Inspection on 20/09/05 for The Goodwins

This inspection was carried out on 20th September 2005.

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

Other inspections for this house

The Goodwins 22/06/07

The Goodwins 22/08/06

The Goodwins 04/01/06

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 The Goodwins 3 St Richards Road Deal Kent CT14 9JR Lead Inspector Mary Cochrane Unannounced Inspection 20th September 2005 09:30 The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 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 Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 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 Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Goodwins Address 3 St Richards Road Deal Kent CT14 9JR 01304 389149 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) CareTech Community Services (No.2) Ltd Vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd February 2005 Brief Description of the Service: The Goodwin’s is registered to provide 24-hour residential care for up to 8 adults with learning difficulties. At present there are 7 Service Users in residence. The Home is located in a residential area on the outskirts of the costal town of Deal. There are public amenities and good transport links close by. The property is a substantial detached house with a parking facility to the front. The accommodation is arranged over two floors. All of the Service Users have their own bedrooms and all of the rooms have washbasins. There are three bathrooms, a large communal lounge, a small lounge area, conservatory, dining room and a kitchen. There is a large garden to the rear of the property, which is reasonably well maintained for Service Users to enjoy in the better weather. . The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out in accordance with the Care Standards Act 2000 and under the new guidance of ‘Inspecting for Better Lives’. The inspection took place over a day on Tuesday 20th September 2005. At the time of the inspection the manager was on annual leave the deputy was off duty. The 2 seniors on duty assisted throughout the inspection and were available and helpful during the day. The following methods of inspection and information gathering were used: one-to-one discussion with staff, observing interactions, care interventions and activities, reading and discussing individual support plans, risk assessments, selected policies, medication charts, training matrix and a tour of the building also took place. At the previous visit 17 requirements were made and 6 recommendations. There have been some improvements and the home seems to be moving slowly in the right direction. This will be reflected throughout the report. The home still has a lot of work to do before all standards are met. All of the service users within the home have limited verbal communication skills; some do use a limited amount Makaton. The care staff at the home know the service users well enough to anticipate and interpret their needs and are able to communicate through body language, behaviours and verbal sounds. On arrival at the home 3 of the service users had already left to attend the companies activity centre in Folkestone. There were 4 service users left at the home, it was observed that little constructive activity took place for these service users. It was also evidenced that the home does not provide individual activities programmes for the service users, which results in long periods without any time structuring, meaningful activities or leisure pursuits. All the staff spoken to reported that there are not enough staff on duty at any one time to provide activities for all the service users. At the time of the visit all the service users were well dressed and looked physically well cared for. At the present time the home employs 1 manager 1deputy manager 12 care staff members, and a cook. Agency staff that have worked at the home for some months cover night shifts. There is always a permanent member of staff in the building at night in case any problems arise. Care staff undertake cleaning duties and also prepare the evening and weekend meals. One service users also requires 1 to 1 input throughout the day. Some of the standards were not looked at this visit, as the staff on duty did not have access to staff files and other confidential information. Also the staff on duty were not aware of some of the issues and documents pertaining to quality assurance. These will be looked at during the next visit. The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? Since the appointment of the new manager the staff reported that certain aspects within the home have improved, they now feel that they have some leader-ship, direction and guidance. The also reported that there is a more consistent approach when dealing with the behaviours in the home. There is also now a balance of female and male staff so as to ensure that service users personal care is attended to by a member of their own gender. All service users now have appointments with the local consultant psychiatrist and hopefully this will develop into more involvement with the local learning disability team. Also everyone now has regular visits to the Gap’s surgery for health checks and medication reviews. The Service Users Guide is now in a format that might be more understandable to some of the service users. The homes environment has improved since the last visit. Redecoration and refurbishment of some of the bedrooms has taken place to create a more personalised, private space for the service users where they feel comfortable. The spare bedroom has been up-graded to a reasonable standard and is now ready for use. The odour that was detected in the downstairs hallway at the previous visit has been eliminated. Bathrooms and toilets are clean and the downstairs bathroom had been refurbished (all except the sink and cupboard The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 7 underneath which needs replacing). Generally the home did seem cleaner and more cared for. The laundry room has now been up-graded to house adequate facilities to launder all linen and clothes. The furniture in the lounge has been replaced. Overall the home is more homely and comfortable creating a more conducive environment for service users to live in. What they could do better: The home needs to ensure the safety of the service users at all times. It was evidenced that one of the seat belts on the homes transport was not working properly; apparently this had been faulty for some time. An immediate was requirement was made to have the belt made safe before any one else travelled in the seat. The senior carer on duty took immediate action and booked the vehicle in for repair. Each of the service users should have a weekly activities programme in place, which allows them, if they wish to participate in fulfilling activities both in-side and out-side the home. Documentation needs to be kept by the home to evidence the activities that took place, whether or not they were enjoyed or beneficial or whether the service users decided not to participate and the reasons why and what they did instead. More leisure activities are also needed. The home needs to employ more staff so the service users needs can be meet at all times. The staff reported that they cannot provide activities or interventions for the service users due to staff low staffing levels throughout the day. This was a concern that all staff reported and it will be explored and evidenced further in the main body of the report. Staff are working long days to cover shifts and some staff felt moral was low throughout the team. It was also observed that some of the care staff did not interact or communicate or try to engage service users in any time structuring activities. The end result is that service users spend a lot of time sitting around or wandering aimlessly and care staff just watch and follow them. The manager is in the process of trying to get the funding authorities to provide a dedicated care manager for each service users. It needs to be ensured that the each service user has a 6 monthly review involving significant professionals, families, friends and advocates. Any changes in care should then be reflected in the service users care plan and actioned. The manager needs to complete his NVQ level 4 and R.M.A. and become the registered manager of the home. The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 8 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 Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2, 3 The homes Statement of Purpose and Service Users Guide provides prospective service users with details of the services the home offers, enabling them to make an informed decision about admission to the home. The home does have an admission procedure to ensure the needs of potential service users can be meet. EVIDENCE: The home has an up to date Statement of Purpose, which contains the information out-lined in regulation 4 and schedule 1 of the National Minimum Standards. The Service Users Guide is well written and informative and it is now also written in a format and language, which is more suitable for people for whom the home is intended. At the time of the inspection the home had a vacancy and the deputy manager had recently been to visit and assess a prospective service user. There was evidence to show an initial assessment had been undertaken. The service user was visited in their present residence. The assessment is going to be undertaken over a period of time with the service user being invited to spend time at the home before making a decision as to whether or not they wish to stay permanently. This also allows staff to get a true picture of the service users needs and all involved parties will then be able to make an informed decision as to whether or not the home is suitable. All the information gathered The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 11 is then incorporated into the individuals care plan and risk assessment. There will be a 3-month probationary period before a final decision about permanency is made. The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 &, 9 There is a consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. Service users are able to make decisions about their own lives and assisted as necessary Risks are identified, recorded and minimised ensuring that service users are protected and kept as safe as possible. EVIDENCE: There is a key worker system operating within the home. Comprehensive and detailed care plans are held for each individual service user. A sample of care plans was looked at. They are of a good standard and reflect the individual and changing needs of the service users. . Needs are identified and the action and care the staff have to implement is clearly explained. The care plans are used as a working document by the staff and are well organised, so to enable easy and quick access to the information required. The service users files also include risk assessments; medical and specialist needs, approaches to personal care, eating and drinking needs. There is also a clothing and property list. The The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 13 care plans include behavioural programmes/management plans and behavioural interventions guidelines for each individual service user. Positive and negative behaviours are recorded to give an indication to staff of what they were aiming for what to avoid. At the time of the visit no evidence could be found to indicate that 6 monthly reviews are undertaken involving families, advocates and significant professionals. The staff reported that they were not aware of care managers or others being involved with reviews. Through observation and talking to staff there was evidence to support that service users are involved in making decisions on how they live their lives and any limitations and restrictions are recorded in the individuals care plan. The service users have regular one to one meetings with the key workers, which are recorded. Service users are encouraged to be to do things for themselves, choosing clothes, shopping for their rooms they are also encouraged to help keep their rooms clean, wash and put clothes away. At the previous inspection a recommendation was made to individualise and develop the risk assessments; it was evidenced at this visit that this had been done. There are clear risk assessments in place, which are individualised and provide information on how to minimise identified risks, these are of a good standard. It was discussed at the visit that each service users needs and individual risk assessment with regards travelling in the homes own transport. . The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 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): 11,12,13,14,15,16 &17 The home does not provide the service users with opportunities and facilities that enable them to maintain an appropriate and fulfilling lifestyle in and outside the home, therefore their lives are restricted. Family links are encouraged and maintained wherever possible. The dietary needs of the service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: All the service users at the home have complex learning disabilities but there is no evidence to show that they are offered specialist interventions and opportunities by trained staff. The home has had input from a speech therapist but there was no evidence at the time of the inspection to show that any programmes or interventions had taken place. There was little evidence at this visit to support that the service users are assisted or enabled to undertake a fulfilling life style in or out-side the home. The staff reported that this was due The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 15 to low staffing levels and it was evidence that there are not enough staff on duty to provide the level of support and guidance the service users need to undertake activities. (Staffing levels will be discussed later in the report.) The home does offer the opportunity for 3 service users to attend the companies Opportunity and Choices Centre in Folkestone, which is about 23 miles away from the home. This activity is offered on a Monday, Tuesday and Thursday morning. There is a local disco on a Wednesday evening, which 2 service users attend and 2 attend a Friday morning swimming session. Magic Moments (an arts and crafts session) happens at the home on a Thursday. Any other activities provided are unorganised, unstructured and ad-hoc. There are long periods of time when service users are left with no time structuring activities. Each service users requires an individual activities programmes so gaps can be identified and then the home can start to develop meaningful and fulfilling activities for each service users. This would also give the staff and the service users direction and guidance. The leisure activities at the home are also limited. It was reported that even if staff take service users for a walk they are very limited by time as they have to get back to perform other duties. One service users does attend church on a regular basis. This year none of the service users have had an annual holiday. Apparently a holiday was organised for 2 of the service users but the holiday had to be cancelled at the last minute. Reports on why it was cancelled are conflicting. Staff reported that they have spoken to management about the lack of activities and leisure pursuits but feel they are unsupported and unheard. At the time of the visit it was observed that some service users were left sitting for long periods. Although staff were engaging with them periodically it was in between undertaking other tasks. Most of the service users at the home require continual assistance and guidance to focus and undertake any activity or task. This issue needs to be addressed and a requirement has been made. Staff were seen to be respectful of the service users’ privacy and dignity and most of the staff on duty were seen to be inclusive on interactions within the home. However as documented at the previous inspection it was observed that some of the care staff at the home were non-communicative towards the service users and displayed little evidence of meaningful interaction. The service users have unrestricted access throughout most of the communal areas and are escorted by staff members into the kitchen and dining room area, as these are areas of risk. Service users can choose when to be alone or in company, and when not to join in activity. Staff respect the private space of the service users. Any restrictions are documented in individual plans and rationalised. The service users are encouraged to undertake tasks within the home. The inspectors spoke to the cook and witnessed her cooking the midday meal and preparing the evening meal ready for heating and serving by the carers. The cook encourages a very healthy diet using fresh meat and vegetables; there is plenty of fresh fruit available. Currently there are no special diets, ethnic or cultural needs to cater for but the cook will provide for The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 16 these whenever necessary. Service users likes and dislikes are taken into consideration when planning meals and the cook has developed an awareness of service users preferences. All service users eat their meals in the communal dining area assisted if necessary by a carer. The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 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 home provides appropriate personal care for the service users promoting control over their lives. The home needs to provide adequate health-care for the service users to ensure health and welfare of the service users is maximised. EVIDENCE: From talking to the care staff it was established that some do have a good knowledge and understanding of the service users and personal care and support is given to meet the needs of the individuals. Since the last visit the ratio of female to male staff is now balanced. The staff now have 7 female staff and 6 male therefore service users personal care can be tended to by a person of their own gender. Routines are flexible and this was evidenced in the daily records and in the care plans. Each Service User has a key worker to ensure consistency and continuity. All the of the service users have now been referred to the consultant from the local learning disability team and are in the process of attending appointments. Hopefully this may lead to further intervention from other specialist from within the learning disability team. Some of the members of the learning disability team were asked if they had any in-put or contact at the Goodwins. They reported that there had been previous in-put at the home when behavioural plans and O.T plans had been developed apparently these plans had not been implemented by the staff and The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 18 went missing, further copies have been sent to the home but there was no evidence of them in the service users files. The home needs to try and reengage with this service, as it would offer direction and guidance to staff when interacting and planning for the needs of the service users. Service users do require more support from out-side specialist services and this is an area that the manager needs to develop. The home reported that all service users now have regular appointments with their G. P and ensures that the service users have access to healthcare facilities and routine checks are carried out frequently. All service users health care needs are monitored and they are referred to professionals when necessary. A member of staff accompanies service users when they are attending appointments and visits from healthcare professionals are conducted in private. A medical report sheet is maintained by the home to evidence dental, chiropody, G.P. and other health care appointments. None of the current service users are able to administer and control their own medication. The home uses the Boots Monitored Dosage system and two members of staff administer all medication. The records of medication administration were all in order. Medication was seen to be stored correctly. Comprehensive notes of each service users medication, noting the reason for use and the possible side effects were witnessed in the service users care plans. At present there are no controlled drugs prescribed by the home. The manager has now developed protocols for the administration of P.R.N medication and there is guidance in place. There should be evidence to show that the G.P or prescribing person is in agreement with the written protocol. 2 large tubs of a topical cream were also found in a bathroom cupboard. Staff explained that they apply this to service users skin if any redness appears. This is not good practise. If service users have skin problems then they should be assessed by the district nurse or G.P and individually prescribed topical creams, which then need to be stored appropriately. This was discussed with the senior carer who disposed of the cream at the time of the visit. The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 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 The home has a satisfactory complaints procedure, which protects service users EVIDENCE: The home does have a satisfactory complaints procedure in place clearly outlining the different stages for making a complaint, and how to contact the Commission. A copy of the procedure is available in the staff office and there is also a copy on display in the hallway. The staff spoken to are aware of what to do should they have a complaint and know what action to take if their complaint is not satisfactorily dealt with. The home has not received any complaints since the last inspection. The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26, 27,28,30 The standard of the environment within this home has improved. The home needs to continue with its on-going maintenance and refurbishment plans so as to create an environment that is homely and comfortable. EVIDENCE: The premises are suitable for the stated purpose of the home and in keeping with the local community. Since the last inspection the company have produced an action plan with regards the on-going refurbishment and redecoration of the home. It needs to be ensured that improvements are on going and maintenance and redecoration continue. Since the last inspection some of the up-stairs bedrooms have been redecorated and refurbished and are now more individualised and inviting. Staff reported that some service users now like to spend more time in their rooms. 2 of the bedrooms have had new flooring; one of these rooms now has a strong odour. Staff think this may be due to sealant/glue used and hope that over time it will fade. This does need to be monitored. One of the downstairs bedrooms still needs attention to an area in the corner between the cornice and the picture rail. The spare room has been totally redecorated and a prospective service user is coming to view it. The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 21 The downstairs toilet and bath have been replaced and the walls partly tiled, however an old sink and cupboard have been left in; these do need to be replaced as well. Toilets and bathrooms are now clean and fresh. Generally the standard of cleanliness throughout has improved and the home is better cared for. Cleaning rotas are in place and service users are encouraged to clean their own rooms with assistance from staff. The lounge area is being improved and is now more homely and comfortable. The service users spend a lot of time in this area. Redecoration and refurbishment now needs to take place in the dining room and kitchen. A recent inspection by environmental health on the 18/07/05 highlighted that kitchen cupboards were old in need of replacing, fly screens are required for the doors and windows and that the area behind the fridge required cleaning. Although cleaning rotas are in place they do need to be more specific and offer more direction to staff. Care staff at the home still do not have safe place to store personal belongings. The washing machine and tumble dryer have been replaced and the laundry room re-decorated. Staff are aware of infection control procedures and soiled linen is washed appropriately at the required temperature. This was an immediate requirement at the previous inspection and this standard has now been met. The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35, All the staff at the home do not have the competencies, training or skills to meet all the needs of the service users leaving them potentially at risk. Staff moral is low, which affects the care delivered to the service users. EVIDENCE: Not all the standards in this section could be looked at, as the staff on duty were unable to access some information It was observed at the visit that some of the staff at the home were approachable and accessible to the service users and could communicate effectively, however it was also observed that some staff did not have these skills and just sat and watched service users or engaged in their own activity. Some of the staff need to obtain further skills and knowledge in order to prioritise the needs of the service users. They also need to have the interest motivation and commitment to want to work with and meet the needs of this client group. The manager must be able to evidence that all the staff have the competencies and qualities to meet the needs of the service users. There has been a significant improvement in the number of staff undertaking NVQ training. The home employ 13 care staff, 4 staff have now completed their NVQ level 2 training and 4 staff are in various stages of the training. If the home retain their present staff group they should have achieved the 50 by the next visit. The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 23 During the visit a number of staff were spoken to. Their reports and views on the home were varied and conflicting at times. Some thought that it had improved since the appointment of the new manager some thought that it had not. Some said that the team are now working well together others claimed that there was conflict and ‘back-biting’ within the staff group. All of the staff felt that there was now more direction and leadership. Staff also reported that there was not enough staff on duty at any one time to meet the needs of the service users. Staff reported that they would like to be able to do more and take the service users out regularly but at the moment it was not possible. This was evidenced at the time of the visit, when there was 5 staff on duty. 2 staff took 3 service users to the day centre. 1 service users requires 1 to 1 input, 1 member of staff did cleaning duties, which left 1 staff member with 3 service users with complex needs. It was observed that it was not possible for the staff member to undertake any fulfilling activity with these service users. If a service users then required personal care the member of staff had to be called from up-stairs to assist. Potentially this could leave other service users at risk and leaves them without the required level of support and input. In the evening and at weekends care staff also undertake cooking duties. On afternoon shifts during the week there are usually only 4 staff on duty (except on a Wednesday when there is extra member of staff to allow 2 service users to attend a local disco) For the remaining days service users are not able to go out in the evening due to low staffing levels. It was also evidenced that these concerns had been discussed at the most recent staff meeting. The above has subsequently been discussed with the manager and area manager of the home. They are going to ways in which staff can make better use of their time and how to be more structured in using the time effectively. The inspector was informed that the present staffing levels within the home meet the needs and requirements of the service users. The home is actively trying to recruit more staff. Staff are still working extra duties to cover shifts and some staff reported that moral is low amongst the staff group, some reported that they feel unsupported and undervalued by the company. All new staff employed by the home undergo their induction training through the Learning Disability Award Framework. The numbers of staff members who have received mandatory training has now increased, the Manager needs to ensure that all mandatory training has been received by staff within the required timescales and that it is up to date and on going. Quite a few members of staff had not yet received infection control training but the relevant courses have been organised. The staff at the home do require more specialist training to enable them to meet the needs of the client group at the home, especially with regards to providing structured activities, The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 24 communication, improving social skills and team building. The home was now able to produce an up-to date training matrix for each staff member so that any training gaps can be quickly identified and appropriate action taken. . The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 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): None of these standards were inspected at this visit, as the inspector was unable to access the information required. They will be looked at during the next visit. EVIDENCE: The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X 1 3 1 X 2 LIFESTYLES Standard No Score 11 1 12 1 13 1 14 1 15 3 16 1 17 Standard No 31 32 33 34 35 36 Score X 1 1 X 1 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Goodwins Score 1 3 3 X Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000065342.V249021.R01.S.doc Version 5.0 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 Regulation Requirement The home needs to ensure that service users are enabled to engage in local, social, and community activities and that the local learning disability team or other specialists are involved in their care. An individual programmes of activities need to be organised for each service users and the home needs to implement it Staff need to ensure that they talk to, interact and involve service users in conversations and daily activities. The manager needs to access more specialist input and interventions for the service users. Outcomes of the interventions/programmes of care need to be documented and acted on. (Outstanding requirement from the previous inspection.) The kitchen and the dining Version 5.0 Timescale for action YA11YA12YA13YA14 16(m)(n) 30/11/05 2 YA16 12(4)(a) 30/10/05 3 YA18 13(1)(b) 30/11/05 4 YA28 23(2)(b) 30/12/05 Page 28 The Goodwins DS0000065342.V249021.R01.S.doc room need improvements and redecoration 5 YA28YA28 23(3)(ii) The staff require safe storage facilities for their belongings. (Outstanding requirement from the previous inspection. Timescale of the 30/06/05 not met.) All staff at the home need to be accessible and approachable and exhibit good communication skills so as to enable them to meet the needs of the service users. . (Outstanding requirement from the previous inspection. Timescale of the 30/04/05 not met.) There needs to be an effective staff team on duty at all times who have the complimentary skills (especially in time management) to meet the needs of the service users. The staff group need to feel supported and valued. (Outstanding requirement from the previous inspection. Timescale of the 31/03/05 not met.) The home needs to ensure that all mandatory training is up-to date and on-going. The staff also require specialist training, support and guidance to meet the complex needs of the service users (Outstanding requirement from the previous inspection. Timescale of the 31/03/05 not met.) 30/11/05 5 YA32 18(1)(a) 30/12/05 6 YA33 18(1)(a) 30/10/05 7 YA35 18(1)(c) 30/12/05 The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA30 Good Practice Recommendations To ensure 6 monthly reviews are organised and any changes reflected in the service users care plan Cleaning rotas need to be more specific and directive to ensure all areas of the home are kept hygienically clean. The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 30 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Goodwins DS0000065342.V249021.R01.S.doc Version 5.0 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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