Inspection on 17/01/07 for The Green

This inspection was carried out on 17th January 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Green 04/12/08

The Green 09/02/06

The Green 18/05/05

The Green 01/03/05

The Green 09/09/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Pinta

Kestrel House, St Anne`s Opportunity Centre,

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

CARE HOME ADULTS 18-65 The Green Ravenswood Village Nine Mile Ride Crowthorne Berkshire RG45 6BQ Lead Inspector Stephen Webb Unannounced Inspection 17th January 2007 10:15 The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Green Address Ravenswood Village Nine Mile Ride Crowthorne Berkshire RG45 6BQ 01344 755568 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) green@norwood.org.uk bucketsandspades@norwood.org.uk Norwood Ravenswood Ltd T/A Norwood Mrs Christine Terry Care Home 15 Category(ies) of Learning disability (15) registration, with number of places The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th February 2006 Brief Description of the Service: The Green cares for 15 adults with learning disabilities. It is set in Ravenswood Village, which is a community operating within the Jewish faith, although it also caters for non-Jewish residents. At the time of inspection, 13 out of the 15 residents were from the Jewish faith. The home is unique in that it is a complex of individual flats built around a green, with a separate building that provides the communal facilities of the home, including the lounge and dining space, laundry and kitchen. All of the flats are individually personalised to reflect the interests and preferences of the residents and they are large enough to be a bed-sitting room. Residents have their own shower/toilet within their flat, and have a front-door key. Most residents have their own mini-fridge and tea/coffee making facilities, as well as television and audio equipment. The home has a dedicated vehicle and residents are able to access public transport as appropriate. The current fees at the time of inspection were from £39,000 to £67,644 per annum. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit from 10.15am until 7.00pm on 17th of January 2007. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with three of the residents, the manager and brief conversation with staff members. Written feedback was also obtained from the family of one of the residents, a healthcare professional and five of the residents (supported by staff/speech therapist). The inspector examined the communal areas of the premises and two of the flats, and ate lunch with residents, as well as making informal observations of interactions between staff and residents at various points during the inspection. The residents are being encouraged to have an increased involvement in the day-to-day household routines, and to make daily choices and decisions for themselves, with support and prompting by staff. What the service does well: Residents/their relatives receive appropriate information about the home and an appropriate pre-admission assessment system is in place. Care plans reflect the needs and wishes of residents and case records are thorough. Residents are encouraged to take part in decision-making in their lives and in the day-to-day tasks in the home. Residents have opportunities to engage in lots of activities both on and off-site, and also have education and employment opportunities. They are encouraged to maintain contact with family, and residents without family contact have befrienders. Relationships between residents are supported, reflecting their status as adults, and their dignity and rights are also respected in other areas. A healthy diet is provided and residents have opportunities for involvement in the planning of menus and the preparation of meals. Residents are supported to use their chosen methods of communication and their healthcare needs are addressed effectively. Medication is appropriately managed by the home. There are a range of ways for residents to raise any concerns they may have including a village-wide residents’ forum. Staff are appropriately trained in the The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 6 protection of vulnerable adults, and the home has an appropriate and flexible system for managing residents’ finances. The home is maintained appropriately and decorated satisfactorily. Residents are supported by a competent team of staff who receive good core training and staff are appointed following an appropriate vetting process to protect residents. The home is well run and has an experienced and competent management team in place. The health, safety and welfare of residents is promoted and protected. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents/their representatives receive the necessary information to enable them to make an informed choice about moving to The Green, although the service user guide would benefit from review. The needs of prospective residents are appropriately assessed ahead of them moving into the service. EVIDENCE: The home has a statement of purpose and a service user guide, although the latter contained some out of date information, and would benefit from review. The manager has an up-to-date copy of the statement of purpose on computer, and this document is regularly reviewed. The service user guide does include a copy of the complaints procedure in symbol format. The majority of the current group are long-standing residents, whose assessments would have been done to a previous format, but one resident transferred to The Green from another unit within the “village” in June 2006. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 9 The resident had previously lived at The Green and had transferred out, but wished to return. An appropriate transition process took place, including initial meetings between unit managers and the care manager, followed by a planned reintroduction over a number of visits including overnight stays, and a review was undertaken a few weeks after the move. A copy of the assessment was on file. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Detailed individual information on the individual preferences, likes and dislikes of the residents around how they are supported is included within the individual “All About” booklet for each resident. These booklets also include detailed care plan sheets, with individual staff signature sheets to maximise consistency and detailed support guidelines with review sheets. Relevant risk assessments were also part of this booklet, together with a quarterly review sheet which had been recently introduced. Where necessary, a log of specific incidents or behaviours being monitored is established to evidence the success or otherwise of the planned intervention. This is good practice. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 11 There is also an individual copy of the service user guide and contract, and a new “My Health” booklet has also been introduced. Each resident also has an individual daily diary, where day-to-day notes are recorded, together with other relevant information. It may be that these various formats can be further simplified to avoid the risk of duplication, and the management might wish to keep this under review. The case record files were indexed and orderly, enabling information to be found readily. They contained a set of standard documents including an individual profile (dated and signed by the author), individual timetable of regular planned activities, a keyworker checklist, a record of individual aims and objectives as agreed at review and copies of individual healthcare appointment record sheets. The deputy manager had devised an IP management schedule to support keyworkers in planning between reviews and a copy was on each file. The deputy was keen to further streamline the recording systems to free the staff to spend as much time as possible supporting the residents, whilst ensuring that the records provided readily available information when needed. There was good evidence of ongoing systems management and review by the management team to enable them to effectively oversee the delivery of care. Copies of the most recent review (in 2006) were present in the three tracked files. In the case of the most recent admission, a copy of the pre-admission assessment was also present. In one case there was also a copy of the review of the specific behaviour management plan which had been put in place, indicating good progress and agreement that there was no longer a need for the planned intervention to be used due to its success in changing the behaviour. Each resident also has a background file, used to archive older and confidential documents, which is held in the manager’s office but remains available to the keyworker should they need it. Examples of residents deciding how/where they wished to spend their time and making other day-to-day choices were observed during the inspection. It was evident that residents have a high degree of freedom, and they can freely access their friends in the other flats or units. Residents have been consulted regarding colour schemes when their flats are redecorated, and have individualised arrangements for supporting their access to their funds. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 12 Staff demonstrated their understanding of the communication strategies used by individual residents, and were able to support them, via their chosen method, to make their views and wishes known. The care plan documents also included reference to encouragement and prompting by staff and other indications of residents being supported to do as much for themselves as possible. The Green DS0000011334.V328002.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, 14, 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. Residents have opportunities to engage in a good range of activities and events, both on and off-site, and have regular access to events in the community. Opportunities for involvement in employment and education are also provided, both on and off-site. Residents are encouraged to maintain links with family wherever possible, and those without family have befrienders. Appropriate relationships between residents are supported, reflecting their status as adults, and their dignity and rights are also respected in other areas. Residents receive a healthy diet and have opportunities for involvement in the planning of menus and meal preparation. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 14 EVIDENCE: Individual diaries and timetables of regular activities indicate involvement in a good range of activities within the home, the village community and outside in the wider community. Residents can choose whether to engage with the group or spend time in their own private space within their own flat. Observation during the inspection indicated that a number of residents enjoyed using the communal facilities and spending time with the staff, and two residents confirmed that they could spend time alone when they wanted. The communal facilities are not available after 10pm when the waking staff go off duty, but each resident has their own TV and hi fi, etc, and can stay up in their flat after this. Residents confirmed that there were opportunities for employment and college attendance as well as for attending activities, and that holidays at home and abroad had taken place. Holidays are either individual or in small groups where they share the same interests. One holiday per year is paid for from funding, and any subsequent trips are paid for from the resident’s accumulated savings. A wide range of overseas holidays had been undertaken, including fundraising trips on behalf of the organisation to a variety of countries. Eight of the residents attend sessions at two local colleges, two have part-time paid work off-site, and one volunteers at a local stables. Various opportunities are also available for therapeutic or paid work within the “village”, including post delivery, office work, grounds care, kitchen, coffee shop, stables, cleaning and distributing flowers to the units. Thirteen of the fifteen current residents are of the Jewish faith, and their needs are provide for across all aspects of the service. There is a Synagogue on site in the “village” for worship. Two of the residents have no identified spiritual needs, but arrangements would be made for these to be met should alternative provision be needed, as it is for other residents across the village. Residents are supported by the staff to maintain contact with family via the telephone or by letter. Three of the residents have no family contact, but do have befrienders who may also act in an advocacy capacity, and one has only occasional visits from family. The others have regular family contact through a mixture of visits, letters and e-mail. On occasions staff have also provided transport to support family visits, and they take one resident to the airport when they fly to stay with family several times per year. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 15 The relationships between staff and residents were reported to be very positive for the most part, and where any difficulties arise, the staff support residents to resolve these. The observed interactions between staff and residents demonstrated respect and staff offered support and guidance where necessary, with respect for the dignity of residents. Consenting relationships between residents in the ”village” are also enabled and appropriately supported. Residents have a greater degree of independence, via the provision of separate flats, than they might within a more traditional residential unit, and each has their own front door to which they have a key. Residents are encouraged to clean and tidy their own flat, although the standard of hygiene is monitored. Residents are able to move about freely within the “village” but most are supported by staff when they go off-site. All meals taken on site are provided within the context of a kosher diet and the Rabbi visits periodically to monitor that this and other aspects of the Jewish faith are observed appropriately. Residents help themselves to breakfast of their choice in their own time, with any necessary support or encouragement from the staff. It is positive that the unit no longer takes any meals from the village’s central kitchen, preferring instead to prepare all meals within the unit’s kitchen, as this allows menus to reflect the preferences of the resident group more effectively, and provides opportunities for resident involvement. There is a focus on using fresh ingredients and providing a healthier diet, and some residents take part in aspects of food shopping (although the main shop is via supermarket delivery) and meal preparation. One resident in particular helps prepare the Shabbat meal every Friday. Residents are involved in helping to plan the weekly menu. The main meal of the day is at lunchtime and was seen being prepared by a staff member during the morning of the inspection. The meal was healthy, tasty and well presented, comprising salmon fillets with fresh vegetables and the option of a parsley sauce. Residents clearly enjoyed the meal, and the mealtime was relaxed and flexible to suit the needs of the individual residents. At the time of inspection the “homemaker” post, who would take the lead on meal preparation, etc, was vacant, and care staff were covering this. The Green DS0000011334.V328002.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 good. This judgement has been made using available evidence including a visit to this service. Residents are supported effectively by staff and are enabled to communicate how they prefer this to be provided. The physical and emotional health needs of the residents are effectively addressed. An appropriate medication management system is in place to protect the residents. EVIDENCE: The support observed by staff was appropriate and respected the dignity of individuals. Considerable warmth and humour were evident from residents and staff and interactions were relaxed and calm. Staff showed flexibility in their approach, and demonstrated their familiarity with residents’ individual communication techniques. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 17 Residents were offered options, encouraged to make choices and decisions for themselves and prompted where appropriate. Around half of the residents need some support and prompting with aspects of personal care, and the others manage this with little need for staff intervention most of the time. Although the unit does not have waking night staff, there is an emergency call button in each flat by which a resident could summon the assistance of the staff member sleeping-in if they needed help. There were good records of instances where planned interventions had been used in response to challenging behaviour, to record the frequency and effectiveness of interventions and facilitate effective review of these. Residents receive support from a speech and language therapist where necessary to develop an understanding of their individual communication strategies, in order to enable them to communicate their wishes, and the staff have received training on these methods. The speech therapist also attends four staff meetings per year to provide support to the staff and discuss any communication issues. Individual programmes are established where necessary to provide a clear and consistent system of communication. Healthcare records were in good order and included a collective summary sheet for recording the dates of appointments with the GP, district nurse, dentist, dietician, optician, chiropodist, etc, as well as individual sheets to record the details and any resulting issues. None of the current residents was able to manage their own medication, although some are encouraged to administer their own creams. An appropriate medication management system was in place, which included records of the quantities of medication received, confirmation of administration and details of any returns, which provides an appropriate audit trail. The Green DS0000011334.V328002.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 views and concerns of residents are listened to and there is an appropriate complaints procedure in place as well as an independently chaired residents’ forum, where residents from across the “village” can express their views. Systems are in place to protect residents from abuse, etc, and an accredited trainer provides training to staff on the protection of vulnerable adults. A good system is in place to protect residents’ finances. EVIDENCE: The service has a written complaints procedure, which is available within the service user guide in symbol format. The manager indicated that the procedure is discussed periodically within residents’ meetings as a way to encourage individuals to raise anything about which they are unhappy. Basic information about any complaints is recorded in the complaints log. A complaints form is also completed and retained in a separate file by the manager, with any related correspondence or confidential information. There was only one recorded complaint since the last inspection, from a resident in a neighbouring unit, which appeared to have been resolved appropriately. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 19 Two of the residents spoken to confirmed that they were aware that they could complain to the manager if they were unhappy about something. Three of the residents who were supported to complete inspection questionnaires also confirmed this, but two were unclear about this. The service has a residents’ committee (externally chaired) that meets monthly, and one resident from The Green attends regularly. This would be another forum where any concerns could be raised. The service has an appropriate policy regarding the protection of vulnerable adults (POVA), and where an issue arose outside of the unit itself, this was recorded and referred to the appropriate agencies. Most of the staff have received POVA training as part of induction training and updates are provided by a qualified external trainer from a local unitary authority, on a three year cycle. This is good practice, although it is suggested that some in-house refresher training on POVA could be offered on an annual basis in between the external events. Examination of the individual training records for staff confirmed that all staff had received POVA training and, where the refresher training was due for one staff member, they had been booked on the next available course. The manager had also undertaken a two-day advanced course on adult protection in 2006. Where there are concerns about the behaviour of an individual resident towards others, the advice of the in-house behavioural psychologist is sought and planned interventions devised to address instances of the negative behaviour. The effectiveness of the intervention is then monitored and reviewed over an appropriate period. This is good practice. The home manages finances on behalf of the residents. Each resident has an individual building society account and staff will accompany individuals to the building society for them to withdraw regular amounts. The building society books are kept in the safe. Residents who are working may have their wages paid into this account or may receive them directly. There is an individual log book for each resident where monies in and out of the building society and individual cash tins are recorded, and a running balance is recorded. Some residents are given sums of money to hold, where they are able to manage this, whilst others can request money as and when they need it. All monies in and out are signed for and receipts are retained, cross-referenced to the log entry. The financial logs for the three tracked residents were examined and found to be in good order. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 20 Two seniors undertake monthly audits of the logs and cash tins and there are also periodical audits by auditors on behalf of Norwood. The Green DS0000011334.V328002.R01.S.doc Version 5.2 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. 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. Residents are provided with a homely and safe environment, and have the option of spending time with others, or alone in their flat. The individual flats are decorated and equipped to reflect the wishes of their occupant. The home is maintained in a clean and hygienic condition, with residents being encouraged to take appropriate day-to-day responsibility for cleaning, and overall management monitoring of basic standards. EVIDENCE: The layout of the unit is unusual, with 14 separate flats (one of which can be shared by two residents) each with its own shower/toilet provided, arranged around a green, with a separate communal building providing a large lounge-dining space, kitchen, laundry, toilets and a staff office. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 22 Outside the communal building is a seating area, which is a popular congregating point in good weather. The communal building is the hub of the service, where residents can meet together, socialise and come to see the staff. There was a good atmosphere in this area, with quite a lot of coming and going by residents. The building provides opportunities for activities as well as being equipped with two televisions where residents can choose to watch TV together. The manager felt that the large open-plan communal lounge-dining space would benefit from being divided up, perhaps to provide a separate quiet area and also to enable better separation of different activities. The dining area was attractively decorated and furnished, although it would perhaps benefit from some division from the remainder of the large open-plan area, as any visitors during the mealtime come into the dining area to access either the office, kitchen or laundry. The toilets either side of the front door were both in need of redecoration to bring them up to the standard of the rest of the environment. Individual flats had been decorated in consultation with their occupant, and were personalised by them, including the purchase of ornaments, posters, lamps, etc, as well as souvenirs from holidays, family photos and certificates of achievement from college courses and fundraising events. Each flat is provided with a kettle and small fridge for milk, unless a risk assessment indicates this to be inappropriate. Residents have their own TV and CD player. Where residents are hard of hearing, a flashing fire alarm warning is provided within the individual flats, although it was reported that, at present, all of the residents were able to hear the alarm sounding. At the time of inspection few additional aids were required to meet the needs of residents, but this may need to be considered in the future. The flats were all satisfactorily decorated and the older shower enclosures were being enlarged on a rolling programme to make them more pleasant and less cramped. Three remain to be converted and this should be prioritised as the resulting improvement is significant. Residents have a front door key to their own flat. The laundry facilities were good, and each resident is supported/encouraged to undertake their own laundry weekly. Standards of hygiene throughout the buildings were good. The residents are responsible for cleaning within their flats, although monitoring by senior staff takes place to ensure that basic standards are maintained. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 23 Residents are encouraged to take part in cleaning and other responsibilities within the communal areas. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 24 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 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by a competent staff team who receive a good foundation and core training and then go on to undertake NVQ unless they have an equivalent qualification. The recommended frequency of fire safety training updates should be clarified in writing with the fire authority. Residents are protected by the recruitment and vetting system operated. EVIDENCE: Staff were observed to interact appropriately with residents, with the emphasis being on encouraging their active participation in daily decisions and tasks, but there was also evident warmth and humour in these interactions. There was a sense that the unit was a happy place. One resident said they felt safe and very much at home in The Green. One regular visitor from another unit in the village also said he was made very welcome. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 25 Staff indicated that there was a good training programme in place. On appointment an organisational induction takes place followed by induction and foundation training over the next six months. Once confirmed in post, new staff will then commence on their NVQ. The management team is well qualified and experienced, and the team is a stable one with only one staff having left since the last inspection. Around 80 of staff have NVQ Level 2 or equivalent, or above. The remaining staff are still undertaking their LDAF foundation. As noted earlier there was only one staff vacancy at the time of inspection, for a homemaker, responsible for food ordering leading on catering and kitchen health and safety. The post had been advertised and short-listing was imminent. One care support worker post was technically still not covered as the person had yet to transfer from another unit in the village, but had been appointed. The use of agency staff is low although it was not easy to identify the agency staff from the rotas supplied. Ideally agency/bank staff should be clearly identified in some way on the rotas. Staff receive a good core training, with a three year cycle between training updates for most courses. This is rather a long period, in areas such as fire safety training, which might be better provided annually. Challenging behaviour intervention training is, however, updated annually. The appropriate frequency for fire safety training updates should be clarified in writing with the fire authority. Examination of a sample of two recent recruitment records (held centrally by personnel, but available on request) indicated an appropriate vetting process and retention of records to evidence this. Written references are verified by telephone. CRB check numbers are recorded, together with a record of whether any convictions were present. Records of interview are also retained which would enable checking of the interview process. Although there is no confirmation within the recruitment file of a POVA check having been requested, this was indicated within the new computerised database. It was confirmed that POVA/POCA checks were requested on all appointees. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 26 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 good. This judgement has been made using available evidence including a visit to this service. R Residents benefit from a well run home with an experienced and competent management team in place. Although residents have access to the residents’ committee and the Regulation 26 monitoring visitor, the provider has yet to establish a quality assurance system to seek the views of residents, relatives and other relevant parties about the service provided, in a systematic way. The health, safety and welfare of residents is promoted and protected for the most part, although the provider should ensure that all health and safety-related servicing, etc, is undertaken with the correct frequency. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manager has extensive relevant experience, and has completed her NVQ Level 4 and Registered Manager’s Award. She also has an Advanced Management in Care qualification, a City and Guilds teacher training certificate and is an NVQ assessor and internal verifier. The manager keeps up to date via attendance at various training and other events, including a recent two-day vulnerable adults course. She is clear in her expectations and is supported by a competent management team within the unit. The manager has a three year development plan in place, written in November 2006, which identifies a number of future priorities for the unit, given the planned changes within the “village” and the possible increased future needs identified in the resident group. The views of residents and other relevant parties should be obtained on any proposed changes to the service. As yet, no quality assurance survey has been undertaken and the provider is still developing the required quality assurance system. A senior management team is reported to be currently working on developing this system, which should be put into operation as soon as possible. It is suggested that provision be made for residents to be supported to complete their questionnaires, where necessary, by an external advocate or other person from outside of the unit. A summary report should be produced of the findings of the quality assurance survey which should indicate the proposed actions in response to any issues raised. The report should be made available to participants and other interested parties. The provider does have a system of lay monitor visits, usually parents of service users, who undertake quarterly visits during which they speak with residents and staff, and produce a report of their findings, although the reports are not made public. Residents also have access to the monthly residents’ committee, which is independently chaired. The provider undertakes regular monthly Regulation 26 monitoring visits to the unit, which are reported upon. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 28 The reports often do not include much detail of the feedback and observations regarding the care of residents and their comments, and it is suggested that this aspect be expanded, since it is understood that the visitor does spend time with residents and staff during most of these visits. Within the unit, the manager also undertakes quarterly management checks, including a quarter of care files and required records in rotation on each occasion. This is good practice. The building risk assessment had been signed by the staff, which is good practice, and a fire risk assessment for the unit, dated 11/06 was also in place. The fire evacuation procedure was satisfactory and was posted in the unit as well as being available to residents in symbol format. The most recent fire drill indicated appropriate responses from all residents, although some individuals had been reluctant to evacuate on previous occasions. If such problems are ongoing, individual fire evacuation guidelines for those residents should be devised, outlining the actions to be taken by staff. These should be approved by the fire authority. Examination of a sample of health and safety-related service certification indicated that servicing was up to date and regular for the most part, although the five-yearly electrical wiring examination was overdue and the most recent certificate for servicing of the fire extinguishers was not present on file. It was confirmed from the extinguishers that a service had in fact taken place in December 2006. Records indicated that the wiring check had been requisitioned in late in 2006, but this had yet to be undertaken, and should be pursued as it is a health and safety matter. Accident and incident records are filed together as a collective record (although separated by resident within the file), and copies of accident forms are also filed on the individual resident’s archive files. It is, however, suggested that staff are reminded of the importance of indicating whether a form relates to an accident or incident, as this enables more effective monitoring, given that the forms are filed together. There is also an individual accident summary sheet where an entry is made each time there is an accident to a resident. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 29 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 X The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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 YA39 Regulation 24 Requirement The provider must establish an appropriate quality assurance system to seek the views of relevant parties about the operation of the home, in a systematic way, and make available a summary report of the findings of the survey. Timescale for action 17/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA24 YA24 YA35 YA42 Good Practice Recommendations The conversion of the remaining three showers should be prioritised to bring them up to the same standard as those which have already been converted. The toilets either side of the front door should be redecorated to bring them up to standard. Written confirmation should be sought from the fire authority regarding the appropriate frequency for staff fire safety training updates. The overdue testing of the electrical installation should be pursued as a health and safety matter. The Green DS0000011334.V328002.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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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