Inspection on 16/08/07 for Pen y Bryn

This inspection was carried out on 16th August 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Pen y Bryn 26/10/09

Pen y Bryn 20/06/06

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Hafod Road, 48 Hafod Road Hereford HR1 1SQ Lead Inspector Christina Lavelle Key Unannounced Inspection 16 & 22 August 2007 2.15-5.45 & 10-4.30 th nd Hafod Road, 48 DS0000065468.V343067.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 Hafod Road, 48 DS0000065468.V343067.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. Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hafod Road, 48 Address Hafod Road Hereford HR1 1SQ 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) 01432 375926 Milbury Miss Angela Tracy Townsend Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users may also have a physical disability and/or a mental disorder that are associated with their learning disability. 20th & 27th June 2006 Date of last inspection Brief Description of the Service: The service provider is Milbury, which is a national company that runs many registered care homes and supported living schemes for people with complex needs. This home at Hafod Road was registered in November 2005 to provide accommodation with personal care for up to eight adults, (men and women). Service users must require care primarily due to learning disabilities and may also have physical disabilities and/or a mental health disorder that is associated with their learning disability. Most service users will have an autistic spectrum disorder and may also use behaviours that can be challenging to a care service. They therefore have complex needs and require a high level of support from staff. One of the main aims of this service is stated as being to encourage the people living at the home to achieve their maximum potential in social skills and everyday life skills, so they may live as independent a life as possible. Hafod Road is located in one of Hereford’s older residential areas about a mile from the city centre. Service users can walk to town if they are physically able and the home is on a main bus route. The house is a large, detached Victorian property that has been converted to a care home. There are parking spaces at the front of the house and a large, enclosed garden to the rear. The home offers six bedrooms with en-suite facilities (including a shower or bath) and two self-contained flats with their own sitting room, kitchen and bathroom. There is a lounge, dining room and room with sensory equipment for everyone to use as well as a kitchen, laundry room, storage areas and an office. Fee levels vary according to the assessed needs of individual service users, as agreed with their funding authority. Additional charges include the following:• Personal toiletries and clothing. • Holidays - the first £200 being paid by the provider. • Newspapers & magazines. • Hairdressing. • Home’s vehicles -a weekly payment depending on whether they receive a higher or lower rate mobility allowance. Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a key inspection of Hafod Road, which means all the Standards that can be most important for people who live in care homes were checked. The first visit was made without telling anyone at the home beforehand. Time was spent with and/or talking to the people who live there and to staff. The second visit was arranged at the first visit to discuss how the home is being run and any changes made since the last inspection with the manager. Surveys asking about the service were sent to seven relatives of people living at the home and six health or social care professionals who are involved with their care. Six were returned and their views are mentioned in this report. A new annual self-assessment form was also completed before these visits. This asks managers to say what they think their home does well, what it could do better, what has improved and about their plans to improve the service. It also has information about people living there, staff and other aspects of the home. Various records kept by the home were checked and the house looked around. All other information received by the Commission about Hafod Road since the last inspection is also considered, including events affecting people living there. What the service does well: The manager and staff always visit people who might want to live at the home to assess their care needs. They can then visit and stay at the home to meet everyone and check out it would be suitable and they want to move in there. Each person living at the home has a care plan they are involved in making. Plans show all their needs, skills, likes & dislikes, goals and any possible risks. They help staff know how best to support them and how to keep them safe. People living at the home can choose what they do every day and their meals. Staff encourage them to be independent and develop their life and social skills. They support them with activities they like and to mix out in the community. Staff ensure the personal and health care needs of people living at the home are met properly. The home also manages their medicines safely for them. 48 Hafod Road is an ordinary house, which helps people living there fit in with the community. The home is in a good place near Hereford city centre with its shops and other facilities. It offers them a secure and very comfortable home. The home is generally well run by a qualified, experienced manager and staff provide good individual care to people living there. The quality of the service is regularly checked and plans made to keep on improving it for their benefit. Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. Thorough assessment and admission procedures are in place that help to make sure the home could meet the needs and wishes of prospective service users. EVIDENCE: It is confirmed by the manager that the needs of prospective service users are fully assessed. When a referral is received information is gathered from the person’s family, current placement and carers, health care professionals and a copy is obtained of their community care assessment drawn up by their care manager. Personal histories are sought and their views and preferences taken into account, through their families if they are unable to express them. A care plan and communication passport is drawn up as a starting block for a person centred plan that includes any risk assessments necessary. The home does not admit anyone unless they are compatible with people already living there. The home’s statement of purpose document describes an admission policy and procedure. Having received a copy of a community care assessment Milbury’s Operations manager (in consultation with the home’s manager and regional Behaviour Therapist) arranges a series of assessments for prospective service users. This includes their family and relevant people involved with their care. A service user’s guide to the home is provided in a user-friendly format. Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 9 There is then a transition period when the manager visits them at their current residence with care staff. They spend time there so they can get to know each other and staff observe and learn about support strategies. A care plan is then agreed that meets all the individual’s needs and wishes, with risk assessments when necessary. Any additional support and input needed is set out in their care plan and costs are agreed and shown in a service agreement document. This transition process appropriately includes introductory visits arranged to the home for a meal, overnight and weekend stays. Efforts are made to make admissions personal so that when a new person moves in for a trial stay they have started to develop a relationship with some staff and a staff member is allocated to show them around and help them settle in. A review is held at the end of three months, involving the service user, their family, staff and relevant other people before a decision is made about the suitability of the placement. Hafod Road, 48 DS0000065468.V343067.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. This judgement has been made using available evidence including these visits to the service. People living at the home each have a care plan showing their care needs and preferences, with risk assessments to minimise any safety risks. Staff promote their independence by supporting them to make choices in their daily lives and routines. When anyone is not able to make informed decisions then significant other people are involved and agree the action needed, in their best interests. EVIDENCE: A sample of care records was looked at and care planning discussed with the manager. They include a photograph, pen picture and background information. Each person has a care plan based on an assessment of their needs at the time and since their admission. Plans cover all relevant areas i.e. personal & health care, medication, mobility, social, relationships, daily living skills, cultural & spiritual expression, finance, behavioural and psychological needs. Most have their preferred morning and nighttime routines detailed and the plans include programmes to promote their independence and skills development. Some identify personal goals, although goal setting can be difficult as people with autism tend not to adapt well to changes and need a lot of support to do so. Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 11 The home operates an appropriately person centred approach to care planning. This aims to involve people living at the home in planning their own care and making choices to the extent they are able to. Plans are called “My Plan of Support” and are drawn up with their families and other professionals involved and reviewed by staff. The manager intends to introduce plans in a format that people living there can understand more easily and to develop life books. A keyworker and co-worker from the care staff team are allocated to particular people and try to get to know them better and provide more personal support. Plans are reviewed at least six monthly currently, although it is planned that keyworkers will review them three monthly. This review process also involves the people who live in the home as much as possible. Staff try to obtain the views of people living at the home about such as décor, food, when they rest, go to bed and what they wear. Although some people’s verbal communication is limited staff observe and take account of non-verbal signs and body language and use a variety of communication methods such as PECS symbols & Makaton sign language to obtain their individual views and preferences. Some have a communication passport to help staff understand their communication needs when they have built up methods to help them know what they like and want. Staff receive training relating to communication methods and it is good that the home is planning more training and to develop other techniques, such as using photographs and objects of reference. Behaviour management plans are in place for people who may use aggressive and extreme behaviours and/or self-harm. Some plans specify staff levels and additional support needed when they are at home or out in the community. Any limitations placed on their choice and freedom are specified and agreed. Risk assessments are also carried out, which focus mostly on promoting safety and welfare, including necessary guidance and protocols for staff to follow. Regarding issues of equality and diversity the home’s philosophy is to focus on individual needs. Whilst there are no specific or cultural differences amongst the current resident group gender issues are considered and would be reflected in their plans. Milbury’s policies & procedures promote equality and staff are encouraged to take a non-judgmental approach. All staff receive instruction on attitudes, values and confidentiality as part of their induction and the manager recently attended a training session on the Mental Capacity Act. She is aware of the process to set up best interests groups and how to ensure decisions are made by appropriate others when a person cannot make informed choices. Hafod Road, 48 DS0000065468.V343067.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, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. People living at the home are supported to take part in activities they enjoy and to maintain links with their families. With more staff time opportunities to pursue their individual interests and to go out in the community would increase Staff encourage shared responsibilities and the development of daily life skills. The home provides food that people like whilst healthier options are promoted. EVIDENCE: Each person living at the home has a schedule of activities they enjoy and a checklist showing what they have taken part in and if they seemed to enjoy and/or benefited from them or not. The manager plans to set up a format to find out what they think of their activities and rate the favourable ones, which would be good. In view that people with autism do not always relate well to other people or cope with unfamiliar environments and there can be difficulties due to behaviours, most do not attend day services or have work placements. Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 13 Despite this two people now attend a farm project and horticultural college and they all have a variety of options for activities within the home and out in the community, which are flexible with achievable goals set. These include a social club for people with learning disabilities and visiting local pubs and facilities. Staff report some have made progress and now mix with other people much more comfortably in community settings. The home has two vehicles and a few people had successful holidays this year. In the house there is a sensory room and foot spa and the garden is private and secure with space to walk around, play games in etc. if they want to. Everyone also has a TV, music centre and other personal possessions in their bedrooms to occupy them. The manager recognises that activity schedules need to be reviewed to include more individualised “person centred” activities. However this is somewhat difficult currently due to staff shortages. The home is trying to make sure that most people go out every day but as most need a lot of support, and some prefer to go out on their own, more group and in-house activities are having to be arranged. Staff also encourage their involvement in cooking and household tasks, which could just be observing. Some people help with their laundry and cleaning their bedrooms on a flexible basis, to help them develop daily living skills and take some responsibility for the day-to-day running of the home. It is confirmed that people living at the home are supported to maintain links with their families. Visitors are made welcome and keyworkers help to arrange and facilitate visits and stays at their family homes. Relatives indicate in their surveys they are satisfied with the overall care provided, some commenting that efforts are being made to provide social stimulation and to meet individual needs. Whilst they also acknowledge difficulties due to their behaviours and the adverse effect of a high staff turnover. Most of them feel they are kept in touch and all say they are always kept up to date about important issues. Regarding food provided by the home there is a four-week set menu and staff involve people living there in choosing the meals and/or take account of known preferences. Menus include special dietary needs and alternatives can always be requested. They reflect a variety of wholesome meals and staff have made efforts to produce them using more fresh ingredients. The manager’s plan to create menus in a pictorial format would be good. Snack meals and breakfasts are chosen more flexibly and staff also promote healthier options e.g. cereals, yoghurts, fresh fruit and juice, home made soups and omelettes. Two people receive input and advice from a Dietician and there is guidance for staff about suitable food and healthy eating in general. A mealtime was seen to be a social occasion, although people choose to eat alone if they prefer or need to. Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including these visits to the service. Staff support people who live at the home with their personal and health care. It would help to confirm all their health related needs are being monitored, and preventative as well as routine and specialist health care input accessed to promote their wellbeing, when their Health Action Plans are fully implemented. Medicines are managed safely in the home on behalf of the people living there. EVIDENCE: Care records include detailed information about the physical and mental health and the personal care needed by people who live at the home. They include support and interventions required from staff and their preferences in respect of personal care e.g. a bath or shower and the gender of carers. Some people have a communication strategy for their continence management. Records are made of any specific and general health related issues and all visits, input and of treatment received from health care professionals e.g. GPs and Dentists and to specialists (such as a Psychiatrist) with outcomes. When necessary physical checks are made for individuals e.g. weight and food intake, with records kept. One care manager comments, “Physical health needs are well attended to”. Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 15 Everyone living at the home is registered at one GP surgery. This practice indicates that the home communicates and works in partnership with them and there is always a senior to confer with. They can see their patients in private and feel that staff understand the needs of people who live at the home and incorporate advice they give in their care plans. This GP has no complaints and is satisfied with the care provided. Milbury provide a specialised service and so have a qualified Crisis Prevention Intervention & Behavioural Therapist to support and train staff. Although the home and a care manager report that this professional now has an increased workload and is currently not always able to give as quick and detailed a response and input as may be needed. Milbury provides a Health Action Plan (HAP) format, which is a comprehensive checklist of how service users’ health care needs are being addressed and the preventative measures taken to identify any health care issues as they arise. However the HAPs seen at the home had not been fully set up and some only included basic details. HAPs are recommended by the Department of Health for people with learning disabilities. Their main aims are to support people to manage their own health care and to ensure all their special health care needs are identified and being monitored and their good health promoted through preventative, as well as routine and specialist, health care input. Clearly the sooner they are implemented and used as a working tool the better. Regarding medicines kept in the home, all staff designated to deal with and administer undertake appropriate safe handling of medicines training. Milbury provides policies & procedures on medication including guidance on practices, use of controlled drugs and relating to specific medications some service users may be prescribed. Care records at the home include details of each person’s medical history and their current medication. There are also protocols in place when medicines are prescribed “as and when required” and only senior staff can authorise their use and then have to explain the reasons in care records and ask another staff member to countersign this account. Patient Information Leaflets are always kept and there is an up to date medication reference book available to staff. Records of medicines kept in the home and administered are maintained properly and include a sample of staff signatures and photographs of people living at the home who receive medication. Whilst the home assesses and would support self-administration most are unable to. Medicines are a stored in a suitably secure cabinet and staff hold the keys for safety. There is a fridge if needed, and it’s temperature is checked regularly. Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 16 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. This judgement has been made using available evidence including these visits to the service. People living at the home are supported to express their views. There are also systems in place to protect them and to manage complaints about the service. EVIDENCE: There is a suitable written complaints procedure and prospective service users are given a copy during their admission. Whilst most people living at the home are not able to raise concerns directly their views and choices are sought through keyworkers and using communication methods set up to meet their individual needs. They all have family input and their relatives confirm they know how to make a complaint, feel able to raise concerns and mostly received appropriate responses from managers. The home operates a system to record complaints received, with details of investigations, action taken and outcomes. No complaints had been made to the Commission since the last inspection. Staff are required by Milbury to attend training sessions relating to abuse, adult protection and whistle blowing and provide relevant policies & procedure. The home also has a copy of the Herefordshire multi-agency procedures for the Protection of Vulnerable Adults (POVA) and staff attended a training session taken by the local POVA co-ordinator. Staff also receive training to help them manage crises and challenging behaviours. Incident and accident records are kept and reviewed to make sure they are being dealt with appropriately. Two notifications have been reported to the Commission regarding possible abusive staff practices. Both were dealt with under Milbury’s disciplinary processes and one was appropriately referred under the POVA multi-agency procedures. Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 17 There are also policies & procedures in respect of the management of money and financial affairs. Everyone living at the home has an individual savings account at the bank for their personal allowance. One person can sign their name to withdraw their own money and the home supports and deals with the others with them and on their behalf. Records and receipts to account for all withdrawals and spending are appropriately kept. Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including these visits to the service. Hafod Road provides a very comfortable home that suitably meets the needs of the people who live there. Arrangements are in place to keep the premises clean, safe and to maintain good repair, hygiene and infection control. EVIDENCE: Hafod Road is conveniently located for the shops, services and amenities of Hereford city, which are within a reasonable walking distance. The home also has its own vehicle to provide transport further afield. The property is a large detached house with a large enclosed garden at the rear. The home is decorated, furnished, and equipped to a high standard and the impression is a homely and comfortable environment. A care manager comments it “Provides a warm, homely environment and the physical surroundings are excellent”. The accommodation includes six spacious and suitably furnished bedrooms, with en-suite facilities that include a bath or shower. There are also two selfcontained flats with separate entrances, their own living room, kitchen and Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 19 bathroom. People living there have been encouraged to make their bedrooms personal and to use them as private space when they want to . The home has a separate sitting and dining room and a fully equipped sensory room for everyone living there to use. The furniture is suitably robust and mirrors and fittings etc. are stainless steel to protect them if necessary from destructive behaviours. The décor is low stimulus and there are arrangements to ensure the security of the building, such as fencing around the garden and front door and other keypad locks. It was previously confirmed that this would not restrict access to anyone capable of going out or into the kitchen alone and they could have the code if able to use it (or staff would facilitate their access). There is also a suitably equipped laundry room, storage areas and office. It is confirmed that maintenance and repair systems are working efficiently and the home can sort out any emergencies directly. There are policies & procedures in respect of infection control and protective gloves and clothing are provided. The home was seen to be clean and tidy and a cleaning schedule is operated to make sure necessary jobs are done. The home has a clinical waste contract and liquid soap and paper towels are used for good hygiene. Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 20 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, 33, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including these visits to the service. Staff turnover is affecting staffing levels, which has an adverse impact on care continuity, staff training and the time staff have to provide individual support to people living in the home and to facilitate their activities outside the home. Milbury operate thorough recruitment procedures, which should help to ensure only suitable staff work at the home for the protection of people living there. EVIDENCE: The home has a large staffing establishment, comprising the manager, deputy manager, two seniors and twenty support workers. This level is necessary due to service users’ complex needs and is why the intent is expressed in the home’s service user guide for one staff member to be available for each person living at the home all day. However ten staff have left during the last year and there are currently still three vacant posts and two staff not available for work. This has affected the stability of the staff team and consistency of care. It also means experienced staff have had to support new staff through their induction training and probationary period and this also impacts on time to refresh their own training and for all staff to attend training on more specialist topics. Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 21 One care manager comments on staff turnover and shortages as they feel this has somewhat affected the implementation of care plans and opportunities to access the community. Two relatives say staff levels affect their availability to support people with activities, which has already been discussed in this report. The manager does feel however that the core staff team is more settled and is hopeful the continued recruitment drive will focus on attracting suitable staff. Whilst she is reluctant to use agency staff (because people with autism find it difficult to deal with new people and their complex needs require more time to understand) there is regularly not enough staff to provide individual support for the seven people, which clearly must put pressure on staff. The staffing situation therefore should be kept under continual review to ensure the home is fulfilling its purpose and meeting agreements made with funding authorities. Regarding staff selection and recruitment Milbury provides the full range of employment policies & procedures. Each person employed undergoes a robust recruitment process and is given a copy of a code of conduct, an induction workbook, whistle blowing and grievance & disciplinary procedures. They are required to sign a contract and have a clear job description. It is confirmed prospective staff complete an application form, including their full job history. Any gaps are explored and two written references taken up, one from their most recent employer. New staff never work directly with people living in care homes until two satisfactory references and a CRB (police check) are received. Milbury provides a comprehensive induction programme that new staff have to complete within their first thee months. Each staff member has an individual development & supervision plan with formal supervision sessions arranged and they have an annual appraisal and skills assessment. New staff then enrol on the LDAF induction programme, which is accredited especially for staff working with people who have learning difficulties. Their appointment is not confirmed until they have completed a six-month probationary period. All the staff team also undertake training in the mandatory health & safety areas. They are expected to move onto an NVQ qualification in care and although only eight staff currently have an NVQ, more are soon to start. Training in topics relating to the special needs of people living in the home are also available e.g. autism awareness, effective communication and non-violent crisis intervention. Whilst there is clearly a commitment to training this has been effected by staff turnover, which in turn reflects on the knowledge and skills of the staff team. It is good however that the home’s training plan shows much training is being arranged to make sure staff receive necessary training and/or refreshers due. Regular staff meetings are also held and staff are clear about their role and responsibilities. They receive formal individual supervision, which again will be more regular now that the new deputy manager is settled in post. Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including these visits to the service. The home is well run by a qualified and experienced manager and there seems to be an open, positive management approach. There are systems in place to monitor the quality of the service, which should ensure it continually develops for the benefit of the people who live there. Policies, procedures and working practices promote safety to protect people living and working at the home. EVIDENCE: The manager (Angela Townsend) has over eighteen years experience working in residential care with people who have learning disabilities. Ms Townsend has undertaken much training relevant for this role and recently achieved a qualification in management and care (The Registered Manager’s Award NVQ level 4). She is clear about the post’s responsibilities and some management tasks are appropriately delegated to the deputy manager and senior staff. It is Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 23 confirmed the home and manager also receives support from Milbury through regular visits, supervision and the company’s teams e.g. Human Resources. Milbury have implemented a formal quality assurance and monitoring system (QA) for their care services that results in an annual business plan for their development. All aspects of the service are audited regularly when shortfalls are identified and action plans are drawn up, with timescales to address them. As part of the QA process the views of people living in the home are sought and/or represented through their keyworkers, family and other professionals. There is a service quality questionnaire sent out to them, which has a scale for them to rate the environment, catering, personal support & care, daily living, within the home and management for families, with space for their comments. Regarding health & safety staff undertake training in the mandatory topics i.e. fire safety, first aid, food hygiene, infection control and moving & handling. Comprehensive policies and procedures are also provided covering all relevant areas of health & safety to ensure that staff practices and the environment promote the health, safety and welfare of residents and staff. The following information supports this: • The fire safety system & equipment are serviced/checked as required. • Contracts are in place for regular serving of gas & electrical installations. • Portable electrical appliances are checked annually. • Water temperatures are checked weekly and steps taken to reduce risks from Legionella. • COSHH and other necessary risk assessments are carried out. • Accident and incident records are kept and reported appropriately. Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 24 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 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 2 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X X 3 X Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered persons meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the registered provider to consider carrying out. N Refer to o. Standard 1 YA19 Good Practice Recommendations The home should fully implement Health Action Plans (HAPs) for people who live in the home as soon as possible. HAPs help to confirm their health needs are being monitored and their good health promoted. Also they show they are being supported to manage their health care through preventative, as well as routine and specialist, health care input Staffing levels should be sufficient to provide individual support for people living at the home and to facilitate their activities and community integration. The home’s recruitment drive should continue and high staff turnover be reviewed to ensure the home is fulfilling its stated purpose and meeting agreements made with funding authorities 2 YA33 Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Hafod Road, 48 DS0000065468.V343067.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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