Inspection on 24/04/07 for Safe Harbour Care Home

This inspection was carried out on 24th April 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 found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Safe Harbour Care Home 28/02/06

Safe Harbour Care Home 29/06/05

Safe Harbour Care Home 07/12/04

Safe Harbour Care Home 06/04/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Safe Harbour Care Home 254 Hagley Road Stourbridge West Midlands DY9 0RW Lead Inspector Jayne Fisher Key Unannounced Inspection 24th April 2007 09:15 Safe Harbour Care Home DS0000046649.V330004.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 Safe Harbour Care Home DS0000046649.V330004.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. Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Safe Harbour Care Home Address 254 Hagley Road Stourbridge West Midlands DY9 0RW 01562 888125 01562 888152 juliett.prodger@btconnect.com 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) Safeharbour Juliet Prodger Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 Service user aged 17 years Date of last inspection 28th February 2006 Brief Description of the Service: 254 Hagley Road, known as Safeharbour, is a large detached building recently converted to provide accommodation for seven younger adults with a learning disability. The Home was Registered on 4 August 2003. It is situated in a residential area, on a main road in the Pedmore district of Dudley borough, with good access to community facilities and public transport. The building is set back from the road with off road parking for several vehicles and an enclosed area to the side of the property and level rear garden. The facilities include seven single bedrooms, well in excess of the minimum space requirements, all with wash hand basins. The services and facilities were set up with specific service users in mind and as a result of risk assessments carried out many weeks prior to each individuals admission to the home, there are currently no en suite facilities. Each room contains the pipe work and space to install en suite facilities should any service user be reassessed as being able to safely make use of such facilities in the future. There are adequate toilet and bathing facilities provided throughout. Individual bedrooms have been personalised with service users own belongings and with décor and furnishings of their choice. In addition there are three communal rooms, two with a television and one without. The Home was set up from the starting point of the needs of the service users who were known to be moving into the home, the service and facilities were developed to meet those needs. A statement of purpose and service user guide are available to inform residents of their entitlements. Information regarding fee levels was made available by the provider in April 2007 and are between £1814.82 - £3684.52 per week. There are additional charges for toiletries and hairdressing. Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between 09.15 a.m. and 6.30 p.m. and was undertaken by one inspector with the home being given no prior notice. A second inspector visited on the following day to look at medication. We spoke with the manager, six staff members and met the residents who live at the home. One of the residents was happy to talk to us and showed us his bedroom. One resident was able to complete a questionnaire without assistance from staff. Questionnaires were received from five relatives and seven visiting professionals. We looked around the home, examined records and observed care practice. We also looked at all of the information that we have received about this home since it was last inspected. What the service does well: Safeharbour provides a highly specialized service with a team of expert staff who know how to meet the specific needs of people who have autism. We saw staff being able to easily communicate with residents, supporting with them visual cues and sign language to aid their understanding. Staff ensure that residents have a clear structure to their days and are enabled to follow their preferred routines in order to reduce their anxiety. There is a very large staff group who work in teams of dedicated workers for each resident which results in people leading stimulating and meaningful lifestyles with plenty of access into the local community in order to undertake interesting activities. Great care is taken in ensuring that residents are matched with staff who they like and want to support them. The atmosphere in the home was relaxed and friendly. We saw staff treating residents with dignity and respect; they were patient and showed great understanding of their individual needs. Staff carefully monitor the health care needs of residents and react promptly when they identify a problem. They enable residents to have access to a wide range of specialists and have developed good working relationships with other professionals. We saw that the home is clean and fresh. It is decorated and furnished to meet peoples’ needs and minimize their anxieties. Residents’ bedrooms are individually decorated, contained lots of their personal possessions and were safe environments. There are robust recruitment and selection procedures to ensure that residents are safeguarded and protected. Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 6 Safeharbour is run by a highly skilled and competent manager who is very supportive of her staff and is dedicated to providing the best possible opportunities for residents to be safe and happy. All relatives and visiting professionals praised the management and staff highly. Their comments are included through out this report and include: “Safeharbour is the best residential home I have the pleasure of working with” and: “This kind of care should be encouraged to expand. I am sure Safeharbour can do the same great job on a larger scale. We are lucky our son is in such a good place”. 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. Safe Harbour Care Home DS0000046649.V330004.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 Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service user guide are comprehensive providing residents and prospective residents with details of the service the home provides enabling an informed decision about admission to be made. A large amount of time and effort is spent in making sure that staff can meet the needs of new residents before they are admitted. All people who use the service receive a contract which gives them clear information although these would benefit from extra details regarding additional charges. EVIDENCE: We saw a copy of the statement of purpose and service user guide. These are very informative and have been produced in different formats to assist residents in understanding about the services they are entitled to. We looked at records held for one new resident who was admitted to the home in January 2007. There were lots of assessments undertaken by other professionals. Staff from Safeharbour had visited the resident six months prior to their admission on a twice weekly basis in order to gradually get to know the person and their needs. There were detailed records of these visits. Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 9 There were on-going assessments currently being undertaken by staff which the manager said had not yet been fully completed in order for a full range of care plans to be developed. The manager explained how she takes part in the assessment process of new residents but admitted that she does not complete a written pre-admission assessment tool; she agreed that this would be a useful aid to show her involvement in this process. A visiting professional involved in the placement of the new resident has commented: “my client has only been at Safeharbour since 3 January 2007, but so far I have been extremely pleased with the service provided”. We looked at residents’ contracts and these have been expanded to include all of the information required by the National Minimum Standards. There are details of how much fees are paid by the Council for residents to live at the home. However, these did not contain all of the extra charges that residents have to pay for such as activities at weekends and evenings. Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are comprehensive tools used by staff to assist them in providing support to residents. The plans are person centred and focus upon the individual’s strengths and personal preferences. Residents are enabled to take risks as part of every day living and this is managed in a constructive and supportive manner. EVIDENCE: We looked at care plans and talked to staff. They were very knowledgeable and were clearly familiar with the content of residents’ care plans. The care plan format was devised with other health care professionals; the result is a concise and practical tool for staff. Assessments are kept under regular review in order to ensure that care plans are relevant and reflect the needs of residents. Care plans cover a wide range of subjects and are reviewed within multi-disciplinary teams. Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 11 Care plans are person centred and these have been developed using different approaches such as establishing ‘life story’ books and circle of friends. The manager told us that she has tried to reproduce care plans in formats suitable for residents but apart from using some photographs and pictures, has struggled to identify formats which are meaningful for residents, despite speaking with other professionals. Further strategies were discussed and the manager said that she would explore these further. All five relatives stated that they felt they (and their family member) were usually or always given information to support them to make decision. One comment included: “they find out as much as they can about the person who needs to be cared for and do everything in their power to make life interesting, busy and fun for them”. A visiting professional told us “the home continues to provide the highest standards of care and support to my client within clearly modelled person centred approaches. This is one of the best residential service I work within the borough”. Only a couple of areas need improvement. Although the new resident had been living at the home since early January 2007, they had no care plans in place apart from behavioural management guidelines. The manager told us that this was because staff were still assessing needs. However, in the short term, temporary care plans should be in place particularly as strategies had been devised to help improve eating and weight loss. Another resident had been following a healthy eating regime because of weight gain but there was no care plan in place regarding nutrition to demonstrate how staff supported him. There are very useful monthly key worker reports completed which demonstrate that care plans are monitored. However, care plans are formally reviewed on a twelve monthly basis and this should take place six monthly in accordance with the National Minimum Standards. We saw that case files contained detailed communication packages which had been devised with the help from speech and language therapists. We saw that staff communicated well with residents using their preferred methods such as Makaton. There are details of advocacy services displayed on the notice board in the home and these have been reproduced in a pictorial format. The manager remains appointee for two peoples’ finances and told us that she still needs to arrange for an independent auditor to visit the home. We saw that there are detailed risk assessments in place. A comprehensive rating code is used by the manager which results in a easy to use ‘traffic light’ system in order to determine whether a particular risk justifies further assessment. Difficulties experienced by residents with autistic spectrum Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 12 disorders and how these can create problems for others in trying to interpret behaviour, are fully recognised such as communication, socially inappropriate behaviour and aggression. All behaviours and implications are fully assessed. Risks associated with the environment, community and medication are also examined. Safe Harbour Care Home DS0000046649.V330004.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): 12, 13, 15, 16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. Daily routines promote independence and staff fully respect and promote residents’ rights. Residents are able to choose what they want to eat however staff need to monitor this more carefully in order to try and encourage more healthy eating. However upon pointing this out, management had already started to introduce changes. EVIDENCE: We saw that residents had individualised activity programmes in place which demonstrated a wide range of stimulating and therapeutic activities within the community and home. There are monthly key worker reports completed that summarize the outings and activities undertaken by the resident. There are separate detailed guidelines for staff to help them plan activities for residents. There is comprehensive monitoring and evaluation of all activities undertaken Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 14 so that staff can measure whether or not they meet the needs and individual preferences of the resident with excellent records maintained. During the day we saw residents going out on various trips into the community and helping around the home with housework tasks. We spoke with one resident who had a picture board in his bedroom to help him understand who was going to support him during the day and what activity he would be undertaking. Staff had taken photographs of his preferred activities and he showed us what he liked to do which included going to college, visiting the pub, going to the gym and helping to cook. One resident who completed a questionnaire confirmed that he could choose what he wanted to do during the day time and at weekends. He said that he was always given choices. Feedback from five relatives confirmed that their family member was assisted by staff to keep in touch with them. One person commented: “our son has changed so much. He is more sociable and outgoing. He is living a ‘life’ at Safe Harbour”. Another stated: “they teach the clients life skills and give them as normal a life as possible”. All five relatives felt that the care home gives the support to their family member that they expect them to receive and that they support people to live the life that they choose. We talked to staff who demonstrated an in depth knowledge of residents’ individual preferences regarding daily routines which is supplemented by comprehensive care plans. We saw that residents are able to have keys to their own bedrooms and are able to access all parts of the house unless there is a health and safety risk. At a previous visit we asked the manager to introduce a nutritional screening tool. The manager has not found a suitable tool so as a compromise has agreed that regular calculations of people’s ideal body weight are carried out and recorded. We saw that menus are based upon residents’ individual food preferences which are clearly recorded within their case file. On a regular basis these are reviewed to ensure that they are still applicable and taster sessions have been used. We saw that each evening one resident’s preferred evening meal will be cooked along with two other options for the remaining residents to choose Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 15 from. We looked at food records and saw that some residents have a high fat and highly processed diet. Management stated that this is because they particularly like this type of food but said that staff were supposed to be monitoring this so that healthy eating options could also be encouraged. This is not always taking place. The housekeeper explained that some times residents will help themselves to all three meal options which are provided for the evening meal and staff will also serve residents some of each meal. Management agreed that monitoring strategies need to re-established so that staff check to see what residents have eaten and introduce healthy options to compensate for some of the high fat and processed foods they like. Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Personal support is offered in such a way as to promote residents’ privacy, dignity and independence. The health needs of residents are very well met with evidence of good multi-disciplinary working taking place regularly. The management of medication within the service is of a good standard. EVIDENCE: We saw that there is a person centred approach to providing residents with effective personal and healthcare support. There is a large team of both male and female staff. When we interviewed staff they stated that they were carefully matched to working with individual residents in small teams. We saw that residents enjoyed good relationships with their carers by looking at their body language and facial expressions. When we asked one resident if he had any friends he pointed to a staff member (one of his key workers). There are copies of the gender policy held in residents’ case files. We have asked the manager to record whether or not residents’ prefer male or female staff to help them with different aspects of their support needs. Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 17 We saw lots of records to confirm that residents have access to a wide range of specialists. There is very good monitoring and recording methods used by staff. They react promptly upon identifying any area of concern by seeking further advice from the relevant specialist. The psychiatrist visits and sees all residents every two to three months. Each resident has a ‘Priority for Health Screening’ booklet in place. One resident who was able to complete a questionnaire stated that staff treated him well and that they always listened and acted upon what he said. All seven professionals who completed comment cards stated that the home communicates clearly and work in partnership with them. They state that there is always a senior member of staff to confer with and that they can see the resident in private. They all say that if they give any specialist advice that this is incorporated into the care plan. All feel satisfied with the overall care provided within the home. One professional commented: “staff are always welcoming and appreciative of specialist input. The service users are treated with the utmost respect and their best interests considered at all times. Any decisions regarding changes in care are discussed with all concerned. Safeharbour is the best residential home I have had the pleasure of working with”. 5 relatives who completed comment cards stated that they felt that the service meets the different needs of residents. One person stated “this kind of care should be encouraged to expand. I am sure Safeharbour can do the same great job on a larger scale. We are lucky our son is in such a good place”. The pharmacist inspector assessed the control and handling of medication in the service. Medication procedures, storage and records were seen. The home has a good relationship with the supplying pharmacy. All service users have their medication reviewed by a multidisciplinary team at least every three months. This is good practice and ensures all service users healthcare needs are safeguarded. Medication was secure and locked within a dedicated locked cupboard. Medication requiring refrigeration was placed inside a locked container in the refrigerator. The medication keys were held by the person in charge to ensure safety. Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 18 Medication is administered to the service users by trained care staff who have completed a ‘Safe Handling of medication’ accredited course. None of the service users looked after their own medication. A comprehensive and detailed medication policy was available in the office, which staff could easily access. It was last updated in February 2007. Staff have signed to agree to follow the policy. Management would take disciplinary action if the medicine policy was not strictly followed. This ensures service users are safeguarded by a written medicine procedure. Up to date records for the receipt and disposal of medication were available. The home also completed their own daily medication checks to ensure medication had been recorded and also to ensure the service user had received their correct medication. One medication audit was undertaken at the inspection, which was correct. This showed evidence of good practice. All of the medicine record charts were seen, which recorded the administration of medication to service users. Some of the medicine records did not clearly indicate who had administered medication, particularly for service users who went out of the home during the day or for the application of creams and ointments. This was discussed with a team leader during the inspection and it was agreed that action would be taken to ensure all records were accurate. Some service users went home for social leave and required medication to take home. Currently the home provides any medication in the form of secondary dispensing from the original container into another second container to take home. A protocol and records were available to ensure the safe supply of medication. It was recognised by the home that this was not best practice and they intend to discuss this with the supplying pharmacy to ensure safe practice. Two service users care plans were seen. There were both up to date regarding service users medication requirements. Detailed protocols for the administration of medication to be administered when necessary were available. This was good practice. Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear and effective complaints procedure thereby reassuring people that their views are listened to and acted upon. The service has policies, procedures and practices in place which offer residents suitable safeguards from abuse. EVIDENCE: No formal complaints have been made to the home or to the Commission for Social Care Inspection within the last twelve months. We saw that two concerns have been raised with regard to car parking by neighbours and a personal support issue by a relative which were recorded in the complaints log. The manager had treated these as formal complaints and had responded to them as such, which is a good initiative. All seven visiting professionals state that they have not received any complaints about the service. All five relatives completing comment cards state that they know how to make a complaint. One relative stated: “the manager is always contactable for any problems and will always sort out any difficulties. I have great faith in her abilities”. Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 20 Another stated: “they always listen and are very understanding of our family’s circumstances”. We spoke with staff who gave us good responses as to how they would deal with any potential incidents of abuse and understood the principles of Whistle Blowing. The manager told us that all staff have now received training in vulnerable adult abuse awareness and we saw training certificates in staff files. On a very occasional basis staff may have to physically restrain a person if they are in danger of hurting themselves or others. We saw that good records are maintained regarding these incidents and there are detailed behavioural support plans in place as agreed by a multi-disciplinary team. We saw that not all staff have yet received training in managing challenging behaviour and physical interventions but the manager told us that this is due to take place in June 2007. The manager told us that the trainers are seeking accreditation with the British Institute of Learning Disabilities (BILD) for physical interventions trainers as they do not currently hold this award. We looked at the systems in place to manage residents’ finances. We found these to be robust with regular audits undertaken by staff on a daily basis and detailed records of residents’ financial transactions and receipts obtained by staff for purchases made. We found that one resident’s money did not balance accurately with records maintained. The resident was found to have an extra small amount of money in loose change. The manager agreed that the records needed to be adjusted to show this extra amount of money. When looking at records we saw that residents pay an occasional small contribution towards fuel costs for a car owned by one resident. The manager told us that this had been formally agreed within a multi-disciplinary team and explained how this is done fairly between the residents. We suggested that a written protocol be established for staff to follow regarding this process. The manager said she might have one already in place but would check. Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable and attractive home. The premises are well maintained, clean and fresh. Slight improvements are needed to infection control practice so that this does not have an opportunity to impact upon residents’ wellbeing. EVIDENCE: We had a tour of the premises and saw two residents’ bedrooms who gave their consent and were present. The home is spacious with lots of communal space for residents to relax in and to undertake any in-house activities including a snoezelen. The premises are decorated and fitted with appropriate lighting systems to meet the needs of people who have an autistic spectrum disorder. There is a garden to the rear which is secure. We saw that residents’ bedrooms were decorated to meet their individual tastes and personalities. They contained lots of residents’ own personal possessions and were homely. Residents looked comfortable in their surroundings. Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 22 We saw that one resident’s wardrobe was no longer secured to his bedroom wall. Staff explained that he likes to move his furniture around and the manager told us that she does not feel he is at risk or in danger. We have recommended that a written risk assessment is completed. We saw that the dining room is in need of redecoration but the team leader told us that this is due in the near future. The carpet in the corridor outside of the staff toilet has become slightly frayed in one area and we pointed this out to the team leader. We saw that there were disposable gloves in the communal bathroom on the second floor but there were no disposable aprons which the team leader agreed should be in place. We also saw that staff had installed plastic shopping ‘carrier’ bags into a number of clinical waste bins in toilets and bathrooms instead of using appropriate clinical waste bags or sealable bin liners. The laundry is located in the cellar and we saw that the door was kept safely locked. The laundry was found to be dusty in some areas and in need of a good clean. The team leader agreed with us and said that a second housekeeper had recently been appointed which should help make improvements. The laundry contained a number of miscellaneous items such as bricks, a ladder and Christmas decorations. The flooring is damaged and cracked making this no longer impermeable or easily cleanable. Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by a skilled and very motivated staff team. There are sufficient numbers of staff on duty to meet the needs of people. Recruitment and selection procedures are robust and offer suitable safeguards to residents. There is on-going specialist training for staff in order to provide them with the knowledge to meet the complex needs of residents however, specialist induction and foundation training needs to be arranged. EVIDENCE: The manager told us that more than 50 of the staff team are now qualified to NVQ II or above. During interviews staff confirmed that they were fully supported to undertake further qualifications and training. We saw training certificates to confirm that staff had received training in epilepsy, autism, specialist medication techniques and Makaton. When we spoke with staff they demonstrated a positive and caring approach towards residents and could give lots of examples why they enjoyed their work. Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 24 We received comments from five relatives who all felt that the staff have the right skills and experience to look after people properly. Comments included: “I think they care very well and to their utmost to make a client happy and content. This is not easy but Safeharbour work hard to run a happy home and actually care about their clients’ wellbeing” “the staff and management at the home give our son a lot of love and support”. All seven professionals who completed comment cards stated that staff demonstrate a clear understanding of the care needs of residents. One person said: “I have always found staff very approachable and professional when I have contact with them”. We examined the duty rota and this confirmed that there are at least eight staff on duty per shift during the day time. This highlighted study days for staff, handover periods and persons in charge of each shift. We discussed with the manager the use of correctional fluid on this document which should be avoided. We examined a personal file of a new member of staff and this confirmed that all pre-employment checks are undertaken. According to records provided by the manager the majority of staff do not commence work until a full criminal record bureau (CRB) disclosure check has been received. Existing staff are also periodically undergoing new CRB checks. Only one person had started work on a Protection of Vulnerable Adult (POVAFirst) check whilst awaiting the return of a full and satisfactory CRB disclosure. The manager told us she had assessed the risks involved but had forgotten to complete a written risk assessment or discuss the appointment with the Commission as is good practice. We recommended that a copy of the job description is held on staff personal files as is good practice. We saw an induction pack which was currently being completed by a new member of staff. The manager told us that unfortunately she had been unable to source induction and foundation training by accredited learning disability awards framework (LDAF) provider. She told us that there are currently around twelve staff who need to do this training. Not all staff have received training in equality and diversity; according to records there are fourteen staff who need this training. Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 25 We looked at staff supervision records which demonstrated that staff are receiving regular structured supervision during which a wide range of subjects are discussed. During interviews staff told us that they felt very supported by management. The manager told us that she has completed 60 of annual appraisals of the staff group and we saw evidence of this when we looked at staff files. Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a home that is run by a competent, dedicated and skilled manager. There is very good progress towards introducing quality assurance systems so that people can feel confident their views are taken into account. Generally there are good systems to promote people’s health and safety although training in some areas for staff has lapsed which management are taking steps to address. EVIDENCE: We found lots of evidence to confirm that the manager, Ms. Prodger, is highly competent to run the home and meet its stated aims and objectives. For example, there are regular staff meetings and structured supervision for staff, any practice issues are swiftly dealt with. Staff were very positive regarding the manager whom they described as approachable and helpful. Staff told us: Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 27 “she’s a good teacher, I’ve learnt a lot from her” “she’s great. From a professional point of view she’s fair and she listens. She always has the clients’ best interests at heart”. Feedback was positive from all five relatives none of whom could identify any areas where they thought improvements could be made. One person stated “the manager is always contactable I have great faith in her abilities etc.”. All seven professionals who completed comment cards said that staff communicated clearly, and that management and staff take appropriate action when they feel that they cannot meet a care need. Ms. Prodger told us that she still needs to complete her management qualification. We saw that good progress is being made towards introducing an effective and comprehensive quality assurance system. The manager is in the process of implementing a professionally recognised quality assurance system which is operated by the National Autistic Society. In addition there are in-house quality assurance systems which include a quality working party and monthly quality audit report. Residents, families and stakeholders have all been consulted. The manager told us that she has yet to produce an annual development plan following an analysis of the outcomes of the quality audits and consultations. We checked a sample of maintenance and service check records and these were found to be up to date. For example, there is weekly testing of the fire alarm system, monthly checking of the emergency lighting and visual checks of fire safety equipment on a monthly basis. We looked at the accident book and saw that only a small number of accidents have been reported. The manager has systems in place to monitor accidents. Mandatory training for staff needs improvement particularly as existing staff now need refresher training, and new staff have yet to be provided with training in certain disciplines. The home employs thirty two support staff however only nine have up to date first aid training. This inevitably means that there are occasions when residents are not supported by staff who are trained in basic first aid. The manager told us that she has had difficulty in finding funding for this training but has now resorted to employing an external trainer. We asked for verification of the training which is due to take place for all staff in the next couple of weeks and the manager was able to provide us with confirmation from the trainers. The manager told us that Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 28 she feels confident that she has introduced systems to ensure that training does not fall to such poor levels in the future. We visited the kitchen and looked at food hygiene practice. We saw good procedures being followed by staff and there is good record keeping. There is only one area which needs slight improvement and this is with regard to checking fridge temperatures and recording action taken when these fall below or above safe limits. There is a long outstanding requirement to establish a business and financial plan which has now been withdrawn and made a good practice recommendation. Safe Harbour Care Home DS0000046649.V330004.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 4 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 2 X 2 X X 2 x Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard YA24 YA30 Regulation 23(2)(b) 13(3) Requirement To repair the small area of frayed carpet outside the staff toilet in the communal corridor. To make improvements to infection control practice: 1) to ensure that there is an adequate supply of disposable aprons kept in communal bathrooms. 2) to ensure that appropriate clinical waste bags or sealable bin liners are used in clinical waste bins and receptacles. 3) to keep the laundry area thoroughly clean and dust free at all times. 4) to remove miscellaneous items from the laundry area such as bricks, Christmas decorations etc. 5) to ensure that the laundry floor is made impermeable. To introduce an annual appraisal system for staff. (Previous timescale of 1/11/05 is partly met). DS0000046649.V330004.R01.S.doc Timescale for action 01/07/07 01/07/07 3. YA36 18(2) 01/10/07 Safe Harbour Care Home Version 5.2 Page 31 4. YA37 18(1)(c) 5. YA39 24 6. YA42 18(1)(c) To ensure that the Registered Manager has completed an NVQ IV in management by 2005. (Previous timescale of 01/01/06 is not met). To continue to develop an effective quality assurance system and establish an annual development plan. (Previous timescale of 1/6/06 is partly met). To continue to pursue plans to ensure that all staff receive training in: 1) infection control (Previous timescale of 1/4/05 is partly met). 2) first aid awareness (Previous timescale of 1/4/05 is not met). 3) health and safety (Previous timescale of 1/4/05 is partly met). 01/10/07 01/11/07 01/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA5 YA6 Good Practice Recommendations To expand residents’ contracts to include all details of additional charges such as the payment for activities at weekends and evenings. To continue to explore ways of reproducing care plans in formats suitable for residents. To ensure that nutritional care plans are established for people who have problems associated with eating, weight loss or gain. Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 32 3. 4. YA7 YA17 To ensure that care plans are formally reviewed every six months. To appoint an independent auditor to carry out audits of service users finances and records on a regular basis (at least annually). To re-introduce strategies for ensuring that healthy eating options are offered on a more regular basis to supplement residents’ preferences for high fat and processed foods. Systems should be in place for managers and staff to monitor more effectively what residents’ are eating. To carry out regular calculations of residents’ ideal body weight using the Body Mass Index scoring system with records maintained. To keep written records of residents’ preferences as to whether they like male or female staff to support them with all aspects of their personal care (or whether they have no preferences). To continue to pursue accredited training in medication for staff who witness administration of medication. It is recommended that there are suitable records available for staff to use and record the administration of medication when a resident has medication away from the home. It is recommended that secondary dispensing is discussed with the supplying pharmacy to ensure safe practice guidance is followed. To continue to pursue plans to ensure that all staff have received training in positive approaches to challenging behaviour which includes training in physical interventions. To obtain written verification that the physical interventions trainer has been an accredited to provide this type of training by a professional body such as BILD. To ensure that there is a written protocol in place regarding how residents’ share the cost of fuel towards the running of one resident’s vehicle. To carry out a written risk assessment if wardrobes are not secured to bedroom walls to demonstrate what control measures are in place to minimize risks. To cease using correctional fluid on the duty rota. To ensure that written risk assessments are completed for staff who commence work on a POVAFirst and that their appointment is discussed with the Commission. To keep copies of job descriptions on staff personal files. 5. YA18 6. YA20 7. YA23 8. 9. 10. YA24 YA33 YA34 Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 33 11. YA35 To continue to pursue induction and foundation training for staff with an accredited learning disability awards framework (LDAF) provider. To provide staff with training in equality and diversity. To ensure that fridge and freezer temperatures are more consistently checked and recorded. To ensure that there are written records maintained to confirm what action staff take when fridge/freezer temperatures fall above or below safe limits. To provide a business and financial plan for the Home. 12. YA42 13. YA43 Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Safe Harbour Care Home DS0000046649.V330004.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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