Inspection on 20/02/07 for Purbeck Care

This inspection was carried out on 20th February 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Purbeck Care 26/01/10

Purbeck Care 13/10/09

Purbeck Care 11/05/09

Purbeck Care 22/10/07

Purbeck Care 08/05/06

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 Purbeck Care East Stoke Wareham Dorset BH20 6AT Lead Inspector Marion Hurley Key Announced Inspection 20th February 2007 10:00 DS0000066059.V330614.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 DS0000066059.V330614.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. DS0000066059.V330614.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Purbeck Care Address East Stoke Wareham Dorset BH20 6AT 01929 552201 01929 556441 Purbeck@bmlhealthcare.co.uk www.purbeckcare.com Purbeck Care Limited 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) Terence Leslie Hartley Care Home 52 Category(ies) of Learning disability (52) registration, with number of places DS0000066059.V330614.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 5 people in the category of LD (E) Date of last inspection 8th May 2006 Brief Description of the Service: Purbeck Care Ltd is registered to provide a residential service for up to 52 people with Learning Disabilities. The accommodation is provided in four separate units and each unit offers a different type and level of support. Binnegar Hall, West Wing provides care and support to both older and younger residents and has 15 bedrooms, 3 of which are on the ground floor. Binnegar Hall, East Wing provides support and care in a structured environment for people whose behaviour may be both complex and challenging to the services. There are 9 bedrooms available. Garden Cottage provides a more independent environment for residents who have a higher level of self determination and independence. There are 5 bedrooms each with en suite facilities. Stable Cottage provides care and support to residents whose behaviour has been identified as falling within an autistic spectrum. All 7 bedrooms have en suite facilities. Each unit has ample communal rooms: - lounge, dining room, and sufficient toilet and bathroom facilities appropriately sited. The two cottages have separate kitchen areas. The accommodation is set in approximately twenty acres of land. There is a productive walled garden providing fruit and vegetables, which are regularly used in the catering for the residents and in addition an area of the grounds has been set aside for animal husbandry. Entrance to the home and grounds, which are just off the main Wool to Wareham Road, is via large electronic gates, which provide extra safety for residents. There is ample parking for both staff and visitors. There is a separate Day Centre, which provides space for a range of different activities as well as having its own kitchen and dining areas. At the time of the inspection 26 people were accommodated. DS0000066059.V330614.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was completed over of two days. On arrival at the home the Service Development Manager and Head of Operations were both available and the registered manager was on duty working with people in the West Wing of Binnegar Hall. Some of the service users were already out completing activities like a trip on the local bus, going shopping and others were making their way to the on site Activity Centre. The Registered Provider was represented by the Service Development Manager who was present throughout the inspection whilst the registered manager continued with their scheduled work. A tour of the premises was completed and service users made comments like “ I like my room”, “it is private”, “and it’s mine”. All of the bedrooms seen were quite homely and personalised by the people living in them. Observations during the visit showed that the relationship between the staff and service users were respectful, positive and supportive. Comments from staff were very positive about the Registered Provider and in particular the Service Development Manager – Mark Goodman who they said was really “hands on” and “listened to them”. The principle method used to gather evidence was case tracking. This involves examining the care notes and other related documents for a select number of people living at the home. This is followed up by talking to them or their representative, or observing them. This provides a useful, in depth insight as to how people’s needs are being met from more than one source of evidence. In addition to examining the service users care records, other records and procedures required by these regulations were examined and the majority were found to be in order. Prospective service users are given a Service User’s Guide that provides them with information about the service provided by Purbeck Care Ltd. In addition to this the Home has a Statement of Purpose. Fees to live at the Home range from £965.18 and are calculated according to the individuals assessed needs and support required to safely live at the home. The inspector worked side by side with a member of Dorset County Council Contracts Team. The Inspector would like to thank the staff and service users for their hospitality during the visit and was grateful for the preparation and time taken during the visit by the Head of Operations Sarah Goodwin and the Service Development Manager Mark Goodman. DS0000066059.V330614.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The facilities available to the service users continue to be improved and the decoration and refurbishment programme remains on schedule. Binnegar Hall has been safely divided into two units however for emergency situations can be accessed through electromagnetic locking doors which are linked to the fire alarm system. Each Wing has now benefited from a degree of reconfigurement i.e. each has a separate lounge and dining room. Further work identified will create catering and laundry facilities in both units. At the present time the main kitchen and laundry are sited in the West Wing. Binnegar Hall, West & East Wings are now managed and operated as two separate units each with their own staff team. The units are line managed by appropriately qualified senior staff. The quality of care records has generally improved and in some files there was clear, quantifiable evidence showing active support and progress towards meeting individual objectives. There was some good information relating to the service users life experiences, individual communication styles and specifically in one unit, detailed information for staff on how to recognise signs of distress and agitation and clear guidelines on appropriate action to take to support the service user to help reduce a stressful situation. The Day Services are now successfully up and running and operate a three monthly activity timetable. Service users were observed enjoying different activities, which included sculpturing with willow, papier-mâché work, sensory time and more traditional board games. The Day Services are run and managed by two experienced staff with additional care staff accompanying service users from the units. The timetable reflects a good mix of centre based activities plus community out reach visits. Specialist tutors are employed on a sessional basis and undertake particular activities with service users for example, working with the willow or running a Pilates group DS0000066059.V330614.R01.S.doc Version 5.2 Page 7 All staff have received training in Total Communication and the benefits of this specialist training was quite evident when observing the attitude and skills of staff when communicating with service users who have both complex needs and very individual methods of communicating their needs. The Registered Providers continue to invest in the Estate and premises and slowly each unit is taking on its own identity and will in time establish a “homely” environment for the service users to really make their own home. In addition the Registered Providers have continued their investment in staffing and this is evident from the robust recruitment procedures followed and the quality and range of training provided. Several staff commented on the training they had completed with both specialist and mandatory training courses regularly held e.g., Understanding Autism, Oral Hygiene, Foot Care, Total Communication, The Protection of Vulnerable Adults, First Aid, Nutrition. Relatives have been invited to comment on the services provided by Purbeck Care Ltd and were recently asked to complete a questionnaire. This information and evidence of service user meetings all contribute to the Purbeck Care Ltd monitoring and quality assurance programme. Relatives and visitors are always welcome. What they could do better: The Registered Providers must ensure that the quality of recording in the service user care records is consistent in all units. For example all care records should be regularly reviewed at appropriate intervals to ensure that the written instructions for staff reflect the current needs of the service users. Two of the four units did not meet this standard and information from daily records and the service user’s care plan and risk assessments could not be triangulated and information was either missing from the file or not up to date. Clear goal settings should be at the heart of the service users plan with guidance for staff as to how such goals can be met. It is understood new signage is due and this will enhance the overall impression for visitors as they approach the Home and will also identify the different units once on campus. The Registered Providers must continue with the refurbishment and redecoration programme to ensure the environment becomes “homely” and all parts of the environment are free from any unhygienic odours. DS0000066059.V330614.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000066059.V330614.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000066059.V330614.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about the home and services is made available for prospective service users and their families, to enable them to make a decision as to whether the home and range of services and facilities could meet their needs and aspirations. Since the last inspection a detailed pre-admission assessment has been developed which clearly demonstrates how the home can or cannot meet an individual’s needs. EVIDENCE: Purbeck Care Ltd has an admission procedure and since the last key inspection one person has moved to the home. Through discussion with staff and the service user it was established that the admission procedure of introductory visits, to allow new service users time to adjust to their new surroundings and to allow existing services users time to adapt to a new person moving into their home, had been comprehensively implemented for the individual service user. DS0000066059.V330614.R01.S.doc Version 5.2 Page 11 Further evidence showed that a detailed assessment of the person’s needs including specific support needs and the level of staff support required for the service user to live as independently a life as possible had been completed before they moved in. They had been invited to visit the home, which they did with the support of people who knew and understood their needs. The person was given the opportunity and time to meet with other residents and staff and was invited to stay for a meal. All these experiences helped the individual make an informed choice about their future. In addition their family visited independently. The service user verbally confirmed they had “visited” and “ looked about”, “I am happy”. Photos of their family were shown to the inspector and these were particularly relevant, as the move has made it possible for the person to see more of their family. There were records of the visits and it was apparent that every effort to make the introductions go smoothly and to get to know the person had been considered. The records and care plan covered the following areas: • Behaviour management including techniques for calming situations • Personal care needs • Social and leisure activities – including hobbies and interests • Communication • Finance and personal money • Health and medication • Meals and food. Each of these areas was looked at in detail and identified the person’s needs and how they should be addressed. The care plans had been reviewed following a short introductory period. The service user has an identified key worker who, with the service user, helped the inspector by going through their file and the key worker demonstrated a sound knowledge of the details and practical application of the information and details in the records. The statement of purpose and a new service user guide is available to all prospective service users and their representatives. A copy of the new Service User Guide will shortly be available to all the current residents at Purbeck Care Ltd. DS0000066059.V330614.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, & 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individual care plans and appropriate assessment of risks makes sure the health and welfare of residents are met. Detailed care plans in one of the units, enable staff to provide a consistent approach when meeting people’s needs. People are supported to make decisions about their lifestyles and where people have a disability that may inhibit this techniques are employed to enable people to experience choices and then indicate their preferences. Potential hazards for service users are identified so that they are not put at unnecessary risks. Not all files looked at had risk assessments and not all care records demonstrated that regular reviews were being conducted. DS0000066059.V330614.R01.S.doc Version 5.2 Page 13 EVIDENCE: A personal care plan is in place for everyone receiving services from Purbeck Care Ltd living at East Stoke. The quality of the plans varied from unit to unit, with some providing information about service users, their strengths and their likes and dislikes. Some plans were written sensitively and in plain language and provided an excellent tool for staff. Much of the information from the care plans could be cross referenced with the daily notes and risk assessments and this provided further evidence that staff were following behaviour plans and being consistent in supporting residents with complex needs. Unfortunately the standard was not consistent in all the units. Two of the units failed to have specific risk assessments completed yet staff when asked immediately knew of the risks to the individuals, and several care plans and daily notes in one unit were not up to date for example one member of staff described the eating difficulties for one of the service users and how this posed a choking risk yet there was no risk assessment on the service users file. Those care plans identified as comprehensive included all the areas identified and listed under NMS 2. These files also contained risk assessments and examples seen in the files included assessments for: personal care, leaving the home and completing activities, and using the stairs. All of theses assessments identified potential risks and the strategies to minimise them, whilst still enabling people to take acceptable risks. Observations during the site visit showed that service users were given opportunities to decide what they would like to do and that staff supported them in this. Staffing and support systems were in place to ensure 1:1 support for identified service users. Through conversation with staff on duty it was established that they were becoming more “skilled and comfortable” in communicating with service users who had limited use of language and staff appeared more aware of each service users non- verbal communication style. It was apparent from these discussions that staff were developing their own understanding of the individual personalities of each service user. This was applicable of staff working in all four units. The Service Development Manager is currently undertaking an audit of all the Care Plans, this is good practice and will challenge staff to really think about the phrases used and found in some of the records i.e. “personal care needed” does not offer enough detail or instructions to staff. The issues identified through the audit will form the basis for future training sessions as Purbeck Care Ltd introduce person centred plans for each person living at the home and will ensure over time that they become accessible documents for all the service users. DS0000066059.V330614.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People take part in a range of activities that are age appropriate and chosen by them. People’s rights are respected and they are supported to take responsibility for themselves in their day to day lives. People have a healthy diet that helps to support them with active lifestyles. EVIDENCE: Purbeck Care Ltd provides a service to a group of people of differing ages and abilities. However records indicated that service users individual preferences, leisure and social activities were “person centred”. Examination of care plans and activity records coupled with discussions with staff and management indicates that the lifestyle for the people is in line with DS0000066059.V330614.R01.S.doc Version 5.2 Page 15 their needs and wishes. For example one person loves to travel on buses and has been supported to apply for a bus pass, which has opened up many opportunities for them to enjoy independent day trips on the buses. Purbeck Care Ltd offers an internal employment scheme where service users if interested must complete the full process of applying for a job. If successful service users are formally employed and receive minimum wages. To date one person has applied however it is hoped more service users will take up these opportunities. Four people attend the local college at Poole; three attend full time courses and one a horticulture group. Other examples of activities that people are involved in regularly include visits to the local market, shopping, visits to garden centres and the home has recently subscribed to a year’s membership at a local Museum. A number of activities take part in the units in addition to those run in the on site but independent Activity Centre. Several people spoke about enjoying listening to music, reading and writing. The Coda Music Trust operate an out reach service from the Activity Centre one day a week and the purchase of this professional music therapy service is both enjoyed and valued by residents and staff and provides just one example of the range of activities now available to residents. The quality of the records maintained by the staff responsible for the Activity Centre were very detailed and provided a clear evaluation of the different activities people had participated in e.g. “often laughs and has fun with both staff and service users, can be extremely assertive” “is keen to take part” another person described as “ smiling and playing practical jokes, can be assertive, doesn’t get bored easily” “some prompting” “always positive in attitude and has a sense of humour, “ high motivation in some activities likes using the computer”. The inspector enjoyed observing people in the Activity Centre who were participating in a variety of different activities from one to one willow sculpturing, papier-mâché work, another enjoying the use of the sensory equipment and a small group of others using board games. The atmosphere was positive and busy and service users seemed relaxed and happy to share their experiences. Residents living in Garden Cottage are involved in the normal domestic routines and chores associated with living in a small group i.e. cleaning and tidying up. All help in making the weekly menu and shopping list. In other units it was obvious that staff were aware of the dietary needs of the service users and this was particularly relevant for those service users less DS0000066059.V330614.R01.S.doc Version 5.2 Page 16 inclined to state their preferences and who might only indicate their likes and dislikes through various gestures and non-verbal clues. The menus in all the houses are varied and consideration given to healthy eating options. Binnegar Hall West & East Wings has a four-week menu and people are asked at breakfast what they would like for their lunch. The menu clearly showed a good variety of options for people to choose from. Comments from the service users included “I can choose what I want”. Some people require assistance to manage their meal and it is recommended that all staff sit beside the person they are supporting and an alternative to plastic aprons are found for those people who need to wear protective clothing during their mealtime. Opportunities for residents in the main house to become involved in domestic routines is more limited in part due to their individual interests and abilities and in part due to the continued reconfiguration of the internal design of the East and West Wings. However services users that had the capacity and interest were encouraged with staff support to participate in basic activities i.e. laying the tables and clearing up after the meal. The kitchen in the main house Binnegar Hall is adequate and meets all the environmental Health Standards. However, it would benefit from being refurbished. Service users have the opportunity to go away on holidays or have “special days out” and one person had recently booked to go away with their key worker to Wales. Other service users may go on holiday with their family. Comments about the holidays were very positive from staff and service users. Records showed that people have regular contact with their families and friends. This contact maybe via the telephone, e-mails or visits. Staff support and remind service users to send greetings cards to family members and friends on significant occasions. Visitors are always welcome and Purbeck Care has written a short explanatory note for all visitors offering procedures to follow with reference to personal safety. This is a practical step to ensure that visitors are aware that some people supported by Purbeck Care Ltd have complex and at times behaviour, which may be challenging. DS0000066059.V330614.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. In most cases personal care needs care assessed and care plans provide staff with sufficient information to meet peoples identified needs consistently. Other specialist professionals are used appropriately to meet people’s needs where the home is not able. Appropriate procedures are in place for the receipt, storage and administration and disposal of medication. EVIDENCE: Service users physical and emotional healthcare needs are monitored and information within the service users care plans was detailed and up to date. However, as previously referred to the standard was not consistent in all units and some records were clearly not kept up to date. On speaking with the staff in these units it was evident that they were fully aware of the current needs of the service users even though the written information in the care plan and daily notes required updating. DS0000066059.V330614.R01.S.doc Version 5.2 Page 18 Documentation was available to demonstrate that any changes in the service user’s health were brought to the attention of the healthcare professionals and action taken. Records, which are well maintained, were up to date and included all details of contacts, the reasons for the contact and the outcomes of the appointments. Everyone living at the home has access to all NHS healthcare facilities and regular appointments are seen as important and staff ensure these are not missed. Historically healthcare professionals in particular GPs have visited the home “to see everyone”. The management team are gradually changing this system to ensure only individual appointments are made and where possible people access the surgeries in the local vicinity. The increase in staff support should ensure that service users are appropriately supported to access all community based healthcare services. The medication storage and administration records were seen to be in good order. Head of Operations has recently completed a medication audit and their report was available. It was positive to note that the good practise recommendations following this audit had already been implemented. All staff have recently received training and two of the assistant managers have successfully completed training to qualify as assessors for other staff. Staff said they had found the medication training informative; copies of certificates gained by staff were available in their files DS0000066059.V330614.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 good. This judgement has been made using available evidence including a visit to this service. There is a complaints system in place for service users and their representatives to raise any concerns or complaints they may have about the home and services provided by Purbeck Care Ltd. EVIDENCE: The service has a complaints procedure. No complaints have been made since the previous inspection. Risk assessments indicated where staff might have to support and or physically intervene to protect service users from potentially abusive situations. Policies and procedures were in place for the protection of vulnerable adults and the home’s management have acted upon the requirement made by the Commission for Social Care Inspection that all staff must receive training on the protection of vulnerable adults. At the time of this inspection all staff working at the home had completed training on the Protection of Vulnerable Adults. Observations of the interactions between staff and service users throughout the two days showed that relationships were positive and respectful. All of the service users looked comfortable in the presence of the staff. DS0000066059.V330614.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe and generally well-maintained and comfortable environment. Despite the premises being reasonably clean there were distinct odours in certain areas. EVIDENCE: The main house, Binnegar Hall is divided into two wings currently referred to as West & East. Each side of the house has a lounge, dining room and sufficient bathrooms and toilets. A corridor connects the two and is sealed by electronic doors connected to the fire alarm system. A coded keypad will activate the door. DS0000066059.V330614.R01.S.doc Version 5.2 Page 21 All of the bedrooms visited showed that the people living in them had personalised them with their possessions. All bedroom doors have locks and where people want keys they have them though for some people it is not yet a viable option to retain their own key at this stage in their lives. These decisions are made based on the evidence of risk assessments and other information available in the care plans. There are sufficient bathrooms for the number of people living in the different units. There are sufficient toilets to enable immediate access. There is a policy on infection control and this is adhered to. On the day of this inspection two of the bathrooms had a distinct odour – this may have been due to poor ventilation. One unit also had a non-specific odour. Since the last inspection a programme of redecoration and refurbishment has continued with the ground floor toilets in West wing being upgraded, a second lounge area has been created though this room is not totally functional at the moment as further work on the fixture and fittings is required. Service users are actively involved in choosing colour schemes and furnishings and fixtures for this area. Records of building upkeep such as water and electrical tests were available to view. DS0000066059.V330614.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The recruitment procedures followed by Purbeck Care Ltd minimises the risk of service users being supported by staff without the appropriate skills. The home is adequately staffed and the team is establishing a consistent level of care. Staff training meets the current needs of the service users and minimises the potential risks to them. EVIDENCE: The service provides a sufficient staffing level to meet the dependency needs of the service users living at the home. One new member of staff was spoken with and they confirmed they were working through their induction programme. Through discussion with the staff and observation of care practices it was judged that the service users were being cared for by staff skilled within their respective roles and fully aware of the service users needs. DS0000066059.V330614.R01.S.doc Version 5.2 Page 23 Training records demonstrated that mandatory training was provided to all staff such as food hygiene, first aid, medication and adult protection, and staff were supported in achieving the National Vocational Qualifications in care. In addition to statutory training the specific needs of service users are identified and the specialist skills needed by staff to support them become topics of training sessions and this helps ensure that staff receive appropriate training to equip them to meet the needs of service users. For example training has been provided in on behaviours, which is challenging to service providers, (No Panic), least restrictive intervention (physical), and Total Communication. Staff commented on the quality of the training sessions stating they were informative and linked directly with their work with the service users. Staff files viewed demonstrated that staff recruitment and selection procedures were robust and comprehensive to meet the criteria of the regulations. DS0000066059.V330614.R01.S.doc Version 5.2 Page 24 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 good. This judgement has been made using available evidence including a visit to this service. The management of the home is based on respect and openness. The home is run in the best interests of the service users and their health, the regular monitoring of potential risks by the staff team protects safety and welfare. The views of relatives and other care providers about the way the service is provided are welcomed. DS0000066059.V330614.R01.S.doc Version 5.2 Page 25 EVIDENCE: The management team are person centred in their approach, and offer support and encouragement to staff and provide the staff team with regular supervision. Members of the management teamwork to continuously improve the service and to provide a quality lifestyle for all service users. All of the staff spoken with during the inspection agreed that the Service Development Manager was really “positive”, “open” and had a “hands on approach”, this was also confirmed by comments from service users and observations by the inspector. The service has a comprehensive set of policies and procedures, which are reviewed regularly. Systems are in place to ensure that staff follow procedures in their day-to-day practice. A new incident /accident reporting system has recently been agreed and these new records provide valuable information which can be used to help identify any triggers for particular behaviour patterns or incidents. The service has now established a good record of meeting relevant health and safety requirements, regular checks are carried out around the home and any repairs are dealt with promptly. A maintenance book is kept and this was appropriately used with all jobs being completed quickly and then signed off. On the day of this inspection the records showed that not all that staff were up to date with their fire prevention training. However, a session had already been scheduled to ensure the remaining staff received this training immediately. Relative and other representatives of residents are consulted about the way the service is provided. Questionnaires were recently sent out to relatives, and those received up to the time of this inspection indicated that relatives are quite happy with the quality of service provided. Within the management team there is a good understanding of equality and diversity issues, and there is evidence that this is cascading to staff who are beginning to translate this in to positive outcomes for people who use the service. DS0000066059.V330614.R01.S.doc Version 5.2 Page 26 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 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 x 32 3 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 x 2 x LIFESTYLES Standard No Score 11 X 12 3 13 2 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 3 3 2 x DS0000066059.V330614.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 (2) (a)(b) (c) Requirement The registered provider must ensure all care plans are up to date and reflect the service user’s current needs and how these are to be met. The registered provider must ensure all service users have completed and current risk assessments. The registered provider must ensure all parts of the home are kept clean, hygienic and free from offensive odours. The registered provider must ensure all staff receive regular fire training. Timescale for action 31/03/07 2. YA9 13 (4) (b) 31/03/07 3. YA30 16 (2) (k) 31/03/07 4 YA42 23 (4) (e) 31/03/07 DS0000066059.V330614.R01.S.doc Version 5.2 Page 28 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 YA7 Good Practice Recommendations It recommended that service users be encouraged with support and understanding to manage their own personal allowances. Please note this good practice recommendation was not assessed at this inspection. The management team are currently looking at the most appropriate well to ensure service user’s may manage and take control of their own finances. 2. YA17 It is recommended that service users who may need assistance to eat be assisted appropriately and in such a way that ensures the dignity and respect of the service user. It is recommended staff sit beside the service user they are supporting and do not stand over the person to help feed them. If the service user requires protective clothing during the mealtime then this should be age appropriate and discreet. 3. YA24 It is recommended that the works to improve the living and working environment ensuring it is comfortable and homely are completed as soon as possible. The work to fully meet this standard is progressing. DS0000066059.V330614.R01.S.doc Version 5.2 Page 29 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000066059.V330614.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!