Inspection on 26/03/07 for Principle House

This inspection was carried out on 26th March 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Principle House 12/11/07

Principle House 20/02/06

Principle House 15/11/05

Principle House 07/02/05

Principle House 21/09/04

Principle House 29/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Principle House 95 Ringwood Road Walkford Christchurch Dorset BH23 5RA Lead Inspector Alison Stone Unannounced Inspection 26th March 2007 12:00p Principle House DS0000031699.V331900.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 Principle House DS0000031699.V331900.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. Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Principle House Address 95 Ringwood Road Walkford Christchurch Dorset BH23 5RA 01425 277707 01425 277026 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) Principle Care Ltd Mrs Lisa Trepka Rudkin Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Staffing levels must be calculated using the Residential Forum’s `Care Staffing` model (published 2002) The registered manager Mrs Lisa Trepka Rudkin must attain level 4 NVQ awards in management and care by December 2006. 20th February 2006 Date of last inspection Brief Description of the Service: Principle House opened in August 2002. It is registered to provide accommodation and support to six adults who have a learning disability. The home is situated in Walkford, Christchurch, on the main road through the town. It is a family style home and similar in appearance to the other houses in the road. All six bedrooms are single with en-suite facilities. There is a large lounge / dining room, separate kitchen and a garden to the rear of the house. There is an area for parking at the front of the house. Accommodation is on two floors. There is also an office and staff sleep-in room. Local shops are within walking distance and there is a bus route into the neighbouring town of Christchurch. Fees range from £1055.47 to £2305.73 per week. Fees are assessed on an individual basis and according to the needs of the service users. This information was given on the 05 January 2007. Readers of this report may find it helpful if they have any queries about fees to contact the Office of Fair Trading WWW.oft.gov.uk. The manager had copies of the last report available within the home. The report of this inspection is available from enquiries@csci.gsi.gov.uk. Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of this care home by the Commission for Social Care inspection this year, the inspection year runs from 1 April 06 to 31 March 07. This was a key inspection. The key standards are identified in the main body of report in each outcome area. In order to obtain a fuller picture of the home the reader should refer to the earlier inspection report dated 20 February 2006. The inspector arrived on the first day at 12.00pm and left at 6.00pm. During the visit, which lasted six hours, the inspector spoke with two service users, the manager, the Responsible Individual and two members of staff. The inspector joined service users for lunch, observed practice and looked at medication supplies. She inspected records relating to service users care, staffing and medication and other documentation relating to the running of the home. Preparation work included, reading, collation and analysis of surveys and comment cards and reviewing of the Pre Inspection Questionnaire sent to the manager prior to the inspection being completed. The Commission received seven comment cards three from relatives/friends and four from social and health care professionals, including two from GPs. The manager was present for the majority of the inspection and the Responsible Individual was also present initially. They both provided the inspector with all the relevant information relating to the inspection and any necessary background information. Feedback was given to the manager at the end of the first day of the inspection. Of the 43 National Minimum Standards, all 22 Key Standards were assessed and a further three standards that are not included as key standards were also assessed. What the service does well: The home ensures they have a good knowledge of service users needs through a comprehensive assessment process prior to a person moving into the home. Service user are offered trail visits at the home where they can come and visit and get to know the other service users and staff before making a decision about moving in. Care plans are developed in conjunction with service users, their families and professionals, providing lots of information about what support people require. Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 6 Care plans include information about people’s likes and dislikes and choices. Service users involvement in daily activities is protected by good risk assessments. Feedback from involved health care professionals indicated that staff have a good understanding of service user’s needs and the home’s staff work in a professional cooperative way with them. Service users are encouraged to be involved in their care and are supported to make choices about their lives. People benefit from being able to take part in a wide variety of activities of their choice and are encouraged to develop their skills. Relatives contacted as part of the inspection said positive things about the care provided at the home. Comments included “I am very pleased with the care x is getting at the home” and I am extremely satisfied with the care provided by Principle Care Ltd, my son has settled well and seems very happy”. People are supported and encouraged to maintain relationships with their family and friends. What has improved since the last inspection? At the inspection of the 20 February 2006 three requirements and six recommendations were made. The manager has worked to address these issues and has met two of the requirements, two of the recommendations and partially met another one recommendation. Two requirements and one recommendation was made at this inspection. There is now a specific care plan in place that guides staff on how to support a service user’s immediate health needs when they experience seizures. The manager has ensured night staff are included in the annual fire training sessions. The home has reviewed and risk assessed it’s medication practices in relation to secondary dispensing and has put in place practices to minimise risks associated with this procedure. The manger has ensured all verbal messages relating to service users medication are now also written down in the appropriate records. The manager said that she now ensures that an accurate record is kept of all professional discussions relating to the care of service users. Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 7 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. Principle House DS0000031699.V331900.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 Principle House DS0000031699.V331900.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): 2&4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be confident that the home will meet their aspirations and needs because the manager ensures people are supported with a thorough assessment prior to them moving in. Service users have the opportunity to visit and spend time in the home, helping them to make an informed decision about whether they want to live there before moving. EVIDENCE: Three service user’s files were reviewed as part of the inspection process. Since the last inspection one service user has moved into Principle House. For the purposes of assessing the key standard in this area this person’s file was reviewed. It was noted that there were comprehensive assessments in place that took into account the person’s needs and aspirations. The assessment process was noted to include a social work assessment and information from the previous residential placement. Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 10 The review of the service user’s file demonstrated that the home had arranged and supported the person to have a series of trial visits to the home, which included overnight stays. Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 & 10 Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. Service users can be confident that they will be supported to have a care plans which reflect their changing needs. Service users are supported by staff to make every day decisions about their lives, promoting their sense of individuality and independence. Service users are appropriately supported by staff to take risks as part of their daily lives. Service users can be confident that staff understand the importance of maintaining confidentiality and that personal information relating to service users is kept securely in the home. Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 12 EVIDENCE: Three service users files were reviewed as part of the inspection. All service users had in place comprehensive plans of care that clearly detailed their needs and included information about how staff were to support them. The inspection of these files demonstrated that regular reviews of people’s care took place. It was noted that review meetings included all the people that were important to the service user, like their family, social worker, and the service user’s key worker and where appropriate other health care professionals. Reviews were well documented and following on from the issues raised at the last inspection, the manager had ensured service users were fully involved in their reviews. In one case it was noted that the home had gone some way to produce the review in a semi accessible format. The manager said she had worked very hard since the last inspection to ensure service users were more involved in their plans of care and encourages staff to have a person centred approach towards supporting service users. The home has yet to develop individual Person Centred Plans. The home operates a key worker system and the manager said she encouraged key workers to become involved in service user meetings, for example their reviews. Staff spoken with agreed that they worked with individual service users, supporting and encouraging people to make choices about their daily lives with things like meal choices, personal shopping and activities. The staff said there were weekly service user meetings and it was noted that minutes were kept of these meetings. The people who live at Principle house need support to ensure they are fully involved in their own lives and need help with daily activities like cooking, shopping and going out. From these care plans risk assessments had been developed, these were noted to provide appropriate guidance to staff on how to support people with daily activities that presented risks. The home has a robust confidentiality policy and it was noted throughout the inspection staff were respectful in all their interactions with service users. All service users personal records were stored appropriately in the office. Principle House DS0000031699.V331900.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): 12, 13, 14, 15, 16 &17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to enjoy a wide range of age, cultural and peer appropriate leisure activities within their local community, meaning they are offered and active life in their own community. Service users are encouraged and supported by the home to develop and maintain positive relationships with their family and friends. Service users can be confident that their rights and responsibilities are respected and encouraged by the staff at the home, through regular service users meetings and staff encouragement. Menu choices need to be developed further to ensure service users are offered a well balanced diet. Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 14 EVIDENCE: Three service user’s files were looked at and this included reviewing the activities offered to people who live at the home. The home employs a day care manager who’s responsibly, to work with individual service users to design activities programmes. The manager said these programmes reflect the service users choices. It was noted that each person had a weekly timetable of regular activities in place and the review of daily records indicated that service users did undertake these activities. Staff spoke positively about the amount of time service users spent out of the home taking part in activities of their choice. Staff commentated that one of the reasons they enjoyed working at Principle House was because of all the activities service users could take part in. Staff said that as well as varied planned activities they were also able to facilitate spontaneous activities such as going to the pub or having a barbecue. The pre inspection questionnaire listed the activities available within the home as books, DVD’s, music and garden games. The staff also support service users to take part in activities away from the home available, such as college courses, swimming, pubs, drama courses, communication skills and attending an activity centre. The manager stated in the pre inspection questionnaire that activities were arranged on an individual basis reflecting people’s choices and interests. All the service users have the opportunity to go on holiday every year and they are able to choose the sort of holiday they would like to go on and also who they would like to go with. It was evident that service user’s family and friend are very much involved at Principle House and all the people who live there have regular contact with their families. Two relatives contacted as part of the inspection made positive comments about the service provided at Principle House. One service user was receiving a package of care to help promote and maintain their independence with the aim for them to move back into semi independent living in the community. It was noted the work being undertaken with this service user involved their family members and the home was facilitating regular contact with the person’s extended family to ensure close relationships were maintained. One mealtime was observed during the inspection and this was noted to be a pleasant experience for service users. Service users were able to have a choice about what they ate and were encouraged to be part of the whole social Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 15 experience. Service users were noted to help lay the table and were encouraged by staff to clear away the table after people had finished eating. A four week plan of meals was reviewed as part of the inspection and it was noted that people were offered a good choice of meals. The home employs a cook to prepare the main meal and the staff help with preparing other meals. Staff said that they felt the meals were of a high quality and kitchen cupboards and the fridges were noted to store a large choice of brand food. It was also noted that there was plenty of fruit and vegetables available to people and there was not an over reliance of pre packed food. However most of the service users have weight issues and menu choices did not always reflect a balanced diet. Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be confident that their chooses relating to personal support are respected because personal preferences are recorded in their care plans. Service users can be reassured that the care they receive at the home meets their physical and emotional needs. The homes procedures and staff practices promote safe systems for administering medication. EVIDENCE: It was noted that care plans were very detailed and provided staff with a clear break down of how people liked to receive support and what support they required. Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 17 For instance care plans detailed what time people liked to get up and go to bed and whether they preferred a bath or a shower and the sort of toiletries they liked to use. The health care provided in the home was very good, staff worked well with a range of multi disciplinary professionals to ensure service users received all the support they needed. Service user’s records demonstrated that they regularly saw the dentist, had regular check ups with the optician and visited the chiropodist. The home had clearly developed close working relationships with all the health professionals involved in the service user’s care. Health professionals contacted as part of the inspection were positive about the care provided at the home. A GP commented that the home worked in partnership with them and felt the staff had a clear understanding of service users needs. A consultant Psychologist said, “This is a good home supporting difficult people and staff are co-operative with me and caring to residents”. A community nurse commented, “I have always enjoyed a good working relationship with this particular care provider, staff and clients. They have a good understanding of service user’s needs and contact multi-agency professionals and myself appropriately”. Because of the complex health needs the service users have, the home needs to work closely with specialist health providers. Service user’s files indicated that staff were responsive to service users health needs and did involve specialist professionals like psychology, consultant geriatricians, physiotherapists and community nurses as required. The home is currently supporting one person with very complex health needs and they were able to demonstrate that they were doing this very well. The manager had considered the persons long term health needs as well as any immediate health concerns. The service users records showed that staff closely monitored their health and any concerns were reported immediately to the appropriate health professional. The change in this persons needs had put pressure on the home to change how they cared for this person and increase the support they were offered. The home also had to make some changes to the physical environmental to ensure this person’s needs continued to be met at the home. It was noted that all these changes had been successfully accommodated without any adverse affects on the other people who live there. The issues at the last inspection around not having effective interim measures of support in place to monitor and manage a persons epileptic seizures have Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 18 now been addressed and it was noted that there is now a care plan in place supporting staff to appropriately manage this person’s seizures. Medication was again sampled as part of this inspection. Medication practices remain unchanged since the last inspection. The home still practices secondary administration, which is not considered the safest form of administering medication. However there have been no drug errors relating to the style of administration since the last inspection and the home undertakes all the necessary practices to ensure medication administration is as safe as it can be. Staff are supported to undertake medication training through a local college prior to being involved in giving service users their medication, this included a period of assessment. All medication is booked in and checked against the service users individual prescription chart. Medication Administration Charts are printed weekly by the home and include a photo of the service users to ensure potential errors are minimised. Two staff sign for the medication and the manager ensures weekly audits of all medications are undertaken to ensure staff are giving service users their medication as prescribed. The home also operated a Homely Remedies Policy and records are kept of any remedies given. It was noted there are also PRN protocols in place that provide staff with clear guidance on giving out these types of medicines. Principle House DS0000031699.V331900.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): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can be confident that staff listen to their views and will act upon issues and concerns they raise. The homes procedures in relation to ‘Safeguarding Adults’ ensure staff are aware of the appropriate action they should take in the event of an incident. Further staff training is necessary to ensure staff fully understanding their roles and responsibilities in relation to ‘Safe Guarding Adults’. EVIDENCE: All staff are trained in basic “Safeguarding Adult training” in their inductions. However it was noted in the homes training schedule that only 11 staff out of the 34 staff employed have completed the recognised ‘No Secrets’ training. There have not been any recent reports of any “Safeguarding” issues and/or concerns reported to the Commission for Social Care and Inspection since the Agency’s last inspection. The home had the Social Care and Health Multi Agency Guidelines, The Department of Health White Paper “No Secrets” and their own policy on Adult Protection procedures available in the office. Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 20 The agency also had a “Whistle Blowing” policy that was available to all staff. This policy informs staff how to report any of practices at the home they have concerns about. There have not been any complaints made to CSCI about the service the agency provides since the last inspection. There was one concern raised with CSCI since the last inspection, which the manager is aware of. The review of the agency complaints/concerns file indicated that the concern made by a neighbour had been appropriately managed. The home has a complaints policy which is available to service users in the Service Users Guide. Service users are also supported to make complaints and/or raise issue on a weekly basis during the service user’s meetings. The format used for these meetings included a section to discuss any service users issues and/or concerns. The reviews of these minutes indicated staff regularly encouraged people to raise issues in these meetings. Relatives contacted as part of the inspection said that they were aware of the complaints procedure and know who to contact in the event of a complaint. Relatives involved in this inspection commented that they were very satisfied with the service provided at the home. Principle House DS0000031699.V331900.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): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a spacious, comfortable environment that is decorated in a style that reflects the age of the people who live there. The home is well maintained and provides people with a clean and tidy environment to live in. EVIDENCE: Principle House is a large ordinary house located in a nice residential area on the outskirts of Christchurch. The home is in keeping with neighbouring properties and does not stand out as a residential home. The house is located close to local amenities and the home also has use of a large people mover to support service users going out on a regular basis. The accommodation provided to people is spacious and the home was well maintained and nicely decorated. The home operates an annual maintenance Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 22 schedule ensuring there is a rolling programme of renewing old and/or damaged furniture as required. The home environment is light and airy and offers people a clean and tidy environment to live in. The house also benefits form a large garden that is clearly well used by the service users. Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are generally supported by a skilled and trained staff team, who are encouraged by the organisation to undertake regular training. However further specialist staff training would ensure staff are kept safe in the work place and ensure all service users specialist needs are met. Service users can be confident that the home’s recruitment procedures and practices safeguard adults. Service users cannot be confident that staff are supervised with enough regularity to ensure they are consistently monitored and reviewed in their work with service users. EVIDENCE: The homes staff training programme was discussed with the manager on the day of the inspection. She advised the inspector that the home operates an induction programme where staff are supported to undertake a series of Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 24 training relevant to their post, such as health and safety, safe guarding adults, manual handling, fire training, first aid and food hygiene. The home further complements this training with specialist training around the needs of the service users, for example, LDAF (Learning Development Awards Framework), dementia training, medication, epilepsy training and training in managing service users who present with aggressive behaviours. However the current programme of specialist training offered to staff does not meet all of the service users needs. The staff induction is in line with nationally recognised induction programme ‘skills for care’. The pre-inspection questionnaire stated that five staff are currently registered to do their NVQ, this is out of team of 34 staff employed across the three houses the organisation owns and manages. The manager said the number of staff holding their NVQ was a lot higher than this figure, however due to staff leaving and new staff starting the number of staff with there NVQ qualification has reduced since the last inspection on the 20 February 2006. The National target for staff holding a NVQ qualification or equivalent was at least 50 of the work force in a care home by 2005. The manager said that she is working to address this shortfall. Discussions with two staff indicted that they generally felt supported by the organisation with training to feel competent in their jobs. However staff commented that they had to wait a long time for the Non-violent Crisis intervention training and they felt this initially undermined their confidence in working with service users who display behaviours that challenge the service. It was of particular concern that one member of night staff who has worker in the home for over 12 months has not received non violent crises intervention training. However it was noted on service user and staff incident forms that this member of staff had been regularly involved in dealing with one service user when they were agitated or anxious, often displaying challenging behaviour. The review of four staff records indicated that all the necessary recruitment checks had taken place prior to employing staff. Staff spoken to during the inspection said they felt well supported by the manager of the service and that they felt confident in approaching her with any concerns. However the review of staff files indicated staff were not supervised regularly and not at a frequency that met with the National Minimum Standard of at least six times a year. This was brought to the attention of the manager at the last inspection; the manager said that she is working to address this shortfall. Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from having an experienced acting manager who is committed to improving their quality of life and runs the home efficiently and in the best interests of the people who live there. Work as commenced within the service to ensure service users views underpin the development of the home. The home has effective procedures and practices in place to ensure the health and safety of service users is protected. However there was not enough evidence to demonstrate staff are provided with a good standard of fire training. Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 26 EVIDENCE: The home benefits from having an experienced and consistent manager in post. She has just completed her NVQ award, which will further support her in the role of manager at Principle House. The home has gone some way towards developing a quality assurance system and has developed questionnaires for service users about the service provided at the home. However a process including all stakeholders in the evaluation the care provided at the home is yet to be developed. The inspection of fire records showed that staff regularly test the fire equipment and regular fire drills take place. Staff have received fire training and the manager is aware of the new fire regulations and has put into place the appropriate risk assessments in line with the new rules around fire prevention. It was noted that some of the staff team needed to attend refresher course in the area of fire safety, further staff training is booked. The manager of Principle House and the two mangers from the organisations other homes take a lead in providing fire training. However it was noted that the manager last attended an accredited fire training course over three year ago. It is important that in health and safety areas such as Fire, the training provided to staff is of a good standard. The manager must be confident and satisfied that training provided is to a standard that enables staff to be confident and competent in their role. As part of the inspection the kitchen area was looked at. This area was found to be clean and hygienic, with foodstuffs generally stored appropriately. It was noted that there were a number of items in the fridge that were opened and unlabeled, this was pointed out to the staff who immediately rectified the situation. The manager said that they have regular visits from the environmental health officer. It was noted that there was an up to date portable appliance testing certificate in place, along with the appropriate five-year hard wiring check. There was also an up to date gas landlord certificate in place. Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 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 X 32 2 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 2 X Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 YA39 Regulation 24 Requirement Timescale for action 26/06/07 2. YA42 23 3. YA42 23(4)(d) The registered person must ensure that the quality assurance strategy within the home is fully implemented. This is outstanding from the last inspection of the 20/02/07 and is unmet at this inspection time scale extended. The registered person must 26/03/07 ensure that all staff, including night staff, attends the appropriate number of formal fire training sessions each year. This is outstanding from the last inspection of the 20/02/07 and is unmet at this inspection time scale extended. The registered person, shall after 26/06/07 consultation with the fire authority, make adequate arrangements for the evacuation, in the event of a fire, of all persons in the care home. The provider must review existing arrangements for fire training to ensure that all staff access regular formal training Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 29 from a competent person. 4 YA42 13(6) The registered person shall make 26/06/07 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. All staff must have training in safe physical intervention ad soon as they commence employment. All staff must be provided with training in ‘safeguarding adults’. Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA17 YA20 Good Practice Recommendations Service users should be supported to have a well balanced diet. Guidance from the Royal Pharmaceutical Society should be followed with regards to the receipt, recording, storage, handling, administration and disposal of medicines. It is recommended that the home’s procedure for redispensing medicines be reviewed and risk assessed. Medicines should be given directly from the container in which the pharmacy supplied them labelled with the doctor’s prescription directions. This recommendation has been amended to show the progress made toward it. 50 of all care staff in the home should obtain a care NVQ Level 2 or above. This recommendation is made for the second time. The home’s training and development programme should be reviewed to ensure that all staff receive training that is linked to the home’s service aims, service users’ needs and individual plans. This should include, for example, training in epilepsy, total communication, autism, sexuality and personal relationships and challenging behaviour. This recommendation is made for the second time. The manager should ensure that all staff receive at least six supervision sessions each year, which are clearly recorded. This recommendation is made for the third time. 3. 4. YA32 YA35 5. YA36 Principle House DS0000031699.V331900.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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. 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