Inspection on 27/09/07 for Plean Dene

This inspection was carried out on 27th September 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

Plean Dene 12/08/08

Plean Dene 23/02/07

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 Mark Sims Unannounced Inspection 27th September 2007 10:30 Plean Dene DS0000012523.V344888.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.V344888.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.V344888.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 Ltd Vacant 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.V344888.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd February 2007 Brief Description of the Service: Plean Dene is a home providing care and accommodation for up to thirteen residents with a learning disability. 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.V344888.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was, a ‘Key Inspection’, which is part of the regulatory programme that measures the service against core National Minimum Standards. The fieldwork visit, the actual visit to the site of the home, was conducted over six hours, where in addition to any paperwork that required reviewing we met with service users and staff in their bedrooms and communal areas to see what it was like for service users and whether the home was meeting their needs. Several issues outstanding from the last inspection were also considered during the fieldwork visit. The inspection process involves pre fieldwork visit activity, gathering information from a variety of professional sources, the Commission’s database, and pre-inspection information provided by the service and linking with previous inspectors who have visited the home. What the service does well: Choice of Home: People moving into the home are provided with the opportunity to visit and to meet with both their prospective service users and members of the staff team. Pre-admission information could be made more widely accessible by adopting a wider variety of communication aids, written, pictorial, ‘Makaton’ symbols, audio, etc. Needs and Choices: The acting manager is in the process of agreeing the client new person centred plans, these have been created in conjunction with the service user, their representatives, keyworkers and professional sources. The plans that have been created are far more reflective of the persons’ individual support needs than the previous style of care planning, although in places rigid use of the written word and/or formal style of writing seems to lose the emphasis of this being about the person and how they like things done. Lifestyle: The people living at the home are clearly involved in a range of day services that provide both educational and recreational activities. Personal and Healthcare Support: The service users and staff have been well supported by the ‘Community Learning disabilities Nurses’, in creating detailed and informative health management plans for each service user. These plans cover all aspects of a person’s health care and clearly identify, which professionals and professional agencies they are involved with, where Plean Dene DS0000012523.V344888.R01.S.doc Version 5.2 Page 6 they prefer to receive any treatment or check ups and how they are best supported throughout the process by the staff, etc. The service users medication was noted to be appropriately stored and the medication administration records accurately maintained. Complaints & Protection: The home has policies that cover both complaints and the protection. Details of how to raise concerns are displayed within the main hallway where residents, visitors and staff can clearly view them, the notice combines signs and words in an attempt to make the process of raising complaints or concerns clear to a larger cross section of people. Environment: The premise is in a reasonable state of repair and the décor is generally good, with most peoples’ bedrooms being individually set out and furnished. Management: The Company has arranged for the training manager to take temporary charge of the home, whilst a new permanent manager is recruited. The training manager is an experienced leader who has held senior positions within several Islecare Home’s across both the older persons and younger adults services. The indication from the staff is that she has brought her wealth of knowledge and experience into the home and used it to good stead, implementing several new systems, for example the person centred plans, the improved health action plans, changes in staff working patterns, etc all of which are intended to improve the quality of life for the service users. What has improved since the last inspection? Individual Needs and Choices: New person centred plans have been introduced into the home, which have involved input from service users, their representatives, staff and professional agencies. Personal and Healthcare Support: The home has been well supported by the ‘Community Learning Disability Nurses’ in creating very clear, concise and informative health action / management plans. The home’s arrangements for supporting / managing service users medications was satisfactory. Environment: The environment was reasonably well decorated and furnished and the service users’, staff and management have tried to create a homely atmosphere, although the size and configuration of the home make achieving this goal very difficult. Plean Dene DS0000012523.V344888.R01.S.doc Version 5.2 Page 7 Staffing: The staff consider that their training opportunities have improved and had prior to the inspector arriving at the home completed a training sessions on ‘Down Syndrome’. However, the training records do not yet reflect the improvements spoken by the staff. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Plean Dene DS0000012523.V344888.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.V344888.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standard 2: The people to use the service and their representatives have the information needed when choosing the home and their needs assessed. EVIDENCE: The existing support plans contain details of the assessment carried out preadmission and professional assessments supplied in preparation for the service user to visit the home. The last person to move into the home, did so in the April of this year (2007) and would from observations, appear to have settled well into the home environment, people observed generally to be accepting of the other service users company, although there was little one-to-one interaction witnessed during the visit. Information provided by three service users also indicate that they were involved in making a decision about the home’s suitability to meet their needs, all three confirming that they choose to move into the home, one person adding that her ‘mum’ came with her during her visit to the home. Plean Dene DS0000012523.V344888.R01.S.doc Version 5.2 Page 10 Information taken from conversations with members of the staff team, suggest that all prospective new clients’ are provided with opportunities to visit the home prior to moving in, as this enables them to familiarise themselves with the home, fellow residents and members of staff. Plean Dene DS0000012523.V344888.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 6, 7 and 9 Individuals are involved in making decisions about their lives, and encouraged to play an active role in planning the care and support they receive. EVIDENCE: The level of understanding within the home’s current client group differs from person to person. However, where people are/or have been able to contribute towards the development of their person centred plan this has occurred and is easily identifiable within the new plans being drafted. Where people’s comprehension or ability to communicate their needs and wishes is impaired the staff team have involved families, representatives, keyworkers and professional staff in the development and shaping of the persons’ support plan. Plean Dene DS0000012523.V344888.R01.S.doc Version 5.2 Page 12 In discussion with the acting manager, it was established that the newly generated person centred plans had not yet been implemented, as the home wished the people involved in the production of the plan, to agree the content and how well it reflected the persons’ support needs. In discussion with the staff it was clear that they have been heavily involved, as keyworkers’, in the creation and/or development of the resident’s support plans and that they believe the new system is far better and more dynamic than the previous care planning system. Information taken from five relative comment cards suggest and/or indicate that generally people feel the support needs of their next-of-kin, is being meet, three people ticking ‘always’ to the question ‘does the care home give the support to your relative that you expect’, one person ticking ‘usually’ and the final person ‘sometimes’. The relatives comments also appear to support the efforts made in assisting people to live, as independent a life, as can be achieved with one person commenting on the independent flat their next-of-kin occupies, whilst other opted to ticked ‘always’ and ‘usually’ in response to the question ‘does the care service support people to live the life they choose’. The service users were also quick to use the comment cards to inform the Commission of the support they receive in leading independent lives, one person describing how they have been helped to secure employment, whilst another added ‘I choose what I want to do and staff support me with this’. The support plans, as mentioned above, also reflect far more the care and support the person requires and/or wishes, as do the newly developed and introduced health action plans. Observations, also established the lack of routine within the home, with people noted to be involved in numerous self-directed activities, reading, listen to music, watching television, going back and forth from their bedrooms, moving between lounges, etc. One person was keen and pleased to show us their bedroom, which was set out according to the persons’ wishes, although the person did suggest to staff during the fieldwork visit that they would like to re-arrange their bedroom and move their bed up against a wall, creating more floor space and reducing the likelihood of the person rolling out of bed, which apparently they had recent experience of. The staff’s response was both appropriate and supportive, suggesting to the service user that this would be fine and that perhaps they and their keyworker could work on making the changes, as the room would require a major rearrangement. Plean Dene DS0000012523.V344888.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 12, 13, 15, 16 and 17: People who use the service are able to make choices about their life style and are supported to develop their life skills, social, educational, cultural and recreational activities. EVIDENCE: The client group are involved with a number of day services across the Island, people observed returning from various destinations during the fieldwork visit. The AQAA also contained the following statement: ‘staff support service users to maintain relationships with families and attend day services’, which further establishes people’s involvement with these varied services, as does the information contained within the ‘person centred plans’, which sets out a persons’ leisure pursuits and activities. Plean Dene DS0000012523.V344888.R01.S.doc Version 5.2 Page 14 The home has two vehicles, which are used to take people out to various events and activities however; according to the staff there is presently a shortage of drivers, which they fear could impact upon the availability of staff to take people out. As a short-term measure the acting manager has agreed with one of the senior staff that she will alter her work pattern to ensure she is available within the home throughout the day, as apposed to working shifts, this it is hoped should improve the situation and elevate the pressure. However, concerns were also expressed over the age and suitability of the vehicles, as the physical health care/support needs of some of the service users are not best suited to the vehicles provided, which could limit their opportunities for out, etc. Information taken from the service user comment cards establishes that generally people feel they are enabled and/or supported to undertake the activities they enjoy, one person presenting rugs they had made to the inspector and explaining that this kind of creative work was their particular hobby. The staff also discussed how people make use of the local facilities, such as the nearby public gardens and tearoom and the amenities of the old town, which are approximately ten minutes walk from the home. It is difficult to gauge, with any certainty, the degree to which social cohesion exists between the client group, although people clearly seem to accept each other’s company and were noted to be sharing the facilities of the home, lounge, diner, etc. Some client’s were noted to be far more tactile and demonstrative than their fellow residents or clients and actively sought physical contact on arriving home from their day services, on encountering staff newly on shift or as a way to reinforce friendship. None of the interactions witnessed where considered inappropriate, given the situation and circumstances within which they occurred and all were freely sought and/or initiated by the client. People’s support plans also take into considerations the boundaries within which physical affection, etc is expressed and describe for those clients, that are non-verbal or unable to communicate, etc the variety and means employed to conveyed emotions and/or meaning. This could be varying noises, facial expressions, body language or gestures, which are unique to the person and unique to the message being communicated. Plean Dene DS0000012523.V344888.R01.S.doc Version 5.2 Page 15 Families are clearly involved with the majority of service users, several people opting to complete the survey’s provided by the Commission or supporting their next-of-kin to complete the survey sent to them. Photographs were also noted in some people’s bedrooms, which establishes relationships beyond those that exist within the home and the support plans contained details of persons’ relatives or representatives. The home’s layout and design ensures that sufficient spaces is available for people to dine communally if they wish, although sometimes people do not return from their day services, etc to eat with the main client group. Ample staff are employed to support people with any specific dietary needs or assistance required whilst eating and the food prepared and presented is suited to the age of the clients. Menu’s are produced but are of little use or value to the general client group given the range of communication problems experienced, however, it is known that the company is considering introducing photographic menu’s into its home’s for clients with differing communication needs and these will undoubtedly benefit people in the long run. The kitchen visited during the tour of the premises was noted to be a large and well equipped facility, which is secured when not in use, as some service users have been identified or assessed as potentially at risk if left unsupervised within the area. Plean Dene DS0000012523.V344888.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 18, 19 & 20 The health and personal care that people receive is based on their individual needs and the principles of respect, dignity and privacy. EVIDENCE: The new ‘person centred plans’ set out very clearly how each person wishes to be assisted and/or supported with their personal care and how people are to be provided with choice when choosing their clothing, etc, even if their ability to communicate a preference is restricted. One person’s plan describes how, if the staff present me with a choice of clothing I will produce a vocalised response, which indicates my preferred items of dress. Each client is also allocated a keyworker; whose role is to help and support the person with routine tasks, such as purchasing toiletries, clothing and to a lesser degree bathing, although people are encouraged to take baths and/or showers when they wish regardless of their keyworker being on duty. Plean Dene DS0000012523.V344888.R01.S.doc Version 5.2 Page 17 Where possible clients are supported to undertake their personal care independently, as demonstrated by one person who came to speak with the manager, to report a damaged shower door, which was preventing her showering. However, where people do require support the staff undertake this in a sensitive and professional manner, the inspector observing the staff assisting a client to their bedroom to freshen up and change following an episode of incontinence. The staff involved in the process providing the person with plenty of reassurance and comforting, as they were upset at the incident that had occurred and ensuring that a minimum of fuss and attention was drawn to what they were doing in supporting the client. People’s health care needs are also being well managed, with a member of the Community Nursing Learning Disabilities team involved in supporting the home and/or staff in the development of individual client health management plans. A sample of these plans were reviewed during the visit and found to be extremely well structured and informative documents, which focused extensively on the health care professionals and agencies each person was involved with and described how and where a person preferred to engage and/or meet with the professionals. In discussion with the Learning Disabilities Nurse, it was ascertained that she has worked with both the service users and their keyworkers to create these comprehensive plans and that she is confident that the work undertaken, by all parties, will improve the service users experience when accessing health care service. The role of the staff, when supporting the residents’ to access appropriate health care services and following any treatment, etc, is also acknowledged by the service users relatives, people making comments such as: ‘when our nextof-kin had surgery earlier this year, we were kept fully informed’ & ‘after five years as a resident of Plean Dene we feel that our son has received the best care and respect. His wellbeing, appearance and health are a credit to the staff’. The dataset make clear that policies and procedures are available to guide staff when handling service users medication and comments from staff indicate that only senior carers dispense medications and that training is provided. Storage facilities were seen during the inspection and considered satisfactory, as were medication administration records, which had been appropriately completed. Plean Dene DS0000012523.V344888.R01.S.doc Version 5.2 Page 18 The staff observed dispensing medications did so in a structure and methodical way and appropriately completed the medication records once the medicine had been administered. Medications are dispensed from a ‘monitored dosage system’ (MDS), which is provided by ‘Boots’. Plean Dene DS0000012523.V344888.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 22 and 23: People who use the service are able to express their concerns and have access to a robust, effective complaints procedure and are protected from abuse. EVIDENCE: The AQAA and dataset both indicate that the service users and staff have access to policies designed to help them raise concerns/complaints and protected them from harm The ‘concerns and complaints, disclosure of abuse and bad practice; and the safeguarding adults and the prevention of abuse’ all reviewed and updated in January 2007. Unlike other documents identified within this report, the complaints policy and procedure are not only available in a written format, having been transcribed into a pictorial guide for the service users. A copy of this document was seen on display within the entrance hallway and combines both pictures and words. Information taken from both the service users and relatives comment cards indicate that generally people understand the complaints process and who to approach if they are unhappy or dissatisfied with the service being provided. One relative did indicate via the comment card that they were not familiar with the home’s complaints process but then wrote later that they were ‘hopeful Plean Dene DS0000012523.V344888.R01.S.doc Version 5.2 Page 20 that recent concerns were being dealt with’, which would indicate that whilst they may not be aware of the home’s procedure they were at least confident in the manager’s ability to address the concerns raised. Many service users, as discussed, have a restricted communication range, which limits their ability to verbally express concern or dissatisfaction, however, the person centred plans have been developed to include details of how people express themselves physically and vocally, which should help staff determine the person’s feelings if not the related cause. Observations, established that the staff have developed good relationships with the service users and that they have a good awareness of how people express themselves and communicate their wishes even without verbal prompts and cues. The service has been the subject of several safeguarding investigations, which have been overseen by the Local Authority. The home and/or the proprietary company have co-operated with all ensuing investigations and have implemented any recommended changes following the conclusion of the investigation. Visits undertaken by the Local Authority Commissioning/Contracting Department appear to support the claims that changes have been implement, lead to improvements, which have been sustained across a number of visits. Safeguarding adults is now considered a mandatory course by the proprietary company and is a central feature of the home’s contract with the Local Authority Social Services, which is agreed on behalf of all funded clients. The AQAA / Dataset make reference to safeguarding adults training being made available to staff, it also identifies, as mentioned above that policies and procedures are in place. Plean Dene DS0000012523.V344888.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 24 and 30: The physical design and layout of the home enables people to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: A tour of the premise established that the property is generally in a good decorative condition and was clean and tidy throughout. Visits to people’s bedrooms, undertaken with service users and/or staff, established that each room was different in design and layout and that the person had been empowered and supported to create an individualised environment based on their wishes and taste. The service users comment cards, also indicate that people consider the home to be fresh and clean and people appeared happy within the environment, Plean Dene DS0000012523.V344888.R01.S.doc Version 5.2 Page 22 relaxing in the lounges, undertaking independent activities, migrating between rooms as they wished, etc. Several relative comment cards also indicated that the home is considered to be a happy and homely environment, whilst others spoke of the benefits afforded their next-of-kin through the independence of their own flat. As with most premises the homes biggest draw is the fact that the service users accommodation is largely confined to the first floor, which means negotiating a flight of stairs. Whilst the stairs are not significantly step they do pose a risk to some clients with mobility problems. However, the installation of a stairlift has greatly reduced this potential problem and people were noted to use this facility when climbing the stairs. Communal areas of the home were noted to be large and reasonably well furnished, with a range of seating provided within the lounge, sufficient space to accommodate all of the service users is provided within the dining room and a mixture of bathing – showering and toileting facilities are provided. Plean Dene DS0000012523.V344888.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards 32, 34 and 35: Staff in the home are trained, skilled and supplied in sufficient numbers to support the people who use the service. The home’s recruitment and selection process requires attention to ensure it operates efficiently. EVIDENCE: Records maintained by the manager, show that staff have attended both mandatory and non-mandatory skills development courses over the last twelve months. In discussion with the staff it was established that training opportunities had increased significantly and that prior to the fieldwork visit an awareness course, around the needs and support of people with Downs Syndrome had taken place. Plean Dene DS0000012523.V344888.R01.S.doc Version 5.2 Page 24 The staff also highlighted how training is logged and explained that annually they are required to attend mandatory refresher. Information provided by service users relatives indicate that generally people feel the staff have the key skills required to meet the needs of the service users and support them in achieving their goals and aims, etc. One person did query whether sufficient training was being made available regarding the needs of people with specific syndrome’s and conditions, however, the staffs comments about the training provided that morning indicate that specific skills and knowledge training is now being provided. The company provides both procedural guidelines, reviewed and updated in January 2007 and administrative support to managers when recruiting new staff, according to information contained within the AQAA and Dataset. On reviewing the files of several newly recruited staff it was noted that the company were not always approaching the person’s last employer for a reference or asking the applicant to provide a full employment history. The files of several longstanding staff were also reviewed and noted to contain no details of the persons’ Criminal Records Bureau (CRB) or Protection Of Vulnerable Adults (POVA) check outcomes. On talking to the manager it was established that after a year the CRB and POVA outcomes are destroyed, following National and company guidance. However, the service should be retaining details of the CRB disclosure number and the date the outcome of the CRB has been obtained. It is also important that every three years the company re-submit CRB checks for its existing staff, in accordance with good practice recommendations. Plean Dene DS0000012523.V344888.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards: 37, 39 and 42: The management and administration of the home is based on openness and respect, and has effective quality assurance systems developed by a qualified, competent manager. EVIDENCE: The home has experienced some managerial upheaval recently with the previous manager leaving her position following a spate of safeguarding concerns and the involvement of the Local Authority Commissioning/Contracting Department with the service. Plean Dene DS0000012523.V344888.R01.S.doc Version 5.2 Page 26 The acting or interim manager has since taking up her position overseen the implementation of new support plans, based on the needs and wishes of the service users. Provided support and co-operation to the Learning Disabilities Nurses visiting the home and involved in the development of the health management plans for the service users. Increased and improved staffs access to training and development opportunities, including specific and specialised training around syndromes and conditions, etc. Reviewed the working arrangements and deployment of staff to ensure people are not being overstretched and where necessary agreeing new working arrangements to cover gaps within the current staff team, i.e. agreeing with a staff member that they will work 09:00 to 17:00 to ensure the availability of a driver. Increased the staffing complement via the recruitment process to ensure more carers are available and undertaken supervision sessions to support staff. The feedback from the staff is that they appreciate the efforts of the acting manager and would like her to consider taking the role on permanently, as she provides a clear vision of how the service should be operating and is always available to support and speak to people. Observations allowed the inspector to witness people approaching the manager to discuss a number of issues, including a service user who wished to discuss a damaged shower room door, which they wished repaired. The manager also spent time ensuring that the staff team were dealing with any problems and/or concerns effectively and met with one staff member, who has recently returned to work, to ensure they had not found their first day to stressful and overpowering. It was also noted that the acting manager was pro-active and not reactive, the loss of a persons’ wallet leading the manager to make changes to the way the home secured and managed peoples’ monies, prior to receiving recommendations from the safeguarding meeting, which had been convened. Quality audit has not been a priority for the acting manager since taking up her posted, however, the increased involvement of the service users in the development of both the person centred plans and the health management plans; indicate that the manager is committed to involving people in shaping their support packages. Plean Dene DS0000012523.V344888.R01.S.doc Version 5.2 Page 27 The manager has also improved the staff’s access to supervision sessions and has arranged at least one staff meeting in her time at the home, although both systems would benefit from the advanced scheduling of future sessions. The AQAA and Dataset documents establish that the company are involved in regularly reviewing and updating their policies and procedures and Regulation 26 visit reports are being made available for inspection. The AQAA and dataset also establish that full health and safety policies/guidance documents are made available to the staff and that equipment is regularly maintained and serviced, gas, electrical installations, portable electrical appliances, hoists, baths, etc. Health and safety training is clearly made available to staff, with the Staffing records evidencing that staff have complete moving and handling, infection control and food hygiene training as part of their annual mandatory training/refresher sessions. The tour of the premise identified no immediate health and safety concerns and risk assessments were in place for issues such as the use of the stairlift, etc. Bath’s were noted to be fitted with appropriate water temperature restrictors, windows on the first floor were limited in the distance they would open and the kitchen is secured when not in use, to prevent harm to people. Plean Dene DS0000012523.V344888.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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 X 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Plean Dene DS0000012523.V344888.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered 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 YA33 Regulation Requirement Timescale for action 19/11/07 Regulation The company must ensure 19 details of all CRB and POVA checks are retained following the disposal of the outcome report. The manager must ensure that all applications are fully completed and appropriate employment histories obtained. The manager must ensure that an applicant’s last employer is approached for a reference. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Plean Dene DS0000012523.V344888.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South East Regional Contact Team The Oast Hermitage Court Hermitage Lane Maidstone, Kent ME16 9NT 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.V344888.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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