Inspection on 19/04/06 for The Copse

This inspection was carried out on 19th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Copse 03/12/07

The Copse 20/02/07

The Copse 03/10/05

The Copse 07/04/05

The Copse 11/10/04

The Copse 14/06/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 The Copse Beechmount Close Old Mixon Weston Super Mare North Somerset BS24 9EX Lead Inspector Nicola Hill Key Unannounced Inspection 19 – 21 & 24th April 2006 09:30 th st The Copse DS0000020375.V292899.R01.S.doc Version 5.1 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 Copse DS0000020375.V292899.R01.S.doc Version 5.1 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 Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Copse Address Beechmount Close Old Mixon Weston Super Mare North Somerset BS24 9EX 01934 811448 01934 811352 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) Shaw healthcare Limited Mrs Terina Noke Care Home 24 Category(ies) of Learning disability (24), Learning disability over registration, with number 65 years of age (24), Physical disability (14), of places Physical disability over 65 years of age (14) The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 24 Adults, aged 18 and over, with Learning Difficulties which can include 14 Physically Disabled Persons. Manager must be a RN on Parts 3, 5, 13 or 14 of the NMC register. Staffing levels as detailed in the Notice of Registration dated 1st September 2004 apply. 3rd October 2005 Date of last inspection Brief Description of the Service: The Copse is care home with nursing for younger adults with learning disabilities and physical disabilities. It is situated on the outskirts of Weston super Mare. The home is arranged into four small units each with their own communal areas. The residents at the home can also access a minibus. The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was an agreed visit to review the outcomes of care for residents at The Copse. The inspector planned with the manager the observation of residents at different times of the day, and the collation of activity and behaviour of the residents that indicated their ill/well being. The inspector observed or spoke with all the residents at the home during the visits that were made over a period of four days, with 18 hours spent at the home. There was also an opportunity to talk with staff on duty and observe their practice and interactions with residents. The relatives of six of the residents at the home had been contacted by post to obtain their views. The outcomes of the inspection for residents were that there has been positive improvement in the amount of community services used, and one-to-one excursions outside the home. The inspector observed this as resulting in positive signs of well being shown by residents in that residents were animated, engaging with staff and smiling. However, the underpinning culture of the home has not yet moved from being staff led to service user led. The review of records and processes relating to the provision of quality informed care, needed to support residents, revealed poor practice in many areas. In addition to this, there have been several Adult Protection incidents at the home, which have led to disciplinary action against staff. In addition to this the inspector noted the home had not kept to the conditions of registration and have more than 14 residents with a physical and learning disability. The high dependency level of the current resident group excludes the admission of any new residents who have a physical disability and a high level of support needs. The requirements made following this inspection are reflective of the areas in need of action. The improvements must be implemented to ensure that the home promotes individual support for the residents. It is of concern to the inspector that many of the issues raised at this inspection were raised in October 2004. Improvements made and assessed by subsequent inspections have not been maintained. The organisation has failed to support the home and staff through the period of change, and this is reflected in the standard of service found by the inspector. What the service does well: The Copse is a pleasant environment with good facilities, which enables the residents to be supported in small group living. The home also has a minibus that allows for ad hoc activities to take place, and for residents to access community facilities on evenings and weekends. The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The areas identified by the inspection for improvement are that: All residents should have a service user plan, which contains up-to-date information and is kept under review. The plan should indicate the level of consultation with the service user and with any representative. The registered manager produces a menu that consists of a balanced nutritious diet, which offers a choice of main meal, and includes the foods that, in respect of the medical conditions of the residents, they are able to eat. The quality of the meals must be monitored and recorded on a daily basis. The home must be made accessible to disabled people. Communication systems must be developed with residents to ensure they are consulted and supported to make decisions about their daily life. The registered manager must ensure that where necessary treatment and advice from any healthcare professional is followed. Any follow-up action must be recorded and link to the care planning process. The manager must implement a system of monitoring the practical skills of the staff team in order that a high standard of support is given. The registered manager must implement the routine of regular supervision and performance monitoring for all staff. The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 7 Staff must understand what constitutes abuse and adult protection procedures in respect to the whistle blowing policies of the organisation. 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 Copse DS0000020375.V292899.R01.S.doc Version 5.1 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 The Copse DS0000020375.V292899.R01.S.doc Version 5.1 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): 1,5 The service user guide is not accessible to potential residents. EVIDENCE: The inspector discussed the service user guide currently available at The Copse with the senior assistant manager. Although the guide now has pictures relating to the home and the facilities the home offers, because of the large amount of text used, it would not be accessible to the client group. The inspector suggested that the expertise within the staff team could be used to produce a short DVD about the home, which could be narrated by one of the current residents. This project was agreed to be implemented before the inspector completed the visit. The residents all have a contract pertaining to the terms and conditions of occupancy at The Copse. The contract is standard and is not accessible to residents. The inspector discussed the contract with the manager who is currently identifying the local authority responsible for each resident and their review of provision. For some of the residents the specific needs have changed since admission, and this may be an opportunity to seek additional funding for one-to-one support for those residents with very complex needs and minimal day-care funding. The Copse DS0000020375.V292899.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 The home has not completed a person centred plan for each resident, which reflects fully all their support needs. EVIDENCE: In order to identify individual needs and choices and to promote person centred planning the home has changed their care planning format and introduced essential lifestyle planning since the last inspection. The residents now have a file containing the essential lifestyle plan, a second file for historical documents, a health action plan and some residents have a photo file depicting their life at The Copse. The essential lifestyle plans were reviewed for all the residents and common themes identified with the plans and the information contained in them. • There is little or no evidence in the files to indicate the level of resident’s involvement in drawing up the plans, which are supposed to contain specific information about how residents wish to be supported to lead their lives. None of the plans reviewed indicated involvement of relatives DS0000020375.V292899.R01.S.doc Version 5.1 Page 11 The Copse or people close to the resident and who knew them well. One resident who was able to look through their plan with the inspector, was aware that the file was kept in their room, but were unaware what information was in the files apart from the photo file. When the inspector and the resident looked at their essential lifestyle plan it was evident that the plan was not in an accessible format for the resident to read easily, although the resident was literate. • Some of the plans were incomplete; especially the occupational aspects/activity plans which are supposed to reflect the aspirations and ambitions of the residents. Several of residents at the home have communication deficits, however preferred methods of communication or interpretation of gestures and signs have not been recorded. One resident has a goal to improve their communication with staff and the key worker for the resident was able to demonstrate how this had been implemented with the resident. The experience and understanding of essential lifestyle planning varies between staff as the quality of the plans varies, and the perception of how information is written and what constitutes a personal goal for a resident varies widely. For example some of the plans were written in the first person whilst others were written for people and this was evident from the language used i.e. he and I. The inspector was able to read that for one resident a personal goal was to attend a football match, whilst for another resident it was to reduce challenging behaviour towards staff, and as a third example to ask the qualified staff if there was enough money to purchase a padded mat to go under a wooden swing to make it safer if the resident fell off. Whilst all the above require staff input, clearly only the first goal is the aspiration of a resident. Information on some plans is abbreviated and language used which would not reflect current practice i.e. fit and seizure. • • • The inspector also case tracked and cross-referenced information on the care plans with the daily records. There were records kept on some residents where action recorded on daily records could not be linked with care plans. An example of this would be where it is recorded that a resident became vocal and therefore was taken back to their room. There is no reference in the care plan that the resident would indicate by being more vocal that they would wish to be returned to their bedroom. There is also no information that secluding the resident was an agreed action plan. A further example would be an entry, which stated that three people were needed to support a resident with personal care; the care plan clearly states two people. The inspector and queried this with the manager as the prospect The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 12 of three people being used to support a resident with personal care would possibly indicate that some form of supportive holding was being used, and this had not been recorded or agreed. The manager was able to inform the inspector that the challenging behaviour team from the community learning disability service had been involved and had written out a very clear protocol on how to support the resident safely and reduce any unsettled behaviour. This had been observed by the manager being put into practice by a home support worker; however, from the records it was clear that not all staff were following the guidance. It was agreed between the inspector and the manager that this resident should have the information held on their individual file reviewed and updated so that there is a clear action plan which all staff follow to support this resident. In general it was acknowledged by the manager that the introduction of the latest care planning formats had not been successful and the information was poorly recorded. Some files contained old assessments; some repeated information and others did not contain enough information to care for the resident safely. The area manager has produced a format of support plans, which are person centred and contain all relevant documentation currently being used by Shaw. These will be introduced into The Copse, the plan agreed between the inspector and a manager for their introduction will be that there will be one plan completed for each flat by the manager and the team leader, this will act as an example of how to produce a person centred support plan. The plans must involve the resident and this must be evidenced as their personal choices and decisions. The team leader for each flat will then be responsible for completing the support plans for the other residents. The photo files, which some residents have, are intended to depict their daily life at The Copse. The text accompanying the photographs is very obviously not from the residents and contains staff opinions. One resident who viewed their file with the inspector enjoyed the photographs but was unable to read the accompanying text. This made the file inaccessible to the resident. Another resident who was able to use a computer preferred their photographs to remain on the computer. Further adaptations to the computer equipment would be necessary to allow the resident to be more independent when accessing this information. The residents in general are still not consulted on or participate in all aspects of life in the home. The manager acknowledged it had been difficult to include residents in the regular meetings held on each flat, however this is due to the communication issues and the reluctance of staff to change practice. The risk assessments carried out on behalf of residents were variable; the examples of residents being supported to take risks as part of an independent lifestyle were in the minority and focused around safe wheelchair use, accessing the minibus etc. The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 13 The inspector asked the manager if the staff that carry out risk assessments fully understood what constituted a risk and risk management. It was acknowledged that this would be an area for staff development to move them away from risk assessing direct care, which has control measures in place to remove the risk, and to support developmental plans towards independence e.g. supporting a resident to make their own cup of tea. The Copse DS0000020375.V292899.R01.S.doc Version 5.1 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): 11,12,16,17 The lifestyle of the residents appears to be dictated by staff routines. EVIDENCE: As previously stated the occupational aspects of the essential lifestyle plans have not been completed for all residents. Some residents did not have an activity plan, however, preferred activities/pastimes have been recorded. The inspector spent time observing the residents in various activities around the home, particularly before and after meals. It was noted that when observing one group of residents at teatime, two residents were changed and ready for bed by 5 pm; this was not evidenced in the care plans as being resident choice. When the inspector arrived on two flats there were no staff, the residents were unattended. The allocation of a minimum of two staff per flat at the home appears to work well if both are present. If one resident is taken out for an activity and one carer is left, it is difficult to meet all the support needs and provide the one to one attention the majority of residents require to engage The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 15 them in any meaningful activity. One flat has a high ratio of residents with sensory impairment. It was noted by the inspector that the residents spent a lot of time disengaged on their own; one resident displayed unsettled behaviours, as reassurance was not available to them when there were different noises or people in the room. In another flat, five of the six residents were showing signs of ill being in that they had withdrawn to sleep, or were anxious and demonstrated this with rhythmic rocking or unsettled behaviour. The agency staff on duty explained that the permanent member of staff was supporting a resident with personal care and that she was “keeping the residents company” although not engaging with them through activities. The overall impression from observing the residents is that there are insufficient staff for the high level of input needed by the residents (usually 1 to 1) for positive engagement. The residents spend a lot of time sat in chairs with either the television on or with music on; the staff were not observed to consult the residents about the choice of programme or of music. The inspector and the manager discussed the lack of engagement and how it linked to unsettled behaviour, this led to the identification of an increase in difficult to manage behaviour by one resident, with a lack of contact from staff. The social activities provided through college, day centres and Brandon day care services continues; the manager would like to be able to review the use of the Brandon day care service as the quality of social contact for residents using these services is variable. The home support workers are encouraged to take residents out side the home more often; this was confirmed by the support workers who stated that it benefited the residents who appeared to enjoy the excursions. This is an improvement in the lifestyle for residents as the focus is for individual rather than group activity. One resident was able to talk about the holiday they had chosen and expressed a choice in which member of staff would provide the support for the holiday. During discussions with staff and management of the home, the quality of meals and nutritional intake by the residents was identified as a concern. The choice of food was limited, there was a main course and an alternative was only provided if it was known the resident didn’t like the main course. The home has been trying alternative evening meals, such as Chinese take-a-ways, which the residents were observed to enjoy and eat with enthusiasm. One inspector questioned the staff the reason behind this; it was a stated staff opinion that the Chinese food provided different tastes and textures, which the normal menu did not. Over the period of the inspection, there were four meals served to residents, three lunches and one supper. Day one - Chilli con carne with chips and rice, with crème caramel as a pudding. The chips were cold on arrival at the flat; the inspector and a member of staff tasted the chilli - it had no flavour. The pudding was difficult The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 16 for the residents to eat as it fell off the spoons and was difficult to grasp with their fingers and so residents went without. Day two – jacket potato with cheese. The potatoes are cooked early in the day and reheated on the flats. The meal was served with no side salad and was bland and unappealing; the cheese was not melted on the potato. Day three – breaded fish, chips, mashed potato, mushy peas and parsley sauce, with tinned sliced peaches and cream as a pudding. The chips were cold, the fish had been oven baked and was hard; the parsley sauce was tasted by both the inspector and the manager, and was inedible. The residents were observed not eating the meal provided, and none of them wished to have the sliced peaches and cream as a pudding. Day four – toad in the hole, with sliced green beans and carrots and mashed potatoes, with scones for pudding. The inspector discussed how the residents had enjoyed this meal with staff, who stated that the main course was ok, but the residents enjoyed the scones more. The inspector questioned the quality of food with the manager in particular whether or not there was insufficient budget available to provide high-quality meals, not just tinned, packet or frozen food. The invoices from food supplies were looked at together and it was noted that few fresh vegetables were ordered. The inspector had also seen that bowls of fresh fruit were available on each flat, however in one flat the fruit was beginning to rot. The manager had purchased smoothie makers for each flat in an attempt to boost the amount of fresh fruit residents were having. The quality and variety of food available to residents that was seen during this inspection is unacceptable and requires immediate action. The manager has planned a meeting with the cook to introduce new menus and to review the quality of food. The space for washing up dishes and serving the meals in the flats is limited, and purchasing dishwashers for the flats is recommended. If food is to be reheated then staff must be aware of the safe temperature it must reach, and record this is the flat diary. The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 17 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 The systems in place for managing health care should be more responsive to changes in residents’ health. EVIDENCE: The inspector witnessed that residents were given choices about their personal care, and that same gender carers were available. The daily routines on some residents’ files are useful especially if the staff do not know the resident well. Although the residents have a high level of support need for personal care, it was noted by the inspector and confirmed by staff, that time was taken to ensure that residents preferred routines are implemented and not rushed. All the residents at the home have the health action plan. Sue Ring from the community learning disability service has been working with the home to develop individual health action plans, which reflect the health care needs and healthcare monitoring of all residents. The health care plans have not been completed and therefore are a mixture of older assessments and new documentation. The information in the plans cannot be cross referenced to daily records, for example, several residents The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 18 required support with daily physiotherapy but there is no indication that this is implemented. The manual handling risk assessments must be completed. The inspector witnessed staff verbally passing on client handling information, the handling assessment for this resident did not have the information on how support the resident whilst walking. The inconsistency in recording the weight of residents was a cause for concern as some records indicated fluctuating weights, one resident weighed 96.9kg on 10/03/06 then weighed 90.6kg on the 27/03/06, no remedial action was taken. The manager asked the handyman to test the scales during the inspection, they were found to be registering weights accurately. The inspector brought to the attention of the manager the blood pressure record for one resident suffering from hypertension. The care plan identified a need for readings on alternate days but from 07/04/06 to 11/04/06 no readings were taken. One reading recorded on 14/04/06 was 88/59, there is no reference to this in the daily records, and no indication that antihypertensive drugs were omitted or that the reading was retaken. This is just one example of the failure of the staff to follow through care plans effectively and to act on information received. The inspector and manager discussed the arrangements for the residents to access primary health care services. She is of the opinion that residents can be supported to access community services and will be reviewing the contract the home has with its current GP. This is intended to empower staff to act when residents are ill, and not save up problems for the GP’s regular Thursday visit. The administration and record keeping of medication at the home has been a concern over recent months. On this visit all the medication records were up to date and stock numbers were accurate. The qualified member of staff administering the morning medication had signed the record sheet in the wrong place, this was noted and a correction made. The inspector advised the manager to introduce protocols for the “when required” medication which give clear instruction to staff of the indicators and action needed. The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The complaints procedure must be followed; staff training has failed to eradicate abusive behaviour by staff to residents. EVIDENCE: The complaints recorded on file indicated that a music therapist who was visiting the home witnessed an incident of inappropriate behaviour towards residents. This issue had been reported in December 2005, currently there is no outcome to the complaint. The manager was advised to follow up this incident and ensure that any outcome is recorded on file. Since the last visit to the home in October 2005 there have been some adult protection referrals in respect of abuse towards residents by staff. The organisation has a zero tolerance approach to abuse and investigate all allegations. The staff involved have been subject to the organisations disciplinary procedures, one member of staff has been dismissed. The inspector discussed with the staff the incidence of abusive behaviour towards residents. Some of the staff stated that although they had received training, it was hard to change practice particularly of established members of staff who had been carrying on this behaviour for a long time. The conversations with the staff confirmed to the inspector that attitudes displayed by some staff are considered now to be abusive, however, the culture of the home is changing. The concern of the staff team is that there is inequity of treatment of staff and that despite concerns being reported to management, the staff have low expectation of any disciplinary action being taken against the qualified nurses on the team. It was confirmed to the inspector that a group of home support workers were planning to write a joint letter to Shaw headquarters outlining The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 20 their concerns about a qualified member of staff because of verbal complaints have not been acted on and the unacceptable behaviour has continued. This issue was shared with manager. The staff team at The Copse have received training in the recognition of abuse, and the reporting procedures. They have also attended values training to enable them to recognise what behaviour constitutes abuse and what is a professional relationship. However, during the inspection two incidents of abuse were reported, indicating that staff are more confident about reporting colleagues, but that the training given to all staff hasnt changed behaviours. The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 The home has not been adapted sufficiently to support the independence of the residents. EVIDENCE: The Copse is a pleasant environment that provides huge opportunities for residents to develop independence skills. There has been a recent assessment of the environment in respect of accessibility for people with disabilities; however, to date no action plan has been formulated. The inspector and manager discussed the specific adaptations needed for people with sensory impairment and recommend the involvement of specialist agencies such as RNIB. The environment must be adapted to promote independence; immediate improvements such as a lower toilet/toilet step for those of small of stature must be implemented. The provision of a low handrail for those of smaller stature should also be made as soon as possible. The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 22 The residents have personalised bedrooms with audiovisual equipment in them; this equipment is also available for communal use on each flat. The residents share the garden and the patio area where efforts have been made to create a sensory garden and provide equipment e.g. wooden swing. The residents would benefit from a snoozelum area, as this would provide sensory stimulation in a safe environment. The manager is seeking funding to use a spare office on the first floor as a snoozelum. The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 Staffing levels do not reflect the dependency level of the residents. EVIDENCE: The inspector met with several members of staff, and observes the staff interactions with residents around the home. The overall impression of the home support workers is that they provided, within their capabilities, a stimulating environment for residents. The residents, who have a wide range of disabilities, were sensitively supported with personal care, but the one-toone interaction to prevent residents’ boredom or withdrawal is not always available. The inspector only observed home support workers interacting with residents; qualified staff were observed interacting with residents was giving medication only. The home support workers stated that over the past year the amount of training that had become available to them had increased, and that they could see the positive benefits of training and bringing new skills to work with the residents. All of the staff have completed statutory training updates, and have the opportunity to study for NVQ qualifications. The staff files indicated that the recruitment process for employees is robust and provide safeguards for residents. The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 24 There are several vacancies in the staff team for home support workers, which the home is actively recruiting to, but vacant hours are often covered by agency staff. The permanent staff have stated to the inspector on this visit, and on previous visits, that this has a negative effect on me continuity of care of residents. It is noted that some residents have unsettled behaviour when they cared for by unfamiliar staff. The manager may look to recruit overseas staff so that there is a settled staff team to work with and provide a continuity of care to residents. The team leaders have responsibility for supervision of the home support workers. The home support workers were able to confirm that supervision does take place, but not on a regular basis. The staff would also like to attend a team day where the aims and objectives of the home are agreed, and the roles of the staff in achieving these objectives are identified. The current staff rota indicates that staff work 12 hour shifts, which can be an issue as the staff work three days a week and have four days off. This means that there is a gap in the contact with residents. This also affects the continuity of care; the recording and communication systems at the home are not effective enough currently, to provide a comprehensive record of what has happened to residents in the four days absence. The manager has planned measures to change this and there is now a handover for all staff everyday. The manager has also had agreement from the area and regional manager to introduce a new four-week rota, which will mean staff work 7.5 hours per shift, for five shifts per week. This will also allow additional time for staff handovers. The benefits for the residents will be that there will be greater continuity of care, and staff available to support residents to go out to evening and weekend activities e.g. disco. The staff ratio currently at the home ensures that there are a minimum of two staff per flat, and at least one qualified nurse on duty between 7.30 a.m. and 8 p.m., and five home support workers at night with one qualified nurse sleeping in. The inspector and manager discussed the dependency levels of the residents that the home. Currently there are two vacancies, fifteen residents have a high level of need, five residents have a medium level of need, and two residents have low level needs. Using the Residential Care Forum guidance on staffing, the home should be providing a minimum of 1219 care hours per week, this is allowing for 200 hours per week to be provided by day-care services. The Copse DS0000020375.V292899.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42 To change the culture of the home. EVIDENCE: The manager has been successful in becoming registered with CSCI. She is an experience health care professional and undertakes appropriate training to enhance her professional and vocational skills. The manager has taken over the home at a point where poor practise and poor outcomes for residents have been identified, and she has been tasked to implement the many changes necessary to improve the quality of services provided to the residents. The area manager visits regularly. The staffing structure has now included a senior assistant manager role to support the manager to change the culture of the home. The deputy manager is currently absent from the home, as is the administrative assistant, leaving deficits in the support structure for the The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 26 manager and staff team. Consequently, with only two people out of a team of 39 staff promoting the changes in working practises and leading by example, the positive benefits to service users are not easily apparent. This has a demotivating effect on any staff that are willing to change. This was confirmed by the home support workers who told the inspector that they felt the changes should be implemented more quickly with more authority (from the organisation) behind them. The home support workers also stated that the manager is approachable but not around all the time and that the home runs differently depending on who is in charge. Staff were also disappointed that there is no team work, and a clear divide between the qualified staff and the home support workers. This was observed by the inspector; the interaction between qualified staff, home support workers and residents only appeared to occur when a task was being completed i.e. medication administration. The home support workers were also able to reflect on the team days held in the past, and suggested that this could be a way of explaining fully why the change in practise was needed and what the objectives for the home were. Several staff commented on recent “Values” training and appeared confused about what constituted a professional relationship and an abusive one. The example used was that some of the residents have no family, and so the staff meet this residents’ emotional support needs. The training appeared to staff to imply that this was abusive. This was reported to the manager who will clarify the situation with staff. The communication systems in the home are not fail proof; for example the inspector arrived at 7.30am to be present for the resident handover of information, however this had already been completed. So any staff starting at 7.30am would have missed this information sharing session. When the inspector asked if there had been any changes, there were none. However, it transpired that one resident had been unsettled overnight and not slept well, and this effected the time they would get up, their afternoon activity (horse riding) and the potential for unsettled behaviour. The home support worker who acted, as key worker for this resident was very concerned as the approach needed to support the resident in these circumstances was very different to when the resident was not sleep deprived. How to keep staff “in the loop” was discussed at length with the manager who has planned that with the introduction of new rota systems, that there is an overlap of staff and this will be used for formal handovers. The inspector did not see any health and safety issues which presented a hazard to residents or staff. However completion of risk assessments and implementation of safe systems of work have been identified for action earlier in the report. The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 27 In respect of accident forms it was noted that one resident had more than one record of unexplained bruising. This may be due to equipment, handling techniques or medication; the manager has started to eliminate potential causes and look at possible preventative measures. These incidents are not suspicious. The Copse DS0000020375.V292899.R01.S.doc Version 5.1 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 2 2 X 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 3 32 3 33 2 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 X LIFESTYLES Standard No Score 11 2 12 2 13 X 14 X 15 X 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 3 X 3 2 X X X X 2 The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 YA19 Regulation 12,13,24 Requirement The registered manager must ensure that where necessary treatment and advice from nay healthcare professional is followed, and follow up action must be recorded and linked to care plans. The registered manager must produce a menu that is balanced and nutritious, and includes food that residents are able to eat. The quality of the meals should be monitored and recorded on a daily basis. The manager cannot admit to the home any person with a physical disability or with a medium or high level of support needs. The care plans need to be updated, and information held on residents reviewed so that it reflects their current situation. Risk assessments must act as a support for resident selfdevelopment rather than a deterrent. Person centred planning must be progressed so that the DS0000020375.V292899.R01.S.doc Timescale for action 24/04/06 2 YA17 16 24/04/06 3 4 YA17 YA3YA2 16,24 14 24/04/06 24/04/06 5 YA6 15 24/05/06 6 YA9 14 24/04/06 7 YA11YA7YA6 14,15 24/05/06 The Copse Version 5.1 Page 30 8 YA20 18,19 9 YA24 16,23 10 11 12 YA24 YA24 YA38 23 23 16,24 13 YA34YA32 18,19 14 YA36 18 15 YA22 22 16 YA23 18,19 potential of the residents is maximised and that they can express choices and make decisions about their lifestyle. The organisation must continue to monitor the administration of medication in order to reduce the number of errors. The environment must be adapted to promote independence. • Immediate improvements such as a lower toilet/toilet step for those of small of stature must be implemented. • The provision of a low handrail for those of smaller stature should also be made as soon as possible. A review of the physical layout of the home to reduce the flats being used as access routes. The home should have an action plan to improve accessibility for disabled people. The home develops systems for communicating effectively and consulting with residents so they have more influence in the day-to-day running of the home. Staff recruitment must be undertaken to reduce the disruption to residents by using agency staff. The manager must ensure that team leaders must fully implement a system of meaningful supervision for their delegated staff group. All complaints and their outcomes must be fully recorded and available for inspection. Training and procedures for dealing with abuse must be DS0000020375.V292899.R01.S.doc 24/04/06 24/06/06 24/06/06 24/06/06 24/06/06 24/04/06 24/04/06 24/04/06 24/04/06 Page 31 The Copse Version 5.1 17 YA1 16 robust to act, as a deterrent to would be abusers. The introduction of user friendly information is needed to enable potential residents to have a greater understanding of services offered at the home. 24/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Copse DS0000020375.V292899.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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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