Inspection on 09/01/08 for The Legard

This inspection was carried out on 9th January 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

The Legard 10/02/09

The Legard 16/01/07

The Legard 16/03/06

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

Pennine Camphill

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

CARE HOME ADULTS 18-65 The Legard Wivern Road Holderness Road Kingston upon Hull East Yorkshire HU9 4HU Lead Inspector Christina Bettison Key Unannounced Inspection 9th January 2008 09:30 DS0000065035.V357543.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 DS0000065035.V357543.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. DS0000065035.V357543.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Legard Address Wivern Road Holderness Road Kingston upon Hull East Yorkshire HU9 4HU 01482 781039 01482 781008 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) londonroad@tiscali.co.uk Milbury Care Services Ltd Kerry Ann Shepherd Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places DS0000065035.V357543.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Physical disability - Code PD The maximum number of service users who can be accommodated is: 8 16th January 2007 2. Date of last inspection Brief Description of the Service: Milbury Care own and manage The Legard. The home is registered to provide care and accommodation for up to 10 adults between the ages of 18-65 who have a learning disability and may also have physical disabilities. The home is located to the east of Hull city centre and is purpose built. The main home has eight single bedrooms, four upstairs and four downstairs. Bedrooms are paired together, each pair separated by a fully equipped disabled bathroom, each bedroom having individual access from either side. The upstairs bedrooms are set in two apartment-style living arrangements, each with a lounge and kitchen to promote independence living. There is an office, large hallway, kitchen/dining room, laundry, sensory room and shower room downstairs. Upstairs is an activity room and staff sleep-in room. There is wheelchair access throughout and a platform lift providing access to the upstairs accommodation. The home has a large garden to the side and rear. There is a car park area to the side with additional street parking. At the time of inspection there were 8 people living at the home. Fees are between £1500 and £1800 per week depending on a person’s care needs. Information about the home is available in the home and the company’s offices. DS0000065035.V357543.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The site visit took place over 1 day in January 2008. Surveys were posted out prior to inspection; nine were returned from relatives and advocates, five were returned form professionals that visit the home, eight returned from staff and four returned from people who live in the home. The Registered manager, and all of the staff who were on duty on the day of the visit were spoken to and all of the people who live there were seen. The interactions between staff and the people who live in the home were observed to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. The inspector looked around the home and looked at records. Information received by us over the last twelve months was considered in forming a judgement as part of the inspection process. Prior to the visit the inspector referred to notifications sent to the Commission for Social Care Inspection, the event history for the home over the past year and the completed Annual Quality Assurance Assessment all of which forms part of this inspection. The site visit was led by Regulation Inspector Mrs T Bettison, the visit lasted 8 hours. What the service does well: The people that live in the home and their relatives are provided with information that is easy to read so that they know what to expect from the home. Relatives told us “They look after …………….. well being allowing them to live as independently as possible. They allow opportunities to socialise with peers.” “……….is very happy and has no complaints. He lives as independently as he can and has all the support and assistance that he needs.” People who might like to live at the home are able to visit and stay overnight to help them to decide if the home will be able to meet their needs or not. DS0000065035.V357543.R01.S.doc Version 5.2 Page 6 All of the people that live there have a plan of care that help staff to know what their needs are meet them, this includes some health needs. Health professionals told us“The staff are always helpful at reviews and support the clients very well with clinic appointments. They are quick to note and report any changes in needs.” “My impressions are “good” the patients appear well cared for and the carers have good knowledge of their residents, my instructions and recommendations are followed as evidenced by the improved health of the patients.” People that live in the home are treated as individuals and opportunities for activities and outings are provided. All of the people have a single room that is nicely personalised to their own taste, providing them with a private area to their liking where they can spend private time or receive visitors. Relatives are very involved in the home and are made to feel welcome; staff assist people to visit their relatives making sure that family can keep in contact. Relatives told us “we always feel welcome to visit at any time”. The people who live in the home and their relatives concerns are listened to and staff make sure they take action to sort problems out quickly. Relatives told us “I often have little “witters” about things, the staff listen sympathetically and try to deal with things appropriately”. The staff are very committed and caring and treat people with respect and dignity. Relatives told us “the care staff are really dedicated to the residents and are keen to increase skills and learn new ways of doing things”. “I can only praise the staff they really do things for him above and beyond the call of duty.” “The manager and staff give their all. The interaction between staff and residents is absolutely amazing.” “The care home is a fantastic home for ……….. and I’m sure everyone else. they are always happy and loves being there, I cannot thank the staff enough for the help and satisfaction ………….. gets there.” DS0000065035.V357543.R01.S.doc Version 5.2 Page 7 A good recruitment policy is in place and staff are well trained, supervised and supported so that people are protected from harm. The home is safe, comfortable and homely and meets people’s individual needs and the kitchen is kept clean and people are helped to eat a healthy diet but also some foods that they like. Relatives told us - “the home is always clean and tidy. Much effort is put into good nutrition.” An advocate told us “I have always found staff helpful, approachable, welcoming and inclusive with the well being of service users prioritised and their views as an individual listened to and supported fully. The Legard is a warm friendly place to visit.” What has improved since the last inspection? What they could do better: All of the people that live in the home must have a detailed plan and risk assessments and they must say what staff need to do to make sure all of their needs are met so that they are protected from harm. All of the people must have a plan that details their health needs and how these will be met, this must include professional advice and recommendations. Health professionals told us “Recommendations from speech and language not followed re eating and drinking.” “Documentation not always readily available and sometimes inaccurate or unable to read.” DS0000065035.V357543.R01.S.doc Version 5.2 Page 8 People need to have an individual plan of activities/interests and records kept to show that they are happening. More staff need to be available and the second vehicle needs to be provided so that people can access the community more regularly. Relatives told us “It would be beneficial if representatives of “Voyage” attended parents meetings as, although the care staff are giving “good” care, certain elements could be better dealt with by senior management. I.e. two mini buses quoted on information documents but only one available.” “Someone from the senior management team needs to attend relatives meetings. If they could hear our views – like the mini bus issue, they would know it is not just coming from the manager.” “The home could improve by having the second mini bus as was promised when the home was set up.” There needs to be enough staff in the home so that the staff can meet the needs of the people that live there and carry out all of their duties safely. Staff told us “Sometimes working 4 staff instead of 4.5 then unable to go out as all 8 people use wheelchairs.” “Not enough staff to take service users out, 7 wheelchair users and usually only 4 staff.” “We need more staff that drive and 5 staff per shift because we have 8 service users and if we don’t have the staff we can’t go out.” “Need more staff to go out, more drivers and do more activities” Relatives told us “Consideration should be given to employing domestic help to allow the care staff to get on with caring.” “It would be nice for …………. to go out more frequently- even if it’s just for walk.” When people have medicines that are taken “when needed” the instructions for staff need to be clear when and why they can help them to take it. DS0000065035.V357543.R01.S.doc Version 5.2 Page 9 Staff employed to work in the home must be vetted to make sure they are safe to work in the home. All equipment and appliances must be serviced regularly to make sure the home is safe for the people that live there. 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. DS0000065035.V357543.R01.S.doc Version 5.2 Page 10 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 DS0000065035.V357543.R01.S.doc Version 5.2 Page 11 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): 1,2, 3, 4 and 5 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples have all the information they need so that they know that the home will meet their needs, people’s needs are assessed prior to admission and staff have the skills to meet their needs however not all of the needs had been included in the plan of care. EVIDENCE: The home has a statement of purpose and service users guide, and people who might want to live in the home and their representatives are provided with information about the home. There has been one new admission to the home since the previous inspection. The care file was examined as part of the site visit. There was a copy of the Local Authority community care assessment and care plan on file and the home had completed their own assessment. Other professional assessments had been obtained. Some of their needs had been developed into a detailed plan, however there were significant omissions and DS0000065035.V357543.R01.S.doc Version 5.2 Page 12 variations in the quality of the documentation. (See individual needs and choices for further detail) There was evidence that the person had visited the home and had overnight stays prior to admission, to test out the home. The people that live in the home all have individual packages of care funded by various Local authorities, there appears to be some ambiguity regarding the staffing numbers to be provided. In one contract examined it stated “5 staff to be on duty during waking hours as well as a full time manager off rota”, in another it stated “6 staff on duty during waking hours as well as a full time manager off rota.” It also stated that there would be provision of two vehicles. None of the above is actually provided in the home (see staffing and lifestyle sections of this report for further detail. DS0000065035.V357543.R01.S.doc Version 5.2 Page 13 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 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s basic needs are generally met however the quality of the plans needs to improve and risk assessments are very basic. These shortfalls have the potential to place people at risk and mean that all of their assessed needs may not be met. EVIDENCE: There has been some improvement in the quality of the information provided to staff to help them meet the needs of the people that live in the home since the previous inspection however there are still gaps and omissions in the quality of the plans. DS0000065035.V357543.R01.S.doc Version 5.2 Page 14 Everyone has a care file, the inspector is aware that Milbury/Voyage are in the process of introducing new care planning paperwork however this has not yet been introduced at The Legard. Three care files were examined as part of the inspection process. Although plans were detailed and informative they did not include everything that is detailed in the local authority assessment/care plan and they did not reflect people’s full range of needs. The first care file examined was for a new admission; it included a very detailed pen picture however this person has complex needs and significant health needs. The assessment completed by the Local Authority referred to following health professionals recommendations however the reports were not on file and the recommendations had not been included in the care plan meaning that staff may not be aware of all of their needs and they may not be met. This person has a PEG Percutaneous Endoscopic Gastronomy (PEG) fitted but there was no guidance for staff in how to manage and maintain this in the care plan. Their communication passport was one prepared at previous placement and did not reflect the persons communication needs in their current placement. Risk assessments had been completed for a range of issues that pose a risk including moving and assisting, fire, and epilepsy however these were of poor quality. In addition to this the person has bed side rails fitted and is at risk of skin breakdown from poor circulation however satisfactory risk assessments had not been completed for these areas, this person is also at risk of choking however the quality of this risk assessment was poor and did not specify what level of risk still remained. This person had had a review on 21/5/07 that noted that they were not going out enough and that here should be two vehicles at the service. (See lifestyle section of this report). In another care file examined it included the local authority assessment and care plan and a detailed pen picture and care plan. However the quality of the written records need to improve. Grammar was poor and some language used did not promote peoples dignity. i.e the term “nappy” was used instead of incontinence aid. This person sometimes causes themselves injury when agitated and there needs to be clear behaviour management guidelines for staff so that there is a consistent approach to managing this and safeguarding the person from the risk of harm. In addition to this we were informed of some communications that had taken place with professional people that had not been recorded. If DS0000065035.V357543.R01.S.doc Version 5.2 Page 15 information is of highly confidential nature then it still needs recording, however a procedure needs to be in place for the safe storage of confidential information. Risk assessments were in place for a range of activities that may pose a risk however significant areas of risk had not been assessed i.e. the use of bedside rails and choking. In another care file examined there was a plan that covered most identified needs however it had not been updated as needs and circumstances had changed. This person’s speech can sometimes be difficult to understand however there was no care plan or communication passport to guide staff. Risk assessments were generic and again did not include bedside rails and pressure area care. This person can on occasions present with behaviour that is difficult to manage and a behaviour management plan is required to ensure a consistent approach by staff. This person had been supported by an independent mental capacity advocate (IMCA) to take control of their own benefits and manage their own finances. This was an excellent piece of work that empowered the individual to take control of an important part of their life. All care plans, risk assessments and other guidance need to be signed and dated and reviewed and updated when needs change. Some basic health needs had been included in the plans and the Community Team Learning Disability had been approached to undertake health screening however only one person had a health action plan completed. (This is detailed further in the health section of this report) DS0000065035.V357543.R01.S.doc Version 5.2 Page 16 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 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Access to the community for people is inconsistent dependent on the needs of individuals. Inadequate numbers of staff and the provision of only one vehicle reduces the opportunities for providing stimulating and motivating activities that meet peoples individual needs, wants and aspirations. EVIDENCE: One of the people that lives in the home attends college three times a week and a social event one evening a week. Other people regularly visit relatives or their relatives attend the home and take them out. Discussion with staff and records indicated that family and DS0000065035.V357543.R01.S.doc Version 5.2 Page 17 friends are able to visit the home and can use any of the communal facilities or the person’s bedroom. There is no restriction on visiting times. People in the home have all had a holiday this year if they were well enough and we were informed that the organisation contributes £200 per person for this. We were informed that staff are keen and willing to take people out to the cinema, bowling and shopping however the inadequate numbers of staff significantly reduces the opportunities for enabling people to go out. Staff currently do all the shopping, cleaning and cooking in the home as well as provide personal care and provide activities and trips out. Due to the staffing levels people are not able to regularly pursue hobbies and interests in the home and there is little supporting documentation to evidence that people’s needs in this area had been identified, planned for and therefore met. Although there was a weekly planner to assist staff in providing activities, this was not individual and provided group activities. The majority of people that live in the home have limited verbal communication to express their choices and wishes and promote their independence. There was very little information on care files as to how the home are enabling people to maintain and /or develop new skills and how their interests and /or hobbies are being supported and a lack of records of activities undertaken. The diet and nutritional needs of people are detailed in their plan and include their likes and dislikes. The kitchen and food provision had been assessed by Hull City Council under the Food Safety Act and awarded a rating of “B” which is good. DS0000065035.V357543.R01.S.doc Version 5.2 Page 18 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 People who use the service experience adequate outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People’s health and personal care needs are generally met however they are not being not being fully identified and planned for. These shortfalls have the potential for their needs to not be met and place people at risk of harm. EVIDENCE: There was evidence that health professionals are providing some services to the people, i.e. consultant neurologist, consultant psychiatrist, community nurse and specialist nurses however needs are not being adequately identified, planned for and outcomes are not recorded in full therefore it is difficult to evidence if needs are being met. The Community team learning disability has been approached to assist in health screening however only one of the people had been screened at the time of the visit and only one person had a health action plan. DS0000065035.V357543.R01.S.doc Version 5.2 Page 19 On one care file examined the person had a range of health needs, cerebral palsy/physical needs and equipment required, visual impairment and pressure area care yet none of these needs had been incorporated into their care plan and they did not have a health action plan. In another care file the person has a Percutaneous Endoscopic Gastronomy (PEG) fitted but there was no guidance for staff in how to manage and maintain this in the care plan, in addition to this instruction from the speech and language therapist to stop using thickening agent in drinks had not been updated in the plans and a change to their emergency medication had not been amended The inspector was informed that staff were completing administration of medication training with Lloyds pharmacy, the manager provides the training, staff complete the workbooks which is marked by Lloyds and all staff had had their competency assessed. Where people are prescribed medication to be taken as and when required the home must have protocols in place to guide staff for the administration of all medication administered on a PRN basis, these need to be detailed and specify which medication, how much and if more can be administered when and how much and in what circumstances. DS0000065035.V357543.R01.S.doc Version 5.2 Page 20 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 People who use the service experience good outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People that live in the home and their relatives are listened to and the people are protected from harm by a staff team that are well trained however improved staffing arrangements and the further development of care and health plans will evidence this better. EVIDENCE: The home has a complaints procedure and policies and procedures for safeguarding adults. There had been one complaint made to the CSCI regarding the heating and water system which had not been working properly however we were reassured that everything had been done to rectify this and at the time of the visit the engineers were waiting for a part to be able to complete the repair. Temporary arrangements were in place to ensure that the bedroom that was affected was kept warm. All of the staff had received training in safeguarding adults. Examination of staff files evidenced that new staff were in the process of completing their induction and probationary period. All of the other staff had DS0000065035.V357543.R01.S.doc Version 5.2 Page 21 received a range of training that is specific to the needs of the individuals living in the home. The use of an IMCA to support one of the people demonstrates that the home is acting in the best interests of the people that live there and their rights are promoted. People living in the home were being kept safe however improved staffing arrangement and the further development of care plans, risk assessments and health action plans will demonstrate this better. DS0000065035.V357543.R01.S.doc Version 5.2 Page 22 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 People who use the service experience excellent outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The environment provides people with large, spacious, homely and comfortable surroundings in which to live, with all of the equipment provided to ensure peoples physical needs are met and independence is promoted. EVIDENCE: The environment provides people with large, spacious, homely and comfortable surroundings in which to live, with all of the equipment provided to ensure peoples physical needs are met and independence is promoted. The people that live in the home all have a single room with en suite facilities, including a bath. DS0000065035.V357543.R01.S.doc Version 5.2 Page 23 All equipment needed to meet peoples physical needs was provided, this included overhead tracking for hoists, mobile hoists, toilet, bath and shower aids, wheelchairs and one of the people had possum system which enabled them to control their lights, curtains and entertainment systems in their room easily. There are two separate apartments (upstairs), each with two bedrooms, a kitchen and lounge to share. These are aimed at promoting more independent living. Downstairs there are 4 more bedrooms, a communal lounge, kitchen/dining room, activity room, sensory room and laundry. Furnishings were homely and of good quality. The home was well decorated, clean and tidy. The home was well maintained and safety certificates were available for inspection. There had been one complaint made to the CSCI regarding the heating and water system which had not been working properly however we were reassured that everything had been done to rectify this and at the time of the visit the engineers were waiting for a part to be able to complete the repair. Temporary arrangements were in place to ensure that the bedroom that was affected was kept warm. DS0000065035.V357543.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, 33, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are supported by caring and well trained staff however the current staffing arrangements are not sufficient to meet the all of the complex needs of the people that live in the home and provide more regular opportunities to access facilities in the community. EVIDENCE: Since the previous inspection the registered manager has been asked to manage the sister home next door in addition to this home. The deputy manager will be expected to undertake the daily management of the home under the supervision of the registered manager. This will need to be reviewed to ensure that the management of both homes is effective. The inspector was informed that the home has 18 staff in total, comprising of • • • 1 x Registered manager 1 x deputy manager 2 x senior support workers days (one post is vacant) DS0000065035.V357543.R01.S.doc Version 5.2 Page 25 • 2 x senior support workers nights • 11 day support workers (One of these posts is vacant and the other has been filled but the staff member is awaiting their clearances before commencing in post) The registered manager works supernumerary. The rota evidenced that there are usually 4 support workers allocated per day shift - am and 4 support workers per day shift - pm. There are also 2 waking night staff. However the people that live in the home all have individual packages of care funded by various Local authorities, there appears to be some ambiguity regarding the staffing numbers to be provided. In one contract examined it stated “5 staff to be on duty during waking hours as well as a full time manager off rota”, in another it stated “6 staff on duty during waking hours as well as a full time manager off rota.” Relatives told us “Consideration should be given to employing domestic help to allow the care staff to get on with caring.” “It would be nice for …………. to go out more frequently- even if it’s just for walk.” The registered manager informed us that the home has 601 care hours per week. Staff have the responsibility of cleaning bedrooms bathrooms and all communal areas, the preparation, cooking and serving and cleaning up after 3 meals per day, supporting people to attend appointments, activities, undertake shopping and gardening and in addition to this attend to the care needs of the people that live in the home. A staffing calculation was completed based on the 8 people living in the home all with high support needs and this indicated that the home must have a minimum of 636.85 hours per week. This is purely care hours and does not include time taken to undertake domestic chores or management time. 6 staff files were examined in the course of the inspection. All had completed application forms, had 2 satisfactory references and all information required by regulations. However we were informed that staff were commencing in employment with only a POVA first check and before their full CRB clearance had been received. This does not safeguard the people living at the home and ensure that they are kept free from the risk of harm. DS0000065035.V357543.R01.S.doc Version 5.2 Page 26 A recently appointed member of staff was in the process of completing their induction and probationary period. All staff had received regular supervision sessions since the previous inspection however there was no evidence of individual staff appraisals. Staff were up to date with their mandatory training. The inspector was informed that the Elbox electronic system had been introduced in the home and all staff will now be using this method to update some of their mandatory training and to complete NVQ. All of the staff had received a range of training that is specific to the needs of the individuals living in the home and this included:- intensive interaction, eating and swallowing, abdominal massage, postural management, autism, epilepsy and the management of PEG. We were informed that staff will be completing the one day training on how to manage difficult behaviours. A training plan was available and the home has 50 of staff qualified to NVQ level 2. The registered person is required to increase the care staff hours provided in the home to ensure that they can meet the complex needs of the people that live in the home and provide more regular opportunities to access facilities in the community. DS0000065035.V357543.R01.S.doc Version 5.2 Page 27 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 People who use the service experience good outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The management and conduct of the home is good, the people that live in the home are happy and their independence is promoted. Staff and managers act in the best interests of the people that live there, however improvements are needed in the care staff hours provided, quality of care and health plans and the provision of meaningful activities in the community on a more regular basis. EVIDENCE: The Legard is part of Milbury/Voyage Care Services which is a national provider of care and support services for people with a learning disability. DS0000065035.V357543.R01.S.doc Version 5.2 Page 28 Milbury/Voyage is part of the Paragon Health Care group, which is a UK wide organisation that specialises in providing a range of services to vulnerable people. At the previous inspection it was noted that “There has been a slip in some standards since the last inspection and this has coincided with the absence of the permanent manager. The manager is due to return very shortly after this inspection.” The registered manager returned to the service in April 2007. The manager has her NVQ level 4 and the registered managers awards, she was very knowledgably about all of the people that live in the home and very supportive of her staff. She clearly puts the needs of the people at the forefront of everything she does and issues raised throughout this inspection had previously been raised with senior managers but no action had been taken. She has been asked to manage the sister home next door in addition to this home and the deputy manager will be expected to undertake the daily management of the home under the supervision of the registered manager. This will need to be reviewed to ensure that the management of both homes is effective. Improvements are needed in the further development of care and health plans, an increase in the care staff hours provided and more regular provision of activities in the community. The manager had submitted an AQAA which was of a good standard and as part of the site visit we examined the maintenance and servicing records: • • • • • • • • • • • • Premises electrical circuits- 7/9/05 valid for 5 years PAT tests- 12/9/07 Fire detection and fighting equipment- 28/8/07 Fire drills – undertaken monthly Fire alarm – weekly tests undertaken Emergency call equipment- was fitted as new in September 2005 but no ongoing maintenance records were available however it was functioning. Heating system- ongoing repair work being undertaken Hoists/baths and all specialist lifting equaipment-31/10/07 Wheelchairs checked daily and cleaned weekly Water temperatures - checked regularly Gas appliances- 22/9/06 overdue Legionella – August 2007 overdue for re assessment However all of the above areas of maintenance had been raised by the manager to senior managers for attention. DS0000065035.V357543.R01.S.doc Version 5.2 Page 29 Milbury care services have a QA system, which includes regular audits and monitoring of the service culminating in an annual service review. The area manager undertakes regulation 26 visit on a monthly basis however this has failed to be effective in highlighting the areas for improvement. None of the QA documentation was examined by the inspector during the site visit. DS0000065035.V357543.R01.S.doc Version 5.2 Page 30 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 2 3 3 4 3 5 2 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 4 25 x 26 x 27 x 28 x 29 x 30 4 STAFFING Standard No Score 31 x 32 3 33 2 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 1 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 x 3 x x 2 x DS0000065035.V357543.R01.S.doc Version 5.2 Page 31 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 YA2 Regulation 15 and 17 Requirement The registered person must ensure that peoples assessed needs and professional assessments are included in the plan of care so that all of their needs are met. The registered person must ensure that what people are told will be provided in their contracts is provided. I.e. staff numbers and vehicles so that people are not misled about what to expect from the home. The registered person must ensure that service user plans are developed and agreed with people and must detail the action to be taken by staff so that they can meet all of their personal, health and welfare needs. The registered person must ensure that there are individual and generic risk assessments available that are maintained and reviewed so that people are protected from the risk of harm. The registered person must ensure that there are enough staff available to ensure that DS0000065035.V357543.R01.S.doc Timescale for action 31/03/08 2 YA5 5 11/12/08 3 YA6 15 and 17 31/03/08 4 YA9 13 and 17 31/03/08 5 YA12 16 (2 m and n) 31/03/08 Version 5.2 Page 32 people can take part in age, peer and culturally appropriate activities when they want to so that their individual divers needs are met. Their diverse needs must be incorporated into the service user plan and records kept. The Registered person must ensure that people are given the opportunity to participate in the local community with staff support. 6 YA13 16 (2 m and n) 31/03/08 7 YA14 16 (2 m and n) These must be incorporated into the service user plan and records maintained. (Timescale of 31/05/07 not met) 31/03/08 The Registered person must ensure that leisure activities are identified, planned for and provided that meet the diverse needs of the people that live in the home and meet their assessed needs. These must be incorporated into the service user plan and records maintained. (Timescale of 31/05/07 not met) The registered person must 31/03/08 ensure that peoples complex health needs are met by the provision of health screening, health action plans and access to health professionals. The registered person must 31/03/08 ensure that where medications are administered PRN that guidelines for administration are written up and followed by staff. The registered person must 10/01/08 ensure that the home has an effective staff team with sufficient numbers and skills to DS0000065035.V357543.R01.S.doc Version 5.2 Page 33 8 YA19 13 9 YA20 13 and 15 10 YA33 18 11 YA34 18 12 YA35 18 13 YA42 23 support peoples assessed needs at all times. Staffing levels must be regularly reviewed to reflect changing needs. The registered person must 10/01/08 ensure that staff have a satisfactory CRB clearance on file prior to commencing employment. The registered person must 31/03/08 ensure that staff have an individual training profile and an annual appraisal. The registered person must 31/03/08 ensure that the following maintenance and servicing is undertaken and records are available to evidence this • • • Emergency call equipment Gas appliances Legionella 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 YA39 Good Practice Recommendations Monthly visits by senior managers should assess the quality of care and standards at the home and make recommendations as to how this can improve for the people that live there. DS0000065035.V357543.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000065035.V357543.R01.S.doc Version 5.2 Page 35 - 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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