CARE HOME ADULTS 18-65
Shaftesbury Place 52 Marsland Road Cheltenham Glos GL51 0JA Lead Inspector
Ms Lynne Bennett Key Unannounced Inspection 12th July 2007 10:00 Shaftesbury Place DS0000067461.V336698.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 Shaftesbury Place DS0000067461.V336698.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. Shaftesbury Place DS0000067461.V336698.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Shaftesbury Place Address 52 Marsland Road Cheltenham Glos GL51 0JA 01242 227818 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.sanctuary-care.co.uk Sanctuary Care Ltd To be appointed Care Home 18 Category(ies) of Learning disability (18), Physical disability (18) registration, with number of places Shaftesbury Place DS0000067461.V336698.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. To include registration of one flat on the first floor for a named service user (category PD). To include the registration of Room 27 (flat) for one named service user (category LD/PD). The registration of this room will cease once the service user is no longer accommodated. 13th January 2007 Date of last inspection Brief Description of the Service: Shaftesbury Place is home for 18 people with a physical disability and mild learning disability. The home is owned by Sanctuary Care who are responsible for the provision of care and the tenancies of people living at the home. Shaftesbury Place is purpose built for people who are wheelchair users and the accommodation has level access throughout. There are four self-contained units each providing single accommodation, bathroom/shower and toilets, as well as a kitchen and dining area. There is a large communal lounge and separate laundry facilities. Two flats on the first floor are also registered. Theses flats have a bed-sitting room, bathroom and kitchen. Each person has a tenancy agreement in place and has a weekly personal food budget. If they have a private telephone or internet access they will pay for this. Fee levels range from £695 to £1,180 per week. Some people receive funding for holidays from their placing authorities. People also pay a contribution towards transport costs that is calculated using a fixed mileage rate. Shaftesbury Place DS0000067461.V336698.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection took place in July 2007 and included three visits to the home on 12th and 13th July and 18th July. The registered manager was present for the last visit. Prior to these visits eight surveys were returned from parents and relatives. An Annual Quality Assurance Assessment was supplied prior to the visits. Time was spent talking to people who use the service and observing the care they were receiving. Staff also discussed their roles and responsibilities and the care they provide. A range of records were examined which included care plans, medication and financial records, health and safety systems and staff files. Notifications to the Commission (Regulation 37 reports) also provided evidence for this inspection. What the service does well: What has improved since the last inspection?
An activity co-ordinator has been appointed to provide the opportunity for people to access a range of activities and leisure pursuits. One person said they enjoy going to a local art programme and another was looking forward to a holiday. Shaftesbury Place DS0000067461.V336698.R01.S.doc Version 5.2 Page 6 Family and friends have purchased two new vehicles. People have an individual menu sheet to record their diet wherever possible. New kitchens have been installed in each unit and communal areas have been decorated. A new domestic washing machine and tumble dryer have been provided in the laundry for people’s personal use. There has been an increase in the number of staff with a NVQ Award and staff waiting to complete the Award. 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.
Shaftesbury Place DS0000067461.V336698.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 Shaftesbury Place DS0000067461.V336698.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 5. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have access to information, which when updated will provide them with an overview of the service enabling them to make a decision about whether it will meet their needs. A full assessment is completed before the home offers a service to people. EVIDENCE: The home has one vacancy at present for which a person is being considered. Staff described the process whereby people are assessed by the organisation as to whether or not their needs can be met and are then invited for visits to the home. The manager confirmed that information including an assessment and care plans are obtained from the placing authority prior to admission. A pen picture supplied by the family and an assessment completed by the manager were examined. A copy of the person’s care plan had not yet been obtained. People wishing to move into the home have access to a current Statement of Purpose and Service User Guide which gives them information about the service they will receive. The Statement of Purpose does not provide Shaftesbury Place DS0000067461.V336698.R01.S.doc Version 5.2 Page 9 information about room sizes and whether they meet with the National Minimum Standards. People did not have a copy of their terms and conditions with Sanctuary Care. This was confirmed in the Annual Quality Assurance Assessment that identified Sanctuary Care is still to provide these. Some people had a copy of their placing agreement and tenancy and licence agreement with the former providers. Shaftesbury Place DS0000067461.V336698.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. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs are being assessed and met although any changing needs are not always being addressed by amending their individual plans and risk assessments. EVIDENCE: The care of three people was looked at in some depth. This included reading their care plans and other personal information, examining medication and financial records. They were also spoken with about the care they are receiving and staff were asked about their individual needs. Some people sign their records. People have a holistic assessment providing care plans for their physical, intellectual, emotional and social needs. These are regularly monitored with key workers completing monthly or bimonthly reports. One person who moved into the home just over six months ago had no care plans or risk assessments on their personal file. Staff said that these had been handwritten
Shaftesbury Place DS0000067461.V336698.R01.S.doc Version 5.2 Page 11 and were being typed up. Some staff said that they are not confident in their role as key workers but that the manager had requested training in this area. Some people are having annual reviews that include representation from their placing authority. One parent commented that reviews do not appear to take place as regularly as in the past. Hazards identified from care plans cross reference with risk assessments that are being reviewed every six to nine months. The practice of updating and reviewing care plans and risk assessments after an incident or change in circumstances appeared to be inconsistent. For example one person had a fall whilst transferring from their chair whilst using the shower and needed hoisting from the floor as a result. The incident record indicated that there was a problem due to the weight limitations of the hoist available. No care plans or risk assessments have been put in place to give staff guidance should this occur again. The care plan/risk assessment review for bathing in July indicates that there were no changes to assessed need. Two people were scalded recently and their evaluation sheets recorded this. The support provided to one person when making drinks was amended as a result. The person was observed putting this into practice and explained why this was now in place. People were observed being supported to make decisions about their day-today lives and being provided with assistance and the information they needed to do this. One person was observed preparing a shopping list to purchase their weekly food shop and another being supported to access healthcare appointments. Another person wishes to live more independently and told how they are being supported to achieve this. One person confirmed that they have access to an independent advocate. Some people have support to manage their personal finances. Risk assessments are in place that are due for review. Concerns were raised about people financing activities and holidays putting increasing pressure on their resources and leading to some people going into debt. The manager confirmed that Sanctuary Care does not provide resources for activities or holidays. (Also see Standard 23.) Shaftesbury Place DS0000067461.V336698.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): 12,13,14,15,16 and 17. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are able to make choices about their life style and supported to develop life skills. People have the opportunity to participate in social, educational, cultural and recreational activities that reflect their personal expectations. Some people are not being supported to maintain a nutritious diet that may later have implications on their health. EVIDENCE: People are having access to a range of opportunities and activities. The home is close to Gloscat and some people are able to take advantage of courses at the college. Some people said that they like to go the local shops, cafes and pubs. Some people go to church regularly. Several people go to Artshape or to a day centre each week. Two people are involved in work experience or voluntary work. People said that they use a range of transport including two
Shaftesbury Place DS0000067461.V336698.R01.S.doc Version 5.2 Page 13 new vehicles purchased by relatives and friends of the home, local buses and taxis. Some people are totally independent and do not require staff support to go out and about. For others staff support is available and there has been a significant increase in opportunities for people to go to concerts, theatre and day trips as well as bowling and eating out. People fund these activities themselves. People are also planning holidays for this year. Some people receive funding from their placing authorities and this is identified in their individual plans. Staff appeared unsure how people access this funding. In addition to this people’s financial statements indicate that they are saving each week towards the cost of their holiday. People have regular contact with family and friends. Some people have private telephones in their rooms and others have mobile phones. One parent commented that the public telephone has been disconnected and that this has impacted on contact with her relative. They confirmed that they visit regularly. Two visitors were spoken with and said that they are always made to feel welcome. Some people living in the supported living flats (upstairs) visit their friends in the home usually meeting in the communal lounge. People are enabled to be as independent as possible. Support is available from staff and where needed this is clearly indicated in each person’s care plans. Each person has a key to their rooms although some choose not to use them. They also have lockable facilities. People take responsibility for cleaning their rooms, taking care of washing and shopping for their weekly food. Individual menu records are maintained for people. Some people choose to buy convenience food and their menu records indicated an unhealthy choice of diet. Staff support is available to prepare and cook meals. One person was observed chopping vegetables with staff supporting them to cook the meal. One unit regularly cooks a Sunday roast together and people have a takeaway meal each week. Staff said that they encourage people to eat healthily. The manager confirmed that training is going to be arranged promoting healthy eating and that people living at the home would be invited to attend. There was evidence in some of the units of fresh vegetables and fruit. Concerns were raised that a significant number of staff did not have a basic food hygiene certificate. Shaftesbury Place DS0000067461.V336698.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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People receive personal support in a way in which they would prefer respecting their individuality and enabling them to be independent. Medication systems on the whole safeguard people from possible harm. EVIDENCE: The way in which people would like to be supported with their personal and healthcare needs is clearly identified in their care plans. Wherever possible people sign these alongside their key workers. Routines within the home are flexible and dictated by people’s needs. People described how they book times for baths or support with personal care that is largely determined by their schedule for the day. People have regular access to the wheelchair assessment centre and several had recently had new wheelchairs supplied. One person said that when their chair broke down recently staff contacted the centre and they were quick to respond and fix it. People who use communication aids are encouraged to use these by staff. People have access to a range of specialist equipment and
Shaftesbury Place DS0000067461.V336698.R01.S.doc Version 5.2 Page 15 adaptations. Due to alterations to one of the bathrooms people were using a bathroom in another unit, staff described the ways in which they were ensuring the dignity and privacy of people. See also Standard 29. Healthcare records are being kept in a variety of places. Entries are made in daily notes as well as in separate healthcare records and the appointments file. This made it difficult to track appointments and assess whether people are having regular access to dentist, optician and chiropody appointments. Staff said that the local National Health dentist which most people use now only sees people on an emergency basis. People have regular access to the district nurse and physiotherapists. Staff confirmed that people using the new wet room would need a referral to an occupational therapist. Medication administration systems were examined. Staff complete training in the safe handling of medication and have an annual assessment by the organisation. The home recently had a pharmacy inspection and complied with the recommendations which were issued. Medication records were completed correctly with evidence of stock control and handwritten entries being countersigned by two people. Any medication in packaging is labelled with the date of opening. Medication taken off the premises for home leave is signed in and out and stock levels recorded. It was noted that medication was being secondary dispensed for one person during a visit. Discussions focussed on enabling this person to maintain their independence whilst ensuring that medication was not being re-dispensed. Staff put a risk assessment in place during the visit and were arranging an appraisal to assess whether this person is able to self medicate. The manager pointed out that Sanctuary Care’s medication policy gave guidelines for secondary dispensing. Staff thought that this policy had been reviewed to reflect that secondary dispensing was not acceptable. A medication error was identified earlier this year and we were notified immediately. An investigation was carried out. Shaftesbury Place DS0000067461.V336698.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. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are confident that their concerns will be listened to and acted upon. Systems to protect people living at the home from possible financial abuse need to improve to ensure that they are being safeguarded. EVIDENCE: The home has a complaints policy and procedure in place which is accessible to people living at the home. It is produced in a format using text and symbol. People spoken to said that they would speak to staff or management if they have a concern. They also hold regular house meetings that provide a forum for voicing concerns. All comment cards from parents/relatives indicated that they were aware of the complaints procedure. The manager had received two complaints in the past twelve months from people living at the home. Copies of the complaints are kept with a record of their outcome. Training records indicated that less than half of the staff team have received training in the safeguarding of adults. Those spoken with on this issue had a good understanding of their responsibilities with regard to challenging and confronting poor practice. Staff were aware of the whistle blowing policy and procedure confirming it is introduced as part of their induction but spoke about their lack of confidence in this procedure. (Also see Standard 33.) Financial records were examined for those people who are supported by staff to manage their personal finances. There were inconsistencies in the way in which these are being administered. Each time money is debited two staff and
Shaftesbury Place DS0000067461.V336698.R01.S.doc Version 5.2 Page 17 the person sign their agreement of the amount and reason for taking the money out. A receipt is obtained for the shopping or purchases wherever possible. On some accounts the change is then credited back in which balances the account. On other accounts the person keeps the change and no entry is made on the account indicating a shortfall when trying to cross reference with the receipt. If change is kept this should be recorded so that the receipts and record balance. Staff expressed concerns about the financial situation of a number of people who are managing their own finances. A number are getting into debt and some have been unable to pay their rent. Financial risk assessments were being put in place during the third visit to the home. Staff described the processes they have been through to support people from getting into debt including negotiating with them and their bank to restrict overdraft facilities. There has also been a serious incident of theft that has been reported to police and they are presently dealing with this. The home dealt with this appropriately as soon as this information came to light. Shaftesbury Place DS0000067461.V336698.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. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is safe, clean and well maintained which recognises their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those people who need it. EVIDENCE: Shaftesbury Place is a purpose built home for people with a physical disability. The home is divided into four separate lodges and also includes two selfcontained flats on the first floor. Each unit provides accommodation for four people. They have a single room and share a bathroom/shower room, toilet and kitchen/diner/lounge. The kitchens in all units have been replaced and all communal areas have been redecorated. People are involved in the choice of decoration and the redecoration of their own rooms. A person is employed to oversee the day-to-day maintenance of the home. The following issues were identified during the visits as needing attention:
Shaftesbury Place DS0000067461.V336698.R01.S.doc Version 5.2 Page 19 Rooms 1-4 • Odour in toilet – flooring has become separated at wall • Several tiles in the bathroom need attention – either broken or cracked • Bathmat needs replacing • The protective cover at the foot of two doors needs attention • Room 1 – paper peeling on walls Rooms 13-16 • Room 14 – curtains are hanging off the rail, these need attention • Toilet – protective wall covering coming off the wall At the time of the visits a bathroom was being converted into a wet room. People have not yet been assessed for bath chairs and any other specialist equipment they may need. It may be some time before they can access an occupational therapy assessment. The manager stated that she was in the process of purchasing a shower chair and would be involving the occupational therapist as soon as possible. Specialist adaptations and equipment are provided throughout the home. New slings were being ordered at the time of the visits. Several people are unable to use kettles due to the risk of scalding but adaptations to use with kettles have not been provided which might reduce this risk. One of the staff, who has trained to provide moving and handling training was assessing whether further equipment such as slide sheets were needed. The manager stated that three profiling beds had been ordered. Staff have completed infection control training. Personal protective equipment is provided. COSHH analysis sheets are provided and hazardous products were being stored securely. The home was clean and apart from one toilet odour free. Shaftesbury Place DS0000067461.V336698.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): 32,33,34 and 35. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are not being safeguarded from possible abuse due to weak recruitment and selection procedures. The health, safety and welfare of people are being put at risk because staff do not have access to the necessary training. EVIDENCE: A staff team with a mix of knowledge, skills and expertise support people living at the home. Some staff have worked in care for a number of years and others are new to this profession. Staff confirmed that they complete an induction programme and shadow existing staff for the first few shifts. A copy of the induction programme was examined which is equivalent to the Common Induction Standards. Comments from relatives and visitors included, “ helps to ensure good care and enables them to be independent” and “pleased with the general care”. Seven of the staff team have NVQ Awards in Care and a further seven have been registered to start their awards.
Shaftesbury Place DS0000067461.V336698.R01.S.doc Version 5.2 Page 21 It was evident from discussions and records that absence monitoring is in place and that the Human Resources Department of Sanctuary Care takes action when they have concerns about sickness. Concerns were raised about how long term sickness is dealt with. The organisation’s policy and procedure clearly states that absence for staff on long-term sickness leave will be dealt with differently from those people having frequent short leaves of absence. Some staff felt that this was not the case. Minutes for staff meetings in March and April were available for examination. There have been no staff meetings since this time. When talking to staff it became evident that improvements need to be made to the way in which information is passed on. For instance during the visits a bathroom was being converted into a wet room but staff on duty were unaware that this was planned. Staff have a handover each day to discuss the support needed by people living at the home. Recruitment and selection is administered centrally through the Human Resources Department. They forward confirmation that a satisfactory Criminal Records Bureau check (CRB) has been received. There was no evidence that a povafirst check had been obtained for a person who had started work without a Criminal Records Bureau check in place, although the manager stated one had been obtained. A risk assessment was in place detailing the duties of the person until a satisfactory check was returned. Five files for new staff were examined and the following issues were noted: • • • A full employment history is not being obtained gaps in employment history are not being checked the reason for leaving former employment in care is not being obtained. These requirements have been outstanding from the last two inspections. A warning letter has been sent to Sanctuary Care in relation to this that may result in enforcement action being taken if these issues are not resolved. A training matrix is maintained and this indicated that a significant number of staff need training in several mandatory courses such as basic food hygiene, first aid and moving and handling. Only six staff have completed training in the safeguarding of adults. The manager said that she had identified this with Sanctuary Care. Staff said that senior staff have been completing training as trainers using open learning packs. The manager confirmed that moving and training handling was planning to be cascaded to staff as soon as possible. Staff have completed fire training recently and personal care and continence training is arranged for September 2007. A memo confirmed that the manager has also requested training in epilepsy and tissue viability. People living at the home are encouraged to attend training where appropriate. The manager confirmed that some people had attended skin care training. Shaftesbury Place DS0000067461.V336698.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. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are not being safeguarded due to weak management practices. Amendments to fire risk assessments will ensure that the health, safety and welfare of people is promoted and protected. EVIDENCE: The manager has been in position now for almost a year. Her application to become registered manager must be submitted immediately. A satisfactory Criminal Records Bureau check has been returned to the Commission. She has considerable experience working with adults with a learning disability and is doing a Registered Managers Award. She has a HND in Care Management. The manager has a clear developmental plan for the home which is based on the changing needs of people living there. Shaftesbury Place DS0000067461.V336698.R01.S.doc Version 5.2 Page 23 There are major shortfalls in areas of administration that need the urgent attention of the organisation and management including recruitment and selection and monitoring of people’s finances. Staff training also needs to be prioritised in order to ensure that they have access to mandatory as well as more specialised training. A quality assurance system is in place. A representative from the home meets with people from other homes to take part in a forum discussing their experiences and listening to key speakers. Sanctuary Care have also introduced a timetable for audits to be completed for the home in areas such as health and safety, infection control, training, medication and catering. As part of this the home completed a medication audit in June 2007. A financial audit was also completed in January this year. The Annual Quality Assurance Assessment confirmed that Sanctuary Care as part of their quality assurance programme is surveying people living at the home and their families. Systems are in place to monitor health and safety within the home. Fire records are maintained as well as water temperature testing, legionella analysis, portable appliance testing and servicing of hoists/slings and assisted baths. A fire risk assessment is in place that includes a stay put policy. The fire alarm was activated during the visit and this was observed in practice. This needs to be amended in light of changes introduced in the Regulatory Reform (Fire Safety) Order 2005. Recording of fridge and freezer temperatures within the units was inconsistent. Daily record sheets were not always being completed in one unit. None of the units appeared to be testing the temperature of cooked meat. This should be done for meat on the bone in particular. Shaftesbury Place DS0000067461.V336698.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 1 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 2 X Shaftesbury Place DS0000067461.V336698.R01.S.doc Version 5.2 Page 25 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4(2) 5(2) 6(a)(b) Requirement People wishing to move into the home need to know whether the room sizes meet with the National Minimum Standards. This must be included in the Statement of Purpose. (This requirement has been repeated from the last inspection – part of the requirement has been met). People must be provided with a statement in respect of accommodation and personal care and the total cost to them. This must also include additional costs such as activities and holidays. Each person must have a copy of their care plan accessible to staff at all times to make sure that they can obtain information about how to meet their needs. People must have a system in place to ensure that in the case of a fall there is an identified safe method of moving and handling them. The standard contract must
DS0000067461.V336698.R01.S.doc Timescale for action 30/09/07 2. YA5 5(1)(ba) 30/09/07 3. YA6 15(2) 30/09/07 4. YA9 13(5) 30/09/07 5. YA14 5(1)(c) 30/09/07
Page 26 Shaftesbury Place Version 5.2 6. YA17 7. YA17 8. YA20 9. YA23 10. YA23 11. YA24 12.. YA29 13. YA34 indicate the amount funded for holidays where this is part of the placing agreement. 18(1)(c) Staff cooking meals for people must have completed basic food hygiene training, to make sure that people are safeguarded from harm. 16(2)(i) People must be assisted to have a nutritious and healthy diet to minimise risks to their health. 13(2) People who use the services must be given medication directly from the container in which it is dispensed to ensure that errors are minimised and they are safeguarded from possible harm. 13(6) Staff must understand how to safeguard people using the service from possible harm or abuse. 13(4) Financial risk assessments must identify what the service is going to do to safeguard people from getting into debt. 23(2)(a)(b)(c) The environment must be kept in a good state of repair. Protective covering on walls /tiles needs to be fixed, an odour in a toilet investigated, curtains hung properly and a bathmat replaced. 23(2)(n) People using the wet room must have an occupational therapy assessment to review what specialist equipment and/or adaptations they may need to use this facility. 19(1) Sch The registered person shall 2.1,4,617(2) not employ a person to work Sch 4.6 at the care home unless he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule
DS0000067461.V336698.R01.S.doc 30/09/07 30/09/07 30/09/07 30/11/07 30/09/07 30/11/07 31/08/07 31/08/07 Shaftesbury Place Version 5.2 Page 27 14. YA35 13(5) 15. YA35 13(4)(c) 16. YA35 18(1)(c) 17. YA37 9 18. YA42 13(4)(c) 2. (This requirement has been repeated from the last two inspections). Moving and handling training must be provided for all staff that work with people that have been assessed as having difficulty in moving themselves. There must be at least one first aid trained person in the home at all times, to make sure that people living at the home receive appropriate treatment in an accident. Staff must have the knowledge and the skills to support the needs of people living at the home in areas such as epilepsy or tissue viability and protecting them from abuse. The manager must submit an application to the Commission to be considered for registration. People who use the service must be evacuated to a safe place if fire breaks out in the home. A fire risk assessment must be in place that complies with the Regulatory Reform (Fire Safety) Order 2005. 30/09/07 30/09/07 30/11/07 27/07/07 30/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA9 Good Practice Recommendations People should be able to manage their finances with support within an appropriate risk framework that is monitored and reviewed.
DS0000067461.V336698.R01.S.doc Version 5.2 Page 28 Shaftesbury Place 2. 3. 4. YA5 YA15 YA19 People should be able to access funding from their placing authority for holidays. People should have access to a telephone to maintain contact with family and friends. Healthcare records should be maintained so that staff can monitor the frequency of appointments. People should be registered with a NHS Dentist providing them with the opportunity to attend regular check ups. Robust financial records should be kept which identify money debited from the personal finances of each person. People should be offered financial advice and debt counselling to prevent them from getting further into debt. Specialist adaptations should be provided for kettles to minimise the risk of scalding. Regular staff meetings may ensure that information is given to staff necessary to fulfil their roles. The policy and procedure for monitoring absence should indicate how long term sickness should be treated in comparison to the outcomes noted for short-term sickness. Arrangements should be made for Commission for Social Care Inspection to sample original CRB documents annually. Staff should access training in Learning Disability Award Framework. Fridge and freezer temperatures should be recorded daily and the temperature of cooked meat taken, as infection control measures. 5. 6. 7. 8. 9. 10. 11. 12. YA23 YA23 YA29 YA33 YA33 YA34 YA35 YA42 Shaftesbury Place DS0000067461.V336698.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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
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