Inspection on 11/07/06 for Sharpe House

This inspection was carried out on 11th July 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sharpe House 24/06/09

Sharpe House 05/07/07

Sharpe House 24/11/05

Sharpe House 09/06/05

Sharpe House 22/06/04

Similar services:

The Vicarage

St George`s

Credence House

Radfords

Honeybourne House

Stallcombe House

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

CARE HOME ADULTS 18-65 Sharpe House 1 West Road Wiveliscombe Somerset TA4 2JS Lead Inspector David Kidner Key Unannounced Inspection 11th July 2006 10:30 Sharpe House DS0000046271.V298691.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 Sharpe House DS0000046271.V298691.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. Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sharpe House Address 1 West Road Wiveliscombe Somerset TA4 2JS 01984 629220 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) jeddinternational@yahoo.co.uk Jedd International Ltd. Mr Declan Joseph Howlett Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th November 2005 Brief Description of the Service: The home is located in the small town of Wiveliscombe and is situated a short walk from the local community and its facilities. Sharpe House is a large detached property arranged over two floors. The layout of the home would not be suitable for service users with a physical disability. All bedrooms are single and have hand wash basins. Some bedrooms are located on the ground floor. The home does not have a passenger lift to reach the first floor. The home has dining room, lounge, conservatory, and two bathrooms, domestic style kitchen, laundry room and well-presented garden. Sharpe House is registered with the Commission for Social Care Inspection to provide personal care for up to 10 service users, under the age of 65yrs, who have a learning disability. The home is not registered to provide nursing care. The home is owned by JEDD International Ltd. The Registered Provider is Mr Declan Howlett and the Registered Manager is Mr Peter Kidson. Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector conducted this Unannounced Key Inspection over one day (7.5hrs). The Inspector viewed records in relation to care plans, risk assessments, health and safety, the management of medicines, staff recruitment and supervision and toured most of the premises. On the day of the inspection nine service users were living at Sharpe House. Three service users were at home on the day of the inspection and two staff were on duty, including the Registered Manager. The Inspector spoke to eight of the service users as they all returned from activities and Six-Acres whilst the Inspector was still at the home. Three service users were spoken to in private. One service user did not wish to speak to the Inspector. The Inspector spoke to two staff in private and observed care practices. The service users that were spoke to and were able to state an opinion confirmed that they were happy living at Sharpe House. They confirmed that staff respect their privacy and dignity and that they are offered choices and are involved in day-to-day decision making. They liked the food and the activities that they are offered. As part of the Inspection process the Inspector sent Relatives/Visitors comment cards to eight relatives. Four were returned. The majority of the comments received were positive. All were satisfied with the overall care provided. A comment card was sent to the GP but not returned. Comment cards were sent to all 4 Care Managers. Verbal feedback was received by another care manager. Therefore, all Care Managers responded to the comment cards. Four Care Managers stated that they were satisfied with the overall care provided. One Care Manager did not make a comment in relation to this. Two Care managers stated that they have received complaints from parents. Reference has been made that there is now better communication with the home since the appointment of Mr Kidson as Registered Manager. The Inspector would like to thanks service users, relatives, care staff and Care Managers for their contribution to the inspection process. It is the Inspectors opinion that Sharpe House is in need for stability in the post of Registered Manager and of the care team. There are indications that Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 6 the Registered Manager has made a positive impact at the home. It is hoped that thus continues so as to provide a high quality service at Sharpe House. As a result of this inspection the home has four requirements and nine recommendations. What the service does well: What has improved since the last inspection? What they could do better: The home must ensure that service users have access to all health care professionals. It was noted that a very small number of service users have not visited an optician or chiropodist for a significant period of time. Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 7 The home manages medicines well but must ensure that records are kept of PRN medication and that medicines should be returned to the pharmacy when no longer required. An action plan must be developed for staff to achieve formal qualifications in care. The Registered Manager should review the manner in which service users finances are supported. The home need to be more homely and is in need of some refurbishment and redecoration. Hot water temperatures must be set at an appropriate temperature for bathing. The Registered Manager should ensure that all interested stakeholders are aware of the homes complaints procedure and that views of all interested stakeholders are obtained. 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. Sharpe House DS0000046271.V298691.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 Sharpe House DS0000046271.V298691.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 123 The quality outcome is Good The home has a Statement of Purpose that provides service users with the information they need to enable them to make an informed choice about moving to the home. The home has taken appropriate steps to ensure that staff have the skills to meet the needs of service users. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide which clearly identifies services offered by the home and ‘additional charges’. Additional charges include those for toiletries, hairdressing, transport some activities and chiropody. The home has two cars and service users currently contribute 50 of their DLA mobility component towards the cost of transport. The CSCI have not been advised of any changes to the Statement of Purpose or Service User guide. However, the newly appointed Registered Manager is advised to ensure that his name is now included in these documents. The home has not any admissions since November 2002. Therefore, Key Standard 2 could not be fully assessed. However, the Registered Manager has previously advised that a detailed pre-admission assessment would be completed and visits to the home and overnight stays would be encouraged Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 10 before any decisions were made by the service user and other interested stakeholders to move to the home. There were previous concerns raised regarding the lack of staff skills in meeting the assessed needs of service users. It was again positive to note at this inspection that staff have received training in Somerset Total Communication (STC) and Epilepsy. The newly appointed Registered Manager has been very pro-active in addressing the need that staff obtain skills and knowledge in such areas. The vast majority of staff have received training in STC, epilepsy, vulnerable adults, medication, equal opportunity, antidiscrimination and health and safety. Sharpe House DS0000046271.V298691.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 8 9 10 The quality outcome is Adequate The home’s care planning system is clear and consistent. Risk assessments are conducted but the format in which they are presented should be reviewed. The use of Advocates is encouraged where needed. The home is pro-active in offering choices and involving service users in the day-to-day running of the home. Service users meetings are held regularly. EVIDENCE: The Inspector viewed two care plans. The care plans are known as “My Plan” They identified clear information on the individual’s assessed needs, abilities and preferences. Both care plans examined had recently been reviewed and dated. Reviews are also conducted three and six-monthly. The home operates a key worker system. The care plans are produced in symbols. Both care plans identified that a monitoring device is used to monitor health care needs at night and at times during the day. Guidelines are in situ to meet this is need but were not signed and dated. It is recommended that such guidelines are signed, dated and reviewed at regular intervals. Both care plans contained Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 12 information in relation to health care needs. Records are kept of weight and epilepsy recording charts where needed. Individual environmental risk assessments had been recently reviewed and dated. This was a recommendation at the previous inspection. Two service users at the home are unable to communicate verbally. As previously stated the home has taken steps to ensure that staff receive training in STC. The Inspector was able to observe interactions between staff and service users. Interactions were noted to be appropriate to the needs of service users and service users responded well to the staff. The service users appeared relaxed in the presence of staff. Staff were offering choices and it was apparent through observation and talking to individual staff that they were aware of service users needs, likes and dislikes. There was a good atmosphere at the home at the time of the inspection. Since the previous inspection the home has obtained am Advocate for one service user with the support of the service user’s Care Manager. The inspector spoke to the care manager and received very positive comments from the care manager in relation to the care provided at the home. The home conducts regular service user meetings. It was noted that meetings took place in February, March, April and May 2006. Minutes are kept of the meetings and are produced in symbols and images. The Inspector noted that the minutes included discussions around meals and food choices, activities, holidays and concerns / complaints. One service user spoken to confirmed that they attend the meetings and find them good. The home has conducted individual risk assessments in relation to promoting independence, behaviour management and daily living. The inspector discussed the format that the risk assessments were presented. A detailed assessment had been conducted for service users care plans that were viewed, but it was unclear how some risks were to be managed. The Registered Manager agreed to review this format and to ensure that they are well presented and included control measures and a revised level of risk. Service users have access to their personal records in accordance with the Data Protection Act 1998. Service users and visitors have access to the home’s policies and procedures, some of which are available in symbol format. The service users individual records are currently stored where the medicines are located. The Inspector recommended that this is reviewed and that they are stored in another secure area. However, the Inspector discussed the possibility of service users keeping their personal records in their bedrooms where appropriate and so wished. The Registered Manager agreed to address this as soon as possible. Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 13 Sharpe House DS0000046271.V298691.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11 12 13 14 15 16 17 The quality outcome is good The home seeks the views from the service users of the social and leisure activities that the home should provide. Records are kept of activities but some improvements in the recording of such activities needs improving. The home encourages contact with relatives and friends. Menus are based on service users wishes. EVIDENCE: Each service user has a planed programme of activities that is agreed and incorporated in to their plan of care. All but one service user utilises the Six Acres Resource Centre in Taunton and some attend Work Power. Since the last inspection the home has appointed a part time member of staff to ‘focus’ on activities and also supports service users who receive additional funding for activities. The Registered Manager also stated that all staff encourage and promote activities. At the previous inspection it was Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 15 recommended that the home keep detailed records of all activities that are undertaken. One service users activity records were detailed and demonstrated the range and frequency of activities undertaken. This was not the care for another service user, as it appears that all activities are not recorded or recorded as offered but refused. The Inspector recommends that the Registered Manager continue to promote the recording of all activities so that frequency of activities and outcomes can be measured. The Registered Manager advised that a questionnaire had been developed to seek the views of the activities that service users wished to pursue. The Inspector viewed the questionnaire and noted that this was also recorded in the minutes to a service user meeting held in April 2006. This is good practice. The Inspector spoke to a number of service users who confirmed that they have been consulted about activities. They confirmed that they undertake such activities and leisure pursuits such as keep fit, cooking, shopping, listening to music, watching television, walking, cycling and going to Six-Acres. The home is also seeking the views on the service users preferences in relation to holidays and day trips if preferred. This was evidenced in the minutes to service users meetings. The home encourages contact with service users families and friends. The Inspectors viewed the records kept in relation to the contact with relatives and friends. Some service users frequently go home to their parent’s house for a day or longer periods. All Relatives/Visitors comment cards indicted that the staff welcome relatives at any time and that they can visit their relative in private. All but one comment card stated that they are kept informed of important matters affecting their relative. It appears that communication has improved between the home and relatives. One relative has commented that communication has improved. The Registered Manager is aware of the need to communicate with all relatives/ friends of service users as appropriate. The home has developed a three-week menu based on the views and preferences of the service users. The service users spoken to confirm that they are consulted on food choices and that they like the food that is provided. Service users are involved in the shopping and cooking of meals based on individual needs. Currently, there is not the need to provide specialist diets. Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 20 The quality outcome is Adequate Staff offer appropriate levels of support to service users to meet personal and healthcare needs. Not all service users have recently had access to a range of appropriate healthcare professionals. However, generally this is addressed with good records kept. The home’s procedures for the management and administration of medication are generally good. EVIDENCE: In accordance with the individual’s agreed plan of care, and or request, staff support service users to meet personal care needs and to attend health care appointments. Service users that the Inspector spoke to and able to express a view stated that ‘staff treated them well’. Staff spoken with demonstrated a good knowledge on the needs and preferences of service users with regard to assistance with personal care. On the day of the inspection service users Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 17 appeared to be appropriately supported and discreet personal care was given with sensitivity. Service users were well attired and confirmed that they choose their clothes, make up and decide when they wish to go to bed and get up of a morning. All service users are registered with appropriate healthcare professionals. The care plans contain a Health Check form that records visits to GP, dentist, chiropodist, optician, medication review, annual medical and regular recording of weight. Running records are also kept of the visits and outcomes of such visits. The home ensures that service users attend appointments with specialist professionals such as dietician and specialist nurses when needed. It was noted through case tracking that two service users had not attended an optician or chiropodist for a while. This was raised with the Registered Manager at the time of the inspection. This must be addressed. The Inspector received one comment card from a health care professional. The feedback received indicated that the home now communicates more effectively with the Community Team Adults with Learning Difficulties (CTALD) since the appointment of the new Registered Manager. The Inspectors examined the home’s procedures for the management and administration of medication. Staff training records indicated that all but one staff member has received training in medication, epilepsy and rectal diazepam. The home now has a clear procedure in place and written confirmation from individual’s G.P’s on the permitted use of identified ‘homely’ remedies. This was a requirement at the last inspection. Medicines were found to be securely stored and pre-printed Medication Administration Records (MAR) had been appropriately completed. Photos are in each individual section of the MAR sheets. One service user had been given a homely remedy by the District Nurse. This had been recorded on daily running records rather than the MAR sheets. It is recommended that such remedies be written on the MAR sheet and supported by two staff signatures if hand transcribed. The Inspector noted that a number of unused medicines had not been returned to the pharmacy and were still in the drug cupboard. The home has a recording system for returning such medicines. The last recorded date for medicines being returned to the pharmacy was February 2006. The Registered Manager took action to address this at the time of the inspection. It was also noted that there was not a stock record of some PRN medication. This must be addressed. Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 18 Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 23 The quality outcome is adequte The home’s complaints procedure enables service users to raise concerns. The home informs service user how to make a complaint. The home has systems in place to reduce the risk of harm or abuse to service users. The recording and monitoring of service users finances need reviewing to ensure that they are robust. EVIDENCE: The home displays a complaints procedure in a prominent position within the home. This is also displayed in symbol format and includes the contact details of the CSCI. The Inspector spoke to a number of service users who stated that they knew who to speak to if they had a concern or complaint. Two of the Relatives/ Visitors comment cards indicated that they did not know the homes complaints procedure. However, all comments indicated that they had not made a complaint. It is recommended that the Registered manager ensure that all interested stakeholders are aware of the homes complaints procedure. The home has not received any complaints since the last inspection, nor has the Commission for Social Care Inspection (CSCI). Staff that the inspector spoke to were aware of the home’s whistle blowing policy. Training records indicated that all staff have received training in abuse/vulnerable adults. The inspector viewed the individual records of two service users finances. Each service user has an individual bank account. Bank statements are issued three Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 20 monthly. The Inspector suggested that the Registered Manager contact the bank to ascertain if monthly bank account statements could be issued, as this would aid the audit process. The bank accounts identified individual transactions. The home maintains individual spending money records with receipts kept. The Inspector sampled two records of very recent transactions and found them correct. Two service users can manage their own finances and have cash point cards to withdraw money. Discussions took place to ensure that this is secure and robust. Other service users need support. The Responsible Individual is the appointee for three service users. The Inspector strongly recommends that the Registered Manager review the recording and monitoring processes to ensure that they are robust and protect service users. Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 27 28 30 The quality outcome is adequate Sharpe House is domestic in style but is in need of some redecoration and refurbishment to promote homeliness. Service users can choose from a range of communal areas or can spend time in the privacy of their bedroom. The cleaning systems in the home have improved but need constant monitoring. EVIDENCE: Sharpe House would not be suitable for service users with mobility difficulties and is not registered to accommodate service users with a physical disability. It is a large detached property situated in the heart of the small town of Wiveliscombe. Local shops and bus routes are within a short walking distance of the home. The Inspector viewed all communal areas, bathing areas, toilets and two service users bedrooms. The majority of service users bedrooms were locked, Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 22 as they were not at home. When service users returned home the service users that the inspector spoke to commented that they liked their bedroom. However, this standard was not fully assessed at this inspection. The communal areas have furnishing and fixtures of a domestic style. There are some homely touches but the Inspector feels that there could be further improvements to make the home feel more homely. It appears that parts of the home are in need of redecoration and refurbishment. At the previous inspection carpets in two areas posed a tripping hazard. This has been addressed. The home has a large conservatory area off the small lounge area that leads onto the front garden. This area appears somewhat sparse and the flooring is in need of repair. One bathroom is also located in this area that may compromise privacy and dignity. The home’s other bathroom and shower areas were adequate. All bathing and toilet areas had liquid soap and paper towels. This was a requirement at the last inspection. Service users have access to a good sized garden. The home has a no smoking policy. Service users wishing to smoke are able to use the garden area. The home has suitable sleeping-in accommodation for staff. The kitchen & laundry area are domestic in style and appear adequately equipped. The home has systems in place to record when staff have ensured that all communal areas and kitchen/laundry areas have been cleaned. These are recorded on a daily, weekly and monthly basis. Service users assist as mush as possible. It was noted that the general cleanliness of the home has improved but needs constant monitoring. On the day of the inspection the home appeared clean and hygienic. It is recommended that the Registered Manager provide the CSCI with the homes planned maintenance and renewal programme. Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 33 34 35 36 The quality outcome is good Sharpe House provides staff with training to ensure that staff have the skills and knowledge to meet the needs of the service users. However, emphasis needs to be placed on the promotion of NVQ qualifications within the team. It appears that the home has adequate staff on duty to meet the needs of the service users. The home’s staff recruitment procedures are robust. Staff are well supported and supervised. EVIDENCE: There have been concerns raised in the past regarding the skills and experience of staff employed at Sharpe House. It was positive to see that when viewing staff training records that appropriate training had either taken place or dates set. All staff have received training in STC, management and administration of medication, epilepsy, principles and values of care, antidiscrimination, protecting vulnerable adults, promoting choice, health and safety, moving and handling, equal opportunity and food hygiene. Seven of the eight care staff have received first aid training. Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 24 It is noted that none of the care team have NVQ qualifications. Four of the overseas staff are qualified nurses. The Registered Manager stated that the one staff member has been registered to undertake a NVQ3 qualification and that a training provider has been approached to provide LDAF. The home must develop a programme to ensure that 50 of the care staff have a care NVQ2. The Inspector viewed a copy of a four-week rota. It appears that there is adequate staff on duty to meet the needs of the service users. It appears that there is usually 2-3 staff on duty throughout the day and two staff sleep-in at night. Staff that the Inspector spoke to stated that they felt that there were adequate staffing levels. The Registered Manager stated that the staffing levels are kept under constant review and that the rota is addressed to meet the needs of the service users. A member of staff is identified on the staff rota to provide 1:1 support in activities. There is an on-call rota between to Registered manager and the Deputy Manager. The majority of the service users are not at home during the day as they attend Six-Acres resource Centre in Taunton. Three of the four Relatives/Visitors comment cards stated that they felt that there was adequate staff on duty. The home has regular staff meetings. It was noted that meetings took place in February, March, May and June 2006. This is a good practice. The Inspector viewed the minutes to the staff meetings. Topics discussed included continuity and consistency in record keeping, good practice and team work, staff supervision, activities, team responsibilities, communication in the home and specific service users needs. The Inspector viewed the recruitment records of the most recently appointed staff. These had improved greatly since the last inspection. Files contained required documentation as listed in Schedule 3 of the Care Homes Regulations 2001. Staff that the Inspector spoke to confirmed that they receive regular supervision. The Registered Manager keeps records of supervision undertaken. It was noted that staff have received regular 1:1 supervision. Staff spoken with were positive regarding the support they received. Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 42 The quality outcome is adequate. The home appears to be well run. Quality assurance and monitoring systems have begun to take place. Further improvement is needed. The home promotes health and safety. EVIDENCE: After a very unsettling period of time the home now has a Registered Manager. He has previous experience as a deputy manager and manager of a care service and has appropriate formal qualifications. He is also undertaking NVQ4 in Care and Management. Since appointment the Registered Manager has also undertaken training in all mandatory training, epilepsy, medication, infection control, vulnerable adults and STC to Level2. Due to the recent confirmation of the Registered Manager, Standard 38 was not fully assessed, but the feedback that the Inspector received from the service users and care team was very positive and complimentary. Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 26 In accordance with Regulation 26 of the Care Home Regulations 2001, the registered provider has carried out formal monthly visits to the home and has been forwarding these reports to the CSCI. The Registered Manager has started to seek the views of the service users in relation to the services that they receive and questionnaires have been developed in relation to activities and menu choices. The Inspector recommends that the home seek the views of relatives/visitors and other interested stakeholders such as health care professionals and care managers. Following a tour of most the premises, the following records were examined relating to the health and safety of service users, staff and visitors to the home. FIRE SAFETY – The annual service of the fire alarm system and the emergency lighting was conducted on 21/02/06. Weekly checks are conducted on the fire alarm system. The last recorded test was on the 10/07/06. The emergency lighting is tested monthly as well as the homes torches. The last fire drill was conducted on 27/03/06. Staff received regular fire training. ELECTRICAL SAFETY –The home has an up to date electrical hardwiring certificate dated 09/11/04 and valid for 5 years. PAT was conducted on 23/08/05. LEGIONELLA – Weekly test are conducted. HOT WATER- The home maintains monthly records of the temperature of the hot water outlets. The records viewed indicated good record keeping with showers and hot water outlets within recommended temperatures. However, it was noted that the temperature of the hot water from one outlet in a bathroom area was not very hot and was below 30 degrees centigrade. It appears that this bath is mainly used for showering as there is an electric shower fitted. However, the home must ensure that the water is an adequate temperature for bathing. GAS SAFETY – The home’s last annual gas safety check was conducted on 01/02/06. ACCIDENTS – The Inspector was informed that the home had no recorded accidents since the last inspection. FIRST AID – Training records seen at this inspection indicated that all staff had received up to date training in First Aid. FOOD SAFETY – The Inspectors was informed that staff involved in the preparation of food have an appropriate food hygiene certificate. Staff training records seen by the inspectors confirmed this. The home keeps daily records of fridge and freezer temperatures. Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 27 Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 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 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 2 LIFESTYLES Standard No Score 11 3 12 2 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 2 X X 3 X Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 29 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 13 (1) (b) Requirement The Registered Manager must ensure that service users have access to all health care professionals. The Registered Manager must ensure that the home maintains a record of all medicines kept at the home. The Registered Manager must ensure that staff are suitably qualified to meet the needs of the service users. Particularly in relation to developing an action plan for staff to achieve NVQ qualification. The Registered Manager must ensure that all hot water outlets are set to appropriate recommended temperatures appropriate to bathing. Timescale for action 31/07/07 2. YA20 13 (2) 31/07/06 3 YA32 18 (1) (a) 30/09/06 4. YA42 13 (4) 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 30 No. 1. 2. 3 4 5. Refer to Standard YA6 YA9 YA10 YA12 YA20 Good Practice Recommendations The Registered Manager should ensure that the guidelines for monitoring individual needs at night are signed, dated and reviewed at regular intervals. The Registered Manager should review how individual service users risk assessments are conducted and presented. The Registered Manager should review where service users personal records are stored. The Registered Manager should ensure that more detail is recorded relating to service user activities and ensure that the outcome can be measured. The Registered Manager should ensure that unused medicines are returned to the pharmacy on a regular basis and homely remedies should be recorded on individual MAR sheets. The Registered manager should ensure that all interested stakeholders are aware of the homes complaints procedure. The Registered Manager should review the recording and monitoring processes for service user finances to ensure that they are robust and protect service. The Registered Manager should forward the home planned maintenance and renewal programme to the CSCI. The Registered Manager should seek the views of all interested stakeholders as part of the homes quality assurance and quality monitoring systems. 6. 7. 8. 9. YA22 YA23 YA24 YA39 Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 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 Sharpe House DS0000046271.V298691.R01.S.doc Version 5.2 Page 32 - 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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