Inspection on 29/05/08 for Red Admiral Court (3)

This inspection was carried out on 29th May 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Red Admiral Court (3) 22/05/06

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Blenheim House

Prince Bishop Court

Park View (15)

Craigmore House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Red Admiral Court (3) 3 Red Admiral Court Gateshead Tyne and Wear NE11 9TW Lead Inspector Glynis Gaffney Key Unannounced Inspection 29 & 30 May and 10 June 2008 17:00 Red Admiral Court (3) DS0000066171.V365666.R02.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 Red Admiral Court (3) DS0000066171.V365666.R02.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. Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Red Admiral Court (3) Address 3 Red Admiral Court Gateshead Tyne and Wear NE11 9TW 0191 4611469 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) Henshaws Society for Blind People Manager post vacant Care Home 6 Category(ies) of Learning disability (6), Physical disability (3), registration, with number Sensory impairment (6) of places Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th August 2007 Brief Description of the Service: The property at 3 Red Admiral Court is a large, family house in a modern housing estate that was built in 1990. It has been extended to provide six bedrooms that meet the National Minimum Standards for Younger Adults. The home provides six places for younger adults with visual impairments, who may also have learning and physical disabilities. Three bedrooms on the ground floor are suitable for people who use a wheelchair. The remaining three bedrooms are on the first floor, one of which has an en-suite bathroom. There is a communal bathroom on the ground floor and another on the first floor. There is also a kitchen/dining room and a lounge area. There is a small quiet room on the first floor. The building has been assessed by a mobility officer to ensure that the facilities provided meet the needs of people with a visual impairment and a physical disability. There is a large staff office on the second floor. The house is a short walk from the local shops and transport routes. The current residential fee ranges from £1138.63 to £1,165.96 per week. Copies of Commission for Social Care inspection reports are available in the main reception area. Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. How the inspection was carried out: Before the visit: We looked at: • • • • • Information we have received since the last key inspection visit on the 16 August 2007; How the service dealt with any complaints and concerns since the last visit; Any changes to how the home is run; The manager’s view of how well they care for people. We also interviewed three people who use the service and three staff; The views of relatives, other professionals and staff. The Visit: An unannounced visit was made on the 30 May 2008. During the inspection we: • • • • • • Talked with the manager; Looked at information about the people who use the service and how well their needs are met; Looked at other records which must be kept; Checked that staff have the knowledge, skills and training to meet the needs of the people they care for; Looked around the building to make sure it was clean, safe and comfortable; Checked what improvements had been made since the last visit. What the service does well: The manager and her staff team engaged with the inspection process in a very positive manner. It was evident that staff have developed warm and affectionate relationships with the people they care for. The staff on duty were positive and showed a genuine interest in the people they care for. The home had a warm and friendly atmosphere. Staff are polite, courteous and respectful. Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 6 The home has been adapted to meet the needs of people with visual This helps to promote people’s impairments and physical disabilities. independence. The home is domestic in appearance, fits in well with the local community and is nicely furnished. Equality and diversity issues are taken seriously within the home. For example: the rota is organised to ensure that people are cared for by someone of the same sex where this is important to them; people using the service are involved in the staff recruitment process. In-house quality assessments are carried out every three months. People living at the home are able to access the provider’s specialist rehabilitation services. People receive support with planning mobility routes, accessing leisure activities, participating in household tasks and with menu planning. Staff have received visual impairment awareness training and other training that is specific to the needs of the people living at the home. A care manager who returned a survey said: ‘Staff are respectful at all times. (The service user I support has) a full and varied programme of interests. Staffing levels are very good and (the) general approach (is) positive and encouraging. I havent had any concerns (but) feel sure they would be dealt with appropriately. It is a friendly, caring and positive service. It encourages service users to pursue a wide range of interests. I have been delighted with this placement. It offers everything (my) service user needs. It would be difficult to improve upon.’ Staff who returned surveys said: ‘Any changes about the needs of service users are documented and all staff are made aware’; ‘Timesheets are always produced around needs and activities for service users to include GP visits. This is one of the best places I have worked for staff attendance’; ‘I have been very impressed by the support and encouragement service users receive in this establishment. Independence is promoted for everyone daily. Good support is provided when needed. Staff enjoy coming to work and service users enjoy being here’; ‘I think the service users are very happy here as there is a good relationship between staff and residents’; Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 7 ‘We offer great support. We promote choice with various everyday life activities. We also provide a large range of activities promoting an active and healthy lifestyle.’ People using the service are generally satisfied with the support they receive. One person said that ‘staff do a very good job and I am thankful for their support.’ What has improved since the last inspection? A new manager and senior member of staff have been appointed. now receiving regular supervision. The new manager has reviewed: • • Staff’s training needs to establish what further training input is required. Mrs Thornton has also arranged for all staff to have their statutory training updated; Both individual and health and safety related risk assessments. Staff are People using the service have regular one to one meetings with their key worker. Following comments made by people using the service, staff have taken action to provide more individualised day services and activities. The home has become involved with ‘POOL’. Members of ‘POOL’ are likeminded organisations who wish to offer a range of local activities to a wider group of people. To date, Red Admiral Court has organised a number of sessions including creative art and glass painting. Additional aids have been provided for the kitchen following assessments carried out by the provider’s rehabilitation service. A new bed has been purchased at the request of one of the people living at the home. Bedrooms have been re-decorated. More staff have obtained a nationally recognised qualification in care. The manager is in the process of reviewing people’s care records to ensure that they contain the required information. Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 8 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. Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 9 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 Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are suitable arrangements for making sure that people’s needs are assessed before they are admitted into the home. This helps to ensure that staff will be able to meet people’s needs on admission. EVIDENCE: The home’s service user guide and statement of purpose are not available in formats that can be understood by people using the service. The provider has identified this as a shortfall and is taking action to address it. People living at the home said that they had received information about the service before they moved in. The home’s terms and conditions of residency is available in Braile and large print. People admitted into the home are former students of a specialist further education college run by the provider. People’s needs are assessed before admission to ensure that the placement offered is appropriate. This also helps the provider to set up independence programmes for people using the service. Relevant professionals are involved in the pre-admission assessment process. Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 11 All of the records checked contained a social services assessment and relevant information from their previous residential college placement. One person’s record did not contain a copy of their original social services care plan. A care manager who returned a survey said that the home’s assessment arrangements ensure that accurate information is gathered and that the right service is planned and given to individuals. Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s care records do not fully cover their assessed needs. This could lead to staff being unclear about how each person’s needs are to be met. EVIDENCE: People’s care records included: • • • ‘All About Me’ information. This provides staff with important information about people’s lives before coming to live at the home; An ‘Individual Service Plan’ (ISP) addressing their needs in a range of areas. However, those read had recorded each person’s needs as being almost identical and some of the ISP’s had not been fully completed; Individual objectives for each person. For one person these cover the support they need to use the home’s washing machine and to socialise more with other people living at the home. However, the objectives that DS0000066171.V365666.R02.S.doc Version 5.2 Page 13 Red Admiral Court (3) have been set do not fully reflect some of this person’s assessed needs as identified in their last social services review. For example, in this review it was identified that staff help the person to complete their physiotherapy exercises every morning and night. It was also recorded that staff provide assistance with personal care when requested by the person concerned. However, there are no clear plans of intervention providing staff with guidance about how to meet this person’s needs in these areas. Another person’s individual objectives focus on helping them to change their bed linen and order a taxi independently. The person’s social services care plan states that they require support when accessing public areas especially low-light environments. It is also recorded that they are vulnerable to exploitation, can become anxious when out in the local community or if their day to day routines are disrupted. However, clear plans of intervention addressing these needs had not been devised. Some people’s individual objectives have not been regularly reviewed. For example, an objective for one person states that staff will support the person to cook independently. However, the objective has not been reviewed since February 2007. People have not always signed their individual objectives to confirm their agreement with the contents. Some have not been dated. Failing to date documents can create difficulties when staff try to judge what improvements people have made and over what periods of time. People’s placements are reviewed regularly. For example, each person had had a social services review within the last six months. In addition, the new manager had set dates for each person’s next in-house six monthly review. People said that they are always invited to attend their reviews. Staff are expected to complete monthly key worker reports. This is useful as it records what events have taken place in the person’s life during the previous month. However, an examination of a sample of people’s records showed that some monthly key workers reports had not been completed. There was evidence that the manager is addressing this shortfall. People’s care records contain information about their preferred routines, likes and dislikes. However, there is no evidence that consideration has been given to assessing each person’s capacity to make decisions under the Mental Capacity Act. People said that they are able to make their own decisions but receive support from staff when they feel they need it. People are supported to take appropriate risks. For example, in one person’s care records, the risks associated with them using the bathroom, attending the gym and going swimming had all been assessed. However, some of the risk assessments had not been regularly reviewed, signed or dated. The manager Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 14 had recently devised a complex and robust risk assessment to support staff working with a person presenting challenging behaviours. Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to choose how they want to live their lives, and they receive the level of staff support that suits them. This means that people are able to lead fulfilling lives. EVIDENCE: People are supported to take part in culturally age appropriate activities and to make use of community based facilities. For example: • In line with personal preferences, people are supported to visit local pubs in the area, the cinema, theatre, museums and concerts. Leisure pursuits are agreed with individuals and their families. Red Admiral Court staff recently ran a craft course at the local Library; DS0000066171.V365666.R02.S.doc Version 5.2 Page 16 Red Admiral Court (3) • Two people have completed computer training and a travel course at Newcastle College. The provider said that both people have expressed a wish to continue learning and hope to enrol on further courses. Planned activity timetables had been completed in two of the care records checked. People said that they have something important to do each day such as going swimming or visiting the Alan Shearer Centre. One person said ‘…I never get bored. There are always lots of things for me to do. Staff help me to do what I want with my time.’ Another person said that they are very happy with their weekly timetable. Henshaws Rehabiliatation Service provides people with individual support to develop independent living skills in such areas as shopping, carrying out household tasks and cooking. The rehabiliation team provides staff with written guidance based on an assessment of each person’s needs. People are supported to participate in the running of the home. The new manager has arranged for regular householder meetings to take place. Staff support people to keep in regular contact with family members and friends of their choosing. One person said ‘I enjoy being busy. I visit my family regularly. I am very happy.’ Another person said staff will help you to phone your family and they are always ‘nice and polite.’ A care manager who returned a survey said that the home helped people to live the life they choose wherever possible. Each person has a ‘living skills’ day each week where they design their own menu, go shopping for the ingredients and prepare their own meal. Most other main meals are prepared by staff as people are out at activities on most days. People said that they are very satisfied with the help they receive in this area and all commented that they enjoy the meals provided. Where people have specialist dietary needs, staff ensure that these catered for. The kitchen was clean, hygienic, tidy and well equipped. Due to the size of the kitchen it is not always possible for staff to sit with people during main meal times. There was a pleasant atmosphere during the meal times observed. When undertaking day time activities, the provider funds people’s meals. During the evenings and weekend, the home’s terms and conditions of residency state that people will fund their own meals if they go out. Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although people receive personal and healthcare support and assistance with medication, a suitable health action plan has not been completed for each individual. This could lead to staff being unclear about how to meet people’s assessed healthcare needs. EVIDENCE: Arrangements have been made to meet people’s health care needs. For example, each person has seen a dentist and optician during the last 12 months. Staff support people to attend outpatient appointments and arrange for their wheelchairs to be serviced. However, in the three care records checked, only one person had a Health Action Plan. There was no evidence of this person’s Health Action Plan being reviewed during the previous 12 months. Mrs Thornton said that at present none of the people living at the home are at risk of under or over nutrition. A pressure care risk assessment had not been completed for a person with limited mobility. Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 18 The service operates a keyworker system. Keyworkers act as a point of contact for families, friends and other professionals. They are responsible for developing people’s support plans and ensuring that all records are up to date. People said that staff gave them good support and looked after them very well. One person said that they if they became poorly, staff would help them to see a doctor. Staff said that they are clear about how to meet people’s personal care needs. However, some people’s support plans do not clearly identify their personal care needs, how these will be met and what staff hope to achieve by their involvement. A care manager who returned a survey said that: • • The care service always respects people’s privacy and dignity; Individuals health care needs are properly monitored and attended to by the care service. Moving and handling risk assessments had been completed for each person. Although two assessments had been recently updated, one had not been reviewed during the last 12 months. In addition, the assessment completed for one person did not clearly describe the actions taken by staff when assisting them to mobilise and transfer. All medication had original prescription labels attached. In the absence of a standardised Medication Administration Record (MAR), the manger has devised her own format. A number of concerns were identified: • • • • • • • • • Some of the staff team have not received accredited training in the safe handling of medication; Arrangements are not in place to ensure that new staff receive level 1 medication training as part of their induction; Staffs’ competency to administer medication has not been assessed; Staff are not always completing the MAR after administering people’s medication; One person’s eye drops had not been administered in line with the GP’s directions; Photos to identify each person have not been placed within their medication records; The service has not been inspected by a pharmacist within the last 12 months; The in-house MAR did not include a prompt to remind staff of the need to record any known allergies, or a key to explain reasons for nonadministration of medication; The present arrangements for storing medication are unsuitable. Medication is currently stored in a filing cabinet. Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 19 During the feedback session, Mrs Thornton confirmed that she had already begun to take action to address the above concerns and was in the process of sourcing appropriate training. A care manager who returned a survey said that the care service manages people’s medication correctly. Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good arrangements for keeping people safe and for ensuring that complaints are responded to appropriately. This means that people can be confident that they will be protected from harm, and that their views will be listened to and their concerns acted upon. EVIDENCE: Details of the home’s complaints procedure are included in the service user guide. The procedure is available in Braile and large print. People said that they had been told how to make a complaint as well as whom they should raise concerns with. People also said that they would feel comfortable raising concerns with staff working at the home. The provider said that people are given the opportunity to raise matters of concern at residents’ meetings. Neither the home nor the Commission have been notified of any complaints since the last inspection. Two people using the service returned surveys. One person said they had been told how to complain and one said that they had not. Staff said that they had been told how to manage a complaint. A copy of the local authority’s safeguarding procedures is available within the home. There has been only one safeguarding referral since the last inspection. This involved a disclosure by a person living at the home to the inspector. This matter is currently under investigation. On receipt of the concern, the manager took immediate action to contact the relevant professionals and they Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 21 have worked in partnership with them to support the investigation. The staff whose files were checked had received safeguarding training and they were clear about how they would handle any abuse occurring within the home. The manager has arranged for two remaining staff to complete safeguarding training. People living at the home said that they felt safe. Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a home that has good facilities, is generally well maintained and clean, and has been adapted to meet their needs. EVIDENCE: The home is a large, family house in a modern housing estate. It is indistinguishable from the identical neighbouring houses. It has been extended to provide six places for young people with visual impairments and learning disabilities. The house has a front driveway and a good-sized back garden. Two of the three bedrooms on the ground floor are suitable for use by people who use a wheelchair. Two of these bedrooms have large en-suite shower rooms, and there is a separate, shared bathroom. The remaining three Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 23 bedrooms are on the first floor, and one of these has an en-suite bathroom. There is also a communal bathroom on the first floor. Modern blinds are fitted to all the bedroom windows to support people’s privacy and dignity. Bedrooms are bright and cheerful, and are only occupied by one person. People said that they had been involved in choosing the décor, furnishings and fittings in their bedrooms. All rooms had been personalised to reflect the preferences of the occupant. The home has colour-contrasted paintwork and appropriate lighting levels to meet the needs of the individuals living there. The house is generally well decorated and furnished, comfortable, warm and clean. The paintwork was very scuffed in places because the people use their hands on walls to get around the house independently. The manager said that the home had recently been painted throughout. There are appropriate symbols fixed to each door so that people can identify their own particular room. A range of aids has been provided to help people be more independent. Staff from the provider’s rehabilitation team visit the home on a regular basis to assess whether people need extra equipment to support more independent living. Other aids have also been provided. For example, the home has a talking microwave and scales. Staff and people using the service have access to taped recipes. A colour contrasted carpet has been fitted on the stairs. Although staff carry out the main domestic tasks, people are involved in cleaning their own rooms and doing their own laundry, with the necessary support. The Department of Health checklist for assessing infection control measures in residential care homes has not yet been completed. All radiators have been guarded to keep people safe. No hazards or health and safety concerns were identified during the inspection. The Henshaws Property Services Director visits the service on an annual basis to discuss and address future needs and repairs. The home has a large back garden. This is a pleasant area, but is not as accessible to the people living there as it could be. Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can feel confident that their needs will be met by professionally qualified staff that are able to provide good quality care. However, staff records did not always contain sufficient documentary evidence demonstrating that robust pre-employment checks had been carried out and for some, a thorough induction had not been provided. EVIDENCE: There are rotas that show which staff are on duty and at what times. The staff team consists of the manager, one senior support worker and 11 support staff. The rotas show that for six service users there is always a minimum of two staff on duty between 8 am and 10 pm. In addition, there are extra staff on duty during busier times of the day or to support people attending community based activities. One member of staff ‘sleeps over’ in the building each night. Although there was no evidence during the inspection that people’s needs went unmet, some staff that returned surveys said: Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 25 ‘We now have less staff which now means that some activities do not get done and some staff are supporting/guiding two residents at a time which is totally dangerous and unprofessional’; ‘Henshaws has a one to one Sighted Guide policy which rarely works as we are short staffed. The staff ratio is sometimes 2 to 1 or 3 to 1 in some cases;’ ‘I think that if the service was adequately staffed all the time which I understand is hard…we could provide a better service…we are not allowed to use agency staff and the strain is put on permanent staff.’ ‘When a service user wants 1 to 1 support on an activity we should be always be able to provide this and sometimes we can’t.’ With the exception of the safeguarding concern referred to earlier in this report, people living at the home spoke very well of the staff who support them. Over 50 of the staff team have obtained a National Vocational Qualification at Levels 2 and 3 and a further three staff are in the process of doing so. In 2007, staff did not receive supervision at the frequency stipulated in the National Minimum Standards. However, since the new manager took over staff have been receiving structured supervision on a more regular basis. A range of pre-employment checks is carried out before staff can commence work at the service. For example: • • Staff are required to complete an application form, attend a selection interview, provide statements about their physical and mental health and whether they have any convictions; Each person’s identity is checked and verified. However, the documentary evidence demonstrating that all of the required checks have been carried out was not in place in either the home’s or the central office personnel records made available during the inspection. For example, there was only one written reference for each person. In addition, for one member of staff, the provider could not supply documentary evidence confirming that a Criminal Records Bureau (CRB) disclosure check had been obtained. The member of staff concerned did say that a CRB check had been carried out. This was also confirmed by the provider following the inspection. Arrangements about where the home’s staff records will be kept is to be the subject of further discussion with the provider. Staff said that they had had an in-house induction. However, two people said that their inductions had been basic and limited. In the three staff files examined, there was no evidence demonstrating that an in-house induction Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 26 had been completed or that staff had received an induction that met with the Skills for Care standards. However, since the new manager took over, she has used the provider’s recently developed induction package, to induct a new member of staff. This had been well completed. There are opportunities for staff to complete and update their training in key areas. For example, in the sample of staff files examined, there was documentary evidence that all had completed training in first aid, fire safety and health and safety. However, not all staff had completed training in infection control or food hygiene awareness. In addition, two staff had not updated their moving and handling training during the previous 12 months and there was no documentary evidence that one person had completed any training in this area. Since taking on the role of home’s manager, Mrs Thornton has carried out a staff training audit and devised a matrix which shows who has completed what training and when this next needs updating. The new manager is now in the process of arranging training updates where this is necessary. The manager is in the process of obtaining permission from people’s GPs that staff can administer over the counter medicines when necessary. A care manager who returned a survey said that staff have the right skills and experience to support peoples social and health care needs. Of the seven staff that returned surveys: • • All said the provider had carried out employment checks such as obtaining a Criminal Records Bureau disclosure before they started work at the home; Two said that their induction covered everything that they needed to know to do the job. Two said this was ‘mostly’ the case and two others only partly the case. One individual said that their induction training did not cover what they needed to know to do the job; All said that their training was relevant to their role, helped them to understand the needs of people using the service and kept them up to date with new ways of working; Four said that their manager met with them ‘regularly’. One person said that this happened ‘often’ and two others said this took place ‘sometimes;’ One said that there are ‘always’ enough staff on duty to meet people’s needs. One said that this is ‘usually’ the case and four others said that this is ‘sometimes’ the case; Three said that they felt they had the right support, experience, and knowledge to meet the different needs of people using the service. Three said that this is ‘usually’ the case and one said that it is only ‘sometimes’ the case; Three said they are ‘always’ given up to date information about people’s needs. Four said that this is ‘usually’ the case. DS0000066171.V365666.R02.S.doc Version 5.2 Page 27 • • • • • Red Admiral Court (3) Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 28 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, 38, 39, 41 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provider and new manager are taking robust action to ensure that people living at Red Admiral Court are able to benefit from a home that is well run and organised. EVIDENCE: At the time of the inspection the home did not have a registered manager. However, Mrs Thornton has since submitted an application and has successfully registered with the Commission. Mrs Thornton is in the process of completing the required management qualifications. Since taking up her post, she has completed statutory training in such areas as moving and handling, health and safety, first aid, safe handling of medication and infection control Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 29 training. Mrs Thornton demonstrated good leadership skills and had a clear vision of what improvements she wants to make at the home. Staff said that they felt that things had improved since the new manager took up post. Arrangements are in place to monitor the quality of the service. For example: • Monthly meetings involving the people living at the home are now taking place. People are being encouraged to express their views about the home that they live in; An in-house quality audit is carried out every six months. People’s views about the service they receive have recently been obtained using the provider’s ‘What Do I Think’ tool; The Community Housing Manager carries out on a three monthly quality assurance assessment. • • Since February 2008, the provider has carried out regular monthly visits to monitor the quality of services and care provided at the home. A good quality Annual Quality Assurance Assessment was submitted before the inspection. This contained robust evidence to support the self-assessment judgements that had been reached. However, the home does not have an annual development plan that takes into account the findings of the last inspection and its own internal quality monitoring systems. People take responsibility for managing their own money. Each person has access to a lockable cashbox which is kept in their bedroom. A cash book is kept and includes details of when money is put in and taken out of the tin. People’s health and safety is promoted. For example: • • • • • • • • The home’s fire alarms are regularly tested; Staff have recently received certificated fire training as well as in-house fire training. The home has a trained fire warden in place; There is a current gas safety certificate; The home’s electrical equipment has been recently safety checked and there is a current electrical safety certificate; No health and safety concerns were identified during the inspection. The new manager said that she now completes a monthly health and safety check of the entire building; The emergency call system has recently been serviced; A range of workplace risk assessments has been carried out. These are up to date; The temperature of the hot water supplied to the kitchen area was tested and found to be satisfactory. However, some concerns were identified: Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 30 • • • A clear record of when fire prevention issues have been addressed has not always been kept; Some staff had not participated in the two fire drills held during 2007; The home’s fire risk assessment has not been updated since May 2006. Mrs Thornton agreed to take immediate action to address these matters following the inspection. Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 31 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 1 2 3 4 5 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 3 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X X X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 3 2 X X 2 X Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? No 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 YA6 YA18 YA19 Regulation 15 Requirement Ensure that each person’s: 1. Needs are clearly outlined in their support plans; 2. Support plans clearly state what action staff must take to meet all of their assessed needs; 3. Support plans contain desired outcomes; This will help staff to be clear about what help and support people require and how this is to be done. 2. YA20 13(2) Ensure that: • All staff administering medication receive accredited medication training; Medication administration records are signed immediately following the administration of each person’s medication; People receive their medication in line with Version 5.2 Page 33 Timescale for action 01/12/08 01/11/08 • • Red Admiral Court (3) DS0000066171.V365666.R02.S.doc • their GPs prescribing instructions; Medication is stored in line with current guidelines and regulations. This will help to ensure that people’s health and welfare is protected by the home’s medication practices, policies and procedures. 3. YA34 Schedule 2 Ensure that there is 01/09/08 documentary evidence that two written references and a Criminal Records Bureau Disclosure check have been obtained for each person working at the home. This will help to ensure that only suitable people are employed to work with the vulnerable individuals cared for at the home. 4. YA35 18 Ensure that: • All staff have completed infection control and food hygiene awareness training; Staff records contain documentary evidence of the training they have received. 01/12/08 • This will help to ensure that people’s needs are met by appropriately trained staff. 5. YA42 23 Ensure that: • Monthly visual checks of the home’s emergency lighting and fire fighting equipment are carried out and a written record kept; Version 5.2 Page 34 01/09/08 Red Admiral Court (3) DS0000066171.V365666.R02.S.doc • Staff participate in a minimum of two fire drills per annum. This will help to ensure that people are kept safe by staff that have had the required fire prevention training. 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 YA1 Good Practice Recommendations Ensure that the home’s statement of purpose and service user guide are available in easy to read versions that can be understood by the people using the service. Ensure that: • • • • 3. YA9 A copy of the social services care plan is obtained before a person is admitted into the home; Monthly key worker reports are completed for each person People’s care records contain evidence of the ways in which they are supported to contribute to the records that are kept about them; Staff sign and date people’s care records and assessments. 2. YA6 People’s risk assessments should demonstrate how they have been consulted about the plans the home has put in place to keep them safe. Risk assessments should be signed, dated and regularly reviewed. Ensure that: • • A ‘Health Action Plan’ is devised for each person. The plan should be regularly reviewed; A nutritional risk assessment is completed for each person. The Commission recommends the MUST DS0000066171.V365666.R02.S.doc Version 5.2 Page 35 4. YA19 Red Admiral Court (3) • nutritional risk assessment; A recognised assessment tool is used to assess the pressure area care needs of the person living at the home who needs to use a wheelchair to mobilise. 5. YA20 Ensure that: • • • • All staff receive level 1 medication training as part of their induction; Staffs’ competency to administer medication is assessed and a written record kept; The home’s medication practices, policies and procedures are checked on a regular basis by an experienced pharmacist; The home’s medication administration record includes reference to any known allergies and a key to explain reasons for the non-administration of prescribed medication. 6. 7. YA24 YA35 Arrange for the garden areas to be made more accessible to people using the service. Ensure that staff update their moving and handling training every 12 months. Carry out a staffing review to ensure that: • • Staff are confident that satisfactorily meet people’s support plans; There are sufficient staff on the provider’s Sighted Guide they will be able to needs in line with their duty to safely carry out policy. 8. YA37 Submit an application to the Commission to register a manager for the service. Ensure that the manager: • • Obtains the necessary management qualifications as set out in the National Minimum Standards; Updates their statutory training in the following areas: first aid, safe handling of medication and infection control. 9 YA39 Devise an annual development plan that takes account of: • Inspection findings, requirements Version 5.2 and Page 36 Red Admiral Court (3) DS0000066171.V365666.R02.S.doc • • recommendations; Feedback from surveys completed by people using the service and their families, professionals who have contact with the home and staff; The improvements referred to in the Home’s Annual Quality Assurance Assessment and its own internal quality monitoring systems. 10. YA42 In respect of one person living at the home, ensure that their moving and handling risk assessment describes how staff support them to mobilise and transfer. Ensure that moving and handling risk assessments are reviewed at least annually or more often where people’s needs change. 11. YA36 Ensure that staff receive: • • Supervision at least six times a year; An annual appraisal. 12 YA37 YA7 Assess whether each person is able to manage their own finances and manage any associated risks. Use the single test set out in the Mental Capacity Act 2005 when assessing people’s capacity to take a particular decision and adopt ‘best interest’ principles where a decision has to be made on a person’s behalf. Consult with each person’s care manager to obtain their consent to any capacity or risk assessment conducted and any finanical care plan put in place to help staff meet people’s need for support for support in this area. 13. YA42 Ensure that: • • A clear written record is kept of when fire related maintenance work is carried out; The home’s fire risk assessment is updated annually. Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 37 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Red Admiral Court (3) DS0000066171.V365666.R02.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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