Inspection on 30/05/07 for Saxonbury

This inspection was carried out on 30th May 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Saxonbury 12/10/06

Saxonbury 16/11/05

Saxonbury 14/06/05

Saxonbury 21/12/04

Saxonbury 08/07/04

Saxonbury 12/03/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Saxonbury Heathfield Road Freshwater Isle Of Wight PO40 9SH Lead Inspector Mark Sims Unannounced Inspection 30th May 2007 16:30 Saxonbury DS0000012531.V336236.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 Saxonbury DS0000012531.V336236.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. Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Saxonbury Address Heathfield Road Freshwater Isle Of Wight PO40 9SH 01983 755228 F/P 01983 755228 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) Islecare `97 Limited Mr Ian Desmond Vallender Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 2006 Brief Description of the Service: Saxonbury is a residential home providing care and accommodation for up to six younger adults with Learning Disabilities, one of whom is now over sixtyfive years of age. The home is a detached two-storey property situated in a quiet residential area of Freshwater. It offers single room accommodation, one with en-suite facilities. The town centre of Freshwater with its shops and amenities is about three quarters of a mile away. There is off-road parking for several cars at the front of the building, from which there is level access into the home. An average sized garden is provided at the rear with seating available for residents’ use. Saxonbury is owned by South Wight Housing Association and leased to Islecare ‘97 the homes proprietors. Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the second ‘Key Inspection’ for Saxonbury, a ‘Key Inspection’ being part of the Commission’s inspection programme, which measures the service against the core and/or key National Minimum Standards. The fieldwork visit, the actual visit to the site of the service was conducted over 3.5 hours, where in addition to paperwork that required reviewing the inspector met with the service users and staff. The inspection process also involves far more pre fieldwork visit activity, with the inspector gathering information from a variety of sources: the Commission’s database and pre-inspection information provided by the service provider, questionnaires, etc. What the service does well: The following is an indication of the areas where the service is performing well: • Choice of Home: The last person to be admitted to the home arrived in the August of 2006, records show the admission process was well structured and involved the person visiting the before making any decisions about moving to Saxonbury. During the fieldwork visit the last service user admitted to the home was observed and interacted with; and generally they appear to have settled well and would seem to be enjoying life in the home. • • Lifestyle: The people living at the home are clearly involved in a range of day services that provide both educational and recreational activities. Personal and Healthcare Support: There is clear evidence with the service user plans that people are supported in accessing appropriate health care services and that their individual health action plans have been completed, with the intention of supporting people access services in a safe and comfortable/appropriate way. The service users medication was noted to be appropriately stored and the medication administration records accurately maintained. • Complaints & Protection: The home has clear policies that cover both of these issues, the complaints policy and the protection guidelines displayed within the kitchen where staff, visitors and residents can view them, although they are only displayed in a written format. Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 6 • Environment: The home is in a reasonably good state of repair, with ongoing redecoration work noted during the fieldwork visit. People’s bedrooms, visited during a tour of the home, were noted to be individualised and a service user was clear when asked that he had been involved in the decision about his room colour scheme, etc. However, he was also clear that he, nor any other resident, had been consulted about the colour scheme within the communal areas of the home. • Management: The manager has only recently completed the registration process with the Commission, although he is experienced and has overseen the day-to-day running of the home for sometime. Ongoing staffing problems make managing some aspects of the service difficult, although generally it is considered he is doing a good job of running Saxonbury. What has improved since the last inspection? What they could do better: The following is an indication of the areas where the service could perform better: • Individual Needs and Choices: The service users plans have yet to be fully updated and converted to a client centred/focus tool. During the visit a prototype plan was seen and this appears promising, although it was only in use with one of the six people residing at the home. The home’s continued staff recruitment and retention problems are a serious issue, although a recruitment strategy is in place and a local recruitment drive planned. However, lack of permanent staff and insufficient numbers of staff impact on all aspects of the service users lives, limiting their social Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 7 activities, reducing their abilities to make independent decisions and restricting community contacts, etc. The inspector also found the practice of encouraging service users to go to bed, shortly after tea concerning. The staff on duty explained that this was the individual choice of the residents, however, it is easy for such practices to become ingrained and for carers to think this is in people’s best interest. • Staffing: For the above reasons. There is now an over reliance on agency staff, with several permanent staff having resigned recently, leaving six staff including the manager, three part-time and three fulltime. 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. Saxonbury DS0000012531.V336236.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 Saxonbury DS0000012531.V336236.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standard 2: The people who use the service and their representatives have the information needed when choosing the home. They have their needs assessed and a contract which clearly tells them about the service they will receive. EVIDENCE: At the previous key inspection the outcome judgement for this section of the report was ‘good’. Assessments: The evidence indicates that the home’s pre-admission assessment process is both robust and suited to the needs of the service and current resident group. • At the last inspection it was reported that: ‘This inspection provided a rare opportunity to look at the home’s admissions process, since prior to 2006 there had been no new admissions for about eight years. The newest resident moved into the home in August 2006. During the site visit the inspector looked at records relating to the admission, and had earlier spoken at length with the resident’s representative. In discussions it was apparent that the process took several months and Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 10 followed two trial visits before Saxonbury was judged to be where he wanted to live, and where his needs would be best met’. • This inspection established that no one has been admitted to the home since August 2006 and that the person admitted at this time remains in the home and is happy residing at Saxonbury. The service user spending time with the inspector during the visit, when the question of his settling into the home was raised. • The Annual Quality Assurance Assessment (AQAA), indicates that: ‘each prospective client receives a statement of purpose, which includes the aims, objectives and philosophy of care,’ and that ‘a recent client from the mainland had a graduated introduction to Saxonbury with a number of day visits and a planned weekend stay. This enabled an assessment of the impact on other service users to see if the placement was appropriate, this being a two way process’. The above declaration supporting the findings of the last inspection and the evidence noted during the fieldwork visit. • It was also evident from the feedback of a relative that they found the home ‘usually’ provided information in sufficient detail, as to enable them and their relative to make decisions, which would incorporate admission to the home. Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards 6, 7 and 9: Individuals are involved in decisions about their lives, and play an active role in planning the care and support they receive, however, staff shortages can impinge on their choices. Care plans are not sufficiently client focused, EVIDENCE: At the previous key inspection the outcome judgement for this section of the report was ‘adequate’. Care Planning: The evidence indicates that care plans do not centre on the support needs of the individual but rather continue to focus on caring for the person. • At the last key inspection it was reported that: ‘whilst opportunities for residents to make decisions and choices in their lives are determined by assessment and recorded in individual personal plans, they lack a ‘person DS0000012531.V336236.R01.S.doc Version 5.2 Page 12 Saxonbury centred’ approach and need to reflect best practice in this area. Additionally, opportunities have been limited because of recent staff shortages’. • During this visit three service user plans were reviewed, two following the established format whilst the third was an attempt to introduce a person centred tool into the care planning programme. Whilst the traditional style of care plan was found to be satisfactory, from an information recording perspective, they were both found to be poorly structured and maintained, with too much information retained on the files making them cumbersome and not particularly user friendly. The new system of client centred planning, appeared to be far more structured and due to the newness of the system not overloaded with additional and/or dated information. The new system, whilst not fully completed, clearly involved the service user more in the development and review stage and clearly placed the person at the centre of the process, which focused more on support and less on care delivery. However, this is only one plan out of six and it is suggested that efforts be made to introduce the new system into the home, as soon as possible and to re-assess and review the current plans to ensure only essential and/or relevant information is maintained on the day-to-day files. • However, despite the concerns over the service user plans, the evidence from the service users indicates that they generally enjoy living at Saxonbury and feel the staff provide the support they require. One of the two service users to complete a comment card stating: ‘I really enjoy living at Saxonbury with my friends’. Whilst the second person made a clear statement about his weekly planner: ‘I have a weekly planner, this is different every week’. The latter assertion demonstrating how the home/staff are actually involved in supporting clients to lead fulfilling lives, despite their failures to include this information within a client focused plan. Decision-making: The evidence conflicts and indicates that service users are sometimes supported to make independent decisions, whilst at other times their ability to make decisions is restricted or impaired. • It is clear from information contained within the AQAA form, the comment cards returned by both the service users and their Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 13 relatives/advocates and information gathered during the fieldwork visit, that staffing shortages are affecting the home. With people commenting on wanting to go out more but being unable to due to the lack of staff, people’s abilities to take holiday’s restricted due to the lack of available staff, etc. This issue is quite clearly impacting upon the service users rights to make decisions about their day-to-day activities and the home/staff to respond to these decisions appropriately, which does not imply that all requests can be or should be fulfilled. • However, people also feel that the home/staff do promote decisionmaking in other ways, with it evident given the service users comment quoted above, re his weekly planner, that for some people the shortage of staff is not an issue, as services provided outside of the home are available and accessible. Of the six people residing at the Saxonbury, most are regularly involved with a day service/centre outside of the home, which provides social contact and stimulation. • It was also evident that people are given the option of accompanying staff on trips out, when escorting other clients to day centre’s, etc and that often people enjoy these trips. The contradiction or conflict between how the home promote decisionmaking, also spills over into issues affecting the internal aspects of the home, as mentioned earlier. One client discussing how he was involved in deciding how his room should be decorated, yet all service users were excluded from the decision-making process of how the communal areas of the home should be painted. The inspector also found the practice of people going to bed around six o’clock, perturbing, as adults are often expected to stay up much later than this, although this was not all of the service users, roughly fifty percent of the clients were assisted to bed after tea. When asked the staff on duty stated that this was because the clients found their days long and tiring and that they would retire to bed with some form of entertainment/activity to help unwind before going to sleep. The remaining service users, were observed to be involved in various self directed activities, including watching the telly in the lounge, listen to music and watching videos in their bedrooms and going outside to walk around the garden. • • Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 14 • Given the evidence gathered it is the opinion of the inspector that efforts are being made to support clients when making decisions about their day-to-day activities, etc and that a recruitment strategy planned by the company, if successful, should improve the situation further, as this would allow some of the clients additional choices to be met/supported. Lifestyle and risk taking: Some aspects of the service are limiting people’s abilities to lead active, independent lives. • Following the last inspection it was reported that: ‘The inspector noted specific risk assessments on the sample of residents’ personal plans. Risks are identified, and to what degree. Guidance is given for staff on what to do to reduce the risk. A manual handling risk assessment, clearly designed for use in an older persons’ service was noted in the new resident’s file. This reinforces the need for all areas of personal plans to be reviewed’. During this visit it was established that individualised risk assessments are still being undertaken, reviewed and made available to staff, although the amount of information on each file makes it difficult to locate the assessment documentation. • It has also been reported above that staffing levels/difficulties are affecting the service users opportunities to lead independent lives, which obviously impacts upon their rights to take risks and expand the boundaries of their day-to-day lives. The above statement is supported by the views of relatives and/or advocates with people adding comments such as: ‘could be much better, often lack of time or staff, seem to deny residents of the things they would like’ and ‘sometimes’, the latter a direct response to the question: ‘does the care service support people to live the life they choose’. Feedback from the service users also indicate that people are not experiencing the freedom to take risks, etc, one person commenting: ‘I would like to go out more but there is not always enough staff to take me’. • • Saxonbury DS0000012531.V336236.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards 12, 13, 15, 16 and 17: People who use services are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet some individuals expectations, but a lack of staff means others’ needs or wishes are impeded. There is some evidence that service users’ rights may also be compromised. EVIDENCE: Activities: The evidence indicates that the activities and entertainments undertaken by the service users do not always meet their specific needs and wishes. • It is clear based on the feedback from the resident group, some of which has been quoted previously within this report, that some people feel they access/attend sufficient events, activities, day services, etc to meet their needs, whilst others would like to enjoy additional activities. DS0000012531.V336236.R01.S.doc Version 5.2 Page 16 Saxonbury • As the view of the relatives/visitors/advocates, etc, indicate that people feel the lack of staffing impedes people’s opportunities to experience a full life and given the findings of the previous inspection, when it was reported: ‘Residents are encouraged and supported to take part in a range of activities appropriate to their age and individual likes and dislikes. However, recent staff shortages have limited their opportunities for community links, especially in the evenings and at weekends’. It appears clear that whilst the staff team are trying to provide a wide range of experiences for staff, their reducing numbers are limiting people’s opportunities to experience appropriate entertainments. • This particular, impression, was reinforced during discussions with staff members, when exploring the range of evening entertainments within the local area and asking if anyone would like to visit the local pubs/inns, etc and if so why do they not. The staff explaining that perhaps one or two people would like to go out to a pub, etc but this would leave one person to look after four people in the home and this could be unsafe, especially when relying on agency staff at this time. Community Contacts: The evidence indicates that the people living at Saxonbury have limited access to community services. • It has been discussed at length that the people residing at the home would prefer to be more actively involved within the community but that the current staffing issues appear to be having a direct impact on this desire/wish, etc. The AQAA lists a large number of community based activities, which people can access or are involved with: Horse Riding Swimming Drama Music Cooking Day Centres IOW College Day Trips Excursions. • 1. 2. 3. 4. 5. 6. 7. 8. 9. Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 17 However, on reading through the service user plans, the majority of the events listed appear to be undertaken by only one client, with the remaining five people involved in perhaps one or two of the activities listed. The activities listed are also exclusively weekday based and do not take into consideration evenings of weekends, when people would have time to get involved in group activities, or more specific activities of their own. • Specific or personal activities, aspirational events, etc can clearly be arranged for service users within the community given sufficient time, staff and contacts. One client showing the inspector pictures of his trip on a trike (three wheeled motorcycle), which was arranged/organised by one of the agency staff, who works regularly at the home and who has contacts within a local club. Judging from the photos and the service users reaction when discussing the trip, it was clear that he had really enjoyed the experience one, which he is hoping to repeat in the future. Relationships: The evidence indicates that people are maintaining good relations with families and friends. • It was clear from the fieldwork visit that the dynamics of the home work well and that generally all of the service users and staff have good working relationships, although continued staffing problems could cause complications, one service user already mentioning that he currently does not have a keyworker, which is a vital support structure within the home for the service users. During the fieldwork visit the inspector had the opportunity to speak with a visitor to the home the person commenting on the fact that he is a regular visitor and generally made welcome by the staff. The AQAA indicates that the client group at Saxonbury is generally quite static, although one new person has come to live at the home within the last twelve months. In observing the interaction between the service users it was ascertained that the arrival of a new person into the home has not destabilised the homes dynamic, as stated above and the staff discussed how any initial upset or disruption, caused by admitting someone new has now settled. • • Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 18 The home’s admission strategy mentioned earlier in the report going someway to reducing the negative impact of inviting somebody new into the home. • The indication, within the service user plans, is that people are as involved with their families as they wish and as often as they wish. However, given people’s comments about not being able to attend any of the day centres/clubs, which operate in the evenings, presumably due the result of the staffing issues, people’s contact with friends appears restricted. Rights and Responsibilities: The service users rights are not clearly defined within the home and some practices should be reviewed. • As mentioned earlier within the report, several service users were supported to retire to bed shortly after tea, between six and seven o’clock. Whilst the staff appeared sure that this was in the clients best interest, as people become tired towards the end of the day, etc, it is not clearly identified within their service user plans nor is it evident that this is an agreed process, which has been discussed with the service user, their relative/advocate or care manager. This is not to say that given the opportunity the clients would not have opted to go to bed voluntarily. However, it seemed as though little choice was involved, as the staff directed the people towards going to bed, which is a more entrenched and institutionalised practice, as opposed to one that offers a choice and respects someone’s right to self-determination. • However, other observations indicate that people are offered the opportunity to make-decisions and their rights to undertake independent tasks, like making hot drinks, etc are encouraged. One person noted to make several cups of tea for himself during the inspectors time in the home. • Another service user went to his room to watch DVD’s, Video’s and listen to music, which he showed to the inspector during a visit to his bedroom, the service user inviting the inspector. However, the overriding indication is that the home is failing to adequately take into consideration people’s rights, their being no obvious route for people to comment on the service delivered (residents meetings, etc), people saying they are not consulted about changes DS0000012531.V336236.R01.S.doc Version 5.2 Page 19 • Saxonbury made to their home environment and comment cards and the previous report identifying the lack of opportunity people have or have had for going on a holiday. Meals and Menu’s: The evidence indicates that people enjoy meals that are based on their preferences and are varied and well balanced. • During the fieldwork visit the inspector observed people eating their tea, which was the main meal, people appearing to enjoy eating their main meal in the evening when they can sit down as a group. The observation of the mealtime, whilst brief, indicated that teatime is a social event with the service users eating in small groups, within the lounge. People spoken with stated that they enjoyed the meals provided. • • Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 18, 19 and 20: The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Personal Care: The evidence indicates that the service users receive support with their personal care needs that meets their individual needs and wishes. • The problem with the service user plans, in as much as they seek to provide care and not offer support, as would be considered appropriate if a client focused planning system was in operation, remains an issue, as discussed earlier in the report. However, these documents establish that the majority of service users residing at Saxonbury require support with their personal care, which is clearly set out within the care plans, although as above, the focus should be on what people can achieve independently, the staff then supporting Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 21 people to address those elements of their care they cannot manage alone. • The service users spoken with during the visit were happy with the care provided and felt the staff were caring, kind and considerate; and provided the support they required on a day-to-day basis. These remarks were supported by the views expressed via the service user comment cards, both comment cards ticked ‘yes’ in response to the question: ‘do staff treat you well’. • Health and Emotional care needs: The evidence indicates that the health care needs of the service users are being appropriately identified and addressed. • At the last inspection it was identified and reported that: ‘Records showed that residents’ health care needs are regularly addressed. They receive checks from the GP, dentist, optician and specialist health care professionals. All health care needs of the residents are identified in their personal plans. The manager said that all residents are registered with the local Brookside clinic where there are several GPs. Both care managers confirmed in discussions that staff had a good understanding of residents’ healthcare needs, and kept them informed of important events affecting their well-being, via the advocate in on case’. • At this visit the care planning files were noted to contain detailed information about people’s medical histories and health action plans, which identified the individuals preferences with regards to their health care and where they feel most comfortable receiving that care. Findings that mirror those of the last inspection undertaken on the 12th October 2006. During discussions with service users, no one raised concerns with regards to their access to either health or social care support, one person during a discussion, stating that he has regular reviews with his care manager when at his day centre, whilst a visitor added that he had attended additional reviews within the home. A comment card also made a direct statement about the home’s approach to supporting people to access health and social care services: ‘Generally good, can be delays with regular health checks, eyes and hearing tests, etc’. • • Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 22 Medication: The evidence indicates that service users are appropriately supported in managing their medication. • Following the last inspection it was reported that: ‘The inspector looked at the home’s arrangements for residents’ medication. Records showed that medication is administered by staff who have been trained and deemed competent by the manager. At the time of the site visit medication for residents was securely held in appropriate facilities, and records relating to its safekeeping and administration were found to be in good order. • At this visit it was ascertained that no changes had occurred in the home’s approach to supporting clients to manage their medication needs and that storage, record keeping and training were all still being appropriately addressed. The dataset provided evidence of the existence of medication guidance, policies and procedures, although there was not indication given of when this was last reviewed or updated. One of the staff on duty confirmed that only people who had completed the appointed persons’ training could administer medications, as this topic was covered as part of the training course. • • Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 22 and 23: People who use the service are able to express their concerns and have access to a robust, effective complaints procedure and are protected from abuse. EVIDENCE: Complaints and Concerns: The evidence indicates that service users are both able and happy to raise issues with the home and/or the staff if they need. • Both service user comment cards indicate that they are aware of how to make complaints, both parties ticking ‘yes’ in response to the question: ‘do you know how to make a complaint’. Copies of the home’s complaints and adult protection procedures were observed to be on display within the dining room/kitchen. The dataset further establishes the existence of the home’s complaints and concerns procedure, although again this provides no indication of when the document was last reviewed or updated. The dataset also contains details of the home’s complaints activity over the last twelve months: 1. No of complaints: 0. Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 24 • • • 2. 3. 4. 5. No of complaints substantiated: 0. No of complaints partially substantiated: 0. Percentage of complaints responded to within 28 days: N/A. No of complaints pending an outcome: 0. Safeguarding Adults: The evidence indicates that the service users’ welfare is promoted and that the management and/or staff seek to protect people from abuse and harm by their practices. • The Commission’s database’s evidence that one adult protection referral has been made since the last inspection and that this has been successfully resolved. The dataset also provides evidence that the company has an adult protection strategy, although yet again there is no indication of when this was last updated. The service users raised no concerns, either during their conversations with the inspector, who found the general atmosphere of the home to be relaxed. • • Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 24 and 30: The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: Environment and cleanliness: The evidence indicates that all service users live within a well-maintained, clean and tidy environment that meets their immediate and long-term care needs. • • The tour of the premise highlighted no concerns with all areas of the home being well maintained, decorated and furnished. The main lounge, as mentioned was in the process of being redecorated, although was in use, as the decorator was able to work when people were at day services/centres, etc and so minimise disruption. Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 26 • Many of the bedrooms visited during the tour of the premise and later in the company of the service users, had been furnished by the occupant, creating a sense of ownership. The AQAA makes clear that as the property is leased, the responsibility for maintaining the premise is ‘South Wight Housings’, although as part of a large company the service has access to an estates team, who will oversee minor repairs and refurbishment. The dataset indicates that all maintenance issues, fire systems, electrical and gas installations, etc, are being appropriately maintained and serviced. In discussions with the service users, the only issue regarding the premise was the lack of consultation around the decoration of the communal areas. • • • Cleanliness: The evidence indicates that the home is generally clean, tidy and free from odours. • Again the tour of the premise raised no concerns with regards to the cleanliness of the home, staff undertaking the majority of the cleaning, when the premise is quiet and the service users out at day services. It is clear from the comment cards, that where possible the service users take some responsibility for the cleanliness of their bedrooms, one person remarking: ‘I clean my own bedroom’. The residents generally appear happy living at the home and described it in terms of being homely, one comment card pointing out ‘I really enjoy living at Saxonbury with my friends’. The dataset establishes that the staff have access to infection control guidelines, if required, and that as with other documents these were last reviewed in the February of 2007. • • • Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 27 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards 32, 34 and 35: Staff in the home are trained and skilled but supplied in insufficient numbers to support the people who use the service. EVIDENCE: Training & Responsibility: The evidence indicates that the training opportunities for the staff are good. • The dataset and AQAA forms state that the home provides a comprehensive induction programme for staff, a statement confirmed by the staff on duty, the agency carer indicating that she was provided with a practical induction when commencing work as Saxonbury. In discussion with the permanent staff member, it was ascertained that training opportunities are good and that ‘Islecare’, arrange and provide staff with access to a variety of educational events, including the appointed persons’ training mentioned earlier. • Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 28 • The dataset, also indicates that the home/service is registered with ‘Skills for Care’, the sector skills training council, who monitor and approve all courses undertaken. The comment cards completed by relatives and/or advocates, etc also indicate that they feel the staff have the skills and knowledge required to care for the service users, although raised concerns over the lack of permanent staff. • Recruitment and Selection: The evidence indicates that the recruitment and selection process of the company is well structured but failing to attract sufficient new recruits. • Evidence has been included throughout this report, which demonstrates that the home is experiencing serious recruitment and retention difficulties. The manager himself, via the AQAA states: ‘staffing remains an ongoing problem not just for Islecare but the profession in general’. However, the situation faced at Saxonbury is serious, with only three fulltime and three part-time care staff (including the manager) available to support the service users (this information was taken from the home’s duty roster). • Whilst it is acknowledged that the company is taking steps to address the issue, a recruitment day planned for the 10th June 2007, the impact upon the service users is becoming more and more obvious one person remarking via the comment cards: ‘I miss those who have recently left’. • Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 29 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards: 37, 39 and 42: Managers and staff make best use of resources to deliver a high quality service. EVIDENCE: Management: The evidence indicates that the home is being reasonable well run under difficult circumstances. • The manager has only recently completed the registration process with Commission, demonstrating through this process his suitability and fitness to become ‘Registered Manager’. Whilst the home is experiencing difficulties, with regards to the staffing issue, the home is generally well run, as highlighted throughout the report. DS0000012531.V336236.R01.S.doc Version 5.2 Page 30 • Saxonbury It is also clear that the service users appreciate the service provided and enjoy living at the home and that the staff are satisfied with the managers’ style and approach to running and organising the service. • The AQAA states that the manager possesses a National Vocational Qualification level four in care, the Registered Managers Award, as well as a number of professionally awarded qualifications. It also evidences that he has worked within the social care field for more than twenty years, as he is shortly to receive a twenty year service certificate; and has been managing services for ten of those twenty years. Quality Assurance: The service users could be more actively involved in the day-to-day decision-making about the home and its function. • At the last inspection it was reported that: ‘the home is relatively small and domestic in scale. In discussions with the manager he outlined the steps taken to monitor the quality of service at Saxonbury and produced some documentary evidence: Key worker system Quality assurance feedback from residents/representatives. New quality assurance methodology (just introduced). Annual service audits by a representative of the Company. Annual care/support reviews involving residents, families, advocates and social services. Regular contact with families/representatives. Staff meetings and supervisions. Monthly statutory visits to monitor the conduct of the home. Investors in People Award’. At this visit it was ascertained that some of the service users do not feel part of the decision-making processes within the home, as evidenced earlier within the report, when discussing the redecoration of the communal areas. However, many of the quality assurance tools listed above are still in operation, with the exception of the ‘keyworker’ role, which, whilst still theoretically in place, cannot be considered to be operating effectively given the staffing issues faced by the service. • This point is best evidenced by a remark made via the comment card system: ‘at the moment I haven’t got a keyworker, so I would speak to Ian or Elaine’, the remark added to section ‘do you know who to speak to if you are not happy’. DS0000012531.V336236.R01.S.doc Version 5.2 Page 31 1. 2. 3. 4. 5. 6. 7. 8. 9. • Saxonbury Health and Safety: The evidence indicates that the health and safety of the service users and staff is being appropriately managed. • • No immediate health and safety concerns were identified with regards to the fabric of the premises during the tour of the premises. The dataset and AQAA establish that full health and safety policies/guidance documents are made available to the staff and that equipment is regularly maintained and serviced, gas, electrical installations, portable electrical appliances, etc. Health and safety training is clearly made available to staff, with the care staff providing testimony of the training completed and the dataset evidencing that staff have completed such courses as, food hygiene, etc. The tour of the premises also evidenced the wide range of moving and handling equipment available to the staff and that chemicals are stored in accordance with the appropriate regulations. • • Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 X 33 X 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X X 3 Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 YA7 YA9 Regulation Requirement Timescale for action 01/10/07 Regulation To review the personal planning 15 process, to ensure that each plan is appropriate to the age and needs of the individual and that it addresses issues of independence and peoples’ rights to take risks. Regulation Efforts to recruit and retain 18 permanent staff members must be improved, to ensure that the service users lifestyle is not impeded or restricted. Regulation The service must employ more 18 permanent staff, so as they can continue to effectively meet the needs and aspirations of the service users. 2 YA12 YA13 YA16 01/10/07 3. YA34 01/10/07 Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 34 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Saxonbury DS0000012531.V336236.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!