Inspection on 08/01/08 for Pennings View

This inspection was carried out on 8th January 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pennings View 22/01/07

Pennings View 02/12/05

Pennings View 25/05/05

Pennings View 12/01/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Pennings View Porton Road Amesbury Wiltshire SP4 7LL Lead Inspector Elaine Barber Unannounced Inspection 8th January 2008 10:55 Pennings View DS0000060337.V354646.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 Pennings View DS0000060337.V354646.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. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pennings View Address Porton Road Amesbury Wiltshire SP4 7LL 01980 624370 01672 569477 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) Cornerstones (UK) Ltd Acting Manager Pascale Oban Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Any placement for short-term care or for emergency placement must be agreed with the Commission before the placement commences. For the purpose of this condition, short-term is defined as a placement that is expected to last not longer than 3 months. An emergency admission is defined as an admission whereby someone is likely to be placed at short notice without an up-to-date assessment of needs having been carried out and the person has not had the opportunity to visit the home prior to placement. 22nd January 2007 Date of last inspection Brief Description of the Service: Pennings View is a privately owned home. It provides care and accommodation for 7 young adults with learning disabilities. The owners, Cornerstones UK Ltd., have a number of similar homes across the county of Wiltshire. Pennings View is on the outskirts of Amesbury. Residents are able to access a range of local amenities. The property is a two storey domestic dwelling. There are bedrooms on both floors. Each person who lives in the home has a single room. One of these has an en-suite bathroom. There is a large garden at the rear of the house. Information about the home is available in the home’s Statement of Purpose and Service User Guide. Inspection reports are available in the home and can be downloaded from www.csci.org.uk. The fees range between £799.36 and £1062.83. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection included an unannounced visit to the home on 8th January 2008 and a planned visit the following day. During the visits information was gathered using: • • • • • Observation Speaking to seven people who lived in the home Discussion with the manager. Discussion with two members of staff. Reading records including care records. Other information has been received and taken into account as part of this inspection: • • An Annual Quality Assurance Assessment (referred to as the AQAA). The AQAA is the owner’s assessment of how well they are performing. It also provides information about what has happened during the last year. Comment cards that were returned by four people who lived in the home, four relatives, two staff members and two social workers. The judgements contained in this report have been made from all this evidence gathered during the inspection. What the service does well: There was a statement of purpose and a service user guide with simple words and pictures. Each person had been given a copy of the guide. This meant that they had had enough information to decide whether the home could meet their needs. People were able to visit the home, to decide whether the home could meet their needs. Their needs were assessed by a social worker before they moved in to make sure that their needs would be met. Each person had a contract with the home when they moved in so that they knew what fees they had to pay. Each person had a care plan setting out how their needs would be met, to ensure that their needs would be met. People made decisions about their lives with assistance as needed. They were supported to manage their money. They chose the food they ate, the clothes they bought and wore, the décor of their rooms and their activities. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 6 Each person had risk assessments, which focused on keeping them safe. People were supported to take risks as part of an independent lifestyle. People were provided with a range of activities and opportunities, offering access to their local community. Each person had a day time activity of their choice. The used the community facilities such as the shops, pub, cafes and church. People had access to the community on a daily basis. Staff took them out individually and in small groups. People were able to maintain and develop appropriate relationships with family and friends. They had regular visits to friends and relatives and friends and relatives were also welcome in the home at any time. Everyone had visited their family or friends at Christmas. Routines were flexible and fitted in with people’s activities. People participated in the household chores. Each person had their own room and chose to spend time in the privacy of their room or in company in the communal areas. People’s rights were respected and their responsibilities were recognised in their daily lives. There was a varied menu, which reflected people’s choice of meals. Special diets were catered for. People had opportunities to go food shopping. Everyone had decided to concentrate on healthy eating and exercise after Christmas. They were offered a healthy diet and enjoyed their meals. There was information about people’s individual needs and preferences in their assessments and care plans. People’s preferred routines were recorded in their personal notes so that people received support in ways they preferred and required. People’s healthcare needs were included in their personal plans. Each person was registered with a GP and they saw a range of health professionals including a physiotherapist, community nurse, practice nurse, occupational therapist, psychiatrist, dentist, optician and chiropodist. People’s physical and emotional health needs were met. Staff supported people to take their medication. There were appropriate arrangements for the administration and recording of medication and people were protected by the home’s policies and practices. There was a large lounge with a dining area and a large kitchen with a seating area. People lived in a comfortable, clean and safe environment, suitable to their needs. The shared spaces complemented people’s rooms, which were individually decorated and furnished. There were sufficient toilet and bathroom facilities to ensure privacy and meet people’s needs. There were infection control guidelines and the laundry facilities met the needs of the people who lived in Pennings View. The home was clean and hygienic. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 7 There were six support workers, the manager and a deputy. There was a range of training to ensure that staff could meet people’s diverse needs. More than 50 of the staff had a National Vocational Qualification or equivalent. People were supported by an effective staff team, who were appropriately trained and competent to meet their needs. There had been no new staff since the last inspection when it was noted that all the appropriate recruitment checks were completed before staff started work. People were protected by the home’s recruitment practices. The manager had a relevant qualification and experience and people were benefiting from a well run home. A quality assurance survey had been conducted and views of people who lived in the home and relevant professionals had been collected. The need for improvements in some areas of the service had been identified. There was a range of health and safety measures and staff had received appropriate training. People’s health and safety were protected by the majority of the systems in place. What has improved since the last inspection? What they could do better: Each person must have an up to date contract and statement of terms and conditions with the home so they know what to expect from the service and how much it costs. They or their representative should sign the contract to show that they are in agreement with it. The risk assessments could be improved by including the benefits to people of taking particular risks. This would show why risks are being taken and whether it is in the interests of the person. Improvements must be made to the recording of personal money to ensure that their financial interests are safeguarded. Improvements also need to be made to the storage of medication to ensure the medicines people take are effective. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 8 The guidance about the application of physical interventions to individual people should be developed further, to include more detail about the techniques that are appropriate with each person, how long it is appropriate to use the techniques and when and how to disengage. There should be clearer explanations about some behaviours for example when someone had ‘calmed down’. This will help to ensure that people do not suffer harm. Changes identified in the quality assurance process should be based on the views of people who live in the home and show how these changes will benefit them. The thermostatic valves on taps should be regularly serviced and water temperatures should be checked regularly to ensure that the valves maintain the water at the correct temperature and reduce the risk of scalding. 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. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 9 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 Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 10 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): 1, 2, 5 Quality in this outcome area is generally good. This judgement has been made using available evidence including a visit to this service. People were given enough information and were able to visit the home, to decide whether the home could meet their needs. Their needs were assessed before they moved in to make sure that their needs would be met. Each person had an old contract with social services and the home so people would not know how much they had to pay at the time. EVIDENCE: There was a very detailed statement pf purpose, which contained all the required information about the service. This had been updated in October 2007. There was also a service user guide, which contained the necessary information. This was being updated and the new one was in large print and had pictures. One person who lived in the home looked at the new guide and said that they were able to read it. The records of three people were read including their care plans. There was a comment in each plan to say that the person had been given a service user guide. At the last inspection it was noted that people had visited the home and met the staff and people who lived there before they moved in. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 11 Nobody had moved into the home since then. Two out of the four people who completed comment cards said that they were asked if they wanted to move into the house. They also said that they received enough information before they moved in so that they could decide if it was the right place for them. The other two could not remember when they moved in. Four relatives said in their comment cards that they and their relative were always given enough information to make decisions. Each of the three people had assessment information in their file. They also had social work care plans when they moved in and new social work care plans following a review. The manager said that people had contracts with social services. There were old contracts from when people moved into the home. However, up to date contracts could not be found for each person. The area manager had written to one of the community teams for people with learning disabilities to ask for new copies but there had been no reply. One person had a contract with another community team showing recurring payments but this was not signed by any of the parties to the contract. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 12 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 generally good. This judgement has been made using available evidence including a visit to this service. Each person had a care plan setting out how their needs would be met, and these were reviewed regularly to ensure their needs were met. People made decisions about their lives with assistance as needed. They were supported to manage their money but their interests were not wholly safeguarded by the way this was recorded. People were supported to take risks as part of an independent lifestyle. However, it was not clear why some risks were being taken and whether this was in the interests of the person. EVIDENCE: The care plans of three people were read. Each person had a detailed care plan covering all aspects of their personal, social and health care needs. Plans included information about each person’s strengths, needs, likes and dislikes. Care issues were defined, with goals and objectives set for addressing these. Support was described under a range of headings. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 13 Plans were cross-referenced to other relevant documents, such as risk assessments. Each plan was signed by the person and the staff. The plans had been reviewed and dates of reviews were recorded. There were evaluations of progress with meeting care plan objectives every month and three months. Any restrictions were recorded in the care plans. All four relatives who completed comment cards said that the home always gave their relative the support that they expected. Each of the three people, whose records were seen, had a series of risk assessments. Some were general for each person for example going out in the community or locking the fridge. This was done at night because of certain behaviours by some people. Others related to the particular needs of the person and their behaviours or activities. The risk assessments focused upon hazards and problems and the actions needed to reduce risks. Some of the risks appeared to be so great it was not clear why people were continuing with the activity such as using electrical equipment. The risk assessments did not include the benefits of taking a particular risk, for example, using electrical equipment or going out in the community. Outside the home, all the people who lived in the home required staff support. Risk assessments made it clear which people were not safe to travel together. Staff working away from Pennings View carried mobile phones, so that they could obtain support if necessary. During the inspection people were observed making choices, for example, whether or not to go out, what drinks to have and where in the house to spend their time. Staff said that people were involved in choosing the menus and shopping for food. During the inspection a balance was observed between activities and household routines. Any restrictions were recorded in the care plans and there were detailed plans to manage behaviour. Three people who completed comment cards said that they always made decisions about what they do each day and one person said that they sometimes did. All four said that they could do what they wanted during the day, the evening and at weekends. Staff supported people to manage their own money. The manager was appointee for one person. There was information in the care plans about how people managed their money and the arrangements for withdrawing money. Each of the three people had a bank account and paid their fees by standing order. Staff helped people to withdraw small amounts of money to spend. Bank statements and cash records were seen. The cash sheets were cross referenced with the bank statements and were signed by two members of staff when a withdrawal was made. One error was noted in the cash records. A member of staff had helped someone to withdraw £60 from the bank to buy Christmas presents for their relatives. However, this was recorded on the cash sheet as £50 in and £40 was taken out. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 14 The member of staff said that they took the person shopping and knew how much they had spent but could not produce the receipts to confirm this. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 15 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. This judgement has been made using available evidence including a visit to this service. People were provided with a range of activities and opportunities to use community facilities. They maintained and developed appropriate relationships with family and friends. People’s rights were respected and their responsibilities were recognised in their daily lives. They were offered a healthy diet and enjoyed their meals. EVIDENCE: All the people who lived at Pennings View were spoken to. One person was at home all day on one day of the inspection. They said that they preferred not to go out on a regular basis. They were looking forward to going to the pub for a meal the following day. On the first day of the inspection five people had been to the day service run by the organisation and one person had been to a day centre. They came home and talked about their day. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 16 All said that they enjoyed going to their day services and had had a good day. The following day two people went to the day centre. When they came home they talked about going swimming and said that they had enjoyed themselves. The other five had been to the pub for lunch and to play skittles. They all said that they had enjoyed their lunch and had a good day. People had monthly evaluation sheets and quarterly evaluation sheets in their personal records to monitor aspects of their care. Three people’s records were seen. These showed that they had a range of activities. These included going to church, arts and crafts, going for a drive, going shopping for food and for personal items, beauty sessions, discos and clubs. People also went for walks and had meals out. At home they watched television and DVDs and participated in the household chores. People talked about their activities. People said that they went to the pub, to restaurants, the shops, clubs, discos and on holiday. One person had been on holiday to America with their family. Staff had supported people to buy presents for their relatives just before Christmas. The manager said that everyone had gone to visit friends or relatives over Christmas. People said that they visited their family and friends. Six people talked about staying with their families over the Christmas period. One person said that they went to visit their boyfriend on Christmas day and regularly saw their boyfriend. Another said that they phoned their father and stepmother weekly and they visited them. A third person said that they visited their mother regularly. There were records of contact with family in the personal notes. The four relatives who completed comment cards said that the home always helped their relative to keep in touch with them. One said that their relative could ring them whenever she liked. All four relatives also said that they were always kept up to date with important issues affecting their relative. Routines were flexible and fitted in with people’s activities. People had their own bedrooms and they had unrestricted access to the shared areas. People could see their visitors in the privacy of their rooms. The staff were observed to interact with the people who lived in the home and not just with each other. People could choose to have privacy in their rooms or be with others in the communal areas. There was a varied menu. The manager said that staff sit down with people and choose the menu. She said that staff have knowledge of people’s likes and dislikes. She also said that at the last residents’ meeting everyone decided to concentrate on healthy eating and exercise after Christmas and two of the people confirmed this. There was a choice of breakfast. People tended to eat their main meal at the day service or take a packed lunch. The person who stayed at home was offered a choice of sandwiches for their lunch. On the second day of the inspection two people who had been to the day centre took sandwiches and were offered a choice of cooked meal for their tea. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 17 The people who had been for the pub lunch were offered a choice of sandwiches or toast. All the people spoken to said that they enjoyed the food. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 18 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 a visit to this service. People received support in ways they preferred and required. Their physical and emotional health needs were met. People were protected by the home’s policies and practices about medication although some improvements need to be made to the storage to ensure the medicines people take are effective. EVIDENCE: People’s individual routines and the ways in which they liked to be supported were recorded in their care plans. People’s health care needs were also recorded in the support plans. People were registered with the GP. The manager and a member of staff said that people also saw the optician, dentist and chiropodist. Some people saw the chiropodist on the second evening of the inspection. Each person had health care records. Three of these were seen. They showed that people saw the GP, physiotherapist, occupational therapist, psychiatrist, community nurse, practice nurse, optician and chiropodist. Some people also had hospital visits. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 19 The two professionals who completed comment cards said that people’s health care needs were met. One person had a health action plan. This is a plan provided by the health service to ensure that people get the health care they need. A member of staff said that everybody had not yet had a health action plan. There were comprehensive medication policies including administration, storage, self-medication and leaving the home with medication. People’s consent to take medication was recorded in their personal plans. They also had a list of medication taken. Medication was stored in a locked cabinet. However, this was over a radiator and in a place where it could be affected by steam and heat. Some medicines are badly affected by heat and steam. The manager said that she would think about other places she could put the cabinet. Records were kept of medication received into the home, administered and returned to the pharmacist. The medication administration records were appropriately recorded. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 20 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 a visit to this service. People’s views were listened to and acted upon. People were generally protected from abuse, neglect and self harm. However, there should be further clarity about when it is appropriate to use physical intervention and improvements need to be made to the recording of money so that people are protected. EVIDENCE: There was information in the statement of purpose and service user guide about how to make a complaint. There was also information in the personal records about staff explaining the complaints procedure to people so that they would understand the process. One person could not remember being given a copy but they knew how to make a complaint. The other people who were spoken to knew who to talk to if they had a complaint. Three out of four relatives who completed comment cards were aware of the complaints procedure. Three relatives said that the home responded appropriately if they had any concerns about the care and one said this was not applicable. There had been no complaints. Three people who completed comment cards said that they always knew how to make a complaint and one said that they sometimes did. Three people also said that staff always listen and act on what they say and one said that they sometimes did. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 21 There were guidelines about protection from abuse and a procedure for reporting allegations of abuse. There was information in the personal records which showed that the procedures had been used appropriately in the past. There had been no recent allegations of abuse. There were also policies about whistleblowing, harassment and bullying. All the staff had received training about prevention of abuse in May 2006. Some people required support with managing their behaviour and there was guidance about this. There was information about which behaviours may cause problems for people along with information on how to minimise the likelihood of these occurring. Strategies had been developed with input from the whole staff team, and other relevant professionals. Any agreed restrictions were set out, along with the reasons for them. There was space on support plans for everyone to sign up to the agreed approach. On occasions staff were physically holding some people to prevent them from coming to harm. A record was made whenever this occurred, and was generally of good quality, with clear and informative detail. Incidents were reported to the CSCI as required. There was evidence that staff have received relevant training on the techniques used. The same four different holds could be used for each person. A recommendation was made at the last inspection that the guidance about the application of physical interventions to individual people should be developed further, to include more detail about the techniques that are appropriate with each person, how long it is appropriate to use the techniques and when and how to disengage. This had not been addressed. The guidance had changed little since the last inspection. There was a copy of the policy in each person’s file and it stated that staff should disengage when the person had calmed down. Each person had the same policy in their file and it was not specific to their individual requirements. One person had a list of codes, which described the severity of behaviours and the specific behaviours which required particular physical or verbal interventions. The psychologist had recommended a more specific procedure for one person to manage incidents of self-harm. They suggested that the person’s procedure should include indicators of when the person had calmed down and descriptions of behaviours such as what was meant by ‘aggressive’. These recommendations had not been followed up. There had been one allegation of abuse, which had been investigated by the police and social services. They had found the allegation to have been unfounded. The organisation co-operated fully with the investigation. People were supported to manage their money and to withdraw money from their bank accounts when applicable. The manager was appointee for one person. As referred to earlier in this report some errors were identified in the financial records. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People lived in a homely comfortable and safe environment. Their bedrooms suited their needs and lifestyles. There were sufficient toilet and bathroom facilities to ensure privacy and meet people’s needs. The shared spaces were large and freshly decorated and complemented people’s rooms. The home was clean and hygienic. EVIDENCE: There was information in the statement of purpose about room sizes, which indicated that all the bedrooms exceeded 10 square meters. Each person had a single room, which was decorated and furnished to reflect their individual personality. All the rooms were lockable. The bedrooms varied considerably in size and layout. Two were on the first floor and these had areas of sloping ceiling, and dormer windows. Some ground floor bedrooms had French doors. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 23 One bedroom had an en-suite bathroom. The rest of the household had two other baths, both with showers. There were also three toilets. Communal space consisted of a large lounge; an entrance hall with some seating; and a large kitchen with a small seating area around a table. Since the last inspection the lounge had been redecorated with neutral colours. There were new sofas and cushions and new curtains had been bought and were waiting to be hung. People said that they liked the new décor. The front hall, stairway and one of the bathrooms had also been redecorated. New flooring had been laid in this bathroom and an adjustment had been made to the edge of the bath to make it easier to get into the bath. The other bathroom was in the process of being redecorated. There was a staff sleep in room on the first floor, which was also used as an office. There was a large well-maintained garden, which was used in the summer. There was a laundry area next to the kitchen, with a washing machine and tumble drier. There was a problem with the tumble drier door at the time of the inspection and the manager was arranging for it to be repaired. There were infection control guidelines. The home was clean throughout. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were supported by an effective staff team, who were appropriately trained and competent to meet their needs. People were protected by the home’s recruitment practices. EVIDENCE: The staff rota showed that there were three staff on duty during the day and evening with one member of staff sleeping in. Usually two staff went to the day service with people and one member of staff stayed in the home with the person who chose not to go to day service. The staff team consisted of the manager, deputy manager, and six support workers. There had been no new staff since the last inspection. It was noted at previous inspections that all the staff employed had had all the necessary recruitment checks before they started to work with the people who lived in the home. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 25 Two staff who completed comment cards said that the employer completed checks such as Criminal Records Bureau (CRB) and references before they started work. Staff received a range of training including first aid, food hygiene, manual handling, health and safety, physical intervention, safe handling of medication, prevention of abuse, autistic spectrum disorder and mental health needs. One staff member said that there was a range of training and they had regular updates. The training plan for the forthcoming month showed that staff had refresher training for example in first aid and food hygiene. Two staff who completed comment cards said that they were given training that was relevant to their role, helped them to understand the needs of the people they supported and kept them up to date with new ways of working. One of these staff said that there was lots of ongoing training. Three of the four relatives who completed comment cards said that staff always had the right skills and experience to look after people properly and one said they usually did. Three relatives said that staff always met people’s diverse needs and one said that they usually did. The manager had a qualification in the advanced management of care. The deputy had National Vocational Qualification (NVQ) in care at level 3. Two other staff had NVQ 3, one had NVQ 2. Two staff had undertaken learning disability award framework training. Another staff member had a degree in psychology. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is generally good. This judgement has been made using available evidence including a visit to this service. The manager had appropriate training and experience and people were benefiting from a well run home. There was a detailed quality assurance process but service developments were not based on the views of people who lived in the home. People’s health and safety were protected by the systems in place. EVIDENCE: The registered manager had retired since the last inspection. A new manager had been appointed and had been the acting manager since May 2007. They had recently applied to become the registered manager. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 27 They had a qualification in the advanced management of care and were undertaking the registered managers award. There is evidence throughout this report that the service was being well managed. Quality assurance was being developed. At the last inspection it was noted that questionnaires had been sent to care managers, doctors, community nurses and other professionals. The views of the people who lived in the home had been sought. The information had been collated at head office and some recommendations about improvements in communication with professionals had been made. However a report of the findings and an improvement plan had not been produced. A requirement was made that the registered person must produce a report of the findings from the quality assurance survey, supply to the Commission a copy of the report and make a copy of the report available to people who use the service. This had been addressed. A report of the quality review was sent to CSCI in April 2007 and a quality assurance audit of the environment report was sent in May 2007. The report identified provision for questionnaires to be sent to people who used the service, relatives and interested professionals but the findings of the report did not appear to be based on these and referred mainly to care planning. There was a strong focus on the systems and processes in place, for example for care planning, rather than the outcomes for people and how developments would benefit them. The manager reported that surveys had been sent out again to people who lived in the home, relatives and care managers but these had not been collated yet. There was a health and safety policy. There was information about health and safety, Control of Substances Hazardous to Health (COSHH), food safety and manual handling. Staff received training about health and safety, first aid, food hygiene, and manual handling. There was a quarterly check of all areas of the house to ensure they were maintained safely. Radiators were covered and the hot water temperature was regulated by thermostatic valves to reduce the risk of burns and scalding. These were installed about three years ago. A recommendation was made at the last inspection that the thermostatic valves on taps should be regularly serviced and water temperatures should be checked regularly to ensure that the valves maintain the water at the correct temperature and reduce the risk of scalding. The manager reported that this had not been done. However, there were some problems with the flow of water and the water from the hot taps ran for a long time before it became hot, which allowed a lot of time for people to note if there was a problem. This meant the risk of scalding was low. Portable appliances were tested annually and the last test was in January 2008. The boiler was serviced annually and the last service was in May 2007. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 28 There were general and individual risk assessments. Risk assessments for lone working had been updated in December 2005, and all staff had signed to indicate their awareness of these. This would ensure that people who lived in the home and the staff were kept safe. There was also a detailed fire risk assessment for all areas of the building and this was due to be reviewed in January 2008. Fire safety checks took place and were recorded and the January checks were due. There were regular fire drills and staff received fire instruction. The fire extinguishers were serviced during the first day of the inspection and a fault was repaired on one of the smoke detectors. The environmental health officer visited in June 2006 and made a requirement. The manager had addressed this by buying a new fridge. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 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 3 X X 3 X Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 30 No 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 (b)(c) Requirement Timescale for action 28/02/08 2. YA7 16(1)(l) Schedule 4 , 9(a) The registered person must agree with each person an up to date contract with a statement of the terms and conditions and the fees. When money is kept on behalf of 08/01/08 a person an accurate record must be kept of when the money is deposited and when the money is returned to them. Any withdrawals of cash from the bank must be accurately accounted for. When staff support people to buy items receipts must be kept and cross referenced with the cash sheets. 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. Refer to Standard YA5 Good Practice Recommendations The contracts should be signed by the person who uses the service or their representative to show that they are in agreement with it and it represents their interests. DS0000060337.V354646.R01.S.doc Version 5.2 Page 31 Pennings View 2. YA9 3. YA20 4. YA23 5. 6. YA39 YA42 The risk assessments could be improved by including the benefits to people of taking particular risks. This would show why risks are being taken and whether it is in the interests of the person. The temperature of the medication cupboard should be monitored to ensure it does not exceed the limits identified in the patient information leaflets. If a problem is identified the medication cupboard should be moved to a place where medicines cannot be affected by heat or steam. The guidance about the application of physical interventions to individual people should be developed further, to include more detail about the techniques that are appropriate with each person, how long it is appropriate to use the techniques and when and how to disengage. There should be clearer explanations about some behaviours for example when someone had ‘calmed down’. Developments identified in the quality assurance report should be based on the views of people who live in the home and show how these developments will benefit them. The thermostatic valves on taps should be regularly serviced and water temperatures should be checked regularly to ensure that the valves maintain the water at the correct temperature and reduce the risk of scalding. Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Pennings View DS0000060337.V354646.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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