Inspection on 07/05/08 for Quarrydene

This inspection was carried out on 7th May 2008.

CSCI found this care home to be providing an Adequate service.

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 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 24/05/07

Quarrydene 12/10/06

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Quarrydene Pavenhill Purton Wiltshire SN5 4DA Lead Inspector Alison Duffy Unannounced Inspection 7th May 2008 09:50 Quarrydene DS0000067364.V361938.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.V361938.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.V361938.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 Vacant Care Home 9 Category(ies) of Learning disability (9), Physical disability (9), registration, with number Sensory impairment (4) of places Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th May 2007 Brief Description of the Service: Quarrydene is a residential care home run by Holmleigh Care Homes Limited. The Director is Mr Rod Correia. The Registered Manager, Mrs Janet Ashford left her position in December 2007. Mr Correia has seconded Mrs Glenda Gabriel, a deputy manager, from another of the organisation’s care homes, to become the acting manager. Mrs Gabriel has not as yet submitted an application to us to become the registered manager. 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 younger adults with a physical and/or learning disability. Four people 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 rooms and provide an ensuite 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 are maintained at five support workers in the morning and four in the evening. At night there two waking night staff. Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection took place on the 7th May 2008 between the hours of 9.50am and 6.50pm. Mrs Gabriel, the acting manager was available throughout the inspection. We met with five people who use the service and five staff members. We looked at the medication systems and at care-planning information, staff training records and recruitment documentation. All except one person, who use the service, do not have verbal communication skills. The one person, who was able to, told us in detail what it was like to live at the home. We have not included their views in this report, as this would clearly identify them. We observed interactions between people and staff. We used the quality of these interactions, as evidence to make our judgements, identified in this report. As part of the inspection process, we sent surveys, to be distributed by the home to people’s relatives, their GPs and other health care professionals. The feedback received, is reported upon within this report. We sent Mrs Gabriel an Annual Quality Assurance Assessment (AQAA) to complete. To date, this has not been returned and therefore not completed within the timescale given. The home’s last key inspection took place in May 2007. There was also a random inspection in October 2007 and January 2008. The random inspection in October 2007 took place to check whether requirements, set at the key inspection, had been met. There had been no progress in meeting the requirements. The second random inspection took place to check the management arrangements of the home, in the absence of a registered manager. The deputy manager was providing day-to-day management responsibility, while a permanent manager was appointed. Since the home opened in 2006, there has been on going non-compliance in meeting the requirements, we have made. It is acknowledged, there have been difficulties with the management arrangements of the home. However, all requirements must be met in full, on time. Following this inspection, we will require the registered provider, to submit an improvement plan, as to how the identified requirements will be addressed. If considerable improvement is not assured, we will consider taking legal action. Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 6 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 a visit to the service and takes into account the experiences of people using the service. What the service does well: What has improved since the last inspection? A Service User’s Guide in a format more conducive to people’s needs is being developed. All people who use the service now have a care plan. The content of the plans has been improved upon. A new person centred plan is in the process of being developed. Individual and environmental risk assessments have been developed. Tissue viability training for staff has been arranged. Scales, which enable people to remain in their wheelchair when being weighed, have been purchased. A call bell system and new beds with attached bed rails have been ordered. The standard of cleanliness within the home has improved. Cleaning schedules to be undertaken at night, have been completed. Incidents, which affect the well being of people using the service, are now being reported to us. Additional staff have been recruited enabling less reliance on agency. Guidelines have been gained from the GP regarding homely remedies and ‘as required’ medication. Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Quarrydene DS0000067364.V361938.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.V361938.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. People have insufficient information to be able to make an informed choice of moving into the home. A more robust assessment procedure would provide staff with more information to meet people’s needs and ensure appropriate placements. EVIDENCE: At the inspection in 2006, we made a requirement that the Statement of Purpose must identify the care needs, which can be met within the home. We also said the fee levels must be stipulated. At the inspection in May 2007, the requirement had not been addressed. In addition, we required that information needed to detail transport costs, the absence of locks on doors and a call bell system. During this inspection, Mrs Gabriel showed us a reviewed copy of the Statement of Purpose, undertaken by the organisation. The information we required, as stated above, was not identified within the document. Room sizes were also not evident. The absence of this information has been outstanding since 2006 and must be addressed without delay. Mrs Gabriel showed us a separate Service User’s Guide, which she was in the process of developing. This was in a format more conducive to people’s needs. Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 10 At the random inspection that took place in October 2007, documentation to evidence the admission of the most recent person was minimal. The home’s assessment was incomplete and a copy of the assessment undertaken by the placing authority was not available. We made a requirement to ensure that people are admitted only after a robust, assessment process. We could not check this requirement, as there have been no new admissions to the home. Mrs Gabriel told us about the procedure she would follow when receiving a referral for admission. This was detailed and appeared robust. We will consider the assessment process further, at the next inspection. We made a requirement at the random inspection, that people’s complex needs and safety must be taken into account when considering new admissions. Again, as there have been no new admissions, this requirement could not be assessed. Mrs Gabriel told us that she was aware of the vulnerability of people using the service and her responsibility of ensuring safety. She said she would ensure the next admission would be undertaken using a robust assessment procedure. Mrs Gabriel gave us assurance that the outstanding requirements, as described above, would be addressed without delay. Quarrydene DS0000067364.V361938.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. Improvements with care planning documentation enables staff to have more information when supporting people. Communication systems could be further developed to enhance people’s ability to make decisions. People are assured greater protection through the recent focus on the risk assessment process. EVIDENCE: Within a survey, a relative said ‘XX is happier at Quarrydene than he/she has been anywhere. Not only are his/her physical needs being met properly but the staff have been able to make him/her feel safe and appreciated as an individual.’ At the key inspection in May 2007, we saw that care-planning information did not fully reflect the complexity of the person’s needs. We advised greater detail be applied to certain areas. At the random inspection in October 2007, the most newly admitted person did not have a care plan. Staff were relying on information from a previous placement. We made a requirement to ensure that Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 12 each person had a care plan in place. Mrs Gabriel has addressed this. She has also worked with staff to develop, a more person centred care planning format. Within a survey, a member of staff told us that they are ‘sometimes’ given up to date information about the people they support. They also said the ways in which information is passed between staff, ‘sometimes,’ works well. We advise that Mrs Gabriel reviews the systems for the sharing of information. The care plans, which have recently been developed, contain details of people’s preferred daily routines. Aspects such as eating and drinking, personal care, medication and mobility are addressed within the plans. Mrs Gabriel told us she was giving priority to making the care plans, as detailed as possible. Once all plans have been revised, the standard of care planning will be much improved. At the key inspection of December 2006, due to peoples’ limitations with their communication, we made a requirement that all care plans were to be developed and signed by the person’s representative. Mrs Gabriel told us that so far, each person’s care plan had been developed from information already known to staff. Mrs Gabriel said she had contacted relatives and requested their involvement in the development of the plans. To aid this, Mrs Gabriel has placed a copy of each person’s care plan in his or her bedroom. When next visiting, relatives said they would make any additions or alterations. They said they would then sign the plan. Staff told us about ways in which people communicate. One person is able to verbally communicate. Others use eye movement, facial expression or gestures. We saw staff ask people, unable to verbally communicate, if they wanted a drink. One person nodded. Another person looked up, which indicated yes. Another person was asked if they wanted some ice cream, as this was a personal favourite. Staff told us that people choose what they want to wear. They said one person liked choosing their shoes. Staff told us that this was achieved by showing the person a selection. They would then indicate which ones they wanted. There was no evidence to show that pictorial formats or other communication systems were in place, to promote decision-making. Mrs Gabriel told us she was currently developing written documentation using a ‘widget’ format. This enabled the use of symbols, as words. Within one care plan, it was stated ‘staff should try to use (hand signals) signing.’ We advised that all staff should be offered training in this area. Mrs Gabriel told us she would look into the development of individual communication systems for people. At the key inspection of October 2006 we saw that risk assessments needed to be developed. These needed to take into account peoples’ needs, the environment and particular tasks, completed by staff. In September 2007, a concern was reported to us, highlighting that the risks to people of travelling in the home’s vehicle, had not been addressed. We completed a random Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 13 inspection and saw that the concern was upheld. Mrs Gabriel told us that since being in post, she has given care planning and risk assessments priority. There are now a number of detailed risk assessments regarding the environment and specific tasks, in place. A number of risk assessments regarding people’s individual needs have also been developed. Mrs Gabriel told us that there are more assessments to do, but good progress has been made. When the home opened, there were no call bells. Senior managers believed that people would not have the capacity to use them. Mrs Gabriel told us that this has now changed and a call bell system has been ordered. The system will be installed shortly. Quarrydene DS0000067364.V361938.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. Greater opportunities for social activity are being developed. Important relationships are promoted and visitors made welcome. Greater focus on communication systems would enhance people’s rights and responsibilities. Meal provision lacks variety and nutritional content. EVIDENCE: Mrs Gabriel told us that people, who use the service, no longer attend their day service in Gloucester. She said the distance became a problem and people did not always want to go. One person goes to college twice a week. Other people are not involved with day services or college. Within a survey, one relative/friend told us ‘staff changes and problems with transport have resulted in long periods when he/she has been unable to go out of the home. This has meant being unable to attend church and not taking part in activities that we think are essential for his/her future development. We Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 15 understand steps are being taken to allow XX to enjoy life outside the home, as well as in it.’ Mrs Gabriel told us that she is looking to enhance opportunities for social activity provision. She said she felt this was now more realistic, due to improved numbers of staff on duty. A smaller vehicle has also been ordered, so that more staff can drive the home’s transport. Staff told us that they regularly organise external events within the general community. They said they often support people with going for a walk, out for a drive or to the pub. One person regularly goes swimming. Mrs Gabriel told us people are also supported to the local shop or to take their prescriptions to the surgery. We advised Mrs Gabriel to ensure staff record these events, as there was little evidence of external social activity within documentation. Staff told us that people went on holiday to ‘Butlins’ last summer. We saw one person being supported with a jigsaw puzzle. One person was watching television in their room. Other people were outside playing skittles, or listening to music and singing. We saw staff interact well with people. Good relationships were evident. We saw one person being supported with receiving a telephone call from their family. Staff told us that family contact is promoted. Some people go to their parental home on a regular basis. Staff may assist with the provision of transport. Staff said visitors are welcomed at any time. Within a survey, one relative/friend said ‘all the staff at Quarrydene are willing to talk to you and give you any information that you may require. The staff are good at keeping us informed about any developments.’ They said their relative/friend is given assistance, to keep in contact with them. Mrs Gabriel and staff told us that the routines of the day are flexible. People are able to go to bed and get up when they wish. Some people have an afternoon rest. One person needed staff support with personal care. They received this in their own room. Staff were discreet and sensitive to the person’s needs. One member of staff said that people, due to their disabilities, do not help with housekeeping tasks or cooking. As stated earlier in this report, we said communication systems should be developed to promote peoples’ involvement in decision-making. We saw that one person’s bed had been tipped up against the wall. Mrs Gabriel explained the reason for this. We said that this was a restriction and must be discussed, on behalf of the person, with their family and care manager. We said that alternate methods of behaviour management, should be sought from a specialised health care professional, such as a psychologist. The restriction must be detailed and agreed, within the person’s care plan. Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 16 Staff told us that the weekly menu is devised with people at the beginning of the week. Staff said people generally have a snack at lunchtime. We saw that lunch was over by 12.30pm. Staff said the meal was served at 12.10pm. The main meal of the day is eaten in the evening. People eat in the dining room with staff. We saw a member of staff prepare the evening meal. They made a mixed salad. They said they were going to add pasta. They were following a recipe book for the rest of the meal. We looked at the menus. We saw that the meals contained a high level of pasta and rice. There was little evidence of fresh vegetables. One person was a vegetarian. Staff spoke of a range of meat free meals they provided. We advised a review of the menus to ensure a healthy, balanced diet. Mrs Gabriel told us she would ask a dietician to give advice. Quarrydene DS0000067364.V361938.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 adequate. This judgement has been made using available evidence including a visit to this service. Greater detail within care plans would ensure people’s needs are met more safely and efficiently. People have good support from health care personnel. Medication administration is generally well managed therefore reducing the risk of error. EVIDENCE: People, who use the service, receive full assistance from staff in all aspects of daily living. Mrs Gabriel is in the process of developing care plans so that this assistance is fully documented. Photographs have been used, in one care plan, to clearly evidence the person’s preferred position when in bed. This is good practice and gives clear information to staff when providing support. People are generally unable to tell staff how they wish their care to be given. Mrs Gabriel told us that through getting to know people, staff have learnt people’s likes and dislikes. Staff said they have found one person enjoys the Jacuzzi programme on their bath. Another enjoys a hand massage. Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 18 Mrs Gabriel said that staff work closely with specialised health care personnel, including the occupational therapist. They have given guidance on people’s positioning and equipment. Documentation demonstrated visits from the GP and community nurse. Some people have their food and medication within a ‘peg feed.’ Staff have had training in this procedure. Information about the management of the ‘peg feed’ site and the procedure for the feeds were unclear. We said clarity was needed and all information relevant to the ‘peg feed’ should be kept together. There was evidence in the past, that the manager had changed the peg feed tube. We said this was a nursing procedure and must only be performed by a community nurse or trained professional. Mrs Gabriel told us she was aware of this. She said while she had been in post, the community nurse had always undertaken the procedure. Mrs Gabriel was clear about the remit of staff in relation to nursing procedures. There was a record of people’s weight in their care plan. New weighing scales had been purchased. These enabled people to stay in their wheelchair while being weighed. We saw that people’s bodily functions were reported upon on a daily basis. We advised that the reasons for this should be related to the care plan. We saw that people’s fluid intake was monitored. The fluid charts were totalled daily. We advised that the level of fluid, to ensure wellbeing, should be agreed with the community nurse and documented on the charts. At the last key inspection in May 2007, we saw that the risk of people developing a pressure sore was not being addressed. We made a requirement to develop this area, in terms of tissue viability assessments and staff training. Mrs Gabriel told us that she had made an appointment to meet the specialist tissue viability nurse. In the meantime, the occupational therapist was assisting staff in reducing potential risks and developing documentation. We saw that further work was needed in this area. Within two plans, we saw that staff had recorded details of ‘red marks.’ There was no follow up action. Control measures to minimise the risk of developing a sore were minimal. We said more attention was needed in this area. We said staff should also give clarity to their recording of ‘red marks.’ People, who use the service, are reliant on staff for their medication administration. One person receives their medication covertly in drinks. Mrs Gabriel had gained written authorisation from the GP regarding this. Guidance regarding ‘as required’ medication had also been gained from the GP. These letters had been laminated and were stored in the medication administration file. At the last random inspection, we made a requirement that staff must sign the medication record to denote each administration of medication. We saw, at this inspection, that there was one occasion when a staff member had not signed the record. Mrs Gabriel told us that this had been addressed with the staff Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 19 member. We also made a recommendation to countersign any hand written medication instruction within the administration record. This had been addressed in part. We saw there were two hand-written instructions, which had not been signed, countersigned or dated. All staff administering medication have received training in the safe handling of medication. The medication was orderly stored. As good practice, all medication had been dated when opened. Within the medication administration record, one medication was prescribed four times a day. There was no evidence that this had been given. Mrs Gabriel told us that the medication had recently been changed to ‘as required.’ This needs to be stipulated on the medication administration sheet. We saw that two people have suppositories. Mrs Gabriel told us that the community nurse administers these. This must be clearly stated on each care plan. Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People generally rely on others to recognise any form of discontentment. Greater knowledge of local adult protection reporting procedures would ensure people greater protection. EVIDENCE: There is a copy of the complaint procedure within each person’s file. Mrs Gabriel has developed this in a pictorial format for easier understanding. Staff told us that one person, who used the service is able to verbally raise any concerns they might have. They said other people rely on staff or family members to identify discontentment and raise issues, on their behalf. Mrs Gabriel said she has developed a complaint log. So far, no entries have been made. Within a survey, a relative/friend said they were aware of how to make a complaint about the service. They said ‘the manager of Quarrydene and the proprietor of Holmleigh Care are always willing to listen to us and help where they can.’ One member of staff, within their survey told us, they did not know what to do, if someone had concerns about the home. Following the resignation of the registered manager, we were informed a safeguarding alert had been made. We were not involved or kept informed of the process, which followed. We were told the responsibility of making safeguarding alerts had been given to a member of the Human Resources Team at the organisation’s main office. Staff confirmed this. They said they Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 21 would immediately report any allegation or suspicion of abuse to Mrs Gabriel or the on call manager. They said the allegation would then be reported to Human Resources. Staff said they would use the whistle blowing policy, if required. We saw that a copy of the local adult protection reporting protocol ‘No Secrets in Swindon and Wiltshire’ was displayed on the notice boards. Mrs Gabriel was not fully aware of the procedure. She said her remit, if an allegation were made, would be to immediately contact senior management. We said Mrs Gabriel must familiarise herself with the Wiltshire and Swindon, adult protection reporting protocols. Documentation demonstrated that staff have received training in the protection of vulnerable adults. The training included the adult protection procedures of Gloucester County Council. As the home is in Wiltshire, we said that staff should be aware of the local adult protection reporting procedures, rather than those of Gloucestershire. We looked at the procedure for managing people’s personal monies, held for safe-keeping. Records demonstrated transactions. We advised that another member of staff should countersign each transaction. We checked two cash amounts against the balance sheets. Both were correct. Receipts were in place to demonstrate expenditures. Mrs Gabriel regularly audits the systems. Mrs Gabriel said they are also checked during the monthly operational visits undertaken by senior managers. Quarrydene DS0000067364.V361938.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 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 comfortable, well-equipped and conducive to individual need. Clarity of the suitability of the locks on all fire doors would ensure peoples’ safety in the event of a fire. EVIDENCE: Quarrydene is a spacious bungalow within a quiet village setting. There are nine single bedrooms. Some have individual en-suite facilities including a specialised bath or shower. A number of rooms share an en-suite facility. To ensure people’s privacy and dignity, people requiring full staff support with their personal care needs, should occupy these rooms. All bedrooms have overhead hoisting facilities. People have personalised their rooms to varying degrees. All rooms have light switches at an appropriate height for wheelchair users. Radiators have low temperature surfaces. Hand washbasins in the en-suite facilities have hot water temperature controls. Doors have mechanical devices, which enable Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 23 them to be held open safely. There are no locks on bedroom doors or lockable storage facilities. As stated earlier in this report, these factors must be identified within the statement of purpose. On admission, people must be offered the opportunity of a lock on their door and lockable storage facilities. If they decline, this must be detailed on the person’s care plan. As identified at previous inspections, the hand washbasins in the en-suite facilities are very small. This may restrict their use. People who use the service and/or their relatives and care managers should be asked if the facility is adequate. If not, the hand washbasins should be replaced. There is a lounge, a sunroom, a sensory room and a separate dining room. All are comfortably furnished. Mrs Gabriel said the sensory room is not being used at present. This is because the height of the electrical sockets is causing a health and safety hazard. Attention is being given to this matter. We saw that the main corridor would benefit from redecoration. We saw one bedroom contained a fire exit. This was locked. All other fire exits in the corridors and the sunroom were also locked. We told Mrs Gabriel that she must discuss the fire exit routes and the existing door lock mechanisms, with the Fire and Rescue service. The home is surrounded with pleasant gardens, which have been mainly laid to lawn. Mrs Gabriel told us she is aiming to develop the gardens with more seating areas for people. Within a survey, one relative/friend said, under the heading, what the home does well, ‘Quarrydene is very good at providing a safe and secure environment where XX feels valued.’ There are two laundry rooms in order to ensure that soiled linen is not carried through communal areas. Mrs Gabriel said the smallest laundry gets very hot. An extractor fan is being fitted. Both rooms were clean, tidy and ordered. Staff have access to disposable protective clothing. Bacterial hand wash is located throughout the home. Mrs Gabriel told us she had ordered foot-operated waste units, in line with infection control guidance. Hazardous substances were satisfactorily stored in the main laundry, within a locked cupboard. At the last random inspection in October 2007, we saw that greater attention needed to be given to the standard of cleanliness within the home. We made a requirement to address this. Mrs Gabriel told us she had developed cleaning schedules. Most of the cleaning is now done at night. The standard of cleaning we saw during this inspection, was much improved. Quarrydene DS0000067364.V361938.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 adequate. This judgement has been made using available evidence including a visit to this service. With increased staffing levels, people are benefiting from extra time spent with them. People are protected through a clear, well-managed recruitment procedure. EVIDENCE: Mrs Gabriel told us that recent recruitment had been successful. There is now less reliance on agency staff. There are five staff on duty in the morning and four in the evening. There is a senior member of staff on each shift during the day. At night there are two waking night staff. There is also an on call system for support and advice. Within a survey, a member of staff said there are ‘sometimes’ enough staff to meet the individual needs of the people who use the service. Staff told us that the increased numbers of staff had improved their social time with people. They said the home is now more relaxed and moral had improved. Mrs Gabriel told us the staff team were working well. She said she was aiming to empower them, so that they could take more responsibility. Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 25 At the beginning of the year, to assist with the staff shortages, a member of staff began living on the premises. They stayed in a vacant bedroom. This was a short-term arrangement, which must now cease. Mrs Gabriel gave assurance that notice had been given to the member of staff. We looked at a sample of staff files. Mrs Gabriel told us that two staff from a local agency had been recruited. There was no information to demonstrate this recruitment process. There was no information about the bank staff. Mrs Gabriel told us that this information was held at Head Office, as the staff files were being sorted. We said these records must be available for inspection and therefore a copy must be kept in the home. We looked at the recruitment documentation of three other members of staff. The information was ordered and all required information was in place. There were two written references. Checks had been made, in relation to the person’s suitability to work with vulnerable people, before they commenced employment. Within their survey, one member of staff told us that their employer had carried out checks, such as a CRB and references before they started work. We saw staff spending time with people and interacting well. We saw positive relationships had been developed. Within a survey, one relative/friend said ‘inside the home the staff have shown great skill and patience in looking after XX. There does however appear to be a shortage of staff able to drive or take XX out in his/her wheelchair.’ As stated earlier in this report, Mrs Gabriel told us that the numbers of staff, able to drive, had increased. Mrs Gabriel told us that she was in the process of reviewing peoples’ training needs. Ms Gabriel and staff told us that the organisation gave priority to training. One member of staff said ‘it’s ongoing. We do the mandatory subjects but can also ask if there is something we are particularly interested in.’ Another staff member said ‘it’s the best organisation I’ve worked for, for training. We do one course and the next one is being planned.’ Within a survey, a member of staff told us that they received regular training. They said they ‘sometimes’ meet with their manager to gain support and discuss the way in which they work. Mrs Gabriel told us that all staff have been booked on a manual handling training course. Two staff are doing a British Sign Language course. Training records showed us that subjects such as epilepsy, medication, MRSA and an introduction to learning disability had been covered. Mrs Gabriel told us that five staff have a National Vocational Qualification (NVQ) level 3. One has almost completed the award. All staff have NVQ level 2. Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 26 At the last key inspection we made a requirement that staff must have training in tissue viability. Mrs Gabriel told us that this had been arranged. We also made a recommendation for staff to have sensory impairment training. This has not been addressed. Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 27 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 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are benefiting from an improved service through clearer attention to management systems. Peoples’ wellbeing is being enhanced through the introduction of clear risk assessments. EVIDENCE: As stated earlier in this report, the registered manager left her post, in January 2008. The deputy manager originally provided management cover, with support from senior managers. Mrs Gabriel was seconded from another care home within the organisation, as acting manager. Mrs Gabriel told us she has experience of working with people with a learning disability. She has the Registered Manager’s Award. Mrs Gabriel has not as yet submitted an application to register with us. She said she is currently waiting for her disclosure (CRB) to evidence her suitability of working with vulnerable people. Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 28 Mrs Gabriel said she would ensure her application to register with us, was sent, as soon as possible. As stated earlier within this report, previous compliance with meeting requirements has been poor. Mrs Gabriel told us that she is committed to addressing the shortfalls identified. She has started to develop the care plans and has devised detailed risk assessments. She said she has prioritised her focus, regarding the areas needing attention. Mrs Gabriel told us she is clear of what is needed and will address issues, as quickly as possible. Within a survey, one member of staff said ‘regular inspections by CSCI would improve management of the home and lead to better performance and quality of life.’ At the key inspection in 2006, we made a requirement to develop and implement a quality assurance system. At the key inspection in May 2007, the manager said the organisation had developed a quality-auditing framework but it had not been implemented. Mrs Gabriel told us that she has sent questionnaires out to people’s relatives and health care professionals. The questionnaires have not as yet been coordinated. Mrs Gabriel told us the feedback would be used towards the home’s annual development plan. Mrs Gabriel told us that senior managers regularly visit the home. They undertake regular audits of the environment, the medication and the safekeeping of people’s monies. At the last key inspection, policies and procedures were not in place to address the criteria of admission, travelling in the home’s vehicle, emergency situations and invasive treatments. We made a requirement to devise these. Mrs Gabriel told us that senior managers were in the process of reviewing all policies. She said a range of new policies had been sent to the home. She said she would ensure those stated within the requirement, were addressed without delay. The fire safety records demonstrated that the fire systems are regularly checked. There was no record of fire drills. Mrs Gabriel told us a programme of fire drills had been arranged. These would involve different times of the day. Staff had received a fire talk and demonstration from Gloucester Fire and Rescue Service. We advised that the Wiltshire Fire and Rescue Service be used for any advice. As stated earlier in this report, clarification is needed in relation to easy exiting from all fire exits, in the event of a fire. Mrs Gabriel told us she had introduced regular health and safety checks. Staff are now recording the temperatures of the hot water, the refrigerator and the freezer. All portable electrical appliances were tested, to ensure their safety, at the beginning of the year. Individual and environmental risk assessments are now in place. Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 29 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 1 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 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 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 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 2 X 2 X X 3 X Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 30 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 The Registered Person must ensure that the Statement of Purpose contains details of the fees and the care needs, which can be met at the home. Transport costs and the absence of locks on doors must also be stipulated. This was initially identified on 12.10.06. Despite a review of the Statement of Purpose, the requirement remains outstanding. The Registered Person must ensure that people are only admitted after a robust, assessment process, to see whether their needs can be met. The home must complete a formal documented assessment and a copy of the assessment undertaken by the placing authority must be gained. This requirement was not assessed, as there have been no new admissions to the home. Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 31 Timescale for action 30/06/08 2 YA2 14(1)(a)(b) 07/05/08 3 YA3 13(4)(c) The Registered Person must ensure that peoples’ complex needs and safety are taken into account when considering new admissions. This requirement was not assessed, as there have been no new admissions to the home. The Registered Person must ensure that due to peoples’ limitations with their communication, all care plans are to be developed and signed by the person’s representative. 07/05/08 4 YA6 15 30/07/08 5 YA16 12(2) 6 YA23 13(6) 7 YA26 12(4)(a) This was initially identified on 12.10.06. While progress has been made, the requirement remains outstanding. The Registered Person must 07/05/08 ensure that any restrictions on people’s liberty is discussed and agreed within a multi-disciplinary setting. All agreements must be fully recorded in the person’s care plan. The Registered Person must 07/05/08 ensure that they are familiar with the Wiltshire and Swindon, adult protection reporting procedures. The Registered Person must 30/07/08 ensure that people who use the service 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 person’s care plan. This was initially identified on 12.10.06. While progress has been made, the requirement Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 32 remains outstanding. 8 YA34 19 The Registered Person must ensure that written documentation is available to evidence a robust recruitment procedure. The Registered Person must ensure that a quality assurance system is developed and implemented within the home. This was initially identified on 12.10.06. While progress has been made, the requirement remains outstanding. The Registered Person must ensure that policies and procedures are devised to the address admission, travelling in the home’s vehicle, emergency situations and invasive treatments. This was initially identified on 12.10.06. While progress has been made, the requirement remains outstanding. 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. This was identified on 24.05.07. A date has been arranged for staff to have tissue viability training. The Registered Person must ensure that each person has an assessment as to his or her risk of developing a pressure sore. Clear control measures to minimise any potential risk must be clearly DS0000067364.V361938.R01.S.doc 07/05/08 9 YA39 24 30/07/08 10 YA40 18(1)(c)(i) 30/07/08 11 YA19 12(1)(a) 30/07/08 12 YA19 12(1)(a) 30/06/08 Quarrydene Version 5.2 Page 33 identified. 13 YA19 12(1)(a) The Registered Person must ensure that clear guidelines are in place regarding the management of ‘peg’ feeding. This must include clear guidance for staff regarding nursing procedures, which must only be undertaken by a health care professional, such as a Community Nurse. The Registered Person must ensure that the locked fire doors and associated fire procedures are discussed with the Fire and Rescue Service. 30/06/08 14 YA42 23(4)(b) 30/06/08 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 YA12 Good Practice Recommendations The Registered Person should ensure that daily records contain evidence of social activity and quality of life matters, rather than routine care provision. This has not been addressed. The Registered Person should ensure that greater focus is given to communication systems so that people are enabled to express themselves more. This has not been addressed. The Registered Person should review all meal provision so that people are assured a nutritional diet. The Registered Person should ensure that the recommended level of fluid intake for wellbeing is recorded on the fluid intake charts. The Registered Person should ensure staff countersign any hand written medication instruction within the administration record. This has been addressed in part. The Registered Person should ensure that staff have training in the Wiltshire and Swindon adult protection protocols rather than those of Gloucestershire. DS0000067364.V361938.R01.S.doc Version 5.2 Page 34 2 YA16 3 4 5 YA17 YA19 YA20 6 YA23 Quarrydene 7 YA26 8 9 10 YA26 YA35 YA35 The Registered Person should ensure that people who use the service 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 has not been addressed. The Registered Person should give consideration to decorating the main hallway/corridor. The Registered Person should ensure that staff receive sensory impairment training. This has not been addressed. The Registered Person should ensure that a training matrix identifying the dates of completed and proposed training is developed. This has not been addressed. Quarrydene DS0000067364.V361938.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V361938.R01.S.doc Version 5.2 Page 36 - 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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