CARE HOME ADULTS 18-65
Purbeck Care East Stoke Wareham Dorset BH20 6AT Lead Inspector
Marion Hurley Key Unannounced Inspection 22nd October 2007 10:00 Purbeck Care DS0000066059.V352859.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 Purbeck Care DS0000066059.V352859.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. Purbeck Care DS0000066059.V352859.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) ****Post Vacant**** Care Home 52 Category(ies) of Learning disability (52) registration, with number of places Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th February 2007 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. The main house is divided into two separate wings, West Wing provides care and support to both older and younger residents and has 15 bedrooms, 4 of which are on the ground floor. The 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 32 people were accommodated. Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was initially unannounced and then two further visits to the home were completed within the week. The focus of this inspection undertaken by the Commission for Social Care Inspection (CSCI) is based upon the outcomes for the residents and their views of the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further developments. The primary method of inspection involved observing and talking with residents, tracking the care they received, through review of their records, discussions with them and care staff. During the course of the inspection some residents were out on a trip to a local county park, others were working in the activity centre and others were enjoying the freedom of the grounds and other communal areas in the units. Part of the day was spent with the service development manager discussing policies, procedures and records. What the service does well:
Purbeck care provides a range of activities to meet the needs of the residents. This may include assisting residents out for pub meals, attending college or arranged outings. The staff have a range of transport available from cars to a large people carrier and these are used for organised trips or spontaneous outings with the residents. Some residents are able to access community facilities independently, using public transport. All residents have key workers and feel confident to discuss any issues with them or members of the management team. The residents spoken with during the inspection were complimentary about the standard of care provided. Routines are very flexible in the home. The service development manager said that community care assessments are provided to the home before any resident moves in and showed one for a forthcoming admission. Other assessments were seen on file. The service development manager said that staff from the home would go to visit any prospective resident to assess their needs. One resident recalled someone had come to visit them before they moved into the home. The evidence showed that new residents are assessed before they come to live at the home. Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 6 Risk assessments are carried out to assess what reasonable risks residents are able to manage and the service development manager confirmed that residents are encouraged to take responsible risks. The evidence shows that residents are supported to take risks as part of an independent lifestyle. The home has an activity centre, which is well used and offers a variety of activities and one off projects. The evidence shows that residents are able to take part in age, peer and culturally appropriate activities. Residents use facilities within the local community. Resident spoke of going out to the shops, bowling and using local parks. Residents are supported to keep in contact with families and friends and staff contact families to keep them up to date. Residents contribute to domestic tasks according to their abilities. Residents follow their own routines and do not have to conform to any set pattern so they can do things at their own pace. The evidence shows that residents’ rights are respected and responsibilities recognised in their daily lives. The service development manager said that whilst residents are expected to keep to commitments these can be altered if needed. Staff said they give residents the information they need to make decisions and some residents described making regular choices. The evidence shows that residents make decisions about their lives with assistance as need. Staff are aware of the differing ability levels of residents and provide support according to these. The evidence shows that residents receive personal support in the way they prefer and require. A record is made of all healthcare appointments and routine healthcare checks are arranged. Residents spoke of having been for a variety of medical check ups. The evidence shows that residents physical and emotional health needs are met. Medication is only given out by staff trained to do so. The evidence shows that residents can retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Staff have received training on safe guarding adults and were aware of the home’s whistle blowing procedures. The evidence shows that systems are in place to protect residents from abuse, neglect and self-harm. Staff files showed that the correct recruitment procedures and practices are followed and the evidence shows that residents are protected by the home’s recruitment policy and procedures. Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
All food must be stored in line with basic food hygiene practices. The evidence shows that residents are offered a healthy diet and enjoy their meals and mealtimes but basic food hygiene standards are not being consistently adhered to in all the units where some food was found left on the counter tops, and food was not sealed in one of the fridges and freezer. The evidence shows that the arrangements for the laundry are not suitable. The laundry must be kept clean and hygienic at all times. Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 8 All staff must complete all mandatory training, the evidence showed that staff had not received training in basic food hygiene nor were all the staff up to date with their fire safety training. Mandatory training is essential to ensure the staff can safely carry out their duties. 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.
Purbeck Care DS0000066059.V352859.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 Purbeck Care DS0000066059.V352859.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. Residents are fully assessed prior to moving into the home and the residents are confident that the home is suitable for them. EVIDENCE: There were community care assessments seen on files of residents living in each of the four units. The service development manager explained that following an enquiry for a placement he will go and visit the prospective resident in their current setting and then make arrangements for them to visit the home and progress the assessment process. Often an overnight stay will be arranged and then a planned admission process carried out. Operational staff are actively involved in this process and may accompany the manager on the various visits. Senior staff develop with each resident a plan based on the assessment that details any restrictions of freedom, services or facilities balanced with their rights and personal needs. Staff said that the plans are discussed with residents and attempts are made to ensure that they are in agreement with
Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 11 their plan. There was evidence that where possible residents are asked to sign the plan ensuring that they are involved in the plan. The plans identified individual procedures and behavioural protocol and specific programmes including detailed preventative steps for all residents who have challenging difficulties. In addition the home obtains specialist advise from health care professionals. This was supported by documentation in the care plans. Residents spoke about visiting community health services, such as community psychiatric nurses and doctor services. One resident when asked about moving to Purbeck Care recalled “ someone came to see me at home and asked me questions.” Purbeck Care DS0000066059.V352859.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 good. This judgement has been made using available evidence including a visit to this service. Residents know their needs are assessed and changing needs and personal goals are reflected in their care plans. Residents make decisions about their lives with assistance as needed. Residents are supported to take risks and have an active independent lifestyle. EVIDENCE: Six care plans were looked at. These plans had sufficient details to enable staff to work appropriately with residents. This helps them to meet their needs and ensure they maintain a level of independence. A large photo is in the front of each plan and those read reflected choices and decisions made by residents and indicated that the residents had a definite
Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 13 input into what they do. The plans cover all aspects of the residents’ daily life and provide clear information on how the resident prefers to receive their care. There are risk assessments to ensure the safe participation of chosen activities. There was evidence in the plans that senior staff regularly review them and that the risk assessments are used in relation to maintaining independence and risks for all areas of daily living. Staff demonstrated a good understanding of the care planning process and the management of risks. The service development manager said that residents are able to take reasonable risks if assessed as being able to do so. Residents spoken with were able to describe what they were supported with and how the staff approached this. Observations were made throughout the inspection visits. Residents were seen coming and going, spending time in their rooms, in communal areas, walking around the grounds and in the Activity Centre. Residents are encouraged to follow their daily routines, but can discuss if they want to change anything. The service development manager said staff work hard to understand the residents and will discuss with the residents their decisions. Staff said that they encourage residents to make decisions and explained that for some this might involve a choice of two options to help them form their decision. One resident said, “ I can get up when I want and wear what I want” There are details of residents chosen morning routines included in the care plans, but none were seen for other times of the day. The service development manager said that they try to fit the service to the individual routine than the resident having to fit in. Residents follow their own individual routine but are not put under pressure to complete things as this can lead to behavioural problems. Staff said that routines and responsibilities differ between the units according to the residents’ abilities. Care plans were updated and were recorded clearly to help staff understand and be aware when attending residents. The care plans included details about specific programmes of support prepared for each individual. Apart from the routine review and update of care plans, the home also reviews and update care plans as and when necessary as the needs of residents change. It is recommended that when the care plans are reviewed the individual with their key worker is encouraged to identify and focus on desired outcomes and proposed action plans. Care plans need to be written in a variety of different Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 14 modes and use of photographs and symbols could be included to help individuals make a contribution to their individual plan. Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 15 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. Residents are able to take part in age, peer and culturally appropriate activities. Residents are supported to maintain relationships with family and friends. Residents’ rights are respected and responsibilities recognised in their daily lives. Residents are offered a healthy diet and enjoy their meals and mealtimes but basic food hygiene practices are not being maintained in all units. (Garden Cottage & Stable Cottage) Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 16 EVIDENCE: Residents were seen spending time in their rooms, in communal areas, walking around the grounds and in the Activity Centre. There are various activities organised in and around the home a lot of which take place in the activity centre, which is a separate building. There was an activities timetable, which showed that residents regularly use the local community. Residents who have personal and cultural and religious needs are supported to attend services of their choice. Staff said that residents go to the local town centres and walk round the local shops. One resident described going bowling, and another swimming. In general residents commented that they were happy with the level of activities within the home and outside. Residents commented that the attitude of the staff enabled them to make choices and that generally they felt respected. Staff said they encourage residents to participate in events and outings. Residents said the home has a people carrier, which is regularly used for trips or for spontaneous outings. One of the activity centre co-ordinators explained that residents have individual programmes designed to match their interests and abilities and showed the timetable of various activities available and how in turn these are adjusted according to the person’s abilities. E.g. the nature walk is designed at three different levels, from those who can complete the walk independently and those who need a modified and supported walk. There was information in care plans about contact arrangements with families and details were seen about supporting these relationships. The service development manager confirmed that residents are supported to visit their relatives and equally families can just turn up but it is suggested that they contact the home first to ensure the residents are at home. Staff said they encourage residents to keep in contact with relatives and friends and keyworkers phone families to update them. The plans showed how staff promote and maintain residents’ privacy and dignity and staff spoken to clearly understood the importance of promoting this with residents. The main commercial kitchen is based in the West Wing and meals are collected by staff from this central kitchen and taken into the East Wing, as this unit currently does not have any kitchen facilities. Observations in East Wing noted that the food was placed on a sideboard in the dining room and the staff served each resident as they came into the room. This appeared rather a confused time however once everyone had been served the staff then sat down with the residents and enjoyed a more relaxed and social atmosphere. Some residents in the East Wing find mealtimes stressful and staff are aware of the most appropriate method to ensure
Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 17 residents get the most from their meals and avoid any confrontation during this period. Each unit keeps their own record of meals eaten in addition to the cook maintain a record of the menu. Stable Cottage has a dedicated cook who prepares meals for this more dependent group of residents. Garden Cottage residents are assisted to prepare their own meals. A small amount of food was found un-covered in the freezer in Garden Cottage which was also in need of a clean and defrost. Cooked food had also been left on the worktop in Stable Cottage and there was prepared food in the fridge not covered. The record of food in this unit needs to be more explicit i.e. “roast” is not adequate to describe the meal and if any vegetables accompanied this. Staff said there was a good choice of food and they can request special meals for residents. Garden Cottage residents require supervision to prepare their meals and on the day of the inspection all but two residents had gone out this resulted in the remaining two receiving their lunch very late. It was also of concern that these two residents received their meal from the remains of the food initially taken for the residents in East Wing. Staff and the assistant managers must be aware of all the residents needs and ensure all receive an equal service and the location and numbers of residents having lunch should be advised to the cook who could have simply prepared separate dishes for the two residents at Garden Cottage. Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 18 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. Residents receive personal support in the way they prefer and require and their physical and emotional health needs are met. Residents can retain their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Staff were seen providing differing levels of support to residents in the separate units. Staff spoken with understood the different needs and preferences of residents and understood the importance of supporting residents in the way they preferred. The service development manager said that staff work with residents to cooperate with them in meeting their personal needs so it is more a question of doing something with the resident rather than doing it for them. One resident clearly said, “I can see to myself”
Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 19 There was evidence in the care plans and daily notes of residents attending GP appointments and other healthcare visits such as seeking advice regarding residents’ behaviour and medication. It was possible to track information from the care plans, daily notes and diary entries to the Medication Administration Records (MAR) sheets to show that appropriate action had been taken following incidents or reviews. The MAR charts in each unit were checked and there were no unaccountable gaps in the administration. The service development manager also stated that residents’ health needs are followed through and appointments made for all routine health checks. Staff said that keyworkers normally go with residents to any medical appointments. One resident told the inspector “I can see a doctor if I want to” Staff confirmed that only those who have completed training are permitted to administer medication and for each shift in each of the separate units a named member of staff is identified as the responsible person for the medication. This is good practices and provides staff with very clear guidance how the medication procedure needs to be followed to ensure the effective management of medication and help reduce risks for residents and staff. Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 20 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. Systems are in place to protect residents from abuse, neglect and self-harm. Residents are supported to make complaints and staff know how to respond to complaints made. EVIDENCE: Purbeck Care has a complaints procedure and complaints log to record any complaints or concerns. Staff spoken with had a good understanding of the importance of enabling residents to voice their concerns. Residents spoken with said they would speak to the managers (assistant managers or service development manager) if they were not happy about anything. One person explained how they had moved units after they had spoken to the manager about a problem and this had resolved the problem and made “things better”. Another resident said, “If I am not happy I tell staff and they sort it out, if other people wind me up staff go and talk to them” Some residents are clearly able to approach staff and tell them about any concerns however there are several who do not have the skills and experience to verbally approach staff and the service development manager said the home calls on the services of advocates who will come to speak with residents about any particular issues.
Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 21 Some residents are members of Dorset People First and others are supported through Speaking Up Groups and Citizen Advocacy work. Staff spoken with had an understanding of what constituted abuse and what responsibilities they had to ensure residents remained safe. Staff confirmed they had received training on safe guarding adults and knew the home had a whistle blowing policy. Training records verified these details. There was a copy of the Adult Protection and Complaints procedures available in each unit. Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 22 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 home is suitable for its stated purpose however; the arrangements for laundry are not suitable. One specific area of Stable Cottage had a very unpleasant odour. EVIDENCE: The home is made up of 4 units, the main house divided into East & West Wings and the two separate buildings known as Stable Cottage and Garden Cottage. All four units were looked at and the communal areas viewed this included kitchens, bathrooms, lounge, and hallways in addition to some of the residents’ personal bedrooms. Bedrooms had been personalised and provide residents with a pleasant space to relax in. Staff thought the residents benefited from being in smaller groups and with people having similar abilities and needs.
Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 23 The home carries out various environmental checks with the help of staff and external professionals. The various checks included fire officer visit, fire drill, weekly fire checks, EHO visit, water temperature checks, food temperature checks, and fridge and freezer checks. However not all the units are managing all the checks regularly and some gaps were found particularly in the two smaller units known as Garden Cottage and The Stables. An extremely strong and offensive odour was present in the main entrance/hallway of Stable Cottage and this needs to be rectified. Radiators in East & West Wing were hot to the touch and a convector heater in Stable Cottage was equally hot to the touch and if any resident had prolonged contact would cause extreme discomfort and likely to burn. Staff were present at the time of testing the temperatures and the thermostats were adjusted however these should be regularly checked as a preventive and obvious safety measure. The home affords ample grounds and gardens and this additional space clearly suits some residents’ specific needs as it allows them the freedom to “roam” but within safe boundaries. Staff were aware that despite residents needing this level of space and freedom there is still a need to supervise albeit from a discreet distance. Risk assessments identified the importance of supervision in the grounds to ensure the safety of the residents and the property of staff and visitors and to this affect certain areas are marked by red-topped posts which indicate to residents that they should not enter these areas e.g. the visitors and staff car park. Purbeck Care DS0000066059.V352859.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s recruitment policy and operational practice. Training records showed that not all staff were up to date with the mandatory training required to ensure they are competent and qualified to carry out their duties. EVIDENCE: Four staff files were looked at and they contained all relevant recruitment documentation and were well maintained. Interviews are recorded and kept on file. All the personnel files that were examined revealed that thorough preemployment checks are carried out. Staff confirmed that all these recruitment procedures had taken place i.e. they had provided referees and had a Criminal Record Bureau (CRB) check done before starting work at the home. Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 25 Staff said that there were times when the staffing is “very tight” and recently a number of staff have left which has forced the company to revert to topping up the staff quotas with agency staff. Staff said that some units are more stressful to work in than others but there is a system for staff to be able to have a break from these if they want. The service development manager stated that suitable induction and a regular program of training is in place for staff. However the training records showed that there were some gaps in the staff training and the service development manager who had delegated this responsibility to an assistant manager stated this would be rectified immediately and the necessary training scheduled to ensure all staff were up to date with their mandatory training. Staff confirmed they had been on specialist training courses to help them understand some of the complex and challenging behaviour a few residents display. Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 26 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 home has been operating without a registered manager since August 2007, however, the service development manager and the assistant managers have continued to run the home for the benefit of the residents. These management arrangements have ensured the home is well managed. The health, safety and welfare of residents are promoted and protected despite some mandatory training not being completed and some basic unhygienic practices regarding food hygiene and the management of the laundry. Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 27 EVIDENCE: Staff said they thought the home was well managed and that both the service development manager and assistant managers were supportive and approachable. The staff who spoke with the inspector confirmed they received regular supervision and attended regular staff meetings and that this was part of a supportive management style provided by the current management. All of the residents spoken with stated that they felt they were consulted about day-to-day issues. There was evidence of reviews, resident meetings and consultation carried out with individual residents. Purbeck Care has a system for assessing the quality of its services and the views of residents and various stakeholders and this information forms the basis of the companies annual development plan. A relevant policy with regards to the safe keeping of resident’s personal allowances is in place and followed. Records of resident’s cash allowances were seen and checked and found to be satisfactory. A sample of records showing the checks and tests undertaken were looked at and these showed that the required health and safety checks and tests are being carried out and confirmed information provided prior to the inspection in the completed Annual Quality Assessment. (AQAA). Risk assessments were seen on individual files and are also in place for the buildings and grounds. Staff spoken with were aware of health and safety issues but the training records indicated that not all staff were up to date with fire training nor had completed basic food hygiene training. In addition the laundry located in the main house in the west wing was very unhygienic, the door was found propped open by an unsealed “red bag” which would be used to carry soiled items down to the laundry room. The laundry is small and inadequate for the amount of laundry it has to cope with however there is no excuse for it not to be kept clean and tidy and hygienic. Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 29 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 YA30 Regulation 16 (2) (k) Requirement The registered provider must ensure all parts of the home are kept clean, hygienic and free from offensive odours. This is an outstanding requirement from the last inspection. The registered provider must ensure all staff receives regular fire training. This is an outstanding requirement from the last inspection. Timescale for action 14/12/07 2. YA42 23 (4) (e) 14/12/07 Purbeck Care DS0000066059.V352859.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. Refer to Good Practice Recommendations Standard 1. YA6 It is recommended that the care plans are developed in variety of formats to help resident’s access and understand their own service plans. 2. YA7 It recommended that service users be encouraged with support and understanding to manage their own personal allowances. 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. e.g. dining room and kitchen facilities in East Wing. 3. YA24 Purbeck Care DS0000066059.V352859.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. Extracts may not be used or reproduced without the express permission of CSCI Purbeck Care DS0000066059.V352859.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
