Inspection on 06/12/05 for Smock Acre

This inspection was carried out on 6th December 2005.

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

Other inspections for this house

Smock Acre 26/11/08

Smock Acre 18/12/06

Smock Acre 22/07/05

Smock Acre 08/02/05

Smock Acre 15/11/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Smock Acre Hollow Lane Hoath Canterbury Kent CT3 4LF Lead Inspector Jenny McGookin Announced Inspection 6th December 2005 10:00 Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 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 Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 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. Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Smock Acre Address Hollow Lane Hoath Canterbury Kent CT3 4LF 01227 860136 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) The Avenues Trust Limited Caroline Fleming Care Home 3 Category(ies) of Learning disability (2), Learning disability over registration, with number 65 years of age (1) of places Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Older People with a Learing Disability is restricted to one person whose Date of Birth is 28/09/1917 22nd July 2005 Date of last inspection Brief Description of the Service: Smock Acre is a care home, first registered in 1999 to provide accommodation and personal care to 3 adults with a learning disability, who have additional physical needs. Currently, there are 3 service users in residence. The registered provider is the Avenues Trust Limited, which has been operating since 1993 and is now a major provider of residential support services in South East England. Maintenance of the building is by Kelsey Housing Association. The home is a large, spacious bungalow along a farm road outside the rural village of Hoath, surrounded by fields. It is approximately 8 miles from the city of Canterbury and 6 miles from the seaside town of Herne Bay. There is a halfacre garden at the rear, and a large flat garden at the front. The home is not on any direct bus route, and the farm road does not have footpaths or street lighting. Residents rely on the homes own adapted minibus to access the community. There is a drive on either side of the site with ample parking spaces in each case. The home itself is fully wheelchair accessible. The gardens are not. There was a manager in place, Fiona Cialis, who started in April 2005, initially on a temporary basis, now on a permanent basis subject to the successful completion of her probationary and registration processes. Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which was used to check progress with matters raised from the last inspection (July 2005,) accepting that a number of timeframes had run their course; and to reach a preliminary view on other aspects of the day-to day running of the home not assessed at the last inspection. The inspection process took seven hours, and involved meetings with the visiting service manager, manager, a senior support worker and two support workers. Meetings with the residents were not possible as none has verbal skills, sign language or Makaton. However, feedback forms were received from all three, as interpreted by their key workers and two relatives sent in their own feedback forms – all of which, expressed satisfaction with the services received. The inspection also involved an examination of records and policy documents and the selection of one resident’s case file, to track his care. All areas of the home were checked for compliance with the National Minimum Standards, and interactions between staff and residents were observed throughout the day. What the service does well: The layout of this home is generally suitable for its registered purpose, and convenient for visitors as long as they have cars. The property is being maintained to a very satisfactory standard. Very few matters were raised for attention. The health and personal care needs of the current residents are generally well addressed, and there was good evidence of holistic care planning. There is input from a range of healthcare professionals. The residents were observed being supported to understand what choices were available to them. Staff actively try to improve the quality of lives of the residents, each of whom has very high support needs and had lead very controlled, institutionalised lives before their admission to Smock Acre. The home also provides opportunities to access to the community and to be involved in day-to-day routines such as cooking and cleaning, as far as they are able. . Staff confirmed there was a systematic approach to recruitment, regular supervision, training and a good level of management support. And staff showed a commitment to challenge and report poor practice, should it ever occur. Overall, there was a high level of compliance with the National Minimum Standards throughout the inspection process. Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 6 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. Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 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 Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 1. The homes’ Statement of Purpose and Service User Guide are only fully compliant with all the elements of this standard, when read in conjunction. When this is the case, it does mean, however, that the residents’ families or representatives as well as funding authorities have all the information required to make appropriate decisions about placements. 2. Residents did not have any choice over their admission, but the decision to place them at this home was based on full multi—disciplinary assessments, which involved the residents at every stage. 3. The home is able to demonstrate its capacity to meet the assessed needs of individuals it admits. 4. Avenues Trust Ltd. has a careful admission process, designed to enable the prospective resident to sample the facilities and activities provided by the home, before their admission is confirmed. This process includes visits, overnight stays and a trial period. 5. Each resident’s placement is subject to a documented contract, terms and conditions and Licence Agreement. There should be a draft contract available in a format more suitable for the residents Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 9 EVIDENCE: Copies of the most recent Statement of Purpose (December 2005 issue) and a Service User Guide drawn up specifically for one resident (September 2005 issue) were supplied for inspection. It was noted that a number of elements listed by this standard in respect of the Service User Guide had been incorporated into the Statement of Purpose instead. Given the special communication needs of the current residents (none of the residents speaks, or uses any sign language or Makaton), and their current level of understanding, this is judged appropriate. Taken in conjunction, it does mean that anyone representing the interests of the residents (families, key workers, care managers or funding authorities) has all the information required to make each placement effective. Some recommendations are made to improve the Statement of Purpose. The document should be given an issue date, so that its currency can be evaluated The document would benefit by a contents page and numbered pages, to facilitate the reader’s access. It needs to describe the experience of the registered provider and needs to provide the organisational structure of the care home. It would also benefit by a staffing statement, so that visitors would know what to expect for each shift. The document should outline the arrangements for visiting Admissions None of the three current residents had any choice about their transfer from previous placements, as these decisions were led by the Primary Care Trust, which has a block contract with Avenues Trust Ltd. Two of the three residents were admitted in February 1999 i.e. predating the emergence of the Care Standards Act 2000 and National Minimum Standards. The third was admitted in February 2005 and his admission process is reported on in the last inspection report. There have been no new admissions since then. Avenues has a policy on admissions which prescribes a careful step-by-step process, based on multi disciplinary assessments and meetings, and which is inclusive of the resident’s responses (and their representatives) at every stage. This process includes overnight stays, joining in with activities and a trial stay of three months, which can be extended. The home is able to demonstrate its capacity to meet the special needs of these residents. Examples are detailed throughout this report. Records are set up to document access to healthcare professionals as appropriate. Examples include: epilepsy specialists, Physiotherapist, chiropodist (monthly – the residents pay for this), Occupational Therapy, audiologist, dentist, Speech and Language therapists as well as Primary Care Trust commissioners. A reflexologist visits one resident, and the home is trying to access a dietician. Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 10 Contracts Each placement is confirmed with a contract, which is intended to be read in conjunction with a Licence Agreement (not supplied with sample contract supplied for inspection) and Terms and Conditions of Residence. When read in conjunction, they do generally obtain full compliance with the elements of this standard. The contract should identify the allocated bedroom, and work should be done to produce a much simplified picture / symbol assisted version of the contract for the residents. Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 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 6. The preadmission assessment and care planning processes cover a range of health and personal care needs, as well as some social care needs. Less clear, however, was the extent to which the residents were involved in these processes in the first instance (see s.8). 7. The current residents were observed being supported in the daily routines, and observed interactions between staff and the residents were appropriately familiar and respectful during this inspection. 8. The current residents have more opportunities to influence their daily routines, and their responses are used to gauge their level of personal choice. 9. There are risk assessments to cover the residents as individuals, their activities and their environment (inside and outside the home), to maximise their capacity to be independent. 10. The arrangements for the storage and disclosure of confidential information is generally satisfactory, though some original documents were not dated and it was not always clear who had produced them. Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 12 EVIDENCE: There was a range of preadmission assessments on file, which were in the first instance drawn up by the NHS/PCT Trust, then updated (and in some cases corrected) by the home’s own. The home has made good progress with the introduction of a Person Centred Planning approach to care planning. The Care / Support Plans which followed on covered a range of daily living routines, but the home does not appear to be summarising the care plans monthly (matter raised by the last inspection) so that progress and trends can’t be tracked by anyone authorised to inspect them. Up until recently it has not been clear to what extent the residents are being actively engaged in the assessment and care planning process, or how the home establishes the resident’s own perspective and any emerging unmet needs. However, each resident has an “Avenues to Quality” file, which features “Opportunities” sessions, designed specifically for residents with special communication needs. This involves his being presented with a modest selection of choices (e.g. cereals, cheeses, colours) and being discreetly observed by staff to see if he shows any positive preferences. The residents’ capacity to make choices is expected to help redefine their care packages. It is still early days, but the extension of this principle of working to other experiences is judged potentially exemplary practice. The care plans were usefully underpinned by risk assessments to cover the resident’s safety in the home, bus and community, and there was better evidence at this inspection of their being dated and reviewed. Relatives are offered the opportunity to attend individual reviews and the manager said she had even collected one herself, but uptake is said to be variable. The residents were observed being supported by staff in their own daily living routines. The home’s arrangements for keeping confidential information secure against unauthorized access was satisfactory. Cabinets and office facilities are all properly secured. Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 13 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 11. Staff enable residents to develop their capacity to make positive choices and exercise control over their daily routines. 12. There is limited choice over aspects of daily routines, subject to staff interpreting residents’ non verbal responses correctly. The current residents appear generally content with their lifestyles in this home, and the home has been able to match their expectations as interpreted by their representatives. 13. This home offers a range of activities inside and outside the home. Links with the community are invited and pursued, notwithstanding its isolated rural setting and staff support and enrich residents’ social opportunities. Access to activities is recorded. 14. Staff ensure residents have access to a range of appropriate leisure activities. 15. Families and friends are welcomed, and their involvement in the care planning processes is encouraged, subject to the residents’ wishes 16. The daily routines promote choice and independence, subject to risk assessments Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 14 17. Residents are offered a choice of suitable menus to suit their dietary needs and preferences, 17. The meals in this home offer choice and variety and are catering for this resident’s needs and preferences. Meals are enjoyed, unhurried and the setting is congenial. EVIDENCE: Abilities, activities and personal preferences are established as part of the preadmission assessment process, and confirmed by care plans and day-today planning thereon. These residents have high dependency needs and are non-verbal. Routine is quite important to the residents, but this can become obsessive. They are said to need the confidence to accept flexibility. See section on “Individual Needs and Choices” for findings in respect of the way staff have been interpreting their likes and dislikes in “Opportunities” sections. Avenues Trust Ltd has its own day centre and uses community buildings for activities, where they are accessible (see below). The residents have access to a range of therapeutic sessions: exercise classes, relaxation and sensory experiences, gardening – though the last inspection found this has in some cases amounted to no more than passive observation rather that active participation. The day centre is, however, holding quarterly reviews, and these are being used to evaluate the observed benefits of these sessions and to plan others. One recent success has been the residents’ introduction to swimming and hydro-therapy sessions. Staff are trying to building up the residents’ involvement by trial and error. Shift plans are being redesigned to offer even more flexibility, and the staff team is hoping to further benefit from the skills and experiences of new recruits. Community Access The home is in an isolated rural setting, and there is no path along the access road, which would make its use by pedestrians dangerous, but has its own dedicated adapted minibus and can access community resources for events not restricted to, or readily identifiable with, their disabilities such as pub lunches, a local fete and outings. A cinema and a swimming pool in Margate are reported to have suitable access facilities for residents in wheelchairs. And access to a pantomime was planned for the Christmas period. Meals Menus are planned a month in advance – there are winter and summer menus but these are applied flexibly. Staff make sure meals for two residents are Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 15 chopped up into small enough pieces. They can’t feed themselves. One can drink with his food. Since the last inspection, a speech and language therapist was called in to assess his scope for using a cup, though no changes to his arrangements were found to be warranted. The third resident is PEG fed separately elsewhere. The inspector joined the residents for lunch and observed how residents were supported with their meal. The dining area is a light spacious area, which provides a congenial setting for meals. As was reported at the last inspection, staff eat the same food (this is judged a sound quality assurance tool) and chatted light heartedly with them throughout. Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 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, 21 18, 19. The current residents receive an appropriate level of support with their personal, emotional and healthcare needs. Personal care is offered in a way protect their privacy and dignity and promote their capacity for independence. 19. The health needs of the current residents are well met with evidence of access to a range of healthcare services. 21. Avenues Trust has a policy on care of the dying, to ensure residents are accorded with sensitivity and respect. EVIDENCE: The preadmission and care planning processes assess the extent to which each resident requires assistance with their own personal care, and their choice and control is actively promoted by staff as far as possible. All the bedrooms are single occupancy and there are enough toilet and personal care facilities (baths, showers, wash hand basins) to guarantee their availability and privacy. Staff are available on a 24 hour basis to assist residents. The care planning process routinely addresses a range of standard healthcare needs e.g. GP, optician etc. Records have been set up on file to document Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 17 access to a range of other healthcare professionals as appropriate: epilepsy specialists; audiologist, dentist, OT, physiotherapy, dieticians. Eleven staff are reported to be trained to administer medication and thirteen are reported to have up to date First Aid certificates. The medication arrangements were not assessed against the National Minimum Standards on this occasion. Avenues Trust has a comprehensive policy on the ageing process and death, which has the resident’s personal and cultural preferences as its central principles. It gives guidance on planning for growing older; terminal illness and death (expected and sudden); as well as financial and other matters such as bereavement and counselling. It quite properly includes the retention of medication and reporting duties. Of particular interest was the appendix material detailing leading principles on a range of religious beliefs – Christian, Jews, Moslems, Hindus, Jehovah Witnesses, Bhuddists, and Mormons. This is judged an inclusive approach. Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 18 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 22. The manager and staff are attentive to the responses of the residents, and a lot of work has been do e on a corporate level into making the complaints policy more accessible to special communication needs 23. Residents are safeguarded against abuse, neglect and self-harm by a range of policies, staff training and staff commitment. EVIDENCE: Avenues Trust has policies on complaints and whistle-bowing, which were judged comprehensive. The complaints procedure also has a picture assisted version and CD version to make it more accessible, though this is more likely to benefit residents at other homes in the group. Since the last inspection, the home has set up a complaints register, as required, but there were no complaints in it. Given the special communication needs of these residents and their heavy dependency on staff, this is judged understandable. And it is accepted that a lot of work has been done to draw up communication passports. See also section on “Individual Needs and Choices” on “Opportunities” sessions. However, the challenge continues to be to find ways of translating expressions of dissatisfaction into recordable events, so that anyone authorised to inspect the records can evaluate the extent to which their responses are listened to and acted on. These residents do not have active access to independent advocacy services (although an application was reported to have been made on behalf of one resident three years before, to no avail), and rely, therefore, on families or Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 19 staff to represent their interests. The inspector was advised that one member of staff, who is scheduled to be seconded to a new service, is being funded by Avenues Trust to continue working as one resident’s advocate. As long as the worker’s independence can be assured, this is judged the next best arrangement available. The Home has a copy of the Kent and Medway Multi-Disciplinary Adult Protection Policy, to ensure a timely and co-ordinated approach should an adult protection issue arise. In discussions with staff, they invariably confirmed feedback from staff at the last inspection in respect of their commitment to challenge and report any instances of abuse, should it occur. The rapport between staff and the current resident appeared appropriately familiar and respectful. Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 20 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, 25, 26, 27, 28, 29, 30 24, 25, 28. The standard of the property is good. The furniture is a mix of domestic and specialist in style, and comfortable. Residents have a choice of communal areas, and there are homely touches throughout. 26. Each resident has a bedroom which has furniture and fittings suitable to meet their needs, and each room has been personalised. 27. Each bedroom has a wash basin cubicles, and there are sufficient communal bath and WC facilities to guarantee their availability and privacy. 29. The home is wheelchair accessible and has ample useable floor space throughout. There is equipment and adaptations to me the residents’ assessed needs. The garden areas are no, however, adapted for people with physical disabilities. 30. The home is well maintained, clean and free of offensive odours. EVIDENCE: The layout of this home is generally suitable for its registered purpose. All areas of the home were inspected and found to be homely, comfortable and Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 21 clean. The furniture tends to be an appropriate mix of domestic in style and specialist / adapted. There were homely touches throughout. The front garden is reasonably flat but offers few discrete focal areas to draw the attention to, or to sit in, and there are no paths across it, for use when the ground is wet. The rear garden is populated by fruit trees and its surface is uneven, making it inaccessible to the residents, though the inspector was advised that since the last inspection, funding had been secured to make it more accessible. This is judged a satisfactory response as better access to the garden was an emerging theme in feedback obtained for this inspection. One resident is particularly susceptible to the sunshine, because of his medication and would require shaded areas. The site would, therefore, benefit by private, sheltered areas and sensory gardens, ramps, paths and levelled areas, to facilitate access. The home has a “No Smoking” policy. Communal Areas The communal areas of this home are all open plan. There is a spacious lounge leading directly into the dining area and kitchen. All the windows offer pleasant views of the grounds and surrounding fields. The dining chairs are uniform in style, but this is appropriate for the staff or visitors who use them. The lounge furniture is more varied and includes a bean bag, a long bolster and mat for floor exercises. The residents all use their own comfywheelchairs, and these are subject to periodic checks to ensure they maintain their suitability (one such check was due that week). The kitchen is light, airy, clean and well maintained. No matters were raised for attention. Communal Bathrooms / WCs The communal WC and bathroom facilities are reasonably accessible to bedrooms and communal areas. There is a one Arjo Hi/Lo bath and a wheel-in shower (though this tends to be used by staff, not the residents, except occasionally). The flooring in the shower room was lime-scale stained (matter raised by the last inspection), because it is said to be difficult to dry off this room, though there had been some improvement since the last inspection. No other matters were raised for attention. Bedrooms All the bedrooms are spacious and single occupancy. All the bedrooms were inspected and found to be well maintained. In terms of their furniture and fittings, they were generally compliant with the provisions of the National Minimum Standards, and each had its own range of sensory equipment. More is planned for one resident who spends more time in his room. No matters were raised for attention. Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 22 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, 35, 36 32, 35. Staff feel they are suitably invested in, in terms of training opportunities and supervision, and gave a number of examples of the way they positively promoted the residents’ quality of life. 33. There was general compliance with the staffing arrangements as described. Team working and support for the resident were identified as a key strength. 36. The service users are safeguarded by training and supervision EVIDENCE: Smock Acre has a staff establishment of 14 full time equivalent staff, which includes a House Manager; two senior Home Support Workers and 11 Support Workers. The following staffing arrangements apply. There are usually 3 staff on duty during the day (7.30-2.30/3pm; 2.30-10pm) and 2 at night (one on wake night duty, and one on sleep-in duty). Every day there is a senior on duty. The manager is on site five days a week, and there is an on-call rota system in her absence. There is no dedicated ancillary staff. Support staff do all the cooking and cleaning. Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 23 Staffing rotas were supplied for the four-week period 28 November to 1 January 2006, which showed, with the exception of two late afternoon shifts (where staffing levels dropped to two and one) compliance with these staffing levels as described, and were exceeded on three morning shifts. At the last inspection, the manager was advised to include a legend on staffing rotas to explain any codes used on any rotas submitted for inspection. Meetings with staff confirmed records and feedback at the last inspection in respect of the range of key training opportunities available to staff, such as food safety, fire safety, manual handling, First Aid, challenging behaviour, adult protection; as well as specialist training in issues such as challenging behaviour, epilepsy, sensory stimulation, stesolid, and the care and management of gastronomy, oxygen. 4/13 staff are reported to have obtained NVQ Level 2 accreditation or above, which translates into 28 . Two more are in prospect. The manager is an NVQ assessor. Since the last inspection, the manager has been sharing the supervision of staff with senior support staff, and supervises the senior support staff herself. Three staff who met with the inspector confirmed that they had regular formal supervision, usually once every 6-8 weeks, and line management was said to be accessible and supportive. Since the last inspection, there have been changes to the long-standing staff team, with secondment opportunities being taken up and the recruitment of three staff, two of whom were external applicants. This has signalled a significant turning point in the working practices and the staff group’s ability to team work will be crucial to the success of this. In common with one other home in the group, however, recruitment records have not been readily available for inspection, as they have traditionally been kept at the head office. Access to recruitment records is an issue over which Avenues Trust will need to reach a formal, documented agreement with the CSCI. This matter has been raised for attention with Avenues Trust, though an interim arrangement was agreed with the service manager. Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42 37, 38, 42. The Home is well managed, and actively supports the resident’s independence, health, safety and welfare. 39. Quality assurance and quality monitoring systems are in place to measure the home’s effectiveness. 40. Policies are comprehensive in their scope 41. Records required by regulation for the protection of residents and for the effective running of the home are properly maintained. 42. The manager ensures as far as is reasonably practicable the health, safety and welfare of residents and staff. EVIDENCE: Following the resignation of the registered manager there has been a manager in place - Fiona Cialis, who started in April 2005, initially on a temporary basis, Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 25 and is now on permanent contract. An application for her formal registration by the Commission has yet to be made. The manager has City & Guilds qualification in Advanced Management for Care and several years’ experience in the learning disabilities residential care sector. Feedback confirmed that obtained at the last inspection, that she had quickly established a good relationship with staff and the residents, and was reported to be very accessible and supportive. There are clear lines of accountability within the home and organisation. The service manager’s monthly inspection visits (Reg 20) are judged exemplary in their scope and the conspicuous links they make with the National Minimum Standards. The organisation as a whole maintains a proactive overview of organisational issues. Reg 20 reports go to Head Office. Anything outstanding for three months or more is highlighted for attention and there are quarterly overview sessions by the organisation. Avenues also has a proactive approach to quality assurance which places its stakeholders at the centre. See section on “Individual Needs and Choices” for details on the way this principle is being applied on a daily basis, and there are also annual satisfaction questionnaires for families, care managers and funding authorities. Over the last two inspections, twelve key corporate policies have been selected for closer examination, and were judged comprehensive in their scope. Avenues Trust has a range of policies governing health and safety matters, which are underpinned by a robust level of investment in training and all maintenance records seen were up to date and systematically stored. The home has the requisite insurance cover arrangements. Access to activities not necessarily confined to this client group and community presence are central features of the care planning processes and have been reported on elsewhere in this report. Some records were without dates or authorship but these tended to be original preadmission documents. More recent records were in the main judged in good order and maintained in the best interests of the resident. The transition to Person Centred Planning should be of demonstrable benefit to the residents. Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 2 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 X 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Smock Acre Score 3 3 X 3 Standard No 37 38 39 40 41 42 43 Score 3 3 4 3 3 3 X DS0000023587.V256193.R01.S.doc Version 5.0 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 YA33 Regulation Schedule 4 Requirement Timescale for action 31/12/05 2. YA34 Staffing rotas. The following matters are raised for attention: - they need to include a legend to explain any codes used. 7,9,19&Sch That all documentation required 2,4(6) by this Regulation is in place for each member of staff (matter originally raised in November 2004) 31/12/05 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 YA1 Good Practice Recommendations Statement of Purpose (December 2005 edition). The following recommendations are made: - The document should be given an issue date, so that its currency can be evaluated - The document would benefit by a contents page and numbered pages, to facilitate the reader’s access. - It needs to describe the experience of the registered provider and needs to provide the organisational structure of the care home. - It would also benefit by a staffing statement, so that DS0000023587.V256193.R01.S.doc Version 5.0 Page 28 Smock Acre 2. YA5 3. YA6 4. YA22 5. YA24 visitors would know what to expect for each shift. - The document should outline the arrangements for visiting The contract should identify the bedroom being allocated and work should be done to produce a much simplified picture / symbol assisted version of the contract for the residents. The Care / Support Plans should be summarised monthly (matter raised by the last inspection) so that progress and trends can’t be tracked by anyone authorised to inspect them. Complaints Register. The challenge will be to translate residents expression of dissatisfaction into recordable events, so that anyone authorised to inspect the records can evaluate the extent to which their responses are listened to and acted on. The site would benefit by private, sheltered areas and sensory gardens, ramps, paths and levelled areas, to facilitate access. Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 29 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 Smock Acre DS0000023587.V256193.R01.S.doc Version 5.0 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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