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Inspection on 17/10/06 for The Close Short Break Service

Also see our care home review for The Close Short Break Service for more information

This inspection was carried out on 17th October 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 no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

This service provides accommodation to a very good standard. The way the daily routines are organised compares with that of a good quality hotel. The building is well maintained, and as a result of effective cleaning routines, offers a clean and hygienic environment. The grounds are attractive, with well cared for garden areas, where guests can relax and enjoy the surroundings. The friendly contact between guests and staff creates a warm and welcoming atmosphere in the home. So that guests are able to form and maintain relationships between each other, careful planning is carried out by the home so that friends receive breaks together. This is often at the request of guests, or as a result of an assessment carried out by staff, who try hard to create groups who get on well together. Observations showed that guests are supported to live a full and active lifestyle. Guests confirmed that staff supports them to go shopping, enjoy a drink at the pub, go bowling and go to the cinema. Staff were observed working with respect and skill and involved guests in making their own choices about what they preferred to do.

What has improved since the last inspection?

The home has been without a permanent manager since the previous manager retired in March this year. A new manager who is experienced and well qualified has now been employed to manage The Close.

What the care home could do better:

So that guests are given accurate information about The Close, the information in the Statement of Purpose and Service User Guide must be brought up to date to reflect the changes that have recently taken place. To avoid people being inappropriately placed at The Close, the guidance in relation to emergency admissions, must be reviewed, so that it is clear to everyone. In any emergency situation the staff at The Close must be informed of the immediate needs of the person to be admitted and the person in charge of The Close at the time, must be included in the decision on whether to admit. This is to ensure that there are enough staff with the appropriate competencies, to meet the needs of the prospective service user. It will also ensure that other guests and staff are not put at risk. Some of the guests who stay at The Close have special needs, for example one person is registered blind. So that staff have the skills to support all guests appropriately, they must receive training in relation to the disability. To ensure that guests who administer their own medication are appropriately supported and able to do it safely, guidelines should be in place in the care plan to identify how staff monitor and guide them. This service is currently developing a programme that supports young people with the transition process from children`s to adult services. If this is to involve young people 16 or 17 years old then staff must receive training in child protection and be aware of the supplementary standards in the Department of Health`s Care Homes for Younger Adults (16-17). This will equip staff with the appropriate knowledge and skills while at the same time support and protect young guests. The care planning system should be further developed so that guests are empowered to take the lead in the development of their individual care plans. This will mean that guests will lead staff to support them in their preferred way.Steps must be taken to reduce any risk that may restrict a guest from taking part in a chosen activity or prevent them from developing their independence further.

CARE HOME ADULTS 18-65 The Close Short Break Service Rock Lodge Road Roker Sunderland SR6 9NX Lead Inspector Mrs Elsie Allnutt Key Unannounced Inspection 17 and 19th October 2006 10:00 th The Close Short Break Service DS0000032753.V313502.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 Close Short Break Service DS0000032753.V313502.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 Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Close Short Break Service Address Rock Lodge Road Roker Sunderland SR6 9NX 0191 553 5425 0191 553 5430 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) Council of City of Sunderland Care Home 12 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (3) of places The Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th December 2005 Brief Description of the Service: This short break service operates in a large detached building, which stands in enclosed grounds. The service provides personal care for younger adults with a learning disability and is situated close to the sea front at Roker in Sunderland. The house has its own grounds with mature trees; lawns and well cared for gardens and retains many attractive original features such as wood panelling and fire- places. The décor and furnishings reflect the style and period of the building. There is a large reception area that leads onto a large staircase up to bedrooms on the first floor. It has eight single bedrooms, two of which are on the ground floor and which provide accommodation for people with disabilities. There are also two twin bedrooms offering accommodation to friends or family members who request to share. A music centre and TV is provided in each bedroom. The dining room and two lounges also lead off from the reception area and overlook the gardens. There is a main lounge that is very large, and a smaller one that offers a more quiet area. The building provides four bathrooms and eight toilets. Three of the bathrooms also have showers and there is also one separate shower room. The top floor of the building accommodates a full sized snooker table, dartboard, music centre, and a wide screened TV and coffee corner. The majority of people who use the service are quite independent and are able to access all areas of the building. However, people with a physical disability are restricted to using the ground floor. The aim of the service is to provide a holiday type break for people attending the service while providing a break for the carers at home. A team of staff provide a programme of organised activities, as well as personal support, during each person’s stay. The Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 5 The home has developed a Service User Guide that informs prospective guests about the service, the aims and how these are met. A copy of the recent inspection report is available in the home for anyone to read. The fees charged by the home to guests are £90 per week. The Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. As this is a respite service that offers a holiday type experience, people who use this service are referred to as guests rather than service users. This will be respected throughout this report. This unannounced but planned inspection took 9.5 hours over two days in October 2006. The manager was new to the service and had only been in post for 2 weeks. To support the new manager the assistant manager also assisted with the inspection. Two completed surveys were returned from guests’ carers prior to the inspection and both showed their satisfaction with the care. The views of 6 guests and 4 members of staff were also sought. As well as having conversations with the guests, their degree of satisfaction with the service was also interpreted through the observation of body language, interaction with staff and the examination of records. This showed that all guests using the service during the inspection were satisfied with the service and the care and support given by staff. As part of the inspection samples of guests’ care files and some of the homes records were examined. A tour of some parts of the building also took place. What the service does well: This service provides accommodation to a very good standard. The way the daily routines are organised compares with that of a good quality hotel. The building is well maintained, and as a result of effective cleaning routines, offers a clean and hygienic environment. The grounds are attractive, with well cared for garden areas, where guests can relax and enjoy the surroundings. The friendly contact between guests and staff creates a warm and welcoming atmosphere in the home. So that guests are able to form and maintain relationships between each other, careful planning is carried out by the home so that friends receive breaks together. This is often at the request of guests, or as a result of an assessment carried out by staff, who try hard to create groups who get on well together. Observations showed that guests are supported to live a full and active lifestyle. Guests confirmed that staff supports them to go shopping, enjoy a drink at the pub, go bowling and go to the cinema. Staff were observed working with respect and skill and involved guests in making their own choices about what they preferred to do. The Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: So that guests are given accurate information about The Close, the information in the Statement of Purpose and Service User Guide must be brought up to date to reflect the changes that have recently taken place. To avoid people being inappropriately placed at The Close, the guidance in relation to emergency admissions, must be reviewed, so that it is clear to everyone. In any emergency situation the staff at The Close must be informed of the immediate needs of the person to be admitted and the person in charge of The Close at the time, must be included in the decision on whether to admit. This is to ensure that there are enough staff with the appropriate competencies, to meet the needs of the prospective service user. It will also ensure that other guests and staff are not put at risk. Some of the guests who stay at The Close have special needs, for example one person is registered blind. So that staff have the skills to support all guests appropriately, they must receive training in relation to the disability. To ensure that guests who administer their own medication are appropriately supported and able to do it safely, guidelines should be in place in the care plan to identify how staff monitor and guide them. This service is currently developing a programme that supports young people with the transition process from children’s to adult services. If this is to involve young people 16 or 17 years old then staff must receive training in child protection and be aware of the supplementary standards in the Department of Health’s Care Homes for Younger Adults (16-17). This will equip staff with the appropriate knowledge and skills while at the same time support and protect young guests. The care planning system should be further developed so that guests are empowered to take the lead in the development of their individual care plans. This will mean that guests will lead staff to support them in their preferred way. The Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 8 Steps must be taken to reduce any risk that may restrict a guest from taking part in a chosen activity or prevent them from developing their independence further. 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 Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 9 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 Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Prospective guests are provided with information about the service and are invited to look around before making a decision to stay. This helps guests to make an informed choice about whether to use the service. However the Statement of Purpose and Service User Guide need to be brought up to date so the information is accurate and people are not mislead. The service generally carries out an appropriate pre admission assessment to ensure that they can meet the needs of guests planning to stay for a short break. However due to the absence of a clear protocol in relation to emergency admissions, the safety and needs of guests and staff have been put at risk. The Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 11 EVIDENCE: Due to the recent changes in the service, minor adjustments need to be made to the Statement of Purpose and Service User Guide, which the manager agreed to. A recent emergency admission to The Close was made without the person’s full needs being assessed and the needs of the people using the service at the time, being taken into consideration. This resulted in an inappropriate placement being made and consequently one service user was physically abused and other guests and staff put at risk. Furthermore the Emergency Admission Policy that is included in the Statement of Purpose is lacking in clarity. A sample of guests’ care files was examined. All included preadmission assessments from the appropriate referring agencies and evidence from The Close that they could meet the guests’ needs. Staff confirmed that guests are encouraged to visit The Close prior to using the service. The manager and staff discussed the work that is also being carried out by the service in relation to the transition process of young people from children’s to adult respite care services. An observed telephone conversation demonstrated the arrangements being made for such a visit to take place. The manager was reminded that if The Close is to offer a service to people under 18years old then it must be registered to do so. The service must apply for a variation of registration and the manager and staff must be aware of the Supplementary Standards for care homes accommodating young people aged 16 and 17 found at the back of the Department of Health’s Care Homes for Younger Adults (18-65) National Minimum Standards and Care Homes Regulations. One preadmission assessment and current care plan confirmed that one guest has a sight impairment and therefore has special needs in relation to this, however staff confirmed that they have not received training in relation to addressing these needs. This was discussed with the manager who agreed to address it. The Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 12 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): 6,7,9 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. Care plans are developed by the home using information gathered from the guest, their families and preadmission assessments. This means that staff are guided to effectively address guests’ individual needs. However guests could be further involved in developing their care plans. A variety of activities take place which promote service users independence but these this could be improved upon. EVIDENCE: Care plans are in place for all guests currently using this service. In discussion with the manager however it was evident that she has plans to develop the care plan system further by empowering guests to direct their own care. She stated that this is to be achieved by using a person centred approach. Of the care plans examined it is currently unclear how an individual’s goal is determined or whether it has been achieved. The Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 13 Although some of the guests’ preferences, likes and dislikes are recorded in the care plans, there is room for this sort of information to be expanded on further. This will enable staff to support guests with decision-making and achieving individual goals. The care plans do not always record guests’ changing needs. An incident that upset a guest and put them at risk, was recorded in the guest’s daily notes. Staff were able to discuss how they had given appropriate emotional support to the guest. However, there were no guidelines recorded in the care plan for staff to follow referring to the person’s changing emotional needs. A detailed risk assessment has been put in place relating to how the person should be protected and supported if another similar incident occurred. Although there are risk assessments in place and the above in particular is recorded in detail, generally they too could be developed further to cover all areas of guests’ limitations. Risk assessments must also be kept under regular review. Guests’ care plans are regularly reviewed to ensure needs continue to be met. Staff members also attend the reviews of other services which guests use. Recorded minutes of such meetings demonstrate shared ideas regarding the individual’s development and support needed. The Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Guests take part in a variety of community-based activities, however individual care plans do not always identify what people enjoy doing and the goals they have for a particular visit. This may result in guests’ aspirations and right to choice not being fully met. Important relationships are maintained and promoted with families and efforts made to develop friendships by accommodating friends to take breaks together at the request of guests. Service users are provided with wholesome food that is both nutritious and varied and supports them to live a healthy lifestyle. The Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 15 EVIDENCE: On arrival at The Close there was a pleasant busy atmosphere while guests were preparing for shopping trips out to 3 different venues. All were looking forward to the events and confirmed that they had been given a choice of venue. One guest said, “ I love coming here so I can go shopping.” Another said, “ I’m going to buy some music.” Staff were observed sensitively supporting guests to prepare for the event gently reminding them of what they might need. Guests were observed locking bedroom doors and hanging their keys in the key cupboard in the hallway. One guest showed their bus pass that they were to use on local transport. Three of the guests discussed plans to listen to the local football team playing a rival team on the radio that evening and one stated, “We’ve got our cans to drink while listening to it”. All guests commented that they enjoyed coming to The Close for short breaks and they usually decide what they want to do on their arrival. The guests could not confirm what they would be doing the following day, however records confirmed that local community facilities are used and these include visits to the local funfair, pubs, the bowling alley and the dog track. The manager demonstrated her enthusiasm towards the plans to develop person centred planning and felt that this will have positive outcomes in relation to identifying guests’ individual aspirations that will in turn assist in developing new experiences and further develop activity programmes. She also confirmed her aims to continue to develop the good relationships with family and carers that previously has been established in this service. A sample of menus confirmed a variety of food on offer and guests said that the meals offered were good. A member of the kitchen staff was observed offering guests a choice of an evening meal.. The Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Guests receive support from staff to ensure that their personal, physical and emotional health needs are met. Medication arrangements are appropriate for the needs of service users, and are managed in a safe way. EVIDENCE: Many of the people using this service are independent, however records demonstrate that, when needed, guests are supported appropriately with personal tasks. One guest said, “I look after myself,” but added that if assistance is needed, for example when I get a bath, a member of staff helps me.” Another guest discussed how their key worker gives support if they are worried about anything and commented that they liked having one particular member of staff to go to if needed. Several other guests were able to refer to their key workers and had a good understanding of their role. The Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 17 The home is not equipped with any special appliances apart from a bath seat in one of the bathrooms. For guests who cannot manage stairs there are two bedrooms and bathing facilities on the ground floor however neither are adapted or fitted with special facilities. The nature of the service does not generally include supporting service users with their healthcare needs, however staff stated that if a GP is needed during anyone’s stay then they are contactable. Records confirmed this. A new policy in relation to the Administration of Medication is now in place and records confirmed that all staff have received training in relation to this. One guest confirmed that they administer their own medication and showed the key they had to a small medication cupboard in their room. The guest knew of the importance of keeping their medication safe and locked away and records confirmed that a risk assessment was in place. However there are no specific guidelines in place in the care plan or risk assessment in relation to how staff might prompt, check or confirm, that the guest has taken their medication. The Close Short Break Service DS0000032753.V313502.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): 22,23 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. The service has robust procedures in place that protect the guests from abuse. However it has been proved that these are not always followed accurately, resulting in delay of informing appropriate agencies about incidences of alleged abuse within the service. This could put guests at further risk of harm. EVIDENCE: The service has a complaints procedure that is picture format, making it easier for guests to understand. Records demonstrate that staff support guests to discuss the service they have received and to make comments about it, including any concerns, that they might have. Staff confirmed that they had received training in relation to verbal and physical aggression but it was not certain whether this is accredited. Any training related to challenging behaviour that may include the use of break away techniques needs to be accredited by the British Institute of Learning Disabilities (BILD). The manager agreed to confirm this. Staff and records confirmed that staff receive training in relation to the local authority’s protection of vulnerable adult procedures, however these have not always been followed accurately. The manager agreed to address this with all staff. Staff were observed working with guests in a respectful and sensitive manner, however there were some records in staff files relating to reports of abusive practice within the home. It was unclear how the reports had been dealt with and whether the appropriate procedures were followed. The Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 19 The manager is currently looking into this further and has agreed to report back to the Commission for Social Care Inspection (CSCI) with the outcome. A serious incident involving one service user attacking another has taken place in the home. Although the police were informed and the incident was handled appropriately at the time, CSCI was not informed of the incident until nine days after the event. The manager was reminded that any incident that may affect the wellbeing or safety of any service user must be reported to the CSCI without delay. The Close Short Break Service DS0000032753.V313502.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): Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. The Close is well maintained, homely, safe and clean and offers service users a pleasant, comfortable and safe environment in which to stay. EVIDENCE: All of the rooms seen were clean and free from any offensive odours. Furnishings are well maintained offering the guests a comfortable and attractive building in which to stay. The cleanliness of the home reflects good and effective cleaning routines as well as effective procedures relating to infection control. Staff confirmed that they had received training in relation to this. Domestic staff have successfully worked through NVQ training relevant to their role. Two guests willingly showed their rooms and both were attractively decorated and furnished. One guest commented that they had requested that particular room prior to this stay as they had stayed in it before and liked it. Another guest commented that they liked staying at The Close because it was just like staying in a hotel. The Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 21 The lounge door was open and guests had free access to the large well-stocked and maintained gardens surrounding the house. The upper two floors can be reached by a flight of stairs. Guests therefore must have reasonable mobility to use them. This means, that it restricts guests who might rely on a wheelchair for mobility, using the games room on the top floor. However this limitation is reflected in the Statement of Purpose. The Close Short Break Service DS0000032753.V313502.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): 33,34,35 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. An effective, well-trained staff team, who are recruited following robust procedures, appropriately supports the needs of guests. However both guests and staff have been put at risk as a result of staff not being equipped to deal with the needs of a person who was inappropriately placed in the home as an emergency. EVIDENCE: Four members of staff, the manager, deputy manager and cook were on duty at the time of the inspection. This was an adequate number of staff to address the needs of the guests currently using the service. However it was evident that on the day of the emergency admission incident, staffing levels, although adequate for the number of people using the service at the time, were not adequate to address the complex needs of the person placed as an emergency. This put a guest at significant risk. Three staff files were examined and all included appropriate recruitment records, including application forms, two adequate references and Criminal Record Bureau checks. The Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 23 One guest confirmed that they had sat on the interviewing panel for the last recruitment of staff and discussed the questions that they had asked. They also confirmed that the person that they had preferred had been given the job. Records and staff confirmed that they receive appropriate training although one member of staff felt that the variety of training opportunities was now restricted. Staff confirmed that they worked through the Learning Disabilities Award Framework (LDAF) as part of their induction training. This they felt raised their awareness of issues surrounding people with learning disabilities. A training matrix confirmed that plans are in place to ensure that staff keep up to date with mandatory training. Records also confirmed that 14 out of 18 staff are qualified in NVQ. The Close Short Break Service DS0000032753.V313502.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): 37,39,40,42 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. The new manager demonstrates an enthusiasm to have a well run service, in a way that will create an atmosphere of openness and respect in which guests, their families and staff feel valued, listened to and empowered. EVIDENCE: The new manager took up post two weeks prior to the inspection. The deputy manager had been acting up following the retirement of the previous manager in March 2006. The manager stated that she is receiving good support from the deputy manager, administrative staff and staff team during her induction period. Due to the manager’s previous experience and training, many of the issues raised in this report were already being addressed. The Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 25 The manager is qualified in NVQ4 in Care, has the Diploma in Managing Care Services and was a registered manager at another local authority establishment prior to moving to The Close. She managed residential services for people with learning disabilities for several years and is currently working through the units of the Registered Managers Award not already covered in her management diploma. The manager is up to date with her mandatory training and is currently going through the application process to be the registered manager for The Close. The manager demonstrated enthusiasm and determination in maintaining the good standard of the service; to address the current issues and to develop the service further. She stated that she welcomes an open door policy and has plans to introduce herself to people who use the service, their families and friends as well as developing positive relationships with other agencies. Guests and staff showed a positive attitude towards her. Amongst her plans the manager aims to review the service’s policies and procedures and to implement a new quality assurance system that will encompass the monitoring of all areas of the service into one system. The fire log and accident books were examined and both were satisfactorily completed. The Close Short Break Service DS0000032753.V313502.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 2 2 2 3 2 4 2 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 30 2 3 X 3 X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 STAFFING Standard No Score 31 X 32 X 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 2 X 2 X Version 5.2 Page 27 The Close Short Break Service DS0000032753.V313502.R01.S.doc no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 6 (a)(b) Requirement The Statement of Purpose and Service User Guide must be reviewed and updated to address all changes in the service and to include a clear protocol for any emergency admission. Prior to a person being admitted to The Close the needs of the person must be assessed by a suitably qualified/trained person. The registered person must be able to demonstrate the home’s capacity to meet the assessed needs, including specialist needs of anyone admitted to the home. Staff must receive training related to service users’ specialist needs in particular sensory impairment. If the home is to offer a service to young people 16 or 17 years then an application for a variation to the registration must be requested and staff must be made aware of the Supplementary Standards for care homes accommodating young people aged 16 and 17 set out in the National Minimum Standards Care Homes for DS0000032753.V313502.R01.S.doc Timescale for action 30/11/06 2 YA2 14(a) 30/11/06 3 YA3 12(1) 14(1) 30/11/06 4 YA3 12(1) 31/01/07 5 YA3 12(1) 31/12/06 The Close Short Break Service Version 5.2 Page 28 6 YA4 YA42 12(1)(a) 13(4)(c) 14(1) 7 YA6 14(2) Adults (18-65). This must also be reflected in the Statement of Purpose. The home must only admit people to the home within the categories that they are registered for and must not admit a person who may impose a risk to other service users and staff. The preferences and changing needs of service users must be kept under review and recorded in their care plan. Timescale of 31/01/06 not met. Care plans must be: service user led, identify the goals to be achieved, identify individual preferences, how choices are made and include the support needed to achieve these. Guidelines for staff to follow relating to any changing needs must also be included. Any incident that may affect the wellbeing or safety of any service user must be reported to the CSCI without delay. If concerns are reported about inappropriate care practices or attitude towards guests, they must be taken seriously and addressed appropriately. Staff who work with young people under 18 years old must be checked on the POCA list. They must also receive training relating to the procedures they need to take, as set by the Area Child Protection Committee (ACPC), if an allegation, or suspicion of abuse becomes known to them. There must always be enough staff on duty to meet the needs of the service users using the DS0000032753.V313502.R01.S.doc 30/11/06 30/11/06 8 YA6 15(1) 31/01/07 14(2)(b) 9 YA23 37(1)(e) 31/10/06 12(1)(5) 10 YA23 32 30/11/06 11 YA33 18(1)(a) 31/10/06 The Close Short Break Service Version 5.2 Page 29 service at any one time. 12 YA35 18(4) The registered manager must make sure that all staff understand and follow the standards and practice expected of social care workers as stated in the Codes of Practice set out by the GSCC (General Social Care Council). Timescale of 31/01/06 not met The policies and procedures of the service must be reviewed and adapted where appropriate, in particular the Emergency Admission Procedure. 30/11/06 13 YA40 10(1) 12(1) 31/12/06 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 Refer to Standard YA6 YA6 YA20 Good Practice Recommendations It is suggested that by eliminating some of the repetitive information in the care plans they could be more accessible and effective. The plans to develop the care plans in a person centred approach should go ahead. The risk assessment relating to a guest being responsible to take their own medication should include guidelines for staff to follow relating to how they monitor and support the guest with this task. The Close Short Break Service DS0000032753.V313502.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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. 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