Inspection on 24/05/07 for Quarrydene

This inspection was carried out on 24th May 2007.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 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 12/10/06

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 Key Unannounced Inspection 24th May 2007 09:40 Quarrydene DS0000067364.V335623.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 Quarrydene DS0000067364.V335623.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. Quarrydene DS0000067364.V335623.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 Quarrydene DS0000067364.V335623.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 2006 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 was 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. Quarrydene DS0000067364.V335623.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 initially on the 24th May 2007 between the hours of 9.40am and 5.10pm. It was concluded on the 8th June 2007 between 9.40am and 2.15pm. Mrs Ashford was available for discussion throughout the inspection and received feedback. The Inspector was able to meet with all four 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. 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 the home to distribute. Following the second day of the inspection, Mrs Ashford distributed these to relatives and health care professionals. One service user survey, which had relative input, was returned to CSCI. Discussion also took place with two health and social care professionals. Mrs Ashford did not complete the Pre-Inspection Questionnaire sent to the home before the inspection. Mrs Ashford explained that her workload limited the time available to complete the documentation. Due to not being involved with service user’s finances, Mrs Ashford was not aware of the fees for living at the home. 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. What the service does well: The home has a detailed admission procedure. Following an assessment and receipt of documentation from the service user’s placing authority, a transition plan is established. This involves staff visiting and supporting the service user in their existing environment for a period of time before their admission. Service users receive a high level of personal care due to their level of need. All have regular support from specialised health care professionals. Medication systems are ordered and well managed. Quarrydene DS0000067364.V335623.R01.S.doc Version 5.2 Page 6 The environment is of a good standard and is conducive to service users needs. A range of specialised equipment is available. Recruitment procedures are thorough and robust which minimised potential risks to service users. What has improved since the last inspection? What they could do better: A high number of requirements that were identified at the last inspection have not been addressed. Priority must be given to these areas in order to ensure compliance. The Statement of Purpose requires review to ensure an accurate reflection of service provision. Aspects such as fees, transport costs, staffing levels and the omission of a call bell system, locks on doors and lockable storage, need to be stipulated. The Statement of Purpose and Service User’s Guide are combined at present. There may be benefits from separating the documents so that the Service User’s Guide, can be developed in a user-friendly format. While the assessment process is thorough, the home’s assessment documentation should be adequately completed to fully identify service users needs. Detail, both within assessments and care plans, should be sufficiently explicit to identify the support required. The home is relaxed and routines are flexible. However, greater focus and attention to communication systems may enable service users to express their views more readily. 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. Quarrydene DS0000067364.V335623.R01.S.doc Version 5.2 Page 7 Consideration to risk management is given on an informal basis. To minimise potential hazards and promote service users’ safety, systems must be formalised. Individual and environmental risk assessments must be developed and fully documented. 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. Quarrydene DS0000067364.V335623.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 Quarrydene DS0000067364.V335623.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): 1 and 2. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Written documentation does not give a clear indication of key aspects, which may be important to service users before their admission. People are assessed and have a clear transition plan to ensure their needs can be met within the home. Greater clarity with assessment documentation would enable staff to have clearer information, when offering support. EVIDENCE: Mrs Ashford confirmed that a combined Statement of Purpose and Service User’s Guide is sent to any new referral. Mrs Ashford explained that she has recently discussed the document with senior management, as the format is not specifically related to service users’ needs. Mrs Ashford believed the document to be under review, as a photographer had recently taken photographs of the home. At the last inspection, a requirement was made to ensure the document, contained details of the fees and needs, which could be met within the home. This has not been addressed. Additional factors such as staffing levels and the absence of call bells, locks on doors and lockable storage are also not identified. Mrs Ashford reported that these matters would be discussed with senior management. Within received surveys, one relative confirmed they had enough information to make a decision about Quarrydene, being the right place for their family member. Quarrydene DS0000067364.V335623.R01.S.doc Version 5.2 Page 10 Mrs Ashford confirmed that all service users have signed copies of their terms and conditions. However, within individual files, there was a standard format. Mrs Ashford reported that the signed copies are stored at the organisation’s main office. At the last inspection a recommendation was made to store the documents in the home. This has not been addressed. It was not possible therefore to fully assess this standard. The general format referred to transport costs, although the exact detail was not stipulated. Mrs Ashford believed a percentage of each service user’s mobility allowance is deducted, although she was not sure, due to not being involved in financial matters. Transport costs are not detailed within the Statement of Purpose and therefore clarity is required. There is a detailed assessment procedure, which commences with senior managers meeting with the placing authority and assessing the prospective service user. Following the assessment, senior managers decide whether the individual’s needs can be met within the home. If so, Mrs Ashford is informed and undertakes her own assessment to confirm. A transition plan is then established. This involves Mrs Ashford and senior staff, visiting the prospective service user in their own home. Initially, additional information is gained. Further visits involve staff assisting with personal care routines. The prospective service user is then encouraged to spend time within Quarrydene. This may include an afternoon visit or an overnight stay. Once all parties are confident the placement is appropriate, an assessment period within the home is arranged. A formal review confirms permanency. One member of staff confirmed the transition plan is extremely beneficial, as practical knowledge can be gained from those who know the service user best. This is especially so when a service user is unable to communicate their needs. The staff member confirmed that a basic level of information is established and then while getting to know the service user within Quarrydene, the initial information is built upon. Assessment documentation of the most recent service user to the home was viewed. A written assessment from the placing authority was in place. There were also two documents, which Mrs Ashford had completed. One was a pictorial format while the second was worded, with greater clarification within the questions. There were a number of areas within documentation, which were not completed. These included social/health issues of significance, personal care and potential risks. A number of areas had been completed yet the documented information did not fully capture the support required. For example, ‘needs assistance with dressing’ and ‘needs hoisting’ were stated, yet specific detail was not evident. ‘Understanding - fairly ok’ was recorded under the heading, communication. ‘Yes’ was also ticked against ‘uses body language and facial expression.’ When discussing the meaning of the written information, Mrs Ashford showed clear awareness of need. This detail should be recorded, in order to assist staff when providing personal support. Quarrydene DS0000067364.V335623.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 generally of a good standard yet greater clarity in the way in which service users are supported, would maximise safety and ensure individual needs are fully met. People would have greater opportunities with decision making, if communication systems were developed. People are enabled to take every day risks yet a more formal approach to risk taking would ensure greater protection. EVIDENCE: All service users have a care plan, which is well written and easy to follow. The overall document is separated into sections of identified need. A care plan has been developed in relation to each need. Many of the plans contain good detail highlighting individuality. This includes preferred forms of dress or hairstyle. Others give specific timescales of required intervention with personal care. All contain practices, which support service users’ rights to privacy and dignity. Such examples include using a towel to cover the service user when assisting with personal care. Following discussion at the last inspection, daily routines Quarrydene DS0000067364.V335623.R01.S.doc Version 5.2 Page 12 are now commented upon. While some aspects of care planning give clear direction, other areas are less specific. For example, an entry stating ‘needs to have teeth cleaned’ did not expand upon, how this was undertaken. Also, ‘ensure safety by securing straps on chair’ highlighted a need, but was not clarified, as to what the statement meant in practice. Through discussion, one member of staff appeared clear about these areas. Mrs Ashford was also very aware of the support required. It was agreed that further clarity within documentation, would enable less experienced members of staff to have greater information. It would also ensure consistency and accurate support to individuals. Mrs Ashford confirmed that she would review the information currently in place. Mrs Ashford also explained, that she was aware, there were certain areas, such as travelling in the home’s transport, which have not been addressed. Attention would be given to these areas. At the last inspection, there were various uses of subjective terminology. This included ‘is aggressive’ and ‘has tantrums.’ Mrs Ashford has addressed these areas and there was no evidence of this, within the documentation viewed. Detailed behavioural management guidelines have recently been developed in relation to one service user. These were agreed within a multi-disciplinary meeting. Within discussion, one staff member confirmed the approach, which had been agreed upon and when they needed to intervene. Records were in place, so that the success of the new strategies could be monitored and reviewed. Due to service users’ limitations with their communication, at the last inspection, a requirement was made for all care plans to be developed and signed by the service user’s representative. Mrs Ashford confirmed that discussion with family members regularly takes place although none, as yet have signed the documentation. Mrs Ashford continued to report that she is planning to formalise the care plans on the computer. Once printed, rather than being handwritten, family members will be asked to sign. Service users are unable to verbally communicate their needs and therefore decision-making is more restricted. Through observation it was evident, that signs or behaviours may indicate a specific need. Service users are reliant on staff to recognise these yet information regarding this area, was limited within care plans. When asked about communication, two staff members answered similarly. They explained, sometimes a ‘yes’ or ‘no’ could be expressed, so simple, clear questions are important. In other situations, basic care needs would be addressed and then a process of elimination would establish the requirements of the service user. Both members of staff reported that service users would demonstrate their dislike of undertaking something against their wishes. This included pulling bed covers tighter over them, if they did not want to get up. One service user was observed to push their food away, potentially highlighting that they had had enough. Other alternatives were offered but a similar reaction was observed. They then resisted staff assistance to move Quarrydene DS0000067364.V335623.R01.S.doc Version 5.2 Page 13 away from the table. Staff were observed positively interacting with the service user and after a while, assistance was accepted. The service user then led staff to where they wanted to go. While staff were able to discuss individual choice and its importance, there was limited evidence of this, within documentation. A focus on developing communication systems was also not evident. Within one care plan, picture cards were detailed as a form of communication. One member of staff commented upon this yet another was unaware of the system. When staff were observed to communicate with the service user, the picture cards were not used. Mrs Ashford confirmed that communication systems had been discussed with the Occupational Therapist, who visits on a regular basis. In response, consideration was being given to computerised equipment. Mrs Ashford stated that she was aware that communication was an area, which needed to be developed. Due to this, she was in the process of discussing additional training with senior management. At the last inspection, a requirement was made to address risk assessments on an individual basis. While many risks have been informally addressed, many have not been formally documented. The requirement has therefore not been met. Mrs Ashford confirmed that priority would be given to this area and a revised timescale was identified. Mrs Ashford explained that service users continue to be encouraged to take risks as part of every day life. This includes going out with the potential of becoming unwell with a seizure. Mrs Ashford gave examples of risks, which had been assessed as too high. This included a service user travelling in the home’s transport without adequate support to their posture. A specialised harness is being investigated. Mrs Ashford also explained potential risks of a service user, who received ‘tasters’ despite being peg fed. Due to the high risks of choking, tasters are no longer offered. There are no call bells in the home, as senior managers believed that service users would not have the capacity to use them. At the last inspection, a requirement was made, to formalise the systems of service users calling for assistance. This area is now addressed within care plans. Nighttime sleep charts are also in place, so that staff evidence regular intervention. A listening device is used to alert staff, of one service user’s movements. Following a requirement at the last inspection, guidelines are now in place regarding the time it should be used. A written agreement, regarding its use, from a health care professional is also in place. Quarrydene DS0000067364.V335623.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. People are enabled to undertake various activities yet greater attention to individuality would further enhance quality of life. People are supported to maintain personal relationships. Peoples’ rights and responsibilities would be further promoted through greater attention to communication systems. EVIDENCE: Since the last inspection, three service users now attend a day centre for three mornings a week. The day centre is run by the organisation and is located in Gloucester. At present, service users only attend the morning session. This is due to there being no facilities for staff to safely assist service users with their personal care needs. The journey to the day centre takes approximately an hour or just over. Mrs Ashford confirmed that while some enjoy the journey, some find it tiring. There was no evidence in respect to day care attendance that individual needs and preferences had been taken into account. Within one Quarrydene DS0000067364.V335623.R01.S.doc Version 5.2 Page 15 daily record, ‘went on bus to XX, didn’t like it much’ was documented. There was no further follow up or investigation into what was disliked. During the inspection, there appeared to be little activity, taking place. On the first morning, service users were asked if they wanted the television on. An agreement could not be reached, so a member of staff offered to read stories. This was started but shortly afterwards the television was turned on. All service users later went out for a walk in the village, with one-to-one staff assistance. During various times of the day, one service user was observed to be resting on their bed. Another service user was also lying on their bed during the afternoon. Mrs Ashford explained that an afternoon rest is encouraged. This is mainly due to tiredness and to enable service users, a change in position. One member of staff said that one service user in particular, clearly demonstrates their wish to retire to their bed. While acknowledging this, possible causes of tiredness should be investigated, as there may be an underlying reason, which could be addressed. Mrs Ashford was also advised to investigate more local options for activities, so that the distance with travelling to day care could be minimised. Mrs Ashford confirmed that she was looking into this although the day centre was an organisational resource. Attendance was therefore encouraged organisationally. One relative confirmed that some events are structured i.e. going out to day care 3 x a week. The relative stated that ‘XX would be able to choose what he/she does in his/her spare time.’ As rest times are currently an integral part of care provision, these should be clearly identified and monitored within individual plans of care. In addition to the day centre, other organisational events are arranged. This includes the celebration of calendar events, with other care homes. Activity in relation to individual need and aspirations, however were less evident. Mrs Ashford explained that she aims to develop a more person centred approach to care. Mrs Ashford expects this to be more easily achieved, now that staffing levels have increased. One member of staff confirmed that as all service users enjoy going out, trips to the local park or a drive, are promoted. Another confirmed that community involvement was important, so visits to the village shop and pub are regularly made. Service users accompany staff to collect prescriptions and undertake the home’s shopping. All service users have a documented activity plan involving aspects such as baking and music. The home has its own minibus although due to its size, not all staff feel confident to drive it. This is taken into consideration, when developing staffing rosters. Various members of staff confirmed that they felt visitors are welcomed at any time. One relative confirmed this within a survey. The visitor’s book also demonstrated regular visitors including a range of visits from health care professionals. Staff spoke of the general relaxed nature of the home and the flexibility of routines. Service users rights to privacy were promoted and observed interactions were positive. Staff were observed to reassure and explain various Quarrydene DS0000067364.V335623.R01.S.doc Version 5.2 Page 16 tasks to service users. One member of staff explained that noting body language was important in relation to how a service user felt. Other than day centre days, times for getting up were varied and dependent on waking times. One member of staff said they had noted a later breakfast enabled one service user to eat more. If given earlier, the food was pushed away. The service user was observed to have breakfast at approximately 10.30am. Within a survey, a relative stated ‘XX’s ability is limited yet my understanding is that XX is asked and is able to make choices at times.’ The member of staff explained that some service users are able to make a decision from limited options. Others rely on staff making sense of gestures, body language and general behaviours, as well as promoting known preferences. Through discussion and observation, it was evident that staff respond to what they see and hear. However, to enable service users to make more individual choices, greater focus with communication systems is needed. As only one service user currently eats orally, the menu continues to be based on the individual’s preference. Staff confirmed that they aim to make the meals as varied and healthy as possible. One member of staff commented on the link between good food and good health. Another spoke of what the service user enjoyed. Mealtime support was observed and the interactions were focused, at the service user’s pace and contained commentaries of the days’ events. Quarrydene DS0000067364.V335623.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People benefit from a high level of care intervention and regular support from specialist health care personnel. Greater awareness by staff in relation to tissue viability would minimise the risk of a service user developing a pressure sore. Medication systems are well managed, which reduces the risk of potential error. EVIDENCE: Service users continue to require a high level of staff support in all aspects of daily living. Such support is identified within care planning information, although staff may find specific information, of greater benefit. For example, ‘needs hoisting’ and ‘ensure straps are safely in place’ may be better explained through further detail and the use of photographs. As service users have complex communication needs, establishing how they wish to have their care delivered, is difficult to ascertain. Mrs Ashford explained that regular contact is made with service users’ representatives, in order to discuss such matters. Representative involvement, as stated earlier in this report, should be reflected within care planning information. Quarrydene DS0000067364.V335623.R01.S.doc Version 5.2 Page 18 Within documentation there was evidence of regular support from health care professionals. This included a dietician, a speech and language therapist and a specialist in peg feeding. As stated earlier in this report, staff are currently following behavioural management guidelines with one service user. These were agreed within a multi agency forum. Another service user has recently been assessed in relation to their epilepsy. An epilepsy profile is now in place. At the last inspection, a requirement was made to address tissue viability. This had been addressed in care planning information. However, staff members’ understanding was less clear. For example, within a body map, a red mark was identified. The entry stated ‘red area starting to break down.’ There was no further follow up. The care plan was conflicting, by stating that the service user should be encouraged to lie off of their back. The side of the ‘red area’ was identified, as the service user’s preferred lying position. Mrs Ashford believed ‘the red area’ was not, as it seemed from the documentation. She explained that she had recently assisted the service user with personal care and there was no evidence of any mark. Staff also regularly apply cream as a preventative measure. Mrs Ashford agreed to investigate the issue although was sure, it was an error in the written description. Due to this, tissue viability training was advised. Within documentation, there were records of maintaining weight and fluid intake. While staff were documenting various amounts of fluids, they were not being totalled at the end of the day. Mrs Ashford was advised to ensure this practice. On the day of the inspection, an Occupational Therapist was visiting. Mrs Ashford explained that good local health care support is received although due to complexity of need, a referral to specialist personnel is often required. One health care professional, spoken to on the telephone after the inspection, reported that staff appeared attentive to service users’ needs. They felt Mrs Ashford and the staff were approachable, open to new ideas and took advice competently. However, there had been times, following out of county placements, when additional support or equipment had been requested from them. Understandably, such issues should be agreed before admission. The health care professional had addressed this directly with Mrs Ashford and the organisation. In response, the situation has improved. Medication, generally in bottled form, is stored securely in the medication cupboard. This is attached to the wall and is only accessible to senior staff who have been assessed as competent. A list of these staff is stated within the medication file. Service users do not have the capacity to administer their own medication. One of the senior members of staff who undertakes medication administration explained the process. They reported that much of the medication is administered via the peg feed site. Details of this are stated within care plans. The medication administration sheets were well maintained with staff recording variable doses on the back of the sheet. Discussion took place regarding service users’ ability to express their pain. The member of staff Quarrydene DS0000067364.V335623.R01.S.doc Version 5.2 Page 19 explained that at times, this is difficult. However if a service user presents distress and they are prescribed, ‘as required’ pain relief, the medication, would be given. Mrs Ashford was advised to address pain management within care planning. Within one medication administration sheet, two forms of a liquid medication were stated, although staff had only signed one. Mrs Ashford confirmed that one medication had replaced the other, but the pharmacy continued to print both medications. Mrs Ashford confirmed that she would raise this again with the pharmacy. Records demonstrated satisfactory receipt and disposal of medication. Information sheets, in relation to each medication were available for staff reference. The home does not use homely remedies. Quarrydene DS0000067364.V335623.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People are reliant on others to recognise their concerns yet a more friendly complaint procedure may enable individuals to express themselves. People are assured greater protection from abuse through recent staff training yet this would be maximised through consistent, relevant documentation. EVIDENCE: The home has a complaints procedure within the policies and procedures file. It is not clearly visible to visitors. At the last inspection, it was noted that the policy was in need of updating. This was to ensure it related specifically to Quarrydene, rather than the organisation’s other homes. To date this has not been addressed although Mrs Ashford confirmed that senior managers are currently reviewing all policies. There is not a user-friendly complaint procedure. Relatives and other representatives are relied upon to raise any concern on the service user’s behalf. One relative confirmed this and reported that they would speak to the manager, if they were unhappy. While service users are unable to verbalise their concerns, two members of staff explained, that all service users would show discontentment, if they were really unhappy. Through discussion, Mrs Ashford described the action taken in relation to a formal complaint recently received. The complaint was not recorded. Mrs Ashford was informed of the need to ensure written records are maintained in the form of a complaint log. Documentation must detail the complaint, the investigation, the outcome and the response given to the complainant. Quarrydene DS0000067364.V335623.R01.S.doc Version 5.2 Page 21 In relation to a requirement made at the last inspection, all staff have received adult protection training undertaken by an external facilitator. More sessions are booked in order to incorporate any new staff. There is an adult protection policy within the policies and procedures file. At the last inspection, it was identified that the policy was in need of review as it detailed in house investigations and ensuring consent before commencing. To date this has not been addressed although as stated above, Mrs Ashford explained senior managers are currently reviewing all policies. A copy of the Alerter’s Guide for the Protection of Vulnerable Adults in Gloucester is displayed on the notice board in the office. There was no evidence of Wiltshire’s procedures. Mrs Ashford reported that local procedures are discussed within supervision. This was identified within supervision records. Adult protection is also discussed in induction although it is not part of the documented induction format. Mrs Ashford explained that she was aware, she needed to order copies of the ‘No Secrets’ documentation. Once received, all staff would be given their own copy. When asked a hypothetical question about abuse, staff explained that they would inform the manager. In her absence, a senior manager within the organisation would be notified. It is not within any staff members remit to make a referral to the Safeguarding Adults Unit. Staff recognised the vulnerability of service users, with particular attention to their very complex needs. The home employs both male and female staff yet a gender working policy is not in place. Mrs Ashford confirmed that male staff generally assist only male service users. Mrs Ashford reported that discussions had taken place with senior managers in relation to this although a formal policy has not been agreed. Due to service users very complex needs, it was agreed that systems to give greater protection to both service users and staff, should be further explored. Strategies should be documented within care planning information. Mrs Ashford confirmed that she would discuss this area again, with senior management. Quarrydene DS0000067364.V335623.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, 28 and 30. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People benefit from an environment, which is well equipped, clean, furnished to a good standard and conducive to individual need. EVIDENCE: Quarrydene consists of a spacious bungalow within a quiet village setting. Previously a home for older people, the property was been totally refurbished to a high standard. There are nine single bedrooms. Some have individual ensuite 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. At present all bedrooms are decorated in a neutral colour. Mrs Ashford reported that staff are in the process of enabling one service user to choose the colour scheme of their room. Some service users have their own sensory lighting in their room. All rooms have overhead tracking for hoisting that Quarrydene DS0000067364.V335623.R01.S.doc Version 5.2 Page 23 continues from the bedroom to the en-suite facility. Bedrooms also have a television aerial point, a number of electrical 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. This was a considered decision on registration although needs to be stipulated within the home’s Statement of Purpose. The opportunity of these facilities must also be offered on admission. If declined, this must be evidenced within care planning information. As stated within the earlier part of this report, the home does not have a call bell system. This information must also be stated within the Statement of Purpose. All radiators have low temperature surfaces. Hand washbasins in the en-suite facilities have hot water temperature controls. As commented within the last inspection, the hand washbasins are very small. This may restrict their usage so service users, their relatives and care managers should be asked if the facility is adequate. Mrs Ashford reported that as yet, this has not been seen as a problem. One service user’s representative has confirmed this. 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. Within corridors, lighting has been installed which 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. This has not however, been risk assessed although all service users require full assistance, to access the garden. There are two laundry rooms in order to ensure that soiled linen is not carried through communal areas. Both rooms were clean, tidy and ordered. Staff have access to protective clothing and bacterial hand wash is located throughout the home. Hazardous substances are satisfactorily stored in the main laundry within a locked cupboard. There was no evidence of any substances, left around the home. All areas were cleaned to a good standard and there were no unpleasant odours. Within a survey, one relative confirmed that the home is always fresh and clean. Quarrydene DS0000067364.V335623.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 and 35. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People benefit from recently increased staffing levels, which enable more oneto-one support. A clear, robust recruitment procedure is in place, which assures service users’ greater protection. Training is promoted yet greater focus on specific conditions affecting service users, may improve the support staff give. EVIDENCE: At the last inspection, staffing levels were maintained at generally two, sometimes three staff throughout the waking day, with three service users. This was identified as insufficient, as all service users required the assistance of two members of staff and one required full one-to-one support. A requirement was therefore made. This has been addressed and there are now four staff on duty throughout the waking day. Mrs Ashford reported that this has made a great difference to the individual time, which is spent with service users. There are also more opportunities for external activity. Mrs Ashford confirmed that the home is now operating at the agreed level that was established, when the home was registered. Mrs Ashford anticipates however, that staffing levels will be further increased with additional service users. Staff Quarrydene DS0000067364.V335623.R01.S.doc Version 5.2 Page 25 confirmed that sleeping in provision has ceased and there are now two waking night staff. One member of staff reported that they [care staff] are currently undertaking housekeeping tasks. They stated that domestic staff are planned, when the home is fully occupied. Within a survey, one relative reported that the staff always treat XX well and they usually listen and act on what is said. They also identified however, that they ‘are not always there, to see what goes on.’ Since the last inspection, six staff have been recruited. The recruitment documentation of the most newly appointed staff member was not available. Mrs Ashford explained that the organisation sends out all documentation to the prospective candidate and complete all checks. They establish the file and maintain it, until the whole recruitment process has been completed. The information is then forwarded to the home. The documentation of two other members of staff was viewed. Both had an application form, appropriate references, a POVA First check and a clear CRB. There were also interview notes. Induction formats were evident within those files viewed. Mrs Ashford confirmed that new staff also work with another member of staff until they feel confident to undertake various tasks on their own. Training is given priority and all staff, other then those who are very new, are up to date with their mandatory training. Those staff spoken to confirmed that there are many opportunities for training and they are encouraged to attend. The organisation organises all provision centrally and staff are then put forward for selection. A specific training matrix has not as yet been developed. Mrs Ashford reported that she intends to undertake this, when all staff have received their mandatory training. Certificates within staff files demonstrated the courses, which staff have attended. While the training plan contains key aspects such as fire, medication, adult abuse, challenging behaviour and epilepsy, training in relation to the home’s client group was not identified. For example, there were no opportunities for staff to learn more about sensory impairment or specific conditions such as cerebral palsy. Mrs Ashford confirmed these areas would be useful and she would therefore discuss this with senior management. Mrs Ashford explained that she has recently asked for Positive Behavioural Management training. This had been agreed and sessions are being arranged. Mrs Ashford confirmed that at present three staff are undertaking NVQ 2. One member of staff has NVQ level 2 and another has NVQ level 3. Quarrydene DS0000067364.V335623.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People benefit from a manager who has a strong value base and with more time, greater focus can be given to management issues and further improving the service. People are not protected from potential hazards, as a risk assessment process is not in place. EVIDENCE: Mrs Ashford has recently completed the Registered Manager’s Award and is planning to commence NVQ level 4 in Care. Mrs Ashford is a registered nurse in her country of origin although has not undertaken her conversion training. Mrs Ashford has many years’ experience of residential and hospital settings. She has clear standards of service provision. Mrs Ashford recognised that establishing the home has been a learning curve although agreed her training has helped considerably. Mrs Ashford confirmed that she is not an integral part of the working roster now, so has more time to apply her learning into Quarrydene DS0000067364.V335623.R01.S.doc Version 5.2 Page 27 practice. As a result, some systems such as monitoring have been tightened. It was agreed that greater time available to manage the home was essential. In particular, this was evidenced by a number of requirements that were identified at the last inspection, which have not been met. Mrs Ashford reported that there had been shortfalls with time although focus would now be given to the required areas. The organisation has developed a quality-auditing framework. This has been given to Mrs Ashford to complete although none of the areas have, as yet been undertaken. Mrs Ashford explained that she has not had the time, as there have been other priorities. Focused attention however is required. Regular 26 visits are undertaken and the findings are forwarded to CSCI. There are also audits regarding environmental and vehicle safety. At the last inspection it was identified that many of the homes policies and procedures were related to other homes within the organisation. A requirement was therefore made to address this. Within this inspection, the policies remained the same. Many were dated 2004. Mrs Ashford confirmed that senior managers are in the process of a full review yet final copies have not been distributed to the home. The requirement has therefore been repeated with a new timescale. Various systems such as audits are in place to address health and safety. Since the last inspection, a mechanical device has been fitted to the office door so that it can be appropriately held open. The fire log book demonstrated satisfactory testing of the fire alarm systems. There was no evidence however, of regular fire instruction with staff. Mrs Ashford reported that fire safety was discussed in staff supervision. An entry within a supervision record was shown to confirm. As stated earlier in this report, individual risk assessments need to be developed. There are also no environmental risk assessments in place. A requirement has been identified to address this area. Quarrydene DS0000067364.V335623.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 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 X 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 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 2 X 2 2 X 2 X Quarrydene DS0000067364.V335623.R01.S.doc Version 5.2 Page 29 Yes 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 Timescale for action 30/08/07 2 YA6 3 YA9 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. This was identified at the last inspection of the 12.10.06 yet has not been addressed. At this inspection, it was identified that transport costs, the absence of a call bell system and locks on doors must also be stipulated. 15 The Registered Person must ensure that due to service users’ limitations with their communication, all care plans are to be developed and signed by the service user’s representative. This was identified at the last inspection of the 12.10.06 yet has not been addressed. 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 DS0000067364.V335623.R01.S.doc 30/08/07 30/08/07 Quarrydene Version 5.2 Page 30 4 YA19 12(1)(a) 5 YA23 13(6) 6 YA26 12(4)(a) 7 YA39 24 8 YA40 18(1)(c)(i) environment. This was identified at the last inspection of the 12.10.06 yet has not been addressed. The Registered Person must ensure that staff have an understanding of tissue viability and the preventative measures, which need to be undertaken to minimise the risk of developing a pressure sore. The Registered Person must ensure that adult protection procedures are consistent, accurate and relevant to the home’s location. 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. This was identified at the last inspection of the 12.10.06. Service users representatives have been asked, yet their wishes have not been identified within documentation. The Registered Person must ensure that a quality assurance system is developed and implemented within the home. This was identified at the last inspection of the 12.10.06. A system has been developed although has not been implemented. The Registered Person must ensure that all policies and procedures relate specifically to the home and are kept up to date. This was identified at the last inspection of the DS0000067364.V335623.R01.S.doc 30/09/07 30/08/07 30/08/07 30/09/07 30/09/07 Quarrydene Version 5.2 Page 31 12.10.06 yet has not been addressed. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA2 Good Practice Recommendations The Registered Person should ensure that all aspects of the home’s assessment form are completed to ensure the service users needs are identified and can be met within the home. The Registered Person should ensure that each service user’s copy of their terms and conditions is readily available within the home. This was identified at the last inspection on the 12.10.06 yet has not been addressed. The Registered Person should ensure that specific areas are further developed within the care plans. This should include aspects such as communication. This was identified at the last inspection of the 12.10.06 yet has not been addressed. The Registered Person should ensure that existing day care services are monitored to ensure they meet service users’ individual needs. The Registered Person should ensure that greater focus is given to communication systems so that service users are enabled to express themselves more. The Registered Person should ensure that fluid intake charts are totalled at the end of the day to ensure effective monitoring. The Registered Person should ensure that the management of pain is identified within care planning information. The Registered Person should ensure that the complaints procedure identifies contact details of the local CSCI office in Chippenham rather than Gloucester. This was identified at the last inspection of the 12.10.06 yet has not been addressed. The Registered Person should ensure that service users’ or their representatives’ preferences of a male or female carer are identified. A gender working policy should be developed to give greater protection to service users and staff. DS0000067364.V335623.R01.S.doc Version 5.2 Page 32 2 YA5 3 YA6 4 5 6 7 8 YA12 YA16 YA19 YA20 YA22 9 YA23 Quarrydene 10 YA26 11 12 YA35 YA35 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. This was identified at the last inspection of the 12.10.06 yet has not been addressed. The Registered Person should ensure that staff receive sensory impairment training. This was identified at the last inspection of the 12.10.06 yet has not been addressed. The Registered Person should ensure that a training matrix identifying the dates of completed and proposed training is developed. This was identified at the last inspection of the 12.10.06 yet has not been addressed. Quarrydene DS0000067364.V335623.R01.S.doc Version 5.2 Page 33 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 Quarrydene DS0000067364.V335623.R01.S.doc Version 5.2 Page 34 - 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. 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