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Inspection on 22/01/07 for Paks Trust Clarence Street

Also see our care home review for Paks Trust Clarence Street for more information

This inspection was carried out on 22nd January 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 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 environment within the three houses is individualised and homely and the people living at each house have the aids and equipment they need to promote their independence. Staff members have a sound understanding of individual needs and are involving service users in planning daily routines and promoting lifestyle opportunities that are fulfilling and meaningful.Service users appeared happy and relaxed and in conversation or observation of them, showed satisfaction with life in the home and their lifestyles. Staff involve residents as far as possible in making decisions and choices about their daily life. Records confirmed how sometimes behaviours could indicate the wishes of a service user and how this behaviour should be interpreted and managed to maintain the wellbeing of service user. The majority of the staff who care for residents have achieved a National Vocational (NVQ) II in Care qualification to help them provide more effective care to the service users.

What has improved since the last inspection?

The roof at No 42 has been repaired to ensure the environment is safe for the service users. A new bathroom has been fitted at No 18 for the benefit of the service users. A new non-slip kitchen floor and cooker has also been provided. Both bedrooms at No 18 have been redecorated to improve the environment for the service users. Further work has taken place on improving and updating care plans so that these are uniform across the three houses. A quality monitoring system based on seeking the views of service users has been introduced so that staff can identify if the service users are happy/unhappy with the care and service they receive.

What the care home could do better:

Some attention is needed in regard to medication management; this in particular applies to the recording of all medications to ensure there are no oversights in medication administration. Risk assessments need to be completed and actioned in regard to hot water and radiators as these could pose a burn/scald risk to some service users. The home needs to demonstrate that the outcomes of quality monitoring are considered and acted upon to the benefit of the service users.It is not currently clear that the registered properties meet with the fire precautions in regard to the roof spaces of adjoining properties. Confirmation is required that the home have sought advice from the fire officer regarding this matter to ensure the fire safety of the residents is not unnecessarily compromised. In regard to health and safety, action is required to ensure the homes have a five year Electrical Wiring Check and a Fire Risk Assessment to ensure homes are safe for the service users.

CARE HOME ADULTS 18-65 Paks Trust Clarence Street 17 Clarence Street Nuneaton Warwickshire CV11 5PT Lead Inspector Sandra Wade Key Unannounced Inspection 22nd January 2007 09:30 Paks Trust Clarence Street DS0000004458.V313018.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 Clarence Street DS0000004458.V313018.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 Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Paks Trust Clarence Street Address 17 Clarence Street Nuneaton Warwickshire CV11 5PT 02476 742201 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 Mr Robert S Forsyth Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Mr Forsyth achieves the NVQ Level 4 in managing care, including the Registered Managers Award by 1 February 2006. PAKS Trust must provide adequate support to the registered manager, which takes into account his level of management experience and experience of working in residential care. For the first 12 months from the date of this (the registration) certificate this support will include regular (at least quarterly) meetings with a care home manager who has current experience of providing an operational presence in a care home, who will act as the registered manager’s mentor. This mentoring process will be in addition to supervision and support from the registered manager’s line manager. 23rd February 2006 Date of last inspection Brief Description of the Service: The registration of Clarence Street covers three separate houses in one street. Two of the houses are for two residents and the other is for one resident. These are terraced houses, each providing a domestic environment as a care home setting. Two of the houses have a communal living room, kitchen and bathroom on the ground floor. The third has the bathroom on the first floor. Service users’ bedroom(s) are also the first floor. All of the houses are staffed 24 hours a day and personal care is offered to some degree in all three houses. The registration is for residents with learning disabilities. PAKS Trust operates this service. At the time of this inspection, the fees for the placements homes ranged from £778.00 to £1,459 per week. Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first Key inspection to Clarence House for this inspection year. 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 provision that need further development. Prior to this inspection visit, the manager had forwarded to the Commission a pre-inspection questionnaire, staffing rotas and menu records for the homes. Some of this information has been used in assessing actions taken by the home to meet care standards. The inspection took place between 9.30pm and 3.15pm on 22 January 2007 and 5.30pm and 7.30pm on 23 January 2007 and the inspection included:• • • Discussions with the manager and three care workers. Observation of working practices and of the interaction between service users and staff. Observation or discussion with four residents - it was difficult to establish through conversation the views of residents about their care due to their learning disabilities and the focus of the inspection was therefore based on observations, staff discussion and the review of records. 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 within each of the three houses was undertaken. A review of the home records were sampled, including staff training, staff recruitment, health and safety checks, duty rotas, accident records, medication and daily diaries. • • • What the service does well: The environment within the three houses is individualised and homely and the people living at each house have the aids and equipment they need to promote their independence. Staff members have a sound understanding of individual needs and are involving service users in planning daily routines and promoting lifestyle opportunities that are fulfilling and meaningful. Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 6 Service users appeared happy and relaxed and in conversation or observation of them, showed satisfaction with life in the home and their lifestyles. Staff involve residents as far as possible in making decisions and choices about their daily life. Records confirmed how sometimes behaviours could indicate the wishes of a service user and how this behaviour should be interpreted and managed to maintain the wellbeing of service user. The majority of the staff who care for residents have achieved a National Vocational (NVQ) II in Care qualification to help them provide more effective care to the service users. What has improved since the last inspection? What they could do better: Some attention is needed in regard to medication management; this in particular applies to the recording of all medications to ensure there are no oversights in medication administration. Risk assessments need to be completed and actioned in regard to hot water and radiators as these could pose a burn/scald risk to some service users. The home needs to demonstrate that the outcomes of quality monitoring are considered and acted upon to the benefit of the service users. Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 7 It is not currently clear that the registered properties meet with the fire precautions in regard to the roof spaces of adjoining properties. Confirmation is required that the home have sought advice from the fire officer regarding this matter to ensure the fire safety of the residents is not unnecessarily compromised. In regard to health and safety, action is required to ensure the homes have a five year Electrical Wiring Check and a Fire Risk Assessment to ensure homes are safe for the 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. Paks Trust Clarence Street DS0000004458.V313018.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 Clarence Street DS0000004458.V313018.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 Quality in this outcome area is good. Suitable systems are in place to ensure any new service users are fully assessed to identify their needs and aspirations so these can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no new admissions to the home since the last inspection. The manager explained that if a new service user was to be admitted to any of the three houses, then a social worker would initially be involved in organising this with the home. The prospective service user would be invited to visit the home when they would be given a Service User Guide giving details about the care and services provided. The service user would be invited to stay for tea on a few occasions followed by an invite for an overnight stay and arrangements would then be made for the person to be placed in one of the homes as appropriate. Detailed assessment records were in place showing the information that would be collected about the new service user so that the home could ensure their needs could be met. The assessment records contained pictures to help the prospective service user understand the information being requested about them. Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. Care plans are in place for each service user detailing their needs and goals so that staff are clear on what support is needed to help them enjoy an active lifestyle of their choosing in a safe manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection, the manager has been working on the care plan formats and these had been updated for the two residents who were case tracked. The care plan records viewed gave detailed information about each resident including their usual daily routine and their likes and dislikes. One service user spoken to said that they usually went out at a certain time in the morning and returned at around a certain time at night. Care plans confirmed this information and staff also confirmed this daily routine and said it was rare for the resident not to stick to the same times each day. It was identified in one care plan that the service user could have mood swings and their coping strategy for dealing with this was to go for a walk or visit one of the other two houses. Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 11 Staff were recording any relevant information about the residents general mood in the daily diary and staff said that the residents behaviour did not give any cause for concern and the moods were no longer as frequent as they were. Staff confirmed that where possible service users are always involved in making decisions relating to their daily life. It was explained that this was difficult for two residents in particular and sometimes staff would have to make the decision for them. Staff did however explain that residents are always involved as far as is possible when decisions are made which affect them. An example was given in regard to decorating their room. Although two service users were not able to choose themselves what they would like, staff did take the residents with them to choose the wallpaper and paint and it was evident that their rooms had been pleasantly decorated in appropriate colours. Despite the limited communication needs of some service users, it was observed that staff were able to identify what the service users wanted through their behaviour and the service users were able to fully understand what staff were saying to them. A communication care plan was viewed for one person and this gave instructions to staff on how this should be managed. Staff said that the use of visual aids or objects would not be beneficial communication aids for this person. Some risk assessments had been completed for service users taking into account their specific needs and staff actions had been identified on how to manage these. For one service user it was not evident a risk assessment had been carried out for the use of a piece of equipment which could compromise their privacy within the home. This was discussed with the manager and supervisor and advice was given. Systems were in place across the three homes to manage service user monies and clear records of transactions made were being kept. A member of staff explained the safeguards put in place to protect service users money and to ensure this was stored safely in the home. No external audits currently take place of resident financial records. One service user explained that they kept their own money and kept their bedroom door locked. They explained that staff respected this wish and it was noted on the care plan documentation that staff had been requested to knock the residents door prior to entering. Care plans included details of when service users wished to have their meals, if they wanted to be involved in preparing them and their preferences of the types of meals. Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. Service users are able to make choices about their lifestyle including meals and recreational activities and are supported to develop their life skills. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the service users attend day placements, which enable them the opportunity to develop their knowledge, skills and socialise with other people. Activities include horse riding, Jacuzzi, sensory garden, massage, reflexology. It was evident through discussions with the manager and the review of records as well as observations on the day of inspection, that they also access facilities within the community and experience a variety of activities and social events. This includes, parties, dances, shopping, pubs, and cafes. Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 13 On arrival at one of the houses, the service user was just leaving to attend a day placement and their transport had arrived. In another house they had already left for their day placements and in one house a resident was preparing to leave. This person said that they were going to college and then would be going into town; they explained that they also went out during the evenings and they would be attending a New Year party arranged by the organisation on Friday. Staff advised that they do encourage service users to do things for themselves even if this is just to put a cup in the kitchen to develop their daily living skills. It was evident that the varying needs of the service users across the three houses impacts on what can reasonably be expected of them. One resident is fully able to tidy their room and make their bed but another has very limited skills and therefore relies on staff to do this for them. It was evident from discussions with staff and on reviewing diaries for service users that they all have the benefit of regular family contact. One person was independently able to visit their family when they wished. On one day of the inspection a resident was leaving the house to visit a member of their family. The care plan records for one service user showed that they liked to go to the pub, colouring books, jigsaws and music. This resident was observed to be using a colouring book in the dining room. Staff said that they took residents with them when doing the shopping and gave them the opportunity to make choices about the food they wanted. The manager said that a holiday to Devon had been arranged for this year and two caravans had been booked to accommodate one resident in each to allow them sufficient space to feel comfortable. Records viewed in the home showed that in 2006 a holiday had been arranged to Butlins in Skegness. The manager said that all residents had at least one holiday a year and one service user had had several holidays in 2006 which included holidays with their family. The manager said that through the year they organise various activities and functions such as dances and parties which the organisation arranges at social clubs. A service user spoken to confirmed this. Photographs on display in the houses showed residents enjoying social events. One service users care records showed that they enjoyed horse riding. Staff said that this was provided through the day centre and the resident had one to one supervision to ensure their safety could be maintained. Any risks associated with this person having a seizure had been considered and the appropriate medication provided to the day centre to administer if needed. Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 14 Where possible residents are given keys to keep their rooms locked and staff respect the individuals choice not to be disturbed. One person confirmed that they kept their door locked all the time. Staff explained that some residents were unable to lock their rooms because they would lose the keys and they therefore would keep the doors shut and would respect the service users wishes to stay in their room alone if they wanted to. Service users are either given their mail to open independently or staff will open this with the resident. No concerns regarding respecting the residents rights were observed during the inspection. Staff were aware of the importance of respecting confidential information of service users and records were kept securely in each home. Fresh fruit and vegetables were available in each house and meals observed in two houses looked appetising. Mealtimes were not rushed and two of three service users observed seemed to enjoy their meals, one service user did not eat much. Records viewed on this persons file confirmed that sometimes this person did not eat their food and also explained there eating patterns. A care plan had been developed around this and staff know to record any concerns in daily diaries completed for each service user. Staff spoken to be aware of the need to provide a healthy diet for service users and the manager said that one person was being given multi-vitamins to supplement their current diet. Staff confirmed that service users are involved in making choices about their meals and help to do the food shopping once the menus have been agreed. One service user said that they liked the meals and they “got the meat out” of the freezer in the morning that was to be prepared that night. Food diaries showed that a varied menu is being provided across the three houses. Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. Service users receive health and personal care in accordance with their needs and the principles of respect, dignity and privacy are put into practice. Some attention to medicine management is required to ensure this is managed effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans gave detailed information on the type of personal support each service user requires and both male and female carers are available to provide support as appropriate. Discussions with staff and observations of service users confirmed that their health and personal care needs are being addressed. Staff spoken to confirmed that residents had a daily shower or bath and it was evident from records that this formed part of the resident’s daily routine. Staff were very knowledgeable about each residents and likes and dislikes when supporting them. Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 16 Service users were all smart in their appearance, their clothes were clean and fresh and appropriate to their individual lifestyle and needs. All care plans viewed showed that residents had access to dental care, eye care and had received a health care check from the doctor. Booklets of the outcomes of the health care checks were available in picture format to help residents understand these. Where follow up appointments were needed, these were also indicated. Specialist treatments and interventions had been recorded along with specialised information to enable the staff team to support the service users with specific healthcare needs as necessary. One service user had a medical condition that had resulted in several hospital appointments and consultations with their doctor. The manager was able to give detailed information about how this resident had been supported to deal with this and described the ongoing difficulties of trying to resolve this with the hospital. A review of medication was carried out in two of the three houses. In one of the houses the medication administration record (MAR) had lines across the chart beside a cream that was to be applied. The member of staff on duty was not able to confirm why this had been done but confirmed the cream was being applied. The code “R” was being used to show that a resident was refusing medication but the code on the MAR for indicating a resident was refusing their medication was “A”. This could cause confusion is the correct code is not applied. The number of Sodium Valporate tablets given and remaining did not add up to the total amount received – there were two extra tablets suggesting they either had not been given on one occasion or the number of tablets they had started with had not been accurately recorded. Diclofenac medication was found in the medication box but was not indicated on the MAR. The manager advised this should have been returned to the pharmacist. Lorazepam medication was also found in the medication box but was not indicated on the MAR. This had been prescribed in August 2005 and staff confirmed the service user rarely had this but it needed to be kept in case it was required. When medications are rarely needed, these should be reviewed with the GP on a regular basis such as 3/6 monthly. A clear protocol on how this should be recorded on the MAR should be developed so that staff only need to record when it is given. In the other house, a medication no longer in use was still showing on the MAR chart, this should be removed to prevent any confusion when administering medication. Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 17 For three medications the exact amount the home had started with at the beginning of the prescribing period had not been recorded on the MAR making it difficult to audit that the amount given and remaining was correct. Paks Trust Clarence Street DS0000004458.V313018.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): 22,23 Quality in this outcome area is good. Systems are in place to ensure service user complaints would be listened and acted upon and staff understand their responsibilities in protecting service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The organisation has a uniform complaints procedure which is adopted across the three houses. In one house the complaints procedure available was not up-to-date in that it did not indicate the investigation time or details of the Commission. The manager said that there had been no complaints received since the last inspection and no allegations of abuse. It was evident that one of the service users was sufficiently independent to voice any concerns they may have to care staff or the manager. Staff were able to give detailed information about the service users including behaviour patterns which may suggest service users were not happy. Care plans confirmed how residents liked to deal with this so that staff could support them accordingly. Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 19 Organisational policies on guidance to care staff on the abuse of vulnerable adults, bullying in the work place and the application of the POVA register were in place in the home. Staff spoken with said they had accessed some training in the protection of vulnerable adults through the Learning Disability Awards Framework (LDAF). Staff confirmed that if abuse was reported or observed by them, they would report this to the manager. A whistleblowing policy was available detailing the support to staff should they need to report any abuse observed. Paks Trust Clarence Street DS0000004458.V313018.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): 24,30 Quality in this outcome area is adequate. Service users live in a pleasant and homely environment but some attention is required in one of the bathrooms to ensure this is a safe area for service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The three houses covered by the registration that make up the Clarence Street service are two mid-terrace houses and one end terrace. Each provides a domestic environment as a care home setting. Two of the houses have a communal living room, kitchen and bathroom on the ground floor. The third has the bathroom on the first floor. Residents’ bedrooms are also the first floor. All three houses were comfortable, nicely furnished, clean, tidy and homely. The houses are small and domestic in scale with cleaning procedures in place that reflect this. Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 21 In House 17 the grouting was in need of attention around the bath. It was established that there was no thermostatic control on the hot water taps, which could pose a scald risk to the service user. The manager explained that a new bathroom had been fitted and the thermostatic mixing valve had not been replaced to control the water temperatures. The manager agreed to address this. In house 18 there were no guards on the radiators and these were not of a low surface temperature to protect the residents from the risk of burns. This matter was discussed and advice given. In house 18, a new bathroom had been fitted and a new non-slip floor fitted in the kitchen. The two bedrooms in this house were viewed and staff confirmed these had also been decorated. Within each house, the laundry is based in the kitchen. In two of the houses the bathrooms are located off the kitchen. Staff confirmed that the residents go straight into the bathrooms in the morning and the laundry is taken from them and placed directly into the washing machines which are placed at the bathroom end of the kitchen. This prevents dirty laundry being placed near food preparation areas. No concerns regarding hygiene practices and the cleanliness of the home were identified during this inspection. Paks Trust Clarence Street DS0000004458.V313018.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): 32,34,35 Quality in this outcome area is good. Staff in the home are trained and sufficient in numbers to support people who use the service and ensure their needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each house has its own dedicated staff team that is led by a house supervisor. The registered manager oversees all three houses within the registration that makes up the Clarence Street service. The registered manager does not have a permanent base in any of the houses but the main office base is within reasonable distance of the houses. Staff spoken with were knowledgeable about the residents that they support, and interactions observed were positive and resident focused. A review of staff records was undertaken to confirm safe recruitment practices are being carried out. Detailed records were in place including two written references, interview notes, certificates of training and criminal record bureau (CRB) checks. Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 23 It was noted that for one person who had worked at the home for some time, the CRB check in place had not been obtained prior to the person commencing employment. This was discussed with the manager who confirmed he was now aware this must be in place for any new staff employed before they start work. It was evident that appropriately detailed inductions are carried out in line with the Learning Disability Awareness Framework (LDAF) and that staff were being encouraged to complete a National Vocational Qualification (NVQ) in care to enhance their skills in caring and supporting service users. The manager confirmed that there were ten staff working across the three homes and out of these, seven had achieved a NVQ II in Care and the rest were in the process of taking this. A member of staff spoken to said that they had completed training in first aid, fire, basic food hygiene and moving and handling. The manager confirmed this training is provided on an ongoing basis for staff as required. Paks Trust Clarence Street DS0000004458.V313018.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): 37,39,42 Quality in this outcome area is adequate. Service users benefit from effective management of the homes and can openly make their views known to staff. Some attention is required in regard to health and safety to maintain a safe environment for the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is both suitably qualified and experienced to run the registered homes within Clarence Street. The manager has worked within the organisation since 1992 and a certificate was viewed showing he had achieved the Registered Managers Award /NVQ 4 in Care as well as a Diploma in Welfare Studies. The manager had recently attended health and safety training and training in the management of medication to ensure his knowledge remains updated. Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 25 A quality assurance system had been implemented but it was not evident that the outcomes of this had been fully collated and actioned. Staff had undertaken to complete questionnaires with some residents on their views about the care and support they receive. Questionnaires included questions on food, personal care, daily living and management, all of which had very positive responses. Where less positive answers had been given such as the cost and cleanliness of the transport, it was not clear actions had been taken to look into these matters to ensure the ongoing contentment of the residents. The possibilities of a quality review exercise using an independent person was discussed so that service users do not feel obliged to answer some of the questions how they think staff would want them to. The manager advised that he keeps in regular contact with all three houses so he is kept up-to-date on any concerns or developments concerning the service users. The manager also carries out staff supervision sessions on a regular basis so that any concerns staff may have can be discussed and actioned. A review of health and safety checks was undertaken to confirm residents are being cared for in a safe environment. Records confirmed that electrical portable appliance had been completed in all three houses. Weekly fire alarm tests were being undertaken and recorded and fire drills were taking place every eight weeks. It was not evident that each home had a Fire Risk Assessment in place. Gas safety check records were viewed for two houses and the manager has subsequently forwarded records to confirm the third house has been checked. It was not evident that each house has received a five-year electrical wiring check to confirm the electrics in the houses are safe. Fridge and freezer temperature records viewed showed these were operating at suitable levels for the safe storage of food. During the last inspection it was identified that there was no dividing partition in the roof space between property number 42 and the next-door house. This potentially leaves the property vulnerable in the case of a fire. The manager advised that he had been in touch with the local council to discuss this matter and to check if this was required. This issue remains outstanding and requires confirmation from the fire officer in regard to any actions that may need to be taken to ensure the home is complying with fire precautions. Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X 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 3 X 2 X X 2 X Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 27 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(2) Requirement Timescale for action 28/02/07 2. YA24 23(2)(p) 13(4) The manager is to review the management of medication to ensure this is effectively managed across the three houses. This includes the use of correct codes, recording all medication available and ensuring accurate records of administration. The registered manager is to 31/03/07 ensure appropriate risk assessments are carried out in regard to hot water and radiators and actions taken to manage any risks to service users. Other matters as contained in the body of this report are also to be addressed. The Registered Manager is to ensure a quality monitoring system is introduced which incorporates the views of service users; their representatives and other interested parties and publish any outcome results and actions in a report as appropriate. 3. YA39 24 30/04/07 Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 28 4. YA42 23(4) The Registered Manager must contact the local fire officer for advice concerning partitions between the roof spaces of adjoining properties to confirm if this meets with fire precautions. (Outstanding from February 2006 inspection) The Registered Manager is to take action in regard to health and safety checks required to safeguard residents. This includes the 5 year Electrical Wiring Check and Fire Risk Assessments for all homes. 31/03/07 5. YA42 13(4_) 23(4) 31/03/07 Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Paks Trust Clarence Street DS0000004458.V313018.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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