Inspection on 23/05/06 for REACH Bierton Road

This inspection was carried out on 23rd May 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 3 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 20/12/06

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 MIXED CATEGORY MAJORITY ADULTS 18-65 Bierton Road (20-22) Aylesbury Bucks HP20 1EJ Lead Inspector Mike Murphy Unannounced Inspection 23 May 2006 10:00 Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 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 Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 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 Older People and 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. Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Bierton Road (20-22) 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 Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 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. 2nd December 2005 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. Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector over two days. On the first day, a Tuesday, between 10.00 a.m. and 7.00 pm, and two days later, on Thursday, between 10.00 hours and approximately 14.00 hours. The inspection methodology consisted of discussion with managers, staff and service users, examination of service user and staff files, a walk around the building and grounds, checking relevant health & safety records, consideration of comment cards received in advance of the inspection, and testing hot water temperatures. The first day involved liaison with the registered manager, service users and staff. The inspection continued on the second day, which was ‘announced’ in terms of being agreed with the registered manager. The operations manager was present for most of the inspection on the second day. The inspection finds an uneven picture. The home provides a safe and comfortable environment for service users. The structure of its Person Centred Planning (PCP) (care planning) is comprehensive but the quality of its application in practice has been variable. Staffing pressures have had an effect on a number of areas of the service. While staff shortages lead to one form of pressure, the introduction of four new staff to a small home over a short period of time can lead to other pressures. The home has experienced both over the course of the year and is now hoping for a degree of stability. It is difficult to assess the impact of these pressures on service users but it was reported that the social care ethos of the home was challenged at one point and this was clearly not in their interests. The pressures had eased by the time of this inspection and it is to be hoped that the service can now operate in keeping with its ethos and aspirations. In particular it is hoped, that with the appointment of new staff, service users and staff will be able to get out more and take advantage of the amenities of the town and the local area. This inspection identifies a number of aspects of staffing and staff development which require management attention. The quality of the environment varies. The home is an older building, a pair of semi-detached houses adapted to form one house, and needs a continual programme of refurbishment. On this inspection two matters gave cause for concern from the health and safety point of view – a bedroom window which opened wide and the office door being held open with a fire extinguisher. On a more positive note, however, it was pleasing to see that all hot water taps are now regulated and that radiator covers have been fitted throughout the house. Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Ensure that staff are appropriately inducted and trained and have a full understanding of the values, philosophy, aims and methods of a social care service. Provide more opportunities for staff and service users to go out together to the town and surrounding areas. Maintain files in the home which provide evidence of conformance to the Regulations and standards in the recruitment of staff Amend the complaints procedure to ensure conformance to the standards. Ensure that its arrangements for the storage, control and administration of medicines complies with the standards and includes staff training and an appropriately comprehensive service from its pharmacy. Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 7 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. Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The needs of prospective service users are carefully assessed by experienced staff prior to admission in order to minimise the chances of admitting a person whose needs cannot be met. The process is conducted at a pace which suits the needs of the prospective service user and take account of the need for existing service users and staff to get to know the new person. Higher than anticipated turnover of staff over the past year may have limited the extent to which the full range of service users needs can be met. EVIDENCE: The home had not admitted a new service user since the most recent unannounced inspection in December 2006. All eight places were occupied at the time of this inspection. It is important, because of the size and the longer Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 10 term nature of the service, that the admission of any new service user is carefully considered and that a good fit is obtained between the needs of the prospective service user, the homes ability to meet those needs and the needs of existing service users. REACH is sensitive to these matters and admissions to this home are carefully assessed and considered. This includes liaison with the referring care manager, the prospective service user, his or her family and others involved with the person. Where it is agreed that the home is likely to be able to meet those needs the prospective service user is invited to see the home. Where admission is agreed then then a trial period of admission takes place. During this time close liaison is maintained between the new service user, the home manager and the team providing care for the service user before admission. This continues for a period of time until the new service user is more settled. In assessing the referral REACH staff have access to relevant information held by social services and NHS staff. The process outlined was followed in the case of the most recent admission which occurred about a year prior to this inspection. This standard is rated on the description of that process by the registered manager and by evidence seen on the inspection of July 2005. Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14, and 33 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has a care plan (Person Centred Plan (PCP)) in place for each service user. However, plans vary, both in content and quality, and the development of the PCP approach may have been limited by pressures on staffing over the past year. This may disadvantage service users whose PCPs are not kept up to date. Staff support service users over a range of activities and aim to ensure that service users needs are met. EVIDENCE: A care plan is in place for each service user. This is in the form of REACHs PCP format and does not follow the structure of conventional care plans although it Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 12 does include the elements of assessment of needs, a care plan to meet needs, implementation, evaluation and review of that care plan. The plans are very comprehensive and many sections are written from the service users perspective. Staff turnover has affected the quality of entries and the manager has endeavoured to maintain standards. However, the quality of care plans was found to vary. While the basic standard is fairly good, there was one example which was considered excellent and which could serve as a benchmark for others. The plan takes account of assessments and care plans drawn up by care managers as well as REACHs own assessments. The contents of the main document include personal details, photograph, communications passport, a penpicture of the service user, likes & dislikes, list of agencies involved in the person’s care, list of family and friends, a What I do now section (people, choices, talents) and future aspirations. A very useful section lists individual behaviours, what the behaviour might mean and the action to be taken. The plan includes goals and what and who might help the service user to achieve them. The support requirements and personal care guidelines outline the support required. A range of risk assessments are included. Other sections include health records and correspondence. One section is for current medication’ and it difficult to see the purpose of this when there is already a proper record of current medicines for each service user (the medicines administration record (MAR)). Some sections do not appear to be in use, for example monthly questionnaire, index of specific programmes and signature sheets. Two different forms of ‘communication passport’ were in use. The system may benefit from review and rationalisation in the light of the first years experience. Due to staffing pressures some service users did not have a key worker at the time of this inspection. Daily notes are made in a separate diary and give a good account of the service users day. Staff endeavour to assist service users in making decisions and were indirectly observed doing so during the course of the inspection. The home is in contact with Aylesbury Vale Advocates. An advocate who regularly visited and knew the service users well has recently retired and a replacement advocate was about to take over. Service users participation in the home is encouraged and the notes of house meetings for January, March, April and May 2006 were examined. Issues disussed included menus, holidays, key working and summer outings in the kitchen. Risk assessment processes, both generic and specific, are well developed. Staff are aware of the need to protect service users confidentiality although some individual records are stored on open shelves in the staff office. Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users attend a variety of social, training and recreational activities (including holidays in the UK) which aim to meet needs and improve service users well-being. Current Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 14 staffing pressures may limit the amount of time which staff and service users can spend outside of the home together and it is hoped that greater stability in staffing over the latter half of 2006 will enable staff to support service users in making greater use of the amenities of the town and local area. EVIDENCE: The home provides care for a small but diverse group of service users. Service users attend a range of activities in the community including QUEST (a training project), information technology and cooking at Aylesbury college, an art group at Bierton Hill resource centre and activities at Bierton Road day centre. Some service users also regularly attend a social club in Aylesbury. Staff support service users in carrying out activities and service users are encouraged to be as independent as possible. Service users share in house chores and help staff with shopping. The home is a relatively short distance from Aylesbury town centre. It has a car for outings where agreed although it was suggested that a larger vehicle such as a ‘people carrier’ would enable a larger group to go out together – a good suggestion. Due to staffing pressures over the past year some service users have been unable to get out as much as they might wish and the manager is hopeful that imminent improvements in staffing will enable staff and service users to go out more together Within the home service users follow their own interests which include knitting, painting, sewing, board games, tv, video and music. Holidays planned for 2006 include breaks in Lyme Regis, Bognor Regis and possibly a location close to the Beamish Museum in County Durham. Contact with families is maintained by some service users. The pace of life in the home seems to suit the needs of service users. Service users and staff were observed to interact well together over the two days of the inspection. Service users seemed satisfied with the care provided and attended scheduled activities in the community. Staff and service users plan, do the shopping and share meals together. Lunch on the first day of the inspection consisted of corned beef, salad and cheese. Quantities were good and the meal was well presented. Weights are regularly checked and recorded in care documents. Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected at least once during a 12 month period. 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 the service. Service users preferences for care are recorded in PCPs to ensure that staff take account of them when providing care. The home liaises with GPs and other health and social care agencies in meeting service users healthcare needs. Weaknesses in the control and storage of medicines need to be addressed because they could place service users at risk. EVIDENCE: Service users preferences are taken account of by staff and personal care is provided in private. This is recorded in the PCP. Service users are expected to be up in time for planned activities, such as college, and are encouraged to participate in activities. Those living in the home at the time of this inspection Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 16 seemed comfortable with the pace of daily activities. All service users are registered with a GP and are supported in accessing other health and social care services in the community as required. This includes liaison with the community learning disability team where required. Healthcare needs are recorded in PCPs (Person Centred Plans). Medicines are prescribed by the service users GP and supplied by a local branch of Lloyds pharmacy. Medicines are stored in a locked cupboard. Stock internal and some external preparations are stored in a locked metal cabinet within the cupboard. Stock control could be improved because at the time of this inspection in May 2006 a number of medicines were out of date: natural senna use by August 2005, TCP use by December 2005, Paracetamol use by Mar 2006. There was a stock of Paracetamol for each service user. Protocols are in place for as required medicines and the home is careful in its use of such prescriptions. It was noted that some handwritten entries on MAR sheets were undated and unsigned. However, no gaps in recording the administration of medicines were seen. Reference books for staff and service users consisted of a 1998 edition of BMA guide to medicines (an excellent reference but a newer edition should be obtained), a 2004 BNF (British National Formularly) and a downloaded copy of the Royal Pharmaceutical guidelines with regard to medicines in care homes. Prescribed medicines in measured dose containers which are filled by the pharmacy in accordance with the prescription and MAR sheet are stored in a locked container. The home does not appear to be receiving the support it needs from its pharmacy. According to the manager the pharmacy do not do visits to check the homes arrangements and wont take medicines back. The home now uses a local TESCO pharmacy for returning medicines which are no longer required. This is done on a goodwill basis. Training in the administration of medicines was not included in the training programme which accompanied the pre-inspection papers but according to the manager is due to take place in 2006. Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected at least once during a 12 month period. 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 the service. The home provides information and guidance to staff on the reporting and management of suspected abuse. This needs to be kept up to date with developments in local statutory agencies and reinforced through staff training. The home’s complaints procedure fails to fully conform to the minimum standard in not stating that a complainant may refer to CSCI at any stage. The established links with a local advocacy organisation ensure that service users have access to independent advice and support. This protects the interests of service users and supports good practice in the home. EVIDENCE: The home is required to comply with REACH policy and procedure which is available in the home. The home reports that it has not received any complaints over the past twelve months. Dissatisfaction expressed by service users is dealt with at the time and may not be recorded as a complaint. It is noted that REACH complaints procedure does not conform to the 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 continues to include Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 18 the statement if not satisfied after following the procedure above please refer to CSCI. The home has had regular visits from Aylesbury Vale Advocates but the advocate concerned has now retired. A new advocate had been appointed and was due to visit the home soon. As with complaints the home is required to comply with REACH policy and practice with regard to POVA. A new policy was about to be issued by the care services manager. According to training records one member of staff had attended training in POVA over the past year (in June 2005). The home had a downloaded copy of draft POVA guidelines issued in 2004 but not of the most recent version which were published in January 2006. However, it is noted that the 2004 guidelines were downloaded in 2006 and the website may not have been up to date on that day. This is outside of the home’s control. The website did have the January 2006 version when checked in May 2006. The telephone number of the confidential Careline reporting system was on a notice board and a member of staff to whom the inspector spoke was aware of it. Most staff have attended the organisation’s training sessions on Non-Violent Intervention. Service users are registered to vote. Good systems appear to be in place for managing service users money. The organisation acts as appointee for six of the eight service users. Accounts are in place and there are appropriate controls on the withdrawal of funds on behalf of service users. The balance of cash held for two service users was checked and found to be correct. Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home provides a comfortable and secure environment for service users and is quite well located for the amenities of Aylesbury town centre. The standard of accommodation is generally satisfactory but some details will need to be addressed by managers in order to ensure the safety of service users, staff and visitors. EVIDENCE: Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 20 The home is located about one mile from Aylesbury town centre. It is conveniently located for the facilities of nearby NHS services. It is accessible by public transport. Car parking is available in streets nearby. The home is comprised of two older style semi-detached houses and is in keeping with other homes in the locality. Access from the main road is up a set of steps. There is a small garden to the front and a larger garden to the rear of the house. Separate access on fairly level path is available from the back. Access and exit to and from the building is controlled by staff. The quality of the accommodation varies. The ground floor consists of a hallway, kitchen, dining room, lounge, staff office, laundry, small meeting area, one bedroom, and two wcs. Other bedrooms, wcs and bathrooms are on the first floor. Natural light varies but the lounge is bright and cheerful. Service users bedrooms vary in size and are comfortably furnished with each having been personalised by the occupant. Window restrictors are fitted but it was noted that one bedroom window opened wide. The manager was aware of the matter and was arranging a repair. Temperature control valves have now been fitted to all areas to which service users have access and were operating satisfactorily at the time of the inspection. Radiator covers have been fitted throughout the home. The kitchen is sufficient for the needs of the present group of service users and all areas were very clean and tidy. Fridge and freezers located in a outhouse and were clean and tidy. However, the outhouse it self was untidy and dusty and in need of a good spring clean. The garden is suitable for the needs of current service users. It was noted that the door to the staff office was being held open with a fire extinguisher. This is not acceptable. This is quite a busy area and there may be good reasons why this door needs to remain open for long periods. The manager must seek the opinion of the fire authority on the most appropriate means of achieving this consistent with fire regulations. The laundry is locked when not in use. A carpet in one of the hallway was worn and in need of replacement. The manager expected this to be done in the near future. Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Staffing pressures over the past year have led to difficulties in maintaining continuity of care and on occasions the social care ethos of the home. Staff files stored in the home did not contain the information required under the Regulations and it is, therefore, not possible to assess whether or not the organisation’s recruitment procedures conform to the standards. The report of a recent audit of staff skills and training needs should inform the organisation’s training plans. It is expected that this will lead to the development of training programmes to equip staff with the skills to meet the needs of service users. EVIDENCE: Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 22 Staff recruitment is managed from REACH head office in Gerrards Cross. Job descriptions are in place for staff. Copies of the GSCC codes of practice are given to staff on induction. The home has experienced severe strains on its staff resources over the past year. At the time of this inspection, of a funded establishment of 9.5 full time equivalent staff the home had 4.0 permanent staff in post. Staffing levels were being maintained through some staff working additional hours, the transfer of one full-time care worker from another REACH home and agency staff. Two new staff were about to start at the time of this inspection. Four staff with healthcare backgrounds were recruited in the autumn of 2005. While this eased problems in terms of staff numbers it created problems of its own. The introduction of four new staff (almost half of the staff establishment) at one time in such a small home had a significant impact on service users and existing staff. The problem was compounded by the lack of knowledge of the specialty, the model of care which the new staff were trained and used to working with (all were healthcare professionals), problems which some experienced in adjusting to working in the learning disability specialty and perhaps in role (from qualified practitioner to care assistant), and some problems with language were reported (the staff were from eastern Europe). The experience was clearly difficult for everone concerned and may raise questions on the need to review processes of induction to the organisation and the home, introduction to the field of learning disability, re-orientation to social care for staff whose previous experience is in general healthcare, and the level and nature of supervision and support during the probationary period. At the time of this inspection only one of the four files of staff recruited in the last year was available for examination. The other three files were at REACH head office. A request for access to those files was made to REACH on the second day of the inspection (25 May 2006). In response REACH said that data protection issues would need to be considered before allowing such access but undertook to give its response within one week. This did not occur. CSCI is still awaiting a response on the date of submitting this report (16 June 2006). One file was examined and the findings discussed with the registered manager and operations manager. Staff are appointed on a POVA first basis and are considered to be working under supervision until an enhanced CRB certificate is received. Over the past twelve months staff have attended training in moving & handling (X5 staff), food hygiene (X3), fire safety (X4), first aid (X5), health & safety(X3), culture awareness (X2), POVA (X1), Non-Vioent intervention (X6), Dementia Care (X1), and Safe and Enjoyable Eating (X3). The home had benefited from a recent skills and training needs audit conducted by Skills2Care consultants and a report submitted to the manager. It is expected that the outcome of this exercise will inform REACH training priorities for the next year or two. Supervision is in place and the manager endeavours to ensure that it is held every two months. Records are maintained. Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 23 Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 43 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The management of the home needs to be strengthened by the appointment of a team leader in order to support the registered manager in maintaining its ethos and meeting its aims. Arrangements for maintaining a safe environment have improved since the last inspection and are generally thorough, but the advice of the fire Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 25 authority needs to be obtained with regard to retaining the office door in the open position without compromising fire safety. The organisation’s arrangements for managing service user’s monies are thorough and protect the interests of individual service users. EVIDENCE: The registered manager is experienced in the care of service users with learning disability and has been in her present post since 2002. To date she has been unable to find time to do the RMA or NVQ4 in care because of recurring staffing pressures. The manager has a job description which fits with the aims of the home. The managers most recent appraisal was in December 2005. Since June 2005 the manager has attended training in first aid, cultural awareness, non-violent intervention, and staff development. It is felt that the ethos of the home, in terms of its model of care, has been challenged over the past year but that it is now reverting to an appropriate social care model. The manager endeavoured to reinforce the ethos and lead by example when on duty but without a team leader to continue this at other times found it difficult to maintain. The post of team leader was about to be advertised at the time of this inspection. A major quality assurance initiative is the stakeholders survey which was scheduled to be carried out at the end of May 2006. The last one took place in May 2005. The home does not have a development plan for the current year – improvements are said to occur on an ad hoc basis. Monitoring the quality of the service on a day to day basis is informal - by managers walking around and getting feedback from service users and visiting relatives. This is supplemented by REACH’s regular and informative Regulation 26 reports to CSCI. The views of care managers are sought at annual reviews and other contacts. House meetings are held monthly and notes taken. Inspection comment cards are sent out to professionals and relatives. Five completed comment cards were received from service users in connection with this inspection. All expressed a high level of satisfaction with the care, liked living in the home, knew who to complain to if unhappy, and did not wish to be more involved in decision making within the home. Responsibility for reviewing policies and procedures lies with a senior manager at REACH head office. The manager said that staff receive training in moving & handling, fire safety, medication, infection control, food hygiene and first aid during their first six months in post. Training records for 2005/06 confirm this with the exception of infection control and medication but the addition of non-violent intervention. The registered manager reported in the pre-inspection questionnaire on a range of other health & safety matters and all appear to be in order. The home has a contract with PHS for clinical waste. A check for legionella last took place in March 2004 - a report was not available in the home. Hot water outlets are now regulated and radiator covers fitted. REACH has engaged Peninsula health Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 26 & safety consultant to oversee its arrangements for health & safety matters which includes the provision and update of policies and procedures and an annual audit. Generic and specific risk assessments are in place for a range of activities. It was noted that the office door was being held open with a fire extinguisher. This practice must stop and the registered manager must seek the advice of the fire authority on the best means of retaining that door in the open position. Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 2 4 3 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 1 34 2 35 2 36 3 CONDUCT AND MANAGEMENT Standard No Score 37 2 38 2 39 3 40 X 41 X 42 2 43 X 2 3 3 3 2 LIFESTYLES Standard No Score 11 2 12 3 13 2 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bierton Road (20-22) Score 3 3 2 X DS0000023044.V288791.R03.S.doc Version 5.1 Page 28 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 YA42 Regulation 13 (4) Requirement The registered manager is required to obtain the opinion of the fire authority on the most appropriate means of retaining the office door in the open position. The registered manager is required to ensure that staff records in the home have, at a minimum, the information required in this Schedule. The registered manager, in liaison with senior managers, is required to ensure that all new staff are appropriately inducted, trained and supervised in order to work effectively with service users. Timescale for action 30/06/06 2 YA34 Sch 2 30/06/06 3 YA35 18 (1) (a), (b), (c) (i) 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 29 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 and ensure conformance with this standard It is recommended that the registered manager obtain a copy of the current Buckinghamshire joint agency guidelines on the protection of vulnerable adults 2 3 4 YA20 YA22 YA23 Bierton Road (20-22) DS0000023044.V288791.R03.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 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. 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