Inspection on 28/11/07 for Paddock House

This inspection was carried out on 28th November 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Paddock House 25/03/08

Paddock House 06/07/06

Paddock House 27/01/06

Paddock House 01/07/05

Paddock House 27/01/05

Paddock House 08/09/04

Paddock House 20/03/04

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

CARE HOME ADULTS 18-65 Paddock House 13 Prospect Road Hythe Kent CT21 5NN Lead Inspector Michele Etherton Key Unannounced Inspection 28th November 2007 09:30 Paddock House DS0000023503.V352653.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 Paddock House DS0000023503.V352653.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. Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Paddock House Address 13 Prospect Road Hythe Kent CT21 5NN 01303 230067 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) Mr James Peter McCarthy Vacant Mr James Peter McCarthy Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th July 2006 Brief Description of the Service: Paddock House is registered to provide accommodation and personal care to 16 adults with a mental health disorder (excluding learning disability and dementia), and is owned and managed by Mr Jamie McCarthy. Paddock House occupies detached premises with sixteen single bedrooms, one of which having ensuite facilities. Accommodation for Residents is on two floors. The frontage of the home opens onto a public pavement, but there is a small garden and seating area at the rear for Residents to use. There are bathing and shower facilities on both floors in addition to a number of toilets throughout the premises. The home is situated centrally in a small costal town, with good access to local shops, pubs, clubs, library, swimming pool and public transport. The current fee for this service is £392.34 per week Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection of this service has been undertaken in November 2007. This has taken account of information received by and about the home since the last inspection including an annual quality assurance assessment completed by the home for the first time. This was returned within agreed timescales but lacked content and detail in some areas, these shortfalls were discussed at the site visit. A site visit was conducted as part of the inspection on 27/11/07 between 9.30 am and 16.30 pm, this comprised a review of a range of documentation including samples of staff and service user files, medication and accident records, complaints information etc. Interviews and discussions with service users and staff have also been conducted as part of the site visit and responses from these and analysis of survey responses received from a range of stakeholders including health professionals and relatives have been influential in compiling this report. The home has demonstrated a sustained commitment to promoting independence for services users, enabling and supporting them to take control of their lives in a supportive setting where help is available to them when needed, outcomes for service users are generally good although the home recognises there are areas where they need to make improvements or strengthen existing systems and this is reflected in the quality ratings awarded. What the service does well: The home liaises well with health and social care professionals and maintains good communication. It provides a comfortable and relaxed environment for people with mental health difficulties to maximise their potential for independence at their own pace, and to take control and responsibility for their personal daily routines They are also encouraged to take an active role in daily routines within the home. Experienced and qualified staff team are available to support those people who are less able to take full control of all aspects of their daily routines. People in the home are encouraged to make use of community facilities and to develop their interests and hobbies. and to have an active community presence Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 6 The home advocates on behalf of people in the home to ensure they gain access to health and social care appointments, and input from relevant professionals. The home has developed systems for enabling people living in the home to express their views and these are influential in service development. What has improved since the last inspection? What they could do better: The home has partly addressed an outstanding medication requirement and are still to implement systems for auditing medication and to ensure signed handwritten entries on medication records are also dated. The review of staff documentation in the home highlighted the need for them to strengthen the recruitment procedure to ensure that background checks have been fully explored and judgements made in respect of recruitment can be clearly evidenced within documentation. Some recommendations for improved practice have also been made with regard to ensuring support plans contain adequate detail around staff interventions in personal care routines and management of behaviour, that the medication administration arrangements would benefit from the development Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 7 of medication profiles and PRN guidelines, and the development of a clear training strategy with a training matrix, and individual training profiles. It is also recommended that the current smoking room arrangements be reviewed to assess whether a smoke free corridor can be created for nonsmokers to access other parts of the home without entering the smoking area. The home have been asked to look at the feasibility of covering fuse boxes placed in a downstairs toilet accessible to 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. The summary of this inspection report can be made available in other formats on request. Paddock House DS0000023503.V352653.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 Paddock House DS0000023503.V352653.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): 2,4,5 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People referred to the home for placement are provided with information about the home and the terms and conditions of their stay. They can be assured that their needs will be assessed prior to admission to ensure these can be met, they are provided with opportunities to visit the home prior to admission to help with their decision-making EVIDENCE: A sample of service user files viewed during the site visit provided evidence of initial assessment and that supporting background reports, histories etc, had also been gathered. Senior staff highlighted the continuing difficulties they face in obtaining necessary assessment information from referring agencies and how they also undertake their own initial assessment to inform their decisionmaking. Service users new to the home confirmed in discussions that they had been given information about the home before visiting and provided with opportunities to visit for trial visits and stays prior to any admission. They reported that the decision to come to the home was their own, and they at no Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 10 time felt under pressure to accept a placement, even though they were not offered other alternatives to view by their care managers. “My Social Worker recommended this home to me” Senior staff confirmed that at admission service users have the terms and conditions of their stay read to them, usually in the company of their representative i.e. care manager. Signed terms and conditions documentation was noted on user files viewed. “Choice and freedom even though I’m disabled” Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home ensures that people living in the home are supported in accordance with their preference and abilities to make their own decisions, take greater control of their daily lives asserting their independence and taking responsible risks. Minor improvements in clarity would benefit supporting documentation. EVIDENCE: Four user files were reviewed to assess content and quality of documentation. All provided evidence of care plans, and risk assessment information. Care plans are routinely agreed with the service user and care manager at reviews and there was evidence of updating. Although timescales for these are drifting owing to shortages of staff within the mental health team. The home maintains its own user plans and these reflected that staff are there to encourage and support service users to retain control and responsibility for their day to day care and activity routines, staff and service users commented that input from staff is available as and when needed. Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 12 Whilst service users are mainly self caring with prompting and supervision from staff, there are a few who require some minimal physical interventions from staff e.g. helping service users in and out of baths or showers, it is recommended that in these cases the home should develop moving and handling risk assessments and reflect these interventions in greater detail within support plans. User surveys and user meetings indicate that opportunities are provided for users to express their views and opinions they are also given 1-1 time with their key worker on a regular basis. Discussion with people living in the home and observation evidenced that where people have the capacity to do so they come and go from the home and make use of community facilities, People were observed moving around the home, having cigarettes, having drinks, the home has taken account of the mental capacity act and has rescinded control of peoples money in most cases except four where the service users concerned either lack capacity or are at risk from exploitation from others, the home need to evidence more clearly within user information how the judgement has been made, the home also encourages participation by the majority of users in the administration of medication to some degree or another.(see medication standard). Service users commented that: “I am happy here, in the future I would like to move on” “I can do what I want “I go home every weekend” “They are helpful and help you when needed” The home encourages people living in the home to be independent and where able to access the community or participate in activities etc, this by its nature brings users into risk situations and the home highlights and assesses these where necessary. The manager/provider confirmed that some people who have been appropriately risk assessed have kettles in their rooms where they can make hot drinks. The provider and senior staff feel that they take a pragmatic but responsible approach to risk and do not stifle service users independence where it is not deemed there is a risk either to the individual service user or other people. They report that they are often disappointed that health professionals they feel, take a less realistic assessment of risk and override concerns raised by the home in respect of individuals and high-risk activities Relatives and social care professionals commented that: “He has plenty of choice and support” “The home tries to give my relative the best possible care however they have very little support from third parties” Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 13 Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 14 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): 12,13,15,16,17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are encouraged to take greater personal control of their daily routines and develop their independence skills and personal interests. They are encouraged to have an active community presence. Service users who lack capacity to do this would benefit from more structured activities. Service users in the home are supported and enabled to maintain links with family and friends where these exist and make new relationships. They enjoy a healthy diet that reflects their own preferences and tastes. EVIDENCE: Since the last inspection the home has lost its day care staff member. The home is currently recruiting to this important post, that enables those service users who require support with activities, appointments and supervision/escorting when in the community to have this support without it impacting unduly on the staffing levels within the home. Whilst staffing levels Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 15 did not feature as a concern, one survey comment did suggest that staffing levels were impacting adversely on users attendance at appointments, this was refuted by the home who could evidence occasions recently where users had been supported to appointments. Whilst there may be reduced opportunities for those people who need support to go out as often, the provider/manager and staff reported that everyone is getting an opportunity to go out during the week, and they are all personally undertaking some outings and appointments with service users. In discussion with more able residents they confirmed that whilst they are not particularly interested in participating in organised activities during the day they do participate now in some evening activities e.g. games and bingo etc particularly as some have a winning prize. This is borne out in information gathered by the home in surveys and from user meetings. The home has now obtained a new vehicle for use on day care outings and all staff that are named drivers will be insured for this. Relatives and social care professionals reported that: “He is given little daily responsibilities e.g. do the washing up, tidy his room room, they have a good understanding of him”. “From my relatives perspective they do usually support him to live the life he chooses” “Very client orientated, appears to have good links with us as the Community mental health team” “The service is good at linking with the community team and advocates well on behalf of the clients” “The service does well in offering a consistent routine to residents who have difficulty coping with change” “Always had a good relationship with managers, very approachable and supportive of clients” Whilst none of the current residents have any paid or voluntary employment outside of the home, discussion with them during the site visit indicated that they do access voluntary organisation groups and have a varied range of interests and activities that occupy them in the community. e.g. MIND day centre, bird-watching, horseracing. Discussion with staff and service users evidenced that service users are bale to conduct relationships both inside and outside the home where these are of a mutually consenting nature, and the home is supportive of the diverse nature of these relationships. Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 16 Feedback from relatives indicates that they are made to feel welcome at the home when visiting, feedback suggests they have confidence that the home would contact them if something significant happened but don’t tend to do so otherwise, they have a good working relationship with the home. The home does not produce written menus in advance but service users’ tend to record what they would like on a daily basis for the main meal. There was evidence from user meeting minutes that they actively influence menu development and changes. Surveys undertaken by the home indicate more than 90 like the food quality and variety. People tend to eat at their own pace and are not hurried out of the dining area, there was evidence of users still coming to the breakfast table quite late. Observations during the site visit confirmed in discussion with service users highlighted that service users also take an active role in daily household routines, some help with preparing drinks others help with washing up, laying tables and clearing tables, all have responsibility for their own rooms and laundry with staff support to the level needed. Paddock House DS0000023503.V352653.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): 18,19,20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are prompted and encouraged to undertake their own personal routines. They actively participate in their medication regime, which would benefit from minor improvements, the home advocates on their behalf to gain access to routine and more specialist healthcare. EVIDENCE: The majority of people in the home undertake all their own personal care routines, staff provide some minimal physical support for a few service users in accessing baths and showers, or where supervision and prompting is needed, staff interventions need further clarity within support plans. Discussion with a new resident indicated a flexible approach by staff in supporting service users with their care routines and individual preference. Feedback from staff indicated that there are no hard and fast rules they adopt in respect of supporting user routines, this is undertaken at the users pace and dictated by their level of need. A newer staff member reported that they found Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 18 this more relaxed approach and their role of prompting and supervising rather than doing, enjoyable and fulfilling. A sample of four files viewed provided evidence of contacts with health professionals for routine appointments and specialist appointments, discussion with service users confirmed they have specialist appointments for specific health issues and are supported to attend these by the care staff from the home. There was no evidence to support a comment from a health professional that staff shortages were impacting on service users attendance at appointments at this time. Discussion with staff provided evidence that where needed they advocate on behalf of service users to ensure they receive appropriate health interventions and support with their mental health. The home has experience of supporting service users with deteriorating physical health conditions and has a good understanding of the limitations of the home in supporting people with these conditions, they can evidence that they have sought appropriate intervention by health and social care professionals when needed to seek alternative placements. The home has been proactive in participation by service users in their medication regime with the majority self administering under supervision, it is hoped to extend this to full self-administration for some in the next 12 months. The home has implemented the majority of required actions from the last inspection but are still to date sighed entries on Medication Administration Records (MAR) sheets and the development of a system for auditing medication. Discussion with a senior staff member regarding administration issues indicated that the home are responsive to diversity in the administration regime in relation to service users preferred times for taking their medication, where this can be flexible, they should formalise these arrangements with the GP and/or pharmacist. It was recommended that the home make use of the medication received sections on the MAR sheet to evidence receipt of medication and that the home develop individual PRN guidelines to aid consistency of this medication and implement medication profiles Paddock House DS0000023503.V352653.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): 22,23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People in the home feel confident of expressing their views and that they will be listened to, the home takes a responsible attitude to risks and promotes and protects the safety of service users EVIDENCE: The home has indicated in pre-inspection information that no complaints or adult safeguarding issues have arisen since the last inspection. The home has responded to a previous recommendation to update complaints information but needs to ensure that the full procedure is displayed for service users and visitors to view. Feedback from survey responses indicated they felt able to raise issues within the home and clearly there are a number of opportunities for service users to raise issues through regular user meetings, 1-1 sessions with key workers, twice yearly user surveys. It was also reported by staff that sometimes more able service users act as unofficial advocates for other residents. Observation of a new service user highlighted that even new residents feel comfortable about expressing their views and feel listened to. The ethos of the home has created a settled and stable existence for service users and re-admissions to hospital have become rare for the majority. There are established protocols and guidelines for staff to follow in managing behaviour safely, discussion with staff as to how the behaviour of one service Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 20 user is dealt with indicated that there is consistency in practice amongst staff even those new to the service, this should be supported by the clearly agreed strategy being confirmed within user plan information as standard and this is a recommendation. The home in response to the Mental Capacity Act 2005 and a previous inspection requirement has rescinded control of all personal allowance monies except for four people, and there are plans for this to reduce to two. Two cash balances were checked against finance records held and were found to be accurate. The home undertakes the required checks and vetting of new staff but have been given a requirement to strengthen the depth of scrutiny around gaps in working history, and verification of reasons for leaving previous care roles where these do not feature as references. Paddock House DS0000023503.V352653.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): 24,25,26,27,28,29,30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a comfortable, and safe environment and are benefiting from an ongoing programme of redecoration, they are enabled and supported to personalise their own space and to maintain this. Some minor improvements to the environment including a review of existing smoking room arrangements would reduce risk to service users. EVIDENCE: A tour of the premises evidenced that the home was clean, uncluttered, and warm, on the day of the site visit, with no obvious unpleasant odours. It is comfortably furnished in a domestic style. A programme of upgrading internal areas of the home has been ongoing for the last twelve months, during which time communal areas and bedrooms Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 22 have been redecorated to a pleasant standard. Service users confirmed that bedrooms had been redecorated, and where this had occurred it was to their own taste and they were pleased with outcomes. One service user reported that they had made the decision not to have their room upgraded and this had been accepted by the home. Carpeting in communal areas is still in need of replacement as this is heavily soiled in some places, this is to be addressed as part of the upgrade programme. The upgrading has included the installation of some replacements windows and doors to a double glazed standard. Service users are kept informed at service user meetings of the progress of the upgrade programme. Concerns have been expressed regarding the location of the smoking room and the impact on non smokers, staff do promote healthier lifestyles and smoking cessation programmes, but respect the right of service users to smoke in the home and this is supported within current legislation, they have agreed to look at whether a smoke free corridor can be created to enable access to all areas of the home without accessing the smoking area. The home has also been asked to check with the Environmental health officer about displaying the appropriate smoking signage, these are recommendations of this report. “Still a smoking room that residents have to walk through to get to their rooms” Fire risk assessment has been updated. Extinguishers evidenced signs of service checks. The home managers confirmed that tests and checks of fire equipment and alarm systems are happening although this was not checked on this occasion. Fire exits were clear. It is a recommendation that the home consider placing a cover over the fuse boxes in the downstairs toilet to safeguard them from tampering and to protect service users. The home has adequate bathroom and toilet facilities and these were seen to be clean and in satisfactory condition. Three service user bedrooms were viewed with their permission, these varied in personal effects and overall content, and were personalised to reflect individual tastes and interests. Aids are provided for service use where needed but the home must ensure these are suitable to meet the need and appropriately fitted. Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 23 The laundry was in a good state with equipment in working order, service users undertake their own laundry with staff support, Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The recruitment process needs strengthening. The home has a high number of staff qualified to NVQ2 and above. Staff’ have access to training but the training strategy lacks clarity. Staff’ feel supported, their work is routinely monitored through individual supervision sessions with senior staff, and in this forum and in team meetings they feel able to express their views EVIDENCE: A selection of staff files viewed evidenced that all necessary checks and references are in place and the procedure is generally robust, however, the home must evidence more clearly within the interview process that gaps in employment history have been fully explored, where previous work has been with vulnerable adults and children the home must evidence that it has obtained verification as to the reasons for the applicant ceasing that work, particularly where this does not feature as a reference. Additionally where Criminal record checks are returned unclear, the home must clearly evidence discussions with staff around recorded offences and how the decision has been reached to continue with employment, this should be supported by appropriate Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 25 risk assessment and additional monitoring where necessary, these improvements are a requirement of this report. Discussion with service users and survey responses from them and a range of other stakeholders highlighted in all but two responses no concerns in respect of staffing levels in the home, the home acknowledges however that they currently have the day care worker post vacant and this does impact on the frequency and range of activities that can be undertaken with people outside the home, and as a consequence the home are actively trying to recruit to this post. Discussion with a new staff member experienced in working with other user groups indicated that she felt the Home’ induction programme was providing her with the necessary skills and knowledge to feel confident in working with this user group. She confirmed that she had already completed all mandatory training at her previous employment and is awaiting her certificates for this. The home senior management have developed their own induction with reference to skills for care induction standards, and have introduced a mental health element to improve content. The home has exceeded its 50 qualified staff levels and there is evidence that staff have opportunities to train beyond NVQ2 with some having NVQ3 and looking at NVQ4. Staff reported through discussion and survey that they have had opportunities to attend specialist training and the home are updating mandatory skills, with all staff having recently completed Moving and handling and will be undertaking infection control shortly. Staff files provided evidence of training certificates, competency assessment of medication administration and regular supervision, staff feedback indicates good team working relationships within the whole team and a loyalty to the service, they feel well supported and that training is good to enable them to work effectively with at times very ill people. They reported they have opportunities for staff meetings. Although training of staff is taking place the senior staff were unable to advise whether all mandatory training was up to date, the lack of individual training profiles could also not inform this, it is recommended that the home reintroduce individual training profiles to be used in conjunction with supervision to identify skills gaps and this is to be translated to a staff training matrix. Paddock House DS0000023503.V352653.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): 37,38,39,40,42 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is well managed. Policies and procedures need to be reviewed more regularly and reflect changes in legislation. People living in the home feel confident about expressing their views and these influence service development. Systems are in place to promote and protect the health, safety and welfare of service users. EVIDENCE: The AQAA was completed and returned on time. The content of the AQAA was discussed at the site visit, it was acknowledged that the home had made a good attempt in completing the forms, but it was made clear that CSCI expectations of the level of detail and overall content would be higher for Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 27 future form submissions. AQAA information indicates that policies and procedures have not been reviewed in some cases for a number of years, consideration must be given to increasing the frequency of review to ensure that polices accurately reflect and respond to changes in legislation and current good practice, the home has demonstrated it actively is responsive to changes in legislation but must amend policies, procedures and guidance for staff to ensure these direct their practices and there is a clear understanding of roles and responsibilities. The Owner manager has many years of experience of working within the health and social care field and twelve years experience of managing this service successfully, he holds a health care qualification and should undertake a recognised management qualification to fulfil registered manager qualification standards as this remains outstanding. He can evidence that he is training to refresh and update skills and keep abreast of new legislation, and that this is influential on the development of the scheme. The owner manager has a good grasp on the budget and financial expenditure of the home, the cost of the service is competitive and still allows the home to make some improvements. There is evidence of good working relationships between staff at all levels, users are made to feel that this is their home and are encouraged to express views and dissatisfaction. The home is not run in a manner that makes it feel institutional users are not required to participate in activities or socialise although they may be offered encouragement to do so. “They are the best staff we have ever had” “They work closely with mental health team, effective communication, respond well to suggestions on care” “They maintain good and effective links with strategy services” “Always had a good relationship with managers, very approachable and supportive of clients” Documentation in the home evidences that the management have good systems in place for engaging with users and that they are listening to feedback and acting upon this, analysis of user surveys that are undertaken twice per year are published for users to see on notice board as is the last report, user meeting minutes are also available for people to see. A review of accident records highlight a low level of accidents to individual service users has been maintained over several years. The home has provided regulation 37 incident reports to CSCI on a regular basis, although there is a Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 28 need for some improved detail around outcomes on occasion, and this has been discussed during inspection. The owner manager has confirmed through the AQAA that all servicing and checks are up to date, and has confirmed that a previous requirement in respect of servicing the electrical installation has been carried out. Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 29 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 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 2 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 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 2 3 3 2 X 3 X Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 30 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13 Requirement The use of sticky labels from the pharmacist to place on MAR sheets where medication changes have occurred must be discontinued, home to discuss with pharmacist. (MET) All handwritten entries by staff on MAR sheets must be signed (MET) and dated (NOT MET) by the person entering the information. Home to implement routine auditing of medications and this should include liquid medications, (NOT MET) the dating upon opening of liquid meds will support this (MET) (Not fully met within timescale new date for completion) The home must evidence more clearly within the interview process that: Gaps in employment history Have been fully explored. Where previous work has been with vulnerable adults and children the home must evidence Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 31 Timescale for action 30/01/08 2 YA34 19 30/01/08 that it has obtained verification as to the reasons for the applicant ceasing that work, particularly where this does not feature as a reference. Where Criminal record checks are returned unclear, the home must clearly evidence discussions with staff around recorded offences and how the decision has been reached to continue with employment, this should be supported by appropriate risk assessment and additional monitoring where necessary (new) 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. Refer to Standard YA6 YA20 Good Practice Recommendations Care plans should reflect staff interventions in personal care routines, and should be supported by Moving and handling assessments. Home to make use of the medication received sections on the MAR sheet to evidence receipt of medication and that the home develop individual PRN guidelines to aid consistency of this medication and implement medication profiles Agreed strategies adopted by staff to manage behaviour should be clearly recorded in user plans and reviewed accordingly. Home to consider Smoking area- review feasibility of creating smoke free corridor Cover fuse boxes in downstairs toilet. The home reintroduce individual training profiles for staff in keeping with standard 35.5, to strengthen the clarity and recording of individual staff training records, and to develop a staff training matrix. 3 4 5. YA23 YA24 YA35 Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Paddock House DS0000023503.V352653.R01.S.doc Version 5.2 Page 33 - 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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