Inspection on 14/08/07 for Safeharbour

This inspection was carried out on 14th August 2007.

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

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

Other inspections for this house

Safeharbour 09/09/09

Safeharbour 12/07/06

Safeharbour 10/03/06

Safeharbour 28/09/05

Safeharbour 17/03/05

Safeharbour 06/09/04

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 Safeharbour 52 Corbett Avenue Droitwich Spa Worcestershire WR9 7BH Lead Inspector Jean Littler Key Unannounced Inspection 14th August 2007 11:00 Safeharbour DS0000018672.V342375.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 Safeharbour DS0000018672.V342375.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. Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Safeharbour Address 52 Corbett Avenue Droitwich Spa Worcestershire WR9 7BH 01905 796214 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) Dr Anjani Kumar Mr Geoffrey Moultire Copeland Jolene Lisa Riggs Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service is for people with a learning disability but the Home may also accommodate people with an additional mental disorder. 12th July 2006 Date of last inspection Brief Description of the Service: Safeharbour is situated in a quiet residential area within a short distance of Droitwich Spa town centre and a wide range of local amenities. The premises are in keeping with the environment and the local community. There is a small patio area at the rear of the house but no garden. Accommodation is provided on two floors and all the residents have their own single bedroom. The home provides a service for six people with learning disabilities who have high support needs. Information about the service is available from the home on request. The fee for the service range between £1947 and £2812 per week. Additional charges are made for personal services such as hairdressing and personal items such as clothes and toiletries. Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out in six hours on August 14th. The manager was on duty and helped with the process. The inspector looked around the house and spoke with two of the staff. One of the residents showed the inspector her bedroom and they talked about the home. Some records were looked at such as care plans and medication. The manager sent information about the Home to the inspector before the visit. What the service does well: The residents’ support is reviewed at least twice a year. The residents are supported to have their health and physical care needs met in the way they prefer. Each resident has a personalised activity plan but they also have time to relax and follow their hobbies. They are supported to stay in touch with their families. The house is large, homely, comfortable and safe. The residents have nice bedrooms with lots of their own things. The resident and their relatives’ views are listened to and complaints are taken seriously. Residents are protected from harm and abuse. Each resident has at least one named member of staff to support them each day. Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 6 The staff are trained and supported to do a good job. The home is well run and the manager puts the residents’ safety, health and welfare first. 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. Safeharbour DS0000018672.V342375.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 Safeharbour DS0000018672.V342375.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): 1, 2, 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives would be provided with up to date information about the service to help them make an informed choice. The needs of any potential new residents would be assessed and a trial period arranged to ensure they could be met before permanent admission took place. EVIDENCE: The manager continues to keep the Statement of Purpose and Service Users Guide under review. These were last updated in November 2006. A version of the Guide has been developed into a format where the information is more accessible to people with a learning disability. There have not been any new admissions into the Home since 2003. This is before the current manager started in post. There is an admissions policy and this is currently being further developed. The manager showed evidence in the Annual Quality Assurance Assessment, (AQAA), which was submitted to the Commission before the inspection, that she was aware of good practice assessment methods such as full involvement of the client’s representatives. She reports that a 3-12 month transition period would be arranged to ensure the placement is appropriate. She confirmed an assessment would be obtained from the placing authority and then she would complete her own assessment. To support this process she plans to develop the assessment tool ready for when the next vacancy occurs. The care plans seen showed that contracts have been issued to residents. Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 9 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, 9. Quality in the outcome area is good. This judgement has been made using available information and a visit to this service. The residents can be confident that their current needs are reflected in their care plans. The residents are being supported to make decisions and choices where they have the capacity to do this. They are being supported to take reasonable risks as part of ordinary living. EVIDENCE: The manager has continued to develop the care planning process. The two files sampled contained very detailed information. The information is set out under relevant headings such as health, communication, risk assessments etc. It is very person centred and shows that each resident is treated as an individual with very specific needs and preferences. The plans included goals staff are supporting residents to work towards and how they should be supported to be independent and make choices where possible. It is positive that relatives have been involved and have provided social history information and some have seen and agreed the care plan information. Clear intervention strategies have been developed, in some cases with the support of health professionals, to help staff respond consistently to challenging behaviours. Daily records are made on forms that have been personalised to include each resident’s Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 10 development goals. This allows staff to report on progress. Charts are also used for monitoring areas such as behaviours, personal care, bowel movements, sleep patterns, bed linen changes. Keyworkers continue to complete monthly summary reports and these help monitor care issues and inform the six monthly review meetings that are held with residents’ representatives. The manager plans to develop more of the care plan information into a format that each resident can understand. Staff have attended Person Centred Planning training. Staff reported that the team works constantly with each resident in line with their care plan. Both those spoken with were aware of the current needs of residents and were able to talk about the care strategies in a competent manner. In implementing the agreed strategies for responding to challenging behaviours that staff felt supported by the manager and from the professionals involved. Feedback from relatives was positive and they felt confident about their children’s care needs being met. One father said the manager and staff frequently foresee things which he has pondered with his son and after talking with him they implement them. A social worker reported that the home tries to ensure that his client’s specific and cultural needs are met. The residents are being supported to make decisions during each day such as what to wear and whether to participate in their planned activities. Work to support choice making has continued through the use of pictorial and symbol based communication systems. The manager plans to develop this further and increase links with advocacy and befriending services and women’s and men’s groups. The manager is aware of the Mental Capacity Act and has started to consider how to record how decisions are being made when a resident lacks the capacity to make a decision for themselves. The residents are being supported to take reasonable risks to enable them to have a normal life e.g. some go swimming, use public transport. Risk assessments are in place but the manager plans to develop these further to demonstrate the benefits of activities and how the hazards are being managed. Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 11 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, 17. Quality in the outcome area is excellent. This judgement has been made using available information and a visit to this service. The residents are being given opportunities for personal development. They are supported to engage in a wide range of activities they enjoy, some that are community based and non-segregated. Their rights are being respected and they are supported to maintain links with their families. They enjoy their meals and are being provided with healthy home cooked meals. EVIDENCE: As mentioned above each resident has goals identified that staff are supporting them towards. Examples of these included residents taking their washing to the laundry, using the kitchen, coping with medical environments. Both staff were able to give several examples of residents developing new skills and progressing. They both felt the residents have a good quality of life and are given opportunities to go into the community regularly. The daytime weekday activities are paid for by home as part of the funded service. Each resident has a personalised activities plan and there seems to be a positive approach towards trying new activities. Examples of activities on the current plans Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 12 includes going to the jacuzzi and snoozalem, the adult ball pool, going to the bakers to buy lunch. One resident enjoys trampolining so she now chooses to go weekly. Another resident’s health has improved so he is going swimming and to the pub more often, which he enjoys. He is also supported to go on regular walks following the advice from health professionals. Some residents attend college courses and are supported by a worker on a one to one basis with the aim of gaining awards in catering, numeracy, literacy, IT, or needlework. One resident now has a work placement with support once a week. Planning also includes the evenings although free time is also built into the week and weekends are more relaxed. The manager is planning to try to increase the number of residents who access college courses and employment opportunities. Two residents activity plans are not being followed. One is on the advice of health professionals as part of a low arousal strategy as he is very unsettled at the moment. The other resident needs two staff with him but he is only funded to have one to one support. To meet his needs the manager links him with anther resident. This does work well at time however if the other resident is unwell or chooses not to go this means the other resident cannot go. His notes showed he was going out regularly but some of his planned activities had been substituted for walks. The manager has raised this with the funding authority but they have not agreed an increase. The manager agreed to consider how records could better capture information about when the resident’s activity plans are disrupted and why. A holiday has been planned for September 07. Last years holiday was reportedly a great success after much effort had gone into finding accommodation that is suitable for each resident. The photographs were made into personal scrapbooks and shared with the residents’ families. The residents’ rights are being promoted through normal good practice e.g. ensuring their privacy is maintained, supporting them to be independent where possible. The level of support the residents need mean they are unable to vote or exercise some normal rights e.g. going out alone. The speech and language therapist is involved in developing the communication systems to help residents understand information and make more choices. In the last year residents house meetings have been introduced to try and support the residents to have more input into decisions about the Home. . The residents are supported to keep in close contact with family members. Staff provide transport to enable visits to take place in some cases. Two residents do literacy sessions in workbooks in the evening. This has led to one resident writing letters to his mother again, which he has done in the past. Another resident is reported to visit his father’s grave. The keyworker system is used to ensure relatives are appropriately communicated with about concerns and care needs. A record is kept of the contact between relatives. The feedback from relatives was positive about the level of contact maintained. A well-qualified and experienced cook works three days a week. Food is purchased locally, some of it with the residents help, and the meals are Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 13 prepared fresh each day. Meals are eaten in a relaxed atmosphere and staff eat with the residents. Three areas of the house are used for dining so the groups are small and residents are better able to concentrate on their meals. Residents’ food preferences are known and their views sought as much as possible when the menu is planned. Records show a good variety of flavoursome and healthy meals are being provided. Taster sessions are held to find out if new foods will be enjoyed. The current menu choices have been stopped for two weeks so the residents can try new meals rather than choosing old favourites. Good efforts are made to meet one resident’s cultural food requirements. One resident regularly cooks and others help make drinks and snacks. Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 14 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, 20. Quality in the outcome area is excellent. This judgement has been made using available information and a visit to this service. The residents continue to have their personal care and health needs met in a sensitive and proactive manner. Medication is being safely stored and managed. EVIDENCE: Care records showed that residents are bathing or showering daily and their other personal care needs are being met. Appropriate gender care is being provided for the female resident. New and very detailed guidance has been developed about how the residents prefer to be helped with personal and intimate care. The residents all have single rooms and one is able to hold her bedroom key and lock her room when she goes out. Other examples were seen in the care plans to guide staff about maintaining the residents’ rights to privacy and dignity. The manager agreed to review how these issues are covered in the policies, as they were not obvious when she looked during the inspection. A social worker reported that the service conveys an ethos of respect for his client. The care plans include clear details about the residents’ health needs and how these will be met. In case a resident is admitted to hospital information is ready in a quick reference format. Clear records are being made following Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 15 appointments. Currently only three residents have Health Action Plans that were completed with some support from the Worcester community nurses. The manager agreed to develop these for the other residents. Links with local health professionals are well established and all residents are registered with a GP and dentist. Annual health checks continue to be provided by the GP and these had been carried out in January 07. Health appointments continue to be prioritised and senior staff or keyworkers attend these whenever possible. A resident had recently purchased some new fashionable glasses and he was being encouraged to wear them for written work. If a resident needs chiropody input the providers fund this. A resident with a very complex high-risk health condition is sensitively supported and has two named staff supporting him during the waking day. External links with health professionals are in place e.g. the consultant psychiatrist. A community nurse works closely with the home to support health work and she has recently provided epilepsy update training about emergency medication. Currently good work is being carried out to support one resident with a pending operation and another with changes to his behaviour. An arrangement with the Community Behaviour Management Team has been made whereby they give two hours a month for consultation about any of the residents. The manager had recorded details about the ‘best interest’ decision that had been taken for one resident to have an operation. She agreed to consider who else might be involved in future decisions and how their agreement might be better evidenced. Relatives gave feedback that was positive about how health care issues are managed and how staff liaise about these. A social worker reported that the care plan is proactive in recognition of his client’s health needs and the manager ensures follows up health needs are identified. He felt that local health professionals play a key role in supporting the staff with managing the residents’ health needs. The medication is being appropriately stored and the keys kept secure. Deliveries are checked in and a record of stocks is being maintained. Each resident has a medication profile indicating what medication they are on and why. Photos are with the charts, a senior administers the medication and another worker witnesses the process all to help reduce the risk of errors. Clear guidance has been developed for when ‘as needed’ medication can be used. The administration records showed that doses are being given as prescribed. The manager continues to ensure medication is reviewed regularly with the GP and the consultants. Currently one resident is being supported to go through changes as part of the work to support him with his behaviours. Behaviour charts are being completed to enable detailed feedback to be given to the health professionals involved. Staff are being appropriately trained through an accredited course. The manager said she had to authorise new staff to administer medication before attending the training but they were first assessed as competent over three sessions. The manager has appropriately dealt with errors in medication administration when these have occurred and Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 16 she has made changes to the arrangements as a result of these. It is positive that the manager plans to enable one resident to self medicate. Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 17 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, 23. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents and their representatives’ views are listened to and acted upon whenever possible. The residents are being actively protected from abuse, neglect and self-harm. EVIDENCE: A complaints procedure is in place and the manager said this is given to residents and families during the induction period. A version is displayed that is in a format more easily understood by the residents. The manager continues to demonstrate that she responds positively to any concerns raised. Since the last inspection a neighbour complained about noise from a resident who is vocal when enjoying his bath in the morning. The manager was aware of the rights of the resident in his own home, however staff are now assisting him in a different bathroom in the morning and closing the window. Recently a member of the public raised concerns that a worker was not attentive to a resident when supporting them in a café. The manager took prompt disciplinary action and also visited the café and left her contact details. She wrote to the complainant to inform them of the action taken. No complaints have been made to the Commission since the last inspection. The manager is now keeping a record of any concerns raised and the action taken to address them. She agreed to review how confidential information is handled within this system. The majority of the residents are not able to make complaints in a formal way, however they all have families involved and a key and cokeyworker that have a role to advocate for the resident. The residents’ relatives gave feedback that they felt confident any concerns they raised would be listened to and acted upon. As detailed under other sections of the report examples were seen when residents’ choices and wishes have been respected. Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 18 Suitable policies are in place regarding abuse and staffs’ duty to report concerns to protect the residents. Staff training in abuse and protection is being provided. Since the last inspection a situation involving concerns about a member of staff’s care practice were reported to the senior manager. She referred this to Social Services under the vulnerable adult multi-agency procedure. The strategy group asked the providers to investigate this and report back. The manager took over the process after being on annual leave and she liaised well with the family and external professionals. The worker resigned and did not attend the interview session so the investigation was closed. The manager took legal advice about referring the worker to the PoVA List and about what information can be included if requests for employment references are received in the future. The manager reported in the AQAA that the residents are safeguarded by staff training, financial systems and robust procedures for recruitment and the management of behaviours that are challenging. She feels the management has become more efficient in responding to allegations. The staff spoken with said the manager and providers are approachable and they would raise any concerns they had about the residents’ welfare. Relatives gave feedback that they had confidence in the management of concerns and staff misconduct. Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 28, 30. Quality in the outcome area is adequate. This judgement has been made using available information and a visit to this service. The residents have a well maintained, safe, clean and attractive home. Their bedrooms are personalised and the communal rooms are a good size. EVIDENCE: The Home is located in a residential area near to transport links and local facilities. A vehicle is provided to help enable community access. There is no designated staff parking and the close proximity of the house to the neighbours has led to some complaints being made about noise levels. The house has large rooms that are attractively decorated and comfortably furnished. These include a kitchen diner, lounge and conservatory. The garden is very small and is not ideal for the young and mobile group of residents. To balance this an allotment is used and some residents regularly go there to attend to the vegetables. There is one bathroom, one shower room and two toilets. All residents have a sink in their bedroom. The environment has been adapted where necessary e.g. a raised toilet seat has been fitted for one resident. The manager confirmed in the AQAA that the home meets the fire regulations and that she liaises with the Fire and Environmental Health departments to ensure the home meets the required standards. The house is Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 20 being well maintained and a rolling programme of improvements is in place. Last year the downstairs shower-room was attractively refurbished and this year the lounge and other communal areas have been redecorated. A member of staff reported that a carpenter/handyman is employed and so repairs are carried out quickly. The residents all have single bedrooms, which have been personalised. Efforts continue, with some success, to enable a resident who prefers his room to be kept quite clear to accept new items. One resident showed the inspector her bedroom, which she said she liked very much. Her room is full of personal items such as soft toys, TV and DVD equipment. She has pictures of her family and staff and her communication board that helps her know her weekly plan. The home was again found to be clean and tidy. The laundry is sited in the cellar, which is not ideal for staff carrying items up and down the stone steps, or for residents to be involved in doing their own washing. The cellar is vulnerable to flooding and this recently resulted in the equipment being damaged. New machines have been provided and the providers are liaising with the water company to stop this reoccurring. Arrangements are in place to manage infection control risks e.g. pump soap and paper towel dispensers, and staff are provided with infection control training. The manager plans to implement the Department of Health Essential Steps guidance to further improve standards. Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 21 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, 36. Quality in the outcome area is good. This judgement has been made using available information and a visit to this service. The residents are being supported by a competent and effective staff team that are being effectively managed, supported and supervised to meet the residents’ complex needs. The team are being appropriately trained although under a third are formally qualified. The residents are being protected by the recruitment procedures. EVIDENCE: A high staffing level continues to be provided during the day with the usual number on duty being seven. The manager’s hours are usually over and above this. As detailed earlier in the report an increase in staff support hours is being sought from the funding authorities for two residents so they can be supported by two staff for outings and activities. Other than this shortfall the staffing levels were reported by the manager and staff to be suitable to meet the residents’ needs. Each worker is designated a particular resident to support on each shift so their role is clear. The fulltime cook continues to provide a good service, managing the kitchen and food hygiene standards as well as supporting the residents to safely access and use the kitchen area. A domestic assistant supports the care staff to keep the house clean and do the laundry. Designated waking night staff are employed, who also assist with domestic tasks, and a worker also sleeps in and is on call. Two staff have lead Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 22 responsibility for organising activities and between them they cover weekdays 8am-5pm. Feedback from the relatives and professionals indicated that staff were viewed to have a positive attitude and be skilled and committed to their work. Twelve staff have left since the last inspection. This high staff turnover level has been increased because some staff have been dismissed as a result of disciplinary proceedings. There is now only one vacancy and no agency staff have been needed since December 06. Any gaps in the rota are being covered by staff who know the residents. The new deputy was one of the staff who have left. The manager has decided to change the structure and has created two team leader posts that have been filled by current staff. They are due to take up these posts next month. The manager confirmed in the AQAA that robust staff recruitment procedures are in place including getting two or three references and the CRB and PoVA checks back before employment is commenced. New staff complete a formal induction. This has been extended from two to three weeks. During this time they work alongside colleagues until they are familiar with the residents and their needs. The probation period is 3 months and during this time they are expected to complete their core training and gain the Learning Disability Award Framework (LDAF). The manager reported that the three newest workers have not yet completed the LDAF. A worker who had been in post for a year said she had been supported by colleagues to get to know the residents. She felt informed about Autism and gave examples of how residents had developed over the last year. She felt staff had equal access to the training available. Basic training for all staff includes safety training, first aid, medication, infection control and abuse awareness. All staff are encouraged to gain NVQ awards in Care. Currently of the team of twenty-three, seven are qualified and nine others are in the process of gaining an award. Each worker has their own training profile and training needs are discussed at supervisions. Both staff spoken with felt they had attended appropriate training for their role. One was interested in developing more understanding of behavioural issues and how to develop positive intervention strategies. Some specialist training is provided e.g. epilepsy, understanding challenging behaviour, autism awareness and breakaway techniques. Some staff have attended Total Communication training and a Makaton signing course. The manager has equal opportunity books and is planning to deliver training to staff in this area. She agreed to consider how disability awareness training could be delivered by a disabled person in line with the National Minimum Standards. Both staff spoken with reported that team morale is now good again, having dipped earlier in the year. They both felt the staff team is working consistently to meet the residents’ needs. Staff meetings are held at least monthly and the staff felt these were very useful. A handover is held between shifts and a shift leader agrees a shift plan with the team. Staff are being provided with regular supervision sessions at least bi-monthly. The two spoken with found these sessions supportive and positive. The manager is now using staff meetings to hold workshops to supplement more formal staff training courses. Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42. Quality in the outcome area is good. This judgement has been made using available information and a visit to this service. The residents are benefiting from a well run home with a positive ethos. They can be confident their and their representatives’ views are valued. Procedures and record keeping systems are in place to safeguard their best interests. Their health and safety is being actively promoted. EVIDENCE: The manager is suitably qualified and she is planning to complete a diploma in epilepsy. She attends appropriate training courses as they become available to continue her own personal development, for example she has recently attended a course on the Mental Capacity Act. She continues to work to develop the service and improve the quality of life for the residents. The staff spoken with reported that they found her to be a good leader who delegates well and who is supportive and approachable. Feedback from relatives was positive about the management of the home e.g. one father said this Home had his unqualified support. A social worker said the manager has an approach Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 24 that demonstrates her responsibilities are understood and that staff with appropriate skills are employed. The manager liaises well with professionals and families and operates in a transparent manner. She has reported incidents appropriately to the Commission except some instances of staff misconduct. She is now aware that these issues are also reportable. The service is being monitoring by one of the providers and line manager during monthly visits. These visits have proved effective in identifying areas of good practice and shortfalls. Work to implement a formal quality assurance (QA) system has progressed. This now involves a cycle of internal audits on areas such as the environment and monthly checks on all care plans. A QA policy has been written and a senior member of staff is taking the lead on this work. The Organisation’s policies are being reviewed at least annually. A QA group is being held each month with input from a community nurse. The manager agreed to consider linking the audit areas more directly to the Minimum Standards to ensure all areas are covered and to provide clear evidence for the AQAA next year. Questionnaires were sent to families and professionals and were completed with residents last October. The feedback had been collated into graphs and these showed positive replies. The manager has further developed the questions and plans to do the surveys twice a year. To help gain feedback from families about the Keyworkers periodically go out with their key resident and their family for a meal. The manager reported that this more informal approach helps some relatives share their views. Staff do write up notes but these are currently not shared with the families. The manager agreed to review this. Staff need to be mindful about the resident’s confidentiality if holding discussions in public places. The manager is aware that the findings of each consultation period need to be collated and reported back to the stakeholders along with any resulting action plans. The Home has applied for accreditation with the National Autistic Society and hopes to complete this in 2008. They plan to then work towards the Investors in People Award. A sample of records were seen as detailed throughout the report. Record keeping systems continue to be improved e.g. care plans. Health and Safety management systems are in place e.g. checks on hot water before bathing. The sample of records seen were clear and they showed checks are up to date. Fire drills that involved the residents and staff had been held in September 06, March and August 07. Fire training had been held in March and July 07 and the names of staff who attended had been recorded. The manager reported that the Fire Officer had been sent a copy of the revised fire risk assessment. She also provided evidence in the AQAA that routine servicing and safety checks are up to date e.g. an electrical wiring certificate was issued in April 2006. Checks are also monitored during the provider’s monthly visit. Risk assessments are in place relating to residents’ care and environmental hazards. Both staff spoken with reported that safety issues are well managed. Basic safety training is provided during the induction programme and videos are used to provide refresher sessions. Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 X 4 4 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 x 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 3 12 4 13 3 14 4 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 x 3 4 3 3 3 3 x Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA19 Good Practice Recommendations Develop health action plans for the other three residents to help ensure proactive health prevention arrangements are in place in all areas. Consider the benefits of commissioning periodic input from a behavioural therapist as part of the specialist service provided. Brought forward. 2. YA39 Further develop the quality assurance system so the findings of each consultation period are collated and reported back to the stakeholders along with any resulting action plan. Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.worcester@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 Safeharbour DS0000018672.V342375.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!