relatives and social workers were invited, took place approximately every six months. One resident spoken with confirmed attendance at these meetings. The routines of daily living were observed to be flexible. For example residents were observed getting up in the morning at times that suited them and to choose where they spent their day. Residents spoken with also confirmed they had a choice about daily routines. Each week residents met with staff to decide the menu. During the last inspection it was noted that only small variations from the agreed menu were made for individuals. It was also identified that the practice of having only one member of staff on duty after 5pm resulted in spontaneous evening activities not being able to take place. The new manager has already taken steps to address both these issues. Progress in regard to both issues is discussed elsewhere in this report under the section entitled Lifestyle. The new manager said she hoped to develop residents meetings further whereby residents would be involved in more aspects of life at 118 Kings Road. This is a positive initiative and once implemented will provide more evidence of residents being involved and supported to make more decisions about their lives. Most residents had family or friends who could speak on their behalf. During the last inspection it was found that information about independent advocacy services was not displayed. This has now been addressed. Details of advocacy services have now been given to each resident. Records showed that potential risks had been assessed, and balanced against the resident’s right to choice and independence. One resident spoken with said he hoped to eventually go out unaccompanied. Evidence of discussions relating to this issue were kept on file. The residents who were spoken with said they were happy with the support given to them by staff. Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.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 area is good. This judgement has been made from the evidence gathered both during and before the visit to the service. Residents took part in activities both outside and within the home that reflected their choices and preferences. The planned re-organisation of staff duty rosters will increase opportunities for residents to take part in more fulfilling activities in the evening. Residents are supported to maintain contact with relatives and friends. Practices in the home respect residents’ rights to privacy, dignity choice, and independence. Cultural needs are supported. While residents said that they enjoyed their meals the planned changes to the menu will ensure they are provided with a more varied and healthy choice of food. Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 13 EVIDENCE: Residents living in the home needed staff support for most community activities. Residents spoken with gave examples of the community facilities that they used such as public transport, cafes, shops, health centres, and synagogues. One resident had nearly completed an art course at college and hoped to undertake a cookery course. Some residents went to day centres. Two residents went out each week for relaxation therapy. Evidence of residents using community facilities was also observed during the inspection. For example one resident was supported to go to the hairdressers and shopping, while two residents went to “sense around” for relaxation therapy. Good practice was noted in that staff time was provided for residents to take part in these activities. For example on the day of the visit three staff were on duty. Transport is usually by taxi or bus. At home residents liked to listen to music or watch TV. One resident spoken with liked sport and was enjoying watching the world cup. Another resident spent time in his room listening to music. During the last inspection it was noted that after 5pm only one member of staff was on duty. This resulted in activities in the evening being limited. This was discussed with the new manager. The manager indicated she had already identified this as an area, which needed to be improved upon. The manager was in the process of reviewing duty rosters in order for more staff to work in the evening. The manager had already spoken to staff regarding planned alterations and was hoping to introduce new rosters in the near future. This is a positive initiative and once implemented will increase residents opportunities to take part in more meaningful activities during the evening. Discussion with the manager indicated that residents also had an annual holiday. One resident confirmed he had gone to Blackpool and was hoping to do so again later in the year. Another resident liked tennis and it had been arranged for her to go to Wimbledon this year with a member of outreach staff. The resident was looking forward to going particularly as she had a ticket to number one court on the opening day. The manager advised that at the next residents meeting discussion would take place in respect to the next holiday, with residents being actively involved in the decision making process. Written records contained details of residents’ preferences in respect to their daily routines. Residents said that they could choose what time they got up or went to bed, and that they could choose how they spent their time. They gave examples of how staff members helped and encouraged them to do things for themselves, for example make their bed, tidy their rooms, or put laundry in the washing machine. Care plans also take note of resident’s preferences for Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 14 example one read, “I like to go out everyday” and “enjoys going to local shops”. Staff were observed to respect residents privacy when entering bedrooms and bathrooms. Interactions between staff and residents were observed to be frequent and friendly. During the course of the inspection staff were observed spending quality one to one time with residents. For example during the afternoon a member of staff was observed supporting one of the residents in a baking activity. Most residents kept in contact with family and friends. Some regularly spent days with family members. Staff members said that relatives and friends were welcome to visit the home at any time. Feedback in returned relative/visitor comment cards confirmed staff were always welcoming. Residents’ personal plans contain a section covering “relationships, sexuality and partnerships”. Cultural and religious needs were respected. For example, there was an expectation that only kosher food would be brought into the house. Jewish festivals are celebrated. The manager advised that menus were decided at weekly residents meetings. Minutes of which confirmed this. Residents who commented were in the main satisfied with the meals. Residents said that they usually enjoyed meals and that they got enough to eat. They also said that they had suppers, and snacks and drinks throughout the day. Breakfast time was flexible, and depended upon what time people got up or any activities residents were doing. More flexible lunch and teatime meals have also been introduced. Some residents are able to prepare their own breakfast, snacks and drinks and were seen to do so on the day of the inspection. During the last inspection it was noted that residents were expected to have the same lunches and teas and that individual preferences had not been catered for. Prior to the inspection a sample of menus were forwarded to the CSCI (Commission for Social Care Inspection). The menus examined showed some progress had been made in addressing this. For example where a resident didn’t like a particular option an alternative was offered. Discussion took place with the manager regarding the menus. It was noted that a lot of convenience type foods were offered. For example on three days during one week the main meal option consisted of fish fingers, pizza and beef burgers. While on another day of the same week the main meal consisted of jacket potato and beans. Lunch consisted mostly of sandwiches. This was discussed with the manager who advised she had already identified this as an area for improvement. For example the manager had already spoke to staff regarding providing more varied home cooked meals. The manager said the budget was sufficient to provide a good selection of fresh meat, fruit and vegetables. The manager was also planning to discuss with residents any menu suggestions. Following recent discussions more fresh fruit had been Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 15 introduced. For example on the day of the visit one of the staff had made a fresh fruit salad. Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this area is good. This judgement has been made from the evidence gathered both during and before the visit to the service. Residents are assisted to be as independent as possible, and they are included in decisions about how staff will support them. Residents’ physical health was promoted and maintained through regular monitoring and health care checks. Medication procedures are generally satisfactory. However to maintain this the number of staff trained to administer medication needs to be increased. EVIDENCE: One of the aims of the service was to assist residents to be as independent as possible. Residents and staff members were consistent in their descriptions of individual support needs, and these descriptions matched with the information recorded. Residents could express their wishes about the way they were supported. It was clear, from discussions with residents that they had choice about their daily routines, for example what time they got up or went to bed. Residents Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 17 and staff spoke with each other in a natural manner. Residents said that they were happy with the way that staff members treated them, and the way they spoke to them. There was evidence that the resident’s health care needs are regularly monitored. Residents are provided with support to attend regular health care appointments and check ups, details of which are recorded clearly in a designated record sheet. Evidence of which was observed during the inspection where a resident was supported to attend a dental appointment. The home had written guidelines covering medication. Currently none of the residents have been assessed as being able to safely administer their own medication. Medicines were being stored safely, with a clear record of medicines received into the home and any returned to the pharmacist. Medication Administration Records (MAR) were examined and were found to be clear and up to date. It was noted that some staff needed to complete medication training. The manager had already identified this and was in the process of arranging for staff to attend training. Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this area is good. This judgement has been made from the evidence gathered both during and before the visit to the service. The home has a written complaints procedure, and residents feel that any concerns will be listened to and dealt with. The policies and practices of the home protect residents from abuse, but some staff need updated training so they are fully conversant with the procedures, and are aware of the steps to take in the event of an allegation or suspicion of abuse. EVIDENCE: The home had a written complaints procedure. No complaints have been received by either the organisation or CSCI since the last inspection. Those residents who were able to comment had not made a complaint but all indicated they felt able to approach staff with any concerns. One resident who returned a comment card said, “ We talk about the problem”. None of the relatives who returned comment cards had made a complaint. With the exception of one relative all knew whom to approach if they had a concern or complaint. The lack of awareness of one relative was discussed with the manager who offered assurances that this would be discussed in order to ensure they were fully aware of how to raise a concern or make a complaint. There were written procedures covering adult protection and whistle blowing. Staff members had signed to show that they had seen them. The organisation ensures all staff complete a POVA and CRB (Protection of Vulnerable Adults Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 19 Register/Criminal Records Bureau) check before they commence work. No POVA (Protection of Vulnerable Adults) investigations have taken place. The manager was fully aware of the steps to take in the event of a suspicion or allegation of abuse and had undertaken relevant training. Discussion took place in respect to any protection of vulnerable adults training staff had completed. While abuse procedures are covered in the induction programme it was unclear in training records if staff had undertaken any updated training in this area. The manager had already identified training in this area would prove beneficial and was planning to arrange formal training in the near future. Systems were in place to safeguard residents’ finances. It was noted that two staff members checked financial records at each staff handover to make sure there were no discrepancies. As an additional safeguard, only the manager, and the support worker who had done the sleepover, had access to monies. A written gifts and gratuities policy is in place. Staff are not allowed to take gifts and gratuities from residents. Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 & 30 Quality in this area is adequate. This judgement has been made from the evidence gathered both during and before the visit to the service. In the main the standard of the environment is satisfactory providing residents with a homely, comfortable and clean place to live, however some minor improvements are needed to ensure standards don’t fall below an acceptable level. EVIDENCE: The home is situated in a residential area of Prestwich, about a mile from the village centre. It is close to bus routes, local shops, synagogues, and other local amenities. The house is a large terraced home, similar to other properties in the area. It is not identifiable as a care home. The décor and furnishings were domestic in style. Residents had the use of a lounge and kitchen/diner. There was also a pleasant enclosed garden for residents to use. A staff office and a staff sleep-in room are located on the first floor. All bedrooms were single. They were personalised with residents’ own belongings. It was however noted that three of the bedrooms had vinyl Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 21 flooring. This gave a somewhat cold and institutional appearance and as such consideration should be given fitting carpets. The flooring in the bedroom downstairs was seen to becoming loose. This could prove hazardous and as such needs to be attended to. This would prove an ideal opportunity to fit a carpet in this room. Indeed the resident spoken with said he would prefer to have carpet. The new manger was not working in the home when the flooring was fitted so was unsure why this type of flooring had been fitted. The Irwell Valley Housing Association owns the property and they are responsible for general maintenance. It was noted that there was staining on an area of the kitchen ceiling. This was caused by water seeping from the bathroom. This had been addressed but the stained wallpaper needs to be repainted. It was also noted that the kitchen worktops were showing signs of wear and tear and would benefit from being replaced. These issues need to be brought to the housing associations attention. Residents spoken with indicated were in the main happy with environmental standards in the home. The home was clean and odour free. Liquid soap and paper towels were provided for hand washing in the bathroom toilets, and kitchen. Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this area is adequate. This judgement has been made from the evidence gathered both during and before the visit to the service. Outreach provides ongoing training to equip staff with the knowledge and skills that they need to meet the needs of the residents. However, there are some gaps that need to be addressed. Recruitment procedures for staff are robust which ensures people living in the home are protected. EVIDENCE: Relationships between staff and residents seemed warm, caring and friendly, with staff demonstrating a good understanding of residents support needs. It was observed that residents had no hesitation in approaching staff members if they wanted to speak to them. Residents spoken with indicated they were satisfied with the care and support provided. A recently appointed member of staff was spoken with regarding training she had completed. This member of staff confirmed she had completed a period of induction. This included a day spent at the Outreach head office followed by a week “shadowing” an experienced member of staff. The member of staff also confirmed she had been issued with an induction pack and had completed an Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 23 induction workbook and was due to commence NVQ (National Vocational Qualification) level 2. This member of staff described Outreach as being “Good” to work for”. Another member of staff spoken with said there was “A lot of training”. This member of staff gave examples of training she had completed including NVQ level 2, medication and food hygiene. Of the five support staff working at 118 Kings Road one has achieved NVQ (National Vocational Qualification) Level 2. One support worker is due to commence NVQ Level 2 in June 2006. A further two staff are waiting for dates to commence NVQ training. This commitment to training needs to be continued to ensure that 50 qualified staff is reached and then maintained. During the last inspection it was identified there were some shortfalls with regard to training. A requirement was made for staff to undertake updated mandatory training. Progress in regard to this requirement was discussed with the new manager. She advised she had undertaken a review of staff training and development and had identified a number of areas where staff needed training. This included first aid, food hygiene, medication, fire safety, protection of vulnerable adults, moving and handling and infection control. The manager had also identified the need for staff to undertake some specialist training in topics such as challenging behaviour, epilepsy and communication difficulties. The manager has already taken steps to address this and is waiting for confirmation when staff can attend relevant training. Given that action has been taken to address the shortfalls in training the timescale for meeting this requirement has been extended. Staff recruitment records are kept at the Outreach Head Office. A sample of recruitment files (across Outreach homes) was looked at during a visit to the office in June 2006. During this visit the service was advised to keep a full set of recruitment documents in one place and remove any remaining recruitment records from the homes. In the main recruitment records indicated that all necessary recruitment checks had been undertaken. Employment checks that had been done included obtaining employment histories, written references, medical declarations, photographs, CRB (Criminal Records Bureau) disclosures and POVA (Protection of Vulnerable Adults) register checks. Records for recent recruits showed that in the main gaps in their employment records had been looked into. The organisation is reminded that the reasons why prospective employees have left their previous employment now needs to be documented on application forms. Good practice was noted in that prospective staff had completed an application and equal opportunities monitoring form. Details of interview questions and notes are kept on file. Records showed employees were health screened at the Occupational Health Unit at Fairfield Hospital. Following which a statement was issued to confirm that the candidate was fit to undertake their duties. Back to work and exit interviews are routinely undertaken. Records showed that new Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 24 recruits received induction training. The training booklet included a section covering Judaism, and how to respond to residents’ cultural and religious needs. Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this area is good. This judgement has been made from the evidence gathered both during and before the visit to the service. The home is well managed, with staff continuing to feel satisfied and enthusiastic about their work ensuring those living in the home receive a good standard of care and support. However clarification is needed regarding the practice of two homes being managed by one person. Systems for monitoring the quality of the service provided at 118 Kings Road were in place, enabling a regular review of the service received by residents. Shortfalls were identified regarding the health, safety and welfare of residents and staff, which need to be addressed in order to minimise the risk to all parties. EVIDENCE: Since the last inspection Wendy Hardman has been appointed as manager of 118 Kings Road. Discussion took place in regard to this, as Wendy is also the Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 26 registered manager of another Outreach home. The manager advised that the organisation had hoped she could continue managing both establishments given that there was only one resident living at the other home. The person responsible needs to put this proposal in writing and forward it to the CSCI regulatory manager (Nick Lloyd) for consideration. The CSCI would normally require one manager for each establishment so clarification is needed. Once the situation has been clarified the new manager will need to apply for registration. The proposed manager has extensive management experience. She attained the NVQ level 4 registered managers award. In order to keep up to date with contemporary care practices, she undertakes any relevant training that is offered. Although the manager has been in post for a short time she nevertheless has a good understanding of the areas, which need to be improved in the home. She has already identified arranged additional training for staff, the need to reorganise duty rosters and further develop residents meetings. It was clear, from observations and discussions, that the new manager encouraged an open, inclusive atmosphere within the home. During the inspection, it was observed that residents and staff had no hesitation in approaching the manager if they had anything they wished to discuss. Internal and external quality assurance systems are in place. A quality assurance policy is in place, which reads, “ Each member of staff top to bottom should demonstrate a total commitment to quality and quality improvement in every aspect of their working day”. Outreach has undertaken an in-depth quality audit of the service provided by the home. This included asking residents, relatives and staff about their views of the service. A very detailed document had been produced which highlighted areas of good practice and areas identified for improvement. These areas had been summarised into several pages at the back of the document. Internal monthly, unannounced monitoring visits were also now taking place (conducted by managers from other Outreach homes). A sample of which were examined and were found up to be up to date. Resident and staff meetings are held on a regular basis. In the main health and safety issues were satisfactory. Policies and procedures are in place and cover a range of topics linked to health and safety. Information provided in the pre-inspection questionnaire indicated all relevant maintenance checks were being carried out. A fire risk assessment has been completed and regular checks to fire safety equipment is carried out. It was however noted that staff need updated fire safety training and a fire drill needs to be undertaken. As previously noted some staff need to undertake health and safety training (first aid, food hygiene, fire safety and infection control). Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000008440.V294632.R01.S.doc 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 2 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 2 X Version 5.2 Page 28 Outreach Community & Residential Services 118 Kings Rd 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. 2. Standard YA12 Regulation 16 Requirement Planned changes to duty rosters need to be implemented to ensure there is staff support to help residents to access evening activities outside the home if they wish to do so. Staff responsible for the administration of medication must undertake training. The flooring in the ground floor bedroom is becoming detached and must be rectified. The wallpaper damaged by a water leak must be attended to The ongoing programme of staff training must continue so that all staff members have received up to date training in all the mandatory topics including medication, first aid, food hygiene, health and safety and fire safety. Timescale 30/04/06 not met. Written proposals for the new manager to manage 118 Kings Road in addition to continuing to be registered manager of another home must be forwarded to the CSCI (Commission for Social Care DS0000008440.V294632.R01.S.doc Timescale for action 01/08/06 1. 2. 3. 4. YA20 YA24 YA24 YA35 13 23 23 18 30/09/06 01/08/06 31/07/06 30/09/06 5. YA37 9 31/07/06 Outreach Community & Residential Services 118 Kings Rd Version 5.2 Page 29 Inspection) 6. YA42 23(4)(c) To ensure staff and residents know what to do in the event of a fire a fire drill must be arranged. 31/07/06 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. 6. Refer to Standard YA23 YA24 YA24 YA23 YA32 YA35 Good Practice Recommendations Support workers who have not attended formal training in adult protection should be given opportunities to do so. Consideration should be given to replacing the vinyl flooring in bedrooms with carpets. Consideration should be given to replacing the worktops in the kitchen. Support workers who have not attended formal training in adult protection should be given opportunities to do so. Staff should be encouraged and supported to undertake NVQ training with a view to having at least 50 of workers with the qualification. As planned opportunities for further service specific training should be provided to staff. Outreach Community & Residential Services 118 Kings Rd DS0000008440.V294632.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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. 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