Inspection on 16/03/07 for Respond

This inspection was carried out on 16th March 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Respond 01/03/06

Respond 16/10/05

Respond 22/03/05

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Respond 3 Priors Close St Laurence Way Slough Berkshire SL1 2BQ Lead Inspector Stephen Webb Unannounced Inspection 16th March 2007 10:00 DS0000031734.V331260.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000031734.V331260.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000031734.V331260.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Respond Address 3 Priors Close St Laurence Way Slough Berkshire SL1 2BQ 01753 554435 01753 570866 paul.nicoll@slough.gov.uk 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) Slough Borough Council Mr Paul Raymond Nicoll Care Home 8 Category(ies) of Learning disability (8) registration, with number of places DS0000031734.V331260.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st March 2006 Brief Description of the Service: Respond provides planned and emergency respite care for service users with a learning disability and their carers from mainly the Slough area. Service users aged between 18 and 65 with learning and associated physical disabilities are offered a pattern of respite care based upon an assessment of individual need. The service provides a specialist resource for those people with challenging behaviour and is increasingly being asked to provide a service to individuals with additional complex health needs. All accommodation is within single bedrooms, which are set up to meet the needs of each individual before their arrival. The service has a range of specialist aids and equipment to meet the needs of service users, including hoists, sensory equipment and adapted bathing facilities. DS0000031734.V331260.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit from 10.00am until 7.00pm on 16th of March 2007. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit, and forwarded subsequently. The report draws from conversation with the manager and brief conversation with staff members and two of the service users. Some service users had limited verbal communication with the inspector, so some time was also spent observing the interactions between staff and residents. The inspector examined the communal areas of the premises and the bedrooms, and ate lunch with residents, and made informal observations of interactions between staff and residents at various points during the inspection. What the service does well: Service users are assessed appropriately to establish that their needs can be met by the service and the provision of a service is then prioritised according to set criteria. An emergency service is also provided via one bedroom, and where changes are made to planned respite as the result of emergency, the service tries to offer subsequent alternatives. An excellent short dvd had been produced including service users, which is very helpful in conveying what the service is like, to prospective service users. Detailed care plans are produced, which include details of individual’s preferences, as well as identifying their needs. Individual behaviour management plans are produced where necessary. The manager is making ongoing improvements to case recording systems. The unit provides appropriate opportunities for social activities and community access within the context of a respite service, and supports attendance at existing day services. Service users existing relationships with parents or carers are effectively supported. Service users are encouraged to take part in daily household tasks and make decisions and choices for themselves. An appropriately healthy and varied diet is provided. DS0000031734.V331260.R01.S.doc Version 5.2 Page 6 The physical and emotional healthcare needs of service users are met within the context of a respite service. The unit manages service users medication effectively on their behalf, where they are unable to do this for themselves. The service has attempted to make its complaints procedure accessible to all of the service users or their advocates. Appropriate systems are in place to protect service users from abuse, and staff receive training on protecting vulnerable adults. Service users are provided with a homely and comfortable environment within the context of a respite care service, which is provided with specialist equipment as required to meet their needs. Service users are supported by a competent and well qualified team, who receive a good core training in order to address their needs. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000031734.V331260.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000031734.V331260.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2: Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are subject to an appropriate assessment, undertaken by the manager after being identified as potentially appropriate by the Community learning disability team. This identifies specific needs in order to provide an individual programme of respite. EVIDENCE: The unit currently provides a respite service for over sixty service users and has around a dozen new referrals. Some long-term service users do not have assessments on file, though more recent referrals have both a completed core assessment and an SSD care plan. The manager undertakes all assessments of prospective service users, with a colleague from the unit, completing a written assessment format. If a service is offered, initial visits take place within a trial period. Referrals now come via the Slough CTPLD, (Learning Disability team), though Respond continues to provide a service for some long-term clients from other areas. The manager retains a final veto on whether the service can meet the needs of a potential service user. DS0000031734.V331260.R01.S.doc Version 5.2 Page 9 Referrals have to fit strict criteria and are graded on a scale of urgency, which is tending to lead to a service user group with a widening range of additional specialist healthcare needs. The higher the priority grading, the greater the respite package offered, though each is individually tailored to the needs of the service user and their family. The unit’s bookings are planned on a quarterly basis in advance. The unit can accommodate up to eight service users at a time, though appropriate decisions are made when some clients are present, to limit the overall numbers beneath the maximum occupancy, in order to ensure that a safe and appropriate service can be provided. Staffing levels are varied on a daily basis according to risk-assessed need and may be up to 2:1 for some service users. The unit provides one emergency bed from within its maximum occupancy, and a service user on planned respite occupying this “emergency” place may have their session cancelled if an emergency arises. The manager tries to offer additional alternative stays at a later date to address this. This “emergency” bed is generally allocated for planned respite to service users whose needs are assessed as being of a lower priority, in order to try to minimise the potential disruption. Often the missed session is re-booked at the time with the family. The unit has an excellent short video/DVD, which is taken out on assessment home visits, to show the prospective service user what Respond has to offer. The service supports service users around transitions in their permanent placements and had recently accompanied a service user on a visit to a supported living scheme, and was an active participant in the transition planning process. DS0000031734.V331260.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs, abilities and goals of service users are reflected in the care plans and related documentation, and the manager is working to develop and improve care planning documentation and recording systems for the benefit of service users. Service users are supported to make day-to-day decisions during their respite stays at “respond”, and are enabled to look after their own funds if they are able to do so. Where the unit manages funds on their behalf, an appropriate, auditable system is in place for this. Service users are supported to take risks within an individualised risk assessment framework. EVIDENCE: Care plans were examined for three service users. These were detailed and client-centred, and were dated and signed. The care plan for another recent DS0000031734.V331260.R01.S.doc Version 5.2 Page 11 referral was still being updated as the service became more familiar with their needs, and included appropriate cross reference to risk assessments. Although the care plans identify the abilities of service users as well as their preferred activities and day-to-day involvement in unit tasks, the manager is developing an improved ”likes and dislikes” format, to be completed face to face with each service user. This is a positive development. The manager is also planning to develop individual monthly summary formats, (which would be supported by an improved individualised daily record format), and a new care plan goals format, to help focus the work of all staff on identified developmental goals. Individual behaviour management plans were in place where appropriate, as were epilepsy management guidelines, moving and handling guidelines and procedures in the event of seizure. Case files include appropriate individual risk assessments, with evidence of periodic review, though they ought to be signed by the author. There was evidence of reviews on file, though copies of the most recent social services review were not always present. The individual daily records made on each service user during their respite stays, include a good level of detail. However the current format limits the ability to obtain structured and systematic information. The manager agreed that a more individualised and targeted format might be beneficial. Service users come in with sufficient spending money for their stay, which they can retain if able, in a lockable cabinet in their room, or alternatively the unit will look after the funds on their behalf, in separate envelopes, and make it available when required. Where the unit manages a service user’s money, it is logged in on arrival, on an appropriate individual in/out/balance sheet, and out when returned to the client or their carer. Copies of the record sheet are retained in the home, and the original passed to the carer with any receipts for expenditure. The unit clerical officer audits these records. Two service users confirmed they enjoyed coming to “Respond”, and observation during the inspection indicated that staff had developed positive working relationships with service users, and encouraged them to make choices about their lives. One service user had decided not to attend their planned day-services on the day of inspection, and this decision was supported, even though “Respond” does not provide its own day-care as part of the service. The staff were DS0000031734.V331260.R01.S.doc Version 5.2 Page 12 observed to work effectively with this individual, in supporting her to manage her own anxiety, until her carer collected her later in the day. Conversation with staff indicated they had a good awareness of individualised care and were familiar with the needs of the service users present and due in later that day. DS0000031734.V331260.R01.S.doc Version 5.2 Page 13 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): Standards 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. The unit provides service users with appropriate opportunities for social activities and community access within the context of a respite service, as well as supporting their attendance at day services during their stay. Service users existing relationships with parents or carers are also supported, and known friendships between individuals are supported through the matching of some respite sessions where possible. Service users are supported and encouraged to take part in daily household tasks and make decisions and choices for themselves. An appropriately healthy diet is provided together with the availability of daily choices to ensure that meals meet the needs of service users. DS0000031734.V331260.R01.S.doc Version 5.2 Page 14 EVIDENCE: The unit itself does not provide day-care but each individual has a day-care package in place via external providers. If a referred individual does not have day services in place, these are either sought via the care manager prior to commencement of the service or, the individual can only access overnight or weekend respite care, until such time as they are in place. The unit has a people-carrier to provide for transport needs, and there were five drivers plus the manager within the team at the point of inspection. One service user confirmed that they enjoyed their stays in the unit, and had plenty of freedom to choose how they spent their time. Examination of the daily notes indicates that service users have good access to the community via their day services and also in the evenings and weekends whilst at Respond. They visit local pubs, shops and restaurants as well as the cinema, and the facilities of Slough town centre are a short walk away. The diverse staff team will support service users to meet their spiritual needs at local places of worship, where these are identified. Service users have ongoing contact with their family/carers since Respond is only a respite service, and they can make contact during respite stays where appropriate. The service maintains positive relationships with service users families/carers and offers a responsive service with a degree of flexibility, to support them. Where service users develop friendships, the service tries to offer some matched respite, where possible to support this. Service users are encouraged to take part in daily routines and household tasks, such as meal preparation and cleaning. They are able to choose whether to involve themselves in planned and impromptu activities and whether they wish to be with the group or spend time alone or with staff. Given the changing population of the unit it is hard to provide a menu tailored to individuals, but there is an eight-week rolling menu, available in pictorial form, which is discussed within weekly service user meetings to try to ensure it reflects the likes and dislikes of the service users as much as possible. The service acknowledges it cannot provide for a diet including Halal meat, but provides an appropriate vegetarian option instead, as well as another choice at main meals. Some service users are involved in the weekend food shopping. Feedback from one service user was positive about the food provided. DS0000031734.V331260.R01.S.doc Version 5.2 Page 15 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): Standards 18, 19 and 20: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported in ways that meet their needs and any identified preferences, and additional information on the likes and preferences of individuals, is to be sought via new questionnaires being developed. The physical and emotional healthcare needs of service users are met within the context of a respite service. Service users are assessed on their ability to manage their medication and where this is not possible, the unit manages this effectively on their behalf. EVIDENCE: Where identified as necessary to support individuals, detailed behaviour management plans are devised for specific behaviours to support the individual in finding alternatives to negative behaviour. The plans sampled indicated regular review and instances where the management plan was utilised, were recorded in ABC charts to facilitate monitoring of effectiveness. DS0000031734.V331260.R01.S.doc Version 5.2 Page 16 Guidelines are also in place for moving and handling where the needs of individuals necessitate this level of support. The unit is able to influence the funding of additional staffing resources to support individuals where necessary at up to a two-to-one staffing ratio. The need for increased staffing ratios and further specialist training is likely to grow, as the manager identified an increasing demand for support for individuals with complex behavioural and healthcare needs. In one case the unit is involved in the transition planning and in supporting the transition of a service user into supported living and recently supported them during a visit to the scheme. In the past year, the unit has supported around a dozen service users to move on from regular respite support, though occasional ongoing outreach support has been offered to some service users and their carers after they have moved on from Respond. The various care guidelines and plans included reference to the likes and preferences of individual service users around how they are supported, and as already noted, the service is developing a ‘likes and dislikes’ format to obtain this information more systematically. Any necessary specialist items such as adapted chairs etc. also come and go with the individual from home, though the service does have some specialist equipment such as hoists and has ordered additional items, including another adjustable bed. From case tracking it was clear that the incident records for one service user have been tracked and analysed via ABC charts and a behavioural therapist has been consulted to support the service in meeting the individual’s needs. Observation during the inspection indicated that the staff were effective in managing the evident anxiety of one service user, and used various techniques to engage them in constructive activity to occupy their time, whilst waiting to be collected to return home. Staff also demonstrated a good understanding of various de-escalation techniques, and confirmed they had received specific training in these areas. The majority of service users’ routine healthcare needs are met during the time when they are living at home with parents/carers, though support for planned appointments during respite stays would be provided. Prescribed medication is also managed during respite stays, where risk assessment indicates that the individual cannot manage this for themselves. DS0000031734.V331260.R01.S.doc Version 5.2 Page 17 Where necessary, individual epilepsy guidelines were also in place and subject to review, though the unit policy is to summon an ambulance, should certain types of seizure occur. At present the service is unable to meet the needs of service users with some specific healthcare issues, and the manager is clear about those that fall within and outside their current remit. Medication is managed effectively, with only that needed for the duration of the planned stay being delivered to the unit, in original pharmacist-labelled containers, to ensure the correct dosage and other administration instructions. The service uses typed MAR (Medication Administration Record) sheets, and two staff book in and record the quantities of all medication coming in and out, and sign for administration. Any medication changes are detailed in a letter from the GP or family. Should a stay be extended, the service obtains additional medication direct from the service user’s GP. DS0000031734.V331260.R01.S.doc Version 5.2 Page 18 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): Standards 22 and 23: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The views of service users and others are listened and responded to. The service tries to make its complaints procedure accessible to all of the service users or their advocates. The unit had also received a large number of complimentary letters and cards from service users families, about the service provided by Respond. Appropriate systems are in place to protect service users from abuse, and staff receive training on protecting vulnerable adults. EVIDENCE: The service has an appropriate complaints procedure and format and also has a more accessible “Your Shout” format, with happy and sad faces and pictures to support the explanation of the procedure to service users. The procedure is also posted in the unit and is available in other languages and formats. The complaints log indicated four complaints since the previous inspection in March 2006, one of which was subsequently determined to be a POVA (protection of vulnerable adults), issue, rather than a complaint as such, and investigated via more appropriate channels. The three complaints had been appropriately investigated and records included a detailed report of the investigation and outcome by the manager. One of the complaints was raised directly by a service user. DS0000031734.V331260.R01.S.doc Version 5.2 Page 19 The issue identified as relating to the protection of vulnerable adults was also investigated appropriately. The unit also maintains a file of compliments and thank you letters received about the service, from families and others, and it was evident that these were numerous. The unit has an appropriate policy/procedure in place for safeguarding vulnerable adults. All of the staff have received training on safeguarding vulnerable adults in some form, though for some this was up to three years ago. POVA training is recognised as a core skill and the manager had put forward all staff for updates at appropriate levels for this training within his 2006/7 training needs analysis, and some have already attended this. There are a number of scheduled vulnerable adults training courses planned throughout 2007 and the manager confirmed that all staff will attend at least one of these courses in the period. The manager reported that their aim was for annual updates of this training for all staff. DS0000031734.V331260.R01.S.doc Version 5.2 Page 20 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): Standards 24 and 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with a homely and comfortable environment within the context of a respite care service, which is provided with specialist equipment as required to meet their needs. Standards of hygiene are good and the home has appropriate laundry facilities. EVIDENCE: The premises comprises of two linked units that are more or less mirror images of each other. Though they are linked, they can be separated to enable more intensive support of one or more service users on one side, while the needs of others are met separately in the other unit. This increases the flexibility available where individuals are present, whose behaviour may challenge the service or who need a higher staff ratio. DS0000031734.V331260.R01.S.doc Version 5.2 Page 21 Each half of the unit has a lounge diner which is pleasantly decorated and homely, and equipped with TV/dvd and hi fi. These areas were well furnished, and the manager indicated that additional items of furniture were on order. Independent mobility about the unit and staff monitoring of individuals, is aided by an integrated system of electronic fire door holdbacks, which allows the connecting doors to be held open during the day, when needed, but will close them automatically in the event of the fire alarm being triggered. There are two bathing facilities available, one of which is a standard bath and toilet, the other a parker bath, wheel-in shower and toilet. Some hoists are available to meet individual needs and one bedroom is equipped with a modern adjustable hospital-type bed, with another on order. The bedrooms are pleasantly decorated and are set out and equipped to suit the needs of the incoming service user prior to their arrival, including any specialist equipment such as hoists, as well as what furniture, pictures etc. are appropriate to their needs. The standards of hygiene were good and each half of the unit has appropriate laundry facilities. The exterior window frames were in need of repainting, which was reported to be scheduled for this year, and some carpets are due to be replaced. Overall, the premises meet the needs of current residents effectively though additional adaptations may be needed in the future if the unit begins to provide a service for individuals with specialist healthcare needs. DS0000031734.V331260.R01.S.doc Version 5.2 Page 22 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): Standards 32, 34 and 35: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by a competent and well qualified team, who receive a good core training in order to address their needs. The manager has identified some future training needs reflecting the increase in referrals with specialist healthcare needs. Existing recruitment records, available within the unit, were insufficient to satisfactorily evidence the rigor of the system, and should be brought up to an appropriate standard, in order to show that they offer sufficient protection to service users. The manager was confident that required checks had been done and that the records were held in the human resources department. EVIDENCE: The unit has a core of experienced long-term staff and a low rate of staff turnover, with no staff having left since the last inspection. Permanent sessional-workers are used to provide the flexibility needed to staff a respite service where the staffing levels vary with the assessed needs of each different group of respite clients. Some regular agency staff are also used to support DS0000031734.V331260.R01.S.doc Version 5.2 Page 23 this flexibility, covering the four FTE vacancies, though there is a current recruitment drive for permanent and sessional workers for these posts. All but one of the current staff, (including the night staff) has NVQ level 3 or above. Observation of staff interactions with service users during the inspection indicated a calm, relaxed approach and awareness of a variety of distraction and de-escalation techniques. There was evidence of warmth and humour in the interactions observed. A skills training profile is in place for the staff and the manager prepares an annual training needs analysis for the service as part of the cycle of planning. Copies of training certificates are held on file within individual training profiles, thought these needed some work to bring them up to date. Consideration should be given to maintaining an overall staff training spreadsheet as a means of monitoring training updates. The management of challenging behaviour is central to the work of the unit and all staff receive specific training over three days on this, based on nonaversive, low arousal techniques, which is supported by annual refreshers. The training is based on avoiding the need for physical intervention, and where this is the only option, the physical intervention being minimal and respectful of individuals dignity. The training identifies the role of challenging behaviour as a means communication for service users, and aims to help staff understand their own influence on the behaviour of service users. Staff receive a good core training package which equips them well to support the needs of service users. The core training includes first aid, with senior staff having attended a three-day course and others obtaining the one-day certificate. Other core training includes health and safety, moving and handling, fire safety, medication and food hygiene. The manager has identified the potential need for additional training to meet the increasing specialist healthcare needs of new referrals. Within shifts the staffing levels are based on the accumulation of individual staffing risk assessments for the group present at the time. Where two to one staffing is agreed for an individual the overall number of service users may be reduced in order to ensure effective management of individual’s needs. Since there have been no new recruits to the unit in three years, the recruitment records may not be a reflection of current practice in the authority, but examination of a sample of existing staff recruitment records indicated some shortfalls in the information available. DS0000031734.V331260.R01.S.doc Version 5.2 Page 24 The manager was confident that the required checks had been done and suggested that the records were held in the authority’s central human resources department. The manager should ensure that copies of the required evidence of vigorous recruitment checks, or an appropriately detailed checklist thereof, is obtained for all existing staff and held securely in the unit for inspection. DS0000031734.V331260.R01.S.doc Version 5.2 Page 25 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): Standards 37, 39 and 42: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from an effectively managed service, that addresses their individual needs, within a planned but flexible respite programme. The views and involvement of service users are sought in a variety of ways, though there is a need to undertake more regular quality assurance surveys to monitor the satisfaction of service users and others interested parties on a more regular basis, and to report the findings back to participants. The health, safety and welfare of service users are promoted for the most part, though the unit’s fire risk assessment needs to be updated to ensure it maximises the protection of current service users. DS0000031734.V331260.R01.S.doc Version 5.2 Page 26 EVIDENCE: The service is managed by an appropriately experienced, qualified and competent manager who delegates tasks appropriately, to members of the staff team. The manager has a CSS, PQ1, the Registered Manager’s Award, a CMS and a practice teaching qualification. The unit addresses the individual needs of service users within a planned but flexible respite programme. A quality assurance survey was undertaken in March 2005, including questionnaires to service users and their families/carers, which were provided in a format supported by pictures, and were sent out with SAE’s to encourage their return. The results were assessed and a summary report was produced, though this was not circulated to participants and was written more for a management audience. The service should undertake quality assurance surveys annually and ideally provide a more accessible summary of outcomes to participants. The survey should also be broadened out to include other interested parties such as care managers and any regularly involved external healthcare professionals. Some of the service users are also involved in undertaking the second interviews of potential staff, with advocate support, once they have undertaken prior training. Weekly service user meetings are held on Sundays, so most service users have the opportunity to attend at some point, and the minutes are provided in text and “Picture Bank” image format to make them more accessible to service users. The minutes include evidence of service user consultation and choice and the exploration of likes and dislikes. The provider undertakes Regulation 26 monitoring visits, though these did not take place during four months since the last inspection. It is important that these visits take place monthly as they are part of the monitoring of the service to ensure the welfare of service users. The authority undertakes financial audits every three years, and a business action plan, (development plan), was in place for 2004/5, but needs to be produced annually. DS0000031734.V331260.R01.S.doc Version 5.2 Page 27 The manager undertakes monthly health and safety inspections and completes a checklist to record findings. This includes monitoring of the number of accidents to residents. Copies of accident forms are now filed in individual service user’s files, though this has not always been the case, and the manager retains copies of all accident forms within a file as a collective record. A sample of health and safety-related service certification was examined and indicated regular servicing, though in some cases the current certificate was not present, and the information was obtained through other records. The provider should ensure that copies of relevant health and safety certification are available within the unit. A fire risk assessment was present but was dated June 2004. This document should be reviewed to ensure it addresses any current fire safety issues, given the changes in service users since it was written. Some individual risk assessments were in place for service users who wish their bedroom door to remain open at night, though not routinely where individuals have tended not to evacuate in the event of fire drills. The advice of the fire officer should be sought in this instance, but it is suggested that an individual fire evacuation plan should be compiled for any individuals who are unwilling or unable to evacuate unaided. DS0000031734.V331260.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 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 3 3 3 X 3 X 2 X X 2 x DS0000031734.V331260.R01.S.doc Version 5.2 Page 29 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. Standard Regulation Requirement Timescale for action 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 YA34 Good Practice Recommendations The manager should ensure that copies of the required evidence of the recruitment process undertaken for all staff, or an appropriately detailed checklist thereof, are obtained for all existing and future staff. These should be held securely in the unit for inspection; in order to demonstrate that the welfare of service users is promoted and protected by the recruitment process. 2 YA39 The service should undertake quality assurance surveys annually and should provide a more accessible summary of findings to participants. The survey should also be broadened out to include other interested parties such as care managers and any regularly involved external healthcare professionals. DS0000031734.V331260.R01.S.doc Version 5.2 Page 30 3 YA39 The provider is required to undertake regulation 26 monitoring visits on a monthly basis. The manager/provider should produce an annual development plan outlining proposed developments of the service, as part of the ongoing cycle of annual review and service development. The fire risk assessment should be reviewed as a priority and annually thereafter, to ensure it reflects the service and the needs of its current users. The advice of the fire authority may be beneficial regarding evacuation plans. 4 YA39 5 YA39 DS0000031734.V331260.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000031734.V331260.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!