Inspection on 03/10/07 for St Philips Close

This inspection was carried out on 3rd October 2007.

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

Other inspections for this house

St Philips Close 14/11/06

St Philips Close 23/05/06

St Philips Close 23/11/05

St Philips Close 04/05/05

St Philips Close 02/11/04

St Philips Close 18/05/04

St Philips Close 25/11/03

St Philips Close 19/08/03

St Philips Close 09/10/02

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

CARE HOME ADULTS 18-65 St Philips Close 1 St Philips Close Middleton Leeds West Yorkshire LS10 3TR Lead Inspector Dawn Navesey Unannounced Inspection 3 October 2007 10:00 rd St Philips Close DS0000001500.V335441.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 St Philips Close DS0000001500.V335441.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. St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Philips Close Address 1 St Philips Close Middleton Leeds West Yorkshire LS10 3TR 0113 2778069 F/P 0113 2778069 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) londonroad@tiscali.co.uk Milbury Care Services Limited *** Vacant *** Care Home 4 Category(ies) of Learning disability (4) registration, with number of places St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th November 2006 Brief Description of the Service: 1 St Philips Close is a purpose built bungalow located in a residential area of Middleton close to local amenities and public transport routes. There is roadside parking to the front of the home. There are well maintained gardens to the rear of the property that are accessible to the people who live there. The home is registered to provide personal care for four people with learning disabilities. The accommodation includes four single bedrooms, a communal lounge, dining room, a communal bathroom and toilet, a domestic style kitchen and separate laundry room. The current scale of charges at the home is £1009 per week. Additional charges are made for toiletries, magazines, outings, activities and taxis for college. St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.csci.org.uk This visit was unannounced and was carried out by one inspector who was at the home from 10am to 6pm on the 3 October 2007. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people living there. And also to monitor progress on the requirements and recommendations made at the last inspection. Before the inspection evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the visit. An AQAA (Annual Quality Assurance Assessment) was completed by the home before the visit to provide additional information. Survey forms were sent out to people living at the home, their relatives and health and social care professionals. A number of these have been returned and information from them is used in this report. During the visit a number of documents and records were looked at and some areas of the home used by the people living there were visited. Some time was spent with the people who live at the home, talking to them and interacting with them. Time was also spent talking to staff and the deputy manager. Feedback at the end of the visit was given to the deputy manager. I would like to thank everyone who contributed to the inspection process and to the home for their hospitality. What the service does well: Pre-admission assessment is currently being done to a good standard for someone who is thinking of moving into the home. A detailed assessment is being taken to make sure the home can meet the needs of the person. Staff have good knowledge of the needs of the people who use the service. In a returned survey a relative said, “They look after my relative very well”. Staff make sure that people who use the service have regular and varied activity, which includes college courses and activity within the home. In a returned survey a relative said, “Quality of life in St Phillips is second to none”. St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 6 The home is very homely, well maintained and very clean. Furnishings are of a very good standard, giving people who use the service a comfortable environment to live in. Staff receive a good standard of training. There is a commitment to NVQ (National Vocational Training). Over half of the staff team have gained this qualification and the others are working towards it. What has improved since the last inspection? What they could do better: People who use the service must have a detailed and up to date care plan, which includes their specific health needs. This will make sure they receive person centred, safe support that meets their needs properly. The manager should also make sure that the relatives of people who use the service are involved in the care planning process. This will enable the staff to gain as full a picture as possible on the needs of the people using the service. All identified risks for people who use the service must have a detailed action plan in place in order to minimise or prevent the risk. St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 7 A number of health and safety issues must be addressed. The use of bed rails must be reviewed to see if this is safe for the person using them. The bed rails must also be checked regularly to see that they are in good working order. The water is too hot when it first comes out of the tap. This must be fixed and a risk assessment must be done to make sure everyone is kept safe. The manager must also make sure that all records in the home are completed properly and kept up to date. This will ensure the best interests of the people who use the service are safeguarded. Staffing levels must be checked to make sure there are enough staff to provide a safe level of supervision and support at all times. Requirements and recommendations that were identified at this inspection are at the end of this report. 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. St Philips Close DS0000001500.V335441.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 St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, and 5 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People thinking about moving into the home and their family or friends have the information needed to choose a home, which will meet their needs. EVIDENCE: The Statement of Purpose and Service User Guide are documents that give information on what the home can provide. These have been produced in an easy read format using easy words and pictures. They are kept on display in the entrance hall of the home and each person who uses the service or their representative is given their own copy. Some CSCI (Commission for Social Care Inspection) inspection reports are also available in the entrance hall for any visitors to see. However, the most recent and up to date reports are not there. An assessment is currently being completed with a person who is considering using the service. The home manager and deputy manager are doing this, working with the person and their family. The manager has got a copy of the care management assessment and is also working with people who support St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 10 this person at a day centre and respite unit. This is to make sure that a full and detailed assessment is taken. The organisation has developed a new document for contracts and finance arrangements for the people who use the service. This is more detailed and shows clearly the costs of the service. It will also be clear who has signed the contracts on behalf of people who use the service. St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are, in the main, aware of the individual needs of people who use the service. The lack of detail in some care plans and risk management plans could however, lead to the needs of the people who use the service not being properly met. EVIDENCE: The organisation has introduced a new document for care planning. It is planned that each person who uses the service, will have a personal plan that is individual to their needs and wishes. Key workers are in the process of assessing the needs of the people who use the service and writing new care and support plans. The deputy manager said that family members had been involved in drawing up the care plans. There was no evidence to show this St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 12 had happened. In a returned survey a relative said they were concerned that they were not contacted often enough on their relative’s well-being. It would be good practice to show how people who use the service or their relatives are involved in care planning. The deputy said that she and the manager are checking the work of key workers to make sure the plans are of a good standard and accurately reflect the care needs. It would be good practice to show how this has been done. Some of the plans gave clear, detailed instruction on how needs are met. Some of them are person centred and give good information on likes, dislikes and preferences with care and support. However, some care plans need more explanation and more detailed and specific information for staff to make sure that important care needs are not overlooked. For example, a person who has needs relating to dementia has no plans in place for how they are supported with this. Moving and handling plans are vague, asking staff to give ‘assistance’ but not describing what the assistance is. A person who is at risk from pressure sores has a plan that says they are to change position ‘regularly’. This does not say how regularly. The care plans have been like this for some time now and must improve to make sure that the needs of the people who use the service are properly met at all times. Despite these gaps in care planning documents, the current staff have a good knowledge of the needs of the people who use the service. They were able to accurately describe the care they give and talk about the detail of how people like to be supported in their daily routines. People who use the service look well presented and well cared for. In a returned survey, a staff member said, “We are updated on any change to care plans, this enables us to provide the needed care”. Risks to people who use the service have been identified and assessed. Some of the risk assessment information is up to date and reviewed. However some are out of date, containing old information. A person who uses the service, has an assessment in place for walking, when they are no longer able to walk. Some of the information and management plans are vague and do not give enough detail. This again, could lead to important needs being missed. Some of the language used in the care plans and risk assessments is confusing and could be misunderstood. An example of this is that a person who uses the service has a plan in place which describes what would be their worst day, something they do not like to do. Listed in this section is something the person does on a regular basis. On discussion with staff it was explained that the person enjoys the activity but doesn’t like the fact they have to get up early to do it. The way it reads looks like the person is forced to do something they do not want to do. The deputy manager said she was aware of some of the language issues and would deal with them. St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 13 People who use the service were offered choices throughout the day, around what to do or what to eat. They do not use verbal communication so are observed for their body language and facial expressions in response to questions and choices. Staff also rely on their knowledge of the people who use the service and what their usual responses are. One person had some good information in a communication diary. This had been built up as staff have got to know them better. The manager is currently trying to find ways of helping people who use the service to express their views more. Key workers have a monthly meeting with people who use the service to review what they have been doing over the month. Notes of these meetings are kept. St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are supported to make choices about their lifestyle and supported to develop their life skills. Appropriate activities are arranged and a good, healthy and varied diet is offered. EVIDENCE: People who use the service have a variety of activities that they are involved in within their local community. This includes, college classes and social clubs. They have all had a holiday or short break this year, with some more planned for later in the year. There have been improvements made with activity on offer in the home. An activities planner has been developed. This gives staff ideas and guidance on activity such as baking and arts and crafts. Staff said they had noticed an increase in activity in the house and were now creating more opportunities for one to one time with people who use the service. In a St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 15 returned survey, a staff member said, “The service provides opportunities for service users to participate in activities inside and outside the house”. During the visit, people who use the service were involved in watching television, a video of a musical and listening to a variety of music. One person went out to a college class. On the whole, staff seemed to interact well with people who use the service, sitting with them to watch television and generally chatting to them. Staff have also introduced theme nights in the home. A regular session is massage and relaxation nights. In a returned survey, a relative said, “Quality of life in St Phillips is second to none”. The cultural needs of people who use the service have been noted in their support plans. How people like to celebrate Christmas, New Year and their Birthday are detailed. One person who uses the service enjoys a party for his birthday and staff make sure this happens. People who use the service are supported to keep in touch with family and friends. In returned surveys, a relative said they are kept well informed about their relative’s wellbeing. However, as mentioned in the Individual Needs and Choices section of this report, another relative did not feel they were kept informed or involved enough. Staff said they are aware of the importance of assisting people who use the service to be as independent as they can be. They gave examples of what they do to encourage and allow people to develop their independence skills. They said they provide aids and adaptations to help people at meal times and also provide finger foods for people who are unable to use cutlery. The menus and choices of food in the home are good. The food is varied and healthy, while making sure that people who use the service get their preferred choices. In a returned survey staff said they provide a well balanced diet for people who use the service. Some people who use the service are nutritionally at risk due to their fluctuations in appetite. Staff said they make sure that extra snacks are offered at these times. This is not always accurately documented in people’s daily notes and could lead to nutritional needs being missed. Some people who use the service prefer to get up later and have their breakfast mid-morning. On the day of the visit, one person was given breakfast at 11am and was to have lunch at 12-15pm. Staff delayed the lunch when this was pointed out. Consideration must be given to the timing of meals to make sure there is a reasonable gap of time between them. Lunch on the day of the visit was sandwiches followed by trifle. In the main, people were supported with courtesy and thought for their dignity. However, there was very little social interaction between the staff and people who use the service when they were being supported to eat their meal. One person who required support, was assisted in silence by staff. This did not respect the person’s dignity and comfort. St Philips Close DS0000001500.V335441.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19, 20 and 21 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The lack of some written documentation could lead to personal and health care support needs being overlooked. Staff’s practices do not always respect the dignity of people who use the service. EVIDENCE: Staff have a good awareness of the personal care, and likes and dislikes of the people who use the service. Staff were seen to support people with their personal care needs in private and, in the main, with dignity. However, one person was moved from a wheelchair to a chair with the use of a sling and hoist. Staff did not explain this procedure to the person and just carried out the task without any interaction with them. This was not respectful or dignified. In a returned survey one staff member said they felt the home does a good job in making sure that privacy and dignity is maintained at all times for people who use the service. Another said, “I feel a high standard of personal care is maintained”. A relative said, “They look after my relative very St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 17 well”. However, as mentioned in the Individual Needs and Choices section of this report, there is a lack of detail and clear instructions on how to deliver care in the care plans. One person’s plan said he had hygiene needs but did not give any detail on how this is met. There was no information on how the person is supported to bathe, wash, shave or how their continence needs are met, which means they could be overlooked. A person who has bed rails on their bed, had no plans in place for their use. It was noted that he is at risk from bruising himself on the rails, but there was no plan to describe how this is minimised. Staff described what they do to reduce the risk of this happening. It was not clear if all staff do the same. This practice could place the person at risk from injury and the use of the bed rails must be reviewed. There are no checking systems in place for the bed rails to make sure they are in good working order. Some staff said they do this each time they use them, others were unaware of the need to check them. Regular safety checks must be carried out and recorded to make sure the bed rails are safe for use. People who use the service now have plans in place for their last wishes and funeral arrangements. The support plans have details of any health professionals that people who use the service see. These include, GP, speech and language therapist, dentist, specialist nurse, and optician. Records are kept of any health appointments and their outcome. Some people who use the service have specialist health needs such as epilepsy. Most staff have received training in how to manage epilepsy. However, the support plans for people who use the service do not give clear and detailed instruction to staff on how to manage each person’s epilepsy on an individual basis. Staff gave a variety of responses when asked the length of time they should wait before getting medical assistance in the event of a fit. They did not know if emergency medication was prescribed for anyone if they had a fit. This lack of written information could lead to important health care needs being overlooked. The home uses a monitored dosage pre-packed system for medicines. All staff now take responsibility for the administration of medication and have been trained to do so. There are good ordering and checking systems in place, with a clear audit trail for any unused medication returned to the pharmacy. The medication administration records (MAR) were checked and showed some errors in administration. The MAR sheets had not been signed for medication that had been given and an antibiotic had been entered on the MAR sheet and the dates were written in wrong. The deputy manager was made aware of this and said she would investigate the issues. She also said that medication and MAR sheets are checked by senior staff on a weekly basis so that any errors can be picked up sooner rather than later. The home also uses homely St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 18 remedies and has obtained permission from each service users’ GP to administer them when needed. A system has been introduced to make sure this is done safely. St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service and their relatives have their views listened to, taken seriously and acted upon. There are good systems in place to protect people from abuse. EVIDENCE: The home has a complaints procedure displayed in the entrance hall of the home. This is also in the Statement of Purpose and Service User Guide. It is an easy read complaints procedure, making it more accessible. The home has not received any complaints since the last inspection. A relative who returned a survey said they were aware of the complaints procedure and how to complain. Staff have received training on safeguarding adults. They were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. They knew where the policy on adult protection was kept and could refer to it. They were also aware of the organisation’s ‘Whistle–Blowing’ policy. One staff said, “This is drummed into us”. Service users are protected by the use of body maps to document any bruises, scratches or marks they may have. This is good practice to monitor for any signs of possible abuse. St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 20 Good records are kept of the finances of people who use the service and their monies are kept safe. Proper handovers of the monies takes place at each shift change and the manager regularly checks the finance records and receipts. St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home offers an attractive, homely, clean and safe environment for people who use the service. EVIDENCE: The environment of the home continues to improve. The home is very tastefully and attractively decorated and furnished throughout. The use of soft furnishings, ornaments and pictures gives the home a homely feel. It is warm, very clean, fresh smelling, light and airy with a good layout. A relative who returned a survey said, “The house is maintained to a very high standard”. The bedrooms of the people who use the service are well maintained and show their individual interests and personality. One person has recently had a new St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 22 bedroom suite fitted. The bathroom and shower room are attractively decorated and made interesting by the use of pictures and other decorations. The hot water at some of the sinks in the home was found to be very hot when the tap is first turned on. Staff said this was an on-going problem and that the housing association who are responsible for the building had been out on a number of occasions to try and remedy this. Staff have been advised to allow the water to run for three minutes before using it. Staff said that none of the people who use the service use the taps without staff’s assistance and are therefore not at risk from the hot water. However, visitors to the home could be. Records of water temperatures are kept daily and all bath temperatures are taken before anyone has a bath. There was no risk assessment in place regarding this situation with the hot water. The message to run the tap for three minutes is passed on verbally to staff. This could lead to accidents occurring, especially with any visitors to the home. The housing association must be contacted again to see what can be done about the water temperature. The hallway has a new carpet. This was fitted as previously it was a laminate floor and staff were aware that the sound of their footsteps on this flooring could wake people who use the service up at night or disturb those who like a lie in. The home has an attractive enclosed garden. This is shared with the home next door. There is level access to the outside which makes sure anyone with mobility problems can get around outside. The people who use the service have been involved in planting flowers and bushes in the garden over the summer months. Clinical waste is properly managed and staff wear protective clothing when attending to the personal care needs of people who use the service. Staff have received training in infection control and were able to say what infection control measures are in place. St Philips Close DS0000001500.V335441.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are trained and skilled, however they are not always in sufficient numbers to support the people who use the service properly. EVIDENCE: There are staff on duty throughout the day and night. There are usually two staff on the morning shift and two staff on the afternoon shift. At night there is one member of staff on duty, supported by an on-call manager. The manager and deputy have one or two shifts per week where they are supernumerary and can attend to their management role in this home and the home next door. At the moment there are only three people living at the home. The manager has recently devised the rota where at some times of the day there is only one member of staff on duty. This is on occasions between 7am to 11am and 7pm to 9pm. Care plans showed that one person who uses the service needs two staff for some tasks such as moving and handling. The deputy manager explained that this person usually gets up early or later when two staff are on St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 24 duty and goes to bed early while there are two staff around. She said that if there were any emergencies at the times when only one staff member was around that staff could be called on from the adjoining home. This routine and practice of having only one member of staff on duty limits opportunities for personal support, activity and outings for the people who use the service. Staffing levels must be reviewed to make sure there are enough staff to provide a safe level of supervision and a good level of activity and stimulation. This issue was brought up at the last inspection of the home. In the AQAA (Annual Quality Assurance Assessment) the manager said that staff work a flexible rota to make sure all needs are met. Staff said that they had noticed an increase in the amount of one to one and community activity for people who use the service. However, the rota did not show how this was being achieved, as times when there is only one person on duty seem to be increasing. The deputy manager said the home is almost fully staffed and it is expected that when a new person moves in there will always be at least two staff on duty through the day. She also said that the needs of people who use the service are kept under review and if anything changes, extra funding will be sought to increase staffing levels. Staff said they did not feel rushed in their work or understaffed. In a returned survey, a staff member said, “We are well staffed”. A relative said, “Big improvement with the current staff, they are amazing”. Recruitment is properly managed by the home; interviews are held, references and CRB (Criminal Record Bureau) checks are obtained before staff start work and checks are made to make sure staff are eligible for work. References are verified through telephone calls to the people providing them. This is good practice. Staff’s training is mostly up to date. Records are kept of staff’s training and when their updates are due. The manager assesses this every month to make sure training doesn’t get missed. Staff spoke highly of their training and the support they get from the manager. In returned surveys, staff said, “The training has helped me a lot in providing good quality care to the service users”, “The service provides opportunities in staff training and covers all aspects from day to day care to activities” and “The service is good at staff training, all staff are kept up to date”. The organisation has introduced internet ‘e-learning’ courses for staff. This has increased the availability of training. There is an annual training plan provided by the organisation. Training in specialist needs such as epilepsy and dementia are not listed on the training plan. The deputy manager said this would be arranged separately for staff. Well over half of the staff team have achieved an NVQ (National Vocational Qualification) in care at level 2 or above. St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 25 All staff said they felt they had a good team and the management team were supportive. Staff said they felt communication and teamwork within the home were much improved. They said they have team meetings and receive regular supervision. Comments on returned surveys included, “We have supervision at least every six weeks and “There is a team work spirit, hence verbal communication is superb”. St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 26 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, 41 and 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is in the main, well managed and has a competent management team. This means that the interests of the people who use the service are seen as important to the manager and staff and are safeguarded most of the time. EVIDENCE: The home has an experienced manager who has almost completed her NVQ level 4 in care and the Registered Managers Award. She has also recently had her interview to be registered with the CSCI. Staff spoke highly of the manager. Comments included, “I have a lot of respect for her, she is a good manager”, “We get good support from her”, “We are told if we do wrong but St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 27 still respected as a person”, “She is proactive and works alongside us” and “This is the best management team we have ever had here”. A relative who returned a survey said, “We are happy with the general day to day running of the house, very well done to them”. The operations manager visits the home on a monthly basis to carry out regulation 26 visits. This involves talking to people who use the service and staff about the home. A report of these visits is made showing details of any action to be taken to improve the service. In addition to this, the organisation carries out an annual service review, as part of its quality assurance programme. This also includes service users, relatives and staff. The results of this review were not available in the home. As mentioned in the Individual Needs and Choices section and Personal and Healthcare Support section of this report, care plans and risk assessment records must improve. The plans did not show evidence of how the manager checks them to make sure they are of a good standard and give staff detailed and specific instruction on care and support needs. Staff carry out daily, weekly or monthly health and safety checks around the home such as fire alarms, emergency lighting and water temperatures. These records are well kept. Environmental risk assessments are completed and reviewed. However, some risks have not been assessed. These include the current situation with the hot water and the use of bed rails. This could lead to a risk of injury. Staff receive health and safety training. Accident or incident reports are completed. There is a section for follow up action to be taken after any accident or incident. The manager now has a system in place where she can analyse accidents to see if there are patterns, trends or ways of avoiding future accidents. The home has a comprehensive range of policies and procedures in place to ensure health and safety. The manager makes sure staff are familiar with these and asks them to sign them when read. In a returned survey, a staff member said, “The files i.e. human resources, care practice, health and safety have really helped me to know quality care standards”. St Philips Close DS0000001500.V335441.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 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 3 3 X 3 X 2 2 X St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 29 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 YA19 Regulation 15.1 Requirement The manager must make sure that all people who use the service have an up to date detailed care plan, including health care needs. This will ensure that they receive person centred support that meets their needs. The previous timescales of 31/01/07, 30/09/06, 31/07/06, 15/02/06 and 30/08/05 have not been met in full. 2. YA9 13.4 The manager must make sure that all identified risks for people who use the service have a detailed action plan in place in order to minimise or prevent the risk. The manager must make sure that the use of bed rails is reviewed to ensure they are safe for the person using them. The organisation must review the staffing levels to make sure DS0000001500.V335441.R01.S.doc Timescale for action 31/12/07 30/11/07 3. YA18 12.1 (a) 30/11/07 4. YA33 18 31/12/07 St Philips Close Version 5.2 Page 30 there are enough staff to provide a safe level of supervision and support at all times. The previous timescales of 31/01/07 has not been met in full. The manager must make sure that records such as care plans and risk assessments are kept up to date. This will ensure the best interests of the people who use the service are safeguarded. The manager must make sure that any bed rails used are checked regularly to make sure they are in good working order. The manager must make sure that action is taken to remedy the situation of the hot water being too hot when it first exits from the taps. The previous timescale of 17/11/06 has not been met in full. The manager must also make sure that a full and detailed risk assessment is put in place regarding the temperature of the water. This will ensure the safety of all who may be at risk of injury from the hot water. 5. YA41 17.1 (a) 31/12/07 6. YA42 12.1 (a) 30/11/07 7. YA42 12.1 (a) 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000001500.V335441.R01.S.doc Version 5.2 Page 31 St Philips Close 1. Standard YA6 The manager should make sure that the relatives of people who use the service are involved in the care planning process. This will enable the staff to gain as full a picture as possible on the needs of the people using the service. The manager should make sure that food and drink intake are recorded for those who are nutritionally at risk. Meal times should also have a reasonable gap of time between them. This will make sure that the nutritional needs of the people using the service are met. The manager should make sure that staff provide personal support in a way that at all times respects the dignity and comfort of people who use the service. 2. YA17 3. YA18 St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 St Philips Close DS0000001500.V335441.R01.S.doc Version 5.2 Page 33 - 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. 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