Inspection on 13/02/07 for The Gables

This inspection was carried out on 13th February 2007.

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

Other inspections for this house

The Gables 06/08/07

The Gables 17/05/06

The Gables 08/11/05

The Gables 12/07/05

The Gables 17/03/05

The Gables 09/09/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Gables (The) 7 West Moors Road Ferndown Dorset BH22 9SA Lead Inspector Stephanie Omosevwerha Key Unannounced Inspection 13th February 2007 10:15 DS0000026806.V330335.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 DS0000026806.V330335.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. DS0000026806.V330335.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gables (The) Address 7 West Moors Road Ferndown Dorset BH22 9SA 01202 855909 01202 872885 ferndown@gables7.fsnet.co.uk 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) H & H Partners Vacant Care Home 7 Category(ies) of Learning disability (7) registration, with number of places DS0000026806.V330335.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named person (as known to CSCI) may be accommodated prior to their eighteenth birthday. 17th May 2006 Date of last inspection Brief Description of the Service: The Gables is a registered care home for 7 adults of both sexes between the ages of 18 and 65 years who have a learning disability. It is owned by H & H Partners (Mr and Mrs Habgood). The proprietors have regular contact with the home and the service users. At present there are four service users living at the Gables and the home has also been offering a temporary respite service in some of the vacant rooms. The Gables is situated in a residential area of Ferndown, Dorset. It is a large detached house in keeping with other properties in the vicinity. You approach the property via electric gates, and there are gardens to the front and rear of the home. The property is split into two. One side is The Gables residential home, with the other part of the property being a private Day Centre named Avatar (also owned by H & H partners). Avatar is a separate service and if service users choose to attend Avatar, this requires extra funding and assessment. Accommodation in the residential home consists of a large lounge, dining area, and kitchen. All service users have single rooms with en-suite facilities. There is a supermarket close by, and the town centre of Ferndown is within walking distance. The larger towns of Poole and Bournemouth are accessible by public transport also. Current fees provided on 06/03/07 are between £892 and £900 per week. Fees do not include personal items such as toiletries, hairdressing, magazines and sweets. For further information on fee levels and fair terms of contracts you are advised to referred to the Office of Fair Trading website www.oft.gov.uk. The home keeps copies of all inspection reports that are available in the office and can be seen by service users, relatives and professionals at their request. DS0000026806.V330335.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection of the home and took place over approximately 7 hours. It was carried out as part of the planned inspection programme for care homes undertaken by CSCI and to address the requirements and recommendations made at the previous inspection on the 17th May 2006 and a further random inspection completed on the 31st October 2006. This inspection was a key inspection and therefore, assessed all identified key national minimum standards for care homes for adults (18-65). The inspector initially spent time in the office sampling various records and documentation including service users files, staff records, recruitment procedures, health and safety records, financial records and menus. A member of staff was also on duty throughout the day and the inspector was able to talk to them. The proposed manager arrived at approximately 12pm and the inspector was able to discuss any issues identified during the morning with her. The inspector spent time talking with the service users although the extent to which service users were able to give their views on life at the home was limited. The inspector spent further time with service users in the communal areas of the home before and during their evening meal. The inspector had the opportunity to talk to 2 members of staff on duty, although again time was limited due to them being busy working with service users throughout the evening. All communal rooms were viewed during the inspection and a sample of 4 service users bedrooms. . Additional information received by the inspector prior to the inspection was also taken into account. This included previous inspection reports, monthly monitoring visit reports from the responsible individual of the home and any notification made under Regulation 37 of the Care Homes Regulations 2001. What the service does well: The Gables provides service users with an attractive spacious environment. The home was found to be bright, clean and welcoming. All service users have their own bedrooms with ensuite facilities offering a high degree of personal privacy. Service users are provided with a good variety of home cooked food that is served in pleasant surroundings and residents say they enjoy their meals. DS0000026806.V330335.R01.S.doc Version 5.2 Page 6 Service users choices and preferences are promoted where possible although current residents have limited ability to make informed decisions or give consent to more complex decisions. Service users are treated respectfully and can spend time in the privacy of their rooms or have access to all the communal areas of the home. Service users are encouraged to take part in household activities such as meal preparations and shopping. The home has good links with relatives and liaises regularly with them over service users care needs. Staff spoken with during the inspection demonstrated a good knowledge of service users needs and the aims of the home. What has improved since the last inspection? The admission procedures have been improved since the previous inspection ensuring more effective liaison with professionals so that the home has all the information required before considering a prospective placement. The proposed manager has been working towards increasing service users social and leisure activities giving residents more opportunities to access the local community such as attending a course at the local gym. She has also been encouraging service users to take more part in the household routines such as being involved in meal preparation and cleaning the home. There have been fewer turnovers within the staff team providing more stability and consistency of care to residents. Recruitment practices have improved to ensure service users are protected by making sure staff are appropriately vetted. The home has been working towards addressing the training needs of the staff team and courses had been arranged to ensure staff have the skills and competencies they need for working in the home. The home have almost reached a target of having 50 qualified staff in the home, with 2 staff already achieving a NVQ qualification and a further 2 members of staff due to complete this in April 2007. A formal system of supervision has been introduced to ensure staff have the support they need to carry out their jobs. DS0000026806.V330335.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000026806.V330335.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000026806.V330335.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has made improvements to their admission procedures including appropriate liaison with professionals to ensure an accurate picture of service users needs is gained prior to considering a placement. The home needs to ensure that all residents and their representatives are fully informed about the terms and conditions of living in the home. EVIDENCE: The home currently has 4 permanent residents and is also providing a respite service for a further 2 service users. There had been one new admission to the home since the previous inspection. The service users file was examined at the inspection and there was written evidence that a care management assessment and plan had been completed prior to the service user being admitted to the home. The home had also carried out an initial assessment, which set out how they intended to meet the prospective service users needs. There was further evidence that the service user had the opportunity to visit the home prior to admission including overnight stays. Although this service user had limited verbal communication, the inspector spent time with her during the inspection and observation indicated that the service user seemed settled and happy in the home. DS0000026806.V330335.R01.S.doc Version 5.2 Page 10 During the inspection a total of 3 service users’ files were examined. The inspector noted that only 1 of the residents had a written contract with the home. It is a requirement that all service users have contracts that are signed either by themselves or their representative so that they have clear information about the terms of conditions of living in the home. DS0000026806.V330335.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to the way information is stored would provide a more holistic view of residents care needs, give clearer guidance to staff and avoid confusion about where information is kept. The current group of residents are unable to make an informed decision or give consent to more complex decisions but staff support them to make decisions in their daily lives where possible. Written strategies for managing risks are limited and more consideration needs to be given to providing an assessment framework that promotes and extends service user independent living skills. EVIDENCE: A sample of 3 service users’ files was examined as part of the inspection. Each service user has a day-to-day file and a history file. At first there appeared to DS0000026806.V330335.R01.S.doc Version 5.2 Page 12 be no care plans available and when the inspector queried this with a member of staff on duty they were unable to say where the care plans were kept. The inspector eventually located a further file in the office that held care plans for all the residents. The inspector recommended that all current information concerning service users be held on one individual file to avoid confusion and difficultly in locating relevant information. This would also ensure that better links could be made between information on care plans and advice given by professionals regarding residents’ care. Care plans contained information about service users’ daily routines including their personal preferences. There was also further information about residents’ support needs and guidelines for specific issues such as managing aspects of behaviour. Whilst care plans contained a reasonable amount of information there were some gaps in aspects of residents care such as inadequate information about responding to a resident’s epileptic seizures, lack of guidance as to how staff should respond to certain types of behaviour e.g. hair pulling and one resident was described as needing a special diet although no further information was available as to what this entailed. It is recommended that care plans are up-dated to ensure staff have appropriate guidelines to support all aspects of residents’ care needs. There was evidence that service users were supported to make decisions about their daily lives. For example the home also uses picture formats to facilitate residents making choices e.g. pictures of the evening meal were on display. Observation on the day demonstrated service users chose what to do on their return from their daily activities. Some service users enjoyed spending time in the communal facilities whilst other preferred the privacy of their rooms. All service users need support with managing their finances, although there did not appear to be any detailed information or risk assessments detailing how individuals were being supported. The manager told the inspector that 2 residents are supported by their families and 2 residents are supported by the home. Records and receipts are kept of all incoming and outgoing payments and these were checked and found to be up-to-date and accurate. It is recommended, however, that details of residents’ support needs with regards to their finances are detailed on their care plans and risk assessments are in place to demonstrate why this support is necessary. The home’s risk assessments were examined and the inspector noted some risk assessments had been completed on aspects of the residents care such as using the kitchen, undertaking domestic tasks, and accessing the community. There were some gaps such as managing residents’ finances and medication that need to be completed. The inspector also found one risk assessment that described the need for physical intervention if staff were appropriately trained. The proposed manager said that staff do not have the training and therefore, no physical intervention is used in the home. This risk assessment needs to be amended to reflect that physical intervention should not be used. DS0000026806.V330335.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All residents have appropriate daytime activities that they enjoy. There are opportunities to access the local community, and the proposed manager has been working towards improving the range of leisure/social pursuits in the home. The home regularly liaises with families promoting and maintaining service users personal relationships. Service users are able to move independently around the home and their privacy is respected. Opportunities to undertake daily routines in the home have been increased and there is more emphasis on promoting their independent living skills. The home offers a varied and nutritious diet that the service users enjoy. DS0000026806.V330335.R01.S.doc Version 5.2 Page 14 EVIDENCE: All of the service users attend the day service owned by the registered providers, which is based on the same site as the residential home. Timetables were observed on service users files and a range of activities was offered such as horse riding, swimming and cooking. The proposed manager stated she is trying to build more activities into the residents’ week. She gave examples such as one resident joining the local gym and currently undertaking a 12 week programme that their G.P. had referred them for. Residents also attend social clubs with 3 service users going to a Saturday club and one service user attending a club on a Wednesday evening. The home is now keeping a record of activities that residents take part in. This included a trip to the theatre, one service user went to see a tribute band and other trips into the community such as the local shops and walks. The inspector noted that other activities such as cleaning and vacuuming were being recorded as part of this and queried with the proposed manager whether these should be seen as activities or if it would be more appropriate for these to be part of service users’ developing daily living skills. The proposed manager said she was currently working with staff to increase their awareness of recording and encouraging service users to take part in the home and therefore, she did not want to make this distinction yet. However, she agreed that she would be looking towards separating out leisure activities and daily living skills when staff have become more accustomed towards new ways of working in the home. Service users’ relatives’ details were noted on their individual files and visits/phonecalls to relatives were recorded. The proposed manager said that relatives and friends were welcome to visit the home and service users are also encouraged to stay and spend time with their families. There was evidence that these visits were taking place e.g. visits to families over the Christmas period had been recorded and one service user’s aunt had visited the previous evening. During the inspection, staff were seen interacting with the service users and it was clear that service users could choose whether to be alone or in company. Service users responsibilities for housekeeping tasks were recorded on their care plans. The proposed manager has been working with staff to encourage service users to take part in more domestic activities and there was evidence during the inspection of more involvement in these tasks such as one service user helping to prepare the evening meal and another service user laying the table. Residents also helped to clean up the evening meal. A sample of weekly menus was viewed. These showed the home was offering a balanced and nutritious diet with an emphasis on healthy eating. Service DS0000026806.V330335.R01.S.doc Version 5.2 Page 15 users likes and dislikes were taken into account and the home provided pictures of the meals available to facilitate service users making choices. The inspection took place during the evening and the inspector sat with the service users whilst they ate their evening meal, which was spaghetti bolognaise. Service users told the inspector they enjoyed the food. DS0000026806.V330335.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Personal care needs are noted for service users and personal preferences taken into account promoting service users dignity and control over their lives. Assessments from healthcare professionals need to be more closely linked with resident’s care plans and staff need clear guidance on individual’s medical conditions to ensure residents’ healthcare needs are appropriately met. Accurate records of administration of medication must be kept to ensure this is being correctly given promoting service users well being. EVIDENCE: Personal care needs are noted on individual care plans. These cover all aspects of care including showering/bathing, hair care, nail care, brushing teeth, shaving and dressing/undressing. There was evidence personal preferences were taken into account and discussion with service users confirmed times for getting up/going to bed, baths and meals were flexible. DS0000026806.V330335.R01.S.doc Version 5.2 Page 17 Observation of practice demonstrated staff were sensitive to service users needs and they were treated in a way that was respectful and promoted their dignity. Personal health care records were available for each service user. It was noted that service users were facilitated to attend different surgeries promoting individual choice of G.P. Assessments were available from other professionals such as consultant psychiatrists, community nurses, speech and language therapists, psychologists and audiologists, although because these are kept on a separate file the information is not easily linked/incorporated into service users care plans. This is particularly important when implementing behaviour management strategies to demonstrate these have been recommended by healthcare professionals. A record of all appointments was kept which showed service users were being supported to attend all outpatient appointments such as G.P., dentists, opticians and psychiatrist. The inspector noted, however, that when some service users had specific medical conditions noted on their care plans there was not always sufficient guidance to staff how to deal with their healthcare needs e.g. such as epileptic seizures. Medication is kept in a locked cupboard in the office. The home uses a monitored dosage system for most medicines and records of administration were seen. There were some blanks in the records that the inspector pointed out to the proposed manager who said she would address this with the staff involved. All service users need support with managing their medication, although there are currently no risk assessments setting out why it is necessary. This would provide a framework for the management of service users medication. All staff administering medication have completed a course in the safe handling of medication. DS0000026806.V330335.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system with some evidence that service user feel their views are listened to and acted on. Staff have clear guidance and training to ensure the welfare of service users living in the home is safeguarded. EVIDENCE: The home has an appropriate complaints procedure. The Commission had not received any complaints with respect to the service since the previous inspection. Discussion with some of the residents confirmed they had some awareness of whom they could talk to if they had any issues/concerns although the extent to which they understood this was limited. The home has policies and procedures in place for the protection of vulnerable adults. Staff are asked to read and sign the procedures to evidence they have understood them. In addition training has been completed with Dorset Social Care & Health training unit to ensure staff are aware of local adult protection procedures. DS0000026806.V330335.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises are well maintained and provide service users with a comfortable and homely environment. Systems are in place for preventing the spread infection and staff support service users to maintain a clean and hygienic environment. EVIDENCE: A tour of the premises was carried out as part of the inspection including all communal areas and all service users bedrooms. The premises were well maintained and decorated in a comfortable, homely way that was suitable for its stated purpose, i.e. providing care and support to adults with learning disabilities. Service users had personalised their bedrooms to their own individual taste and there was plenty of space for personal possessions. DS0000026806.V330335.R01.S.doc Version 5.2 Page 20 During the inspection the home was observed to be clean, bright and airy with no offensive odours. There are separate laundry facilities so soiled articles are not carried through areas where food is stored or prepared. Hand washing facilities are prominently sited in the kitchen and observation during the inspection demonstrated that service users are encouraged to follow good hygiene practices such as washing their hands before helping with meal preparations. The home has a policy on the control of infection and records showed staff are provided with training on this topic. DS0000026806.V330335.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been fewer turnovers within the staff team providing more consistency of care to residents. Recruitment practices have improved to ensure service users are protected by making sure staff are appropriately vetted. The home has been working towards addressing the training needs of the staff team and courses had been arranged to ensure staff have the skills and competencies they need for working in the home. A formal system of supervision has been introduced to ensure staff have the support they need to carry out their jobs. EVIDENCE: The home currently employs 8 members of care staff and also has a team of 4 regular bank staff. The manager reported this had meant minimal use of agency staff over the last few months and on the occasions they had used DS0000026806.V330335.R01.S.doc Version 5.2 Page 22 agency staff, there were named people they could ask for. There had been less turnover in the staff team than at previous inspections with only one member of staff leaving since the previous inspection. This meant there was more stability in the staff team providing better consistency of care to the residents. Discussion with members of staff confirmed that they had had an induction to working in the home and demonstrated an awareness of residents needs. Staff confirmed they had access to information concerning service users although one member of staff was uncertain where care plans were kept. Observation of practice showed that staff were accessible to service users and fully interacted with them during the evening. For example, one service user helped a member of staff to prepare the evening meal and another member of staff supported service users doing puzzles and games before dinner. The home’s recruitment procedure was seen. This was thorough and included job descriptions, applications forms, standard interview formats that involved informal observation and feedback from residents. No new staff had been recruited since the previous inspection. A sample of 3 staff files was viewed. All of the required documentation and information was in place and some improvements to practice were noted such as requested a third reference when only a brief confirmation of employment had been obtained by one of the nominated referees. All staff had contracts specifying their terms and conditions and were subject to a probationary period. A copy of the homes training plan was seen. There was evidence that the home were monitoring care workers training needs and appropriate courses were being booked. The plan showed that some staff has received training in topics such as food hygiene, first aid, health and safety, manual handling and medication, although some newer members of staff still needed to complete these courses (see standard 42). All staff apart from the newest staff had completed training in the protection of vulnerable adults. Some of the more established members of staff had completed courses relevant to the aims of the home and the needs of the service users e.g. epilepsy, autism and Makaton. It is recommended though that all staff have opportunities to complete courses relevant to the residents needs such as working with challenging behaviour and autism. The proposed manager said she was currently revising the in-house induction for new staff, although she had not employed anyone since she had been in post. She was aware of the need to cover the common induction standards specified by Skills for Care and said she intended to go through this with a prospective member of staff the home was currently in the process of recruiting. Staff confirmed they had undertaken training courses and certificates of qualifications held were observed on staff files. There are currently 2 members of staff who hold a qualification of NVQ level 2 or above and another 2 DS0000026806.V330335.R01.S.doc Version 5.2 Page 23 members of staff who are due to complete NVQ level 2 by April 2007, meaning the home will have reached the target of having 50 of staff with an appropriate qualification. Newer staff said they had also completed the Learning Disability Award Framework induction and foundation stages. The proposed manager had set up supervision sessions with staff since the previous inspection and copies of supervision records were observed on staff files. Staff told the inspector they felt well supported in their work and were clear about on call procedures providing additional management support if required. DS0000026806.V330335.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has had a long period without a registered manager that has had a negative impact on the overall running of the home; however, CSCI is currently processing an application to register a manager for the home. The home has sought feedback about the quality of service from the residents, relatives and staff but needs to finalise a formal plan setting out aims and objectives for future service development. Some aspects of health and safety are satisfactorily managed although care must be taken to ensure all equipment in the home is regularly tested and all staff must complete training in all aspects of safe working practices to protect residents’ welfare at all times. DS0000026806.V330335.R01.S.doc Version 5.2 Page 25 EVIDENCE: Susan Streets has been appointed as the proposed manager and an application for registration has been forwarded to CSCI. A quality assurance file has been set up and questionnaires sent out to relatives, relatives and staff in April 2006. This information has been collated and a draft annual improvement plan has been produced. This now needs to be completed and include more comprehensive information setting out the aims and objectives for service improvement over the forthcoming year. Regular monthly monitoring visits are now being carried out by the responsible individual and reports of these have been made available to the Commission. Records showed that the home was meeting the requirements of other agencies such as Dorset Fire and Rescue Service and Environmental Health Department. Certificates were in place demonstrating that equipment and facilities were regularly serviced and maintained. Records for the weekly alarm testing were out of date and it appeared this had not been carried out since October 2006. This was pointed out to the proposed manager to address as a matter of priority. A written health and safety risk assessment and fire risk assessment for the home have been completed as well as other safe working practices such as COSHH, manual handling, accidents, food hygiene and infection control. Certificates were in place showing some staff had attended various training courses in safe working practices, although there are gaps in some staff training including first aid, manual handling, food hygiene and infection control that need to be addressed. Observation of practice demonstrated staff followed correct procedures and encouraged service users to work safely e.g. when helping with meal preparations. DS0000026806.V330335.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 1 X 2 X 2 X X 1 X DS0000026806.V330335.R01.S.doc Version 5.2 Page 27 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 YA5 Regulation 5 Requirement The registered provider must ensure that service users are provided with a written contract setting out the terms and conditions in respect of the accommodation to be provided including the amount and method of payment of fees. The registered provider must ensure staff have full guidance as to service users health care needs including how to deal with specific medical conditions. In addition care plans should be linked to professional assessments/advice about managing aspects of service users care such as dealing with challenging behaviour. The registered provider must ensure accurate records are kept concerning the administration of medication to ensure staff are carrying out their responsibilities correctly. Timescale for action 01/05/07 2. YA19 12 01/05/07 3. YA20 13 01/04/07 DS0000026806.V330335.R01.S.doc Version 5.2 Page 28 6. YA39 24 The registered provider must 01/05/07 finalise the annual development plan based upon the views of service users and other interested parties, to ensure success in achieving the aims and objectives of the home. This requirement is repeated from the previous inspection with the original timescale of 30/09/06. The registered provider must ensure that all records concerning testing equipment in the home such as fire alarms are up-to date. 01/04/07 7. YA42 23 8. YA42 13 The registered provider must 01/06/07 ensure that all staff have training in safe working practices such as first aid, moving and handling, food hygiene and infection control. 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. Refer to Standard YA6 Good Practice Recommendations It is recommended that all current information concerning service users be held on one individual file to avoid confusion and difficultly in locating relevant information. This would also ensure that better links could be made between information on care plans and advice given by professionals regarding residents’ care. It is recommended that care plans are up-dated to ensure staff have appropriate guidelines to support all aspects of residents’ care needs. It is recommended that details of residents’ support needs with regards to their finances are detailed on their care plans and risk assessments are in place to demonstrate why this support is necessary. DS0000026806.V330335.R01.S.doc Version 5.2 Page 29 2. 3. YA6 YA7 4. 5. 6. YA9 YA20 YA35 It is recommended that risk assessments be reviewed to ensure they accurately reflect current practices in the home particularly with regards to physical intervention. It is recommended that risk assessments be carried out to evidence why it is necessary to support service users to manage their medication. It is recommended that all staff have opportunities to complete courses relevant to the residents needs such as working with challenging behaviour and autism. DS0000026806.V330335.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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