Inspection on 15/01/08 for Shapland Close

This inspection was carried out on 15th January 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 7 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 11/02/09

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 09/07/2008.

CARE HOME ADULTS 18-65 Shapland Close Wilton Road Salisbury Wiltshire SP2 7EJ Lead Inspector Alison Duffy Key Unannounced Inspection 15th January 2008 9:25 Shapland Close DS0000028422.V352078.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.V352078.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.V352078.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 Steve Curtis (not as yet registered with us) Care Home 8 Category(ies) of Physical disability (8) registration, with number of places Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th May 2007 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. Following the retirement of the registered manager, a temporary manager and then an acting manager were deployed. Mr Steve Curtis has recently been recruited as a permanent manager. Mr Curtis is in the process of submitting his application to become registered with us. 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 high 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. Shapland Close DS0000028422.V352078.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 key inspection took place over two days. The first day was on the 15th January 2007 between the hours of 9.20am and 3.30pm. The acting manager was not on duty. Mrs Lyn Turner, senior support worker gave assistance, as required. The second part of the inspection took place on the 13th February 2008. There was a delay, as Mr Steve Curtis had gained the position of manager and was in the process of starting employment. The second day of the inspection coincided with Mr Curtis’ second week of employment. We met with four people who use the service and six staff members. We looked at the medication systems and at care-planning information, training records and recruitment documentation. As part of the inspection process, we sent surveys to the home for people to complete, if they were able to. We also sent surveys, to be distributed by the home to relatives, GPs and other health care professionals. The feedback received, is reported upon within this report. We sent the acting manager, Mr Russell Masters, an Annual Quality Assurance Assessment (AQAA) to complete. This was returned on time and completed in detail. Some information from the AQAA is detailed within this report. As the registered manager retired in December 2006, a random inspection was made to the home in May 2007. The reason for this inspection was to check the management arrangements of the home. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. 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: 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. The environment is well maintained and decorated and furnished to a good standard. Relatives are strong advocates and are confident in raising their concerns. Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 6 A robust recruitment process is in place, which gives people additional protection. 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. Shapland Close DS0000028422.V352078.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 Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. 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 detailed, well-organised admission procedure, which minimises the possibility of unmet need. EVIDENCE: All people who use the service have lived at Shapland Close for a number of years. It was therefore not possible to look at the admission process in detail. SCOPE has detailed admission procedures in place. Mr Curtis told us that these would be followed if a vacancy occurred. The procedures highlighted that an assessment from the person’s placing authority would be gained. The manager would meet with the person and complete the home’s assessment form. Family members and health care professionals would be invited to contribute to the assessment process. If it were felt the home could meet the person’s needs, various visits would be encouraged. A transition plan would be developed and a trial period offered. Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. While care provision is of a good standard, care planning does not reflect people’s needs or the support they require. Documentation states that decision-making is encouraged yet in practice people are not being offered fundamental choices. People’s safety would be further enhanced through greater focus within the risk assessment process. EVIDENCE: At the last random inspection we noted that not all care plans fully reflected individual need. There were also some care needs, which had not received follow up action. We made a requirement to address these issues. The requirement has not been addressed. All people who use the service have an individual care plan. However, the plans we looked at had not been updated. There were some areas containing good detail, but due to poor reviewing, we did not know if the information remained relevant. One plan contained entries dating back to 2005. There was Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 10 also a speech and language assessment on file, which was undertaken in 2005. There was no reference to this in the care plan, so it was not clear whether it formed part of the person’s care. Specific care needs such as the potential of loosing weight or becoming dehydrated were identified in the care plan. However, documentation did not show that the risks were being monitored. For example, the person’s weight had not been consistently monitored. Daily records did not give specific information, but terms such as ‘had something to eat plus plenty to drink’ were stated. We advised that specific charts should be cross-referenced to the person’s care plan. We also advised that any specific instructions regarding care intervention should be recorded in the care plan, as well as the daily notes. Although not up to date, there was good detail about the person’s preferred routines and key aspects such as bathing, eating and mobility. Within one plan, it was stated ‘XX communicates through facial expression and noises.’ We advised that further clarity be given to such statements. Staff told us that they knew care plans were not up to date. They told us that during times of staff shortages they had given priority to actual care practice rather than documentation. They felt the standard of care was good. Mr Curtis told us, that ensuring care plans were up to date and of a good standard, was his first priority. This was confirmed in the AQAA. It stated ‘a new, more person centred care planning format is being rolled out.’ Within surveys, as a means to improve the service, staff said ‘improvements need to be made in the quality of the paperwork/ documentation and the use of IT. Better communication between staff at the unit by finding better systems. Recording information – (care plans etc) Risk assessments etc updating.’ Staff told us that decision-making is promoted in line with the person’s ability. They said that some people, who use the service, might choose what they want to wear, through being given alternatives. Some people however, need staff to make decisions on their behalf. Staff told us, to do this, it was essential to get to know the people who use the service. One relative, in their survey told us ‘within the limitations of our XX to make choices because of his/her profound learning disability, the system is usually satisfactory.’ Another relative, under the heading what the home does well, said ‘the level of general care is good. The atmosphere is generally cheerful with lots of banter, which the residents enjoy. The service liaises well with the residents’ parents.’ Another relative said ‘the service provides a comfortable, safe place to live. The service promotes choice making, independence and embraces diversity. The service provides a happy relaxed environment.’ While documentation highlighted the need to promote choices, we saw that some staff did not always do this in practice. For example, at lunchtime, staff looked in the cupboard to see what was available for lunch. The person who Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 11 used the service was not included in this. There was no reference as to what the person wanted for their meal. We observed staff interacting with people. Some interactions were positive and animated yet others were limited and gave little engagement. Due to the level of people’s complex needs, risk taking is generally associated with tasks of every day life. For example, control measures are in place to enable a person with epilepsy to swim safely. Risk assessments form part of each person’s care plan. However, not all had been reviewed. We advised that further aspects of potential risk, should also be considered. For example we saw that one person spent a large amount of time on the floor. Potential hazards such as picking up debris, catching their fingers in the doorframes or knocking against furniture had not been addressed. We also advised that following any accident or incident, the risk assessment process should used to minimise any further occurrences. Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have opportunities for social and leisure activities yet some relatives believe these could be improved upon. People are supported to maintain important relationships. Greater focus would enable meal provision to be further developed in terms of variety and added nutritional content. EVIDENCE: Some people, who use the service, continue to attend the local day service run by SCOPE. However, some people, due to their general health, now attend fewer sessions and spend more time at home. One person has also been affected by the lack of college placements available. For those people who remain at home, one-to-one staff support has been arranged. One staff member providing one-to-one support spoke of their role in detail and with enthusiasm. They told us about activities such as lunch at a fish and chip shop, coffee at the Christian Centre, going to the library, into town and the local market. They said they support the person, who uses the service, to use public Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 13 transport. Attendance at various social clubs, the Arts Centre and the Studio Theatre formed part of the person’s activity plan. We observed an activity with modelling clay. This was positive with good engagement between the staff and the person using the service. Other people listened to music. They were also supported to play percussion instruments. However, staff did not appear fully attentive and at times, left people unsupported. People then stopped what they were doing so continuity was compromised. Within surveys, relatives gave a number of comments about activity. They said ‘their lives are very mundane. They get up, go to the DAC [day service], come home and sit watching telly’ and ‘the withdrawal of college has caused activity to be limited.’ Further comments included ‘the level of appropriate activities for residents is sometimes poor e.g. excessive reliance on watching TV’ and ‘I would like our XX to have more time at his/her home (Shapland) instead of attending the day service 5 days a week and to be taken out more often (short walks or pub or meals out.)’ We told Mr Curtis about these views. Mr Curtis told us that activity provision would be reviewed as part of the new care planning process. Mr Curtis told us that relatives are strong advocates and are encouraged to visit at any time they wish. Staff told us that they regularly discuss issues with relatives and aim to keep them informed of events. Within surveys, one relative told us they are always kept up to date. Another said they usually were. They said ‘we have always been informed about crises. They are not always so good over changes, which occur over longer periods of time.’ Another relative said ‘1. Unit manager usually keeps parents informed about changes within the local service, which may affect residents. 2. The parent organisation, SCOPE is not so good at informing us of any changes in management structures, which can have a significant effect on the unit. SCOPE’s consultation with parents before decisions are taken is poor.’ The preferred routines of people using the service are detailed within care plans. People are encouraged to choose what they wish to wear. Personal care is undertaken in the privacy of bedrooms or bathrooms. People are not generally involved in cooking and housekeeping tasks. However, Mr Curtis expressed this as an area of potential development. He spoke of encouraging the use of smell and touch through tasks, rather than generally perceived physical involvement. There is a rolling menu although the menu sheets were not dated. Daily diaries gave good detail of what people had eaten. The menus contained basic foods with little variety or creativity. One member of staff told us that the menus had been devised according to individual preferences. They said some changes had been made to meal provision but they had not been successful. Staff told us the food stocks were getting low due to the need to go shopping. At lunchtime, staff heated a tin of stew, for one person. Although the food was eaten, it did not look appetising. Another person having one-to-one support had a sandwich Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 14 and some fruit. With a survey, one relative said meal provision was limited. They felt not all staff were ‘good cooks’ and the nutritional value of food was poor. They told us the meals, especially at teatime were insufficient. Another said ‘not all the staff are able to cook.’ Within the AQAA, it was stated ‘menus are being developed and service users are being more involved in cooking.’ Mr Curtis confirmed that food was an area he wanted to develop. Mr Curtis told us that the menus would be revised and agreed with a dietician. He also wanted more produce to be purchased from local suppliers to enable more community involvement. Within surveys, relatives told us a number of aspects, which they felt could be improved upon. They said ‘1. Overall the standard of care is very good. 2. Sometimes menus are not adequately considered. 3. Also the level of appropriate activities for residents is sometimes poor e.g. excessive reliance on watching TV.’ On a positive note, relatives commented ‘1. The care home provides a high standard of care for people with profound and multiple disabilities including high physical dependency. 2. SCOPE strongly encourages valuing each resident. 3. The physical environment is good. 4. The management of the unit enables us to be very flexible in the arrangements we make for seeing our XX and for specific family events. 5. There are systems in place for regularly consulting parents.’ They also said ‘on the whole I think my XX is in the best place’ and ‘I feel the home is the best we can have for XX. S/he always looks nice and clean but by putting small things right it could be perfect.’ Shapland Close DS0000028422.V352078.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. Quality in this outcome area is adequate. 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. Systems are insufficiently robust to ensure a safe procedure of accurate medication administration. EVIDENCE: People, who use the service, receive full assistance from staff in all aspects of daily living. This support is detailed within care planning information. However, as stated earlier, it was not clear whether the information was an accurate portrayal of individual need. People have a range of individualised specialised equipment. Staff receive regular manual handling training yet one manual handling technique we saw compromised safety. Mr Curtis told us he would investigate this. We saw one person, become agitated when being supported by a member of staff. We advised that such triggers and guidelines to address potential self-harm should be documented within the person’s care plan. People rely on staff to recognise and act upon any sign of ill health. One relative within their survey told us that they did not feel that staff were trained in the complexities of particular health conditions. They felt staff did not at Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 16 times, recognise ill health quickly enough. Another relative told us ‘because of the large number of care staff and frequent changes of staff – they sometimes fail to pick up significant medical conditions.’ Mr Curtis told us he would give consideration to these views. People have access to a range of general and specialised health care provision. The GP provides six-monthly health reviews. People are also able to access physiotherapy, speech and language therapy and occupational therapy. We advised Mr Curtis to give consideration to assessing people’s tissue viability. Within daily records we noted that staff had recorded information about sore areas of skin. However, follow up action or monitoring was not clear. One entry stated ‘use epiderm, not sudacreme.’ There was no evidence of the rational for this or what professional evidence it was based upon. One person, who used the service, was prescribed suppositories, as required. There was clear guidance for staff for when these needed to be administered. However, staff said they had not received up to date training on the procedure. As an invasive treatment, a protocol must also be devised. We discussed epilepsy profiles with staff, as these were not in place. They said they had asked for these but had been unsuccessful. The senior support worker said she would address this again. People who use the service, due to their profound disabilities are unable to administer their own medication. Staff therefore administer all medication, using a monitored dosage system. The medication was stored securely and appropriately receipted. Staff had not however consistently documented when medication had been administered. We advised that any handwritten instruction on the medication administration record be dated and countersigned by another member of staff. The application of topical creams was not always evidenced. Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 17 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 the home’s adult protection systems. EVIDENCE: The home has a detailed complaints procedure devised by SCOPE. People who use the service however, rely on others to recognise any forms of discontentment. People’s relatives are strong advocates. A regular parents meeting is held. Mr Curtis told us he is beginning to get to know relatives. Within this, Mr Curtis is aiming to provide an open approach to complaints. There was evidence that any concern had been appropriately addressed. Within surveys, all relatives told us that they knew how to make a complaint. Two relatives said the service usually responds appropriately to concerns. One relative said they usually did. One relative said ‘at present there is a good locum manager who listens to concerns.’ All staff within their survey told us that they knew what to do, if they received a concern about the home. SCOPE has detailed adult protection policies available to staff for reference. Specific staff have the designated responsibility of adult protection. A referral was recently made to the Safeguarding Vulnerable Adults Unit due to three accidents to people who use the service. SCOPE was asked to investigate the incidents. A number of measures such as up to date care planning and risk Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 18 assessments were identified, as a means to minimise the risk of further incidents. The safeguarding process was concluded, with no further action. Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 19 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: Shapland Close consists of two purpose built bungalows, which are located in a quiet position away from the main road, on the outskirts of Salisbury. All amenities are within close proximity. Both bungalows have full disabled access throughout. People, who use the service, have a single bedroom, which is decorated and furnished to a high standard. All rooms have specialised equipment including an overhead hoist, an individualised bed and armchair and commode as required. Despite such equipment, the rooms are homely and personalised to a high degree. Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 20 Each bungalow has it own facilities although the laundry is shared. Within each bungalow there is a spacious lounge and dining area that is homely and comfortably furnished. Both kitchens are well equipped. The areas we saw, were clean and odour free. Staff have access to disposable protective clothing such as gloves and aprons, as required. Laundry facilities are located within an outside building. This is not ideal, as staff are required to go outside to reach the area. Staff told us, that they do their best with what they have. This means taking items to the laundry at certain times. For example, when it is safe to do so and when there are sufficient staff on duty to stay with people, who use the service. We did not look at the laundry facilities on this occasion. Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 21 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. Staffing shortages and the instability of management has had a negative effect on staff moral, training and various systems. People are protected through a clear, well-managed recruitment procedure. EVIDENCE: There is generally five or six staff on duty during the waking day. There is a minimum of two staff in each bungalow. At night each bungalow has one waking night staff. Another member of staff provides sleeping in provision. At the last inspection, the home was working with a number of staffing vacancies and some long-term sickness. A high level of agency staff was used although the same agency staff were requested to ensure continuity for people. Staff told us what it was like when the manager retired and temporary managers were employed. Staff felt this instability impacted on the service. They told us that everyone worked hard to cover the staffing roster and to ensure a good standard of care, for those people using the service. They felt however that administrative tasks and staff training suffered, as a result of insufficient time. Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 22 Within surveys, relatives and staff commented about the impact the staffing situation had on the service. One relative said ‘changes in staff has been difficult, there is now greater agency use, which is difficult for service users.’ Another said ‘the frequent changes of staff mean that they may not have adequate knowledge of, or training in the various health issues which can affect residents.’ Staff told us ‘we try to cover all eventualities but there are times when things do get very difficult, which are outside of our control and things do have to be prioritised. The residents are informed of any changes where possible and it is the office side of things that get left (assessments, care plans, changes written up etc) to provide direct care to the residents.’ Another member of staff said ‘recruitment and retention and use of agency challenges us on an almost daily basis, but I have never known the care of the residents to fall short of meeting their individual needs.’ Also ‘holidays, sickness and no show take their toll. We do our best but sometimes feel that we could do more for our residents if we had more staff on, especially for walks and outings. Conversely, sometimes the staff levels are there but everybody has self motivation.’ As a means to improve the service, one member of staff said ‘it could provide more staff on certain shifts especially at the weekends which always seems to be at crisis point lately. However we are consistently up against the budget.’ Mr Curtis acknowledged that staffing and management issues gave a difficult time. However, successful recruitment has since taken place. The service is now fully staffed. Mr Curtis told us that any shortfalls in provision would now be addressed. 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. A Criminal Records Disclosure had been received before the member of staff had commenced employment. Staff told us that SCOPE has a mandatory training plan. They said they had access to training, although the staffing situation had minimised their uptake of subjects. The training records were not up to date. The senior support worker told us that a new system was being implemented. All staff would have an individual training profile and training record. They would then be responsible for this. Mr Curtis told us that a number of training sessions had taken place but had not been recorded. These included manual handling, safe administration of medication, control of substances hazardous to health (COSHH) and infection control. Of the twenty-six staff, three have NVQ level 3. Six staff have level 2 and three are currently undertaking level 2. We noted that training specifically related to peoples’ needs was not identified on the training plan. Mr Curtis told us that cerebral palsy, does not form part of the organisation’s training plan. Mr Curtis told us however, that he would aim to source the training externally. Mr Curtis also said that he is planning to audit all training provision and arrange for any refresher training. Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 23 Within surveys, two staff said they had training relevant to their role. One said they had training, which helped them understand and meet the individual needs of people. One said they did not have this. Both staff said the training did not keep them up to date with new ways of working. Specific comments were ‘not enough information/training about new systems or changes within SCOPE’ and ‘it has been difficult to do my training because staff shortages. We do seem to have turned the corner and have started getting things more up to date regarding the basics………..[unreadable.]’ Within their survey, one relative told us ‘1. Staff at the care home need training in how to be more proactive in their care for residents – especially in relation to medical aspects of the care. Day-to-day communication often fails – messages are not passed on to staff on other shifts. This can lead to significant misunderstanding.’ Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The appointment of a permanent manager will enable the service to regain stability. While a formal quality action group is in place, regular quality auditing would further enhance provision. Peoples’ health and welfare are being compromised through insufficient use of the risk assessment process. EVIDENCE: As stated earlier in this report, Mr Curtis has only just started employment at the home. Mr Curtis is in the process of finalising his application to become registered with us. Mr Curtis is currently investigating training providers so that he can commence the Registered Manager’s Award. Mr Curtis was previously an area manager of a large organisation, providing support to people with a learning disability. Mr Curtis therefore has experience of people’s health care conditions and associated needs. Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 25 Following the retirement of the previous registered manager, there was a time when senior support workers were undertaking the day-to-day management of the home. A temporary manager was recruited but did not remain in post. An acting manager was then seconded from the organisation until Mr Curtis was employed. As stated earlier, this instability impacted upon the service. Focus was given to people’s care needs but other aspects such as administration, staff training and staff moral were affected. Within a survey, one staff member said ‘there is a need for a stable management/senior staff structure. This service has been lacking in this respect primarily due to SCOPE’s restructure. The present acting manager has begun to provide the stability and leadership that is needed but unfortunately he is only acting and temporary. Furthermore myself and the seniors, are presently waiting for notice of changes to our jobs, possible redundancy.’ Mr Curtis told us he is giving consideration to these areas. Mr Curtis’ management position has changed from that of the previous registered manager. Mr Curtis has the responsibility of managing Shapland Close and another care home, within the organisation in Salisbury. Mr Curtis told us that at present, he is splitting his time equally between the two services. He felt the role would be clearer once SCOPE had finalised its restructuring process of senior staff. This would enable clearer responsibility and lines of delegation. Mr Curtis told us that the home’s quality action group continues to meet. The group consists of a parent, a representative from the Community Team for People with Learning Disabilities, a member of staff and the manager. Mr Curtis was not aware of the organisation’s formal quality auditing systems. Mr Curtis told us he would investigate this area and inform us of his findings. Mr Curtis told us he would also investigate whether surveys had been sent out to parents and health care professionals in order to gain feedback about the service. The organisation has a range of health and safety policies. Health and safety training forms part of SCOPE’s mandatory staff training programme. Generic and individual risk assessments are in place although many are in need of review. One member of staff has the designated responsibility of health and safety. They have been trained to give staff instruction in manual handling. As stated earlier in this report, some staff may need refresher training due to a manual handling technique we saw, which compromised safety. The environment is well maintained. Mr Curtis told us that a programme is in place, to replace existing radiators in order to minimise the risk of scalding. As building work is taking place next to the home, various power cuts have taken place. Mr Curtis is looking into how the effects of these could be minimised. Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X X 2 X Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 27 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 YA6 Regulation 12(1)(a) Requirement The registered person must ensure that all aspects of required care provision are identified within care planning information. This could include the development of a short-term care plan. This was identified at the last inspection but has not been addressed. The registered person must ensure that any risk such as weight loss is fully monitored and evidenced within documentation. The registered person must ensure a system is developed in relation to the review of care plans. The registered person must ensure that all current risk assessments are reviewed. Consideration must be given to the development of additional assessments. These must take into account accidents or near miss situations. The registered person must ensure that a review of manual DS0000028422.V352078.R01.S.doc Timescale for action 31/05/08 2 YA6 12(1)(a) 13/02/08 3 YA6 15 30/04/08 4 YA9 13(2) 30/04/08 5 YA18 13(4) 30/04/08 Shapland Close Version 5.2 Page 28 6 YA20 13(2) 7 YA20 13(2) handling techniques, used with people who use the service, is undertaken to ensure safety. The registered person must ensure that any member of staff who undertakes an invasive treatment is fully trained to do so, by a health care professional. A protocol for the procedure must also be devised. The registered person must ensure that staff evidence the administration of all medication within the medication administration record. This must also apply to the application of topical creams. 13/02/08 13/02/08 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 5 Refer to Standard YA6 YA6 YA7 YA19 YA35 Good Practice Recommendations The registered person should ensure that any charts used to monitor aspects of the person’s care are crossreferenced to the care plan. The registered person should ensure that specific instructions regarding care intervention are recorded in the care plan, as well as the daily notes. The registered person should ensure that further consideration is given as to how people may engage more with staff and exercise their choices in practice. The registered person should ensure that consideration is given to assessing tissue viability. The registered person should ensure that the home’s training programme, targets people’s individual needs as well as mandatory topics. This should include health conditions such as cerebral palsy. Shapland Close DS0000028422.V352078.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Office 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.V352078.R01.S.doc Version 5.2 Page 30 - 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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