Inspection on 20/12/06 for REACH Bierton Road

This inspection was carried out on 20th December 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

REACH Bierton Road 07/07/08

REACH Bierton Road 13/07/07

REACH Bierton Road 23/05/06

REACH Bierton Road 02/12/05

REACH Bierton Road 07/07/05

REACH Bierton Road 05/01/05

REACH Bierton Road 15/07/04

REACH Bierton Road 20/02/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 REACH Bierton Road Aylesbury Bucks HP20 1EJ Lead Inspector Mike Murphy Unannounced Inspection 20th December 2006 09:30 DS0000023044.V325163.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 DS0000023044.V325163.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. DS0000023044.V325163.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service REACH Bierton Road Address Aylesbury Bucks HP20 1EJ 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) 01296 429586 www.Reach-disabilitycare.co.uk REACH Limited Miss Amanda Follette Care Home 8 Category(ies) of Learning disability (8) registration, with number of places DS0000023044.V325163.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 12 September 2005 - existing service users are to be permitted to remain at 20 - 22 Bierton Road, beyond their 65th birthday. 23rd May 2006 Date of last inspection Brief Description of the Service: 20-22 Bierton Road, Aylesbury, is a care home providing residential care to eight adults with learning disabilities. The home is a conversion of two midterraced house. The service is managed by Rehabilitation Education and Community Homes Limited (REACH), an organisation specialising in residential care for adults with learning disabilities. The home is located about half a mile from Aylesbury town centre, convenient for the facilities of the town, the specialist facilities of Manor House Hospital, which is across the road and public transport. All of the homes bedrooms are single. None have en-suite facilities. The fees at the time of this inspection were £680 to £1300 per week. DS0000023044.V325163.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector in one day in December 2006. The inspection methodology consisted of discussion with the manager, staff and residents, a walk around the building and grounds, and examination of resident (service user) and staff files and other documents. The inspection found a more settled situation to that which prevailed at the last inspection, seven months earlier in May 2006. All eight places in the home were occupied. Pressures on staffing were reported to have eased and this provided residents and staff with more opportunities to go out of the home. At the same time however, some concern was expressed at an apparent reduction in opportunities for residents to benefit from training and education courses in local colleges. It was reported that this is a consequence of a policy which now requires students with a learning disability to make progress and achieve measurable outcomes within a given timescale. This does not fit with the needs of many residents in this home who, while benefiting from attending college, may not be able to progress within the timescales set by the college. It was too early to assess the impact of this on residents. Residents continue to attend other activities outside of the home and three holidays, in Dorset, West Sussex and Durham, have been organised in 2006. Since this inspection took place in the week leading up to Christmas residents had also attended Christmas parties arranged by other services. It is hoped that the improvement in the staffing position will enable the home to address other matters identified on this inspection. Its person centred plans (PCPs) are comprehensive but complex and are not in a format which is accessible to residents. Its complaints procedure is thorough but formal, it does not fully conform to the relevant standard, and again is not available in a form accessible to residents in this home. Areas of the environment in this older home will always require attention in order to maintain a comfortable environment for residents. What the service does well: The home provides a highly supportive environment for a small group of residents with varying levels of learning disability. This offers residents the security of knowing that someone is available to provide support when required. The home is well located to take advantage of the amenities of Aylesbury town centre. This offers many opportunities for residents to get out of the home and enjoy the facilities of the town centre. DS0000023044.V325163.R01.S.doc Version 5.2 Page 6 Residents are involved with staff in day to day activities in the home. This provides residents with opportunities to develop everyday living skills such as shopping, cooking and some domestic tasks. What has improved since the last inspection? 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. DS0000023044.V325163.R01.S.doc Version 5.2 Page 7 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 DS0000023044.V325163.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. The needs of prospective residents are assessed by experienced staff prior to admission in order to ensure that the home can meet those assessed needs and to minimise the chances of admitting a person whose needs it cannot meet. The process is conducted at a pace which suits the prospective resident and take account of the need for current residents and staff to get to know the new person. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No new admissions have taken place since the last inspection. All eight places in the home were occupied. REACH has good systems for assessing the needs of prospective residents. It is important, because of the size and the longer term nature of this service, that the admission of any new resident is carefully considered, and that a good fit is obtained between the needs of the prospective resident, the homes ability to meet those needs and the needs of existing residents. REACH is sensitive to these matters and referrals to this home are assessed and considered by an experienced manager. The process includes liaison with the referring care manager, the prospective resident, his or her family and others involved with the person, consideration of relevant information and completion of an assessment form. DS0000023044.V325163.R01.S.doc Version 5.2 Page 9 Where it is agreed that the home is likely to be able to meet those needs the prospective resident is invited to visit the home. Where the processes progresses to admission, an introductory admission of three months or so is arranged. A review is held at the end of this period or earlier if indicated. DS0000023044.V325163.R01.S.doc Version 5.2 Page 10 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, 8 and 9 Quality in this outcome area is adequate. The home has a care plan (Person Centred Plan (PCP)) in place for each resident. However, the current structure of PCPs is complex and may not be readily understood by many of the residents in this home. This may disadvantage residents by limiting their participation in the care planning process. Staff support residents over a range of activities and aim to ensure that individual needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A service user plan is in place for each resident. These are known as Person Centred Plans (PCPs). The PCPs include assessment of the resident’s needs, a pen picture (including details of significant people such as friends and family), a list of activities which the resident enjoys or participates in (such as clubs, DS0000023044.V325163.R01.S.doc Version 5.2 Page 11 shopping, particular foods), things that the person dislikes, a ‘communications passport’, and aspirations and goals and plans to achieve these. PCPs also include details of personal care needs, other support requirements and risk assessments. Risk assessment may be general, such as the level of support required when going out, or specific to individual residents, such as the risks associated with activities in the kitchen or while eating (the need to maintain supervision while eating for example). Risk assessments include the restrictions required to ensure the safety of individual residents. PCPs include dates of review and records of review meetings. Daily records are maintained in a separate document and include an account of how the resident spent his or her day. While the PCPs are detailed, the current format is quite complex and does facilitate the engagement of residents in the process. The registered manager said that the PCP format across the organisation is to be reviewed with a view to making it more accessible to residents. It is expected that the review will take account of the experience of the first year or so with the current format and that outcomes may include simplifying some sections and presenting some information in pictorial form. Residents are encouraged and supported by staff in making decisions. A local independent advocacy service, Aylesbury Vale Advocates, maintains involvement with some residents. Any limitations on freedom are set out in the risk assessments in PCPs (only one of eight residents is able to go out without staff support). A house meeting is held between residents and staff on a monthly basis. DS0000023044.V325163.R01.S.doc Version 5.2 Page 12 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, 14, 15, 16 and 17 Quality in this outcome area is good. Residents attend a variety of social, training and recreational activities (including holidays in the UK) which aim to meet individual needs, improve resident’s well-being and maintain contact with the wider community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides care for a small but diverse group of residents. PCPs include references to the social, emotional and communication needs of residents and the level of support required in carrying out everyday activities. This inspection took place just before christmas when a number of services had closed for the holiday. At other times residents attend a range of activities in the community including a training project, information technology and cooking at Aylesbury college, an art group at a resource centre and activities at a day centre. The manager said that opportunities in the education sector now appeared to be contracting in the face, it would seem, of a policy which requires that residents should make progress and achieve measurable DS0000023044.V325163.R01.S.doc Version 5.2 Page 13 outcomes within given timescale In many cases residents in this home (and those in other services) were unable to meet such expectations and required longer term support in a training and educational environment. Some residents regularly attend a social club in Aylesbury and a number of christmas parties were being held – including REACH’s own party. Staff provide support to residents in carrying out activities. Residents share in some light housekeeping tasks and help staff with shopping. The home is a relatively short distance from Aylesbury town centre. Within the home, residents follow a range of interests which include knitting, painting, sewing, board games, tv, video and music. Holidays taken earlier in the year included breaks in a cottage near Lyme Regis in Dorset, at Butlins in Bognor Regis in West Sussex, and a cottage not far from the Beamish Industrial Museum in County Durham. Contact with families is maintained by some residents. Three of eight residents were planning to spend time with their families over christmas. The father of one resident was visiting at the time of this inspection and expressed satisfaction with the home. He said that his daughter was settled there and that it seemed a safe place. The pace of life in the home seems to suit the residents. Residents and staff were observed to interact well together over the course of this inspection. The atmosphere felt supportive. The manager said that now that the staffing situation had improved she felt that staff and residents could get out more often in the evenings. Staff and residents do the shopping and prepare and share meals together. Breakfast consists of cereals, fruit juice, toast and tea or coffee. Lunch is a light meal, often soup and sandwiches, filled baguettes, salad or hot dogs followed by fruit or yoghurt. The evening meal is the main meal of the day and choices on the menu close to the time of this inspection included; turkey in wine sauce with roast potatoes, fish pie and vegetables, mince beef curry and rice, and vegetable burgers with salad. Desserts included fruit cocktail, chocolate mousse and trifle. Weights are regularly checked and recorded in care documents. DS0000023044.V325163.R01.S.doc Version 5.2 Page 14 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. Resident’s preferences for care are recorded in PCPs and are taken account of by staff when providing care. The home liaises with GPs and other health and social care agencies in meeting residents’ healthcare needs. Each of these ensure that residents preferences are considered when receiving care and in accessing healthcare services. Weaknesses in the control and storage of medicines need to be addressed because they could place residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: To a large extent the resident’s day is structured by planned activities. However, even if not going out for the day, many residents choose to get up early and spend the day around the home. Residents have own clothes and hairstyle, their preferences are taken into account and are recorded in individual PCPs. Residents are supported by staff in pursuing their interests. The staff group is mixed in terms of gender, age and ethnicity. No technical aids are currently required in this home because all of the residents are DS0000023044.V325163.R01.S.doc Version 5.2 Page 15 mobile. An additional handrail has been fitted to one set of stairs. The need for other aids or environmental adaptations will need to be kept under review as residents grow frail and require more support. All residents are registered with a GP. Residents are supported in accessing other health and social care services in the community as required. This includes liaison with the community learning disability team. Residents healthcare needs are recorded in care plans. Personal care is provided in the privacy of the resident’s own room or in a bathroom. Medicines are prescribed by the residents GP and are supplied by a local branch of Lloyd’s pharmacy. The manager said that the pharmacy does now check the home’s arrangements every six months. However, no records of such checks were available for this inspection. There is a book for recording medicines returned to the pharmacy. The organisation provides training for staff in the administration of medicines. Medicines are stored in a locked cupboard. Stock internal and some external preparations are stored in a locked metal cabinet within the cupboard. Medicine Administration Records (‘MARS’) were examined and were in order. There is a Paracetamol stock for each resident as part of the home’s homely remedies. The manager explained the reasons for this which were concerned with events in controlling such medicines in the past. The practice might now benefit from review. A protocol is in place for the administration of PRN (to be taken as required) medicines for each resident. However, a pack of Haloperidol was noted with PRN directions written in handwriting. This did not correspond with the current prescription. The manager said that this stock was left over from earlier in the year when it was prescribed for a resident. The manager was asked to review the position with the resident’s GP and return stocks of medicines to the pharmacy when no longer required. DS0000023044.V325163.R01.S.doc Version 5.2 Page 16 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. The home provides good guidance to staff on the protection of vulnerable adults. The home’s complaints procedure continues to fail to fully conform to the minimum standard through its formality and in not stating that a complainant may refer to CSCI at any stage. The links with a local advocacy organisation ensure that residents have access to independent advice and support. This protects the interests of residents and supports good practice in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is required to conform to REACH policy and procedure with regard to the management of complaints. The document seen on this inspection, as on previous inspections, remains unsatisfactory. The complaints process is complex, it requires a complainant to put their complaint in writing, and is not available in a form which is suitable for residents. It is noted that the procedure does not conform to the minimum standard in not advising a complainant that they may refer their complaint to CSCI at any stage (standard 22.3) - it outlines the internal process and then states if not satisfied after following the procedure above please refer to CSCI. The manager reports that the policy is currently being reviewed by the proprietors. The homes arrangements for POVA are satisfactory. A policy is in place. The subject is included in the organisations induction programme (there is a very good section in the induction booklet on this subject) and leaflets on Careline are on notice boards in the home. REACH responds promptly to adult DS0000023044.V325163.R01.S.doc Version 5.2 Page 17 protection issues and liaises appropriately with local statutory agencies. Staff were aware of adult protection and indicated confidence in managers to respond appropriately to reports of abuse. The home is in regular contact with Aylesbury Vale Advocates. DS0000023044.V325163.R01.S.doc Version 5.2 Page 18 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 adequate. The home provides a comfortable and reasonably safe environment for residents and is quite well located for the amenities of Aylesbury town centre and those of nearby NHS learning disability and mental health services. The standard of accommodation is generally satisfactory. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is located a mile or so from Aylesbury town centre. It is opposite Manor House Hospital (Learning Disability services) and not far from the Tindal Centre (Mental Health services). It consists of two semi detached houses converted to form one house. All areas were tidy, in good order and clean on day of inspection. Entry is controlled by staff. The entrance hall leads to stairs to first floor, a ground floor bedroom, the lounge, dining room and kitchen. Then further on to the staff office (noted that a ‘DorGard’ fire safety device has been fitted since the last inspection), a small DS0000023044.V325163.R01.S.doc Version 5.2 Page 19 laundry room, and a sitting area to the back of the building. There are stairs to the first floor in each half of the building (a handrail has now been fitted to one stair on the advice of an occupational therapist following a fall by resident earlier in the year). The other bedrooms are on the first floor. One bedroom was having a section of the outside wall re-plastered. This work was being carried out during the day by REACH maintenance staff and the room was then made available again to the resident in the evening. The manager said that the radiator cover was put back in place again at the end of each day. Bedrooms vary in size but are comfortable and have been personalised by the residents. The kitchen was clean and very tidy. The fridges were satisfactory – it was noted that food jars are labelled when opened. Dishwasher clean. Two freezers are located in an exterior building and were in order. A fridge located in the same building was in order. There are sufficient bathrooms and WCs to meet the needs of residents. A bathroom on first floor felt a bit chilly. The manager says that contracters had been appointed to deal with the problem, which she said was due to a problem in circulating hot water. All radiators are covered. All hot water taps are regulated. The garden to rear of the house was in order. This inspection was carried out in December so there was not much activity at this time of year in the garden. DS0000023044.V325163.R01.S.doc Version 5.2 Page 20 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, 33, 34, 35 and 36 Quality in this outcome area is adequate. Staffing pressures encountered earlier in 2006 were reported to have eased and current staffing aims to provide sufficient staff with the right qualities to provide support to residents as required. Potential weaknesses in recruitment are being addressed with a view towards strengthening procedures aimed at protecting residents from the abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The present staff establishment provides for two staff in the morning, two in the afternoon, and one waking and one ‘sleep-in’ at night. The home had recruited a number of new staff since the last inspection and one former member of staff had returned. It was reported that the staffing situation in the home has eased over recent months. However, the home had three staff vacancies at the time of this inspection. The manager said that these were being covered by relief staff who were familiar with the home and its residents. The new staff appeared to have the qualities required to work effectively with residents. The relationship between staff and residents appeared good and the overall atmosphere in the home felt calmer and more positive than on the last inspection. This impression was confirmed by staff. DS0000023044.V325163.R01.S.doc Version 5.2 Page 21 Although caution is advised in assigning ‘cause and effect’, as further evidence of improvement it was reported that the frequency of episodes of disturbed behaviour expressed by one resident earlier in the year had now reduced and that the occasional administration of ‘as required’ medication was no longer necessary. It was also reported that that staff and residents are now getting out more together. Although the new staff are well qualified and experienced (many are qualified nurses in their own country) the proportion of staff with NVQ2 or above falls well short of the 50 requirement. The question of equivalence of an overseas nursing qualification to an NVQ3 qualification was discussed with the registered manager. The only equivalent qualification to an NVQ is a Scottish NVQ (SVQ). Staff with other qualifications might have some of that experience credited as evidence of competence towards an NVQ but that would be a matter for the relevant accrediting body. CSCI published guidance on this in June 2005 and the question is also addressed on the ‘Skills for Care’ website. REACH provides a range of training events over the course of the year. According to information in the office and staff files, over the course of 2006 these have included: ‘Non-Violent intervention’, ‘Infection Control’, ‘Autism’, ‘Medicines Administration’, ‘Moving & Handling’, ‘O’Brien’s Five Accomplishments’, ‘Cultural Awareness’, ‘Risk Assessment’, ‘Sexuality’, and ‘Food Hygiene’. Staff turnover over the course of 2006 in this small home has been relatively high. However, optimism was expressed that this was now easing and that the staffing position was stabilising. Staff recruitment is managed by the organisation’s personnel department based at its head office in Gerrards Cross. The files of three staff of staff recruited in 2006 were examined. One of these files was examined during the course of the inspection carried out in May 2006 and is not subject to further comment on this inspection. The two remaining files included an application form, two references, POVA first and CRB certificates, statements of terms and conditions, correspondence with the Home Office where necessary, and details of academic training in the applicants own country. Evidence of good practice included a signed and dated note on copies of correspondence stating that the original document had been seen, interview notes, attendance at a number of training events during the employees first few months in employment, and good supervision notes. Evidence of less good practice included the acceptance of what appeared to be open references (i.e. not addressed to REACH in connection with the application), the completion of an application form six days after the employee had started work (a CV is required at the application stage), and one instance of a care worker commencing work a couple of days before a POVA first was received. DS0000023044.V325163.R01.S.doc Version 5.2 Page 22 The personnel officer responded the day after the site visit of this inspection and provided a full account of the organisation’s recruitment processes. The personnel officer said that the POVA first error was due to an administrative oversight, that as part of its ‘verification checks’ the Home Office checks references of overseas applicants who require a work permit, and that from 2007 the organisation will require overseas applicants to complete an application form prior to interview. The last named is a welcome development and should reinforce other procedures aimed at protecting vulnerable adults in staff recruitment. The apparent reliance on Home Office procedures to inform the decision on the suitability of an applicant for this particular employment may carry risks. The procedure may not be intended for that specific purpose but as a check on the identity of an applicant. The organisation has nominated a manager to have a lead responsibility for training. Its approach to staff training was reviewed following a training needs analysis by Skills2Care earlier in 2006. Full details of staff training and development were not available for this inspection but as indicated above evidence of induction and basic training was available on staff files and on a calendar on the office notice board. Staff supervision is in place. All care staff are supervised by the registered manager. The manager said that she aims to have supervision monthly but is currently achieving around eight sessions per staff member per year. This exceeds the minimum standard. DS0000023044.V325163.R01.S.doc Version 5.2 Page 23 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. Improvements in the staffing position during 2006 have created opportunities for the home to strengthen its social care ethos and the social and practical skills of residents. The home’s arrangements for the management of health and safety matters appear satisfactory and generally provide a safe environment for residents, staff and visitors. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is experienced in the care of residents with learning disability and has been manager of this home since 2002. The manager expects to start the Registered Managers Award (RMA) in January 2007. In 2006 the manager attended training events in manual handling, crisis prevention and information technology. The manager believes that the staffing DS0000023044.V325163.R01.S.doc Version 5.2 Page 24 pressures which the home experienced earlier in 2006 have now eased and that the new staff are working in accordance with a social care ethos. Unfortunately, the home had not been successful in making an appointment to the post of team leader by the time of this inspection - an important support post to the registered manager. The manager reports that a quality assurance survey of stakeholders was carried out in August 2006. Actions arising from this will be implemented in liaison with senior managers. Other activities aimed at improving the quality of the service include the use of checklists to monitor the state of the environment, continuing efforts to recruit to current staff vacancies, developing more activities in the evening, improving residents’ skills, improvements to the environment (such as new carpets in some areas of the home), and monthly informative Regulation 26 reports by senior managers (now to be retained in the home for inspection). Arrangements for safe working practices appear satisfactory. A senior manager is responsible for health and safety across the organisation. The organisation has engaged ‘Peninsula’ business services to advise on its arrangements for health and safety. A copy of Peninsula health and safety guidance and policies was available in the manager’s office. REACH aim to ensure that new staff receive initial training during their induction and probation period in moving & handling, fire safety, first aid, food hygiene and infection control. Risk assessment processes are well established. The home has not recently had an inspection from the fire authority. A fire risk assessment was carried out in May 2006. A ‘DORGARD’ fire safety device has been fitted to the office door since the last inspection. Fire training was scheduled for January 2007. According to records a fire drill was held in October 2006. Fire alarm points, emergency lighting and fire exits are checked weekly. Fire equipment, fire alarm points and emergency lighting was checked by contractors in September 2006. It was noted that one fire extinguisher was free standing on the floor in the office. This should be firmly and safely mounted on the wall. Gas systems were checked by a CORGI engineer in June 2006. The manager reports that water temperature regulating valves are checked by maintenance monthly. The hot water was recently tested for Legionella. Shower heads are to be descaled and disinfected weekly. Fixed wiring was last checked in 2004 and it is expected that the next check will be in five years from that date. COSHH materials are stored in a cupboard in an outside building. Systems are in place for recording accidents. It is noted that an additional handrail had been fitted to one of the two staircases. DS0000023044.V325163.R01.S.doc Version 5.2 Page 25 Policies and procedures were in the process of being updated by a senior manager. DS0000023044.V325163.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 3 X DS0000023044.V325163.R01.S.doc Version 5.2 Page 27 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 YA34 Regulation Schedule 2 Requirement The registered manager is required to ensure that staff do not take up post before a POVA first is obtained. Timescale for action 31/01/07 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 YA20 Good Practice Recommendations It is recommended that the registered manager review the home’s arrangements for the storage, control and administration of medicines to ensure that medicines are appropriately managed and that the home has access to appropriate advice and support. It is recommended that the registered manager obtain an up to date reference book on medicines It is recommended that the registered manager review the home’s complaints procedure and amend it as necessary to ensure conformance with this standard It is recommended that the registered manager obtain a copy of the current Buckinghamshire joint agency DS0000023044.V325163.R01.S.doc Version 5.2 Page 28 2 3 YA20 YA22 4 YA23 guidelines on the protection of vulnerable adults 5 YA42 It is recommended that the registered manager ensure that the fire extinguisher in the office is properly stored and does not pose a hazard to others. DS0000023044.V325163.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 DS0000023044.V325163.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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