CARE HOME ADULTS 18-65
Roundtrees Roundtrees 340 Beverley Road Kingston upon Hull East Yorkshire HU5 1LH Lead Inspector
Christina Bettison Key Unannounced Inspection 15th April 2008 09:30 Roundtrees DS0000062842.V362156.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 Roundtrees DS0000062842.V362156.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. Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Roundtrees Address Roundtrees 340 Beverley Road Kingston upon Hull East Yorkshire HU5 1LH 01482 342404 F/P 01482 342404 Roundtrees@milewood.co.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) Milewood Healthcare Limited Vacant Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. That the Residential Staffing Forum hours are adhered to. The home should ensure that there is a person on duty at all times with experience in Learning Disability, this condition will be reviewed after three months of registration. That the home do not admit people who have physical disabilities or conditions which affect their mobility. 23rd October 2007 Date of last inspection Brief Description of the Service: Milewood Healthcare own Roundtrees, one of a number of homes the company owns in the area. It is registered to provide personal care and accommodation for up to 9 adults aged 18 to 65, of either gender with a learning disability. The home is on Beverley Road, a main bus route into the city centre. There is a range of local shops and amenities close by. There is an enclosed rear garden and parking is limited to nearby street parking. On the ground floor is a large through lounge and dining room, a kitchen, laundry and one rear bedroom. There is no passenger or chair lift and no wheel chair access. Private accommodation is provided in 9 single bedrooms 8 of which are upstairs on the first and second floors. The home is in the process of being refurbished to provide en suite facilities in all of the bedrooms. There is also a bathroom with WC, shower room without WC and 2 more WCs all located upstairs. Weekly fees range from £1,389 to £1,800, additional 1:1 funding is provided for some people. Additional charges are made for the following: newspapers/magazines and sweets, hairdressing. Information on the service is made available via the statement of purpose, service user guide and inspection report. Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes.
As part of this inspection surveys were posted out; three were returned from professionals that visit the home, seven were returned from staff and two returned from people who live in the home. The site visit took place over one day in April 2008. The home does not have a registered manager at present, so the deputy manager and all of the staff who were on duty on the day of the visit were spoken to and all of the people who live there and were in on the day of the visit were seen. A support manager from another home within the company has been helping the deputy manager and was at the home on the day on the visit and the area manager and new area manager visited the home and were all spoken to as part of the visit. The interactions between staff and the people who live in the home were observed to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. The inspector looked around the home and looked at records. Information received by us over the last twelve months was considered in forming a judgement as part of the inspection process. Prior to the visit the inspector referred to notifications sent to the Commission for Social Care Inspection, the event history for the home over the past year and the completed Annual Quality Assurance Assessment all of which forms part of this inspection. The site visit was led by Regulation Inspector Mrs Tina Bettison and the visit lasted 8 hours. What the service does well:
The service has helped people to maintain a stable home life after many previous placements and the people live a reasonably independent lifestyle within some agreed restrictions. Care managers told us;“they support my client to make good choices within the confines of his care plan ”
Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 6 “Whilst visiting the home,we have observed the staff being respectful and showing the individuals dignity” Some of the people that live at the home were spoken to and said they liked living at Roundtrees, some people said they would like to live more independently and that staff were helping them with this. People told us; “I would like to move on sometime and the staff will give me the support when I am ready” “ I have a menu planner and am learning to cook, I made chilli con carne last night” People said they like the staff who help them do the things they want. People have opportunities to go out and are free to spend time in the privacy of their own rooms. These have been personalised making them individual. People spoken to said they liked the food provided, are well fed and encouraged to eat a healthy diet. Staff do most of the cooking. Medicines are looked after well and staff assist people to take their medicines safely. The home is clean and safe and the environmental health team have assessed the kitchen facilities under the Food Safety Act and rated it as “A” which is excellent. What has improved since the last inspection?
Managers and staff have worked very hard to improve standards in the home and to meet the requirements made at previous inspections. All of the people that live in the home now have a thorough assessment of their health, personal and social care needs by a person qualified to do so and a copy is on their care file so that the staff know what they need to do to meet peoples needs. All of the people that live in the home now have an individual care file and care plan that has a lot of information which helps to make sure that they get the care and support they need. The plans include helping people to keep their independence, be safe and learn new skills. The staff and managers know that they need to make sure that people are protected from harm and know what to do if someone is harmed. A good Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 7 recruitment policy is in place so that on the whole staff employed are safe to work with the people that live in the home. Some of the people that live in the home can on occasions behave in a way that may present a danger to themselves and others, there are now plans in place that guide staff on how to help people to stay calm and if staff need to use physical interventions, the plans tell them how to do this. The people that live in the home and their relatives are listened to and staff make sure they take action to sort problems out quickly. Relatives are made to feel very welcome in the home. All of the people are now being helped to enjoy more planned activities that they like, both in the house and out in the community, this means they have an interesting life and do not get bored. Training has been provided to all staff to make sure all staff are up to date with basic training in basic first aid, basic food hygiene, infection control and fire awareness and special training has been provided to all staff e.g. how to deal with behaviour that may harm people or staff and to help them to meet peoples individual needs. The refurbishment of the home has started meaning that people are provided with a home that is clean, safe and comfortable and that meets their individual needs. The people that live in the home have helped to choose and shop for new furniture, decorations, curtains and carpets. Observations indicated that staff members interact very well with the people that live in the home. There was a warm and friendly atmosphere in the house during the course of the visit. The people that live in the home appeared to be much more settled in their environment and with the staff. The home now has a permanent team of staff that are trained and they are provided in sufficient numbers to meet peoples needs. Staff told us;“Since the previous manager left I feel I have a great amount of support from senior management and my support manager” “Training has been updated and courses have been arranged” “ we have dome training on stigma, equal opportunities, bi- polar disorder and ADHD” “the staffing levels have improved greatly” Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 8 “ I feel both my acting manager and deputy manager are both very approachable and I feel I have a very good working relationship with them both” “staff levels have improved over the past few months due to the recruitment of new staff” New staff joining the home have been helped to get to know the people and what their needs are and have been given basic instruction in the running of the home and the rules. New staff told us;“ I felt very well prepared to take on my new job role from doing an induction and all staff are very helpful and supportive, I have received training and advice from Roundtrees which I have found very helpful. I have a better understanding of challenging behaviour and learning disability” The system to assess the quality of care and other things in the home is now in place and everyone is asked about the running of the home, this will help to identify areas for improvements. Care managers told us;“The home communicates well with the client and care management and provides a balanced view and manages challenges safely and effectively” “my client has been disruptive and violent in other placements, because of the staffs attitude and respect for him he has not been disruptive and has had only two outbursts which were dealt with appropriately and he responded positively” “ Roundtrees has worked well for my client he has been encouraged to face his problems and deal with them. He has grown in maturity and we are impressed by the results achieved” What they could do better:
The plans that guide staff on how to help people to stay calm and how to use physical interventions need to be more individualised so that staff know what physical interventions and/or distraction techniques can be used with each person and when. All of the people that live in the home must have detailed risk assessments and they must say what staff need to do to make sure people are protected from the risk of harm.
Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 9 Peoples health needs must be assessed and the actions need to be written in a plan so that staff can meet the complicated health needs of the people that live in the home and ensure that outcomes are recorded. People living in the home need to be helped to enjoy further activities and educational opportunities so that they can reach their full potential and work towards living a more independent lifestyle. Care managers told us;“We feel that with one of the clients which we have paid an extra 8 hours per day, for the last 3 years whilst he has resided at the home, has not been developed, apart from going to the local pubs and cafes. The home could have supported this client in accessing leisure and recreational facilities in the community” “The home needs to provide more structure for my client to enable skill development and to pursue his hobbies” Staff starting work with only a POVA first must be fully supervised until their clearances come through so that people are fully protected from the risk of harm. Staff need to be given more one to one sessions with their supervisors and this should review the service being delivered to people as well as talk about performance and training and staff need to have an appraisal once a year. Care managers told us;“To build on the staff team that is in place, ensuring that individuals have regular supervision and receive relevant training courses and staff to be supported by the health teams i.e. CTLD or Mental Health” The home needs to have training plan and all staff must be provided with further special training, e.g. mental capacity act New staff need to do basic training (induction) in how to work with people with a learning disability and /or mental health needs that meets the common induction standards. The refurbishment of the home needs to continue and be completed quickly so that the people that live in the home are not disrupted and that they are provided with a home that is clean, safe and comfortable and that meets their individual needs. Care managers told us;- Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 10 “The building in which the care service operates is old and somewhat shabby, it is realised that Roundtrees is gradually being renovated and redecorated. Staff encourage residents to help with DIY and that helps their sense of ownership with the placement” Staff told us;“The building work could have been done a lot quicker but due to unforeseen circumstances it has taken longer” 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. Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 11 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 Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 12 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 5 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service. People’s individual needs are identified prior to admission to ensure that the staff have the skills to meet their needs. The home provides sufficient information in suitable formats to help people thinking of moving into the home to decide if it’s right for them. EVIDENCE: There has been one new admission to the home since the previous inspection and there are currently 6 people living in the home. At the previous inspection it was noted that some of the people that live at the home have a diagnosis of mental health needs, the home is registered to take people whose needs are categorised as learning disabled and the staff team had not received any training in the needs of people with mental health needs. The staff team have all now received training in how to meet the needs of people with a mental health need, how to deal with behaviours that may pose a challenge and all of their mandatory training is up to date. In addition to this,
Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 13 all of the people have been reviewed by the local authority and more detailed care plans have been developed. Three care files were examined and all of them contained a detailed assessment of peoples needs. The manager and staff are now fully aware of what peoples needs are and are able to meet them. Some of the people that live at the home are funded for 1;1 time, this is now recorded on an allocation sheet and staffing has been increased to 4 care staff plus managers on every shift. (See the staffing section of this report). All of the people now have an agreed contract or statement of terms and conditions that explain what the fees are, what is provided and what may cost extra. Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 14 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples needs are generally met and they have been consulted, and the quality of the service user plans and other guidance is much improved however this needs to be maintained to ensure that peoples changing needs continue to be met. EVIDENCE: Three care files were examined and all of them contained a detailed assessment of peoples needs undertaken by a person qualified to do so. Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 15 All of the people that live in the home have a care file and very detailed care plans have been prepared. A range of risk assessments and behaviour management guidelines supports these. All of the care files examined included a key information sheet, a summary of the person’s history and a detailed care plan with the emphasis on the development of independence skills and incorporating the person’s views and wishes. Self-medication assessments had been completed and people had a key to their own room. There was a range of risk assessments however some areas had not been covered, i.e. safety in the kitchen. None of the documents had been dated or signed and this needs to be addressed. FACS (fair access to care) reviews had taken place for everyone, however the home needs to ensure that these now take place on a 6 monthly basis. CPA reviews had taken place for those people that needed them. During the course of the site visit one person informed us that he wants to move away from the home to be nearer their family and this was discussed with the deputy manager and a meeting arranged with the persons placing authority. A number of people in the home have restrictions/limitations placed upon them e.g. managed alcohol consumption, numbers of cigarettes limited, people not allowed to go out without a staff member with them, but there was no evidence of how these decisions had been reached and who had agreed to them. The home need to liaise with the placing authority to determine peoples capacity to make their own decisions in these instances, there needs to be written agreements to evidence decisions taken and any limitations placed on people. If people are deemed not to have capacity to make particular decisions then a best of interest meeting must be held and written record maintained. One person has some additional funding to enable them to go out on a 1;1 with staff and a written record is maintained to evidence that this is happening in practice. In all three care files examined there was a basic health plan however there has been no input from the health authority/community team learning disability in the development of health screening or health action plans and
Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 16 there was no evidence of outcomes of monitoring of health needs. (This is detailed further in the health section of this report) In this home most of the people display behaviours that can be difficult to manage, since the previous inspection there has been a significant reduction in the number of incidents reported, staff confirmed that they feel more confident to manage these situations now that they have had appropriate training and with the new management arrangements. Staff stated that there are times when they have to use Restrictive physical interventions to protect themselves; the person and others that live in the home from the risk of harm. Plans and guidelines for staff have now been prepared that give staff guidance on how to manage difficult situations however these did not detail what specific techniques of RPI can be used for each individual and this must be addressed. In addition to this the placing authority must have agreed to specific techniques being used and evidence maintained in the home of these agreements. The homes policy and procedure for the use of RPI states that staff must have received training and this must be updated annually. 6 staff files were examined and the staff team had all received updated training, which included the use of RPI. The manager and staff are now fully aware of what peoples needs are and are able to meet them safely, however all of the improvements made in the quality of the paperwork and recording methods need to continue. Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 17 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): 11, 12, 13, 14, 15,16 and 17 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Some activities provided within the home and community mean that people have the opportunity to participate however this needs further development so that these activities meet peoples individual needs, wants and aspirations. EVIDENCE: There are 6 people living at the home. During the site visit three care files were examined and all three contained a weekly activity plan and there were records of outcomes to support whether these had actually taken place or not. The people that live in the home are sometimes difficult to motivate and have very definite views about what they like to do and how they like to spend their
Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 18 time. Manager and staff told us that they try to offer people opportunities of different activities but if people choose not to attend they have to respect this. Staff are providing some educational opportunities within the house, i.e. budgeting and cooking skills and have been trying to access some basic life skills course though the college but with little success as yet. The manager and staff need to continue to attempt to secure further activities and educational opportunities for the people living in the home to ensure that can reach their full potential and work towards living a more independent lifestyle. People undertake cleaning of their rooms and help with the communal areas (people were observed doing this on the day of the visit), they do their own laundry, go shopping, some cooking and one person attends a community centre, another regularly visits friends, one person has started going jogging and likes to spend time drawing. Families and friends are welcome to visit and some people go and visit their families in their own homes, subject to any restrictions. Observations indicated that staff members interact very well with the people that live in the home. There was a warm and friendly atmosphere in the house during the course of the visit. There were some disruptions throughout the day as the site visit upset some of the people living in the home, however staff were observed to manage this well and divert any major difficulties. The people that live in the home have their own TV, music systems and personal items in their bedrooms. Staff told us that they promote a healthy eating menu and try to balance this with people’s likes/dislikes and special treats on occasions. The staff members generally prepare the meals with people helping if they were able to, wanted to and if it was safe. People told us that they liked the food. The kitchen was clean and tidy and the environmental heath team have assessed the home under the Food safety Act and given it rating of “A” which is excellent. Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 19 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s basic health needs are generally met and the home has developed health plans, however the lack of health screening and poor quality of the health plans does not evidence that all of peoples health needs are met. EVIDENCE: Although there was evidence in all three files of appointments with the GP and for some people dentist and consultants this was not the same for all of the people. There was little evidence that people were seeing consultant psychiatrists and little community nursing or community psychiatric nurse involvement, however this was not the fault of the home as the deputy manager had been attempting for quite some time to engage professionals to provide support for a person in the home that was experiencing a period of being unwell.
Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 20 In all three care files examined there was a basic health plan however there has been no input from the health authority/community team learning disability in the development of health screening or health action plans and there was little evidence of outcomes of monitoring of health needs. We were told that referrals have been made to the community team learning disability for assistance in health screening and the preparation of health action plans. A number of people in the home have restrictions/limitations placed upon them e.g. managed alcohol consumption, numbers of cigarettes limited, people not allowed to go out without a staff member with them, but there was no evidence of how these decisions had been reached and who had agreed to them. Medication systems were not examined at this visit as they were examined at the previous visit and found to be in good order. The home has policies and procedures to cover all aspects of medicines management and to ensure that staff had the necessary guidance. Staff are about to undergo training in the administration of mediation and this must include a competency check. There were protocols in place for the administration of medication on a PRN basis and people had been assessed for self-administration of medication. At the time of the visit there was no one self medicating. Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 21 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory formal complaints system, whistle blowing policy and procedures to ensure protection of people from the risk of harm, however the home needs to develop a system of recording peoples minor dissatisfactions to ensure issues raised as concerns are looked into and resolved. EVIDENCE: The home has a formal complaints procedure. There had been no complaints to the home or the Commission for Social Care Inspection since the previous inspection. From the care files examined it was evident that a number of people in the home have restrictions/limitations placed upon them e.g. managed alcohol consumption, numbers of cigarettes limited, people not allowed to go out without a staff member with them, but there was no evidence of how these decisions had been reached and who had agreed to them. In this home most of the people display behaviours that can be difficult to manage, since the previous inspection there has been a significant reduction in the number of incidents reported, staff confirmed that they feel more confident
Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 22 to manage these situations now that they have had appropriate training and with the new management arrangements. Staff stated that there are times when they have to use Restrictive physical interventions to protect themselves; the person and others that live in the home from the risk of harm. Plans and guidelines for staff have now been prepared that give staff guidance on how to manage difficult situations however these did not detail what specific techniques of RPI can be used for each individual and this must be addressed. In addition to this the placing authority must have agreed to specific techniques being used and evidence maintained in the home of these agreements. From discussion with staff and staff training records it was evident that most of the staff including the manager and senor staff have received training or briefing on the Protection Of Vulnerable Adults Policies and Procedures and their responsibilities within this and training in how to manage behaviours, incidents of assaults between the people that live in the home are being referred to the Local authority. Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 23 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home which is safe and the refurbishment programme which is underway means that people are now living in a home which is clean and is starting to be more homely and comfortable. EVIDENCE: The home is on Beverley Road, a main bus route into the city centre. There are a range of local shops and amenities close by. There is an enclosed rear garden and parking is limited to nearby street parking. On the ground floor is a large through lounge and dining room, a kitchen, laundry, and one rear bedroom with an en suite bathroom. There is no passenger or chair lift and no wheel chair access.
Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 24 Private accommodation is provided in 7 single bedrooms 6 of which are upstairs on the first and second floors. There is also a bathroom with WC, shower room without WC and 2 more WCs all located upstairs. The home has seen major improvements since the previous inspection, a refurbishment programme is underway which has seen the small cramped downstairs office move to a empty single bedroom on the first floor, the lounge and dining room decorated and new leather suite purchased, new flooring has been laid in the dining room and the manager told us that she was just about to purchase a new dining table. The hall and landing has been redecorated and they are awaiting fitting of new carpeting throughout. All of the bedrooms will have en suite facilities when the refurbishment is complete, some of the bedrooms are completed and some are in the process at the moment. It is planned to replace all of the windows in the home once the interiors are completed. However the building work is taking a lot more time than was anticipated, some of the people that live in the home have had to move rooms whilst the work is taking place and the presence of the builders has been upsetting some people. The managers must ensure that the building work is completed more quickly so that the people that live in the home are not disrupted for more time than is necessary. The staff and the people that live there are responsible for the general cleaning of the home however staffing numbers have been increased and on the day of the site visit the home was clean and tidy albeit lived in. Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 25 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The current staffing arrangements are much improved and now provide sufficient staff to meet the needs of the people who live in the home. The recruitment and deployment of staff needs time to settle down and provide a consistent staff team to ensure that peoples needs continue to be met. EVIDENCE: The inspector was informed that the home currently has 10 staff in total, comprising of • • • • 1x deputy manager 2 x senior support care workers 6 x support workers 2 x bank support workers Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 26 The rota evidenced that staffing has increased to provide 4 support workers allocated per day shift with one of these being a senior support worker or the deputy manager post. The manager post is supernumerary however this was vacant at the time of the visit. The home currently has 6 people living at the home all of which have either a learning disability and/or mental health difficulties. Staff has the responsibility of cleaning bedrooms, bathrooms and all communal areas, supporting people to attend appointments, activities, and in addition to this attend to their care needs. Four new staff have been appointed since the previous inspection and examination of staff files evidenced that new staff had had a basic in house induction however they have not yet undertaken any induction that meets the new common induction standards. Recruitment was generally robust, however due to severe staff shortages one person had commenced employment with a POVA first and although we were told they had been supervised there were no records to evidence this. Four staff files were examined and all but one contained a CRB clearance and all contained two references. In addition to information required by schedule 2 was on file. I.e. copies of passport, driving licences, etc. Mandatory training consisted of in house packs that staff read and complete a questionnaire that the manager marks, however we were told that the company are looking to improve the quality of this training. Staff were up to date with mandatory training and had undertaken some training in mental health awareness, bipolar disorder, attention deficit disorder and equal opportunities. A training plan was not available and the home does not have 50 of staff qualified to NVQ level 2. None of the staff had had an appraisal and most staff had only had one supervision since the previous inspection. The registered person is required to ensure that mandatory training is of a good quality and that staff receive training in the Mental Capacity Act and Equality and Diversity. Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Significant improvements have been made in the development of detailed care plans, staffing numbers and competence and the provision of training, however the staff team needs stable management and time to settle down and ensure consistency and continuity for the people that live in the home. EVIDENCE: At the previous inspection it was noted that there had been significant failings in the previous management arrangements and the staffing situation at the home was in crisis. Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 28 However the deputy manager and support manager (drafted in from another home in the company) and staff have worked hard in improving the standards at the home and working towards meeting all statutory requirements from the previous inspections. Significant improvements have been made in the development of detailed care plans, staffing numbers and competence and the provision of training. (See the main body of this report) We were told that new manager has been appointed to the home and will be commencing soon. The QA process in the home has been implemented, we were told that it consist of a year long plan that includes monthly monitoring of care plans, medication systems, accidents and resulting in a summary of operations. On a quarterly basis health and safety meeting minutes and a medication audit is undertaken and on a six monthly basis a full home audit and health and safety audit is completed and submitted to H/Q. In addition to this regulation 26 visits are undertaken, staff meetings and meetings for the people that live in the home are every two months. On a yearly basis questionnaires are sent out to relatives, the people that live in the home and professionals and are evaluated by H/Q and a summary report completed. It is intended that all of this information will be incorporated within the business plan, however the results of all of the audits, surveys and business plan had not yet been completed. Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 x 2 3 4 5 CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 3 x 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 x 2 x 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 3 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score LIFESTYLES Standard No Score 11 2 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 3 x 2 x 2 x x 3 x
Version 5.2 Page 30 Roundtrees DS0000062842.V362156.R01.S.doc Are there any outstanding requirements from the last inspection? Yes 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 Regulation 15 and 17 Requirement The registered person must ensure that people are reviewed at least 6 monthly and plans are updated to reflect changing needs so that all of their needs are met as they change. (Previous timescale of 31/01/08 not met, timescale extended) The registered person must ensure that where people display behaviours that are difficult to manage or the use of restrictive physical interventions are used to prevent self harm or abuse or harm to others that this is agreed by a multi agency meeting and documented appropriately. Behaviour management guidelines must detail specific techniques to be used with each individual to protect people from the risk of harm. (Previous timescale of 30/11/07 not met, timescale extended) The registered person must ensure that staff follow the principles of the mental capacity
DS0000062842.V362156.R01.S.doc Timescale for action 31/07/08 2 YA7 13 (6 and 7) 31/07/08 3 YA7 15 (1 and 2)17 31/07/08 Roundtrees Version 5.2 Page 31 4 YA9 5 YA11 6 YA12 7 YA14 8 YA19 act and that decisions are taken in respect of peoples best interests and appropriate records maintained, to ensure that people are able to exercise choice and control over their lives. (Previous timescale of 30/11/07 not met, timescale extended) 13 and 17 The registered person must ensure that risk assessments are developed to cover all areas that pose risk to the people that live in the home or to the public and that they are maintained and reviewed to ensure people are protected from the risk of harm. (Previous timescale of 31/01/08 not met, timescale extended) 16 9M and The registered person must n) ensure that people are supported to develop their full potential and continued education and this is detailed within their plan so that all of their needs are met so that all of their needs are met. 16 (m and The registered person must n) ensure that people are supported to develop their full potential and participate in a range of activities/interests and hobbies and this is detailed within their plan so that all of their needs are met. 16 (m and The registered person must n) ensure that people are able to take a 7 day holiday or a series of one day outings as part of their contract price so that they are enabled to take a break from the home and the people they live with. (Previous timescale of 31/01/08 not met, timescale extended) 13 (1) The registered person must
DS0000062842.V362156.R01.S.doc 31/07/08 31/07/08 31/07/08 30/09/08 31/07/08
Page 32 Roundtrees Version 5.2 9 YA22 22 10 YA24 23 11 YA34 19 12 YA35 18 13 YA35 18 ensure that people’s health needs are met by the identification, planning and meeting of health needs and preparation of health action plans and access to relevant professionals secured. (Previous timescale of 31/01/08 not met, timescale extended) The registered person must keep a record of when people who live in the home raise concerns and what the home have done to resolve these concerns so that people are sure that there concerns are listened to and resolved. The registered person must ensure that the refurbishment plan is completed more quickly so that people that live in the home are not disrupted and that they are provided with a safe, comfortable and homely place in which to live. The registered person must ensure that new staff are confirmed in post only following completion of a satisfactory police and CRB check, if staff are employed with a POVA first they must be supervised at all times and records maintained to ensure that people are protected from harm The registered person must ensure that the home has training and development plan that ensures staff have the necessary training to meet peoples needs. (Previous timescale of 31/01/08 not met, timescale extended) The registered person must ensure that staff who need to are registered and working on an
DS0000062842.V362156.R01.S.doc 31/07/08 31/07/08 16/04/08 31/07/08 31/07/08 Roundtrees Version 5.2 Page 33 14 YA36 18 15 YA36 18 16 YA39 24 induction programme that meets the common induction standards so that they are competent to meet peoples needs. The registered person must 31/07/08 ensure that staff receive regular, recorded supervision meetings at least 6 times per year so that they are supported to do their jobs properly. (Previous timescale of 31/03/08 not met, timescale extended) The registered person must 31/07/08 ensure that staff have an annual appraisal to ensure staff have the necessary training to meet peoples needs. (Previous timescale of 31/03/08 not met, timescale extended) The registered person must 31/07/08 ensure that annual development plan is prepared that incorporates the results of QA activity and is available within the home so that the home can demonstrate how it is making improvements and acting in the best interests of the people living in the home. 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 2 Refer to Standard YA32 YA37 Good Practice Recommendations The registered person should ensure that at least 50 of staff are qualified to NVQ level 2 The registered person should ensure that the new manager is registered with CSCI Roundtrees DS0000062842.V362156.R01.S.doc Version 5.2 Page 34 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
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