Inspection on 31/01/08 for Sarum House

This inspection was carried out on 31st January 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sarum House 24/02/09

Sarum House 18/09/07

Sarum House 06/03/07

Sarum House 07/02/06

Sarum House 22/06/05

Sarum House 13/12/04

Sarum House 19/05/04

Sarum House 16/01/03

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Sarum House Beehive Corner Old Sarum Salisbury Wiltshire SP4 6BL Lead Inspector Alyson Fairweather Unannounced Inspection 31 January and 7 February 2008 11:00 st th Sarum House DS0000032418.V357633.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 Sarum House DS0000032418.V357633.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. Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sarum House Address Beehive Corner Old Sarum Salisbury Wiltshire SP4 6BL 01722 335283 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) Wiltshire County Council ****Post Vacant**** Care Home 15 Category(ies) of Learning disability (11), Learning disability over registration, with number 65 years of age (2), Physical disability (2) of places Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability- Code LD Physical disability- Code PD 2. Learning disability over 65 years of age- Code LD(E) The maximum number of service users who can be accommodated is 15. 18th September 2007 Date of last inspection Brief Description of the Service: Sarum House provides personal care and accommodation for 15 people with a learning disability. The home is operated by Wiltshire County Council, and is on the outskirts of Salisbury. A nearby park and ride scheme offers regular bus journeys into the city, and Sarum House also has its own transport. The home is an older property, although good efforts have been made to maintain and enhance it. There are two floors for resident accommodation, and all residents have single bedrooms. Some of the residents on the top floor who have relatively small bedrooms also have their own sitting rooms. The home has no lift, making the upper floor unsuitable for anyone with a physical disability. Baths, showers and toilets for general use are on both floors. Communal areas include a ground floor games room. All residents pay a top up fee in addition to the fee paid by the funding authority. In January 2008 this was: over 60 yrs - £98.60, 25-60 yrs - £63.95 and under 25 yrs - £51.65. Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The inspection took place over two days in January. Several residents and staff members were spoken to, as well as two team leaders and the new home manager. Seven residents, two relatives and four staff members responded in writing to our questionnaire. Various documents and files were examined, including care plans, risk assessments, health and safety procedures, staff files and medication records. The house is currently made up of two floors. The downstairs part of the home houses some older, frailer residents and some people who have lived there for a long time. The residents who have moved from Wiltshire County Council’s training and assessment unit, which has closed down, as well as some of Sarum House’s more able residents use the upstairs part of the house. The manager, Sue Gray, has recently been appointed and is planning to register with the Commission for Social Care Inspection (CSCI). She follows on from a previous interim manager who had been allocated to deal with the problems that the home had been experiencing. At the last two inspections, it was felt that the service was sufficiently underperforming to ask them for improvement plans. The last improvement plan submitted had shown how the home had worked to improve the service it provides. This work was found to have been sustained, and the new manager has made further improvements. However, there were issues with the use of the relief staff employed by Wiltshire County Council. These staff support the permanent staff in times of absence or vacancy, and work not only at Sarum House but also at other Wiltshire County Council services. The home’s manager and one of the team leaders were both clear that these staff had their own training before they came to work in Sarum House. On examination, it was found that this was not always the case, and one person had no evidence of any training on their files. There was confusion about Criminal Records Bureau (CRB) checks and references in relief staff files, and there was no evidence that relief staff were being adequately supervised. This means that the overall improvement seen in Sarum House was somewhat negated by the fact that they are using untrained and unsupervised relief staff Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 6 to support residents, and could lead to residents being at risk, particularly where medication administration training has not been given. What the service does well: What has improved since the last inspection? There were many improvements to be seen since the last inspection. Care plans, risk assessments, health and safety measures and record keeping had all been developed and were now clear and concise. This means that residents are safer, as all staff are now able to see exactly how people need to be supported. New residents now have their needs assessed before they come into the home, and risk assessments are put in place at an early stage. This means that people who come to stay at Sarum House and their families can be surer that their needs will be met. Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 7 There is less chance of accidents being ignored or forgotten now that the way in which accident records are kept has improved. The statement of purpose and the service user guide has been improved, which means that people now have more information about the home before they move in. The new manager has plans to further improve these documents, using pictures which have meaning to the residents. Staff morale seemed to have improved, and people said that this was because they now had a clear idea of what was expected of them, and were being shown how to achieve it by the new manager. 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. Sarum House DS0000032418.V357633.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 Sarum House DS0000032418.V357633.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 and 2 Prospective residents have enough information to make a choice about whether they would like to stay in the home. Their needs, hopes and goals would be assessed and recorded before they move in to the home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and the Service User Guide have been updated since the last inspection, as requested. The new manager is keen that they reflect the diverse needs of the residents, and plans to integrate some meaningful pictures into the documents. One relative said that she “always” gets enough information from the home, and said: “They are excellent at communication”. There had been one new resident admitted to Sarum House since the last inspection. There was good assessment information of file and staff had formulated various risk assessments before the resident had moved in. This means that staff had as much information as possible about how to support a new resident, and were clear that they could offer that support. The manager said that she would not accept any resident without first being sure that there was enough information in place to be sure that the home could cater for the person’s needs. Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Care plans reflect the needs and personal goals of residents, who are assisted to make decisions about their own lives. They are supported to take risks where appropriate, and encouraged to be as independent as possible. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: A great deal of work has been done by staff in relation to compiling care plans for each resident, and these had been personalised to a much greater degree. Each plan now has an index page, which quickly shows where to find specific care plans. Care plans include information on communication, accommodation, literacy skills, health and social activities, Care plans have been reviewed regularly, and this is also done when the situation has changed for any individual. A system of daily records is also in place. One resident was seen to have had the care plan reviewed several times as their needs fluctuated. Anything that had been missing on the first day of the inspection was in place by the second visit. Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 11 Care plans showed that people’s different cultures and faith were taken into account, and arrangements had been made for one person to have a lift to church. So that all staff working in Sarum House are aware of the care plans for all the residents, they are supposed to sign to say they have read them. In one case this had not been done and it is recommended that a system be introduced to ensure that all staff do this. All four staff who wrote to us said that they were always given up-to-date information about the needs of the people they support. Residents are supported to make decisions about their own lives with guidance from the staff. Some are able to manage their own finances, and some have family involvement. Some residents choose to go to day services, although local cut-backs have affected how often this takes place. Of the seven surveys returned to us by residents, a new member of staff had completed one and another resident had helped other people. All seven people were said to be able to choose what they wanted to do during the day. One staff member said: “The service is very focused on enabling people to live up to their full potential”, and another said that they: “Support individuals to achieve a more independent lifestyle”. Residents’ risk assessments are now kept alongside their support plans, and these included such things as self medicating, travelling, cooking and gardening. Some of these were extremely detailed, but several were written on different formats. It is recommended that the same style of risk assessment is used as it would be easier for staff to be consistent in how they record risks and how to manage them. Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Social and leisure activities are varied, although some people reported that if staffing levels were improved they would be able to do more. People have as much or as little contact with family and friends as they wish, and are encouraged and supported by staff. Residents’ rights are respected and responsibilities recognised in their daily lives. They are offered a healthy diet, and those who self-cater are encouraged to use healthy options. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are encouraged to develop and maintain their independence as much as possible and those who are able to can come and go as they wish. Some people have supported work and one resident works in the local Mencap shop. Some people attend the Sarum Centre, and some have done some voluntary work in the past. Another is a member of Salisbury Independent Self Advocacy Group. Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 13 Some residents use the local park and ride bus independently. Another resident has her own bicycle which she uses as transport. One resident is encouraged to keep a diary of her activities herself as she gets busy, and has learnt to text staff when she is out and about. One family who wrote to us said they would like staff to: “Arrange more regular activities in the community. The service users do not have routines that include regular outings. They very often have to stay in colouring and watching TV”. Some residents who are able to, go out with their friends for a pub lunch, and one person said: “I make my own timetable”. One person has a computer with large flatscreen, and during our visit was using clipart on her computer to make a green cross to put on another resident’s medication box in her room. Another resident has a Wii, and others have PS3, TV/DVD and stereos. One resident has a certificate of merit obtained when she talked to the police about how to talk to people with LD. One staff member said: “The new manager is trying to recruit new staff to enable more one to one time with residents”. Some people have visits from and to their family, although some live further away. Friendships both inside and outside the home are encouraged, and staff support links between residents and their family and friends, although the frequency of contact varies depending on the individual circumstances. Residents are free to visit friends outside the house at any time, and can entertain and choose to see whom they like either in their own bedrooms or in the communal areas available. One family member who wrote to us said they were always kept up to date with important issues affecting their relative, and another said: “I feel we have had exceptional care, and that we have been involved completely as parents”. Staff encourage and support residents to develop the skills which will be needed by those who wish to move into less supported accommodation, and the people who live upstairs are somewhat more independent. They do their own cooking and cleaning and maintain their own rooms. Support is given to those people who are less able to do domestic chores such as shopping, cooking and laundry. Some residents have keys to the front door, their bedroom and their private lounge. The food provided in the home is of a good quality, with a good supply of fruit and vegetables available. Healthy eating options are encouraged, and records are kept of likes and dislikes. The upstairs and downstairs parts of the home have separate arrangements for cooking. Downstairs the food is prepared by staff for residents and a full menu is kept of what is on offer each day. Residents contribute to menu planning by telling staff what they would like to eat. The upstairs part of the house is where the people who moved from the training and assessment unit live. They make their own arrangements Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 14 regarding food preparation, and each make a financial contribution to a food budget. The residents take it in turn to cook for each other. The menus showed that the main meal is usually in the evening, except at weekends. Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 20 Residents’ personal support needs are recorded in care plans so that they can receive this support in the way they wish, and their physical and emotional health needs are met. Residents’ are supported to self-medicate where possible, but the lack of training in medication administration by some relief staff means that they are at risk. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Residents have support plans for any personal care required. The information contained in them is gathered from the home’s own assessment and staff knowledge of the residents. People have guidelines in place which say how they like to be helped to get washed and dressed. There is a good gender mix of both male and female keyworkers. One staff member who wrote to us said they felt that one of the best things the service did was to provide personal care and emotional support for residents. All residents are registered with a GP whilst living in the home, and all other medical professionals are seen as and when required. This varies according to Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 16 the needs of individuals. There were records which showed people had visited a number of services, including the optician, dentist and orthodontist. One resident who had been experiencing periods of ill health had been seen by a consultant psychiatrist for people with learning disabilities, and had a care plan devised by a community nurse, who visited every two weeks. One resident has had a problem with fingers which are extremely tightly folded and closed into the hands. There was nothing on the health care plan and no reference to physiotherapy for her hands. By the time of the second visit this had been done and a letter was on file from the physiotherapist saying that she had been seen by them and there was no further action to be taken. A new care plan and risk assessment relating to nail care were also on file. The home has a policy in place for all medication, and all permanent staff have medication training when they first start work. Medication is kept in a locked trolley in a locked room on the ground floor. All residents have a medication profile outlining what drugs they take, and these have information sheets from medication packs alongside. Medication risk assessments are in place. The new manager, Sue Gray, was keen to introduce individual medication boxes for each resident. These would be kept locked in the individual’s room, and support given as before. By the time of the second visit this had been happening, and some residents said they were happy to be able to have this done, as they wanted to become more independently able to take their medication. On checking the stock of medication, it was noted that on one occasion, where a resident had been given some paracetamol, this had not been recorded. The manager has been asked to make sure that this is always done, and that we are notified of any medication error. Staff were seen to be doing a stock check on medication daily, in the evening, and this meant that less time was being spent with residents as a result. Whilst it is good practice to audit medication, some thought should be given to the timing and frequency of this, so that residents are not disadvantaged. One relief staff member who wrote to us said that they had only recently started work at Sarum House, but had not had any medication training. It was hoped that this would be done within a month. This lack of training was confirmed when looking through relief staff files. Senior staff at Sarum House have previously had difficulties with relief staff who have made errors with medication, but had believed that all relief staff who were sent to them to cover shifts had all the necessary training. The results of relief staff administering medication without training could be very serious, and the manager has been asked to ensure that all staff who do this have evidence of their competency on file. Sarum House DS0000032418.V357633.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 and 23 There was evidence that residents and families feel their views are listened to and acted on. Residents are protected from abuse, neglect and self-harm, although if all staff were trained it would make them safer. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints policy has been updated and each resident has a copy. This is done in picture format, but the manager has plans to update this with more user friendly pictures. All the residents spoken to said they knew who to speak to if they weren’t happy with something; some said they would go to their keyworker and some said they would go to the manager. Of the two families who wrote to us, both said they were aware of the home’s complaints procedure, and one said: “Staff gave the complaints procedure to us”. All four staff members who wrote to us said they knew what to do anyone expressed concerns about the home. The home has a copy of the organisational policy and procedure on responding to allegations of abuse, and staff said that they would be comfortable reporting any incidences of poor practice if they saw them. One resident who talks about self harming and wanting to die has a detailed risk assessment in place which outlines what staff should do to make sure she is safe. Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 18 There was evidence that permanent staff have had training in Protection of Vulnerable Adults, and all four staff who wrote to us said they were aware of the procedures, which should be followed. Two of the three files examined for relief staff had no evidence that this training had been done, and the person with responsibility for learning disability services has been asked to ensure that all staff have evidence of protection of vulnerable adults training on file. Sarum House DS0000032418.V357633.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 and 30 The home is clean and hygienic throughout, and residents live in a homely, comfortable and safe environment. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been many recent changes in the building. There are now eight single bedrooms downstairs, including one large one, and seven more upstairs. Because of the small size of four of the upstairs bedrooms, each of the four residents was given another adjacent room, which could act as their sitting room. Staff still currently call this the “Training and Assessment Unit”. The furnishings throughout the house are of good quality and have a homely feel. Residents’ bedrooms were comfortable and each contained individual personal items, such as stereos and TVs and games consoles. One relative who wrote to us recently said: “Whilst Sarum House is in desperate need of repair, the facilities are adequate”. Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 20 Future plans for Sarum House mean that it will be closing down. Some people will be moving from residential accommodation to more independent, supported living, although some of the residents may still require to be living in registered accommodation. One family said to us recently that their relative would be “better served living with people more in his age range”. The home was clean and tidy. There was a kitchen and a separate laundry area, which reduced the risk of cross-infection. New infection control guidelines were in place. Of the seven residents who wrote to us, all said that the home was always fresh and clean. One said: “Upstairs do their own chores and do our own bedroom and lounge and kitchen”. Sarum House DS0000032418.V357633.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, 34, 35 and 36 It was impossible to verify that residents are supported by competent and qualified staff. Not all relevant information was available to verify that residents are protected by Wiltshire County Council’s recruitment policies and practice. Residents do not have their needs met by appropriately trained staff, and they do not benefit from well supported and supervised staff. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Many of the staff working in Sarum House have had a number of years experience of working with people with learning disabilities, although some have recently been employed. They have knowledge of the specific conditions of residents and seek advice from the appropriate professionals when they need more support. Many of the permanent staff have completed NVQ level 3 and NVQ Level 2. All new staff work within the new Learning Disability Qualification framework, (LDQ). There was no evidence on the three relief staff files examined of any NVQ, and no record available of those who were currently undertaking NVQ. The manager has been asked to keep an up-toSarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 22 date record of the number of staff with NVQ and the number of staff still studying for NVQ. Although it is now the third time that the home has been told to do this, it relates to the relief staff only. All the residents we spoke to and who wrote to us said that staff always treated them well. There are at least two members of staff in the house at any given time, with two sleep in staff, one upstairs and one downstairs. Relatives who responded to our questionnaire were happy with the care which staff provided. One said: “In my opinion they do a fantastic job and all appear to have the skills required”. Of the four staff who wrote to us, two said that there were “usually” enough staff to meet the individual needs of all the people who use the service, and two said: “sometimes”. One person said: “Staffing levels are getting better. The new manager is trying to secure sufficient permanent staff to provide service requirements”, and another said: “New staff are being recruited soon to enable more one to one time with residents”. All recruitment information for permanent staff of Wiltshire County Council, including CRB, application form and references are now held centrally at County Hall and will be examined there at a later date. Relief staff files, including training are held nearby. On examination of three relief staff files, it was found that two of them did not contain photographic ID or a medical declaration. One contained an application form but no references, another contained two references, and the third contained no documentation whatsoever. The manager of the relief team was unable to offer any explanation as to why some files held references and some did not. Two files contained a letter from Wiltshire County Council HR department saying that the CRB check was satisfactory, although neither made reference to whether an enhanced check had been done. The third file contained no reference to CRB checks at all. Although Wiltshire County Council has an arrangement with CSCI about holding files for care homes centrally, the relief staff agency was not included in this. The person responsible for the learning disability services must write to CSCI clarifying their position and requesting that this arrangement is made for the relief service. There was no reference on the letters for HR to say that the CRB check had been done at an enhanced level and that a POVA check had also been done. Following the last two inspections, when there was some confusion about exactly what needed to be on file, advice was given to senior managers and to an employee of Wiltshire County Council’s HR department.about the content of the letter which CSCI have agreed will be sufficient evidence of CRB checks. The guidance was reproduced in the last report, and is once again laid out for information. “Guidance issued by CSCI says that the minimum expectation with regard to evidence of CRB checks is that on receipt of the Disclosure, the umbrella Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 23 organisation or corporate body should issue a letter to providers stating the name of the person; date of Disclosure; Level of disclosure; Including POVA Check (if requested); Disclosure reference number; date POVAFirst check was received (if this was sought); and POVAFirst Reference number. Inspectors will accept the letter as evidence of the providers meeting the requirement for staff to be CRB checked. Letters (rather than Disclosures) should be kept on file in the home. This will assist CSCI inspectors when they sample Disclosures to confirm that employers have followed robust recruitment practices”. The person responsible for the learning disability services has been asked to ensure that all staff files have evidence of an enhaced level CRB and POVA check. Although it is now the third time that the home has been told to do this, it relates to the relief staff only. The person responsible for the learning disability services must ensure that all staff files contain appropriate information, including photographic ID. Although it is now the second time that the home has been told to do this, it relates to the relief staff only. The training files of permanent staff are now up-to-date, and contain evidence of training in manual handling, fire training, stoma care, medication handling, infection control, food hygiene and protection of vulnerable adults. New staff have induction training using the new Learning Disability Quality (LDQ) framework. Training planned for new staff includes more stoma training, manual handling, infection control, health and safety and the Boots medication training. One staff member said: “As service users needs change, training is sought to ensure a greater understanding and knowledge. For example, a service user has been assessed as having autism. The team is currently waiting for training in this area”. All four staff who wrote to us said that their induction training covered everything they needed to know to do the job when they started. Of these four people who wrote to us, three said they were being given training which is relevant to their role, helps them understand and meet the needs of service users, and keeps them up to date with new ways of working. One person answered “No” to all of the questions. Training records for relief staff were examined. One file contained an induction sheet completed and signed off by the staff member, but not signed by the manager. two other contained no evidence of induction. One file showed no evidence of training in manual handling, infection control, health and safety, fire training or medication administration. Another had no evidence of training in the protection of vulnerable adults, manual handling, medication administration, infection control or food hygiene. A third file contained no evidence of any training at all. The manager of the relief service thought that perhaps some of the training information was held on the computer, but was unable to show this. Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 24 One relief staff member confirmed these findings when they wrote to us. They said: “I am new on the relief bank and have only had two shifts here. I am hoping to do medication training within a month”. Placing relief staff in care homes without training can be extremely risky for residents, and can leave permanent staff very vulnerable. The manager and senior staff of Sarum House were clear that the expectation is that all relief staff will have had training prior to commencing work with them. The person responsible for the learning disability services must ensure that all staff have evidence on file of satisfactorily completed induction training, and that this is signed off by the manager or by someone who is trained to confirm the competency of the care worker. All staff must have evidence of training in food hygiene infection control, health an safety, and fire safety. All staff must have training in the protection of vulnerable adults. This relates to the relief staff only. All staff must have training in manual handling. Although it is now the second time that the home has been told to do this, it relates to the relief staff only. Sarum House permanent staff have two weekly staff meetings as well as regular supervision sessions. Signed supervision contracts were on their files. The manager provides supervision for senior staff who in turn supervise care staff. Three staff reported that their manager “regularly” meets with them to give them support and discuss how they are working. One person said: “Regularly NOW”, in reference to previous times when this was not happening. Another person said: “I have supervision regularly and feel able to go to my manager at any time for advice and support”. The relief staff member said “NA”, meaning this was either not appropriate or not applicable. Formal supervision is an important part of the working life of care staff, as it gives them an opportunity to discuss their working practice, any difficulties encountered and to look at any training needs. Residents who are supported by unsupervised staff may suffer as a result. The person responsible for the learning disability services must ensure that all staff must have formal, recorded supervision. Although it is now the third time that the home has been told to do this, it relates to the relief staff only. The manager of Sarum House and senior staff have been told that if there are any problems with relief staff, then they must contact the relief service manager. This was done on one occasion, and a letter was sent outlining various failures of a relief staff member, including medication errors and failure to record in daily notes. This letter was kept on the individual’s file. When Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 25 asked if disciplinary measures had taken place, the relief service manager said that he had “spoken to” the staff member concerned. There were no disciplinary notes on file and no record of the incident being recorded in his file. This is in direct contradiction of Wiltshire County Council policy relating to staff who make medication errors. There had been no response made to the concerns expressed by staff at Sarum House. The person responsible for the learning disability services must ensure that full records are be made of any disciplinary action taken. It would be good practice when concerns are raised by the home about the work practice of any of the relief staff, to make a full response to them, outlining any action taken. This relates to the relief staff only. Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Residents benefit from a well run home. They are confident that their views underpin the monitoring and review of care practice. Their health, safety and welfare is promoted or protected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Sarum House has a new manager in place, Ms Sue Gray. She has had many years of experience in working with people with learning disabilities and mental health problems. She has achieved her Registered Managers Award and is currently studying for her NVQ Level 4 in Care. She is a registered NVQ assessor, and also has an NVQ 3 in Anatomy and Physiology. Her recent training has included, Abuse and Protection of Vulnerable Adults, Dementia, Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 27 BAC Counselling, supervision skills and Dangerous Behaviour. She is due to make an application with CSCI to become the registered manager. Residents’ meetings are held weekly, and are held before staff meetings so that staff can discuss any issues then. Minutes of these meetings are typed up by one of the residents. SWAN independent advocacy has been part of residents’ meetings and helped conduct an audit of the home in October 2007. The home now has its own questionnaire which is given to residents to find out their opinions of how the home is run. This is available in picture format. Ms Gray plans to develop this questionnaire for residents, staff, families and others. All seven residents who wrote to us said that carers listened and acted on what they say. One person said: “They give advice on problems”. An annual quality assessment had been sent to us by the home on a previous occasion, and was used when writing this report. There are well developed policies and procedures to ensure the safety of residents and staff at Sarum House. One of the team leaders has taken responsibility for these, and is to be congratulated for improving matters since the last visit. The electrical cupboard is now clear of handyman things, fire drills are held quarterly and an annual health and safety assessment had been done in July 2007. A generic risk assessment had been done for the house, highlighting any potential dangers and planning how to deal with them. Any health and safety incidents are recorded. The accident book was empty, and the manager said there had not been any accidents recently. The book consists of forms which are taken out and placed in the resident’s file when an accident is recorded. By the day of the second visit the manager had put in place a tracking system which will keep track of the number of accidents and where to find the record. Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 X 34 1 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 3 X X 3 X Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 29 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 2 YA20 3 YA20 4 YA23 5 18 (1) (a) 18 (1) (a) 37 Standard YA20 Regulation 13 (2) Requirement All medication must be recorded and signed for when administered. CSCI must be notified of any incident which affects the welfare of a resident. All staff must have training in medication administration. Comment: This particularly relates to the relief staff. All staff must have training in the protection of vulnerable adults. Comment: This particularly relates to the relief staff. The registered provider must keep an up-to-date record of the number of staff with NVQ and the number of staff still studying for NVQ. Comment: This particularly relates to the relief staff, although it is the third time the requirement has been made. All staff must have evidence of an enhaced level CRB and POVA check. Comment: This particularly relates to the relief staff, DS0000032418.V357633.R01.S.doc Timescale for action 07/04/08 07/04/08 07/05/08 07/05/08 07/04/08 YA32 18 (1) (c) (a) 6 YA34 17 Schedule 2 (7) 07/05/08 Sarum House Version 5.2 Page 30 7 YA34 8 17 Schedule 2 17 YA34 9 YA35 10 YA35 18 (1) (a) 18 (1) (a) 11 YA35 18 (1) (a) 12 YA36 18 (2) 13 YA36 17 Schedule 4 (6) although it is the third time the requirement has been made. If CRB checks and references for relief staff are to be held centrally, confirmation of this must be sent to CSCI. All staff files must contain appropriate information, including photographic ID. Comment: This particularly relates to the relief staff, although it is the second time the requirement has been made. All staff must have evidence on file of satisfactorily completed induction training. Comment: This particularly relates to the relief staff. All staff must have training in manual handling. Comment: This particularly relates to the relief staff, although it is the second time the requirement has been made. All staff must have evidence of training in food hygiene infection control, health an safety, and fire safety. Comment: This particularly relates to the relief staff. All staff must have formal, recorded supervision. Comment: This particularly relates to the relief staff, although it is the third time the requirement has been made. Full records must be made of any disciplinary action taken. Comment: This particularly relates to the relief staff. 07/05/08 07/04/08 07/05/08 07/05/08 07/05/08 07/05/08 07/05/08 Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 31 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 3 4 5 6 7 Refer to Standard YA6 YA9 YA20 YA20 YA35 YA36 YA36 Good Practice Recommendations A system should be introduced to ensure that all staff sign when they have read residents’ care plans. All staff should use the same format for risk assessments. When recording medication errors, the name of the resident, the name of the drug and the dose shoul be recorded. The time when medication stock is checked and the number of times it is checked should be reviewed. All induction training should be signed off by the manager or by someone who is trained to confirm the competency of the care worker. When concerns are raised by the home about the work practice of any of the relief staff, a full response should be made to them, outlining any action taken. The person responsible for supervising the relief staff should have evidence of training in supervision skills. Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sarum House DS0000032418.V357633.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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