Inspection on 12/04/07 for Seeleys House

This inspection was carried out on 12th April 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Seeleys House 06/01/09

Seeleys House 16/04/08

Seeleys House 28/12/06

Seeleys House 30/05/06

Seeleys House 22/03/06

Seeleys House 06/09/05

Seeleys House 31/03/05

Seeleys House 30/11/04

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 Seeleys House Seeleys House Campbell Drive Knotty Green Beaconsfield Bucks HP9 1TF Lead Inspector Ms Kerry Kingston Unannounced Inspection 12th April 2007 10:30 Seeleys House DS0000032334.V331168.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 Seeleys House DS0000032334.V331168.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. Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Seeleys House Address 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) Seeleys House Campbell Drive Knotty Green Beaconsfield Bucks HP9 1TF 01494 670902 Buckinghamshire County Council Mrs Wendy S Rutland Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th December 2006 Brief Description of the Service: Seeleys House is registered to provide respite care at any one time for up to 12 people with learning and associated physical disabilities. There is a rolling programme for respite care. The home is sited in a residential area of Beaconsfield and is owned by Buckinghamshire County Council. It is an adapted old school and provides single accommodation for service users with shared social space. Half of the building provides Day Care Services and is also owned by the Council. The fees charged are based on a unit cost per bed per night of £197.96 this is paid by Social Services. In addition to this fee the Service Uses each have a contribution to pay which is based on a financial assessment undertaken by the Counties Finance Department, this is based on the level of income support and disability allowance received by an individual (minus the personal allowance) this combined figure is then divided by seven giving a nightly contribution. This contribution is usually between £7.00 and £11.00 per night. Information to support potential Service Users and their families to make a decision for admission to the home is provided in the homes Statement of Purpose and the Service Users Guide. Both of these documents are provided to potential Service Users, with additional copies held in the home. Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced site visit which took place between the hours of 10.30am and 8.30 pm on the 12th of April 2007, to collect additional information to inform the report for the key inspection. The Information was collected from a pre-inspection questionnaire, completed by the manager and seen on the day of the visit, surveys completed by eight of the eighty-five service users (with help from their families), discussions with staff members, the manager, the homes’ line manager and limited communication with and observation of several service users, there were eight people in residence on the day of the visit. Service users were unable and /or unwilling to engage in talking with someone they didn’t know on this particular day. A tour of the home and reviewing service user and other records was also used to collect information, on the day of the visit. A specialist pharmacy inspection was completed on 7th February 2007, the outcome of which was adequate. The home has made improvements in all of the outcome areas that were judged as poor at the last inspection in December 2006. The manager has received good support from her line manager but there are some areas that require further development and two requirements from the last inspection that have been only partially met. What the service does well: What has improved since the last inspection? The home make sure that the care managers find out and write down what people need before they come to stay at the home. The home looks to see if there are any areas of care where residents need special attention. If there are they write a plan to make sure they are kept as safe as they can be but are still able to do as much for themselves as possible. Most of the residents have a care plan that shows staff what they need help with. Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 6 Everybody has a ‘health’ plan that says what problems people have and what help they need to keep them as well as they can be. The home makes sure that peoples’ medicine is given out and kept safely. Nearly all the staff have been shown how to help residents if there is an emergency and they need ‘first aid’. More staff are being talked to, so that they know if they are working properly and doing a good job with the residents. The home will soon have a deputy manager so that they can take over if the manager is not in the home. 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. Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4. Quality in this outcome area is adequate. The home is ensuring that service users are not admitted without a properly completed assessment. They are working hard to ensure that all service users have an up-to-date assessment on their file. It is not clear if the home is able to fully meet the needs of those service users who have to stay for long periods. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The most recent admission was on the 6th February 2007. The process is that a care manager refers the client to the resources panel and presents the completed Care Managers and risk assessment. The panel decide what the appropriate resource is and if the service can be offered. The home then gathers information from other sources such as families, previous placements and day care placements, completing several pre-admission visits. There is no record of these visits and the home does not produce a written assessment of need or service user plan from them. A ‘care plan’ written by the parent or by a key worker is present on individuals’ files. A spreadsheet identified those people without assessments and the home will no longer accept referrals for admission without a fully completed Care Managers’ Assessment. There have been no admissions without a full care management assessment since December 2006. Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 9 The line manager of the home is trying to ensure that all individuals have an up-to-date assessment and has set a deadline of 16th April for Care managers to ensure their clients have assessments which have been reviewed. The Statement of Purpose and Service User guide state that residents can stay for a maximum of twenty-one days. It is not unusual for people to stay for much longer in emergency situations, there are two people currently resident in the home and it is not clear if a home that primarily provides very short term care is able to meet the needs of people who have to stay ‘long term’. The two people who have been resident in the home for approximately fifteen and six months, had their Care Management assessments reviewed in December 2006 and April 2007 but the reviews have not produced evidence that the home is able to meet their needs. Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. The home has individual ‘care plans’, provided by parents or key workers but these need to be further developed into comprehensive ‘service user plans’, to ensure they are person centred and include all areas of assessed need. The home has developed a safe risk assessment process. Service users are able to make decisions about daily life but there is no mechanism for them to participate in decision making about the operation or provision of the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans for five people were seen, two people have been resident in the home for approximately six and fifteen months. The ‘Care plans’ are documents drawn up by parents or key workers. One seen has been drawn up by the individual and was the only one seen that had a list of likes/dislikes and preferences. Likes and dislikes were referred to in a limited way in some of the other care plans. The samples seen were up-to-date but it was not clear what constituted the homes’ care plan, some of the document identified as a care Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 11 plan described assessed needs rather than how the home would meet/deal with those needs. There were some significant omissions such as emotional well being and personal development (particularly with regard to long term people) One of the long term people packs a bag at weekends to ‘go home’ when they are unable to, it is not noted on the ‘care plan’ how the staff support them with this distressing behaviour. There was discussion with the manager about the need to clarify and separate assessment of needs from the homes’ care plans that inform staff how to meet those needs. The manager undertook to continue the development of the care plans. There is a new Health plan format, which clearly describes peoples’ individual health needs and how the home will meet them. Generally the home has little to do with meeting peoples’ long-term health needs. It is clear that some service users have complex health needs and these are noted, care plans could include more detail of ‘how’ the staff meet those complex needs. The home does not hold any residents meetings or have any formal forums to hear the views of the residents or their representatives. One file contained a completed questionnaire asking a resident what he thought about the standard of care. Staff fully described how they enable people to have choice in their everyday life and routines, such as choosing clothes, food, and activities but knew of no involvement in the decision making with regard to operational policies or procedures. The care plans seen contained risk assessments, as necessary. The specific risks to the individual are identified by the care manager (at the time they complete the care managers’ assessments) and residential staff produce detailed risk assessments for each area identified. Risk assessments seen were of a good standard. Seeleys House DS0000032334.V331168.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. Quality in this outcome area is adequate. The home does not clearly address social needs on service user plans and staffs’ efforts to support service users to enjoy a positive lifestyle are not always clearly recorded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The daily notes of four people were looked at, there were few references to activities although cross-referencing to a ‘seniors message’ book provided some information about activities. . The home does not keep ‘activity logs’ or note activities in diaries. Some staff felt that there are not always enough staff to support people to access the community as their needs are very diverse and they enjoy very different things. It was also stated that some people are very tired after pursuing their usual day- time activities. Staff described service users being taken to the local shops, for walks in the woods, out for a drink, and using the day centre premises for craft activities. These activities appeared not to be always recorded. The manager advised that the home does Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 13 not plan activities on a daily basis, only outings such as a trip to a safari park, which took place on the bank holiday weekend. The manager also said that the home has its’ own transport but both vehicles require a passenger carrying permit one full time and one part time staff member hold these. The full time staff member works during the week so the vehicles are not available in the evenings or at the weekends, on a regular basis for activities and outings. The local community has few facilities and many service users are tired after daytime activities. The social needs of people are not noted on service user plans. Service users were observed on the day of the visit, they appeared to be content and were being engaged by the staff, some went out to for walks before the evening meal. The nature of the service means that families and main carers are always involved in the care of the service users. Families are able to have some choice in booking dates but there are no formal information giving or receiving forums. There are a small number of social events held at the home. Staff were observed treating people with respect and interacting positively with those who were resident on the day of the inspection visit. There were eight people in residence and six staff (including the cook) on the evening of the visit. Staff appeared to have plenty of time to interact constructively with the residents. Seven of the eight service user surveys returned said that the staff always treat them well (one was not completed). The menu seen was varied and nutritious, special diets are catered for, one person who ate a Halal diet was in residence. One service user clearly makes her own choices with regard to her food and this is noted on her ‘care plan’. Five people are artificially fed one of the five is a long term resident. A nutritionist/dietician oversee his feeding regime but written feeding guidelines could be much more detailed and clearer. Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. The healthcare needs of the service users are well met but care plans need further development to increase their quality and include individual preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Five ‘care plans’ were seen, one person had completed her own and had included a long list of preferences/likes dislikes. Some documents had significant omissions including, people’s preferences, social needs and what they like to do. In some plans parents and key workers noted how the individual liked to be helped and what their usual routine is, this is followed by staff in their daily work. The written records are not very clear and it is difficult to tell what is the needs assessment and what is personal care support information/guidelines. Service User (care plans) plans need improvement, the quality is poor in some cases and they are sometimes not specific to the residential care being given, this is a particular issue for those residents who are staying for more than the 21 days, which is the maximum prescribed respite care stay. Five healthcare plans were seen, a new plan was introduced in January 200, it was reviewed and changed in April 2007. They include Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 15 medical conditions, medical information, a medication list and recording charts as necessary. For instance one person has bowel, fluid, seizure and weight charts, this reflects their complex health needs. Information about physical and emotional well-being is passed between the home and primary carers by means of a diary. An example of a detailed record of a residents stay was seen, this was being kept in a more detailed form than usual as the family were away for an extended holiday and need information to check the residents’ progress and well-being on their return. In event of illness of respite residents, families are contacted first if possible and their own medical practitioner is consulted. If this is not possible the home has a surgery that accepts all residents as emergency patients. The home does not have any responsibility for respite residents’ long-term, ongoing Health care programmes but will alert care managers if any concerns are identified. There was a discussion with the manager about the appropriateness of the day centre taking responsibility for some areas of service users’ healthcare if people are to remain longer term in the home. Detailed guidelines for when to use medications that are prescribed, when necessary or for health procedures, such as ‘tube feeding’ were not available on the day of the visit. Medication administration records seen were accurate and properly written, medication is signed in and out of the home promptly and a robust medication procedure is followed. No respite medication ‘stocks’ are held on the premises, residents usually bring only enough for the visit or any excess is sent home with them. A large quantity of medications is kept for one resident who is currently ‘long term’. It is kept in a locked medication cabinet, only one month’s supply (dispensed by the pharmacy) is held. A detailed Pharmacy inspection conducted on the 7th February 2007 assessed the homes medication administration as adequate with no requirements and four good practice recommendations, two recommendations had been complied with and two were not checked on this visit. There is no one using the service, at present, who use needles in their healthcare regime. Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. The home has proper complaints procedures and generally keeps service users safe from all forms of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a robust complaints procedure, the manager confirmed that there have been no complaints received since the last inspection. However a staff meeting showed that there had been one complaint with regard to a member of staff’s conduct when dealing with colleagues, this was not recorded or referred to in the complaints book. The manager confirmed that there had been no ‘safeguarding’ adults referrals or concerns since the last inspection. The Commission for Social care Inspection has received no information with regard to complaints or safeguarding adult’s issues. Complaints records showed that ‘outcomes’ of the complaints (from last year) were not always clear and there was some confusion around what was a complaint against ‘social services’ and what was a complaint against the home. This was discussed with the manager who agreed to add some information to clarify the outcomes and cross reference to where other confidential information relating to a complaint is held. There was also discussion about the use of a ‘complaints’ book. Staff receive up-dated and ongoing training with regard to ‘safeguarding adults’, however staff spoken with were unsure of the procedure and the action to take if a ‘senior’ was not available or was the perpetrator of abuse. That is, they had a general knowledge of Safeguarding Adults but were not Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 17 confident as to how to put it into practice in the home. The ‘line manager’ for the home agreed that there would be some home specific training in this area. The home does not deal with residents’ finances and keeps only a small amount of ‘spending money’ for long term and respite people. Receipts are kept for all expenditure. Six of eight of the Service user surveys received, stated they knew who to talk to if they were not happy and their views would be listened to and acted upon (or family on their behalf.) Three residents were asked if they felt safe but most did not respond in a way that was interpretable, they all smiled and agreed that they felt happy. During observation they appeared to be relaxed and comfortable with staff and confident to make their needs known. Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. The home is clean, hygienic and suitable to meet the needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean and tidy with good quality furniture and fittings. The bathrooms and shower rooms have been renovated to a high standard and contain all the necessary equipment for residents personal needs to be dealt with comfortably, whatever their physical needs. One toilet is awaiting new flooring. Some bedrooms will be in need of decoration in the near future and the manager advised that this is acknowledged and the work is ‘due’. The home does not have an ‘annual’ maintenance plan but work is done, as necessary. The two long- term residents’ bedrooms were seen and efforts have been made to make them look homely, with the residents personal belongings around. Some areas may benefit from some ‘homely’ touches, for example pictures or mobiles. The Kitchen is well kept and received a silver award from Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 19 the environmental health inspector who visited in January 2006. (a silver award means the standard achieved is above the national minimum standard.) Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 20 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, 25 and 36. Quality in this outcome area is good. The home has a competent, well-trained staff team who are able to meet the needs of the service users. Robust recruitment procedures ensure service users are as safe from abuse as possible. Staff offer good care to service users but they are not always as well supported as they could be, to ensure they continue to deliver care to a good standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home currently has three full time vacancies, there were seven vacancies at the last inspection in December 2006. The home has worked hard to try to recruit suitable staff. There are a minimum of four staff on duty plus the senior (during day-time hours), rotas showed these numbers are met, they may include agency or staff doing overtime. The manager is not included on the care rota. Staff numbers can vary and reflect the needs and numbers of people who are resident, the manager decides the staffing complement needed. The home operates a ‘rolling rota’ staff overtime, bank and agency staff cover shortfalls. The manager advised that they try, as far as possible, to get the Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 21 same agency staff who are familiar with the home. The home operates a two tier staffing system, there are nineteen support workers and seven senior staff. The senior staff team consist of six team leaders and the manager, one of the team leaders is always on shift, one team leader, works days only (except for overtime). Staff meetings are held separately with the senior staff meeting together and one senior attending the support workers staff meeting. Discussions in the home showed that some felt staffing was hierarchical and a ‘bit secretive’, with support workers being asked to complete complex tasks with little support from the senior staff team. The manager advised that senior staff are often busy with medical procedures and don’t always have enough time. There were feelings expressed that staff don’t always feel very supported, the home does not operate an ‘open management’ system, information is not always shared and management seem ‘stressed’. The feeling that the staff team have low morale was expressed and this was felt to relate to low staffing numbers, this did not appear to be reflected in the amount of staff on duty or by comments received on the service user surveys. Supervision appears to be carried out regularly by some of the senior staff team but not by others. Three staff files seen showed these staff receive monthly supervision while others said that they are supervised about every ‘three or four months’ or once in ‘eight months’. The manager advised that she has a new supervision ‘auditing’ system that is operational and will address supervision issues. Staff confirmed that there are good training opportunities, most mandatory courses are up-to-date. Thirteen of the twenty-four staff have N.V.Q.2, five have N.V.Q.3. therefore eighteen of the twenty-four staff are qualified. The home has a cook during the week. Recruitment records contained all the necessary information to ensure staff had been properly checked before starting work. ‘Senior’ and ‘junior’ team meetings have been held regularly since December 2006 (last inspection), but there have been no ‘joint’ team meetings. The manager has not attended ‘junior’ team meetings. All staff (but two) have received the emergency treatment of casualties training and infection control training. Staff were observed responding quickly and efficiently to the needs of service users, there were enough staff on duty to meet the needs of the residents, comfortably, on the day of the visit. Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is adequate. The home is adequately managed but there are areas that need reviewing to ensure that the home is well run in the interests of service users, whose views inform the management and running of the home. The home ensures service users are as safe, as possible, within the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has worked in the home for several years, is experienced and has a Registered Managers Award. The manager is now spending a larger percentage of her working week within the home. Staff confirmed that they see much more of her now although there was still some negative feelings about the management of the home, the ‘two tier management system, the lack of support and the lack of involvement of Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 23 the ‘junior’ staff. The ‘Line manager’ is in the home at least one morning per week and is assisting the manager to complete the improvement plan and to continue developing the home. Even with good support from the ‘line manager’ some areas of the management of the home have shortfalls such as the oversight of the team leaders to complete their allocated tasks (e.g. supervision), the checking of the quality of service user plans, the detail of specific guidelines and the recording of activities. The job description for a deputy is being completed and adverts are due to be published at the end of April. The home does not have a quality assurance system or any formal method of collecting the views of service users or other interested parties. This results in there being no evidence or feeling that the home is managed with a service user ‘focus’ or of service user involvement, there is also the feeling of some staff that they are not involved in the overall ‘running’ of the home. A Health and Safety Audit by Buckinghamshire County Council in May 2006 was satisfactory. The usual Health and Safety records of maintenance were seen and were upto-date, as was most of the mandatory Health and Safety Training. Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 24 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 3 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 X 32 3 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 2 2 1 X X 3 X Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement To work in the next 12 months towards providing Service Users with Care plans, which are reflective of a more person centred approach and are formulated with the Service User. (Partially met timescale not reached 06/06/07) To ensure the written plans include all the service users needs and how they are to be met by the home, so that individuals are clear how staff will support them and that it will be in the way they wish, as far as possible. To take into account the wishes and views of service users and ensure their involvement in the care processes. That the manager and staff support service users to be part of the local community. (Partially met further improvement and evidence keeping necessary, new Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 26 Timescale for action 01/11/07 2. YA7 12.3 01/06/07 3. YA13 16(2)(mn) 01/06/07 timescale given) 4. YA36 18(2) It is required that all staff receive regular formal supervisions so that they are properly supported to offer good standards of care to the service users. 01/07/07 5. YA39 24 (Not met for all staff but improvements being made.) To develop a quality monitoring 01/12/07 system that includes the views of service users or their representatives to ensure that the home continues to develop and improve the quality of care it provides. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. Refer to Standard YA18 YA20 Good Practice Recommendations To ensure service user plans note service users likes/dislikes and preferences and how they are encouraged to make decisions and choices. To provide more detailed guidelines for the administration of medication that is prescribed to be taken ‘when necessary’. To provide detailed guidelines for any of the ‘medical’ procedures undertaken by staff. To review the management styles and systems operating in the home to ensure that it encourages the involvement of all staff and service users. 3. YA38 Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Seeleys House DS0000032334.V331168.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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