Inspection on 13/02/07 for Salisbury Court

This inspection was carried out on 13th February 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 22 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Salisbury Court 05/11/08

Salisbury Court 28/11/07

Salisbury Court 07/03/06

Salisbury Court 28/09/05

Salisbury Court 08/02/05

Salisbury Court 02/06/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

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

CARE HOME ADULTS 18-65 Salisbury Court Off Barnoldby Road Waltham Grimsby North East Lincs DN37 0BS Lead Inspector Ms Matun Wawryk Unannounced Inspection 13th February 2007 09:30 Salisbury Court DS0000002910.V314802.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 Salisbury Court DS0000002910.V314802.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. Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Salisbury Court Address Off Barnoldby Road Waltham Grimsby North East Lincs DN37 0BS 01472 821634 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) www.mencap.org.uk Royal Mencap Society Ms Ruth Adamson Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th March 2006 Brief Description of the Service: Salisbury Court is care home providing personal care and accommodation for 6 adults with learning disabilities some also have associated physical disabilities. New Era Housing Association owns the building. Mencap provides staffing and support. The home is located in the village of Old Waltham. It is close to local shops and amenities and there is a regular bus service from the village to the nearby towns of Grimsby and Cleethorpes. The home is a detached dormer bungalow in a quiet residential area. All accommodation for residents is provided on the ground floor with the staff sleep-in room/office and shower/toilet on the first floor. There are six single bedrooms and each has a wash hand basin fitted. The home has a bathroom with an Aqua Nova assisted bath and toilet, a shower room with wheelchair access and toilet and a separate toilet. There is a combined lounge/dining room and adjacent kitchen and a separate laundry room. The gardens are easily accessible to residents and there is a car parking area. As at 28th July 2006 the weekly fee per week was £725.03. Residents will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these and more up to date information on weekly charges can be obtained from the manager. Information on the service is made available to prospective and current residents via the homes statement of purpose, service user guide and inspection report. Copies of these documents can be obtained from the home. Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the homes first key inspection of 2006/07. The inspection visit took place over 1 day in February 2006, Mrs Matun Wawryk carried out the visit. Prior to visiting to the home the inspector sent survey questionnaires to Six residents, none were returned, six relative of which three (50 ) were returned, eighteen staff of which thirteen (72 ) were returned, eleven care managers/health care professionals of which five (45 ) were returned to try and establish whether the residents’ needs were being met Some of the comments received by these people have been included in the report. The manager of the home left in early February 2007 because of this an area manager from Mencap was temporarily managing the home. This manager was not working in the home at the time of the visit because of this the inspector was not able to access some required records. A manger from another Mencap home was present for most of the visit and this person assisted the inspector by answering questions and providing requested documentation as far as she was able to. During the visit the inspector spoke to three support workers, a visiting manager and one relative to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. The inspector also looked around the home and looked at lots of records, for example; resident care plans and risk assessments, daily records, supervision schedules, menus, and other records relating to the running of the home. Information received by the Commission over the last few months was also considered in forming a judgement about the overall standards of care within the home. Six residents live at the home, only one resident was at home during the visit, the remaining residents were out at day services. All the residents had communication difficulties, which meant they were unable to complete a written questionnaire or tell the inspector about their care needs or give their views on the home. What the service does well: The bungalow is located in the local community and is on a bus route making all leisure facilities and shops easy to get to. All residents are provided with a single room that is nicely personalised to their own taste, in a house for no more than 6 people thereby providing them with a more homely environment. Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 6 All of the staff spoken to said the previous manager was effective and efficient. Staff said she dealt with matters as they arose and they said they felt confident to raise issues with her. Residents had good access to professional medical staff and are able to access external services such as dentists and opticians as needed. The home has an enthusiastic staff team who are keen and motivated to ensure that the care provided is of a good standard. What has improved since the last inspection? What they could do better: Three requirements remain outstanding from previous inspections, it is important that these are addressed as it is unlikely that further extensions to timescales will be agreed. Information about the home is made available to prospective residents and their representatives through a statement of purpose and service user guide. The service user guide needs to be updated to show changes of managers, current staffing, outcomes of quality monitoring arrangements and fees charged. This is needed to ensure that the rights and best interests of the people living in the home are promoted and to ensure prospective residents and or their representatives have all the information they need to help make informed choices about the homes ability to meet their needs. Although staff training is generally good, not many support workers had had much specialist training in areas appropriate to the needs of residents for example; communication skills, working with people sensory impairments or those with multiple disabilities. Failure to provide this training may mean staff do not have all the knowledge and skills they need to meet the needs of residents and this could impact on the care they receive. All the staff are receiving one to one supervision from their manager but this is not happening as often as it needs to. Staff must be provided with more regular, formal support, to ensure they are provided with all the guidance; leadership and support they need to ensure they receive management feedback on their performance. Some residents display behaviours, which can be difficult to manage from time to time. Staff had not had any special training to help them deal with these Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 7 behaviours. This must now be provided to ensure the rights and interests of residents are promoted and to ensure staff to have the confidence, skills and knowledge to be able to deal with situations in a competent, consistent, safe and agreed way. Questionnaires and face-to-face discussion with relatives and staff indicates that some relatives are dissatisfied with some aspect of care provided to their son or daughter. This has resulted in long-standing unresolved issues between some relatives and staff and this is affecting morale in the home. Action needs to be taken to address this for the benefit of all concerned. Although the staff in the home were trying to improve things, the home did not have a proper plan in place to monitor the quality of care and services provided to residents. There was no evidence that a system was in place to show how they consulted with residents, staff, relatives and others for example social services care managers, community nurses and physiotherapists. The home must now produce an annual development plan, which details how they consult with people and the outcomes of this consultation. A report then needs to be produced showing how the comments from these individuals have shaped or altered the practices within the home, and show how the home is run in the resident’s best interests. 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. Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 8 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 Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 9 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 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The homes service user guide does not provide all the information prospective residents or their carers need to enable them to make informed decisions about the homes capacity to meet their needs. Residents have their needs assessed prior to admission to the home. EVIDENCE: There had been no new admissions to the home in the last year and the home is fully occupied. Assessment of this outcome group was based on examination of records and information given by people in face-to-face discussions and questionnaires. Staff were unable to locate a copy of the homes statement of purpose, but an assurance was provided that one was in place. A copy of the service user guide, which gives information about the home, was provided. The guide was out of date and must now be updated to show recent changes in managers, current staffing, outcomes of quality monitoring arrangements and to include more information about fees and charges. Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 10 The admission procedure was sufficient to guide staff on the actions to be taken to ensure prospective residents needs are properly assessed and planned for. Staff spoken to were able to give detailed information about the admissions procedure for the home. Not all the files examined contained a copy of the care management assessment for residents. Previous inspection findings showed the manager had tried to obtain copies of these from the relevant local authority without success. The manager spoken to said she was aware of the need to complete a needs assessment in the absence of a professional assessment for any new residents. All the files looked at contained a copy of the local authority care plan and evidence seen showed information contained in these had been used to develop individual resident care plans. Records showed residents had been issued with licensing agreement in 2003, The resident’s representative had subsequently signed these in 2006. Residents had also been issued with a letter from Mencap in April 2005 detailing charges for services. There was nothing to show residents or their representatives had been advised of charges for 2006/07. It is important that each resident and or their representative knows what he or she is paying for and any terms of residency. Mencap is advised to ensure everyone who is coming to live in the home is given a personalised statement specifically relating to the care, accommodation etc that they will receive for the fee being paid. This should be supplied, at the latest, at the point at which someone takes up residence in the home and should be updated as fees change. Full details about what information needs to be provided can be found in the revised Care Homes Regulations. There was nothing to show that residents or their representatives were formally advised that the home could meet their needs, this should now happen for new admissions. There was only one service user at home at the visit. This person could not give information about their care needs and the input they required from the staff and outside professionals. Three relatives returned a questionnaires in response to the question ‘are you satisfied with the overall care provided’? one said yes, one said no and one said yes and no. Five health and social care staff returned a questionnaire in response to the same question three said yes and two said no. Information from the Pre-Inspection Questionnaire completed in June 2006 and discussion with the staff and observation on the day indicates that all of the residents living in the home are white/British. The manager said staff would be able to support individuals with specific cultural or diverse needs following a needs assessment being completed. And where necessary Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 11 additional training and guidance would be provided to staff to enable them to be responsive to the resident’s needs. At the present time residents are able to have a choice of staff gender when receiving personal care as far as practicable, as the home employs both male and female staff. Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All the residents have a range of care plans and these are supported by written risk assessments. Care plans and risk assessments need to better reflect the principles of person centred planning and further works needs to be undertaken to show how individuals are involved in decisions about their lives as far as practicable. EVIDENCE: Case tracking took place for three residents. The methodology used was a physical examination of care plans, risk assessments, daily records, written surveys to staff, relatives and some health and social care professionals, and direct observation on the day of the visit. Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 13 Staff spoken to were knowledgeable about the needs of each resident and had a good understanding about what care was needed on a daily basis. All the residents selected for case tracking had a range of care plans in place and these gave information about the identified needs of the resident together with information about what care needed to be given by staff. Information about the resident’s social interests, likes and dislikes, spiritual needs are also included within the individuals care plan. Plans appeared to be generally task focussed with only limited evidence about promotion of independence, preferred routines or how residents exercise choice within their individual capabilities. Care plans are produced in standard type written format, when residents needs change, staff alter the care plans by hand. The current format for recording individual plans does not assure the accessibility of these important documents for residents and action now needs to be taken to address this. It’s important that Mencap puts in place individual plans, which better reflect the principles of person centred planning. There was limited evidence of the involvement of residents or their representatives in the development of their individual plans other than at the reviews held with the funding authority. There was nothing to show that formal reviews of care plans involving staff at Salisbury Court, the resident and or their representative, and relevant others took place. The manager must ensure that individual care plans are reviewed with the resident, significant others including professional staff and family, friends and/or advocates as agreed with the resident (as appropriate) at least every six months. Discussion with staff and examination of records evidenced some resident’s exhibit challenging behaviours. Staff maintain record of incidents, but the quality of record keeping varied. One resident had several written records, which identify strategies staff should employ to help them manage resident’s behaviours, some of which had been put together by professional staff. Records and staff discussions also showed staff are receiving support from health and social work staff to help them understand and manage the behaviours of some residents. There is a need to formalise these arrangements and to ensure there is a consistent, formal and structured behaviour management plan(s), in place for all residents who display challenging behaviours, these must be supported by clear risk assessments, and all plans should be agreed with the multi-agency care team and/or the resident and their representative. There also a need is ensure staff fully understand how challenging behaviours incidents are to be recorded, what information needs to be recorded and how information will be analysed and who will be responsible for this. The manager then needs to show how lessons leant from the handling of an incident are fed back to the staff team and or individual staff and how this influences future Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 14 interventions and how plans should be modified as a result of this. This is needed to demonstrate proper arrangements are in place to protect the rights of residents and to ensure their welfare and safety. Staff had not had any specific training in the management of challenging behaviours and use of diffusion and diversion techniques, this must now be provided to ensure staff have the necessary confidence and skills to support residents who display challenging behaviours. There were risk assessment tools for mobility, bed rail provision, medication and general issues; high risk areas had been identified and care plans were in place to support appropriate care provision in most cases. However the depth and quality of some risk assessment varied. For further information please refer to comments detailed on page 23 of this report Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to continue their personal development and have access to the community for a range of leisure pursuits. Family contact is maintained although there are long-standing unresolved issues between some relatives and staff and action needs to be taken to address these for the benefit of all concerned. Residents enjoy a healthy and balanced diet. EVIDENCE: Staff said the routines of the home are planned around the resident’s needs and wishes. All of the residents are reliant on staff and family members recognising and identifying their likes and dislikes and for helping them make decisions and choices. Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 16 In discussion staff displayed good knowledge of individual residents needs, likes/dislikes, family support and records contained information on people’s religious observances. Staff said residents would be supported to access local churches or to attend services held in the community where this was requested. Staff described relationships with the neighbours as good. Key workers helped residents to maintain family contact by sending cards at significant occasions such as birthdays and Christmas. Staff said residents had contact with their families and that residents are able to see visitors in the lounge or in the privacy of their own room. Three relatives returned a questionnaire in response to the question ‘do staff and owners welcome you in the home at any time’? two said yes, one said no. Feedback in questionnaires and face-to-face discussion with staff and one relative indicates that some relatives are dissatisfied with aspects of care provided to their son or daughter. This has resulted in long-standing unresolved issues between some relatives and staff and this is affecting morale in the home. Action now needs to be taken to address this with all parties concerned for the benefit of residents, staff and relatives. Residents have access to a range of leisure activities in the community including, swimming, walks, pub meals, shopping trips etc. Residents also have access to more specialist services including, trampolining, hydrotherapy and horse riding. In addition residents have access to a range of indoor activities such as jigsaws, DVD’s, books and foot spa’s. Staff had not had any particular training in organising and implementing activity programmes for people with complex needs. Consideration needs to be given to providing relevant training in this area. All the residents receive day services provided by the local authority where they have the opportunity for continued personal development for example; through participation in art, craft, cookery, road safety, music classes and communication and life skills training dependant on their individual needs, likes and dislikes. Five health and social care staff returned a questionnaire, one wrote ‘the staff do work closely with myself and the staff team. Good at communicating. Occasionally do not have enough staff to support 1-1 activities in the community’. Another wrote ‘there is a very limited understanding of the value of meaningful occupation’. One relative wrote ‘not able to fulfil social activities’. These comments indicate that there is a need to look in more detail at people’s social stimulation needs in order to better tailor daily activities to the individual wishes, needs and capabilities of some residents Residents are provided with three meals a day and a varied menu was available. Staff spoken to said the meals were of good quality and confirmed a Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 17 choice of food was available, including fresh vegetables and fruit, this was confirmed by examination of a sample of menus. Staff advised that residents receiving day services have a cooked meal at the centre. When not attending the day centre staff cook a main meal for the resident(s). One relative wrote in their questionnaire ‘concerns about food, lack of cooked meals’? The dinning room area had been redecorated and it was noted to be clean and tidy. Staff were observed assisting one resident to have drinks and to eat a meal, assistance was provided in a sensitive and timely manner. Staff said residents able to feed themselves are provided with adapted cutlery. Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both before and during the visit to the home Residents receive personal care in the way they need to. The health needs of residents are generally met but some improvement is needed in the way staff complete some risk assessments and monitor the weights of some residents. The arrangements for the management and administration of medication are generally satisfactory but some improvement is needed in recording keeping. EVIDENCE: All the residents are registered with a GP and records of visits by health care professionals are maintained. Records showed residents have access to chiropodists, dentists and optician services, with records of any visits being written into their care plans. There was evidence in the individual plans to show relevant health care professionals had been consulted regarding specific care regimes and advice Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 19 obtained had in most cases been incorporated into the relevant plans. There was also evidence to show dieticians are contacted if staff have particular concerns about an individual. Staff said they were in the process of completing health action plans for all the service residents. Two resident files were looked at, a completed health action plan was in place for one resident but not for the other, action needs to be taken to ensure fully completed plans are in place for each resident. Discussion with the manager indicated plans were in place to review the quality of the health action plans with input from relevant staff and involvement of the resident or their representative. This is a welcomed development because health plans need to not only detail peoples health needs they need to focus on improving peoples lives. There were risk assessment tools for mobility, falls, tissue viability, bed rail provision, medication, nutrition and general issues; high risk areas had been identified and care plans were in place to support appropriate care provision in most cases. Examination of nutritional screening assessments for two residents showed no specific risks had been identified. The assessment for one individual had not been fully completed, the resident was identified as being of average weight, however staff had not weighed this person in addition information on the assessment indicated the person was having swallowing difficulties yet the scoring matrix had not been updated to reflect this. Similarly another resident was described as average weight, records of weight would indicate this individual might be under weight for their height. It is important that risk assessments accurately identify risks and where necessary plans be put in place to address any identified risks. Staff responsible for completing risk assessments must be appropriately trained in the area of the risk being assessed; this is needed to ensure staff have the right level of knowledge and skill needed to complete this task effectively. The inspector could not access staff training records and was therefore unable to verify what risk assessment training had been provided. Records showed staff are monitoring the weight of weight bearing residents but not none weight bearing residents. It is important that this now happens. Care plans should determine how often residents should be weighed and Mencap need to purchase appropriate scales or make alternative arrangements to enable this to happen. Some residents had daily exercise programmes in place devised by a physiotherapist. Records for two residents were examined; records showed plans were being followed for one resident. The care plan for the second individual contained a hand written entry stating this was not needed, but gave no explanation for this. It is important that where health professionals put plans in place for residents these are implemented and if no longer needed the reason for this should be recorded to show an audit trail for decisions. Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 20 Medication systems were examined and policies and procedures were in place, which covered all areas of management. Staff said they were not allowed to administer medication until they have received training from an accredited Mencap trainer. The inspector was not able to gain access to training records and was therefore not able to verify what training had been provided to staff. Storage of all medications and stock control was found to be satisfactory. None of the residents had been prescribed controlled medication. Checks on a sample of medication records showed that overall these were well maintained and kept up to date, however there were a few areas where they needed to be improved, these included; Some residents had been prescribed as and when needed (PRN) medication. Detailed written guidance for use of this type of medication was not in place and action should now be taken to address this. This is important because staff need to understand when this medication should be given and to ensure consistency of practice. Staff were sometimes handwriting medication onto the medication sheets (transcribing), but were not always following good practice, two staff need to sign the entry to indicate they have both witnessed that the information on the sheet is correct. Balances of medication were being recorded on a weekly basis, however a couple of records were not accurate. An assurance was provided that these matters would be addressed with staff. As a matter of good practice staff should obtain copies of the patient information leaflets for each medication from the dispensing chemist Medication is stored in a cupboard; staff are not routinely monitoring the temperature, this should now happen. Medicines must be stored at a temperature that does not exceed 25 degrees Celsius, the maximum temperature recommended by most manufacturers. Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints procedure was in place with evidence that relatives are aware of the complaints process, improvement is needed in ensuring outcomes of investigation are fully recorded. Policies and procedures for adult protection are in place, the welfare and safety of residents and staff would be improved by ensuring all staff receive ‘protect me training’ and by having more robust arrangements in place for the management of challenging behaviours including provision of relevant training for staff. EVIDENCE: The Commission had received one complaint since the last inspection in March 2006; this was referred back to Mencap for them to investigate. A complaints procedure was available and staff said information on the complaints procedure was detailed in the homes statement of purpose. On checking the inspector was advised that National Mencap had produced an easy read guide for complaints’ for residents but a copy of this was not available in the home. The manager acknowledged the importance of accessible information but said she felt none of the residents would be able to understand the contents of this leaflet. The previous manager for the home had dealt with two internal complaints since the last inspection. Copies of responses provided to the complainants were in place; however there was nothing to show these had been resolved to the complaints satisfaction. One relative spoken to said she had not made any Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 22 formal complaints to the home but indicated she had raised a number of concerns. A record of these was not in place in the complaints file. If a system is not already in place staff are advised to record all concerns and the outcomes of these. This will ensure that patterns or trends are identified and show how these have been resolved. Staff spoken to said that they had no complaints about the home and felt confident to raise issues of concern if they arose and that and the previous manager was always available for them to talk to if needed. Information from the Pre-Inspection Questionnaire and discussion with the manager indicated the home had policies and procedures to cover adult protection and prevention of abuse, whistle blowing, management of challenging behaviours and management of residents money and financial affairs. When asked about abuse, what it was and what they would do if they suspected or saw any abuse staff stated that they would report it to the manager. Training records evidenced that some staff had had ‘protect me’ training, however approximately 50 of the staff team still need to receive this training and action must now be taken to address this. This is needed to ensure staff know how to recognise poor practice and to ensure they are aware of and understand the systems in place for reporting and investigating adult protection matters. As indicated in other sections of this report some resident’s display challenging behaviours, improvement is needed in the quality and depth of care plans, risk assessments and monitoring arrangements for challenging behaviours. Staff also need to be provided with challenging behaviour training as it is important for staff to have the confidence, skills and knowledge to be able to deal with situations in a competent, consistent, safe and agreed way. Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is decorated and refurbished to a good standard, thereby providing residents with a safe and comfortable home to live in. EVIDENCE: The home was clean, tidy and well decorated and action had been taken to carryout redecoration and refurbishment work highlighted in the environment section of the March 2006 report. This included redecoration of the sitting/dinning room, purchase of new furniture and redecoration of corridors. This means residents now have a more comfortable home to live in. Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 24 All bedrooms seen were clean and tidy and were furnished and decorated in a homely style. Many residents had furnished their bedrooms with a range of personal items. A tour of the home showed the environment is suitable for the needs of people with physical disabilities. Doorways to bedrooms, communal space and corridors are wide enough for people in wheelchairs or people with walking aids. Discussion with the staff indicates that there is a wide range of equipment provided to help them move and handle people safely and to encourage residents independence within the home. This includes a mobile hoist, bath aids, stand aids, slide sheets, moving belts and handrails. Thirteen staff returned a questionnaire in response to the question ‘ do you feel there is enough equipment in the home’ twelve said yes, one said no. A fire risk assessment was in place and the manager had reviewed this within the last twelve months. Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35 and 36 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Staffing levels are generally satisfactory but improvement is needed in the provision of staff supervision and training. EVIDENCE: The roles and responsibilities of staff are clearly defined and in discussion staff demonstrated understanding of the management and reporting structures for the home. Inspection of the duty rota and discussion with staff indicates they consider staffing levels to be generally satisfactory. Although staff commented that because of some issues with residents they ware not always able to spend as much one to one time with residents as they would wish to. Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 26 Thirteen support workers returned a questionnaire. In response to the question do you feel there enough staff on duty to meet residents needs on all shifts? Twelve said yes, one said no. Three relatives returned a questionnaire, in response to the question ‘in your opinion are there always sufficient numbers of staff on duty, all three said no. A recruitment and selection policy and procedure and equal opportunities policy was in place. The inspector did not have access to any staff personnel records was therefore unable to verify how these are applied in practice. Staff access a corporate induction programme. One staff member spoken to said her induction had been ‘thorough ’. The inspector was not able to view any induction records because staff did not have access to these. The manager spoken to gave an assurance that the induction programme meets Skills for Care Common Induction Standards and the existing Learning Disability Award Framework (LDAF). A training plan to incorporate safe practice training including; moving and handling, first aid, food hygiene and epilepsy was in place and records evidenced staff are up to date with this training. Update training is provided every three years. It was difficult to establish how much training some individuals had received because staff spoken to did not have access to the staff files. Information given indicates limited resident specific training for example; autism training, working with people with sensory impairments or those with multiple disabilities. Information given also indicates annual appraisals are not up to date. There is a need to introduce a rolling programme of training for more specialised subjects. Failure to provide this training may mean staff do not have all the knowledge and skills they need to meet the needs of residents and this could impact on the care they receive. It is also important annual appraisals are kept up to date. This is needed to ensure the homes training plans and priorities accurately reflect the needs of the staff team. Discussion with the staff revealed they were extremely positive about the learning and development they have been able to access and are motivated and enthusiastic about their training experiences. A staff supervision programme was in place and each staff member had an allocated supervisor. Examination of a sample of supervision records showed some staff were not in receipt of regular supervision as a minimum of six times a year. This remains an outstanding requirement from previous the previous inspection and action must now be taken to address this. This is needed to Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 27 ensure staff receive the support and direction they need and to ensure staff receive feedback on their performance. Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there were positive examples of good management practice, resident’s health, welfare and independence would be increased with improved, management of challenging behaviours, care documentation, staff training, resident information and implementation of a structured quality assurance programme. EVIDENCE: The manager left the home in February 2007, staff advised that a permanent manager for the home has been appointed and is due to start work in March 2007. As an interim arrangement an area manager from Mencap is managing Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 29 the home, this manager visits the home two days a week, management support outside of these times is by telephone contact, staff can also access additional support from a manager from another Mencap home if needed. It is important that once the new manager takes up her post, she submits an application to register with the Commission. Feedback from staff surveys and discussions with staff during the visit indicates staff found the previous manager to be approachable, efficient and effective. Staff said any issues raised were dealt with promptly and effectively. Staff meetings are held and minutes of meeting are kept. Records indicate the last staff meeting was held in August 2006. None of the staff spoken to were able to give detailed information about how the quality of service and care provided to residents is formally assessed. Mencap has external assessors who visit their homes and following an assessment a detailed report on their findings is provided. Records indicated the home was last assessed in 2004. Regulation 26 visits do take place, but only copies of reports for two visits in 2006 had been filed in the quality manual. It is important that monthly visits are carried out, after which a report must be produced and made available for inspection purposes. There was nothing to show the outcome of quality monitoring arrangements for the last twelve months. It is important that a structured plan is put in place to monitor the quality of care and services provided to residents, and to have systems in place to show how residents, staff and relevant others for example; relatives, social services care managers and healthcare professionals are consulted about care delivery arrangements. The home must now produce an annual development plan, which details how they consult with people and the outcomes of this consultation. A report then needs to be produced showing how the comments from these individuals have shaped or altered the practices within the home, and show how the home is run in the resident’s best interests. General health and safety was maintained via adherence to policies and procedures, staff training and the maintenance of equipment. Information provided in the pre inspection questionnaire indicates servicing of equipment was up to date. Records of accidents were maintained and regulation 37 reports were sent on to the Commission where appropriate. As indicated in other sections of this report the manager had devised a basic training plan to incorporate safe practice training, including updates. Records evidence staff had accessed required training. Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 30 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 2 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 x 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 2 32 2 33 3 34 X 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000002910.V314802.R01.S.doc 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 2 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Salisbury Court Score 3 2 2 X 2 2 1 X X 3 X Version 5.2 Page 31 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 (2) Requirement Timescale for action 30/04/07 2 YA22 22 (3)(8) 3 YA32 18 (a) 4 YA36 18 (2) The registered person must ensure that individual plans are reviewed with the service user, significant professionals and family, friends and advocates every six months and service users plans updated to reflect changing needs. Timescale of 28/09/05 and 01/06/06 not met) The registered person must keep 13/03/07 a record of all concerns/ complaints and a record of all action taken to resolve the issues. The manager must also ensure that relatives are given an opportunity to comment as to whether they are satisfied with the action taken and response to their concerns. (Timescale of 28/09/05 and 01/06/07 not met) The registered person should 30/06/07 ensure that at least 50 of care workers achieve an NVQ 2 or above in care. The registered person must 30/04/07 ensure that the frequency of staff supervision is a minimum of DS0000002910.V314802.R01.S.doc Version 5.2 Salisbury Court Page 32 5 YA5 5 (1) (b) 6 YA1 5 (1) (b) 7 YA23 YA7 15(1) 13(6) six times a year (pro rata for part time staff). Timescale of 28/09/05 and 1/6/06 not met Each resident must be given a 31/03/07 personalised statement specifically relating to the care, accommodation etc that they will receive for the fee being paid. This should be supplied, at the latest, at the point at which someone takes up residence in the home. Information must be updated when there is any change to fees or charges. It is important that this fee information is widely available at an early stage to support people to make informed choices. Further information about this can be found in the revised Care Homes Regulations. 31/03/07 The registered person must revise the homes service user guide to provide general fee information and to provide details of the registered manager and current staffing. The guide must be produced in more accessible formats to ensure residents or their representatives have access to all the information they need to help them decide if the home is right for them. For residents who display 31/03/07 challenging behaviours, the registered person must put in place a formal and structured behaviour management plan(s), this must be supported by clear risk assessments, and all plans must be agreed with the multiagency care team and/or the resident or their representative to protect the rights of residents and to ensure their welfare and safety. DS0000002910.V314802.R01.S.doc Version 5.2 Page 33 Salisbury Court 8 YA23 YA9 13(6) 9 YA9 YA19 13© 10 YA19 13 © 11 YA20 13(2) 12 YA20 13(2) 13 YA23 YA35 13(6) The registered person must implement a system in the home whereby incidents of challenging behaviour are reviewed with a view to informing best practice in such circumstances. Information obtained must then be used to inform and support individual risk assessments and behaviour management plans to protect the rights of residents and to ensure their welfare and safety. The registered person must ensure risk assessment relating to health matters are accurately maintained. This is needed to ensure the health and welfare of residents. The registered person must purchase or make available other arrangements, which ensure residents with mobility problems can be weighed. Care plans should detail how often residents should be weighed. This is needed to ensure the health and welfare of residents is promoted and any issue with weight are identified. The registered person must ensure balances of medication are accurately recorded to ensure an accurate running total of medication is available. The registered person must ensure detailed written guidance for use of as and when (PRN) medication is in place. This is important because staff need to understand when this medication should be given and to ensure consistency of practice. The registered person must ensure staff identified in the homes training log as needing ‘protect me’ training, receive this training. This is needed to ensure staff know how to DS0000002910.V314802.R01.S.doc 13/03/07 28/02/07 31/03/07 28/02/07 13/03/07 30/04/07 Salisbury Court Version 5.2 Page 34 14 YA23 13(6) 18(i) 15 YA36 18 (i) 16 YA35 18(i) 17 YA38 24 (1)(2) recognise poor practice and to ensure they are aware of and understand the systems in place for reporting and investigating adult protection matters. The registered person must ensure staff are provided with challenging behaviour training by a competently trained person to ensure staff have the confidence, skills and knowledge to be able to deal with situations in a competent, consistent, safe and agreed way and to ensure the welfare and safety of both residents and staff. The registered person must ensure annual appraisals are completed and that these give clear information on the training and development needs of the worker to ensure training plans and priorities reflect the training and development needs of the staff team. The registered person must introduce a rolling programme of training for more specialised subjects relevant to residents for example; sensory impairments, autism, working with people who have multiple disabilities etc. Failure to provide this training may mean staff do not have all the knowledge and skills they need to meet the needs of residents and this could impact on the care they receive. The registered person must ensure that an annual development plan for the home is produced. This must show how residents, relatives and other key people are consulted about services provided by the home and any action taken to address any issues raised by these individuals and any internal or DS0000002910.V314802.R01.S.doc 14/04/07 30/04/07 30/06/07 31/03/07 Salisbury Court Version 5.2 Page 35 18 YA37 17 3(b) external audits. A summary report must be made available in the service user guide. The registered person must 10/03/07 ensure all records as detailed in the care homes regulations are available for inspection in the care home by any person authorised by the Commission to enter and inspect the care home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA12 Good Practice Recommendations The registered person should put in place care plans which reflect the principles of person centred planning. The registered should provide support workers with relevant training in developing and implementing activity programmes for people with complex needs thereby ensuring residents have access to meaningful occupation. The registered person should take steps to resolve the long-standing unresolved issues between some relatives and staff because this is affecting morale in the home. Action needs to be taken to address identified concerns with all parties concerned for the benefit of residents, staff and relatives. A second member of staff should witness all hand written annotations on Medication Administration Record charts. The registered person should ensure staff routinely monitor the temperature of the medication cupboard. Medicines must be stored at a temperature that does not exceed 25 degrees Celsius, the maximum temperature recommended by most manufacturers. 3 YA15 4 5 YA20 YA20 Salisbury Court DS0000002910.V314802.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. 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