Inspection on 11/09/06 for Powys House

This inspection was carried out on 11th September 2006.

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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Powys House 12/10/05

Powys House 27/04/05

Powys House 05/11/04

Powys House 11/05/04

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

CARE HOME ADULTS 18-65 Powys House Powys House 121 York Avenue East Cowes Isle of Wight PO32 6BB Lead Inspector Unannounced Inspection 11th September 2006 10.30 Powys House DS0000055743.V302545.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 Powys House DS0000055743.V302545.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. Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Powys House Address Powys House 121 York Avenue East Cowes Isle of Wight PO32 6BB 01983 291983 01983 291983 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) Harrison Care Enterprises Ltd Mrs Gillian Skeats Care Home 18 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (3), Mental disorder, excluding of places learning disability or dementia (4), Old age, not falling within any other category (2), Physical disability over 65 years of age (1) Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 2005 Brief Description of the Service: Powys House is a large period building, which has been converted to provide residential care to a mixed client group, offering services to younger and older adults with learning disabilities, older persons, 4 places under the category of mental disorder and 1 category for someone with a physical disability. The premises is situated about midway along York Avenue, East Cowes, which is the main thoroughfare into the town and provides service users with easy access to the facilities and amenities of East Cowes, including sources of transport. The building, as highlighted, is a period town house, which has been extended and adapted to provided residential accommodation, including a passenger lift servicing all floors, portable ramped access to the home, assisted bathrooms, etc. All bedrooms are for single occupancy. The home is owned by Harrison Care Enterprises Ltd and managed by registered manager, Mrs Gillian Skeats. Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains information gained prior to and during an unannounced visit to the home undertaken on Monday, 11th September 2006. The manager was not present on this day however the provider and deputy manager were present and assisted the inspector during the visit. The inspector telephoned the manager following the visit to discuss some issues identified in the report. The inspector would like to thank the people who live at the home and the staff for their full assistance and co-operation with the unannounced visit. The visit to the home was undertaken by one inspector and lasted a total of approximately seven hours. All core standards and a number of additional standards were assessed. During the visit to the home the inspector was able to meet with and talk to most of the people who live at the home. The inspector was able to spend time with the care staff on duty and was provided with free access to all areas of the home, documentation requested and service users. Prior to the visit a pre-inspection questionnaire was sent to the home and returned within the required time scale. External professional questionnaires were sent to people identified in the pre-inspection questionnaire as having regular contact with the home. Comment cards were returned from two care managers and the home’s GP. Service user and relative comment cards were sent to the home and these were completed and returned. Five service user comment cards were received. Information was also gained from the link inspector and the home’s file containing notifications of incidents in the home. What the service does well: All service users stated that they liked living at the home and that the staff and manager were all kind and helpful. Service users have active lives and are supported to follow their interests and maintain contact with family and friends. Most service users have lived at the home for many years and have highly individual private accommodation (bedrooms). The manager and care staff demonstrated a very thorough understanding of the individual needs of the people who live at the home. Individual health needs are known and met. Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 6 The manager has been pro-active in identifying appropriate training relevant to ensure that staff have the necessary skills to meet service users’ complex needs. The service has a very low turnover of staff, with only two staff having left in the past year, this being due to retirement. This results in a high level of consistency for service users who are cared for by people who know their individual needs. What has improved since the last inspection? What they could do better: The proprietor has already identified the areas of the home that require modernisation and redecoration. This programme has already been commenced with work seen completed to a high standards. No requirements have been made in respect of the environment, as the proprietor is fully aware of the areas that need attention. Care plans must contain more detail as to how individual care needs should be met. Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 7 The inspector noted that there was no soap or towels in some of the bathrooms and WCs. The proprietor explained that one service user has a compulsive need to use all the soap and hand towels. The manager must consider how service users, staff and visitors can prevent cross infection by having access to facilities to wash and dry hands after use of the toilet. The manager should consider if her intended work hours should be included on the duty rota in order that the home is able to maintain a full and accurate record of people who have worked in the home. A copy of the monthly Regulation 26 reports must be available in the home 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. Powys House DS0000055743.V302545.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 Powys House DS0000055743.V302545.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home would only admit people whose needs it could meet and who would be compatible with the people already living at the home. EVIDENCE: At the time of the visit to the home the service had one vacancy. This was the result of a service user with increasing needs identified as nursing being transferred to an alternative home shortly before the inspector’s visit. The home had therefore not admitted any new people since the previous inspection. It was recommended following the previous inspection that the home create a specific assessment tool for new service users. The inspector was provided with a copy of the assessment tool the home would use in the event of it admitting a new service user. The form can also be used for the reassessment of service users to identify if needs are changing. The assessment tool covers all activities of daily living and would enable the home’s manager and staff team to determine if the home can meet the needs of a referred person. The inspector discussed with the proprietor the procedure the home would undertake during the admission of a new person. This includes contact with care managers and prospective service users visiting the home for a day and Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 10 meeting existing service users. Discussions with the proprietor indicated that the views of the people who already live at the home would be sought and taken into consideration when deciding whether to admit a new person to the home. The proprietor discussed with the inspector the level of need the home can meet and confirmed that should a new service user have any special needs then training for staff would be organised. Comment cards stated that external professionals were satisfied with the level of care provided at the home. Powys House DS0000055743.V302545.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. All service users have individual care plans. Care plans should contain specific information as to how individual care and support needs will be met. Care plans contain relevant risk assessments. Service users are encouraged to make choices and their personal finances are appropriately managed. EVIDENCE: The inspector viewed the care plans for three of the people who live at the home. These included people with high support needs resulting from increasing health needs. The inspector telephoned the manager following the visit to the home to discuss the care plans. During the previous inspection the home was changing the care plan format used at the home. The new format was in use at this visit. Care plans seen were concise and contained only relevant up to date information with other information archived but still available for reference if required. The inspector felt that there should be more information as to how Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 12 specific care needs should be met. An example being that the care plan stated that the service user required help with bathing but did not specify what the person could do for themselves and what they needed assistance with. This could result in care staff doing more for a person than was necessary and service users not using skills they have. It was hard to identify the extent to which service users had been involved in their care plans. The inspector suggested that the care plans could contain statements from the service user as to how they wanted people to help them meet their care and support needs. Service users were aware that they had care plans and confirmed that they were included in reviews with their key workers. Care staff complete daily records stating how support needs have been met and any other relevant observations such as activities and health issues. The home has a mix of service user categories with the people who live at the home therefore having a range of care and support needs. Care plans were seen to contain specific risk assessments, including manual handling, for individual service users relevant to their needs. The pre-admission assessment tool would identify any specific risk areas. The Commission has received a number of notifications of falls for several of the people who live at the home. The notifications contained information as to why people had fallen and the actions the home would take to prevent re-occurrence. Specific risk assessments were seen in care plans of these people in respect of falls. The proprietor is a qualified mental health nurse and discussions with him during the visit indicated that he had a good understanding of positive risk planning in relation to people with mental health needs. The inspector discussed with service users, care staff and the proprietor how decisions are made in the home. Service users confirmed that they are encouraged to make choices and that these choices are supported. The majority of the people who live at the home were going on holiday the week after the inspector’s visit with approximately five having chosen to stay at home. One service user not going on holiday stated that she had not wanted to go and was staying at home and would be going on some special outings she had chosen on the Island. Throughout the visit the inspector witnessed service users’ opinions being sought and their choices respected and acted upon. The home funds a weekly visit from the advocacy group. The advocate is independent of the home and able to assist service users individually and as a group to make choices. Service users confirmed that they are able to decide how their personal allowances are spent. The home has an appropriate procedure for the management of service users’ personal money with full records kept. All service users have their own bank accounts into which their benefits are paid. Social services are responsible for the financial assessment of the service users’ contributions towards their care and these are paid to the home via direct debits from their bank accounts. Bank statements showing this were seen by the inspector. Some service users hold small amounts of personal cash Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 13 themselves. On the day of the visit several had decided not to return straight home from day services but had brought themselves refreshments after getting off the bus in East Cowes. Powys House DS0000055743.V302545.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Service users have varied and active lives, are able to participate in their local community and have visitors to the home. Service users are offered a healthy diet and enjoy their meals and mealtimes. EVIDENCE: The inspector was able to meet with and talk to most of the people who live at the home. Five of the service users returned pre-inspection comment cards. Service users talked with the inspector about what it is like living at Powys House. Service users talked about their weekly activities and holidays planned and undertaken. Service users all have individual weekly plans containing a range of external activities (day services and supported work placements) as well as leisure activities in the evenings and at weekends. Service users are encouraged to undertake domestic tasks but can opt out if they choose to do so. One service user explained to the inspector that she did her own laundry and staff had shown her how to operate the washing machine. The service user Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 15 stated she did not have to do it but liked to do her own laundry. As well as planned weekly activities the home also organises ad hoc activities such as trips to pubs and places of interest. Activities and social events undertaken are recorded in the daily records in care plans. Service users stated in the comment cards returned prior to the visit that they have lots of things to do and that they enjoyed living at the home. As previously stated several service users had decided to purchase themselves refreshments at their local pub on their way home from the bus stop. Service users stated that they can use local shops and are supported to go to Newport if they want to shop at a wider variety of shops. The inspector believes that service users have a good lifestyle with varied activities on offer. Many of the service users were going on holiday the week following the inspector’s visit to the service. They confirmed that they had chosen where they were going and those who did not wish to go on holiday were staying at home and having some special days out chosen by themselves. The service users were clearly looking forward to the holiday. Sample menus were provided to the inspector prior to the visit to the home. These indicated that service users are provided with a varied nutritious diet. During the visit to the home the inspector was able to talk to staff and observe the meal preparation for people at home during the visit. The cook stated that she uses fresh vegetables whenever possible and steams these to keep as much goodness as possible. The meal served during the inspector’s visit looked and smelt nice. The main meal is at midday with a plated meal put aside for service users who have taken sandwiches to day services. Some service users prepare their own packed lunches to take to day services. Staff were aware of individual likes and dislikes of the people who live at the home. Service users stated they liked the food, one who is a vegetarian informed the inspector that she and other vegetarian service users are provided with a non-meat option at every meal. Although there were no visitors to the home during the inspector’s visit service users confirmed that they could invite friends or family to visit. The home has two lounges and the back lounge could be available for private visits or meetings if required. The home has ramps that can be placed over the front steps to facilitate wheelchair access. None of the existing service users requires these but they are available should a relative or friend with limited mobility wish to enter the home. Powys House DS0000055743.V302545.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 at least once during a 12 month period. 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 the available evidence including a visit to this service. Service users receive personal support in the way they prefer and require, and their physical and emotional health needs are met. Appropriate systems are in place for the safe storage and administration of medication. EVIDENCE: Throughout the inspection visit the inspector met most of the people who live at the home. Everybody appeared to have been well supported with their personal care needs. Five comment cards were received from service users and these all stated that they always receive the care and support they require. Individual care plans provided some information as to how personal care needs should be met, however as previously stated the inspector feels that more detailed information should be included on care plans to indicate the specific assistance people require to ensure that maximum independence in this area is maintained. Records of personal care are maintained in daily records. Service users spoken with during the visit stated that staff provide assistance with personal care and that they liked the new shower room. The manager and Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 17 care staff stated that service users liked the shower and that service users were using this more frequently than when the home only had baths. The home now has one shower and two bathrooms. Both bathrooms are in need of modernisation and were seen to contain equipment for supporting people with limited mobility. The proprietor stated that the bathrooms are part of the home’s improvement plans and that he will keep one as a bathroom and convert the other to a second shower room. This would appear appropriate as the service users clearly enjoy the shower and prefer this to baths. In conversation with the staff and deputy manager it was established that a key worker system is in operation within the home and that key workers support two or three service users. The role entailing general support, assistance with purchasing clothing and toiletries, etc. Care plans contained information about service users’ health needs and how these had been met including records of GP, hospital and optician appointments. Care staff confirmed that health action plans had been completed for all service users in the learning disability category. A discussion about these occurred with staff asking if they were able to do health action plans for the service users in other client groups. The inspector stating that health action plans are a tool to ensure health needs are identified and met and as such there is no reason why they could not be completed for all people living at the home regardless of the nature of the disability. Care staff stated they would discuss this with the manager and service users concerned. At the time of the visit one service user was in hospital. Care records concerning her illness and hospital admission were viewed and indicated that staff had recognised she was ill and responded appropriately to a significant health need. Records also indicated that the home was in close contact with the hospital with the proprietor stating that he was intending to visit the service user that evening. Also during the inspection another service user had an outpatient appointment and was supported to attend by the proprietor (a qualified mental health nurse) and a member of care staff. A comment card was received from the home’s GP that stated that he had no concerns about the home and was satisfied with the overall care provided to service users. The proprietor informed the inspector that training had been organised via an external provider in respect of mental health and this was due to commence via a series of sessions in October. Care staff informed the inspector that they had received training from local district nurses such that they could undertake blood glucose monitoring and administration of insulin. The manager had identified a training pack about diabetes that all staff were completing, the pack being seen during the visit and comprehensively covers all aspects of the disease and its management. Care staff also confirmed that those who administer medication have completed training with seven staff being able to administer medication. The arrangements for medication were discussed with the person administering the Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 18 lunchtime medications. The home has an appropriate storage trolley, which is kept secure when not in use. The home uses a blister pack system and, as recommended at the previous inspection, stores medication not able to be dispensed in the blisters together for each service user. Medication administration charts were found to be fully completed, with medication received into the home also recorded. The home also has systems in place for the return of unused medication to the pharmacy. Powys House DS0000055743.V302545.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 at least once during a 12 month period. 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 the available evidence including a visit to this service. The people who live at the home are able to make complaints that would be appropriately investigated and resolved. The home would respond appropriately to adult protection concerns. EVIDENCE: The pre-inspection questionnaire completed by the manager stated that there had been no complaints to the service during the previous year. Comment cards received from care managers and health professionals confirmed that they had no concerns or complaints about the service. The questionnaires completed by the service users also stated that they had no complaints or concerns. The home’s complaints procedure is detailed in the service users’ guide. Discussions with the people who live at the home indicated that they would tell a member of staff or the manager if they had any complaints. Discussions with care staff indicated that any complaints would be listened to and appropriate action taken either to immediately resolve the problem or to inform the manager. Observations of the interactions between the people who live at the home and care staff indicated that they would be able to discuss any concerns or make complaints with the staff or their key workers. Most of the people who live at the home attend external day services and clubs, they would therefore be able to discuss concerns with people not related to the home. The home encourages service users to express their opinions and has Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 20 contracted with an independent advocate who runs weekly sessions at the home. All care staff have completed an adult protection training pack with those spoken to having a clear understanding of what might constitute abuse and the actions they should take should they have concerns that a vulnerable adult was being abused. The home has previously notified the Commission and social services about concerns they had that a service user may be at risk of abuse. These concerns were not in respect of the home but when the service user was elsewhere. The actions taken would indicate that the home would take appropriate action in the event of adult protection concerns. Powys House DS0000055743.V302545.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home has a planned programme of modernisation and improvement with the work having already been undertaken seen to have been completed to a high standard. EVIDENCE: The proprietor showed the inspector round the home and explained the work undertaken and planned as part of the home’s improvement plan. All communal areas and some of the bedrooms were seen. The home provides a comfortable, homely environment for service users. Automatic door closing devices have been fitted to various doors around the home. At the time of the unannounced visit no doors were seen to be held open with inappropriate devices. The home’s boiler was being serviced by a Corgi registered external contractor on the day of the unannounced visit. All bedrooms are for single occupancy with the majority having en-suite facilities. A number of bedrooms have been redecorated and new carpets provided. The proprietor discussed plans to provide en-suite facilities into the remaining two bedrooms where this is practical. Bedrooms seen had been Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 22 highly personalised by their occupants and contained items of home entertainment such as televisions and music systems. Service users stated that they are happy with their bedrooms. As previously stated modernisation work has also been carried out on the ground floor bathroom. This previously contained a bath that has been removed and a shower/wet room created. Service users stated that they like the shower. Staff stated that service users are using the shower more often than when the home only had baths. This has improved their personal care skills and independence. The proprietor showed the inspector the home’s other two bathrooms. These are both in need of redecoration and modernisation. The proprietor stated that as the shower had proved so popular he was hoping to convert one of the remaining bathrooms to another wet room and keep one as a bathroom. This would seem appropriate. Both bathrooms currently contain suitable equipment for supporting service users who require assistance to get into/out of the bath. No requirements are made in connection with the improvements required in the bathrooms as the proprietor has already included these in his modernisation plans. The home provides appropriate communal space including two lounges, dining room and pleasant gardens to the front and back of the home. Since the previous inspection the dining room has been redecorated to a high standard. At the time of the unannounced visit the front lounge was in the process of being redecorated. The proprietor showed the inspector the carpet already purchased which will be used in the lounge and some bedrooms once the redecoration work has been completed. Some of the chairs in the communal rooms have been replaced including a chair specifically purchased for one service user who has problems getting up from the chair. This chair assists the service user to stand by raising the seat and is electrically controlled. The proprietor has also commenced work on the gardens with plans to increase car parking at the front of the home and a new fish pond in the back garden. Service users were seen using the garden during the visit and stated they enjoyed looking after the fish. As previously stated the home has the necessary equipment to support service users and to maximise their independence. The home has a shaft lift that serves all floors, portable ramps that can be placed over the front steps for wheelchair access, bath aids and walk in shower. The single step between the dining room and corridor to the rear of the home has been replaced with a short ramp. The home employs a cleaner with service users being encouraged to help keep their own rooms clean and tidy. Some service users stated they liked to help with domestic activities others were less interested and their rooms were kept clean by staff. At the time of the unannounced visit the home was found to be clean and tidy with no unpleasant odours. Staff stated they had access to all the equipment required for infection control. The inspector noted that there Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 23 was no soap or towels in some of the bathrooms and WCs. The proprietor explained that one service user has a compulsive need to use all the soap and hand towels. The manager must consider how service users, staff and visitors can prevent cross infection by having access to facilities to wash and dry hands after use of the toilet. Powys House DS0000055743.V302545.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home provides an appropriately recruited, trained, supervised, consistent staff team in the necessary numbers to support service users. EVIDENCE: Staffing rotas, information about staff commencement dates, CRB checks and training provided and planned for the future was provided with the preinspection questionnaire completed by the manager. This information was further discussed with the staff, administrator and proprietor during the visit to the home. Five service users returned comment cards prior to the visit to the home. These stated that staff are available when needed and that staff listen and act on what the service users say. During the visit to the home service users confirmed that staff are nice, helpful and available when they are needed. Comment cards from external professionals confirmed that staff demonstrate a clear understanding of the needs of service users and that there is always a senior member of staff available for them to speak with. Interactions between staff and service users throughout the inspection indicated that service users and staff have a warm and easy relationship. Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 25 The numbers of staff on duty at the time of the unannounced visit to the home corresponded to those on the duty rotas supplied prior to the visit. Three staff, including one senior are on duty throughout the day with two care staff (one awake, one sleep-in) at night. The home also employs a part time administrator, handyman, cook and cleaner. The manager is in addition to the above numbers and the proprietor provides additional support with appointments and outings when at the home. Care staff stated that they felt the staffing levels were appropriate and that they had sufficient time to meet service users’ needs and undertake external activities. The proprietor was clear that should a new service user have additional needs then 1-1 hours would be requested to meet these needs. Service users confirmed that staff are available when they need them, and that staff are pleasant, helpful and that activities and outings occur. Information supplied with the pre-inspection questionnaire and confirmed by the home’s administrator stated that only two staff have left the home since the previous inspection approximately one year ago. These two care staff left due to retirement. The home has recruited one new member of care staff. The recruitment procedure and records were explained by the administrator. The process and records seen should ensure that unsuitable people are not employed at the home and includes two written references, CRB and POVA check. Service users are able to meet potential staff as interviews are carried out at the home and applicants’ interactions with service users are observed as part of the recruitment process. During a telephone conversation with the manager following the visit to the home the manager confirmed that she has copies of the new common induction standards for social care workers and would follow these should the home appoint any new staff. The home has engaged the services of Peninsular (an employment advice service). The inspector saw a staff training list on the staff room wall which indicated that staff have undertaken relevant mandatory training. As previously mentioned all staff have completed workbooks in respect of adult protection and at the time of the visit were completing workbooks on diabetes. Additional training in relation to blood glucose testing and insulin administration has been provided by the district nurses. The proprietor informed the inspector that external training about mental health has been organised and will commence in October. This is relevant as the home has four service users in the mental health category. Care staff stated that they felt they had appropriate training to meet service users’ needs and if additional training was required they were confident that the manager would organise this. The pre-inspection questionnaire stated that eleven of the home’s eighteen care staff have at least NVQ level 2 in care. The administrator confirmed these numbers stating that four have NVQ level 3 and one NVQ level 4. The home therefore exceeds the 50 requirement and has approximately 70 of staff having an NVQ in Care. Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 26 Care staff confirmed that they have supervision on a regular basis and an annual appraisal. Supervision is undertaken by either the manager or deputy manager who have undertaken supervision and appraisal training. Records for supervision are maintained with a sample being viewed. As well as formal supervision the manager and deputy work with care staff and are able to supervise practise on a daily basis. Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 27 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Service users benefit from a well run, safe home. Service users’ views are actively sought and used to influence service provision and improvements to the service. The proprietor must supply copies of Regulation 26 reports to the manager. EVIDENCE: On the day of the inspector’s visit to the home the manager was not present, however the administrator and staff confirmed that she works in excess of 35 hours per week. The times the manger intends to be at the home are not included on the duty rotas. The manager should consider if her intended work hours should be included on the duty rota in order that the home is able to maintain a full and accurate record of people who have worked in the home. The manager is appropriately qualified having an NVQ level 4 in both care and management. Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 28 Comment cards received from service users stated that they would discuss any concerns with the manager. Each service user has a key worker who gets to know the service user well and is able to involve them, as appropriate, in decisions about the home and services. Most of the service users were able to name their key worker. The home also contracts with an external advocacy service and has an advocate who visits the home weekly for meetings and individual time with service users. Service users are included in their care reviews as far as possible with a number stating that they had attended reviews. It was also evident that the proprietor spends a lot of time with the service users, and he is able to use his time with people to monitor and guage their satisfaction with the service, as well as listening to suggestions for change or developments they may wish to try. An example of this being his wish to convert a second bathroom to a shower room as the service users love the first shower and use this more than the bathrooms. The proprietor stated that he does undertake Regulation 26 reports, however these were not available in the home. The proprietor stated that he held these at his home on the mainland. A copy of the monthly Regulation 26 reports must be available in the home for the manager and for viewing at inspection visits. Records seen throughout the visit were well maintained, appropriately stored and accessible to people who should have access. Following the previous inspection the home was required to ensure that only approved devices are used to hold doors open. During the tour of the home automatic door closing devices were noted to have been fitted to a number of doors with no doors held open with inappropriate items. The home provides a safe place for service users, visitors and staff. The administrator and proprietor could not locate the electrical safety certificate that had been completed prior to the current owner purchasing the home. As this could not be located the manager arranged for an approved electrical contractor to undertake an inspection of the home’s wiring and subsequently informed the inspector that a new certificate had been issued and the home’s wiring was satisfactory. Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 3 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X 3 3 X Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 30 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP7 YA30 Regulation 15 13 (3) Requirement Care plans must contain more detail as to how individual care needs should be met. The manager must consider how service users, staff and visitors can prevent cross infection by having access to facilities to wash and dry hands after use of the toilet. A copy of the monthly Tegulation 26 reports must be available in the home Timescale for action 01/12/06 01/11/06 3. YA39 26 01/11/06 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 YA37 Good Practice Recommendations The manager should consider if her intended work hours should be included on the duty rota in order that the home is able to maintain a full and accurate record of people who have worked in the home. Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA National Enquiry Line: 0845 015 0120 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 Powys House DS0000055743.V302545.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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