Inspection on 11/02/09 for Shapland Close

This inspection was carried out on 11th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shapland Close 06/10/09

Shapland Close 15/01/08

Shapland Close 07/09/06

Shapland Close 04/01/06

Shapland Close 06/09/05

Shapland Close 07/09/04

Shapland Close 29/04/04

Shapland Close 17/02/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOME ADULTS 18-65 Shapland Close Wilton Road Salisbury Wiltshire SP2 7EJ Lead Inspector Alison Duffy Unannounced Inspection 11th February 2009 09:30 Shapland Close DS0000028422.V374498.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 Shapland Close DS0000028422.V374498.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. Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shapland Close Address Wilton Road Salisbury Wiltshire SP2 7EJ 01722 419777 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.scope.org.uk SCOPE Mr Stephen Curtis Care Home 8 Category(ies) of Physical disability (8) registration, with number of places Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service: Care Home only - Code PC to service users of either gender whose primary needs on admission to the home are within the following category: 2. Physical Disabiliy (Code PD) The maximum number of service users who may be accommodated is 8 Date of last inspection 15th January 2008 Brief Description of the Service: Shapland Close is a residential care home registered to care for eight adults with a physical disability. The home is situated on the outskirts of Salisbury, within close proximity to local amenities. The home is managed by SCOPE. The manager is Mr Steve Curtis. Shapland Close consists of two purpose-built bungalows with disabled access throughout. Each bungalow has four single bedrooms, a spacious lounge with dining area and an adjoining kitchen and specialised bathing facilities. A range of individualised, specialised equipment is in place. All areas of the home are well maintained and decorated and furnished to a good standard. An additional bungalow contains the office and staff sleeping in room. There is a minimum of five staff on duty during the day. This enables two to be in each bungalow with an additional member of staff responding to individual need between the two. At night there is one waking night staff member in each bungalow. Another member of staff provides sleeping in provision. An on call management system is also in place. Fees for living at the home range from £1265.15 to £1667.88 a week. Shapland Close DS0000028422.V374498.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 two star. This means the people who use this service experience good outcomes. This key inspection took place on the 11th February 2009 from 9.30am to 4.15pm. Mr Curtis, the registered manager was available from approximately 11am and received feedback at the end of the visit. On arrival at the home, a team coordinator assisted us with the information we needed. The last key inspection of this service took place on the 15th January 2008. During our visit, two people using the service were at home. Others were out at their day services. Due to the complex communication needs of people, we were not able to gain verbal feedback about the service they received. We observed interactions between people using the service and staff. These are detailed within the main text of this report. We spoke to staff and toured the accommodation. We looked at documentation such as care plans, daily records, staffing rosters and the accident book. We looked at the medication administration systems, the management of people’s personal monies and staff recruitment and training. As part of the inspection process, we sent surveys to the home for people to complete, if they were able to, with support. We also sent surveys, to be distributed by the home to care managers, GPs and other health care professionals. Some parents supported their son/daughter with completing their survey. The feedback received, is reported upon within this report. We sent Mr Curtis an Annual Quality Assurance Assessment (AQAA) to complete. Information from the AQAA is detailed within this report. 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 experiences of people using the service. What the service does well: There is a clear admission procedure in place, which identifies that the prospective person’s needs would be met within the home. A high level of personal care in relation to very complex need is given. Regular consultation and input from specialised health care professionals is received. Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 6 The environment is well maintained and decorated and furnished to a good standard. Relatives are strong advocates and are confident in raising their concerns. A robust recruitment process is in place, which gives people additional protection. Clear health and safety systems are in place to safeguard people. What has improved since the last inspection? What they could do better: The manager agreeing to give management support to other services within the organisation should be discussed with us, as the regulatory authority, before acceptance. Short-term care plans should be used to evidence how staff manage a short term care need such as a dry/sore area of skin. All charts related to a person’s care should be cross-referenced and evaluated within the care plan. When staff Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 7 record ‘please observe/monitor’ in the person’s daily notes, follow up entries to evidence monitoring, should be in place. Due to people’s physical disability and associated restrictions with their mobility, individuals must have their risk of pressure damage assessed. Measures to minimise any potential risk must be implemented and monitored. When undertaking any transaction with people’s personal monies, two staff members should sign the balance sheet. In the event of receiving a poor reference when recruiting a prospective staff member, the reason for appointing should be fully evidenced within written documentation. A review of staff training information should be undertaken to ensure an accurate reflection of up to date training is available. The training matrix would benefit from having details of when refresher training is required. The manager must ensure that staff have completed infection control training. Consultation should take place with the District Nursing service regarding staff administering suppositories to a person. All staff undertaking this procedure must have up to date training and their competency assessed by a qualified health care professional. 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. Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. While there have been no new people to the service, a clear admission procedure is in place. EVIDENCE: There have been no new admissions to the service since the last inspection. People have lived at Shapland Close for a number of years and no changes are expected. Within the AQAA, it stated ‘we have not had a void for a number of years however: Prospective clients would be provided with a Statement of Purpose and Scope information.’ The AQAA continues to state ‘a skilled and suitably qualified member of staff would carry out the initial assessment process. From the assessment meeting a detailed and comprehensive holistic picture of the service user would be produced as the underpinning knowledge for the care plan. We would be working with our partner agencies, including advocacy, to obtain copies of any needs assessment carried out.’ Within the AQAA, we saw that the compatibility of existing people using the service and the prospective person would be given consideration. The local advocacy service would be used to enable people to express their views about Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 10 the placement. The AQAA states ‘we would look at a phased introduction to placement e.g. lunch, day and overnight etc.’ As there have not been any new people to the service, we did not assess these standards further. Evidence gathered at previous inspections and the information within the AQAA, showed a clear admission process was in place. Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning is of a good standard and fully reflects people’s needs and the support they require. Systems are being developed to able people greater involvement within decision-making. Risk taking is well managed. EVIDENCE: At the last inspection, we saw that care plans were out of date and did not reflect the person’s needs or the support they required. We made a requirement to address this. During this visit, the care plans we viewed had been fully revised. They were comprehensive, well written and showed detailed information. People’s preferred routines and how they liked to be supported, were clearly identified. There was clear information about aspects such as communication systems and the administration of medication. We saw that specific plans in relation to eating and drinking were in place. These were followed in practice at lunchtime. One plan contained clear behavioural management guidelines. Information highlighted the need for staff to ascertain the causes of the behaviours. We saw that some potential triggers for staff to Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 12 consider were stated. The plans had been dated at the end of the document. We advised that each segment of the plan be dated. A system to evidence review should also be developed. Although one plan had been updated, out of date information was evident within the file. We advised that this be removed. In addition to the care plans, staff maintained a daily log and a daily diary for each person. The daily log identified aspects of ill health and general wellbeing such as level of mood. The diary contained a record of food consumed and any activities the person had taken part in. We saw within the daily log that issues such as dry and sore areas of skin had been identified. The record stated ‘please monitor.’ There was no evidence that staff had done this. We advised that such issues be detailed within a short-term care plan. We said that once the issue had been addressed, the short-term care plan could be removed and filed away. We saw that people appeared well supported and were well presented. They were wearing clean, well-ironed clothing and had manicured nails and clean hair. People appeared content and did not show any signs of agitation. Staff were responsive to people’s needs and interacted with people well. Mr Curtis told us that decision-making is an area he wishes the staff team to develop further. He said people are encouraged to make basic decisions such as what to wear and times of rising and going to bed. However, Mr Curtis said he is planning greater focus in relation to more person centred care and individualisation. Mr Curtis believes that this is beginning to take place with staff giving more thought to their actions. Some people have been involved in the development of the new menus. They have also been involved in choosing the colour schemes of rooms. Involvement with developing a user-friendly complaints procedure is planned. Within the AQAA we saw that advocacy services are used. Mr Curtis confirmed this within discussion. We saw that staff know people well and respond to individual need effectively through experience. We did not see any specialised communication systems in place such as picture boards or push-button lights to voice, yes or no. Mr Curtis told us that this is another area he wishes to develop. He said this would be undertaken with the support of local specialised services. We saw a member of staff ask a person what they wanted for lunch. They showed them a tin of fish. The person demonstrated what they wanted through gestures. The staff member supported the person with their lunch. They regularly asked the person, what food item they wanted next, from their plate. The staff member was attentive and gave the person time. Staff told us that the person would push items away if they did not want them. They would also drop their cup if they had finished. We saw the person demonstrate that they had had enough food but they wanted a hot drink. At the last inspection, we made a requirement to ensure that all risk assessments were reviewed. This had been addressed. Those assessments Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 13 viewed detailed areas such as choking, manual handling, the use of equipment and travelling in the home’s vehicle. We saw that a minimal amount of accidents had occurred and these had generally involved staff. Mr Curtis told us that although some risks such as choking were clearly evident, other risks are minimised due to the high level of support people need. Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People access the local community and undertake social activity provision, yet the intended focus on activity development would enhance opportunities for people. People are supported to maintain important relationships. Meal provision has improved with emphasis on variety, healthy eating and personal preference. EVIDENCE: Staff told us that some people attend the local Scope day service during the week. Three people choose not to attend and are allocated a staff member to have day care at home. This enables individuals, to be supported to access the community and follow their preferred interests, during the week, on a one to one staff basis. Staff said that this system works very well and without it, people would not have so many available opportunities. Staff said they support people to go into town for shopping or a coffee. They may go for a walk along the river to feed the ducks or go to the library. Trips to the pub or meals out Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 15 are also enjoyed. Some people enjoy local social clubs such as New Horizons and Scoutlink. Mr Curtis told us that social activity provision is a further area he intends to develop with the staff team. He told us ‘people go out but there is more we could do to enable people further opportunities on an individual basis.’ Mr Curtis told us that he would like to see activity provision offered in a more person centred way. This would involve people specifically choosing what they wanted to do, on an individual basis. Mr Curtis was aware that this would impact upon historical attendance at day services, which in turn would raise issues with funding. He said this would need to be managed with consultation of others such as placing authorities. The AQAA confirms Mr Curtis’ desire to focus upon social activity provision. It states ‘we need to get more staff on weekends and evenings. We need to provide more 1-2-1 time. We need to be getting people out into the community more.’ Within their survey, a staff member told us that ‘getting people out home’ is something the service could do better. People using the service, within their survey said that they could not always choose what they wanted to do during the day or at weekends. A relative said ‘unless we bring XX home at weekends s/he rarely gets out due to number of staff on shift.’ Another relative, in response to their son/daughter being able to make choices about what they did in the evening said ‘no – often no staff available to accompany him/her.’ At the last inspection, staff did not engage well with people. Communication and interaction was minimal. Although on this visit, there were limited people at home, interactions were much improved. Staff were attentive and focused upon individuals. People were given time, communicated with on an appropriate level and encouraged to engage. There was no evidence of staff talking over people between themselves. Mr Curtis told us that his focus was to offer people individualised support in a person centred way. He said he was aiming to minimise potential institutional practice associated with people living in a group situation. This would involve aspects such as choosing a meal, shopping for the ingredients and then cooking on an individual basis with staff support. Mr Curtis told us that in the past, staff in one bungalow cooked the meals and transported them across to the second bungalow. This practice has been stopped. All meals are cooked in the bungalow they are to be eaten in. The AQAA confirmed ‘the process of getting the service users more involved in shopping, planning meals and meal preparation has started.’ We saw within care plans that a new area, ‘I like to do and what I do,’ has been developed. Staff told us that the menus have recently been developed. They take into consideration healthy eating and individual preferences. As stated earlier in this report, some people have been supported to participate in the menu’s Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 16 development. At lunchtime, we saw that one person had pilchards, jacket potato and salad followed by yoghurt. Another person had a sandwich, salad and fresh fruit. We saw that staff supported people attentively. One member of staff asked the other staff on duty to leave the vicinity, while one person was supported to eat. This was so the person was not distracted. The staff member prompted the person well and gave time to the interaction. Mr Curtis told us that fresh fruit and vegetables are now delivered to the home. Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive a high level of support with their personal care routines and have good access to health care provision. Greater safeguards with the medication systems have significantly reduced the risk of error. EVIDENCE: Within surveys, in response to what the home does well, staff told us ‘provide very good standard of care to the service users’ and ‘keeps people safe, well and happy.’ People, who use the service, receive full assistance from staff in all aspects of daily living. This support is now clearly detailed within care planning information. Mr Curtis told us that female members of staff provide intimate personal care support to females using the service. However, in an emergency, there might be the necessity for a male member of staff to support a female person using the service. Staff confirmed this. Mr Curtis said the staffing rosters are Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 18 developed to ensure an adequate mix of male and female staff. Scope has a policy on gender yet this was not seen during this visit. At the last inspection we saw staff undertake an inappropriate manual handling technique. We made a requirement to review the techniques used to ensure people’s safety. This has been undertaken. All manual handling assessments have been updated. We did not see any evidence of inappropriate manual handling techniques during this visit. Staff told us that they had received manual handling training. Other sessions have been booked for all new staff. Staff told us about one person’s support needs in detail. We saw that they supported this person with their mobility, as explained. Staff were concerned that the person had not fully recovered following a seizure. They asked the person if they wanted to lie on their bed. Staff supported them to do this. We saw that some people had epilepsy management profiles in place. These included possible signs of a seizure and the procedures to follow. A record detailing the time, the type of seizure and the recovery time, was in place. People received regular support and intervention from health care professionals in relation to their epilepsy. We saw that one person required suppositories on a regular basis. Staff told us that there were five members of staff who undertook this procedure. They said they had training originally but had not undertaken a refresher course. There were no certificates to demonstrate each staff member’s competency in the procedure. Mr Curtis said he was questioning whether staff should be undertaking the procedure without up to date training. Accessing the training had proved a challenge. We advised consultation with the district nursing team with the aim of them undertaking the procedure. At the last inspection, we saw that one person was losing weight. Measures to minimise the weight loss were not evident. We made a requirement to address this. Staff told us about the person’s nutritional needs. They said the person had seen the GP and a dietician. They were both happy with the person’s condition if a high calorie diet was maintained. We saw that this was detailed within the person’s care plan. There was evidence of high calorie snacks and drinks, which the person enjoyed. Staff told us that the GP would consider further intervention if the person stopped eating totally. We saw that staff interacted well with the person at lunchtime and encouraged them to eat as much as possible. There was good detail within the person’s care plan about the amount of fluid the person needed each day. A record of the person’s food and fluid intake was recorded in their daily diary. The person was regularly weighed. Within the AQAA it stated ‘staff members are alert to healthcare triggers/warnings and fully understand how they should respond and take action.’ One relative however, within their survey told us ‘staff usually kind but Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 19 overlook health issues. Staff are not proactive in recognising XX’s health needs.’ This view was not expanded upon. We spoke to staff about people’s health care needs. They said people are reliant on staff to recognise ill health. One staff member said ‘you just know when someone is poorly. They are different. They may be withdrawn or sleepy or be agitated and appear in pain.’ Staff told us that GPs could be called upon for advice at any time or a visit could be requested. There was evidence within documentation that people had received intervention from a GP, a dietician, a consultant, a physiotherapist and a speech and language therapist. Due to people’s physical disability, mobility and changing position are restricted for some individuals. We said that tissue viability assessments must be considered. Within the AQAA, it was stated that there are plans to enable people to spend more time out of their wheelchairs. This would assist as a control measure to enable healthy skin. We saw that bowel charts were in place. We advised that these be evaluated within the care plans. Procedures to follow in the event of a person becoming constipated should be developed. Staff told us that people’s diet is given additional focus when there is a risk of constipation. We saw that people were encouraged to drink fresh fruit juice. Due to health care conditions, people are unable to manage their own medication. Staff who have been trained in the safe handling of medication undertake all medication administration. We looked at the medication systems in place. Mr Curtis had identified that the controlled drugs cupboard did not meet new legislation. A new cupboard was on order. The existing storage of the medication was minimal yet tidy. We saw that a monitored dosage system was used. All medication had been signed when administered to people. The medication had also been appropriately receipted when it arrived into the home. Policies and procedures were in place for staff reference. The keys for the medication cupboard were carried on the staff member’s person. Within one daily record we saw that bath emollient and creams had been prescribed for one person. We advised that these be added to the person’s care plan. Between August 2008 and January 2009 there were five medication errors. Three included individual people not being given their medication. One was an error of the pharmacy. They delivered the wrong medication but it had the correct label on it. The other showed staff had not supported the person to take their medication effectively, as a wet tablet was found on the floor. Mr Curtis told us that the medication systems had been tightened, as a result of the errors. He said team coordinators now have to check the medication after every administration. If staff have not signed the medication administration record, they must do so immediately. In the event of having finished their shift, they are expected to return to the home to do it. Mr Curtis told us that since the new procedure, there have been no medication errors. Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear, well-managed complaint procedure which relatives and staff are confident in using. The risk of abuse to people who use the service is minimised through clear adult protection systems. EVIDENCE: The AQAA stated ‘a very clear complaints procedure is in place. Complaints procedure highlights importance/positive approach to dealing with complaints.’ Mr Curtis told us that people using the service require support to raise any discontentment they may have. Some people need staff to recognise potential signs such as agitation. Body language, facial expressions, self-harm or vocalisation through sounds are some of the triggers, staff use to recognise discontentment. Mr Curtis told us that at present, the service does not have a ‘user friendly’ complaints procedure. Mr Curtis told us that some people using the service would be able to contribute to developing a format. He said this would be undertaken, when focus was given to developing people’s individual communication systems. The AQAA confirms that this work is planned for the next twelve months. Mr Curtis told us that people’s relatives remain strong advocates. A regular parents meeting is held. Mr Curtis said that this is an important forum to enable parents to give their views and share any concerns. Staff told us that they would aim to resolve any issue of concern immediately. One person said ‘I would try to sort it out but I would also offer them the Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 21 opportunity to speak with our manager.’ Mr Curtis confirmed that parents are encouraged to raise issues directly with him. This ensures any concerns are addressed without delay and that staff are free to concentrate on people’s care support. Within surveys, we saw that relatives would support people to raise any concerns. All relatives told us that they were aware of the complaint procedure. One relative said ‘parents and carers work together over any problems.’ Another relative said ‘we have no problems with Shapland Close.’ We saw that a record of complaints is maintained. Since the last inspection, the service has had one formal complaint from a health care professional. Documentation showed that the issue was fully investigated. The complainant was informed of the outcome and measures were put in place to minimise a reoccurrence. Within the AQAA it states ‘the region has put together a local protocol for managing complaints. Reg 26’s are being themed, which will include complaints.’ We saw that complaints training had been booked for the 3rd March 2009. Staff told us that SCOPE has detailed adult protection policies in place. They said that any allegation or suspicion of abuse would be immediately reported. They said this would be to who ever was available, within the line of seniority. Such personnel would include the adult protection lead, a team co-ordinator, the manager, senior managers or Social Services. Staff told us that they would have no hesitation in raising any issue of abuse. Staff spoke of the vulnerability of the people supported and therefore the need to be extra vigilant of any potential signs of abuse. They said it was a priority to make people safe. Staff told us that any factors such as bruising would be reported. Body maps are used to document any marks to the person. Mr Curtis told us that all staff have their own copy of ‘No Secrets.’ We advised that staff sign documentation to demonstrate this. Within the AQAA, it states ‘the staff at the service have very good underpinning knowledge around safeguarding issues and a positive attitude to whistle blowing against poor practice.’ As a form of development the AQAA states ‘in house POVA training.’ Mr Curtis told that all senior staff have undertaken Social Services safeguarding training. Other staff are being put forward for this yet places are restricted. In the meantime, staff are completing training sessions in house. Some people have deposited small amounts of personal monies for the home to hold safely. We looked at the systems for managing this. We saw that policies and procedures are in place regarding the management of people’s personal monies. We saw that the systems were ordered and well maintained. There is restricted access to the storage of people’s personal monies. The balance sheets were clear and showed all transactions. The administrator had signed to demonstrate each transaction. We advised that another member of Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 22 staff countersigns the record at the time of each transaction. This would ensure greater protection. Receipts were in place to demonstrate all expenditures. Mr Curtis told us that the service does not hold any items such as bankcards or pin numbers to people’s bank or building society accounts. He said in the future, it is planned for people to hold their money securely in their own room. Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is well maintained, cleaned to a good standard and conducive to peoples’ needs. People benefit from bedrooms, which are decorated to a good standard and equipped to meet individual need. EVIDENCE: The AQAA states ‘the bungalows are designed for small group living where service users can enjoy maximum independence in non-institutional environment.’ The home consists of two purpose built bungalows. They are situated in a quiet position away from the main road, on the outskirts of Salisbury. All amenities are within close proximity. The environment is fully accessible to people with a disability. Each bungalow has four single bedrooms, a kitchen, a lounge and dining area and toilet/ bathing facilities. We saw that all bedrooms were decorated and furnished to a good standard. People have specialised equipment including an overhead hoist, an individualised bed and armchair and commode, as required. Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 24 Despite such equipment, the rooms are homely and reflect people’s individual preferences. We saw that some people have sensory equipment such as specialised lighting. Some people have televisions and music centres at a height conducive to their needs. The AQAA confirmed that people are able to personalise their room and be involved in decisions about décor/changes to the accommodation. Staff told us that since the last inspection, two bedrooms have been redecorated. New hand washbasins have been fitted. More thorough cleaning has also been introduced. The kitchen in one bungalow is due to be refurbished. Mr Curtis told us that some people using the service are assisting with the new kitchen’s design. The carpets in the second bungalow are due to be replaced. Funding has been agreed for the redecoration of the bathroom in one bungalow although the work has not, as yet commenced. We agreed that redecoration would make the room more homely and inviting. Consideration is being given to the replacement of one person’s specialised bed. Mr Curtis told us that consultation is currently taking place with the person’s relatives, care manager and specialised companies, who provide such equipment. We saw that the organisation has a property and a transformation team. The team is responsible for the maintenance and redevelopment programmes of all its properties within the organisation. Laundry facilities are located within an outside building. Mr Curtis confirmed that this is not ideal, as staff are required to go outside to reach the area. Consideration has been given to relocating the facilities yet options have proved limited. As within a domestic dwelling, there is space within the kitchen. However, this would mean soiled laundry being carried through food preparation areas. Due to this, changes will not be made to the existing facilities at present. Staff told us that they have access to disposable protective clothing as required. Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While additional permanent staff have been recruited, the impact upon the service regarding the staff restructuring process needs to be monitored to ensure people’s needs are met. People are protected through a clear, wellmanaged recruitment procedure. While staff training is arranged, all staff must be up to date with the training needed to perform specialised procedures safely. EVIDENCE: Since the last inspection, Scope has undertaken a major staffing restructure. The role of senior support worker has been withdrawn. There are now team coordinators and support workers. Staff talked to us in detail about the restructuring process. They shared concerns about the impact the changes had upon service provision. Staff told us that the team coordinators each had a different responsibility. They were also responsible administering medication, general administration, staff supervision and liaising with other professionals. They did not generally become involved with supporting people with their personal care routines. Staff told us that this put more pressure on support workers and gave them less time to spend with people. Staff felt the standard Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 26 of care had not suffered due to the commitment of staff. One staff member told us ‘staff are passionate about their work and the well being of people. This has ensured that the care people receive continues to be of a high standard.’ They said however, enabling quality time with people was an issue. Mr Curtis recognised this as a genuine concern yet believed change impacted upon people in various different ways. He said he believed things were generally settling down and hoped staff would see benefits of the restructuring, in due course. Within a survey, a staff member commented about the negative impact they had seen in relation to the staff restructuring process. They said ‘the manager and senior team are overstretched. There is no senior support worker or shift leader tier to the staff structure. Team coordinators are therefore often caught between their ‘hands on’ obligations [supporting people] and the ever increasing need for record keeping and paperwork.’ Staff told us that apart from the restructuring process, the staffing situation had improved. A high number of staff had been recruited. Some continued to be at various stages of their induction. This has reduced the amount of agency staff required. However, due to the numbers of new staff involved, managing systems such as induction, supervision and maintaining the staffing roster with experienced staff has been a challenge. Mr Curtis told us that the challenges were being worked through and new staff were gaining in their knowledge, skills and experience of people. Mr Curtis said within the next twelve months it is expected that no agency use would be in place at all. The organisation’s sickness policy is also being more robustly used so the amount of staff absence through sickness has reduced. In their survey, a relative said ‘staff usually listen but there are so many different ones that it is difficult for them to implement change.’ They continued to state ‘staffing levels are often low because of sickness requiring frequent use of bank staff, XX has an excellent day care worker but when s/he is on leave or not available, cover is poor.’ Staff told us that there is always a minimum of two staff in each bungalow. At night there is one waking night staff in each bungalow and a member of staff provides sleeping in provision. The AQAA confirmed that ‘staffing levels reflect needs of residents. Rotas are flexible to fit around the lifestyles of individuals.’ The AQAA continued to state ‘service is highly selective within recruitment process. Service has a diverse staff team and balance of skills, knowledge and experience.’ We looked at the documentation demonstrating the recruitment process of three new members of staff. The information was clear, ordered and all required information was in place. There were two written references. We discussed the situation of employing a member of staff in the presence of a Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 27 poor reference. We advised that the reason for the appointment be fully documented. We saw that each person had been checked against the Protection of Vulnerable Adults list and had received a Criminal Records Bureau check before commencing employment. This was to ensure the person’s suitability of working with vulnerable people. In one instance, we saw that a staff member had completed some of their induction at home, as his/her checks had not been returned, as expected. We said that if a staff member’s first day of starting was a day off due to their shift pattern, this should be stipulated. This would give a clear audit trail of the recruitment process. Staff told us that staff training provision was good. They said they had recently completed manual handling, epilepsy awareness and medication administration. Within a survey, a staff member told us ‘there is a range of training courses planned for the future, in addition to the ones already undertaken.’ There was a staff training matrix in the office. We saw that topics such as epilepsy awareness, adult protection, enternal tube feeding, the safe handling of medication and fire safety formed part of the training matrix. The training matrix identified the training staff had completed. It did not detail when refresher training was needed. Mr Curtis said he would add a column to the format to identify this information. Mr Curtis told us that apart from two staff members, the whole staff team have now successfully gained a National Vocational Qualification (NVQ) level 2. Mr Curtis told us that a local dentist had undertaken a training session about teeth cleaning. He said staff had been given useful tips on how to support people with this task. It was not evident whether staff had undertaken infection control training. We said the need to do this particularly applied to those staff who undertake peg feeding procedures. Mr Curtis said infection control, palliative care and nutrition, were areas of training planned for staff. As stated earlier in this report, staff require up to date training if they are to administer suppositories. At the last inspection, we recommended that staff attend training related to people’s health care conditions. Mr Curtis told us that training in cerebral palsy is available yet not all staff have completed it. We looked at three staff training files. We saw that some training records were not up to date and did not correspond with the training matrix. Some records detailed training undertaken in 2007 with no evidence of recent, up to date involvement. Due to this, it was not easy to identify an accurate picture of training provision. Mr Curtis told us that staff had undertaken more training than was evidenced. He said he would review and up date all information. Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a manager with a clear person centred focus, yet time restraints need to be monitored to ensure effective leadership. Systems are in place to ensure the development of the service yet coordination of these would further enhance improvement. People are safeguarded through clear, wellmanaged health and safety systems. EVIDENCE: Mr Curtis was registered with us, as registered manager in January 2008. Mr Curtis is also the registered manager of another service within the organisation. Staff told us that managing two services had impacted upon his availability to concentrate fully on Shapland Close. They felt at times, the team coordinators, were managing the service on a day-to-day basis. One member of staff said ‘Steve [the manager] works really hard but I’m afraid he’s spreading himself too thinly. He’s available when we need him but it’s not the Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 29 same as having someone here all the time.’ Another staff member said ‘I hate to say it but I very rarely see him. He’s always available if we need to speak to him and I know he would come in, if we needed him but as for being on shift, I always seem to miss him.’ Mr Curtis told us that he spends his time between the two services. This generally involves three days in one service and two in the other on a rotating weekly basis. Mr Curtis told us that recently however, he has been covering a third service, as an emergency. This period was now coming to a close. We said that in the future, we should be consulted about any such additional responsibility. Mr Curtis told us that he has almost completed his Registered Manager’s Award (RMA.) Since starting at Shapland Close, he has undertaken training in the safe handling of medication, infection control, tissue viability, disciplinary procedures and ‘the manager’ in terms of health and safety. Mr Curtis told us he is registered to undertake epilepsy training. This will include the administration of emergency rescue medication. Within discussion we saw that Mr Curtis has a clear focus regarding the development of the service. This showed an emphasis on person centred care. Key factors were individuality, decision-making, opportunity and developing people’s communication systems. Mr Curtis told us that Scope had forwarded information regarding quality assurance to services. However, no specific guidance or expectations of how the information was to be applied in practice was given. As a result, there is no formal quality assurance system in place, which gives an annual development plan. Mr Curtis told us that monthly regulation 26 visits are undertaken. These are now themed giving structure to the visits. There is a relatives group and a quality action group. Mr Curtis told us that both forums were positive and worked well. We advised that the feedback from these systems be coordinated. Mr Curtis told us that he would also check with senior managers regarding the organisation’s expectation of formal quality auditing. There is a large amount of health and safety material for staff reference. Health and safety training forms part of SCOPE’s mandatory staff training programme. We saw as required at the last inspection, that all individual and generic risk assessments had been updated. One team coordinator is a manual handler trainer. Mr Curtis told us that an external trainer has been organised to facilitate some manual handling training. This is because of the high number of new staff to the service. Mr Curtis said the team coordinator would then continue with refresher courses. As stated earlier in this report, all risk assessments have been updated and added to. The fire log book demonstrated the satisfactory testing of the fire alarm systems. We advised within documentation that the specific date of each check be identified. Records showed that the staff member responsible for fire safety had completed a ‘walk through’ of all fire safety procedures with each Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 30 member of staff. An external contractor had last serviced the fire safety systems in November 2008. All small portable electrical appliances had been tested, as required. Documentation demonstrated the external servicing of the hoists and the call bell system. There was evidence that staff were monitoring the fridge, freezer and hot water temperatures. Since the last inspection, radiator covers have been fitted. Within the lounge in one bungalow, we saw that the front of the radiator covers had been removed. Staff and Mr Curtis told us that in the recent exceptionally cold weather, the heat from the covered radiators was minimal. The covers had been removed to enable more heat. They said people were not at risk of scalding, as individuals were immobile unless receiving staff support. We advised a documented risk assessment be undertaken. Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 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 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 32 No 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 YA19 Regulation 12(1)(a) Requirement Consideration should be given to assessing people’s risk of developing a pressure sore. If a risk is identified, control measures must be put in place and clearly evidenced. Staff must receive up to date training in the administration of suppositories. If training is not available, the responsibility of the procedure must be passed to the district nursing team. A risk assessment must be in place regarding the removal of radiator covers to enable more heat. Timescale for action 30/04/09 2 YA19 12(1)(a) 31/05/09 3 YA42 13(4)(c) 31/03/09 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 YA6 Good Practice Recommendations Each segment of the care plan should be dated to ensure all aspects are up to date and an accurate reflection of the person’s needs. DS0000028422.V374498.R01.S.doc Version 5.2 Page 33 Shapland Close 2 3 4 YA6 YA6 YA6 5 6 7 8 9 10 11 YA23 YA23 YA34 YA35 YA35 YA35 YA42 Consideration should be given to the use of a short-term care plan to address aspects of current need, such as a sore/dry area of skin. When staff record ‘please observe/monitor’ within documentation, follow up entries should be apparent. Any charts used to monitor aspects of the person’s care should be cross-referenced to the care plan. This was identified at the last inspection and has been addressed in part. Bowel charts have not been crossreferenced or evaluated within the care plan. A procedure should be developed in the event of constipation. All staff should sign to demonstrate their receipt of Wiltshire and Swindon’s safeguarding procedures, ‘No Secrets.’ Another member of staff should countersign the balance sheet in the event of any transaction with people’s personal monies. In the event of a poor reference, the decision to appoint should be clearly stated. Training documentation should be reviewed to ensure it is an accurate reflection of the training staff have undertaken. The training matrix should include details of when staff need refresher training in the identified subjects. All staff should have training in infection control. The exact date of the testing of the fire alarm systems should be detailed within the fire log book. Shapland Close DS0000028422.V374498.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. Extracts may not be used or reproduced without the express permission of CSCI Shapland Close DS0000028422.V374498.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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