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Inspection on 18/07/07 for Paks Trust 66 Oaston Road

Also see our care home review for Paks Trust 66 Oaston Road for more information

This inspection was carried out on 18th July 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 no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

The service continues to provide a warm, friendly home, with service users and staff all working together in a friendly and easygoing atmosphere. Service users told us they liked living in the home and were happy with the staff supporting them. Staff spoken with during the visit were clearly committed to supporting people to live ordinary and meaningful lives and daily records confirmed this. Staff appeared to be good listeners and communicators. Service users were happy to talk about the activities in the community they participate in and enjoy, this included attending their day services, work placements, shopping and going to the cinema. People also told us about the activities they enjoy in the home such as baking, cleaning their bedrooms and art and craft. Some of the art and craft was displayed effectively in the lounge and hallway which is supporting people to see the house as their home. Mealtimes are flexible and relaxed, staff are patient and helpful and allow people the time they need to finish their meal comfortably. When we arrived in the morning people were getting ready for the day`s activities at their own pace, helping themselves to their breakfast and putting together the items they would need during the day, for example, their packed lunches. During the visit people were asked what they liked best about living in the home and they made the following comments. "We get up late at weekends which is nice." "I like being able to go to work with the `older` people." "I have a new bed, it`s lovely, and we have a new cooker. I`m going to make a rhubarb crumble." "I like being able to listen to my CDs in my bedroom." Comments from relatives and friends recorded on recently returned survey questionnaires included, "I have no problem whatsoever with the staff. My sister is looked after very well." "We have no concerns about the welfare of XXXX."

What has improved since the last inspection?

People living in the home can now summon assistance from staff should they require support during the night. People spoken with were pleased with the equipment and showed us how it worked. They had instructions in symbol and written format of how to operate the alarm bell, which was easy for them to understand. We have been given a copy of the proposed training and development programme for the home, which shows us that staff will continue to be appropriately trained to meet service user needs. Recommendations are made however for future training to include refresher training in challenging behaviour so that staff can remain familiar with changing best practices. All staff working in the home have accessed training in mental health awareness, which enables them to support people appropriately and according to their specific needs.

What the care home could do better:

CARE HOME ADULTS 18-65 Paks Trust 66 Oaston Road 66 Oaston Road Nuneaton Warwickshire CV11 6JZ Lead Inspector Sheila Briddick Key Unannounced Inspection 18th July 2007 08:30 Paks Trust 66 Oaston Road DS0000004457.V341998.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 Paks Trust 66 Oaston Road DS0000004457.V341998.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. Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Paks Trust 66 Oaston Road Address 66 Oaston Road Nuneaton Warwickshire CV11 6JZ 02476 742201 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) PAKS Trust Alan John Sheppard Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th September 2006 Brief Description of the Service: The property is a 5 bed roomed narrow and tall Victorian end of terrace house on the edge of Nuneaton in a semi industrialised zone. It has a lounge, kitchen diner and lean to/conservatory room; this is also used as the staff ‘sleep in’ facility. Off the kitchen there is a shower room and separate toilet. There is a small back garden. Every one has a single bedroom. The staircase in the house is narrow and steep. The ground floor has one bedroom. On the first floor there are two residents’ bedrooms and a bathroom. The other two bedrooms and a separate toilet are on the top floor. Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Documentation received from the service since the last inspection was examined as part of the inspection process and the evaluation included in this report. This included information regarding a concern that had been raised to us about supporting family relationships. The inspection visit was unannounced and took place on Wednesday, July 18, 2007, starting at 8.30 pm and finishing at 2.00pm. The inspection involved: • • • Discussions with service users and staff on duty at the time. Observation of working practices and of the interaction between service users and staff members. Two service users were identified for close examination by reading their, care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for service users. A tour of the environment was undertaken, and home records were sampled, including staff training, health and safety, and quality assurance records. A visit to the Providers office premises to examine training and recruitment records. Finally, feedback took place with the Manager about the inspection findings. • • • We would like to thank all service users and staff for their hospitality and cooperation during the inspection visits. What the service does well: The service continues to provide a warm, friendly home, with service users and staff all working together in a friendly and easygoing atmosphere. Service users told us they liked living in the home and were happy with the staff supporting them. Staff spoken with during the visit were clearly committed to supporting people to live ordinary and meaningful lives and daily records confirmed this. Staff appeared to be good listeners and communicators. Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 6 Service users were happy to talk about the activities in the community they participate in and enjoy, this included attending their day services, work placements, shopping and going to the cinema. People also told us about the activities they enjoy in the home such as baking, cleaning their bedrooms and art and craft. Some of the art and craft was displayed effectively in the lounge and hallway which is supporting people to see the house as their home. Mealtimes are flexible and relaxed, staff are patient and helpful and allow people the time they need to finish their meal comfortably. When we arrived in the morning people were getting ready for the days activities at their own pace, helping themselves to their breakfast and putting together the items they would need during the day, for example, their packed lunches. During the visit people were asked what they liked best about living in the home and they made the following comments. We get up late at weekends which is nice. I like being able to go to work with the ‘older’ people. I have a new bed, its lovely, and we have a new cooker. Im going to make a rhubarb crumble. I like being able to listen to my CDs in my bedroom. Comments from relatives and friends recorded on recently returned survey questionnaires included, I have no problem whatsoever with the staff. My sister is looked after very well. We have no concerns about the welfare of XXXX. What has improved since the last inspection? People living in the home can now summon assistance from staff should they require support during the night. People spoken with were pleased with the equipment and showed us how it worked. They had instructions in symbol and written format of how to operate the alarm bell, which was easy for them to understand. We have been given a copy of the proposed training and development programme for the home, which shows us that staff will continue to be appropriately trained to meet service user needs. Recommendations are made however for future training to include refresher training in challenging behaviour so that staff can remain familiar with changing best practices. All staff working in the home have accessed training in mental health awareness, which enables them to support people appropriately and according to their specific needs. Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Paks Trust 66 Oaston Road DS0000004457.V341998.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 Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users do not have agreed Contracts, which set out the Terms and Conditions of their residency and without this they cannot be sure of their rights and responsibilities whilst living in the home or those of the service provider. EVIDENCE: There have been no new service users coming to live in this home since the previous inspection, however there is currently a vacancy in the home. Any prospective service user wishing to make a decision about coming to live in the home would have clear information available to them to support the decision-making process. Examination of two care plan files showed us that service users continue to be without a written statement of the Terms and Conditions, or Contract to inform them of what is included in the fee, their liability and overall care. The manager advised that these are in place and waiting to be signed by relatives or advocates of the service user. We looked at these documents, which are in symbol format making it easy for the people living in the home to understand Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 10 and recommend that the document is explained to each service user and they are supported to sign these if they are able. Service users have access to a Charter of Resident’s Rights which is also in symbol and written format. Paks Trust 66 Oaston Road DS0000004457.V341998.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): Standards 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home are involved in decisions being made about their daily activities. Opportunity however to review their care needs with the home on a regular basis is not happening and therefore they cannot be sure that the care they are receiving reflects their changing needs, wishes and personal aspirations. EVIDENCE: The care needs for two service users were looked at to consider how their independence was being maintained and promoted, how they were protected from harm, how involved they were in the decision-making process about their lives and whether this is reviewed with them on a regular basis. The views of the two service users were sought and each gave consent for their care plans to be examined. The daily routines for each person were very detailed and included the specific times preferred for their daily activities, for example times for getting up and times for going to bed. Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 12 Both care plans contained pen pictures of the person’s individual choices, needs and preferred routines and had photographs of them with their friends and enjoying activities. The information on pen pictures was informative and service user focused, however, management and staff must be mindful that it is important that these are reviewed regularly to ensure that the personal information on them is up-to-date. For example, the interest and lifestyles of one service user have changed, there are now doing work experience and have become more independent. Photographs were out of date as the service user now has short hair and has lost some weight and therefore the pictures of themselves do not reflect their current image. A care management review was found on one care plan and this had taken place in 2006. A care management review document could not be found on the second care plan looked at. The manager informed us that he had not been approached by social services for a review to take place and it was advised that the home should request a care management review take place so that they can be sure they are meeting the service user’s assessed and changed needs. Care plan programs are in place for each specific identified need with room for entries to be made to record any changes or significant events, however there was very little evidence of staff making use of monitoring and evaluation processes. For example, entries on one care plan for activities and household tasks had not been made since March 2007 and many care plan programs had no record regarding any progress or changes being made. It is important that staff make regular entries on all care plan programs so this can inform the review and evaluation of the care plan programme. A requirement was made at our last visit for the recording of any changes or significant events and it is disappointing to find that this is not happening. It is recommended that the manager regularly monitors that staff are recording information required of them. There was no evidence on care plans of six monthly reviews taking place with the service user, their family members or advocates. This was a requirement made at the last inspection that remains unmet. Documentation looked at as part of this inspection informs us that there are plans to introduce a regular system of review over the next 12 months. The care plan document for one service user was not dated and without this it is not possible to determine when the service user’s individual choices and preferred routines had been identified with them so that progress could be monitored. Staff spoken with recognised and understood the individual risks for service users both in their environment and community however there continues to be no evidence of formal risk assessment documentation. This was recognised by Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 13 the manager during our last visit as an area that should be improved upon and a requirement was made for all activities to be assessed for any risk to harm. This has not happened, for example, records looked at inform us that there has recently been two incidents in the home when people may have been at risk of harm and risk assessment had not been completed following the incidents and documented on care plans. We were informed that the service user involved had been supported after the incident through an anger management program however this was not recorded on their care plan. Without this information the service user cannot be sure that the staff team supporting them will be consistent with their approach and management of the anger management program. The individual daily records being maintained continue to be to a good standard, giving brief details of what the person had done that day providing a clear guide to the person’s week, their activities, highlights, what had been enjoyed and what difficulties, if any, there had been for them. There is significant evidence to show that people, if they wish to, can give a clear account of their views of the activities that day and are signing when they make comments. There is a key worker system in place and this enables staff and service users to establish special relationships and work on a one to one basis. Service users spoken with knew who their key worker was and had a high regard for them. They continue to enjoy holidays away from home with their key worker. Service users continue to be offered choices and to make decisions in a wide variety of ways, from what, where, and when they have the evening meal, to what they do in the evenings and in the day. People told us they are happy living in the home and enjoy their lifestyle. We were informed that resident meetings no longer taking place as it was felt that feedback was not forthcoming from service users. Although there is significant evidence that service users choices are promoted on a day-to-day basis it is important that feedback on a more formal basis is sought and documented by the manager. Providers have a responsibility to be accountable for the service they provide and how they seek service user views in doing so and it is strongly recommended that the manager reintroduce strategies with the people living in the home for seeking feedback about the service. Paks Trust 66 Oaston Road DS0000004457.V341998.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): Standards 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in this home continue to be supported to access lifestyle activities of their own choice in the areas of education, work opportunity and leisure. This is promoting their right to live ordinary and meaningful lives. EVIDENCE: People living at the home continue to enjoy a variety of day services and it was apparent from the conversation with them that they enjoyed these. Personal diaries looked at informed us that service users go shopping for clothes and other personal items on a regular basis. They are supported to continue with hobbies and interests in the home which include knitting and art and craft. Some of the art and craft was displayed effectively in the lounge and hallway and this is supporting people to see the house as their home. Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 15 One service user talked to us about their work placement at an older persons day centre. They appeared to enjoy their time there and said that when they are there they make cups of tea for people. From discussion with service users it was clear that they are making good use of all community facilities and this includes the library, colleges and the cinema. People are also accessing local hairdressers, dentists and opticians services and banking facilities. People continue to enjoy holidays away from the home and had recently been to Great Yarmouth, staying at a holiday camp, which they told us they enjoyed very much. People living in the home are supported to maintain relationships with family and friends by telephone and making visits to them. How people wish to be supported is documented on their care plan. On one of the care plans looked at it was documented that the family will meet every three months with the staff working in the home to discuss the family support arrangements however, the was no evidence of any of these meetings taking place or of agreements that may have been made. Documenting this information is important for the service user and the family so that they can be sure people working in the home have a good understanding of the service users and familys views on the support they require. There is evidence in daily diaries that service users are encouraged and supported to be independent in the home and involved in daily routines such as cleaning their bedrooms and meal preparation. One service user showed us the new cooker that had recently been purchased and told us how there were looking forward to making a rhubarb crumble. We were advised that the food provision is based on individual likes and dislikes although people generally eat together. There is no set menu but each meal taken by a service user is recorded on their daily record sheet. These were examined and evidenced meals to be balanced, varied and nutritious. Food stocks are in plentiful supply and included fresh and frozen foods. At the time of the visit people were helping themselves to their breakfast and were obviously familiar were food was stored and where crockery and cutlery could be found. People told us they enjoy eating out and having take-away meals ’sometimes’. Paks Trust 66 Oaston Road DS0000004457.V341998.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal support continues to be offered to people in such a way as to promote and protect their privacy, dignity and independence. Medicine is being administered and stored safely people have opportunity to review their medication needs with their GP to ensure that it continues to meet their assessed needs and promote their health and well-being. EVIDENCE: Service users require little or no support to meet their personal care needs, including mobility, and the level of support required is identified on the care plan with an emphasis on maintaining and promoting independence. As identified earlier in this report care plans are not being reviewed on a regular basis and this includes the care plans in place of the personal care. On the two care plans looked at there was evidence to suggest that records are being maintained satisfactorily of health-care appointments and any changes to health care. For example the records maintained for a service user Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 17 who developed a sore one there foot were clear in the guidance for staff to follow and the advice that was given by the service users GP. The two care plans looked out showed us that medication reviews with the service user’s GP had recently taken place and a record maintained of the outcome. There is significant evidence that service users continue to see their GP’s when needed, psychology services, dentists and opticians. Psychology services routinely review service user’s medication needs and the outcome is confirmed with them in writing. The home has a medication policy which is accessible to staff and medication records examined for the two service users care being case tracked were upto-date and their medicines received, administered and disposed of recorded satisfactorily. We were informed that staff administer medicines following an in-house induction. Staff complete accredited training in the administering of medicines through a distance learning program at the local college although this may not be during the induction period as this is dependent on college places at the time. Training records looked at informed us that three staff have not completed this accredited training. Staff induction records looked at do not record the level of competency required during the in-house assessment of competency, how this is assessed and monitored during the staff member’s induction period. Without this the manager cannot demonstrate that people have sufficient competency to administer medicines prior to their completing the distance learning program for safe administration of medicine. Staff working in the home have recently attended a first aid course and this ensures that there is always a person working in the home who can attend to first aid in the event of emergency Paks Trust 66 Oaston Road DS0000004457.V341998.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns and have access to an effective complaints procedure, which is in a format that is easy for them to understand. Staff have a good knowledge and understanding of adult protection issues and endeavour to provide a safe environment to protect them from harm. EVIDENCE: Service users have access to a complaints policy and procedure that is in a written and symbol format, which ensures that they are able to understand how they can express a concern or make a complaint. There is evidence to suggest that service user’s expressed preferences are noted on their daily records and this continues to be a useful indicator of choices being made and preferences being heeded. Service users continue to be positive about their environment and the support they are given by the people supporting them. Observation of interactions between service users and staff clearly shows that each have a respect for the other’s views and that they are able to discuss these when they differ with staff offering them positive advise for decisions to be made. Since our last visit to the home we have received one complaint about the service and this was in relation to supporting the service user appropriately to maintain family relationships. We looked into how this complaint was being managed during the visit and found records relating to the complaint were in Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 19 good order and the complaints policy and procedure was being followed satisfactorily. The complaint has moved forward to Stage Two of the complaints policy and the outcome of the complaint will be forwarded to us so that we can be sure that the complainant is satisfied with the outcome of the investigation. Staff spoken with had a good understanding of their role and responsibility in the protection of people from harm. They had been able to attend training in the protection of vulnerable adults and were familiar with the policy and procedure. Since our last visit to the home there has been an incident reported to us that is now being investigated through the Vulnerable Adults policy and procedure. Warwickshire Social Services are investigating the incident and there is evidence that the home reported the incident to the appropriate agencies as they are required to do so and this included the police and the Commission for Social Care Inspection. The Criminal Records Bureau Agency were approached for guidance on placing names on the Protection of Vulnerable Adult, (PoVA) referral list. The provider was informed that this action was not necessary as the criteria for inclusion on the PoVA list was not met in this instance. The provider will inform the commission of the outcome of any action they may have to take to ensure the continuing safety and well-being of people living in the home. Paks Trust 66 Oaston Road DS0000004457.V341998.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The house provides a warm, homely environment providing people with a comfortable and safe place in which to live. EVIDENCE: There is a warm and welcoming atmosphere in the home, which at the time of the visit was homely, comfortable and safe. People who use the service are encouraged to see the home as their own and are able to move around easily and freely and to go to their bedroom if they wish. Decor, furnishings and fittings were all clean although some of the decor is looking tired and in need of redecoration. The bathroom facility on the firstfloor is in particular need of redecoration as the ceiling is ‘cracked’ and the skirting board is coming away from the wall which does not promote effective cleaning routines. However, the home smelt fresh and pleasant when we visited. Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 21 One service user was happy for us to look at their bedroom, which was personalised, well decorated and suitably furnished. The service user was happy to show off their new bed, which they said was “lovely”, and was waiting to have a new net curtain fitted to their window. Each person living in the home now has an alarm bell which they can use if they need staff support during the night is asleep in facility is on the lower ground floor. The information for people on using the alarm is very clear and in symbol and written format which makes it easy for people living in the home to understand. There are established policies and procedures in place for the control of the risk of infection in the home and staff practices during the visit were seen to be safe. Infection control training is included in mandatory training for all staff and when being assessed towards NVQ Level 2. Paks Trust 66 Oaston Road DS0000004457.V341998.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 32, 33, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in this home are supported by an effective and competent staff team who have the skills and knowledge to meet people’s individual and collective needs, which promotes their health and well being. EVIDENCE: Training records for the home demonstrate that there is a training programme in place for staff which includes safe working practices, care of medicines, Protection of Vulnerable Adults, (PoVA), Learning Disability Award Framework, (LDAF), accreditation towards NVQ at Level 2 and mental health awareness. A staff member spoken with had just finished their NVQ level 2 and had recently completed training in fire safety and personal care. Training records looked at inform us that staff have not had training in challenging behaviour and that the manager has not had training in the management of violence and aggression since February 2002. Training is necessary so that the service can be sure that knowledge and skills within the staff team are in line with current best practice guidelines and legislation. Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 23 The Paks Trust organisation have a designated training and development officer for their services. Discussion with them at the time of the visit identified that further training has been planned for in moving and handling, equality and diversity and infection control. Observation of care practice and discussion with staff on duty at the time determined that positive relationships exist between service users and the staff supporting them. Staff were observed to be approachable by, and comfortable with service users, they were good listeners and communicators, and were interested and committed to the work they were doing. There is currently one vacancy in the home and we were informed that staffing levels have been affected by this vacancy and this is having a small impact on service user activities during the weekend. The provider hopes that the vacancy will be filled shortly and staffing levels will return to a level that enables people to access community facilities according to their needs and wishes. In the short term however the home should take into account individual needs of people living in the home and seek their views about the activities that are important to them and they wish to continue and make suitable arrangements for staffing support for that particular activity. Staff were complimentary about the support from the manager and said that they were able to discuss service issues at supervision and staff meetings. They told us supervision and team meetings were held on a regular basis. Service users spoken with said that they liked the staff and had particular regard for their individual key workers. They said that staff took them out regularly and gave some examples such as, bowling, having meals out and going shopping. One new staff member has come to work in the home since our last visit and their recruitment records were examined. These were found to be complete and included appropriate Criminal Records Bureau, (CRB) and POVA checks; the records were kept securely in the home. The provider has reviewed the recruitment and selection process. This has included amending the application form so that it is in line with the Care Home Regulations 2001. This will ensure that people come into work in the home given full working history of previous employment so that the provider can investigate any gaps in employment. These changes will further promote the protection of the people from harm by the people supporting them in the home. Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager cannot be sure that the home is meeting its stated aims and objectives and promoting the health and well-being of the people living and working in the home without establishing a system for regular monitoring, review and evaluation of the service being provided. EVIDENCE: Discussion with service users, and staff, and observation of their interactions with the manager demonstrated that there is a high regard for him as manager of the home. Service users and staff appeared to have a good relationship with the manager and the atmosphere in the home was relaxed, warm and friendly. There is a quality assurance process, implemented by Paks Trust on an annual basis, including seeking the views of family members. We looked at feedback Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 25 from family members documented at the last quality assurance review in April 2007, and comments included; I have no problem whatsoever with the staff or the home. My sister is looked after very well. I have no concerns over the welfare in the home. It was noticed that all tick boxes for comment regarding questions asked in the survey was positive, i.e. good. The records of surveys are held in Paks Trusts main office in Nuneaton and it is recommended that copies be held in the care home also. The manager informed that the views of service users is determined informally and on daily reports when they can add their comments to daily activity records. We discussed introducing a process for seeking the views of service users on a more formal basis and that advocacy support should be obtained when doing so, this could be day services staff. The reintroduction of resident meetings would also be a good venue giving people opportunity as a group to raise issues in the home that were of concern to or regarding any planned changes that might be introduced. We were informed that the recently introduced annual appraisal for staff members also includes seeking the views of staff regarding the service delivery. The annual appraisal was introduced in January 2007 the documentation regarding this was not available to us at the time to comment on the views staff made at the time. A number of folders and files relating to staff recruitment and care planning looked at during this visit were not in good order. For example, service user files containing letters from health-care professionals, consent forms, bank statements, holiday receipts and other personal information were loosely held and not in sectioned areas. Staffing information held on files regarding recruitment, supervision and other personal information were also loosely held and not in sectioned areas. Records relating to staff and care planning were held securely in the home. Documentation looked at suggests that health and safety in the home is monitored and evaluated. During the visit fire safety records were seen to be up-to-date and in good order. Records show that that fire drills are regularly taking place with service users and their understanding of this is documented on fire safety records. Fridge and freezer temperatures are maintained up to date and show temperatures are within a safe range. To the rear of the property as an enclosed garden, which has a paved area, barbecue, small lawn and growing area for plants or vegetables. The garden is Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 26 being redesigned to provide a pleasant area, which people can enjoy in warm weather. A risk assessment of the environment has not been completed as was required at the last inspection visit and this is now urgently required. Without proper risk assessment having taken place the manager cannot be sure that the people living and working in the home will be safe from harm. Examination of records and discussion with the manager during this visit identified that four of the requirements made at the last inspection remain outstanding. The four requirements are each in a key outcome area for service users, i.e., care planning, risk assessment and quality assurance. It was disappointing to find that the manager had not taken action to make the improvements necessary in these areas. Paks Trust 66 Oaston Road DS0000004457.V341998.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 N/A 3 X 4 X 5 2 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 2 X 3 2 x Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 28 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 YA5 Regulation 5(1)(b) Requirement Copies of the written terms and conditions in respect of the accommodation provided must be available to service users. (Timescale of 31/03/06 and 07/10/06 not met) Up to date care plans must be available, dated, and regularly reviewed with service users at their request, or at least 6 monthly, and updated to reflect changing needs. Agreed changes must be recorded and dated. (Timescale of 21/03/06 and 30/11/06 not met) Timescale for action 07/09/07 2. YA6 15,12(4)(a) 30/07/07 3. YA9 13.4(a)(b)(c) All identified and known risks to service users must be recorded on their care plan and strategies agreed, with written guidelines for staff to follow, and recorded on the care plan of how the risk is to be minimised. (Timescale of 30/11/06 not met) 13(2) The manager must ensure that a record is maintained of staff’s in-house medication DS0000004457.V341998.R01.S.doc 07/09/07 4. YA20 07/09/07 Paks Trust 66 Oaston Road Version 5.2 Page 29 5. YA35 18(1)(c) 6. YA42 13.4(a) training which clearly identifies the necessary competencies required and how these were met during the induction. The manager and staff must 07/11/07 attend training in challenging behaviour so that they can maintain and update knowledge and skills necessary for detecting people from harm with current legislation and good practice. The manager must ensure that 30/11/07 a risk assessment of the environment is completed to ensure that all parts of the home to which service users and staff have access are so far is reasonably practicable free from hazards to their safety and that the outcome of the risk assessment are documented and kept under review. 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 YA5 YA6 Good Practice Recommendations Service user’s contract should be explained to them before they are asked to sign the agreement. The manager should approach Warwickshire Social Services learning Disability Team and request care management reviews take place where these have not happened in the last twelve months. It is recommended that the manager regularly monitors that staff are recording information required of them and this should include care plan records. It is strongly recommended that the manager reintroduce DS0000004457.V341998.R01.S.doc Version 5.2 Page 30 3. YA6 4. YA7 Paks Trust 66 Oaston Road strategies, such as resident meetings, for seeking feedback about the service from the people who are using it. 5. 6. YA24 YA33 It is recommended that a redecoration programme be identified and this includes repairs to the bathroom on the first floor. While staffing levels are reduced due the service vacancy the home should seek their views of service users about the activities that are important to them and they wish to continue and make suitable arrangements for staffing support for that particular activity. It is recommended that service users have the support of an advocate when involved in any process where their views of the service provision are sought, this could be a member of their day services staff, friend or family member. All records held in the home should be maintained in good order so that information is held securely in relevant sections in the folder, for example, all financial information together. 7. YA39 8. YA41 Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-56 Stephenson Street Birmingham B2 4UZ 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 Paks Trust 66 Oaston Road DS0000004457.V341998.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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