Inspection on 12/10/06 for Quarrydene

This inspection was carried out on 12th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Quarrydene 30/04/09

Quarrydene 07/05/08

Quarrydene 24/05/07

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

CARE HOME ADULTS 18-65 Quarrydene Pavenhill Purton Wiltshire SN5 4DA Lead Inspector Alison Duffy Unannounced Inspection 12th October 2006 09:45 DS0000067364.V316055.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 DS0000067364.V316055.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. DS0000067364.V316055.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Quarrydene Address Pavenhill Purton Wiltshire SN5 4DA 01452 300025 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) www.holmleigh-care.co.uk Holmleigh Care Homes Ltd Mrs Janet Cornell Ashford Care Home 9 Category(ies) of Learning disability (9), Physical disability (9), registration, with number Sensory impairment (4) of places DS0000067364.V316055.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection This is a new service and therefore the first inspection Brief Description of the Service: Quarrydene is a residential care home run by Holmleigh Care Homes Limited. The Director is Mr Rod Correia and the Registered Manager is Mrs Janet Ashford. Quarrydene was registered on 7th August 2006. Previously a care home for older people, the property has been totally refurbished. It can now accommodate nine service users with a physical and learning disability. Four service users may also have sensory impairment. Quarrydene is a spacious bungalow that is located in the village setting of Pavenhill, Purton. There are a number of communal areas including a sun lounge and a sensory room. All bedrooms are single and provide an en-suite of either a specialised bath or wet room. In some instances the en-suite may be shared between two bedrooms. There is a range of specialised equipment to assist with individual need. Staffing levels, once all service users occupy the home, will be maintained at four support workers or more throughout the waking day. At night there will be two waking night staff. DS0000067364.V316055.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place over a period of two days. The inspection commenced on the 12th October 2006 between the hours of 9.45am and 3.15pm. Mrs Ashford was available initially although later in the morning, she needed to leave to attend to other commitments. Ms Mimi Collins, Senior Support Worker then assisted as required. The inspection was concluded on the 1st November between the hours of 10am and 3.30pm. Mrs Ashford was available throughout this time and received feedback. The Inspector was able to meet with all service users and members of staff on duty. Due to complex disabilities, service users were unable to give feedback about the service received. Various interactions between staff and service users were observed. Positive relationships were evident. Discussion took place with Mrs Ashford regarding service provision since the home had opened. Mrs Ashford confirmed things were going to plan yet reported that she wanted to develop many other areas. Mrs Ashford confirmed it was early days as the home had only been open for approximately two months. It was apparent that Mrs Ashford and the staff team had worked hard to achieve existing levels of provision. All staff were positive and appeared motivated in their role. A tour of the accommodation was made and varying documentation was viewed. This included care planning information, health and safety material and staffing documentation. Comment cards were forwarded to each service user’s primary relative and a number of health and social care professionals. A GP confirmed the care appeared appropriate and all visits were necessary. The GP reported that the District Nurse had also visited and there were no concerns. The GP was pleased to note that specialised health care personnel such as the speech and language therapist had been asked to visit. Within feedback, one relative reported ‘XX has settled very well which is a big plus. XX is being well cared for, staff are communicative, friendly, informative and keep everyone informed of what’s going on. Behaviour is being managed without medication, which is good and says a lot about the staff.’ Another relative stated ‘from first impressions, XX’s room seemed homely and comfortable and XX was happy. We did not see the rest of the facilities but everything looked clean. The staff we saw were friendly and helpful.’ All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included the visit to the service and taking into account the views raised on behalf of service users. DS0000067364.V316055.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Staffing levels were being maintained at the minimum, which was insufficient to meet service users’ needs. Mrs Ashford immediately contacted agency staff in order to gain an additional member. A clear focus regarding recruitment is required to ensure additional staff are deployed before further service users are admitted to the home. The Statement of Purpose, although a detailed document does not clearly state the needs of service users, Quarrydene is able to meet. Fees are also not stipulated. This needs to be addressed. Service users’ contracts also need to be kept in the home. The risk assessment process needs to be developed in order to address individual risks to service users and those regarding the environment. DS0000067364.V316055.R01.S.doc Version 5.2 Page 7 Policies and procedures are well written yet not all refer specifically to the home. A review is required to ensure all are accurate and up to date. The environment is of a good standard yet service users and their representatives need to be consulted with, regarding a number of issues. These include lockable storage space, locks on doors, listening devices and the absence of a call bell system. The home appears service user focused yet a formal quality assurance system is required to ensure the further improvement of the service. 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. DS0000067364.V316055.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 DS0000067364.V316055.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessment documentation must be consistently available to ensure individual needs are met. The amount of time, spent with some service users before their admission, has significantly benefited all concerned. The Statement of Purpose must include details of fees so that prospective service users are well informed. EVIDENCE: When fully occupied Quarrydene is able to accommodate nine service users. At present three rooms are occupied. Mrs Ashford reported that she believes it is essential for all admissions to be staggered. This is to enable staff to fully assess need and to begin to establish a relationship with each service user. Mrs Ashford reported that her line managers have so far undertaken all initial assessments and have agreed the placements. Once the placement was agreed, Mrs Ashford and the staff team worked closely with two service users before their admission. This involved visiting previous placements and assisting with personal care and individual activity. During this time, different forms of communication were observed. This assisted service users and staff on admission. Detailed documentation is available for these service users. This includes a detailed assessment from the placing authority, information from the previous placement and the homes own assessments. There is less information on the third service user. In particular the home’s assessment was not available. Mrs Ashford explained that the admission took place while she DS0000067364.V316055.R01.S.doc Version 5.2 Page 10 was on annual leave and therefore the assessment material is probably held within the organisation’s main office. Mrs Ashford reported that in future, she would undertake all assessments and have more of a role with agreeing the suitability of the service user. During discussion it was clear that Mrs Ashford is very aware of the needs that the home is able to meet. For example, an additional service user would currently require additional staffing levels. The numbers of staff would also very much depend on the dependency level of the service user. Mrs Ashford confirmed that this would be negotiated with her line manager. Mrs Ashford reported that all service users have a contract yet these are held at the organisation’s main office. They were therefore unavailable for inspection. Mrs Ashford confirmed that a copy would be gained and kept on file. Mrs Ashford reported that she does not become involved in financial matters. Mrs Ashford was not aware of the home’s fees. Mrs Ashford agreed that this information would be gained when contracts were requested. The fees are not stipulated within the Statement of Purpose. The needs of service users the home is able to meet is also not clearly stipulated. Mrs Ashford was informed of the need to address these aspects. DS0000067364.V316055.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 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning is of a good standard, yet the development of some areas would enable care provision to be further developed. Decision-making is encouraged and more systems are planned to enable greater involvement. Service users’ safety is given priority, yet further safety would be assured through individuality within risk assessments. EVIDENCE: All service users have a care plan which is clear, well written and easy to follow. The plans are detailed and a separate plan is allocated to each need. It was recommended however that a number of areas would benefit from further development. These included communication and actual assistance required. For example, individual forms of communication and the possible meaning of cries or gestures were not detailed. In some instances, ‘needs the assistance of two carers’ was recorded yet the detail of the intervention was not apparent. The management to minimise the risk of developing a pressure sore is also required. Mrs Ashford clearly described the preferences of daily routines yet these were not documented. Some detail regarding equipment and the need to ensure, for example, waist straps were secured, was well written. It was recommended that the use of photographs may further assist staff when DS0000067364.V316055.R01.S.doc Version 5.2 Page 12 describing the use of equipment. There was some terminology, which required addressing. This included ‘is aggressive’ and ‘has a tantrum to get her own way.’ It was agreed a factual account is required. Mrs Ashford agreed that alterations would be made. The plans are regularly reviewed and this is evidenced on the back of each separate care plan. Mrs Ashford confirmed that some parents read the care plans and give their views. It was agreed that their involvement in developing the plan should be evidenced. Due to their health condition, service users are unable to express their views regarding how they wish their care to be delivered. Mrs Ashford confirmed, that due to this, parental support is invaluable and regularly sought. Mrs Ashford has printed off various sources of information from the Internet regarding individual health conditions of service users. Staff document any issues on a daily basis within daily reporting sheets. These were informative, clear and very well written. When the home was being registered, Mrs Ashford confirmed that call bells were not going to be installed. This was because the providers believed that service users would not have the capacity to operate the system. It was therefore agreed that alternate measures of ensuring safety was required. Mrs Ashford reported that all service users are monitored regularly at intervals related to their need. At present, this is not recorded within individual care plans. A requirement has been made to address this area. Listening devices are used as required. Mrs Ashford was informed that these must be agreed with the service users’ family and care manager. Guidance must detail when the device should be turned off to enable service users’ privacy. Mrs Ashford confirmed that decision-making is an area that she wishes to develop. Service users have only been in the home for a short period of time and relationships are being developed. Levels of communication vary significantly and are very complex. There are instances whereby service users are able to restrictively communicate their needs. This is through the use of some words, stipulating ‘yes’ or ‘no,’ pointing or gesturing. On other occasions, staff need to use a process of elimination. A member of staff confirmed that basic care needs are used as a starting point. For example, staff aim to ensure the service user is not in any pain, is comfortable and for example, not too hot or cold. Through a process of elimination, the reason is often determined. Within the second day of the inspection however, one service user was portraying distress. Over a period of time both staff members and Mrs Ashford were having difficulty assessing the reason for the emotion. Various options were tried such as changing the service user’s position, undertaking personal care and going for a walk. Little helped and the staff confirmed that this area of their role is a challenge. They confirmed feeling frustrated with not being able to immediately resolve the difficulty for the service user. Mrs Ashford acknowledged this yet confirmed, as relationships develop, such incidents have DS0000067364.V316055.R01.S.doc Version 5.2 Page 13 been reduced. Staff confirmed specific forms of communication and appeared to be developing a clear awareness of individuality. Mrs Ashford confirmed the use of pictorial formats and makaton are to be developed. Due to the complexity of service users’ needs, Mrs Ashford reported that risktaking is usually associated with aspects of daily living. For example, a service user may have a seizure when out. Mrs Ashford believes that service users should not be restricted due to this. Focused consideration is therefore given to control measures. Due to risk, Mrs Ashford has stipulated that all service users must have one-to-one staff support even when going out in the home’s transport. A certain amount of risk, such as self-harm has been identified within care planning information. Mrs Ashford was informed of the need however to further develop the risk assessment process on an individual basis with all service users. Mrs Ashford confirmed this was her next area of focus. DS0000067364.V316055.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 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While service users are offered activity, some opportunities are restricted due to current staffing levels. Service users are assisted to maintain important relationships. Hospitality is evident within the home. Meal provision reflects individual need and preference. EVIDENCE: Service users currently remain in the home and do not attend college or day services. Mrs Ashford reported that it is intended that opportunities will be made available yet these will be arranged with staff. They will not form part of a structured external day service programme. Since the home has opened, regular social functions have been held with service users from other care homes within the organisation. These have included a Halloween and a Firework Party. Mrs Ashford confirmed that calendar events are celebrated, which gives opportunities for service users to get together. Service users also have the opportunity to go to community events. One member of staff reported that being involved with the local community is important. Service DS0000067364.V316055.R01.S.doc Version 5.2 Page 15 users are assisted therefore to go to the local shop and to the surgery to collect prescriptions for example. Mrs Ashford also confirmed that trips out to the local parks, shopping or lunch out are also enjoyed. The home has its own accessible transport to facilitate journeys as required. During the inspection, positive interactions were observed with service users. Staff were actively involved and on one occasion music was playing and staff were encouraging service user involvement. Percussion instruments were being utilised. There was evidence on the walls of painting and drawing. Mrs Ashford confirmed that the home is building a stock of activity products. These were being purchased through specialised catalogues. The home has a sensory room with a range of stimulatory equipment. Large cushions are in place on the floor to enable service users to relax and enjoy a change of position. Although activity is promoted, current staffing levels restrict such activity. This is addressed within greater detail within the staffing section. However, in order to enable one-to-one work with service users, staffing levels must be addressed. Within the Statement of Purpose it is stated that each service user will have an individually designed social programme, built around their wishes and needs. At present this has not been undertaken. Visitors are welcomed at any time. One member of staff confirmed that parental involvement is paramount and therefore discussion takes place on a regular basis. Service users are assisted to telephone their family on a regular basis. Visitors are able to meet with their relative in the privacy of individual rooms or within communal areas. Throughout the inspection hospitality was evident. Mrs Ashford confirmed that staff are beginning to become aware of preferred routines. For example one service user expresses displeasure if she is assisted too early in the morning. Staff therefore now aim to attend to her needs at a time which does not cause upset. While staff appeared aware of individual preferences, such wishes need to be stated within individual plans of care. Mrs Ashford confirmed that she intends to focus on service users’ involvement in the home. This will include choosing individual colours for redecoration. Greater attention in relation to individual interest is also intended. At present however, staffing levels within the home make this a challenge. The housekeeper undertakes meal preparation. Due to limited numbers of service users, at present, a set menu has not been developed. A number of alternatives are offered based on known preferences. These are documented and used as a record to ensure variety. Mrs Ashford confirmed that meal arrangements vary according to the wellbeing of service users and the activities of the day. For example, if a cooked breakfast is consumed, a snack may be provided at lunchtime. A cooked tea may then be undertaken. Meal times are encouraged to be a social occasion with staff offering assistance as required. DS0000067364.V316055.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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and personal care are well managed with regular input from specialised services. Clear, organised medication systems minimise the risk of error. EVIDENCE: Service users require full assistance from staff in all aspects of daily living. Care plans reflect this yet would benefit from more detail in specific areas such as daily routines. All service users have a range of individualised specialised equipment. This includes overhead tracking for the hoist, specialised beds and chairs. Mrs Ashford confirmed that staff have received training in the use of all equipment. Mrs Ashford stated that the beds came complete with bedrails. Mrs Ashford was informed of the need to ensure a specialised health care professional assesses the use of all bed rails. This must be agreed and documented within care planning information. A record of service users’ weight is maintained. This is enabled, as specialised weighing scales have been purchased. Service users are unable to express how they wish their care to be delivered. In such instances, staff rely on knowledge gained from assessments, discussion with parents and their experience of working with the service user. Some service users are able to express a choice through stating ‘yes’ or ‘no’ to a question. Staff also need to recognise gestures, facial expressions, general contentment and individual communication systems. One member of staff DS0000067364.V316055.R01.S.doc Version 5.2 Page 17 reported that determining need is now getting easier through the development of relationships. A key worker system is in operation. This is expected to assist with decision-making and individuality. All service users have now been registered with the local surgery. The GP confirmed that as the home has only recently been registered, contact has been minimal. However it was confirmed that all consultations have been totally appropriately and care provision appeared positive. Records demonstrate medical intervention from a range of health care personnel. This also includes regular monitoring of peg feeding. Mrs Ashford confirmed that she is in the process of updating one service user’s epilepsy profile. One member of staff confirmed that in the event of severe distress, if staff are unable to find the cause of the emotion, a GP may be called. This was to ensure that there was not a medical reason, which needed to be addressed. Mrs Ashford reported that she currently has responsibility for ordering and receiving all service users’ medication. She is planning however to delegate this responsibility to a member of staff in due course. Service users require full support in medication administration and are unable to give consent. All medication is orderly stored in a locked wall mounted cabinet in the office. The keys are kept on the senior staff member’s person. At present only the senior staff administer medication. One service user has their medication administered through specialised means. The medication administration records were satisfactorily maintained. Appropriate systems were in place for receipt and disposal of medication. Due to conditions, Mrs Ashford has stated to the staff that only prescribed medication will be administered. Homely remedies are therefore not used so the medication policy needs to reflect this. DS0000067364.V316055.R01.S.doc Version 5.2 Page 18 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 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that complaints or comments about the service can be raised. Staff have received training in adult protection yet an awareness of local reporting procedures, would further ensure service users’ safety. EVIDENCE: There is a copy of the home’s complaint procedure within the policies and procedures file. The policy is need of updating so that it relates specifically to this location rather than the area of the organisation’s other homes. Service users, due to their disabilities are unable to follow the procedure. Ms Collins reported that service users currently rely on staff, their relatives or their representatives to recognise any form of discontentment. This may include facial expressions, gesturing or vocalisation. Mrs Ashford reported that she is in regular contact with service users’ families and would aim to address any issues at an early stage. An adult protection policy is located within the policies and procedures file. This policy however is in need of review as it details in house investigations and ensuring consent before commencing. Later in the file however there is a procedure detailing local procedures of reporting abuse. CSCI’s guidance on Vulnerable Adult’s was also available. It was suggested that copies of the ‘No Secrets’ documentation should be displayed on the staff notice board. One member of staff reported that they would address any issue immediately with line management. They also discussed the vulnerability of service users and always being attentive to a possible problem. Body maps are used to document any aspect, such as a bruise or scratch. Staff training regarding adult abuse has been undertaken yet local reporting procedures were not DS0000067364.V316055.R01.S.doc Version 5.2 Page 19 covered. Mrs Ashford was advised to contact the local Vulnerable Adults Unit in order to facilitate further training. DS0000067364.V316055.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, 25, 26, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The building has been refurbished to a good standard and is conducive to service users’ needs. Specialised equipment is available enabling the home to be fit for purpose. Clarity with aspects such as locks on doors would ensure service users’ greater privacy. EVIDENCE: Quarrydene consists of a spacious bungalow within a quiet village setting. Previously a home for older people, the property has been totally refurbished to a high standard. There are now nine single bedrooms. Some have individual en-suite facilities including a specialised bath or shower. A number of rooms share an en-suite facility. Those service users using shared en-suite facilities require full staff support for all personal care needs. In such instances, a lock has been provided for staff to use to assist with privacy. All bedrooms measure above 15 square metres. At present all are decorated in a neutral colour. Mrs Ashford reported that in time it is expected for all rooms to be decorated in relation to service users’ preferences. All rooms have overhead tracking for hoisting that continues from the bedroom to the en-suite facility. Bedrooms also have a television aerial point, a number of electrical DS0000067364.V316055.R01.S.doc Version 5.2 Page 21 sockets and a mechanical device, which holds the door open without the need for it to be inappropriately wedged open. Light switches have been installed at a level appropriate to wheelchair users. Bedrooms do not have locks on the doors or have lockable storage facilities. At the time of registration, Mrs Ashford confirmed that this was a considered decision in order to enable a homely approach. Mrs Ashford also confirmed that it was not expected for any service user to be able to use the lock due to their disability. It was agreed that each service user or their relative and care manager must be routinely offered the facility. Their preference must be accommodated and if declined, this must be documented within care planning information. The home does not have a call bell system. Again, Mrs Ashford confirmed this was a considered decision. This was due to an expectation that service users would not be able to use the facility due to their health condition. Arrangements to ensure service users’ safety in the absence of a call bell system must be addressed within individual care plans. All radiators have low temperature surfaces. Hand washbasins in the en-suite facilities have been fitted with hot water temperature controls. The hand washbasins are very small, which may restrict their usage. Service users or their relatives and their care managers should be asked if the facility is adequate. This should be documented and if unsatisfactory for individual need, a larger hand washbasin should be installed. Communal areas consist of a dining room with a hatch to the kitchen, a lounge, a sunroom and a sensory room. The lounge has overhead hoisting equipment. All rooms are light, comfortable and furnished to a good standard. Mrs Ashford confirmed that additional armchairs are planned although will be purchased in accordance with the needs of additional service users. A larger table is also planned. Within the corridors, lighting has been installed that is activated through movement. This enables service users and staff to move around without manipulating switches. The home is surrounded with pleasant gardens, which have been mainly laid to lawn. There is a path around the building and a small patio area. A pond has been built near the patio area as a feature. It is expected that all service users will require full assistance, to access the gardens. The kitchen has been totally refurbished and has been fitted with units and appliances of a good quality. There are two laundry rooms in order to ensure that soiled linen is not carried through communal areas. At present, all service users are located in one area of the home. This is within the region of the main laundry. Due to this, the second laundry is not used at this time. Hazardous substances are satisfactorily stored in the main laundry within a locked cupboard. DS0000067364.V316055.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 and 35. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Mrs Ashford’s efficient response to providing additional staffing, enables service users greater safety. Further focus on recruiting staff is needed before the admission of additional service users. Recruitment processes are well managed. Training is given priority and a range of subjects is available, which increases the standard of service provision. EVIDENCE: At the time of registering the home, when fully occupied, it was agreed that staffing levels must be maintained at 527.13 care hours a week. In terms of staffing levels, this means that there must be four members of care staff on duty during the waking day. At night there must be two waking night staff. Mrs Ashford reported that at present, with three service users within the home, there are always two or more care staff on duty. This sometimes includes Mrs Ashford. At night there is one waking night staff and another member provides sleeping in provision. The staffing roster sometimes reflects two waking night staff. All service users however, require the assistance of two members of staff to undertake their personal care. One service user also requires full one-to-one assistance throughout the waking day and night. To provide such care, the current staffing levels are inadequate. Mrs Ashford confirmed that at night, one member of staff provides the one-to-one support as required. If another service user requires assistance, the member of staff providing sleeping in provision is asked to help. Mrs Ashford was informed that this is unacceptable. DS0000067364.V316055.R01.S.doc Version 5.2 Page 23 An additional member of staff within each shift is clearly required. When informed of this, Mrs Ashford immediately contacted the agency and covered all shifts with an additional person. It was evident that, until further recruitment, the home is reliant on agency staff. Mrs Ashford confirmed that an additional service user could not be accommodated within the home until there are more staff available. It was agreed that a clear focus on recruitment was required by the organisation. Mrs Ashford confirmed that she would expect five or six staff to be on duty during the day when fully occupied. If dependency levels of service users were very high she would expect the staffing levels to be even higher. There are currently two senior carers, four carers, four night staff and a housekeeper within the team. The housekeeper reported that she is responsible for all cleaning and the main meal preparation. Within the staffing roster, there was no evidence of housekeeping hours at the weekend. Care staff are expected to prepare meals and undertake a certain level of cleaning and laundry. All service users require one-to-one staff assistance when out. Current staffing levels therefore, at times, restrict external activity. For example if one service user wanted to go out, there would be insufficient staff remaining, to cover the home. It was also noted that on the second day of the inspection, two staff were required to settle a service user. This meant the other two service users were unsupervised and became anxious over the disruption. It was agreed that discussion with the organisation was required to address these areas. Within the staffing roster, the type of shift, such as early or late was recorded on the roster. Mrs Ashford was informed of the need to record specific times of the shift in order to evidence staffing levels. The recruitment documentation of the two most recent members of staff were viewed. Both had an application form, appropriate references, a POVA First check and a clear CRB. There were also interview notes. Mrs Ashford reported that the organisation manages the recruitment process. They send out all information to the prospective candidate and complete all checks. Mrs Ashford is informed on completion. While staff were waiting for all building works to be completed, a range of training courses were undertaken. This included first aid, manual handling and food hygiene. Staff worked with service users in their previous placements before their admission to the home. This gave invaluable experience and began the development of relationships. Specific training requirements such as peg feeding were identified and subsequently arranged. Senior staff have completed medication training and diabetes training is booked for October 2006. Further updates for those staff who have been recently recruited have been arranged. Disability awareness training is planned and Mrs Ashford aims to arrange further communication training. It was agreed that adult protection and sensory impairment should also be targeted. When viewing training DS0000067364.V316055.R01.S.doc Version 5.2 Page 24 documentation it was noted that the same person signed all certificates. Mrs Ashford reported that the organisation arranges all training and staff are then expected to chose what they need to do. Mrs Ashford was not aware of the trainer’s expertise. It was also noted that adult protection and learning disability had both been undertaken on the same day. It is therefore recommended that Mrs Ashford assesses the courses’ content to ensure staff are receiving sufficient depth with their training. A formalised training matrix identifying planned and completed training is also required. DS0000067364.V316055.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, 40 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has a strong value base and is motivated to provide a high standard of care. Policies are in need of review so that staff have accurate, up to date information. While the home is service user focus, a formal system to assess quality would further develop provision. Health and safety is given priority yet greater attention to the risk assessment process would ensure further protection. EVIDENCE: Mrs Ashford is a registered nurse in her country of origin yet has not undertaken her conversion training. She is currently undertaking the Registered Manager’s Award. Mrs Ashford confirmed she is hoping to complete the course before the end of 2006. Mrs Ashford is then planning to undertake NVQ 4 in Care. Mrs Ashford has many years’ experience of residential and hospital settings. Mrs Ashford reported that she is a perfectionist and expects standards to be high. Developing a new service however has proved to be a learning curve. Mrs DS0000067364.V316055.R01.S.doc Version 5.2 Page 26 Ashford therefore welcomes feedback in order to improve her performance and that of the service. Mrs Ashford has a strong value base and has a clear awareness of service users’ needs. Mrs Ashford confirmed that she has a good team and aims to motivate and involve staff. She is totally committed and is enthusiastic about her role. Mrs Ashford confirmed service users’ well being is paramount. Discussion took place with Mrs Ashford regarding the need to inform CSCI of any incident that affects the well being of any service user. Following the inspection, Mrs Ashford has undertaken this. The home has a number of well-written, detailed policies that have been written by the organisation. Many however are dated 2004 so are in need of review. Some of the policies also do not reflect the arrangements within the home. It appears they were written for another establishment and have been carried over. For example one policy mentions calling assistance if required, from ‘the bungalow.’ Mrs Ashford confirmed that there are regular audits of the home. These include health and safety audits and vehicle and environmental checks. On the second day of the inspection, Mr Correia, the Director of Holmleigh Care, was undertaking a Regulation 26 visit. At this time however, a quality assurance system has not been addressed. Mrs Ashford confirmed that she would discuss this aspect with Mr Correia. Mrs Ashford confirmed that all portable appliances have recently been tested. Staff maintain a record of fridge and water temperatures. Contracts have been developed to enable regular servicing of equipment. The fire log demonstrated satisfactory testing of the fire alarm systems. As stated earlier, all rooms except the office have mechanical devices to appropriately enable doors to be propped open. A device is therefore needed for the office as on the first day of the inspection the office door was propped open with a chair. Mr Correia reported that this had been an oversight and a device would be fitted. DS0000067364.V316055.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 2 2 2 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 2 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 X 34 3 35 2 36 X 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 2 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 2 X 2 X DS0000067364.V316055.R01.S.doc Version 5.2 Page 28 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4 Requirement The Registered Person must ensure that the Statement of Purpose contains details of the needs, which can be met and the fees for living at the home. A record of fees must also be maintained. The Registered Person must ensure that there is evidence of the home’s own assessment, which takes place before the service user’s admission. The Registered Person must ensure that the prevention of pressure sores and preferred daily routines are addressed within care planning information. The Registered Person must ensure that clarity is given to terms such as ‘needs assistance.’ Subjective terminology including ‘is aggressive’ must also be replaced with factual information. The Registered Person must ensure that due to service users’ limitations with their DS0000067364.V316055.R01.S.doc Timescale for action 31/12/06 2 YA2 14 31/12/06 3 YA6 12(1)(a) 31/12/06 4 YA6 12(1)(a) 31/12/06 5 YA6 15 28/02/07 Version 5.2 Page 29 6 YA6 7 YA9 8 YA9 9 YA9 10 YA26 11 YA32 communication, all care plans are to be developed and signed by the service user’s representative. 13(4)(c) The Registered Person must ensure that in the absence of a call bell, strategies to assure service users’ safety, are agreed with representatives and are documented within the care plan. 12(4)(a) The Registered Person must ensure that any listening device is agreed with the service user’s care manager and family. This agreement and guidelines for its use must be documented within the care plan. 13(4)(a)(b)(c) The Registered Person must ensure that risk assessments are further developed. These must take into account service users needs and the environment. 13(4)(c) The Registered Person must ensure that a qualified health care worker undertakes an assessment regarding the use of all bed rails. Any risk identified must be addressed within the risk assessment process. 12(4)(a) The Registered Person must ensure that service users and/or their representative are asked if they wish to have lockable storage space and a lock on their bedroom door. This must be evidenced within the service user’s care plan. 18(1)(a) The Registered Person must ensure that staffing levels are sufficient to meet service users’ individual needs. This must take into account dependency levels, social needs and the omission of DS0000067364.V316055.R01.S.doc 31/12/06 31/12/06 28/02/07 30/01/07 30/01/07 31/12/06 Version 5.2 Page 30 12 YA39 24 13 YA40 18(1)(c)(i) 14 YA42 13(4)(c) housekeeping staff at a weekend. A proposal regarding how such levels will be achieved must be forwarded to the CSCI. The Registered Person must ensure that a quality assurance system is developed and implemented within the home. The Registered Person must ensure that all policies and procedures relate specifically to the home and are kept up to date. The Registered Person must ensure that the office door is held open only with a mechanical device that is linked to the fire alarm system. 31/03/07 31/03/07 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard YA5 YA6 YA22 YA23 YA26 Good Practice Recommendations The Registered Person should ensure that each service user’s copy of their terms and conditions is readily available within the home. The Registered Person should ensure that specific areas are further developed within the care plans. This should include aspects such as communication. The Registered Person should ensure that the complaints procedure details contact details of the local CSCI office in Chippenham rather than Gloucester. The Registered Person should ensure that training from the Vulnerable Adults Unit is arranged, enabling staff to be familiar with local reporting procedures. The Registered Person should ensure that service users or their representatives are satisfied with the provision of a small sink in their en-suite facility. This should be recorded within care plans. DS0000067364.V316055.R01.S.doc Version 5.2 Page 31 6 7 8 9 YA32 YA35 YA35 YA35 The Registered Person should ensure that the staffing roster demonstrates the time of each staff members’ shift. The Registered Person should ensure that staff receive sensory impairment training. The Registered Person should ensure that a training matrix identifying the dates of completed and proposed training is developed. The Registered Person should review the content of some training courses in order to ensure the level is sufficient to meet staff and service provision’s needs. DS0000067364.V316055.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 DS0000067364.V316055.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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