Inspection on 30/05/08 for Peverell

This inspection was carried out on 30th May 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Peverell Station Road Foulsham Dereham Norfolk NR20 5RE Lead Inspector Jenny Rose Unannounced Inspection 30th May 2008 10:00 Peverell DS0000071347.V364365.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 Peverell DS0000071347.V364365.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. Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Peverell Address Station Road Foulsham Dereham Norfolk NR20 5RE 01362 683581 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) www.twoacres.co.uk Devaglade Limited Mrs Denise Janneh Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD The maximum number of service users who can be accommodated is 3 2. Date of last inspection: 10th January 2007 Brief Description of the Service: Peverell is a care home providing accommodation and care for three younger adults with a learning disability in a domestic homely environment. It is owned by Devaglade Limited who oversee the general management with additional management responsibility given to staff employed within the home. Peverell is a detached house located in the centre of the village of Foulsham. The surrounding countryside is rural in character. The home is close to all local amenities, including public transport, although there is a vehicle that is used to transport the service users to a variety of activities and excursions. Each service user has their own bedroom, which they can personalise. The communal facilities include a lounge, conservatory and bath/shower room. The kitchen/dining rooms is domestic in style. There is a laundry room and staff office. The home is staffed 24 hours a day. Residents have access to activities locally and further afield. There is a small garden area at the rear of the building and parking to the front. Peverell DS0000071347.V364365.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 1 star. This means the people who use this service experience adequate quality outcomes. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. This report gives a brief overview of the service and current judgements for each outcome group. This Inspection was unannounced and took place over two days, 5 hours on Friday 30th May 2008 and 3 hours on Saturday, 31st May, when the Inspector returned to speak with the new Manager, (previously the Team Leader/Acting Manager), in order to look at the staff records, which are kept at another establishment. Since December 2007 the Home has changed ownership, although there have not been any changes of staff. Brief discussions also took place on both days with the new owner and the manager of a care home for elderly people with dementia needs, (also owned by the new owner), who has been appointed as a member of a team to oversee the transition of the change of ownership, (hereinafter referred to as the “Transition Manager”. The opportunity was taken to look around the Home, to listen to and observe what was going on. The three people living in the Home were spoken with, as well as two staff members in private. In addition, care records and policies were examined. Other information was available from the Annual Quality Assurance Assessment (AQAA), which the previous owner had completed and was received by the Commission in March 2008. The previous owner had stayed on for an initial period to manage the home for the new owner, but she has now left. Comment cards were received from a healthcare professional and a relative which were positive about the quality of care received by the residents and these comments are reflected in the report. What the service does well: • People living in the Home benefit from a relaxed, friendly, homely and clean atmosphere. Bedrooms are personalised to individual choice and the internal accommodation is adapted and equipment provided to suit individual ongoing and changing needs. • Observation of routines in the Home provided evidence of an attentive approach to individual needs of the people living there by the care staff. DS0000071347.V364365.R01.S.doc Version 5.2 Page 6 Peverell • Staff demonstrated an understanding of people’s individual needs. There are good links with other professionals who help in supporting people. This includes their physical and mental well-being and means they have access to support networks to help them with any difficulties. There have not been many changes in the staff team and agency workers are not needed. This means that people are supported in a consistent manner. However, some of the care records and risk assessments need to be updated to take account of people’s particular changing needs. (see below) People are supported to take part in local community facilities and to maintain contact with relatives, as appropriate. Staff understand those areas where people’s health or social skills might make this difficult or affect their motivation to join in activities and will provide extra support and advice where this might be needed The Home provides an interesting activities programme as well as holidays. The Home uses photo albums as a communication aide, but the brochure and care plans are not written in a format designed to be more accessible to residents. People are supported to follow dietary requirements as may be demanded by individual religious faith. One comment card stated that what the Home did well was to “provide a home and a place of safety”. • • • • • • What has improved since the last inspection? • • • A larger people carrier vehicle is now available to facilitate easier access for residents to outside activities. Staff work towards each person having individualised programmes, according to need and not always the needs of the group. New equipment has been provided in the kitchen, the garden, the office and elsewhere in the Home. Redecoration has taken place in several areas and people have chosen curtains and other items for furnishing their rooms. Staff have received training in nutrition and healthy dietary requirements and there are plans to introduce Malnutrition Universal Screening Tool (MUST) assessments for people living in the Home. The conservatory was warm on the day and there is a heater, which supplies instant warmth. DS0000071347.V364365.R01.S.doc Version 5.2 Page 7 • • Peverell What they could do better: • A draft residents’ brochure drawn up under the new management was seen. However, this gives no details of the staffing and the day to day management of the Home; neither is it in a format which would enable those with communication difficulties to access information. Although people living in the Home are supported to take risks in day to day living, risk assessments could be more specific and reflective of people’s changing needs. Financial care plans should be in place for all residents, which clearly states the agreements and arrangements for looking after their monies with the resident and their advocate or representative. Where people have no advocate or representative, this should be encouraged/developed. Consideration could be given to increasing staffing levels at the weekends, in order to provide more individual attention to people’s needs. • • • There are plans for the following to be implemented by the new owners: • Although the majority of staff have achieved at NVQ2 level and above, there is a need for a training programme to be developed, together with staff appraisals and personal development. Although some information was available in the AQAA, there could be better evidence about what is done well and about people’s views, including those of relatives and other professionals, in order for it to be seen that people’s comments are considered and taken into account. Although staff demonstrated a knowledge of how they can help to protect vulnerable adults and what they should do if they have concerns, this should be reflected and included in written policies and procedures by the new owners to underpin safe practice. Formal supervision by the new management of all staff needs to be improved, so that staff are supported, monitored and developed. • • • • Staff confidential files, including training files should be given secure storage on the premises and all the necessary and required documents relating to recruitment should be held on staff files. Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 8 • The Commission will be asking the provider to produce an Improvement Plan which will need to set out how and when these and other matters, particularly in relation to safeguarding issues, are going to be addressed. 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. Peverell DS0000071347.V364365.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 Peverell DS0000071347.V364365.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): 2, 5 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs and aspirations of the people living in the Home are well known, but the residents’ brochure is in draft at present and also not in a format accessible by people with communication difficulties. EVIDENCE: There have been no new admissions to the Home since the last inspection. The AQAA states that each person had the opportunity to visit the Home and has a trial stay to see if they like it. The people presently living in the Home had a full assessment prior to admission and several meetings took place with all people involved in the person’s care as to the suitability of the Home to meet individual needs. A draft residents’ brochure prepared by the new owner was seen, but this did not include detailed information of the management and staff team; neither was it in a format easily accessible by people with communication difficulties or give a clear understanding of what residents can expect from the service under new management. Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 11 There were two residents without the support of relatives or appointed advocates (see elsewhere in the Report), although the new Manager said that it was her intention to explain the information individually to residents. On the day of the Inspection, the new Manager had only been in post one day, although she had been managing the Home as team leader for five years for the previous Provider/Manager before and since the previous inspection. Peverell DS0000071347.V364365.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 People who use the Service experience good quality outcomes in this area. We have made this judgement made using available evidence including a visit to this service. The people living in the Home are supported to make some decisions about their day-to-day lives and their preferences are well known. However, care plans in a more accessible format and the appointment of independent advocates/representatives, would further promote residents’ rights. EVIDENCE: There was evidence from care plans and discussions with the new manager and with the Transition Manager that statutory reviews take place with social workers and that a Consultant Psychiatrist and the Epilepsy Nurse can be involved in reviews of care as well as the Community Learning Disability Nurse providing help and advice. Parents of residents are able to attend these reviews. However, there are people living in the Home who have no independent advocate/representative. All the care plans contained personal information, a photograph of the resident and the necessary relatives’ and professional contact details. There were also Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 13 plans in place covering a range of other needs, e.g. communication, particular health needs, social skills, continence, falls and challenging behaviour. There are accompanying risk assessments which are reviewed. There are details in one care plan of songs to which one person will respond as a means of communication, together with keywords. However, although there is evidence of the resident’s consent in one care plan, the plans are not written in an accessible format for people with communication difficulties. It was observed on both days of inspection that there was evidence of an attentive approach to the residents’ individual care needs, all of which are complex. Evidence from daily notes also showed that efforts were made by staff to engage people with decisions about health and activities and show these decisions are respected. They also indicate discussion about what people want to do. On the first day of the inspection one resident was anxious to draw attention to the fact that they were pleased with their haircut. The new Acting Manager handles some of the residents’ money and keeps records for this (see elsewhere in this report). One resident is supported to collect his own benefits. The AQAA states that individualised care plans and activity plans could be expanded. Reviews for these were discussed with the new manager and the Transition Manager. It was also noted that risk assessments, which give good instructions for staff to follow, could be more specific, particularly in regard to residents negotiating walking on a narrow pavement in the village with fast approaching traffic, when going for a walk with two staff, while allowing two residents to be as independent as possible. Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 People who use the Service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are provided with variety in their lifestyle and supported to maintain community and family relationships. However, there are limitations in educational opportunity and for the development of peer relationships in this rural area. EVIDENCE: There were certain communication difficulties in securing the views of residents on the days of the inspection, but the comment cards received both stated that the Home always supported people to live the life they chose. One person was able to communicate what had been happening that morning and indicated that he was happy in the Home. The personal photo album gave a good account of holidays, activities with members of staff and with other residents. By invitation, his bedroom was seen to be personalised and there was evidence of photographs, certificates, craft work, TV, DVD and CD players. Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 15 This person also indicated that there was a new lawnmower for use in the garden and the manager confirmed that one resident, with support, enjoyed helping staff with mowing the grass. There are games and musical equipment in the conservatory and a collection of DVDs and CDs on open shelves in the living room. It was clear from discussion with members of staff and from records seen that people were encouraged to make use of local community facilities in as independent a way as possible. One person, with support, uses the Post Office in the village. The staff confirmed that the group often have lunch in the local pub and elsewhere. The manager described situations where residents are supported to develop their social, as well as their literacy and numeracy skills. On the first day of the inspection it was observed that the residents, supported by staff, were enjoying taking a walk around the village in the natural surroundings of this rural area. Records and comment cards showed people’s links with family and where these were problematic. One person has frequent family communication by visits and letters in-between, with support from staff, and there is evidence that relatives are welcomed at reviews. There was a recommendation at the last Inspection concerning the development of educational opportunities, for one resident in particular, as well as peer relationships, which have proved problematic within the rural area. However, on two days a week one resident receives one to one support during holidays funded by the Local Authority and goes on day trips to places of interest. Public transport is used, as far as is possible, to the local town. Activities such as horse riding, swimming at a Health Club, going to the cinema and the theatre take place on a regular basis. Care staff prepare the meals, but the manager described a situation where residents can sometimes make their own preparation with support. On the two days of the inspection the residents were observed enjoying a meal followed by fresh fruit. There are set menus, but a member of staff explained these were often adapted to suit residents’ preferences and to what was occurring on a particular day. The staff have had training in Nutrition and Healthy Eating and encourage residents to choose healthy options. There are clear instructions for the high fibre diet needed by one resident. The Transition Manager confirmed that it was planned to introduce MUST assessments into the Home.. There is a rota for residents for helping in the kitchen, which sometimes takes place, as does cleaning of residents’ rooms. All residents, with staff, shop regularly for groceries and personal shopping, making use of the larger vehicle now owned by the Home. Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service receive support in the way they require individually to help ensure their complex personal and healthcare needs are well attended to. EVIDENCE: All residents require assistance with personal care and hygiene, together with needing prompts and indirect support from staff. The individual preferences of residents are demonstrated in their care plans, as well as risk assessments so that staff are clear about the most appropriate ways to provide support, including clear instructions on how to deal with difficult behaviour. Staff work with each person as an individual enabling them to choose what to wear. There are clear explanations of the complex needs of one resident and actions to be taken to mitigate the effects of these. Two people need to wear special footwear and ‘foot inserts’, another an arm splint and a protective helmet. There are grab rails in the bathroom, adapted crockery and cutlery. Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 17 There is good evidence of consultation with relevant professionals, including consultants. There are six monthly reviews with the GP and with the Epilepsy Specialist. The Practice Nurse examines the female residents every 12 months and one person has yearly consultations with a Consultant Psychiatrist specialising in mental health needs. All residents have access to a continence advisor, the dentist (every 6 months), an optician and a chiropodist, who was visiting on the second day of the inspection. Since the last inspection one person has undergone an operation, which was deemed to be successful. No one self medicates in the Home and one person out of three has signed a consent form for the Home to administer medication. From the staff files it could be seen that all staff who administer medication had received up to date medication training. The medication was seen to be stored appropriately in this domestic situation, which is kept in a locked cupboard within another locked cupboard. The temperature of the storage area was seen to be recorded. However, the lighting in this situation could be of better quality, especially to aid the accurate dispensing of liquids. There were facilities for the storage of Controlled Drugs, although none were prescribed at the time. The MAR sheets appeared to be accurately completed and the manager stated that the local pharmacy were helpful and that there were strict protocols for taking medication out of the Home, for example, on day trips. Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22.23 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff try to respond promptly to people’s concerns. However, there have been instances since the last Inspection under the previous management when issues have not been promptly notified or referred. This means that there is some doubt that people’s concerns and complaints are always acted upon quickly. EVIDENCE: Both comment cards stated that the complaints procedure was known. Also at the previous inspection the same residents had that they would speak to the Team Leader if they had a problem. This person is now the new manager of the Home. The AQAA states that under the former management there was a clear and concise complaints procedure. However, policies and procedures have not yet been written by the new owners, who took control of the Home in December 2007. At the time of inspection these were not available in a form accessible to residents. The appointed Transition Manager, however, confirmed that these were in the process of being produced. It was evident that one person can say whether or not they are unhappy, while staff know that the actions of another resident indicate upset in some respect. Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 19 During the inspection attention was drawn to a safeguarding issue connected with a member of staff who had been dismissed. A member of staff had reported this particular incident to the previous owner, but it had not been reported to the Commission. This is now under investigation. The AQAA detailed that all staff have had training in recognising and understanding abuse, (certificates of attendance were also seen in staff files). Staff spoken with confirmed that they were aware of the Home’s policy (under the former management), in safeguarding and were confident as to how they would raise any concerns immediately. However, at the time of the inspection, confirmed by the Transition Manager, the policy specific to the new management and local written procedures for staff to follow for safeguarding, were in the process of being rewritten, although staff knew that, in the interim, they would refer any concerns to the Transition Manager. Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 People who use the service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. People live in a comfortable, clean and generally safe environment with a homely atmosphere. EVIDENCE: There has been no change to the structure and space available since the last inspection. The conservatory was bright and warm and provides an area where residents can listen to music - as one resident was on the first day of inspection whilst also involved in craft work - or to play board games or relax. A member of staff explained that the heater in this space was virtually instant, as and when required. The communal sitting room is comfortable having large sofas. There are purpose built cupboard units for storage of board games, DVDs and CDs. The house is in keeping with the local community and generally the accommodation is in a good state of repair with comfortable furnishings. Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 21 Some redecoration has taken place and there was evidence from the minutes of the staff meeting with the new owner that more redecoration was planned. One bedroom seen at the invitation of the resident was personalised with comfortable furnishings of the resident’s choosing, with craft work, a new TV, DVD and CD players. The new manager reported that residents did not have locks on their doors, primarily for safety reasons. However, strategies had been devised to afford people privacy. Two of the residents frequently liked to spend time quietly in their rooms and could choose if the door remained open or closed. In the latter case, staff would check on a regular basis to see if the resident wished to be accompanied downstairs. A member of staff explained that the Home had reluctantly ‘let go’ the allotment adjacent to the Home as there was insufficient time for its maintenance, although the conservatory does overlook the allotments, which still provide interest for people living in the Home. One of the residents communicated that they were pleased with the new lawnmower, and a member of staff confirmed that the resident was able to help with cutting the grass with support. Three members of staff spoken with said that new equipment, which had been provided by the new owners throughout the Home was helping them with their work. Lockable storage had been provided in the office, as well as a new computer, fax machine and photocopier to aid the Home’s communication and administration. Subsequent to the inspection, the manager stated, by telephone, that new garden furniture had now been delivered. On the first day of the inspection routine electrical tests were being carried out throughout the Home. There were certain minor maintenance issues, which needed attention such as a broken chain to the basin in the bathroom, the loose handle to the cistern and the drawer front in one resident’s room. There was evidence that the former two had been reported. The Home employs a maintenance person who lives locally. The kitchen was clean with detailed cleaning schedules. In the area used as a laundry room, the washing machine has a sluice cycle. Gloves and aprons are available for infection control. On both days of the inspection the Home was clean, fresh and tidy. Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People are supported by staff sensitive to their needs who have had training in relevant areas. However, staff files were kept in another care home and also did not contain photographs for identification for the further safeguarding of residents. EVIDENCE: It was the opinion expressed in one comment card that the staff had the right skills and experience to look after people properly. The AQAA states that all staff are NVQ2 (or above) trained or are doing the training. The staff rota for the weeks surrounding the Inspection shows 7 support workers, one bank support worker and two night support workers in addition to the new manager. There was one vacancy for a support worker. The new manager confirmed that the Home does not employ agency staff and any bank staff used are previous employees of the Home. There is a core of very experienced staff in the Home and with knowledge of individual people’s needs and the most recent member of staff had been working in the Home for 3 Years, indicating a stable staff team. However, there are only two members Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 23 of staff on duty at weekends and staff spoken with said that they missed the support of younger workers previously employed in the Home at weekends to help residents with craft work, playing games, painting or doing residents’ nails. However, the manager confirmed that the new owners were very approachable and should there be a shortfall in staffing that she would be able to bring this to the new owners’ notice. There was evidence from records that staff have access to a range of mandatory and other specialist training, courses including fire awareness, infection control, adult protection, food hygiene, medication, epilepsy, mental health and challenging behaviour. From speaking with the Transition Manager she confirmed that a training programme will be developed “very shortly” with each member of the staff team to highlight any specific training needs and to develop a personal development plan. Staff files are not kept on the premises. The Transition Manager recognises this fact as not being satisfactory and which she confirmed is being addressed. All the files examined contained the necessary Police checks and two references, but did not contain photographs for ease of identification by other professionals. Staff observed and spoken with have a good understanding of their role and exercise respect for the residents they support. They were also aware of the need to respect the residents’ rights. From observation it was also evident that residents have confidence in the care staff. The new manager spoke of being able to access information on the Internet now that the Home had a new computer in order to develop new ways of communication with the residents. From observation on the two days of Inspection, staff are informally supervised and formal supervision takes place regularly. This was also confirmed by records and a staff member spoken with. The new manager has been formally supervising staff and under the new management she will be supervised by the Transition Manager. Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 People who use the service experience adequate quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. The new manager has provided continuity and leadership to the staff team as a team leader, but there is a need under the new ownership to clarify her responsibilities and to identify further improvements the service can make in the interests of the people using it. EVIDENCE: The new manager had previously been providing leadership and continuity to the staff team for five years as Team Leader in the Home under the previous owner’s management and as Acting Manager of the Home since January 2008. The former owner had not relinquished the Registered Manager’s post until 30th May 2008. The new manager has several years experience working in a school for children with learning difficulties and has management experience Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 25 as Assistant and Deputy Manager in a residential home for adults with learning difficulties. She has achieved her NVQ 4 in Management and is in the process of starting her NVQ 4 in Care and her Registered Manager’s Award. From speaking with staff and from observation, there was a good rapport between staff members and the new manager, who described her management style as ‘working alongside’ the staff team and also one of openness and a belief in dealing with problems as they occur, rather than leaving things to ‘fester’. She had also been responsible for the supervision of staff on a regular basis, which was confirmed by staff spoken with. It was confirmed by the new owner of the Home, on the first day of the inspection, that supervision of the new manager would be by the Transition Manager. Three staff members spoken with made positive comments about the way forward for the Home with the support of the new management arrangements. New equipment had been provided by the new owners for the office to improve communications. The Transition Manager confirmed that an Internet connection had been ordered. New storage had been provided for residents’ confidential information, but the new owners had inherited the system for storing staff files in another establishment, now also in their ownership. The Transition Manager also confirmed that the organisation was aware that this arrangement was unsatisfactory and were taking steps to remedy the practice. In view of the requirement from the previous inspection to the effect that the Commission has to be sure of the management arrangements, the new owners will be asked to submit a clear description of how staff know who is in charge and what the organisation’s expectations are of the new manager, what decisions she can make, what must be passed on to the new organisation and how management responsibilities are to be shared on a day to day basis. Under the management of the previous owner there was no formal quality assurance survey to gather the views of others about how satisfactorily the Home is operating. There is evidence of staff meetings, from daily notes of discussions with residents about their preferences and goals, also that views of relations are sought where appropriate. However, the Home have not yet implemented a formal system to seek the views of family, friends/advocates and other agencies in the community such as social workers, community psychiatric nurses, GP’s and other professionals on how the Home is achieving goals for the people living there, although the Transition Manager confirmed that this would be in the form of the Blue Cross system to be implemented shortly. On the day of the inspection the residents’ monies held in the Home were checked. There was a discrepancy in one record, which was in that resident’s favour. Furthermore, where access was restricted, Building Society books for safe-keeping had not been changed to the name of the new provider. A financial care plan should be in place, which clearly states the agreements for Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 26 looking after all residents’ monies with them and their advocate and/or representative. All statutory training for staff was seen to be kept up to date and the Home was using an outside business service as an independent health and safety consultancy, as well as utilising contractors to carry out regular servicing and checks. This was seen to be the case on the first day of the inspection. Emergency Lighting, Fire Fighting Equipment were seen to be tested regularly and PAT testing was up to date. The Accident Book was accessible in the office and was seen to be appropriately completed. This provides evidence that there appear to be measures in place to help promote the safety and welfare of people living and working in the Home. There was a Fire Risk Assessment dated 18th November 2005, but no evidence of any undertaken by the new owners. Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 4 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 4 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 3 X 3 X 2 X X 3 X Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? New owners 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 YA2 Regulation 14.1(B) Requirement People living in the Home should be provided with a service users guide, containing a summary of the statement of purpose detailing any available independent advocacy services in a format accessible by people with communication difficulties. People living in the Home should have been given (and/or it should be explained to each person) in an appropriate format, information for making a complaint. There should be robust procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of the people living in the Home. Staff files should contain all the necessary documents when staff are confirmed in post (in this case photographs for further identification) to ensure the safety and protection of the people living in the Home. Records required by regulation for the protection of the people living in the Home should be DS0000071347.V364365.R01.S.doc Timescale for action 31/07/08 2. YA22 22(5)(4) 31/07/08 3. YA23 13(6) 31/05/08 4. YA34 19 Schedule 2(5) 31/05/08 5. YA41 17 31/07/08 Peverell Version 5.2 Page 29 6. YA38 7. YA39 8. YA7 9. YA42 maintained, up to date and accurate. In this case the staff files should be stored on the premises. 39 A clear description of how the day to day management tasks are allocated in the home, how staff know who is in charge and what expectations there are of the manager and what decisions she can make should be provided to the Commission, to ensure the Home is run in the best interests of the people living there. 24(1)(a)(b) Feedback should be actively (2)(3) sought about the service provided from the people living in the home and/or their independent advocates in order to further ensure that the Home is run in the best interests of the people living there. 15(1) Each person living in the Home should have a financial care plan, agreed with the person’s advocate or representative, which sets out how that person’s financial needs are to be met to further protect that person. 23 (4) and Evidence of a Fire Risk (5) Assessment for the Home should be provided to further ensure the safety of the people living in the Home. 31/08/08 30/09/08 30/09/08 31/05/08 Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA7 Good Practice Recommendations It would be good practice to document the evidence of individual resident’s involvement and consent where possible in their care plan. It would be good practice to support the people living in the Home, if they wish, to find peer support or an independent advocate to help them make decisions about their own lives. It would be good practice to review risk assessments and to make them more risk specific. In this case, negotiating narrow pavements in the village. It would be good practice to give consideration to improving the lighting in the cupboard used for storage of medication, particularly for the accurate measuring of liquids. It would be good practice to give consideration to increasing staffing at some periods at the weekends when there are only two staff on duty, to enable more individual activities to take place. It would be good practice to further develop a staff training needs assessment to identify the benefits for the people living in the Home. 3. 4. YA9 YA20 5. YA33 6. YA35 Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge CB21 5XE 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 Peverell DS0000071347.V364365.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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