Inspection on 07/12/06 for Tavistock Square (17)

This inspection was carried out on 7th December 2006.

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

Other inspections for this house

Tavistock Square (17) 18/11/08

Tavistock Square (17) 09/01/08

Tavistock Square (17) 23/11/05

Tavistock Square (17) 30/06/05

Tavistock Square (17) 25/01/05

Tavistock Square (17) 02/08/04

Tavistock Square (17) 17/03/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

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

CARE HOME ADULTS 18-65 Tavistock Square (17) Silksworth Sunderland SR3 1DZ Lead Inspector Miss Andrea Goodall Key Unannounced Inspection 7th December 2006 9:30 Tavistock Square (17) DS0000015736.V313495.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 Tavistock Square (17) DS0000015736.V313495.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. Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tavistock Square (17) Address Silksworth Sunderland SR3 1DZ 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) 0191 523 8250 0191 523 8250 Northumberland, Tyne & Wear NHS Trust Mrs Maria Jane Rennoldson Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 23rd November 2005 Brief Description of the Service: The home at 17 Tavistock Square provides accommodation for 6 people with a learning disability, one of whom also has physical disabilities and uses a wheelchair. The home is a modern, purpose-built bungalow with level access at the 2 front entrances and good access around all areas for people with physical disabilities. It is sited in a cul-de-sac of similar modern housing and is set back with a large driveway and large back garden. The home provides personal care and is owned and operated by Northumberland, Tyne & Wear NHS Trust. The bungalow provides 6 good-sized bedrooms, 2 lounges, 2 dining rooms, 2 bathrooms and an activities room. The home is within easy walking distance of various local shops, clubs, health centre and a church. It is also a short drive from main supermarkets and leisure clubs. The fee for a placement at 17 Tavistock Square is £1,131.17 per week. The people who live here each contribute £62.35 per week towards the fee. Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place over one day and was part of a planned key inspection. Some time was spent with the people who live here, looking around parts of the home, and looking at care records. Most people here find it difficult to express their views, so time was spent in their company, looking at their bedrooms with them, and observing their interaction with staff. For part of the visit an ‘Expert by Experience’ came to the home to talk with the people who live here. An expert by experience is someone who uses social care services. We are currently trying visits where Experts by Experience are an important part of the inspection team. They can help inspectors to get a picture of what it is like to use social care services. Miss Victoria Bowman, an Expert by Experience, joined the inspector for part of this visit. She talked with residents and staff, joined them for a lunchtime meal and looked at parts of the house. Miss Bowman’s comments and observations are in this report in bold text. Information that was looked at before the visit included a pre-inspection questionnaire from the Manager and comment cards from 4 relatives of the people who live here. What the service does well: The 4 comment cards from relatives showed that they think it is a good service. One relative said, “My relative’s progress in the past year is fantastic. His independence and choices are promoted at all times.” The Expert by Experience said that good things about the home include: • • • • Each resident has their own care plan. It explains how residents express their needs and preferences. The staff were aware of how pictures and symbols could be used to support resident with communication Residents benefit from an ‘enabler’ (activities staff) to provide support with activities and outings. Residents have the opportunity to experience a range of holidays and outings. The bungalow is very well decorated and furnished. It is a bright, comfortable and modern place for the residents to live. It is spacious and has lots of Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 6 lounges and sitting areas for the people who live here to choose from. It also has good access for people with a physical disability. There are enough staff to support residents with their individual lifestyles. Staff are well trained. There have been no staff changes, so staff are very familiar with residents’ differing needs. A relative said, “The staff team strive to give my relative an excellent quality of life. Very good staff team and keyworker”. The home is well managed. Staff make sure that it is a safe place to live. What has improved since the last inspection? What they could do better: Two people have no relatives, and 2 other people only have occasional contact with distant relatives. These people should have independent advocates to represent them. It would be good if staff kept a record of people’s short-term goals, like planning holidays and parties, and how they support people with these. There should be a record to show why wheelchair straps are used by 2 people when they are out of the house. It would be better if menus were in picture so that residents could make their choices. The Expert by Experience said that areas that could be better include : - Pictures and symbols could be used more to support service users to have more choice and control over their lives, for example pictorial menu choices and activity choices. - A wider variety of activities in lounge areas for residents to enjoy. - The possibility of using information technology to broaden choice for residents. This could include using IT to support people to communicate and also to provide activities for residents. - Residents would greatly benefit from accessing advocacy services. Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 7 - This would help ensure that residents have the greatest choice and control over their lives. It would be good if staff kept a note of the Residents’ Meetings and any suggestions made by the people who live here. Staff must give medicine in the way that a doctor has prescribed it. If the doctor has changed it there should be a record by them. The activities room must be warm enough for residents to use it in comfort. All the residents have been sent a questionnaire to fill in so that the Trust can find out what they think of the home. The residents cannot fill in the questionnaires without help. The Trust should arrange for relatives or advocates to help residents with this. 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. Tavistock Square (17) DS0000015736.V313495.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 Tavistock Square (17) DS0000015736.V313495.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): 2 and 5. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service A full assessment of every residents’ needs was carried out before they moved here to make sure that the home can meet their needs. Each resident has a clear contract, but 2 people need advocacy service to help them with this. EVIDENCE: Four residents have lived here since the home opened several years ago. The other 2 residents have moved to the home over the past couple of years. For all the people who live here, a full assessment of their needs was carried out by health and social care professionals before they moved to the home. All the residents have a copy of a Residents Agreement, which is kept in their own files. This describes the terms and conditions of their residence here. The agreement is written in plain English and pictorial symbols. However it is clear that, due to the severity of their disabilities, residents could not independently understand this contract. Some residents have signed the agreement, even though they do not understand the information. Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 10 The Residents’ Agreements have been sent to relatives or representatives where these exist. In the sample examined it was evident that a relative had signed the agreement on behalf of the resident. However two residents have no relatives or other independent representation. The Manager continues to seek out advocacy services, but there have been no advocates for those 2 people for many years. Is there anything to say about culture/religion/beliefs etc – even if it to say that the assessment process considers this but it is difficult, because of the level of disability, to say for certain what this is. Tavistock Square (17) DS0000015736.V313495.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 and 9. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service Good support planning systems ensure that staff work consistently in support of residents individual needs, but do not reflect the support given to meet their own short-term goals. So what Residents have some opportunities to make daily choices, but there is not enough pictorial information to support them to make informed choices. Residents are adequately supported to take risks as part of an independent lifestyle, but there is no assessment record for the use of wheelchair straps. EVIDENCE: There are support plans in place for each resident. These include good details of each residents needs and goals. The support plans clearly guide staff as to how to support each person with their long-term needs, such as communication, activities and health. Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 12 There is also a monthly summary that reports a general overview of a resident’s well-being, activities and behaviour. However there is no record of residents’ own expressed short-term goals. For example, this year some residents had chosen to go abroad on holiday. Staff had helped them to get passports and to book travel tickets. Staff also talked about how they were going to support one person to arrange a special party for their 40th birthday. Again there was no evidence to demonstrate these goals, and the support given, in their care plan. The care plans have some information in pictorial form to help residents understand their own records. There is also a note at the front of each persons files that states whether or not they are able to be involved in their own care plans. Staff described how residents have the opportunity to be involved with their care plans, but said most people cannot tolerate sitting with staff and records for long. Residents have some daily opportunities to make their own decisions and choices, such as what to wear, what meals they would like and where to spend time in the home. However the severity of their disabilities means that they may find it difficult to express choices. A picture board has started to be used for one resident to help his understanding of the structure of his day. However, there is little pictorial and photographic information to help other residents make their choices. The Expert by Experience said pictures and symbols could be used more to support residents to have more choice and control over their lives. This could include pictorial menu choices and activity choices. Residents would greatly benefit from accessing advocacy services. This would help ensure that they have the greatest choice and control over their lives. Residents have occasional meetings where they are encouraged to be involved in group decisions. However these meetings are not recorded so it is not demonstrated whether they participated, whether any suggestions or decisions were made, and whether these were acted on. There are risk assessments in place for activities that may involve an element of manageable risk. For example one person enjoys horse riding, and one person enjoys helping in the kitchen. There are guidelines about how any risk can be minimised. Two people use wheelchairs when they are out of the home because of their poor mobility. Staff stated that wheelchair straps are used to protect them from falling from the wheelchairs. However there are no risk assessments to show the justification for using the straps. Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 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): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents have good opportunities for activities, if they choose to participate. Residents have good access to the local community and are well supported to maintain contact with families. Residents rights are respected, and their responsibilities promoted. Residents are offered a balanced menu that suits their lifestyle and dietary needs, but do not have information about menus for them to be able to make informed choices. EVIDENCE: Two people have structured daytime occupations outside the home, as they attend a day centre 3 days a week. Two other people have at least one regular activity a week, such as horse riding or trampolining, as well as community activities such as shopping. The remaining 2 people dislike crowds or busy places and tend to have fewer activities. Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 14 Some people have been supported to try new experiences such as swimming and holidays abroad. One relative stated, “The staff team enable (my relative) to access more activities and gain confidence. “ Most activities are provided in the local community. All staff support residents with activities and the home also has an ‘enabler’ staff who has specific role in helping people to access activities, both outside and within the home. The home has an activities budget in order to fund many of the daytime activities. For those that enjoy activities and outings there are lots of chances to go on trips out. The Expert by Experience said there could be a wider variety of activities in lounge areas that residents can enjoy. The possibility of using information technology to broaden choice for residents could be looked into. This could include using IT to support people to communicate and also to provide activities for residents. The people who live here are supported to use local community facilities such as shops, pubs and local transport. All the residents are registered with the local GP practice. The bungalow is sited in a modern estate in a former mining village. In this way, residents are part of the local community. Four people have some contact with relatives, and the home supports this either by telephone or by helping them to visit relatives. The 4 relatives who completed comment cards indicated that they were satisfied with the service provided at Tavistock Square. One relative stated, “His independence and choices are promoted at all times, where the staff team enable him to access more activities and gain more confidence.” Residents right to lead their own lifestyle is respected. One person prefers his own company and expresses his choice, through behaviour, to spend much of his time in a quiet lounge. Staff support him to do this, whilst still offering alternative choices and activities. Residents are encouraged to be involved in daily domestic tasks, such as cleaning and laundry as part of an independent lifestyle. The people here tend to choose not to be involved in many household tasks, and this is accepted whilst they are still offered the opportunity. Residents can use their rooms when they wish for hobbies or private time. All bedroom doors are lockable from the inside so residents can choose to be private. Staff now support people to keep their bedroom doors closed when they are out of the home. The home has fairly structured menus, which are designed from staffs’ knowledge of residents’ known likes and dislikes. Some residents are involved in grocery shopping so those people do have the opportunity to see different Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 15 products and meal choices. There is no set alternative dish at mealtimes for residents to choose from. If residents show that they do not like the main meal then they are offered an alternative. One resident did express her choice in this way. Most residents can make their own choices when dining out at a café or for a bar meal. However in the home there is no demonstration of how their choices are sought. The Expert by Experience stated that pictures and symbols could be used more to support residents to have more choice, including pictorial menus. The home has 2 small dining rooms in either side of the kitchen. Both dining rooms offer a comfortable, pleasant environment for residents to dine in. Residents seem to enjoy their meals. None of the residents are involved in preparing meals due to the severity of their disability or because of their behaviour when in the kitchen (and there are risk assessment about this). Two people do have some supervised support to be involved in making drinks of tea or juice. Does food reflect culture of the residents / do they have opportunity to experience other cultures diet. Tavistock Square (17) DS0000015736.V313495.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 and 20. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service Residents receive appropriate support with personal care needs. Residents’ health care needs are well met. Residents’ medication is generally managed well, but is not always given as directed on the prescription. So what? EVIDENCE: All of the people who live here need some support with personal care to varying degrees. One person has a severe physical disability and needs full physical support of staff. The home provides suitable equipment for this and there is a comprehensive moving & assisting plan for staff to follow. Other residents need support with bathing or dressing, and prompts for personal grooming. All support is carried out in the privacy of a residents own bedrooms or bathrooms. There is a good mix of gender amongst the staff team so that there is always both male and female staff on duty throughout 24 hours to ensure the correct support is available to each resident. Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 17 The home ensure that residents have good access to all community and specialist health care services, whenever necessary. For example, all residents are registered with local GP practices, and one person has visits from a District Nurse. Two people have psychiatrist input, one person has physiotherapy services, and others have input from Learning Disability Nursing services. None of the people who live here have been assessed as able to manage their own medication. Medication is managed by the home using a standard monitored dosage system. This means most medication is delivered to the home in blister packs. Medication is administered by the member of staff allocated to sleep-in duty each day. Most staff have training in Safe Handling of Medication, except two staff. The storage and administration of medication is appropriate. However, medication records indicated that 2 medicines were not being given in the way that these were prescribed. Fore example, eyedrops for one resident were only being given twice a day, not 3 times as prescribed. Another resident had been prescribed an anti-anxiety medication 4 times a day, but staff had written on the record that this was to be administered only ‘as and when required’. In this way medication was not been given as it was prescribed. Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 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 and 23. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home provides information about how to make a complaint, and residents’ expressed dissatisfaction is acted upon. Residents will be better protected by staff retraining in safeguarding adults. Residents have full support to manage their monies safely. EVIDENCE: The Trust has a booklet, Tell Us, for people who use its services. This describes the complaints procedure in easy language for people with a learning disability. Due to their communication needs, most of the people who live here use gestures, noises and behaviourisms to show their dissatisfaction. Staff have built up a very good understanding of different residents likes, dislikes and communication needs. In this way they are able to recognise if a resident is unhappy with a situation. Staff were able to describe such occasions, and how they would support a resident is they showed displeasure or dissatisfaction with a situation. There have been no recorded complaints since the last inspection. All staff have had training in the City of Sunderland MAPPVA (Multi Agency Panel for the Protection of Vulnerable Adults) procedures, as well as the Trust’s own procedures so should know how to report suspected abuse. Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 19 Following an unnecessary delay in the reporting of suspected bad practice last year, all staff have now been re-instructed during team briefings in their duties of care in this area. Also all staff will receive refresher training in safeguarding adult procedures, so they will be clear about how to protect residents from abuse. At this time the home does not carry out physical interventions. However the changing needs of a resident has indicated that this may be a necessary support for that person in the future. Staff have commenced training in this area. The Manager is very clear that no such support would be used prior to all staff being trained and until there are specific guidelines in place. The people who live here are entitled to a number of disability allowances that support their active lifestyles. All their allowances are directly debited into their own individual banks accounts. Their contribution to the weekly residential fee is then directly debited to the Trust. Due to their disabilities, the residents have little or no understanding of the value or concept of money, so this is securely stored for them. All records relating to residents finances are in good order, and include receipts for any transactions made by them or on their behalf. In this way residents’ monies are safely managed on their behalf. Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 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 and 30. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents live in a homely, comfortable and safe environment, but one room is not warm enough for use by the people who live here. The home is clean and hygienic. EVIDENCE: There have been significant and much-needed improvements to the quality of decoration and furnishings within the home over the past couple of years, and the home now offers a good standard of accommodation for the people who live here. Overall, the home is modern, bright, well furnished, contemporary and cheerful. Since the last inspection both bathrooms have been redecorated. Two residents’ bedrooms have also been redecorated and residents were supported to be as fully involved in choosing their own colour scheme as their communication needs allow. Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 21 Most areas of the bungalow are well maintained. However the activities room that leads onto the back garden is very cold, despite a radiator. One resident enjoys spending time listening to music in this room, but it is a very cold room and so staff try to encourage this person to spend time in her own bedroom which is warm. However the lack of suitable heating in the activities room does not support residents in exercising their choice to use this area of their home. Staff are responsible for housekeeping and some residents are encouraged to be involved in cleaning their own bedrooms, is they choose to. All areas of the home that were viewed were clean. All staff have had training in Infection Control. Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 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, 34 and 36. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service There are sufficient staff to meet the needs of the people who live here. The Trusts robust recruitment practices makes sure that only suitable staff work at this home. Residents are supported by well-trained staff. EVIDENCE: The minimum staffing provided at Tavistock Square is 3 support staff on duty from 8am-8pm, and 2 night–time staff (one of whom is on waking duty). However staff are flexible and will provide extra time to help residents go to special events, such as evening parties and concerts. There is also a full-time Enabler on duty for 5 days per week so there are more opportunities for residents to have 1:1 support with their individually preferred activities. The Trust operates robust recruitment and selection procedures that includes all necessary checks and clearances, to make sure that only suitable staff are Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 23 employed. There have been no ‘new’ staff employed at this home over the past year, although a couple of staff have transferred here from other similar homes operated by the Trust. This continuity of the staff team has helped staff and residents to build up good levels of communication, and allowed staff to learn about the different needs of the people who live here. Are there any policies procedures that reflect a commitment to equality legislation and equality of opportunity for staff? Have procedures been impact assessed to meet equality legislation. Bullying and harrassment/ whistle-blowing? Relatives comments card indicated that relatives feel that there are always sufficient staff on duty to support the people who live here. One relative said, “The staff team strive to give (my relative) an excellent quality of life. Very good staff team and keyworker.” Staff stated that they have “good” opportunities for training. There is an individual learning plan for each member of staff that identifies any training that they need. The home also has a record of all training courses already attended by each staff. The home uses a number of different training agencies, including Trusts own training department and local colleges. From discussions with staff it is clear that the Trust is committed to staff training so that residents receive support from a well-trained, competent staff group. Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents live in a well-managed home. The views of residents are not currently sought to review and develop their home. The health and safety of residents are promoted and protected by the homes practices. EVIDENCE: The registered Manager has many years experience in health and social care settings for people with a learning disability. She is suitably qualified in health and social care, and in management. It is clear from previous inspections that the quality of the service at this home has significantly improved since she became the Manager a few years ago. There are clear lines of responsibility within the home and within the Trust. Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 25 The Trust has a quality assurance system (Total Quality Management) to monitor and review the services it provides, including the home at Tavistock Square. The Trust wants to include residents views in reviewing the home, so has designed a questionnaire that uses pictures and easy language to support the communication needs of the people who live here. However, the questionnaires have not yet been used. The Manager stated that residents would not be able to complete them without support. Relatives and independent advocates have not been requested to help residents to complete the questionnaires. In this way residents views have not been formally sought in order to review the service. There are house meetings but due to their disabilities residents find it difficult to take part in these, and no minutes are kept. Staff receive mandatory training in health & safety matters on an annual basis through the Trust. Staff carry out sleep-in duties overnight and in-house fire instruction is carried out and recorded every 3 months. There were no health and safety issues noted at this time of this visit. Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 2 X X 3 X Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 27 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 12(2) Requirement There must be independent advocacy or representation (for those residents without relatives) for support when drawing up agreements. (Previous timescale 01/02/06 not met.) Increased communication aids, including pictures and photographs, must be available to support residents to make their own informed choices. Risk assessments must be in place to demonstrate the reasons for the use of wheelchair straps. Medication must be given as it has been prescribed. Changes to directions must be recorded by the prescriber. The activities room must be made sufficiently warm to be comfortable for use by the people who live here. Timescale for action 01/02/07 2. YA7 12(3) 01/04/07 3. YA9 13(7) 01/02/07 4. YA20 13(3) 01/02/07 5. YA24 23(2) 01/02/07 Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA6 YA7 YA17 YA39 Good Practice Recommendations Consideration could be given to recording each residents’ own short-term goals, the support given to meet them and the outcomes. Consideration should be given to recording suggestions and decision made at Residents’ Meetings and any actions taken to support those decisions. Menu choices should be available to residents in pictorial or photographic forms so that they can make informed choices. Residents should be supported by relatives or independent advocates to complete the Trusts questionnaires that are intended to review the service. Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South of Tyne Area Office St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Tavistock Square (17) DS0000015736.V313495.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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