Inspection on 06/11/07 for Pia - Four Gables

This inspection was carried out on 6th November 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pia - Four Gables 01/11/05

Pia - Four Gables 22/06/05

Pia - Four Gables 23/02/05

Pia - Four Gables 04/08/04

Pia - Four Gables 02/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Pia - Four Gables Ingon Lane, August Hill Snitterfield Stratford On Avon Warwickshire CV37 0QE Lead Inspector Kevin Ward Key Unannounced Inspection 6th November 2007 8:10 Pia - Four Gables DS0000004280.V354203.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 Pia - Four Gables DS0000004280.V354203.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. Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pia - Four Gables Address Ingon Lane, August Hill Snitterfield Stratford On Avon Warwickshire CV37 0QE 01789 204615 02476 640146 awebb@people-in-action.co.uk 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) People in Action Mrs Denise Badger Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: 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 category: Learning disability - Code LD. The maximum number of service users who can be accommodated is 5. 2. Date of last inspection 19th September 2006 Brief Description of the Service: The home is a large domestic property in an isolated rural setting, providing accommodation and care for 5 young adults who have severe learning disabilities, including behaviours on the Autistic Disorder Spectrum, but have few mobility difficulties. South Warwickshire Primary Care Trust owns the property. People in Action manage the home. All of the five bedrooms are single without en-suite facilities. The home has large gardens with a decking area. Fees are based on an assessment of people’s individual support needs, The current fees in the Statement of Purpose range between £1440 – £2082 per person, per week. The fee information included in this report applied at the time of the inspection and the reader may wish to obtain more up to date information from the care home. There are additional charges for toiletries, holidays and trips out, hairdressing and aromatherapy. Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key unannounced inspection which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents’. The inspection focused on assessing the main Key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. The manager completed and returned an annual quality assurance questionnaire, containing helpful information about the home in time for the inspection. The relatives of three people who live at the home and a community nurse returned questionnaires. Due to the communication needs of the people at the home it was not possible to get their views of the service. An annual quality assurance questionnaire was completed and returned by the manager in time for the inspection, providing information about how the home meets the National Minimum Standards. The inspection included meeting everyone living at the home and case tracking the needs of two people. This involves looking at people’s care plans and health records and checking how the person’s needs are met in practice. Other people’s files were also looked at in part to verify the healthcare support being provided at the home. Discussions took place with two staff and an assistant manager, on duty during the morning, as well as the home manager. A number of records, such as care plans, complaints records, staff training certificates and fire safety records were also sampled for information as part of this inspection. What the service does well: Care plans and guidelines are in place for people so that staff are clear about the support they are required to give people to meet their personal needs and to enable them to go about their daily lives safely. Staff had a good understanding of people’s needs and their none verbal ways of communicating what they want. Staffing at the home is adjusted to make sure that there are enough on duty to meet people’s needs at busy times and when they taking part in community activities. Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 6 People are supported to take part in a good range of activities, such as swimming, cinema, meals out, parks and picnics. Support has also been provided for people to go on holiday alone or in small groups, with staff support. Relatives are encouraged to take part in care review meetings and Birthday celebrations and staff support people to visit and stay in touch with relatives. A relative comments, “Since my brother moved into 4 Gables he has led a happy and contented life. I cannot fault the care he has had. Everyone gives their best to all the people in their care, giving 110 ”. The home makes good use of advice from health professionals and supports people to attend check ups and appointments to help them to stay in good health. There have been no complaints to us about the home and the home has procedures in place for dealing with complaints where necessary. Staff are trained to recognise and report any suspicions of abuse or concerns they might hold about the running of the home, so that people are kept safe. Overall the home is clean and comfortably furnished and suitably equipped to meet the need of the people living there. Staff are properly recruited and checks are carried out to make sure they are suitable to work at the home. Staff are well trained so that they can meet people’s needs in a safe and sensitive manner. Staff have been provided with equality and diversity training which helps them to see people as individuals with their own very specific needs. Checks and audits are carried out by the manager, service manager and finance officers to make sure that the home is running well. What has improved since the last inspection? The service manager carries out monitoring visits and the reports demonstrate that shortfalls are identified and progress monitored. There have been improvements to medication procedures. “PRN” (as necessary) medications are checked each week to make sure they properly accounted for. PRN medications taken out with people (e.g. on community activities) and later returned are being recorded on a sheet inn the medicine cabinet so that they can be properly accounted for all the time. Security bars have been removed from people’s windows improving the look of the home. Window restrainers have been fitted instead to restrict the extent to which windows can be opened, to ensure that people do not fall out. The downstairs bathroom has been greatly improved. This is now an attractive walk in shower room and much nicer for people to use. Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 7 The electrical equipment in the home has been checked to make sure it remains safe for people to use. What they could do better: Last year a person at the home cut their hand when they broke a window. Most of the glass looks like it is the original glass rather than safety glass. Hence the manager has agreed risk assess the windows in the home, in relation to people’s assessed needs and challenges and where necessary take action to reduce the potential for injury. There is a need to ensure that transport charges (and any other extra charges) are made clear in the service user guide and copies passed to relatives so that everyone knows what they are required to pay. New care plans provide less space for people to write in. Because of the needs of people at the home there is much detailed information (e.g. behaviour management guidelines). This has led to some duplication of information and a lot of guidelines being cross-referenced to the care plan. This has created larger files and extra work for staff. Hence there is a recommendation to review the benefits of the care plan changes at the home to determine if they are still considered necessary. The home does not currently carry out end of shift medication checks to identify and errors in recording and administering medication. It is recommended that end of shift checks are carried out so any errors can be identified and action taken promptly. The outside of the house is in poor condition and badly needs decorating. The manager said that redecoration is planned and some windows are to be replaced. The views of relatives and professionals have not recently been sought. The manager said she intends to send them questionnaires shortly so that they can influence the work of the home. The emergency lighting in the home is being tested 3 monthly instead of monthly. The manager agreed to ensure that the lighting is tested each month in future to ensure it is working properly in the event of a fire at the home. Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 8 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. Pia - Four Gables DS0000004280.V354203.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 Pia - Four Gables DS0000004280.V354203.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 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information and procedures are in place in order that new people are sensitively supported to move into the home. EVIDENCE: The home has recently revised the home’s Statement of Purpose, providing up to data information about the home and how it runs. A service user guide is also in place, explaining the home’s values and complaints procedure. Positive efforts have been made to make the information more accessible, using photographs and illustrations. Contracts were seen on people’s files detailing what they may expect from the home. The transport fees have changed (reduced) since the contract was signed. Evidence of this was verified in financial records. The manager agreed to arrange for current transport fees to be added to the service user guide that this is made clear to everyone. The home fees are currently recorded in the Statement of Purpose but not the service user guide as required. No one new has moved to the home since the last inspection and the people currently at the home have lived together for several years. The home has a satisfactory admission procedure in place in the event that new people are referred to the home. Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 11 In the annual quality assurance questionnaire completed by the manager she reports: “If a vacancy arose at Four Gables we have a assessment process in place that would be followed, which would include a assessment from social services and myself, I would be looking to see that we could meet any needs without conflicting with the care of current service users were receiving. Visits would be planned, Statement of Purpose would be given, and if the placement was taken up contracts would be issued”. Pia - Four Gables DS0000004280.V354203.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Needs are well planned for and reviewed so that people receive the care and support they require. EVIDENCE: Two people’s care plans and records were looked at to see how people’s needs are planned for and reviewed. Both files contained good levels of information to enable staff to meet people’s needs in the correct manner. Each person has detailed and comprehensive guidelines covering their everyday lives. The care plans include good information about people’s routines at different times of the day so that staff can fit in with their daily living patterns. This is particularly important, as the people at the home cannot easily say what they want and make choices verbally. Comments by staff indicated a good awareness of people’s preferred routines and their likes and dislikes. Staff explained that this knowledge is used to help plan people’s activities and menus. Staff were seen to give people different breakfasts in keeping with their known preferences. Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 13 The files include behaviour guidelines, which have been devised with input from health professionals and staff at the home. A letter was seen verifying a psychologist’s involvement in this process. Care plans are being monitored and reviewed on a regular basis and a record is kept of key-worker meetings that have been carried out. In some cases social work reviews have taken place, to which relatives are invited. The manager explained that social workers have confirmed that they will be carrying out any overdue reviews shortly. Care plan files include a good range of risk assessments to reduce the risks that are associated with people’s health needs and everyday living (e.g. epilepsy and swimming). The risk assessments seen were well thought out and contain good levels of information to satisfactorily reduce risks. Last year a person at the home broke a bedroom window with his hand and in doing so cut his finger. It is currently unclear which windows, if any are toughened, safety glass, which might reduce the likelihood of injury in similar circumstances. The manager agreed to risk assess the glass in the home and to implement safeguards, where necessary, to minimise the potential for further injuries, (e.g. safety film or replacement safety glass). The home is in the process of changing to a new format. The new format provides less space for recording the levels of information that is found in the current care plans and guidelines and could lead to valuable information being lost. To help overcome this problem the manager is cross-referencing the care plans to the more detailed guidelines. Whilst this helps it has led to information being duplicated in some instances. This has led to the need for extra files, making information harder to find. Pia - Four Gables DS0000004280.V354203.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 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s preferences are taken into account when planning activities and meals so that they are provided with a suitable range of activities and meals they enjoy. EVIDENCE: Communication guidelines are in place for people to help staff to understand people’s individual non verbal, behavioural cues and assistance has been sought from a speech and language therapist to develop communication dictionaries for two people at the home, using photographs to help them to make their everyday choices understood, e.g. what car they wish to use for activities and places to go. A weekly activities plan was seen in the hallway and the current day’s activities were recorded on a white board with photographs illustrating individuals’ activities and the staff member allocated to provide them with support. Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 15 On the day of the site visit staff were observed to support people to go about their planned activities, e.g. in the morning, two people went to a day centre and one person went for a car ride and another person went for a walk. Photos are kept of many activities that have taken place, as reminder to people of the places they have been. A photo-board is in place in the hallway containing photographs of some activities enjoyed this year. Discussions with staff and entries in people’s records also provided examples of recent activities, e.g. restaurants, pubs, frequent picnics in parks, cinema, bonfire party, swimming, car rides, walks, bubble baths and foot spa. One person who likes to visit churches and cathedrals was supported to walk to the local church on the day of this site visit. In the annual quality assurance assessment the manager has indicated an intention to seek out more college courses for people to further expand the range of options available to them. During the summer a large garden “inflatable” was used hired for a party to celebrate a person’s birthday. The manager confirmed that everyone has been on holiday this year either in small groups or alone, with staff support. People’s plans and records show that they are encouraged to take part in shopping for groceries and person al items and sure supported to use the barbers to get their haircut. Comments by the manager and staff explained that relatives are encouraged to visit to maintain social contact and take part in care reviews. Further evidence of this was seen in care review notes and day records. On the afternoon of the site visit one person was supported to visit his mother to celebrate his Birthday and took neatly wrapped presents to open in her company. Staff confirmed that encouragement is provided for people to take part in household tasks where they are willing to do so. Examples of this included, room care and food shopping, which were seen to feature on people’s activity timetables. People’s choices are limited by documented health and safety factors. For example, the kitchen is locked unless staff are present and residents can be safely accommodated. Staff were seen to follow guidelines in respect of individual access and were aware of potential risk issues. Menus were seen indicating that people are provided with a balanced diet based on their known food preferences. A team leader at the home was able to give a very good run down of people’s likes and dislikes. One person was offered a choice at breakfast time and staff were seen to provide people with their favourite breakfasts, based on their known preferences. People were seen to return crockery and glasses to the kitchen after eating their breakfast in the dining area. Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 16 Guidelines are in place for supporting a person with swallowing problems to eat his food in a safe manner. A member of staff was seen to provide unhurried one to one support as required and demonstrated a satisfactory understanding of the guidelines in place. A member of staff explained that the guidelines are being reviewed by a speech and language therapist and written evidence of this was seen in a letter on file. A team leader demonstrated a very good understanding of the dietary requirements of a person with irritable bowel syndrome and the foods to be avoided to support good health. Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 17 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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall, people’s needs are well planned for and monitored with the involvement of health professionals and safe medication procedures are in place so that they receive the appropriate support and healthcare they require. EVIDENCE: As previously noted staff were able to demonstrate a good knowledge of people’s needs, routines and preferences. A new member of staff explained that she had been supernumerary for two weeks when she first started at the home, to enable her get to know people and read their care plans. She explained that during this time she had been shown how to meet people’ s personal care needs sensitively before taking on this role herself. Staff were observed to pay attention to the needs of people at the home and to understand and respond to non-verbal requests for assistance. Due to their high support needs some people at the home they require several changes of clothing during the day (e.g. due to spillages on clothes). In the morning people were supported to dress appropriately and to comb their hair and all wore clean clothing. One person was dressed in crumpled jeans that had not been ironed. Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 18 The manager said that she would follow this up with staff so that it did not reoccur. One person chooses not to wear a shirt and becomes very upset if staff seek to persuade him to do so. Staff were seen to ensure that he wore his coat to keep warm when getting on the day service transport. Positive comments were received in questionnaires about the quality of care at the home. One relative says” The staff are very caring and X is taken out for meals, cinema etc on a regular basis. Everything is done to make his life as comfortable as possible. One relative has requested increased information updates from the home. The manager said that she would arrange for 6 weekly reports to be provided. A community nurse comments that staff “are always very professional, especially the manager, but also caring – it is a delight to see this”. The home continues to make purposeful use of support from health professionals where required to assist in planning and monitoring people’s needs. Positive use is made of psychiatry and psychology services to monitor mental health needs and to support the development of appropriate behaviour management guidelines. Comments by staff and information on care files demonstrates that advice has been sought from a speech therapist and dietician to meet the dietary and safe eating needs of a person at the home. A person’s health records demonstrate that good work has taken place to support a person to have dental treatment under a general anaesthetic, involving joint working with a psychiatrist, dentist and staff at the home. Records confirm that people are provided with access to routine vaccinations, such as flu and tetanus to maintain good health. An assistant manager explained that a staff member is nominated on each shift to take responsibility for giving out medication. This normally falls to the sleep in worker but in the event they are not trained a shift leader carries out this duty. The shift leader is highlighted on the staff rota so that there is no confusion over who is responsible. The assistant manager demonstrated a good understanding of the medication system and safe procedures for giving out medications. She was seen to appropriately sign the records after administering medication. Staff confirmed they are provided with medication training and are assessed by managers before they give out medication. Evidence of this was seen on staff files. The medication sheets contain people’s photographs to avoid any confusion about whom the medication is prescribed for. A lockable cabinet is in place for the safe storage of medication, which was clean and well ordered. Following three medication errors in May 07 the staff involved were reassessed to confirm they understand safe medication procedures and there have been no reports of errors since that time. The manager agreed to consider introducing an end of shift medication check so that any errors may be quickly identified and addressed. Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 19 PRN (“as necessary”) medications are checked on a weekly basis (record sheet seen) to account for all the tablets used. Protocols are in place explaining the circumstances under which PRN medications should be given. Where PRN medication is given out this is recorded on the back of the medication sheet so it is possible to monitor it usage. Records are in place to account for medication returned to the pharmacist. The record has been appropriately signed by the pharmacist to verify receipt of medication. Pia - Four Gables DS0000004280.V354203.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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable arrangements are in place for investigating concerns and complaints and staff are being trained to report suspicions of abuse so that people are protected form harm. EVIDENCE: There have been no complaints to us about the home since the last inspection and the manager confirmed that no complaints have been made directly to the home. This was verified in the complaints log, which has been signed by the service manager, as evidence that she is monitoring complaints records at the home. The home has a complaints procedure in place and efforts have been made to devise a more accessible version, as seen in the service user guide. The manager confirmed that this information has been passed to relatives previously. An assistant manager agreed to arrange for fresh copies to be sent to relatives to remind them of the procedure. A new member of staff confirmed that she had been shown the whistlblowing and Safeguarding from abuse procedures and that training on these subjects had been arranged for her. This was also verified in notes seen in her personal training plan. Similarly all the other staff on duty confirmed that they had been provided with this training and demonstrated a satisfactory understanding of the procedures for reporting any suspicions of abuse. There have been no allegations of abuse at the home since the last inspection of the home. Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 21 Staff confirmed that they have been provided with training to enable them to sensitively manage challenging behaviour. This was also verified in staff training records Two people expenditure records were checked. The records demonstrate that staff sign the record and keep receipts to account for money spent on behalf of the people at the home. The reports of monitoring visits, carried out by the service manager indicate that people’s money is also checked as part of this process. The organisation’s finance officers also carry out periodic financial audits, providing an added safeguard for the people at the home. Pia - Four Gables DS0000004280.V354203.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is maintained in a comfortable, clean and tidy condition so that people benefit from a hygienic, homely environment. EVIDENCE: The home continues to provide airy, comfortable space for residents to mingle, interact, and seek privacy as they wish. Some communal and personal areas have laminated flooring to help with cleanliness and combat allergies experienced by some residents. Furnishings and furniture continues to be well maintained. Since the last inspection good work has taken place to remove safety bars from bedroom windows and to fit metal window restraints. This enables windows to be opened far enough to allow fresh air to circulate whilst removing the risk of people falling out. Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 23 The downstairs bathroom has been improved since the last inspection. This is now a walk in shower room and has been attractively tiled to create a comfortable, safe environment for people to take a shower. There is also an upstairs bathroom fitted with handrails. A bath seat has been provided to help a person to lower himself into the bath safely. The exterior paintwork is badly in need of improvement and some window frames are rotten in places. The manager said that plans are in place for replacement frames in some rooms and for exterior redecoration to take place. People’s bedrooms are comfortable and have been personalised for people, with posters, family photographs, music players and other equipment. One person’s room had recently been decorated and a new carpet and bed had been purchased to make it more comfortable for him. Several rooms also have sensory lights to help people to relax. The garden provides lots of open space, trees, and a decked area overlooking open countryside. The whole area to the back of the house is flat and accessible to the people at the home. The front of the house is not accessible to residents unsupervised, as the drive leads on to the road. Staff confirmed that they had been provided with infection control training to support safe hygiene practices in the home. A cleaning schedule was seen for night staff to follow to keep on top of cleaning in the home. Gloves and aprons are stored discretely in bathrooms and other areas of the home so that they are easily available to staff when they want them. Red dissolvable bags are used for safely carrying continence laundry and the home has purchased a new washing machine with a sluice facility, in the event that there is a need to deal with any heavily soiled items. Maps are colour coded to avoid cross contamination, e.g. transferring bugs from the toilets to the kitchen. Pia - Four Gables DS0000004280.V354203.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): 32,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff appropriately recruited and provided with access to relevant training so that the people at the home benefit from a suitable, well trained workforce. EVIDENCE: Comments by staff and an examination of recent rotas indicates that the home continues to be suitably staffed to meet people’s needs. The rota on the day included three staff in the morning, 4 staff in the middle of the day and 5 staff in the evening. The manager explained that staffing is adjusted and increased, in accordance with the number of people at the home during the day and the support required to enable them to pursue activities safely. This enables the home to meet people’s needs flexibly and target extra support where it is most needed. Whilst most staff are female the home also currently provides three male staff. The presence of some male staff, role models, in the home is beneficial given that only men currently live at the home. Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 25 Information in staff training records demonstrates that a good range of training opportunities are provided to staff and mangers to support safe practice and professional development. Two staff training files, including training certificates were sampled, providing further verification of training courses attended. Staff attend a number of courses to support safe practices, such as safe practitioner, moving and handling, first aid, food hygiene, fire safety, medication, Safeguarding vulnerable adults, whistleblowing and physical restraint training. In the annual quality assurance questionnaire completed by the manager as part of this inspection, the manager reports that in the region of 68 of staff have completed National Vocational Qualifications (NVQ’s) at level 2 or above. This represents as a positive achievement and indicates a commitment to ensuring that staff are given the training they require to meet people’s needs properly. An assistant manager explained that she is in the process of training for NVQ level 4 in Care and the manager explained that two other assistant managers have already achieved these qualifications. These qualifications are important for equipping staff to carry out their roles effectively. Staff are also provided with equality and diversity training and the manager showed the inspector she had made for staff to attend sexuality training later this year. The training records show that some staff have been provided with other training related to people’s needs, such as autism, communication, irritable bowel syndrome and challenging behaviour. The files of two new staff were checked and found to contain records to confirm that appropriate recruitment and vetting procedures are followed, including taking up two references and Criminal Record Bureau checks before staff start work at the home. The records demonstrate that staff are subject to an interview process before starting at the home and are supported to attend Learning Disability Award Framework (LDAF) induction training which includes a range of health and safety related courses as well as care related subjects. Pia - Four Gables DS0000004280.V354203.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 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable systems are in place for monitoring and managing the work of the service, in order that people are provided with a safe and well run home. EVIDENCE: The manager has many years experience of working with people with learning disabilities and has completed the Registered Managers Award. The manager also reports that she is in the process of completing the National Vocational Qualification, level 4 in Care. These qualifications are necessary to effectively equip the manager for her role. In addition to the manager there are three well trained assistant managers at the home. Staff confirmed they always have access to management support, where required, and are provided with planned supervision on a regular basis. Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 27 A number of checks and audits are carried out at the home to support he effective running of the home. A monthly house inspection takes place to draw attention to repairs maintenance and safety issues so that these can be addressed. Weekly medication checks take place to account for medication at the home and a team leader checks that money records are properly maintained. A service manager also visits the home each month to check that it is running effectively, reports of which were seen on file. The reports trigger an action plan from the manager to address any shortfalls identified during these visits. No questionnaires have been sent to relatives and professionals yet this year to seek their views of the service. The manager said that she would be doing this very shortly and a copy of the questionnaire to be used for this purpose was seen in the office. The manager said that any issues identified in the survey would be addressed in the home’s development plan. Overall, the comments received by relatives and professionals in questionnaires, sent as part of the inspection process, indicate a good level of satisfaction with the management of the home. One relative writes, “Improvements seem to be being made all the time, especially since the new manager has taken over”. A nurse states, “I am always impressed with the service and the committed team of workers”. Records in the fire safety log were sampled. The record shows that the fire alarms are routinely being tested weekly and that fire drills are periodically carried out at the home. The emergency lights are being tested on a 3 monthly basis rather than monthly. The manager agreed to adjust this practice so that monthly tests are recorded. A log was seen demonstrating that hot water temperatures are checked to protect people from being scalded. Cleaning equipment was stored away in cupboards, in the laundry room, which was kept locked to prevent risks to people at the home. Certificates were seen, demonstrating that the new electrical installation for the downstairs shower is safe and that other electrical equipment in the home has been safety tested. Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 28 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 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 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 3 x x 3 x Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 29 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 YA9 Regulation 13 (4) (c) Requirement A risk assessment must be carried out of the glass in the windows of the home and appropriate measures put in place where necessary, (e.g. safety film, safety glass) to reduce the potential for injury. Timescale for action 31/12/07 Pia - Four Gables DS0000004280.V354203.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 Refer to Standard YA2 Good Practice Recommendations The current fees and extra charges, including transport charges, should be made clear in the service user guide so that the people at the home (or their representatives) know what they are expected to pay. An end of shift medication check should take place to ensure that any medication errors are promptly identified so that any necessary action may taken swiftly to ensure people’s welfare. Proceed with plans to paint the outside of the house and replace windows where necessary to improve the home for people. Proceed with plans to survey relatives and professionals involved with the home to seek their views of the service. Proceed with plans to check emergency lights every month rather than every 3 months, as is currently the practice, to ensure that they remain in safe working order, to safeguard people in the event of a fire. 2 YA20 3 YA24 4 5 YA39 YA2 Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Pia - Four Gables DS0000004280.V354203.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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