Inspection on 23/02/07 for Plean Dene

This inspection was carried out on 23rd February 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Plean Dene 12/08/08

Plean Dene 27/09/07

Plean Dene 27/10/05

Plean Dene 21/06/05

Plean Dene 19/10/04

Plean Dene 13/05/04

Plean Dene 24/02/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Plean Dene 2 Luccombe Road Shanklin Isle Of Wight PO37 6RQ Lead Inspector Annie Kentfield Unannounced Inspection 23rd February 2007 14:30 Plean Dene DS0000012523.V325801.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 Plean Dene DS0000012523.V325801.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. Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Plean Dene Address 2 Luccombe Road Shanklin Isle Of Wight PO37 6RQ 01983 866015 01983 868267 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) Islecare `97 Limited Tina Merrett Care Home 13 Category(ies) of Learning disability (13), Learning disability over registration, with number 65 years of age (3) of places Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th October 2005 Brief Description of the Service: Plean Dene is a home providing care and accommodation for up to thirteen residents with a learning disability whose ages range from twenty five to eighty years. It is managed by Tina Merrett on behalf of Islecare 97 Ltd. The home is a large detached two-storey property set in its own grounds with a car park to the front. The town of Shanklin with its shops and amenities is a few minutes walk away. A main bus service close to the home gives access to the towns of Ventnor and Shanklin. There is a good-sized garden and patio to the rear, which are available for use by the residents. Bedrooms are single accommodation with washing facilities and one has an en-suite bathroom. There are two bedrooms on the ground floor and the rest are on the first floor. There is a large sitting room and a dining room. The building is accessible and access to the first floor is via stairs or a stair lift. The current scale of charges is from £400 - £500 per week with additional charges for transport, toiletries, chiropody, hairdressing, outings and holidays. Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report details the results of an evaluation of the quality of the service provided by Plean Dene and brings together accumulated evidence of activity in the home since the last key inspection on 27 October 2005. Part of the process has been to consult with people who use the service; including a telephone discussion with a representative of one of the residents. Written comments were received from four relatives and a GP. Five residents completed a care homes survey with help from key workers. Included in the inspection was an unannounced site visit to the home by an inspector on 23 February 2007. During the visit the inspector toured the building with the manager, looked at a selection of records and spoke with some of the staff and a resident. The inspector returned to the home on 26 and 27 February when there was an opportunity to speak with more care staff and a resident. The inspector was able to spend some time observing the interaction between residents and staff and residents appear well cared for and care staff clearly know the residents well. However, due to their cognitive impairments it was possible to take views from only two of the residents. The responses from the consultations were generally positive. What the service does well: What has improved since the last inspection? Since the last inspection a new manager has been appointed – Mrs Tina Merrett. Mrs Merrett is now the registered manager and was formerly deputy manager and has worked in the home for many years, and knows the residents well. Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 6 Two small bedrooms have become one large bedroom with an en-suite bathroom, on the first floor. A bathroom on the first floor has been made into a shower room. What they could do better: The report identifies some areas of practice where improvement is required: Care plans produced by the home follow the long-standing Islecare ‘older persons’ format. They are not person centred and in terms of best practice are not considered appropriate for use with younger adults. However, the home is moving towards developing a person centred approach to care planning and the manager must keep the process under review to ensure that care plans are at all times relevant and up to date. Medication is safely stored and appropriate records are maintained. The only area of improvement is for PRN or as required medication, to have a written protocol for each medicine, to ensure that staff are dispensing the medicine according to the instructions of the prescriber. It is considered important that staff are given the skills necessary for the tasks they are expected to do, including communication skills. With there being several Makaton users in the resident group the home must have identified staff who have trained in Makaton signing. Training in the specialist area of autism is also identified as a staff training need in order to fully meet the needs of residents with autism. Other areas identified as needing attention are: • • • Records must demonstrate that all required health and safety checks are regularly maintained. The temperature of the hot water in bedrooms and bathrooms must be suitable for the needs of the residents and meet regulatory requirements. Replacement and refurbishment is needed to some areas of the home environment. A previous requirement for residents or their representatives to be given a contract with the home has not been met and a new date for compliance is given. The manager must develop the quality assurance systems for the home to ensure that the views of residents, relatives and others are regularly sought. A summary of the quality assurance or consultation process should be made available to residents or their representatives. Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 7 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. Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. New residents do not move into the home until they have had an opportunity to visit the home; an assessment of their care needs has been undertaken, and the manager is confident that the home can meet their needs. However, information about the home is limited and provided in written format only and new residents or their representatives are not provided with a contract or terms and conditions of living in the home. EVIDENCE: The home’s guide says that they provide long-term care and this is true for most of the residents who have lived in the home for many years, some of them more than 20 years. Since the last inspection one new resident has moved into the home and it is evident that the process of moving in is carefully and sensitively considered with the resident making several visits, meeting the other residents, and staying overnight, before deciding to move in. In addition, the manager and a senior member of staff visited the prospective resident in their previous home and carried out an assessment of the resident’s care needs. This included gathering information from relevant people involved in the care of the newest resident. The home could consider using an admission assessment checklist or a ready-made assessment form to ensure that all relevant information is gathered in the assessment process. However, all of the assessment information was used in the drawing up of the individual Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 10 care plan. Some parts of the care plan, including the health action plan still need to be fully completed. The previous inspection required the home to update their information for residents and to include details of the complaints procedure. The home was also required to ensure that residents or their representatives are supplied with a contract or details of the terms and conditions of living in the home. These requirements have been partly met and the information about the home has been updated. A copy of the complaints procedure is displayed in the hallway of the home. However, the home does not give residents or their representatives a contract. A standard contract from Islecare is available and could be adapted to be particular to Plean Dene and the manager agreed that this would be put into place. As good practice, and to meet the aims and objectives of the service, the home should consider providing information about the home in formats suitable for the needs of the residents, for example, using picture format or maketon symbols and/or demonstrate that essential information about the home has been discussed with residents. Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 11 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 adequate. This judgement has been made using available evidence including a visit to this service. While opportunities for residents to make decisions and choices in their lives are determined by assessment and recorded in individual personal plans, they lack a ‘person centred’ approach and need to reflect best practice in this area. Residents are supported to have control over their lives. Any limitations are identified in the assessment process and recorded in their personal plans. Residents are encouraged to be as independent as possible and to take sensible risks, which enhance their enjoyment of life. EVIDENCE: Each resident has an individual personal plan. The inspector viewed a sample of three plans. The care plan includes information about day services, likes and dislikes, mobility, diet preferences, interests, particular care needs and risk assessments and management plans. Where risks are identified it would be good practice to demonstrate that these have been discussed with the Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 12 residents as part of a person centred approach, where appropriate and relevant. Care plans have identified a need for some residents to have one-toone time with care staff and this is separately recorded. The recording is time consuming for care staff and the integrity of the recording varies. In discussion with the manager, this was identified as a staff training issue and the manager will review this to look at ‘best practice’. In addition care plans contain a Health Action Plan, with information that is person centred, however, some of the Health Action Plans have yet to be fully completed. In contrast to the Health Action Plans the personal plans produced by the home were seen to contain information dating back some years that is no longer relevant to the current plan. The model used for all residents’ personal plans is an adapted ‘older persons’ model, which places an emphasis on ‘care’ rather than ‘support’. The age range of the residents in the home varies greatly and the care plans need to be more specific to the individual needs of each resident, it is not appropriate for an assessment for safe moving and lifting to be completed for residents who are fully mobile. There is therefore a requirement for the home to review its personal planning process, to ensure that each plan takes a ‘Person Centred’ approach to the recording of information, and is appropriate to the age and needs of the individual. The manager confirmed that Islecare is in the process of developing a Person Centred approach to care planning and training for care staff is planned for later in 2007. Where the new Person Centred care planning process has been started by Plean Dene, there is a lack of clarity in the recording process and unexplained delays as to why the Person Centred Plan was initiated in July 2006 but has not yet been completed. Information in personal plans and discussions with the manager and staff on duty provided evidence of them respecting residents’ rights to make decisions. There are varying limitations with residents’ verbal communication and in the main staff learn the various non-verbal signs, which enable them to understand the wishes of those who have communication difficulties. However, it was apparent during the site visit and in discussions with care staff that some residents use a form of Makaton signing, which encourages speech by linking signs with words. However, currently at Plean Dene there are no Makaton users amongst the staff group. It is strongly recommended that the home identifies staff, to undertake a course in Makaton signing. This would benefit the home by enhancing the skill base in the staff group, providing a more effective means of communicating with certain residents and meeting the changing needs of residents. Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 13 Each resident has a key worker in the staff group who provides the additional personal help and support they require. Based on the residents’ decisions and preferences key workers arrange to take them shopping, arrange hairdressing, take them out for meals, entertainments etc. and arrange a weekly programme that sometimes includes day care services in the community. Residents do not have the cognitive ability to manage their own finances and need staff to assist them. During the site visit the inspector confirmed with the manager that a secure system for managing residents’ monies is in place with the registered manager as appointee and signatory on all financial transactions and residents have their own bank or building society accounts. Plean Dene DS0000012523.V325801.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. Residents are encouraged and supported to take part in a range of activities appropriate to their age and individual likes and dislikes. They are supported to maintain regular contact with family and friends. Residents are offered meals they enjoy with attention given to providing a healthy and nutritious diet. EVIDENCE: The manager and staff said the home explores different activities to stimulate and challenge the residents. Their assessed needs are such that seeking jobs for them is not appropriate. Education and training is limited to that which is offered through the day services they attend throughout the week. Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 15 A weekly programme of activities ensures that the lives of the long-standing residents are as varied and interesting as possible. These activities include: shopping trips and several day services, outings to local attractions, going out for lunch and tea, individual therapies such as ‘soundbeam’ provided by an independent arts group, ‘themed evenings’ with special food and activities, and day trips and holidays. The home has two dedicated vehicles to transport residents to various activities. The manager confirmed that holidays are arranged for residents who choose this option and there were plans for other residents to be consulted on various day trips and outings to places of their choice. Some of the residents maintain contact with their families. The manager supports them to visit family away from the home if required. Bedrooms were seen to be well personalised and reflect residents’ different interests and preferences. Staff respect their privacy and were seen to knock before entering their rooms and to address the residents by their preferred names. During the site visit the inspector observed the interactions between staff and residents. Staff showed understanding, patience and respect for their privacy. Residents are free to access all areas of the home and the grounds with some limitations due to the layout of the building and levels of mobility of the residents. It was noted that areas of the garden would not be accessible for residents who use aids and equipment for mobility as the ground is uneven and rough grass. There is a patio area and this needs to be extended to cover all of the immediate area outside of the building. This is discussed in more detail in the Environment section of the report. During the site visit the inspector had an opportunity to observe the evening meal being eaten by residents, and to speak with the support worker who was preparing it. The home employs a cook who works on 5 days each work and care staff prepare meals on other days. The member of staff doing the cooking confirmed that training had been provided in basic food hygiene awareness. All staff spoken with considered the meals were well received by the residents. They said they knew through several years experience what they liked and needed in their diet. Menus were seen as varied and nutritious. Some of the residents like to go shopping to the local supermarket with care staff and help with choosing food supplies. Plean Dene DS0000012523.V325801.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 and 21 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff provide flexible but consistent support for residents and are responsive to their changing needs. Residents’ healthcare needs are assessed and key workers enable and support them to receive healthcare checks at appropriate intervals. The manager and staff have good professional relationships with health care professionals to ensure that health care needs are met. Medication is safely and securely stored and dispensed. EVIDENCE: Records showed that residents’ health care needs are regularly addressed. They receive checks from the GP, dentist, optician and specialist health care professionals. All health care needs of the residents are identified in their personal plans. The manager said that all residents are registered with a local GP practice. A comment card from the GP practice noted an overall satisfaction with the care provided by the home and communication between the home and the practice is good. The manager and staff confirmed that they Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 17 work closely with the Community Learning Disability Nurse and the Psychology services to meet residents’ health care needs. The Health Action Plans are quite lengthy documents and some of these have yet to be fully completed. The manager explained that training in person centred care planning and writing the health action plans is planned to start in March with a few staff at a time doing the training. Some of the care staff have done some training in ‘deaf awareness’ and are able to assist those residents who use hearing aids. The inspector spoke to one resident in their own room who said that staff in the home are “very friendly and caring”. The inspector observed that the manager and staff have a good awareness of the needs of older residents and the effects of ageing on overall health. The inspector looked at the home’s arrangements for residents’ medication. Records showed that medication is administered by staff that have been trained and deemed competent by the manager. At the time of the site visit medication for residents was securely held in appropriate facilities, and records relating to its safekeeping and administration were found to be in good order. In discussion with the manager it was recommended that the medication competency assessment for senior staff could be recorded with evidence of what is covered in the assessment, and be regularly updated. PRN or ‘when required’ medicine is recorded on the medication administration records but the manager must ensure that each PRN medicine has an individual protocol with clear written guidance for staff on how and when the PRN medicine should be given in accordance with the directions as prescribed for individual residents. Plean Dene DS0000012523.V325801.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 and 23 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s policies, procedures and practices ensure that residents are safeguarded from abuse. Procedures for responding to suspicion or evidence of abuse are robust. The home has a complaints procedure on display in the home. EVIDENCE: The home has a formal complaints policy and procedure, although this is not included in the Service User’s Guide. However, information about the complaints procedure entitled ‘Seeking Your Views’ is conspicuously displayed on the wall in the main hallway of the home. In a general sense residents’ cognitive impairments made it difficult to gauge their understanding of what to do if they had a concern. All of the responses to the relatives/visitors survey indicated they were aware of the home’s complaints procedure. The pre-inspection information about the home, which was forwarded to the Commission prior to the site visit, confirmed that there had been no complaints since the last inspection. The home has a complaints register and in discussions with the staff group it was clear that support workers know how to recognise the non-verbal signs that would point to a resident being unhappy. Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 19 The home has an adult protection policy and procedure in place, which has this year been reviewed and updated to link with the local authority guidance. Islecare has produced a one-page adult protection summary guidance as a reminder for staff on the reporting procedures. In discussions with care support workers it was clear they were confident about reporting issues of concern without delay. Since the last key inspection of the home an adult protection referral had been made to social services. Appropriate action taken by the home has demonstrated that this standard is being met. Plean Dene DS0000012523.V325801.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 and 30 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home environment is comfortable and spacious but some of the communal areas require decoration and refurbishment. The home is clean and tidy and there are policies and procedures in place to maintain good hygiene. EVIDENCE: Plean Dene is a large, detached, period building set in it’s own extensive grounds. Whilst offering residents singe bedroom accommodation with plenty of space and large and comfortable communal rooms, the building requires a lot of upkeep in the general cleaning, maintenance and decoration. There is no passenger lift and residents who are unable to safely negotiate the stairs are assisted to use the stair lift. There is a separate area where one resident lives more independently with support from care staff. The home is currently without a cleaner and care staff are having to do domestic work in addition to their care and support work. However, the manager explained that the Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 21 cleaning post has been advertised and it is hoped that the post will be filled as soon as possible. A previous requirement for a refurbishment programme to be submitted to the Commission has not been met and this inspection identifies a number of additional requirements and recommendations with regard to the building. • The worn flooring in the dining room must be replaced • The ceiling in the sitting room needs repair • The sitting room could be decorated in a colour scheme suitable to the needs of the residents • The sitting room furniture must be replaced (the chairs and sofas are old and worn) • The sitting room lighting must be replaced (light fittings are damaged and are missing lamp shades) • The flooring in the main hallway must be replaced (the carpet is very stained and worn near the dining room) Some of these were requirements or recommendations from the previous inspection. The manager has been advised by the owners of the building that work will start shortly on roof repairs and decoration of the building exterior. The manager also confirmed that Islecare have to fit safety glass to an area of the home known as the Conservatory and the Kitchenette. The kitchenette is a large room with a kitchen area that is no longer used. The room is under utilised in its current state and could be developed into a suitable space for the residents to use, as an alternative to the sitting room where the TV is housed. A portable electric heater being used in the kitchenette posed a health and safety risk and was immediately removed when this was discussed with the manager during a tour of the building. The carpet in the sitting room is regularly cleaned but in the process has stretched and consideration should be given to replacing this as part of the ongoing refurbishment and replacement programme of the home. Since the last inspection, a new bedroom with a spacious en-suite bathroom has been created on the first floor from what were two small single bedrooms. This room is currently vacant. The home does not have a gardener and the extensive grounds are in need of tidying and maintenance. Residents are able to access a paved area outside of the sitting room but this needs to be extended or level access created around the garden for the residents to be able to use and enjoy the garden. The home has policies and procedures in place to maintain good hygiene. There is a contract for the disposal of clinical waste. Staff undertake training in infection control as part of their basic training programme. There are gloves and aprons for staff to use in all of the communal areas. There is a separate utility room for laundry away from food preparation areas. Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 22 Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 23 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 have a good understanding of the residents’ support needs and are keen to develop their professional skills and qualifications. Residents are protected by thorough recruitment procedures. EVIDENCE: The staff rota shows that there are usually five or six care and support workers on duty during the day and evening and two waking staff at night. The hours of the manager are in addition. In order to support the needs of the residents, there are three staff on each shift that are delegated to provide one-to-one support for those residents who have been assessed as needing additional support. All staff working in the home cover the areas of mandatory training that are essential for safe working practice; health and safety, infection control, safe moving and lifting, food hygiene, fire safety and basic first aid. Ten of the staff have already achieved the National Vocational Qualification (NVQ) level 2 in care. Currently five of the staff are working towards achieving the first units of Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 24 the Learning Disability Award (LDAF). Some of the senior staff have done some specific training in topics related to the needs of the residents; downs syndrome, deaf awareness, and epilepsy. During the inspection and in discussion with the registered manager further areas of training were identified that would develop the skill and knowledge base of the staff and ensure that residents particular needs would be met – Makaton communication, and autism. Training for staff in developing person centred care planning is already arranged to start in March 2007. The manager and staff confirmed that systems for staff supervision are in place and formal one-to-one supervision is arranged every three months with ongoing informal supervision and an annual appraisal. The inspector was able to observe a staff hand-over meeting and it was evident that this is an important part of ensuring good communication in the staff team about residents changing support and care needs. Staff recruitment files were inspected and the systems in place demonstrate that thorough checks are carried out before staff start working with the residents. Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 25 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 adequate. This judgement has been made using available evidence including a visit to this service. The home is well run by a manager who has many years of experience and who is in the process of achieving the relevant management qualifications. The home must develop effective quality assurance systems for measuring its performance based on seeking the views of residents, representatives and stakeholders. The home’s policies, procedures and staff training generally ensure as far as is reasonably practicable, the health and safety of the residents and staff. However, improvements are needed to the home’s record keeping of maintenance and safety checks. EVIDENCE: Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 26 The manager was appointed last year and became registered manager at the beginning of 2007 although she has worked in the home for many years and knows the residents very well. The manager has a positive approach and there are clear lines of accountability within the home. The manager is currently working towards achieving the NVQ level 4 in care and will then be enrolled to achieve the NVQ level 4 Registered Manager Award, hopefully achieving both qualifications within the next 12 months. The manager is committed to developing her professional skills and qualifications and is part of an ongoing management development programme provided by Islecare. Some of the requirements that still need to be met from the previous inspection were made before the current manager was in post. However, in discussion, it was clear that the manager has a good understanding of the areas in which the home needs to improve and it was evident that the manager is committed to improving the service for the benefit of the residents in the home. The home regularly reviews aspects of its performance through regular inspections by a representative from Islecare who prepares monthly reports under Regulation 26 of the Care Homes Regulations 2001, and Islecare have their own internal quality audit process. This needs to be developed to include consultations that seek the views of the residents, staff, relatives and professional visitors to the home. Comments received from relatives by the inspector, prior to the inspection, demonstrate that relatives would like to be more involved in care reviews, and issues affecting the residents. These comments were discussed with the manager during the inspection. A number of ways of seeking the views of the residents and others were discussed, including the use of independent advocacy services. The pre-inspection questionnaire completed by the manager prior to the inspection confirmed that health and safety checks and records are maintained in the home, however, some records were not available and the manager needs to ensure that these are up to date: Electrical wiring certificate Record of central heating and gas installation servicing Record of fire drills or practices A food safety inspection by the Department of Environmental Health in November 2006 made one requirement that has been met by the home. The fire safety logbook was up to date and the manager confirmed that the home has a fire safety risk assessment in place. The manager must check that the water temperature in the bathrooms and bedrooms is suitable for the residents’ needs as several tests of the hot water in bathrooms and bedrooms found the temperature barely above cold. Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 27 A portable electric heater that is unsuitable to use in the kitchenette area was immediately removed during the inspection. Cleaning materials are in a locked cupboard and all have been assessed for use. There are risk assessments in place for all aspects of the home environment and a senior member of staff confirmed that all risk assessments had been reviewed in November 2006. Discussion with staff during the inspection confirmed that they receive regular updates of their mandatory training in safe working practice. Plean Dene DS0000012523.V325801.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 3 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 X 2 X X 2 X Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 29 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5(1)(b) Requirement Residents or their representatives must be supplied with a contract or details of terms and conditions of living in the home. This is a repeat requirement and the previous timescale of 31/12/05 has not been met. To review the personal planning process, to ensure that each plan is appropriate to the age and needs of the individual. A protocol or written guidance is needed for all PRN or ‘as required’ medication. The ceiling in the sitting room must be repaired and decorated. This is a repeat requirement and the previous timescale of 28/2/06 has not been met. The lighting in the sitting room must be repaired/replaced. This was a recommendation from the inspection of 27/10/05 The dining room flooring must be replaced. The floor covering in the main hallway must be replaced. The grounds need tidying and DS0000012523.V325801.R01.S.doc Timescale for action 30/04/07 2. YA6 15 30/04/07 3. 4. YA20 YA24 13(2) 23 30/04/07 30/06/07 5. YA24 23 30/06/07 6. YA24 23 30/06/07 7. YA24 23 30/09/07 Page 30 Plean Dene Version 5.2 8. YA7 YA35 18 9. YA35 18 10. YA39 24 11. YA42 13(4) maintenance to provide access and maximise the ability of residents to use and enjoy the garden. The registered manager must access a course in Makaton signing for identified staff, to meet the needs of the residents. The registered manager must access suitable training for staff in meeting the needs of residents with autism. The registered manager must develop effective systems of quality assurance that seek the views of residents, relatives, staff, and visitors, about the service provided. The registered manager must ensure that records of maintenance and safety checks (as listed in the report) and required by regulation, are up to date and available for inspection. 30/09/07 30/09/07 30/09/07 30/04/07 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 YA24 YA24 Good Practice Recommendations Consideration should be given to utilising the kitchenette space for the benefit of the residents in the home. The sitting room could be decorated in a colour scheme that provides residents with a calm and relaxing environment. This was a recommendation from the inspection of 27/10/05 Plean Dene DS0000012523.V325801.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Plean Dene DS0000012523.V325801.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!