Inspection on 17/01/08 for The Byre

This inspection was carried out on 17th January 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Byre 30/03/10

The Byre 17/11/09

The Byre 10/12/08

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Byre Allaston Court Farm Lydney Gloucester GL15 5SR Lead Inspector Mr Richard Leech Key Announced Inspection 17th January 2008 10:30 – 19:10 The Byre DS0000070109.V354803.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 The Byre DS0000070109.V354803.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. The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Byre Address Allaston Court Farm Lydney Gloucester GL15 5SR 01594 844244 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) Footsteps Medical Care Limited Miss Joanne Elizabeth Hook Care Home 4 Category(ies) of Learning disability (4) registration, with number of places The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who may be accommodated is 4. N/A Date of last inspection Brief Description of the Service: The Byre was registered in July 2007 as a new service for adults with a learning disability. It is located in a residential area on the outskirts of Lydney. The property is a bungalow which has been fully redeveloped in order to meet the relevant National Minimum Standards. All bedrooms have en-suite facilities. There is also a spacious shared bathroom with adaptations, a lounge and a kitchen-dining area. Prospective residents and their representatives are provided with information about the home including the Service Users Guide. Fees levels were reported to range from £1385 to £1864 per week, but are negotiated on an individual basis. The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A couple of days’ notice was given for the inspection, in order to check whether anybody had yet moved in and to ensure that the manager would be available. The visit took place on a Thursday from mid-morning to early evening. The manager and deputy manager were present, and another staff member was also spoken with. Both of the people who had moved into the home were met with during the visit. All of the rooms were checked during the visit. Various records were also looked at including care plans, risk assessments, healthcare notes, medication charts, staffing files and training information. Some external feedback was obtained from people with an interest in the home. What the service does well: There is a good approach to admissions. This helps to ensure that The Byre will be able to meet the needs of people who move in. People are being offered choices. There is recognition of how people communicate non-verbally and of how staff need to respond. The people living at The Byre are supported to lead lifestyles which reflect their needs and interests. This is at an early stage, but the team is making great efforts to get to know people and what help they need and want. This includes meeting people’s individual needs and preferences around eating and drinking. People are also being helped to stay in close contact with family and friends. People’s personal care needs are being met in a sensitive way. Information is being gathered about how to meet people’s healthcare needs. This includes liaising with the local Community Learning Disability Team. Arrangements for supporting people to complain are being put in place. Steps are also taken which help to protect people from harm and abuse. The building is spacious and has been completely refurbished. People have single rooms with en-suite facilities. They can also personalise their rooms. Aids and adaptations are provided as necessary. The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 6 Support is provided by caring and skilled staff. This is underpinned by a good training programme. Plans for more training should help to further develop best practice in the home. A family member said that the team had been ‘wonderful’ and ‘marvellous’ so far in the support they were providing for their relative. They described the staff as ‘very kind’. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough approach to admissions helps to ensure that the service will be able to meet the needs of people who move in. EVIDENCE: The service’s Statement of Purpose and Service Users Guide were briefly looked at. These provided information about the service and include an outline of fees and what these cover. The manager said that work was taking place to make the Service Users Guide more accessible, including possibly creating an audio format. The Statement of Purpose provided a summary of the admissions process. This included reference to conducting assessments, gathering background material, offering visits and overnight stays and to a trial period. There was mention of the possibility of emergency admission. The service also has a general admissions policy. The manager described the two admissions to date. The first had taken place in December 2007. The manager talked through the referral and assessment process. This had been conducted under significant time pressure due to particular circumstances. As a consequence there had been no overnight stay. A visit had been planned but the manager said that this had not been possible The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 9 due to staffing issues in the establishment where the person had been living at the time. Instead, the manager made a further visit to meet the person. Assessment and background information was seen, including material from the placing authority and by the manager of The Byre. This was detailed, providing a good overview of the person’s needs. The manager said that as well as meeting family members and staff caring for the person at the time, she had also met with members of the Community Learning Disability Team in advance of the admission. In addition, she had made a visit to meet the person and staff at a day centre. It was accepted that this verged on being an emergency admission for reasons beyond the service’s control, but that as much had been done as possible to ensure that The Byre would be able to meet the person’s needs. The manager said that usually there would be visits and overnight stays. It was reported that the manager and deputy both had previously worked with the person (as well as the second person who moved in) and therefore had some prior knowledge of their support needs. Some assessment material by The Byre was undated and had no author. This information should always be included on documents. Appropriate assessment and background material was seen in relation to the second admission. Some further information was still being gathered, the admission having only taken place a few days earlier. The manager confirmed that she and other staff had made visits to the person to meet them and conduct assessments. The manager said that there had been a visit and an overnight stay. Staff confirmed this. Positive feedback was obtained from family members about the admissions process. The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 10 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 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further work on developing people’s person-centred care plans should help to ensure that, in due course, people’s needs, goals and wishes are comprehensively identified and met as fully as possible. There is an ethos of offering choice and of recognising non-verbal communication, helping to empower the people living in the home. Caution will need to be exercised to ensure that the least restrictive option is adopted to keep people safe where hazards have been identified, in order that their rights are not unnecessarily infringed. A sound framework for risk assessment and management is being developed, although there is scope for this to improve in order to further safeguard people using the service. The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 11 EVIDENCE: Care plans for both of the people living in the home were looked at, although they were at a very early stage. The plans consisted of a person-centred format covering areas such as mobility, eating & drinking, likes, relationships, activities and personal care. Photographs were not yet on file but the manager reported that they would soon be getting a camera. The plans provided much important information about people’s needs and preferences and how these would be met. There were detailed descriptions of some areas such as mobility. Much information was still being gathered, with a view to fleshing-out the plans and ensuring that they were sufficiently wideranging and in-depth. In some cases more information was needed about how identified needs were to be met, such as keeping in touch with family. A keyworker system was in place in the home. There were plans for weekly keyworker sessions involving the people living in the home. The keyworker role was reported to include care planning and review, overseeing healthcare needs, personal shopping and developing activities programmes. Many documents were without a date and author (see recommendation made under Standard 2). The manager and staff described how people made choices, giving examples and demonstrating good knowledge of non-verbal communication. There was some information in care plans about communication although this remained work in progress. People living in the home were seen to be offered choices where possible during the visit. A risk assessment had been written up about one person’s access to the kitchen being supervised. The outcome was that the kitchen was locked only when it was not possible to provide supervision due, for example, to attending to other people’s care needs. This was accepted provided that the restriction is kept to a minimum. The manager was aware of the principle of ‘least restrictive alternative’. There was a discussion about the Mental Capacity Act. The manager had some information about this. The manager was considering restricting one person’s access to their en-suite. This was discussed, along with possibilities for less restrictive options. Risk assessments for both of the people living at the home were looked at although, again, these were necessarily at an early stage. The format was clear, with the risk identified and the action taken to reduce this. Much of the guidance was detailed and gave a good description of what staff needed to do. The following observations were made: The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 12 • • • Some of the assessments needed more information about precisely how the identified risk was to be managed. For example, one assessment stated ‘staff to assist [service user] with feeding, especially when…tired’ without defining what assistance was required. Although many of the assessments stated what response there should be if, despite the control measures, the risk actually presented some of them did not. It is useful to include this information so that staff have clear guidance, for example in relation to a fall or a choking incident in the context of the individual needs and conditions of the person. It was agreed that it would be useful to give some indication of the likelihood of the risk, for example, based on history. The Byre DS0000070109.V354803.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Efforts are being made to develop appropriate and individualised activity programmes for people which should help to promote their quality of life. People are being supported to maintain contact with family. There is awareness of people’s rights, helping them to feel valued and respected. A balanced diet which responds to people’s needs and preferences is provided, promoting their wellbeing. EVIDENCE: Daily notes and activity records for one person who had moved in before Christmas were looked at. Activities noted were generally within the home, for example, listening to music or using the sensory room. They were also attending a day centre several times per week. They had attended this centre The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 14 before moving to the home and it therefore represented some continuity. The manager described some trips out too, for example to a local waterfront. Discussion with the manager and staff provided evidence that considerable thought was going into developing a suitable programme to reflect the person’s needs and interests. Although this was proving challenging, it was clear that the team had a number of ideas which they were going to try. There had been discussion with the person’s family in order to gain more an insight into what the person enjoyed. An activity programme was being developed for the person who had just moved to the home. This included swimming, hydrotherapy, accessing a sensory facility, going horse riding, attending a social club and having sessions at a local art project. Discussion with the manager and staff provided evidence that the team had already developed a good knowledge of the person’s interests and that a programme was being quickly put together. A relative reported that they were pleased with the activity programme being developed so far for their family member. On the basis of the above Standards 12 and 13 are assessed as met. As with all services, actual practice will be revisited during future inspections. The manager said that the home had one vehicle; a minibus which could accommodate wheelchairs. However, there were plans to also obtain a car. Daily records and other notes along with direct feedback from relatives provided evidence of very good liaison taking place with family members. For example, they were being asked to contribute to the assessment process. There was also evidence of the people living in the home being supported to have regular contact with family members, and of general communication from the home being good. Attendance at familiar day centres and social events was providing people with opportunities to stay in contact with friends and acquaintances. One person was seen moving freely around the home, with staff supporting them to be in whichever area they chose. Another person needed assistance to move between rooms. Staff described the indications that the person may wish to change location and talked through how they responded. Discussion with the manager and staff provided evidence of awareness of people’s rights. Policies and other documents such as the Statement of Purpose made reference to the rights of the people living in the home. Sample menus were seen, providing evidence of a varied and balanced diet being provided. These had been forwarded to a dietician working in the field of learning disability for comment. This is good practice. The manager and staff had awareness of people’s dietary needs and preferences, and confirmed that The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 15 alternatives to what was on the menu would be provided. Food records were being kept (although it was agreed that the template should be changed to allow more space). Care plans and risk assessments provided important information about people’s needs around eating and drinking. The Byre DS0000070109.V354803.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are being supported with their personal care needs, promoting their dignity and wellbeing. Arrangements are being made to identify and meet people’s healthcare needs, although this was at an early stage. A satisfactory framework for handling medication is developing, helping to keep people safe and well. EVIDENCE: Care plans provided information about how people’s personal care needs were met. There were also monitoring charts where personal care interventions were recorded. These provided evidence of care plans being followed. In conversation staff demonstrated awareness of the importance of promoting people’s choice, privacy and dignity in personal care, giving examples of how this was done. During the visit people were seen being supported in a discreet and sensitive manner with their personal care needs. Discussion and records showed that the service had already liaised with the Community Learning Disability Team about the care needs of both people The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 17 living in the home. Other healthcare records were at an early stage, with information about routine and specialist healthcare needs still being gathered. For example, it was not yet known whether one person with an eye condition was seen by an optician or a more specialist practitioner. It was suggested that health action planning formats be looked into and implemented. People’s baseline weights had not yet been taken. These were due to be checked in the week following the visit. Some healthcare notes were undated (see recommendation earlier in report). There was documentary evidence of a GP being promptly called when one person had appeared unwell. Other records were seen for staff calling a doctor to seek authorisation for additional ‘as-required’ medication being administered. However, the documentation did not record the doctor’s response/advice. The service has policies covering general aspects of the handling of medication, as well as issues such as self-medication. Reference books about medication were available in the home. Protocols were seen for ‘as required’ medication. Those checked were signed and dated and gave clear information. Storage arrangements appeared to be satisfactory. Medication administration records were sampled. Two staff were initialling for each administration as a double check. The following was noted: • • • The allergy section of the record was not complete. This should be done, even if to record ‘none known’. There were no photographs on the records (the manager said that a camera was being obtained). Times for PRN (as-required) administration were cramped and hard to read. The manager was considering recording this elsewhere. It was also agreed that staff should use either the 24-hour clock or the ‘am/pm’ notation in order that there is no ambiguity about the time of administration. Some entries for PRN stated that staff should refer to the protocol, but it was suggested that the entry on the chart should still contain standard information such as maximum dose in a given period. • The manager and deputy had been undertaking all administration. However, it was stated that all staff would be put through medication training and would then begin to administer. It is standard practice that CSCI’s pharmacist inspector conducts an inspection of medication systems in new services and this may be arranged in due course. It was also suggested that the manager ask the supplying pharmacy whether they offered an audit and advice service. The Byre DS0000070109.V354803.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in operation for handling concerns and complaints, which should help to ensure that people feel listened to if they are unhappy or dissatisfied. There are also systems in place and being developed which will help to safeguard people from harm and abuse. EVIDENCE: The complaints procedure was seen, including timescales, stages of the complaint and reference to CSCI. The manager said that a more accessible version would be produced. This should be done as early as possible. A protocol was seen giving staff guidance about indicators of unhappiness for one person and how to respond. Staff spoken with were able to describe this guidance including non-verbal signs of possible unhappiness or discomfort. The protocol was undated (see earlier recommendation). The manager said that there had been no formal complaints. She described what she would do if a formal complaint were made. This included setting up a complaints log, investigating, drawing conclusions, initiating necessary actions and responding to the complainant. The manager confirmed that the process would be fully documented. Family members confirmed that they would feel able to raise any concerns and complaints, and were confident that they would get a positive response. The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 19 The home has (off the shelf) policies which cover adult protection and whistle blowing, although the former had not been fully adapted to the setting as it required contact details of different agencies to be added. Charts were seen documenting incidents of unsettled behaviour. These were cross-referenced to ‘as-required’ medication protocols. Staff described how they responded in the event of agitated and unsettled behaviour. The manager and staff confirmed that restrictive physical intervention was not used in the home. Records for people’s finances were looked at. The manager said that finances were checked by two people each shift. Records seen provided evidence for this. There was a discussion with the manager about people’s personal expenses allowance and of the need to ensure that people received this as a minimum. It was agreed that the financial records would benefit from a clearer format for recording of money in and out. A house loyalty card for a shop was in use. There was a discussion about how the manager would ensure that distribution of any resulting benefits was entirely fair. Staff spoken with were clear about their responsibilities to report any concerns about practice. The manager confirmed that all staff would be attending training about adult protection. This should be arranged as soon as possible. The Byre DS0000070109.V354803.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clean, homely and adapted environment is provided which meets of the needs of the people living in the home, promoting their comfort and wellbeing. EVIDENCE: The property is a bungalow that has been largely rebuilt and designed to meet the needs of people with a learning disability and associated conditions. The environment was seen to be clean and well decorated throughout. Aids and adaptations were provided in accordance with people’s needs. Staff reported that these were in good working order and that the building was suitable for the needs of the people living there. Bedrooms were pleasant and had begun to be personalised to some extent. The manager confirmed that people were free to personalise their rooms in accordance with their tastes, including having the room repainted if they wished. The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 21 There is a garden for people to use. The property has attractive views over the surrounding countryside. The manager said that in the future a Jacuzzi/hot tub and summerhouse would be installed in the grounds. There was a discussion with the manager about whether the lounge lighting was bright enough. There were plans to address this, initially by changing the light shades. A policy was seen about infection control. The manager and staff described arrangements for cleaning the property and disposing of clinical waste. It was confirmed that personal protective equipment was available. Some external feedback was received about the environment being ‘lovely’. A relative commented on the beautiful setting that the home was in. The Byre DS0000070109.V354803.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Support is provided by competent and skilled staff, enhancing the quality of care. This is underpinned by the home’s training programme. Plans for further training should help to promote best practice. Shortfalls in recruitment procedures could place people at some risk. EVIDENCE: As noted, the manager and deputy had previously worked with the two people living in the home. They therefore had good knowledge of their needs and conditions. They had been ensuring that one of them was always on shift with other staff in order to pass on their knowledge. Staff spoken with were able to demonstrate good knowledge of people’s support needs and care plans. Some staff were heard saying ‘good boy’ or ‘good girl’ to people living in the home. This should be avoided as it could be interpreted as demeaning. The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 23 Information was available in the office about particular conditions such as autism and epilepsy. There were also files covering different aspects of health and safety and relevant law. The manager said that all staff were given copies of the General Social Care Code of practice, although one person spoken with said that they did not have one. The manager reported that three staff out of five (excluding herself) had attained a relevant NVQ, with remaining staff being booked onto programmes. The manager described the recruitment and selection programme. Some staffing files were selected. The following was noted: • Full employment histories were not always provided by candidates. It was suggested that the application form be altered to make it clearer what level of detail people needed to provide. Gaps in people’s employment history will need to be chased up. In many cases references were not on headed paper and/or were personal rather than professional. While this is acceptable in certain circumstances, examples were found where the person’s most recent social care employer of three months or more had not been asked for a reference. One ‘to whom it may concern’ reference had been accepted. Generic references should be avoided. The manager said that references were followed up by a phone call. These calls should be logged on the person’s staffing file. One file had no evidence of a CRB or PoVA-first check having been returned. The manager said that the email of the PoVA-first check would be on the computer but it was not possible to access this at the time. No risk assessments were seen in relation to people who had started on the basis of a PoVA-First check pending return of their full CRB. • • • • • Records and discussion with staff provided evidence that people were generally up to date with core training or that this was booked. The manager described plans for staff to access additional training related to the needs of the people living in the home. This included areas such as medication, adult protection, autism, diabetes, epilepsy and communication/signing. It was also suggested that staff have input about the Mental Capacity Act 2005 and that staff who would be supervising other workers should access training about this. Documentary evidence had been obtained of qualifications obtained by staff in previous employment. Many staff had undertaken highly relevant training in the recent past. The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 24 An induction checklist was seen. The manager said that staff were also accessing the Learning Disability Qualification (LDQ) where necessary and that this would be completed before people began their NVQ courses. Other documentation seen during the visits included handover sheets and a list of dates for monthly staff meetings. A family member was very positive about the team, describing the staff as ‘very kind’ and saying that they were ‘wonderful’. The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is gaining relevant qualifications and developing more experience, which should lay the foundations for a well run home with positive outcomes for people using the service. Plans for checking the quality of the service will need to be implemented in order that people’s satisfaction is monitored and improvements made where necessary. Arrangements are in place which promote the health and safety of people living and working in the home. EVIDENCE: The manager was registered along with the service in July 2007. She had approximately 10 years’ experience working with people with learning The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 26 disabilities, although this is her first post as manager. She was beginning the Registered Manager’s Award and expecting to complete this is September 2008. This will be followed by NVQ level 4 in Health and Social Care. The manager is supported by a deputy, who will undertake some management functions including conducting supervision meetings. The registration process and the Statement of Purpose provided evidence that the manager had undertaken a wide range of relevant courses such as about epilepsy, diabetes and safe handling of medication. The service had files of policies and procedures. However, these were ‘off the shelf’ and in some cases needed to be adapted to the service. For example, the adult protection policy did not list local agencies. The referral and admissions policy noted that service users should have experienced a diagnosed serious mental health problem. Although the service had considerable information about different conditions, practices and legislation, it was suggested that various other documents be obtained for reference. These included ‘Valuing People’, the Department of Health guidance on restrictive physical intervention and Royal Pharmaceutical Society (RPS) guidance on medication in care homes. As noted, some shortfalls were found with recruitment and selection procedures. Arrangements for checking and improving the quality of the service were discussed. The manager reported that there had been no formal visits made under Regulation 26 and agreed to discuss this with the Responsible Individual. There were plans for developing questionnaires for the people living in the home and for their relatives. The manager said that there would also be a monthly questionnaire for staff. The findings from these surveys would translate into an action plan. In addition residents’ meetings would be considered, with keyworkers advocating for people if necessary. The manager said that regular one to one meetings between keyworkers and the people they supported would also be a potential source of feedback about how satisfied people were with the service. The manager also said that she would be conducting periodic audits covering areas such as medication, menus and cleaning. Health and safety arrangements in the home were discussed. The manager described plans for routine checks and servicing. Equipment and wiring was new, the bungalow having been largely rebuilt. The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 27 Records were seen providing evidence of routine checks on fire safety equipment. The manager reported that there would be a fire safety inspection on January 23rd 2008. A fire risk assessment had been written though this was not checked in detail. Some generic risk assessments relating to the environment were seen. Water temperatures were being checked weekly. Some were running at around 45°c and it was suggested that the system be adjusted to bring these down to around 43°c. A report dated January 2008 was seen about a bacteriological check on the water. Freezer temperatures were looked at. The appliance seemed to running at too high a temperature. The manager agreed to look into this and established that there was some confusion about whether these were measured in centigrade or fahrenheit. This should be monitored. The Byre DS0000070109.V354803.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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 1 35 2 36 x 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 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 x 2 x x 3 x The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? N/A 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 YA34 Regulation 12 (1) 19. Sch. 2. (2), (3) & (6) Requirement Ensure that there is a full employment history for all staff, together with a satisfactory written explanation of any gaps in employment. Where a person’s last position of three months or more involved contact with children or vulnerable adults a reference needs to be sought in relation to this period of employment. Staffing files must include evidence of a CRB check having been undertaken or, in exceptional circumstances, a PoVA-First check pending return of the full CRB. In cases where staff being work on a PoVA-First basis there must be an appropriate risk assessment including describing the reason for recruitment on this basis, any interim limitations to their role and arrangements for supervision of their work. 2 The Byre Timescale for action 31/03/08 YA39 26 Unannounced visits by an DS0000070109.V354803.R01.S.doc 29/02/08 Version 5.2 Page 30 appropriate person as defined by Regulation 26 must take place at least once a month. A report on the conduct of the home needs to be written and a copy supplied to the manager and CSCI. 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 YA1 YA2 YA6 YA19 Good Practice Recommendations Take forward plans for the Service Users Guide to be available in different formats to make it more accessible. Ensure all documents include the date and author. Continue to develop care plans, ensuring as far as possible that these describe in sufficient detail how all aspects of people’s identified needs, goals and wishes are to be met. Research health action planning and implement a suitable HAP format in the home as part of supporting people to maintain optimal health. Record people’s weights on admission as soon as possible and regularly thereafter as part of general healthcare monitoring. Ensure that healthcare records provide full information (see example in text about phone calls to doctors seeking authorisation for administering extra ‘as-required’ medication). Note points in text about medication. Move forward with making the complaints procedure more accessible. Add contact details (and if necessary roles) of relevant agencies to the adult protection policy, such as the Gloucestershire Adults at Risk team. The format for financial records should be changed so that the flow of money in and out is clearer. The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 31 5 6 7 YA20 YA22 YA23 8 YA32 Training about adult protection should be arranged as soon as possible for all staff who have not had this input. Ensure that all staff are given copies of the General Social Care Council’s Code of practice. Avoid phrases such as ‘good boy/girl’ when addressing people living in the home. The application form could be altered to make it clearer what level of detail people need to provide about their employment history. Aim for references to be on headed paper where possible. Where not possible document this on the form. Ensure that all telephone contact with referees is documented on the staffing file. 9 YA34 10 11 12 YA35 YA37 YA42 Avoid ‘generic’ (to whom it may concern) references. Move forward as soon as possible with plans for staff to access other training relevant to the needs and conditions of people living in the home and to their roles (see text). Policies and procedures should be adapted to the service where necessary as soon as possible. Hot water temperatures at outlets accessible to people living in the home should be no higher that 43°C, unless risk assessments demonstrate that people are not at significant risk of scalding. Continue to monitor that freezer temperatures are running within acceptable parameters. The Byre DS0000070109.V354803.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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. 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