Inspection on 15/04/08 for Shaftesbury Place

This inspection was carried out on 15th April 2008.

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

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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shaftesbury Place 12/07/07

Shaftesbury Place 05/06/06

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Shaftesbury Place 52 Marsland Road Cheltenham Glos GL51 0JA Lead Inspector Ms Lynne Bennett Unannounced Inspection 15 16 and 30th April 2008 09:45 th th Shaftesbury Place DS0000067461.V359855.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.V359855.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.V359855.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 ****Post Vacant**** Care Home 18 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories Learning disability (Code LD) Physical disability (Code PD) The maximum number of service users who can be accommodated is 18 12th July 2007 2. 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. There are supported living flats on the first floor two of which are registered. Theses flats have a bed-sitting room, bathroom and kitchen. Each person has a tenancy agreement in place and receives 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 and may have to pay towards the cost of activities. People also pay a contribution towards transport costs that is calculated using a fixed mileage rate. Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place in April 2008 and included two visits to the home on 15th and 16th April by the Link Inspector and another visit on 30th April by one of our Pharmacist Inspectors. 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. Surveys were returned from sixteen people living at the home, six staff and two healthcare professionals. The Annual Quality Assurance Assessment (AQAA) was provided last July and we were able to monitor improvements identified in this document. The home did not have a registered manager at the time of the inspection. The acting manager was in attendance throughout the visits and the group manager was present during the first visit to the home. A selection of documents were also examined including care plans, staff records, the Statement of Purpose, health and safety files and medication records. There was some difficulty in accessing some records where possible copies were supplied from Head Office during the inspection. The pharmacist inspector checked the arrangements for managing medicines in the home were still safe following several notifications made to us involving medication. We (the Commission for Social Care Inspection) looked at some stocks and storage arrangements for medicines, some medication records and policy. We saw some medicines prepared for administration at lunchtime. We had discussions with the acting manager and a team leader. 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. What the service does well: Purpose built accommodation is provided for people with a physical disability. People have access to specialist services such as physiotherapy, district nurses and the wheelchair assessment centre. People living at the home said that they are being encouraged to be as independent as possible. However support is available for those people who require it. Healthcare professionals commented staff “treat each client with the dignity, respect and individuality that they deserve”. People living at the home said “I like the staff very much Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 6 all of them” and “staff are helpful and always listen”. Medicines were stored safely and were in stock to administer to people in the home. What has improved since the last inspection? 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.V359855.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.V359855.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): 1,2, 4 and 5. 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 have access to the information they need enabling them to make a decision about whether they wish to live at the home. An assessment of the person’s wishes and needs are taken into consideration before offering them a place. EVIDENCE: People living at the home confirmed that they have access to the Statement of Purpose which was normally displayed on the notice board near the foyer but had been removed at the time of the inspection. The master copy which was kept in the office was available for examination. Amendments had been made to this document to include a statement about the environmental specifications of the home. Additional adjustments needed to be made (such as changing our contact details) and these were dealt with during the inspection. One person had been admitted to the home since the last inspection and they said they had settled in well. They had just had their placement review and their social worker and parents attended. Staff confirmed visits had been arranged with a trial stay. Staff said an assessment had been completed by the home but this could not be located at the time of the visit. The placing authority had supplied an assessment and care plan. Staff said parents and the former placement had also supplied information. There was evidence of Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 9 liaison with a range of healthcare professionals prior to the person moving in to make sure that the appropriate adaptations and equipment were in place. People had copies of their contracts between themselves, Sanctuary Care and the placing authority. Licensing agreements had been amended to reflect that they were in place with Sanctuary Care. Shaftesbury Place DS0000067461.V359855.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 good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A person centred approach to care planning provides the opportunity for people to take control of their lives. People’s needs are being assessed and they are being supported to makes decisions about their lifestyles. Risks are being managed safeguarding them from possible harm. EVIDENCE: The care of four people was case tracked which included reading their care plans, observing the care provided and talking to them and the staff about how their needs were met. The group manager and acting manager explained that a new system of care planning was being introduced. A sample of this was available and included a person centred plan that would be held by the person in their room. Care plans were in place identifying each person’s physical, intellectual, social and emotional needs. There was evidence of regular review including making amendments when changes to the person’s need occurred. For instance one person was experiencing dramatic changes to their mental and physical well Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 11 being as they are getting older. There was evidence that care plans and risk assessments had been changed to reflect this and that referrals had been made to health care professionals for additional assessments and support. A review had been held recently and the minutes were on file. The quality of the review of care plans was variable with some key workers providing a comprehensive summary and others noting simply that there had been no change. The former is good practice. People where able had signed plans and for others it had been noted that they observed the process. There was evidence that some people were having reviews with their placing authorities. Any restrictions that were in place such as the use of bedsides, lap belts and foot straps were recorded and again signed by the person and their placing authority. Records indicated where people had given their permission for the sharing of information with others and having their photograph taken. The home had a missing person’s folder in place with a pen picture of each person and current photograph. Information about the last admission to the home had been included in this folder. Procedures were in place should a person not come home at the expected time. An incident record confirmed that this had been implemented and police contacted at the appropriate time. Risk assessments were discussed with the person after this incident and a new arrangement introduced as a result. Risk assessments had been developed from hazards identified in care plans and could clearly be cross-referenced. There were systems in place for regular review and people living at the home had been involved in putting them together, signing records where appropriate. One risk assessment was identified to the acting manager during the inspection for a person at possible risk from choking. A care plan from the placing authority identified this as a risk although staff spoken with said that they were now supporting them with their meals and they felt this was minimised. The risk assessment however should reflect this. Shaftesbury Place DS0000067461.V359855.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. 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. Staffing levels and access to funding are having a significant impact on the opportunities for people to lead a fulfilling lifestyle. People are supported to maintain relationships with family and friends. The nutritional content of meals is being monitored and people are provided with guidance about a healthy diet. EVIDENCE: Concerns were expressed from people living at the home, staff and parents about access to activities and the chance to be involved in social, recreational and leisure opportunities. This was said to be due to staffing levels and demands on staff time, funding and access to drivers. Staff said that the number of drivers was likely to increase due to several staff completing their assessments to drive the mini buses. The home however carries a significant number of vacancies and uses agency staff to cover shortfalls where possible. People living at the home said they often find they could not go on activities because there were insufficient staff. Comments from staff surveys included Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 13 “we need more staff to be able to support people with activities outside of Shaftesbury” and “I think we have coped quite well with being short staffed, still managed to take people out on trips”. A person living at the home commented in their survey “I would like to go out sometimes maybe to a film or a concert. Life can get boring sometimes.” During the inspection the home received a complaint from the family of a person living there about staffing levels and the lack of opportunities for social activities. Other comments also queried the funding of activities, “need money for activities to enable clients to be more active” and “home could have an activity budget”. The Statement of Purpose states that people may need to make a contribution towards the cost of activities. At the last inspection an activities co-ordinator was being appointed but this post does not appear to have materialised. There did not appear to be a wide range of activities being provided within the home apart from watching sport and a takeaway meal once a week. People had schedules of activities in the files and said that they were attending local colleges, day centres and clubs. Some people were able to access these without staff support and used public transport or taxis but they were very aware of the lack of opportunity for people needing staff support. Some people are able to take advantage of being close to local shops and facilities. People said they were planning holidays for this year and had enjoyed trips to Cornwall and Euro Disney last year. They also go swimming, to the cinema, theatre and to the pub when able. The week of the inspection a group of people were going to Hampshire to attend a conference and fun day held by SHIRE, a user group organised through Sanctuary Care. There was evidence in daily diaries and from people living in the home that they keep regular contact with family and friends. There were often visits to the home or people go out locally. One person said they had been to an event at Cheltenham Racecourse with their family and another person was on holiday with theirs. People have mobile phones but said they also use the home phone to keep in touch. Some people have Internet access in their rooms. A person living at the home was observed taking responsibility for sorting through the post and distributing it. Some people need help from staff with their mail. People were observed using the laundry to do their washing and helping to prepare meals or making drinks. Staff support people to do a weekly shop for provisions where needed. People were being encouraged to be as independent as possible although staff provide help when needed. Care plans clearly indicated the level of support needed by people. People living at the home confirmed that regular house meetings were being held. Minutes for a meeting in January were displayed on the notice board. A person living at the home said another meeting was due to be held. Discussions centred on cooking of meals and looking at other ways of providing these. Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 14 Individual meal records were being kept. There was evidence that a dietician had been involved with some people and that nutrition and healthy eating were being discussed with people. People going to the one-day conference said nutrition and healthy eating was on the agenda. Menus indicated a range of meals were being provided including freshly produced meals with some vegetables. Discussions were ongoing with people living at the home about pooling resources in each unit so that they could purchase provisions together for an evening meal. Some people thought this would be a good idea and recognised that not everyone likes to cook but it would be a good opportunity for those who enjoyed cooking. Staff also felt that they would be able to support people to have a healthy and nutritional diet. Some people were observed preparing their own meals whereas others had staff support. Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 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’s health and personal care needs are being met helping them to stay well. Safe systems for the management of medicines were generally in place although some points for improvement and more attention to detail were identified. EVIDENCE: Care plans clearly provided information about the way in which people would like to be supported with their personal and healthcare needs. People choose when to get up and go to bed and when to have baths or showers. People use hairdressers locally and were being supported to access these. Daily records evidenced appointments with a chiropodist at regular intervals. The AQAA stated that where people have identified the gender of staff providing personal care this is respected. It was noted during the inspection that the daily diary indicated that personal care was being provided to a tenant in an unregistered flat on the first floor. Staff confirmed this was the case and that it had been set up as a private arrangement. Sanctuary Care must address this issue. Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 16 Healthcare appointments were being recorded in the diary and in records on care plans which included a note of the outcome of each appointment. These indicated that people had regular access to a range of healthcare professionals and outpatient appointments. There was also evidence that people were being referred when needed to the local Community Learning Disability Team, Wheelchair assessment and District Nurses. Comments from one healthcare professional stated, “Most healthcare needs are met by the team, however aspects of care require input from other teams, who are welcomed” and “excellent communication between the care service and nursing team, a very proactive approach.” Monitoring records were being maintained with regard to tissue viability, continence and diet. Where there were concerns about tissue viability records confirmed that staff were taking the appropriate action and involving the District Nurse when needed. Body maps were on people’s files but these had not been used. Staff who have training in the safe handling of medicines administered medication to people living in the home. Some staff had recently attended additional training provided by a pharmacist. Recent changes in response to notifications made to us involving medication mean that two staff were involved when night staff administered medicines. There was a medication policy that was available to all staff so that they have written information about how the company expected medication to be safely managed. As this was issued in April 2004 this may need reviewing to make sure that the information is up to date and includes all information about medicines. For example we saw that there was no mention in one policy about keeping records when staff apply creams. A local pharmacy provided most medicines the home used each month in special packs called a monitored dosage system. These packs help staff or people living in the home to easily see what medicines need administering on a particular day and time and what medicines have been administered. As part of this system the pharmacy each month printed a record chart of all the medicines the doctor has prescribed and on which staff record when they have administered each medicine. We found there were records kept of medicines received, administered and leaving the home or disposed of via the pharmacy. The quantity of medication carried forward on to the next record chart at the end of each period was also recorded. These records helped to keep a full account of the medicines that the home was responsible for on behalf of the people living there. Each person had a protocol for the use of any homely remedy medicines and there were records of people’s consent to medication. Staff told us they were no equality and diversity issues concerning medication. Some care plans included information about people’s preferences in relation to their medicines. One person looked after her own medicines with support from staff; there was a risk assessment about this. Medicines received for this person were recorded on the chart but a record must also be made when any Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 17 medicines are handed over for this person to look after so that there is an audit of where the medicines should be. We inspected a sample of records and checked the medicines in stock and found that on the whole (apart from creams and ointments) this indicated that people were receiving their medicines correctly and medicines were in stock. It is important to know exactly what medicines people have received so where a variable dose (one or two tablets for example) was prescribed, in a few cases the actual amount of medicine administered was not always recorded. We found that the records and information about creams and ointments applied to the skin needed improvement as in a number of sample records we looked at these were not kept and there were few directions as to where the treatment was applied. Some medication charts had medicines printed that were no longer administered. The charts should be marked to indicate this to avoid confusion about what was current treatment and arrangements made with the pharmacy to make sure such medicines are removed when they reprint the charts the following month. We found that clear written guidance to staff was needed on how to reach decisions for all those medicines prescribed to be administered “when required”. This should make sure that all staff understand how each medicine is used for the benefit of each person and in a consistent way. We looked in some care plans and found in some cases there was mention of some of these medicines but generally this was not very specific and would not give a clear direction to staff. For example when people were prescribed different inhalers there was no precise information when to administer these. We looked at the care plan for one person on a more complex medication treatment who staff assist to self-administer one particular medicine and perform a routine monitoring test. The plan must fully describe the medicine and include definite actions to take in accordance with defined test results. We had a recent notification that there had been some confusion about a dose that would have been clear if the care plan had this information. The same person was discharged from hospital at some stage with additional medicines. Although the evaluation mentions these there was little direction to staff about their use. For another person where two different tablets (but containing the same active ingredient) were included on the medicine records there was only information in the care plan about how to use one of these. We had received a notification from the home that one product had been administered incorrectly. This illustrates the importance of having very clear guidelines. We counted 39 of these tablets in a pack that was labelled as 20, which could indicate two packs had been combined. This would be poor practice. We have received some other notifications about incidents in recent weeks involving medication. The home has taken actions in response to these and Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 18 information given at the inspection and contained in the report should reduce the risk of happening again. We watched the way in which a member of staff prepared and administered a few medicines to some people living in the home at lunchtime. We consider a risk assessment of the way medicines are transported around the home is needed to make sure that this is safe for everyone in the home and the risks are minimised of people receiving the wrong medication. As a possible solution we discussed alternative storage arrangements with the acting manager. There were safe arrangements for the storage of medicines and records showed this was at the right temperature. We advised putting a thermometer in cupboard where some medicines applied externally were kept to check this was below 25°C. Some opened containers of creams and ointments were stored in bedrooms. This arrangement must be risk-assessed as being safe for everyone in the home. Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 19 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 good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable people to express their concerns and the majority are confident that they will be listened to. People are safeguarded from possible harm or abuse. EVIDENCE: The home has a complaints procedure that is produced in a format appropriate to people’s needs using a mix of text and picture. Our contact address on these documents needed to be changed and this was put into action during the visits. One person out of fifteen said they did not know how to make a complaint. Responses in the surveys indicated that people would speak to staff, the office, the manager or CSCI. One person said “I have made a complaint in the past week and it has been dealt with.” Another said the complaints procedure could be found displayed on the wall. The survey asked people whether staff listen and act on what they say. 31 of people said usually and 69 said always. The acting manager confirmed that complaints were being recorded and a copy of the outcome of the complaint kept. The home had received two complaints from people living there in the last twelve months and Sanctuary Care had received a complaint from a relative. All staff had completed an open learning course on “Adult Abuse”. Those staff spoken with had a good understanding of the issues and how to support both the victims and perpetrators of abuse. The home has had problems with theft over the past twelve months. They had dealt with these appropriately involving the police and informing the local adult protection team. Processes Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 20 and procedures within the home had been changed as a result, safeguarding people from the risk of further thefts. Financial records were examined for those people being case tracked. Financial risk assessments were in place and staff were observed following these processes. Records confirmed that staff check and double-check withdrawals and deposits. Receipts were being obtained and cross-referenced with records. Each record had a significant number of receipts attached to it. A more simplified approach producing a financial record for each month and numbering receipts in relation to that month would make auditing of these easier. Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,29 and 30. 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. Ongoing environmental issues in toilets and bathrooms need to be resolved if the standard of accommodation provided by the home is to be maintained. EVIDENCE: Shaftesbury Place is a purpose built home for people with a physical disability. The group manager discussed long term plans for the development of the home and the supported living flats that included installing a lift. This would improve access for the people living in the registered flats. Since the last inspection the wet rooms in two units have been completed and the appropriate adaptations and equipment had been provided. New boilers were being installed at the time of the inspection. The decoration and presentation of communal areas had improved since the last inspection providing a pleasant area for people to congregate. Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 22 The following issues were identified during the visits as needing attention: Unit 1-4 • • Handle missing to freezer the vinyl wall covering in the toilet needs urgent attention – this could be an infection control hazard. This is repeated from the last inspection and was first highlighted by maintenance in 2006. (A letter of serious concern was sent to Sanctuary Care about this and other issues.) Unit 5-8 • • • Lounge needs redecorating wooden area around kitchen needs attention bumpers protecting the bedsides need to be checked each night to ensure they are in place (they were examined on two separate visits and were not secured in the appropriate position). Unit 9-12 • • The vinyl lining on the wall in the toilet and on the floor needs attention the toilet seat needs replacing. Unit 13-16 • • • The toilet cistern is leaking and needs attention the toilet seat needs replacing the vinyl floor in the bathroom needs attention. Laundry • There is a tear in the floor in two places which is being covered with tape this needs urgent attention. Specialist equipment and adaptations had been provided for people and there was evidence that servicing was in place. When needed referrals were being made to an occupational therapist or physiotherapist for advice and support. During one visit people were having their wheelchairs repaired and maintained. It was noted in one lounge a mobile phone was left on charge. Environmental risk assessments should take account of this to make sure they are not left on charge overnight. Some comments in surveys from people living in the home indicated that at times they have concerns about the cleanliness of the home. In response to the question is the home fresh and clean, 47 replied always, 20 said Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 23 usually and 13 indicated sometimes. People said “staff clean and tidy my room every day”, “ the home is nearly always fresh and clean apart from the laundry” and “if things are dirty, they are cleaned up quickly”. Surveys from staff indicated that they have responsibility for cleaning duties and when levels were affected this put additional demands on their time. During the visits the home including the laundry were clean and tidy. Good infection control measures were observed to be in place. Staff were supplied with personal protective equipment but were discreet when using gloves and aprons. Liquid soap and hand paper towels were supplied to all communal hand washbasins. Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 24 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. Staffing levels severely restrict the ability of the home to deliver person centred support and the quality of training may adversely affect the health and welfare of people at the home. 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. Comments from a healthcare professional stated “very good skills mix during each shift change from our opinion.” Staff, including agency staff, confirmed that they completed an induction programme and shadow existing staff for the first few shifts. Although the content of this provided a mixed reaction from surveys when asked if it covered everything they needed to know, 50 stated partly and 50 said mostly. An induction programme was available for new staff which is equivalent to the Common Induction Standards. One staff survey indicated that they had not worked through this induction programme. Files for three new staff were examined and one contained confirmation that they had completed their induction. Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 25 People talked about positive relationships with their key workers. One survey response stated, “I have always had a good understanding with staff”. Staff spoken with had a good understanding of the needs of the people they support. A NVQ programme was in place and staff were observed making arrangements with assessors to observe their practice. The training matrix indicated that 28 of staff had a NVQ Award in Health and Social Care and 28 are doing their awards. Staff confirmed that staff meetings were taking place and minutes evidenced that in the last four months there had been four staff meetings. In response to ‘do the ways you pass information about people who use services between staff work well’, 34 indicated usually and 66 said sometimes. One person stated that communication between the team was poor and another recognised that “regular team meetings were needed to ensure we all work together.” Agency staff said that there were good systems in place to handover information about people’s needs. Staff spoken with during the visits said that communication within the team had improved. The AQAA had identified this as an area for improvement. Concerns expressed about staffing levels by both people living in the home and staff were verified by examination of the rota. The home schedules a minimum of six care staff per shift including a team leader. Rotas for April indicated that at times there had been four staff on shift. Staff spoken with confirmed that this had happened on occasions when the agency used could not provide staff. The acting manager confirmed that the home had a considerable number of vacancies for which they were currently advertising. They appointed one person during the inspection and were interviewing again for further positions. Under Regulation 37 the home must notify us when staff levels fall below the minimum of six per shift. Recruitment and selection files for three people were examined. Files had been reorganised and records collated to make sure that they comply with the National Minimum Standards. Proof of identity and a current photograph had been put in place. One application had gaps in employment history and these were verified during the inspection. The same applicant also needed written verification of the reason they had left a former position when they worked with children. The home had been using the wrong reference request form. The new one was put in place that requested employers provide the reason staff had left their employment. Proof of obtaining a Pova first request was not on file but was provided by Head Office. The systems in place for staff working without a CRB check in place were evidenced in supervision records. This should also be recorded in a risk assessment. On the whole though records had significantly improved. Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 26 Since the last inspection staff had completed training in fire, moving and handling, food hygiene, health and safety, communication and abuse using an open learning pack provided by Sanctuary Care. Staff spoken with commented that they did not have confidence in this way of learning and had preferred the training provided for first aid and stoma care to a group of staff by a trainer. Staff had also received training in tissue viability but again some felt that this was not provided in any depth and did not meet their needs. A staff survey indicated that staff had not received any training about equality and diversity. Comprehensive training records were in place for each member of staff including a training matrix. This also indicated that there had been no training or awareness for staff on the Mental Capacity Act. Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 27 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): 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. The management and administration of the home is based on openness and respect. Effective quality assurance systems are in place involving people who live at the home. Satisfactory health and safety systems are in place providing a safe environment. EVIDENCE: The home did not have a registered manager in post at the time of the inspection. Sanctuary Care were actively recruiting to fill this position. The acting manager had been promoted from within the staff group and had previously managed the home when there was a registered manager’s vacancy. People living at the home and staff commented that she was approachable and professional in her approach. They talked about respecting her and that she was respectful of them. During the visits she was proactive in her approach to the inspection working with the team to take corrective action Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 28 when any concerns or issues were raised. She and the team have worked together to make sure that requirements issued at the previous inspection were complied with. A quality assurance system was in place. A group of people from the home met 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. The acting manager confirmed that an audit was taking place the week of the inspection. The group manager confirmed that she carries out Regulation 26 visits and people using the service said that they were being involved in this process. The maintenance person confirmed that they have responsibility for health and safety within the home. They expressed concern that they had not received any specialist training in this area. Records were examined verifying that fire systems, environmental risk assessments, food hygiene, water temperatures, portable appliance testing and electrical installation testing were being completed at appropriate intervals. The acting manager confirmed that the fire risk assessment was being reviewed and that new procedures were in place. Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 3 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 2 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 3 X X 3 X Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 30 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 YA13 Regulation 16(2)(m)(n) Requirement Timescale for action 30/06/08 2. 3. YA18 YA20 CSA Section 3 and 11. 13(2) People must have the opportunity to engage in a programme of activities and to pursue their social interests. This will make sure their social, recreational and leisure needs and preferences are met. People receiving personal care 30/04/08 must have this provided by a registered service. When any medication is 30/06/08 administered or applied to people who live in the home it must always be clearly and accurately recorded – (this is particularly about recording medicines used externally.) There must also be clear written guidance for staff on how to reach decisions for each medicine prescribed to be administered “when required”. This will help to make sure people receive the correct amounts of medication and that there is some consistency for them to receive medication when necessary in line with planned DS0000067461.V359855.R01.S.doc Version 5.2 Shaftesbury Place Page 31 actions. 4. YA24 23(2)(a)(b)(c) The environment must be kept in a good state of repair. Protective covering on walls /floors needs to be fixed in toilets and bathrooms. (This requirement has been repeated from the last inspection.) Other issues identified need to be rectified. This is to make sure that the environment is safe and free from possible infection. 18(1)(a) There must be sufficient numbers of staff on duty to meet the needs of people living at the home. 37 Where there are shortfalls in staff during a shift, this must be notified to us. This is because this may effect the well being and safety of people living at the home. 19(1) Sch 2.4 The reason a person left their former employ when working with vulnerable people must be obtained in writing. This is to safeguard people from possible harm. 18(1)(c)(i) New staff must complete a structured induction programme and evidence provided that this has been done. This is so that they have the necessary knowledge and training to meet the needs of people living at the home. 18(1)(c)(i) Staff must be aware of equality and diversity issues as well as the Mental Capacity Act. This is to make sure that staff have the appropriate knowledge and training to meet people’s needs. 18(1)(c)(i) Where staff are delegated responsibility for areas such as health and safety they DS0000067461.V359855.R01.S.doc 30/09/08 5. YA33 30/04/08 6. YA33 30/04/08 7. YA34 30/04/08 8. YA35 30/06/08 9. YA35 30/09/08 10. YA35 30/06/08 Shaftesbury Place Version 5.2 Page 32 must have the knowledge and skills to carry out these tasks. This is to make sure staff are competent to carry out these tasks. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA9 YA14 YA18 YA20 Good Practice Recommendations The risk assessment as identified should be amended to reflect possible risks to choking and systems in place to minimise this. Consider offering a range of activities within the home and researching activities/leisure pursuits with minimal cost implications. Body maps should be used when monitoring tissue viability concerns. Carry out a risk assessment and implement changes to make sure that safe practices are always followed when medicines are transported around the building and administered to people living in the home. This is to reduce the risk of mistakes and make sure people receive the correct medication. Where staff support people to look after and administer their own medication the medicine records should also include when each medication and quantity is actually given to people to look after as well as records of regular monitoring checks staff make that people are using their medication correctly. This is to make sure that people receive the correct levels of medication. Review the medicine policy and procedures to make sure that all aspects about the management of medication are included and contain the correct and up to date information. This is so that staff have clear and specific direction about how the company expects them to deal with all aspects of medication. Individual financial records should be set up monthly. Environmental risk assessments should include monitoring of mobile phones being left on charge. DS0000067461.V359855.R01.S.doc Version 5.2 Page 33 5. YA20 6. YA20 7. 8. YA23 YA24 Shaftesbury Place 9. 10. YA34 YA35 Consider reviewing the arrangements for the cleaning of the home. Risk assessments should be put in place for new staff working without a CRB check in place. Staff should access training in Learning Disability Award Framework. Increase staff awareness of the risks of tissue viability. Shaftesbury Place DS0000067461.V359855.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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