Inspection on 26/04/07 for The Limes

This inspection was carried out on 26th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Limes 24/04/09

The Limes 07/11/05

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 The Limes 13 Welholme Road Grimsby North East Lincs DN32 0DR Lead Inspector Christina Bettison Unannounced Inspection 26th April 2007 10;00 DS0000064078.V337453.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 DS0000064078.V337453.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. DS0000064078.V337453.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Address 13 Welholme Road Grimsby North East Lincs DN32 0DR 01472 358545 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) Linkage Community Trust Barbara Jane Manning Care Home 8 Category(ies) of Learning disability (8) registration, with number of places DS0000064078.V337453.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th November 2005 Brief Description of the Service: The Limes is a semi-detached property situated in a pleasant residential area of Grimsby overlooking an established park. It benefits from it’s own discreet established garden and has the benefit of car parking facilities. On the ground floor there are kitchen, dining room, TV lounge/conservatory, a lounge, an office, laundry, WC, a bathroom and entrance/reception area. There are three bedrooms on the ground floor and a staff sleeping in room, all of which are en suite. On the first floor are 3 bedrooms all of which are en suite. On the second floor there is a separate 2 bed roomed flat that consists of two bedrooms, a lounge and a kitchen/diner and a bathroom. Weekly fees are £518.80 to £528.64 per person per week. Additional charges are made for the following: newspapers/magazines and sweets, hairdressing, chiropody and transport for social activities. Information on the service is made available to current service users via the statement of purpose, service user guide and inspection report. DS0000064078.V337453.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a key inspection and the unannounced site visit took place over 1 day on 26th April 2007. Two relatives’ surveys were returned, eight service user surveys were returned, two care managers surveys were returned, one health professional survey was returned and three staff surveys were returned. The registered manager, service manager, one of the houseparents and three service users were all spoken to on the day of inspection. The inspector looked around the home and looked at records. Information received by the CSCI since the previous inspection was also considered in forming a judgement. Prior to the visit the inspector referred to complaints received and notifications sent to the Commission for Social Care Inspection, the event history for the home over the past year and the completed pre- inspection questionnaire. The site visit was led by Regulation Inspector Mrs.C.Bettison and the visit lasted six hours. What the service does well: Service users and their relatives are provided with information that is easy to read so that they know what to expect from the home. New service users are able to visit the home and stay overnight to help them to decide if the home will be able to meet their needs or not. Each service user had an individual service user plan to make sure they get the care and support they need. The service user plans include helping people to keep their independence and learn new skills. All service users have a single room that is nicely personalised to their own taste, providing them with an area where they can spend private time or receive visitors. Relatives are very involved in the home and are made to feel welcome, making sure that family can keep in contact. The kitchens are kept clean and service users are helped to eat a healthy diet and also some foods that they like. DS0000064078.V337453.R01.S.doc Version 5.2 Page 6 Each service user now has a health action plan which helps to make sure that their health needs are met. Service users medicines are looked after well and staff assist service users to take their medicines safely. Service users and their relatives concerns are listened to and staff make sure they take action to sort problems out quickly. The staff and managers know that they need to make sure service users are protected from harm and what to do if someone is harmed. A good recruitment policy is in place so that staff employed are safe to work with the service users and they are protected from harm. The staff are very caring and treat service users with respect and dignity. What has improved since the last inspection? What they could do better: The registered manager needs to complete the NVQ level 4 and registered managers award so that she has the qualifications needed to perform her role as the manager. At least half of the staff need to obtain a certificate (NVQ Level 2) which says they know how to work with the service users in the home and how to meet their needs. The home needs a new deputy manager and to be fully staffed and the new team needs time to settle down so that they all know the service users and what their needs are. Some of the paperwork needs to be tidied up so that it is clear to see that service users personal and health needs are being met. DS0000064078.V337453.R01.S.doc Version 5.2 Page 7 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. DS0000064078.V337453.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000064078.V337453.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 4 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users needs are assessed in full by a range of professionals and service users and their families are given sufficient information about the home so that they can be assured that the home can meet their needs. EVIDENCE: The home has a statement of purpose and this details all of the information required by this standard and Schedule 1 of the Care Homes Regulations 2001 for adults 18-65 years. A number of appendices have been attached covering key policies such as Adult Protection, Whistle Blowing and Confidentiality. This had also been produced in an audio format. A service user guide is available and this contains all the information required by National Minimum Standard 1.2. The service user guide had been expanded to also meet the requirements of a statement of terms and conditions for service users. The care files of two service users were examined, one of these being a new admission to the home. This contained a range of assessments carried out by a variety of professionals who hade been involved in the care of the service user DS0000064078.V337453.R01.S.doc Version 5.2 Page 10 in previous care settings. In addition to this the manager undertakes a linkage assessment and Linkage employs a professional support team made up of qualified social workers, psychiatrist, clinical psychologist, speech and language therapist, visual impairment specialist and a registered nurse who can support the ongoing assessment process and provision of professional support. The staff team had more than enough information on the assessed needs of the service user and this enabled them to provide an individually tailored service to meet the service users complex needs and ensure their emotional stability. There was evidence and the service user informed the inspector that they had been offered and had taken up the opportunity of visits and overnight stays prior to making a choice about living at the home. In addition to this there was evidence that the other service users in the house had been consulted about the new service user moving in and had agreed to it. Despite an unsettled start the staff have managed this placement admirably and the service user has now settled in well. In a returned questionnaire a care manager commented “Individual has emotional issues and the staff at the Limes have always acted in a professional manner to support the individual during these times. The service has successfully supported individual to deal with issues from the past. The service has supported the individual to develop independent travel skills, new activities and self image. I have been very impressed with the level of communication from the manager and staff and the all round support they have given the individual.” And in another survey returned the consultant psychiatrist commented “A deep awareness of individuals needs and demands. Copes with problematic situations rejected by other services. Plans to reduce pressure are already being considered however this should not diminish the perception that this service has succeeded where others have failed.” DS0000064078.V337453.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users needs are met and service users and their representatives have been consulted, however the quality and consistency of the service user plans and risk assessment needs to be improved. EVIDENCE: Two care Files were examined as part of the inspection process. Each file contained a focus page which gave staff a quick overview of a service users needs, dietary requirements, information on advocacy services and a personal history and signposted towards behaviour management guidelines and risk assessments. DS0000064078.V337453.R01.S.doc Version 5.2 Page 12 Linkage have made some changes to the way they present their care planning for service users. Although all of the information was available to ensure that all of the service users assessed needs were identified and met, the planning process and paperwork was a little disjointed and contained far too may risk assessments. A number of the risk assessments were actually plans of care and the home would benefit for re organising the plans and risk assessments. Some of the care plans required further detail on exactly what support staff needed to provide for service users and an element of what skills and ability service users already have in order to build on these and demonstrate progress. The manager and staff commented that this was not the easiest of formats to follow and would welcome some reorganisation. However this did not in any way detract from ensuring that service users needs were met, observations of care practice, feedback from professionals and discussion with service users evidenced that service users needs were met and independence promoted in many ways. Service users physical and emotional well being was recognised and met by very attentive staff. In addition to this some of the service users had benefited from a person centred planning review, actions from these reviews need to be incorporated into the care planning process making it more comprehensive and cohesive. A number of risks had been identified, assessed and were being minimised by the production of risk assessments that staff were familiar with and followed and a number of these related to measured risk taking allowing service users to develop and maintain their independence. Any limitations placed on service users are only undertaken with their agreement, in their best interests and had been agreed in a multi agency meeting and are reviewed regularly. For example, one of the service users had recently broken a window whilst in an agitated state, the director of care had met with them and they had agreed to pay an amount each week towards the cost of the repair, this is part of a wider behaviour management strategy in consultation with the psychologist that promotes responsibility of actions and consequences. The service user had agreed to this and was able to confirm this in discussion with the inspector. Care plans were kept under constant review and that they were informally reviewed monthly and formally reviewed every 3 months. There was evidence of excellent daily recordings and all service users were reviewed annually by the placing authority. All service users had a key worker and were able to tell the inspector who this was and explain what their specific role was. DS0000064078.V337453.R01.S.doc Version 5.2 Page 13 The inspector observed service users being offered opportunities to participate in the day to day running of their own home; they have house meetings once a week and all service users have a house day when they change their bed, clean their room and do their laundry, with as much or as little support as is required by the individual. Staff and service users confidential information was observed to be securely kept and handled in accordance with the Data Protection Act. Lockable facilities were used and service users are consulted about when and where there information can be shared. Staff were observed to knock on doors and to ask permissions to enter bedrooms. Linkage has a policy on sharing information with partner agencies and a policy/procedure for missing service users. DS0000064078.V337453.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,and 17 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users are assisted to continue their personal development and have access to the community for a range of leisure/educational pursuits. This could be further enhanced by the maintaining and flexibility of the staff rotas and attention to individual’s personal aspirations. Family contact and personal relationships are maintained and all service users enjoy a healthy diet. EVIDENCE: Emphasis is placed on service users developing their independence skills and taking an active role in household chores, they all have at least one day at home to change their beds, clean their rooms and do their laundry with staff support as required. DS0000064078.V337453.R01.S.doc Version 5.2 Page 15 One of the service user in their returned survey stated “I live in an independent flat on the top floor with another service user. I am very proud of our flat.” Some service users attend the Linkage occupational recreational services during the day and take part in activities such as Advocacy groups, drama, ITC, art, communication skills and horticulture. The sessions are tailored to individual need, which is assessed by the instructors. Some service users attend the Grimsby Institute, one for a hairdressing course and another a retail course. One of the service user stated in the survey “ I have chosen new courses to attend” and another stated “ I am an adult and make my own choices” and another stated “I like do my housework, I am pleased with the staff at the Limes. Thank you for your help in the house” however another stated “I am not happy about the housework because I don’t like housework”. Service users told the inspector that they like living at the Limes and enjoy going to the cinema and theatre, bowling, shopping, disco’s, walks and out for meals at burger king, Mc Donald’s and pizza hut and visiting the pub. One of the service users attends a ladies keep fit group. Another is currently taking swimming lessons and another learning to ride a bicycle and is undertaking their cycling proficiency test. One of the service user in their returned survey stated, “I especially like to do the gardening at weekends”. One of the service users has part time job assisting in the delivery of building materials for a local builders merchant. He is able to earn a small sum of money as “therapeutic earnings”. In addition to this two of the service users are due to commence at the Grimsby auditorium helping to make and paint the sets and sell programmes and ice creams during shows. One of the service user is an evangelist and attends religious and family occasions when visiting his relatives however whilst at the Limes he chooses not to attend, and another service user is church of England and was supported to attend the church regularly now has chosen not to attend, however the manager, staff and service users confirmed that they attend carol services at Christmas and Easter if they wish to and this is supported by staff. Most of the service users either visit their parents/relatives homes or are visited by them at The Limes and contact is welcomed. One of the service users has special female friend who he visits or she visits him, and two of the female service users have special male friends this is welcomed and supported DS0000064078.V337453.R01.S.doc Version 5.2 Page 16 by the staff. Service users personal responsibility is promoted and measures in place to ensure both service users are safeguarded. For one of the service users he was supported to host a romantic valentines meal at the home for his special friend. The manager and staff promote a healthy eating menu but try to balance this with service users likes/dislikes and special treats on occasions. Breakfast is service users own choice and they prepare it themselves. Lunch is a choice of sandwiches, soup, toasted sandwiches, beans or egg on toast or omelette. Options on the menu for dinner included chicken, spaghetti Bolognese, home made pizza, pasta, fish, jacket potatoes all served with fresh vegetables and the manager confirmed that there is always plenty of fresh fruit and yogurts available. Any restrictions are clearly documented in the care plan and agreed to by the service user. Due to health needs, weight issues and general well being the home promotes a healthy eating menu however on their house days service users usually go out shopping and can buy whatever they want to, in addition to this when they are out alone, at day services or visiting family they can buy and eat whatever they choose and on special occasions I.e. birthdays, Christmas etc special treats and buffets are provided. It was felt that the balance was right for the service users and ensures their physical well being and ongoing good health. DS0000064078.V337453.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users physical and emotional needs are met, by the provision of a wide range of healthcare professionals and outside agencies and a caring and professional team of staff promotes their privacy, dignity and respect. EVIDENCE: Records examined confirmed that service users health needs were met by GP, dentist, chiropody and that they had access to a wide range of other health professionals e.g. psychiatrist and psychologist, speech and language therapist and visual impairment specialist if and when required. However there needs to be some improvement in the screening, identification and planning to meet health needs. Health action plans had been produced but DS0000064078.V337453.R01.S.doc Version 5.2 Page 18 these were basic and had not been regularly updated. In addition to this the recording of outcomes to health appointments were in the general daily recordings and did not sit alongside the health action plan, this could made it difficult to track if health needs had been met or not. Discussion with Service users and staff and observations confirmed that the staff promoted service users dignity, privacy and respect. Staff were observed to behave in an appropriate manner towards service users. Individual likes and dislikes were recorded on the care plan and service users told the inspector that they had a key worker. Linkage has robust medication policies and procedures that include receipt, storage, administration and disposal of medication. Most of the service users at the Limes are self medicating are encouraged to work toward this with a graduating self-medication programme which is supervised by the staff. The manager and staff will assess the service user prior to commencement and a risk assessment is undertaken. Facilities are made available for service users to lock their medication away in their room. All staff are given medication administration training which includes an exam to ascertain competence. DS0000064078.V337453.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users are protected from harm by a robust complaints procedure that is provided in an accessible format and all service users are aware of and a Protection of Vulnerable Adults policy and procedure that the staff and manager are aware of their responsibilities within this. EVIDENCE: DS0000064078.V337453.R01.S.doc Version 5.2 Page 20 The home had a well-developed complaints procedure. This contained contact details for the CSCI and the ombudsman and gave an assurance that service users and their families would not be victimised for making a complaint. The timescale given for responding to complaints was 21 days. The complaints procedure was also available in Makaton symbols and on audiocassette. In addition to the above the home also had a service user specific complaints policy. All of the surveys received back from service users indicated that the service users knew who to go to if they had a complaint or concern. Each service user had been given a copy of the complaints policies in written and Makaton format, and Social Services “Right to Complain” leaflet. These were kept in service users individual files. All minor issues were dealt with through the house meetings. More serious issues were taken to the manager and a mechanism is in place for responding to these areas of concern and/or complaint. There had been a significant number complaints since the previous inspection, the majority of these were issues of one service user to another and related to altercations, disagreements, horseplay and not respecting each others space/rooms, these were all taken seriously, investigated and resolved appropriately. The manager checked the complaints log on a regular basis. The home had a copy of the “Multi agency Guidelines for the Protection of Vulnerable Adults” and an in house abuse policy and procedure that links in with the “Multi agency Guidelines for the Protection of Vulnerable Adults” in respect of alerting, referral and investigation. All service users had been given a copy of the leaflet from the local authority on abuse and this was kept on their individual file. The home has a separate whistle blowing procedure. There was evidence from the home’s recruitment and selection processes, staff training records, complaints log and the use of risk assessments that the manager ensured that service users were protected and safeguarded from abuse. Training records evidenced that staff had received training on the protection of vulnerable adults and the staff spoken to were clear about their responsibilities within the POVA procedures. DS0000064078.V337453.R01.S.doc Version 5.2 Page 21 The home had a policy for dealing with physical and verbal aggression by a service user. DS0000064078.V337453.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 quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users live in a well maintained home that is safe, homely and comfortable and is in the heart of the local community and meets their assessed needs. EVIDENCE: The Limes is a traditional Victorian property that has been sensitively refurbished to a very high standard to provide small group living for 8 young adults. It is situated in a residential area of Grimsby overlooking Peoples Park. The home has been tastefully decorated and all necessary provision made to provide accommodation, personal care and ongoing support to the service user group. DS0000064078.V337453.R01.S.doc Version 5.2 Page 23 The house comprises of a lounge, a lounge/TV room, a dining room, laundry room and a kitchen. It has 6 en suite bedrooms with either a shower or bath, and a 2 bed roomed flat that comprises a large lounge, kitchen, shared bathroom and 2 bedrooms. All fixtures/fittings and furniture are of a very good quality and on the day of inspection the house was extremely clean and tidy and very well presented. The service users were all very proud of their home and were eager to show the inspector around. There is also a managers office, and staff sleeping in room. The house is very spacious enabling service users to spend time with each other or alone as they choose. Outside is a drive and pleasant gardens. DS0000064078.V337453.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): 32,33,34,35 and 36 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staffing is provided with the competence and qualities to meet service users needs, however the appointment of staff to fill the vacant posts will further enhance the quality and consistency of the service provided. A robust recruitment and selection process protects service users from the risk of harm. EVIDENCE: There have been no changes to the rota pattern and there are usually two staff on duty when all service users are at home. The current staff rota provides waking staff up to 11.00pm and after that they sleep in, this does create some difficulties if service users wish to access activities that finish after 11.00pm therefore Linkage need to review the staffing rotas and ensure that staff can be provided in a flexible manner to support service users diverse needs and expressed wishes. DS0000064078.V337453.R01.S.doc Version 5.2 Page 25 The home has had a period of instability with regard to staffing. The deputy manager has left the employment of Linkage trust to take up a managers post elsewhere and the part time houseparent has left to undertake further studies. This has left the only permanent staff as the registered manager and one full time houseparent, the vacancies are being covered by Linkages own bank staff who are trained and skilled in working with people with a learning disability however this staffing situation has clearly created a period of inconsistency and increased workload for the remaining permanent staff. One relative commented “ better continuity of staff would be beneficial” and another stated “ I think issues like transport and staffing out of normal hours are often an issue but that it is not necessarily the home that is at fault” and a member of staff commented “ staff continue to try and motivate service user regards independence, but this is not easy when we have not got permanent staff”. The posts have been advertised and the part time houseparent has been recruited to and is awaiting clearances prior to commencing work. Observation of staff practices confirmed that they have developed appropriate relationships with service users and treat them in an age appropriate way and with the utmost of dignity and respect whilst offering guidance and support in a firm but sensitive manner. The staff team are supported by a wide range of health professionals e.g. psychiatrist and psychologist, speech and language therapist and visual impairment specialist for advice and support. A new member of staff file was examined as part of the site visit and this evidenced that Linkage recruitment policies and procedures continue to be robust and staff have CRB disclosures, all identity as required by regulation and references obtained prior to commencement in employment at Linkage. Supervision records were examined and were in order and the current staff team are up to date with their mandatory training and have undertaken other specialised training relevant to the needs of the service users, i.e. epilepsy, autism, managing difficult behaviours, downs syndrome and risk assessment training. The new member of staff had completed her probationary period and induction that included LDAF standards. The registered manager had a training and development plan for the staff team that clearly identified staff training needs and all staff had an individual training and development action plan that was completed annually. Due to staff leaving none of the staff have got NVQ level 2 and this must be addressed. DS0000064078.V337453.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 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a home that is part of a creditable organisation that is well run and managed from the top down and the service at Abbey drive is managed by a very competent manager. Service users are at the heart of the organisation and their views are taken into account by the quality monitoring scheme, house meetings and reviews that promote their involvement. EVIDENCE: The manager Jane Manning has worked for Linkage since 1998, She has undertaken various training courses in working with people with learning disabilities and management training and has completed both NVQ level 2 and DS0000064078.V337453.R01.S.doc Version 5.2 Page 27 3 and the assessors award. She is currently working towards the NVQ level 4 and the registered managers award, however this is an outstanding requirement from the previous inspection and must be progressed with some urgency. Regular house meetings that include staff and service users, staff supervision and the key worker system ensure that staff and service users have the opportunity to influence the way the service is delivered. Mrs Manning is a very effective manager, however the service at The Limes has suffered a little from the staffing instability. It is hoped that a new deputy manager will be appointed as soon as possible who it is hoped will lead the staff team and ensure consistency and stability for the staff and service user group. Linkage have a Corporate Quality Monitoring system (EFQM) and a Quality Manager who co ordinates and leads on quality issues. A year long calendar is produced that provides the framework for QA activity including surveys, audits and appraisals. Service user comment cards had been translated into makaton symbols to aid students understanding and enable them to participate in the process. Linkage produces an Annual Review document and regular newsletters. All of which were seen by the inspector. Areas for improvement in the forthcoming year are to increase the numbers of staff across the organisation that have NVQ level 2, to roll out person centred planning, to further promote self advocacy, to purchase a holiday home for linkage and to ensure all staff have basic IT skills. As part of the inspection all maintenance records were seen and were up to date and in order ensuring that the service users live in safe environment. DS0000064078.V337453.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 4 2 4 3 x 4 4 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 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 2 33 2 34 4 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 x 3 4 LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 4 x 3 x 4 x x 4 x DS0000064078.V337453.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA32 Regulation 18 Requirement The registered person must ensure that at least 50 of the care staff are qualified to NVQ level 2. (Timescale of 31/03/06 not met) The registered person must ensure that the home has an effective staff team with sufficient numbers and skills to meet service users needs and the use of bank staff is kept to a minimum. Timescale for action 31/12/07 2 YA33 18 30/06/07 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 Refer to Standard YA6 Good Practice Recommendations The registered person should review and amend to the care planning process/paperwork to ensure its effectiveness and care plans should be produced in a format that is accessible to the service users. The registered person should review the quantity of risk assessments and ensure that they relate to identified risk DS0000064078.V337453.R01.S.doc Version 5.2 Page 30 2 YA9 3 4 YA19 YA37 areas and not areas where service users require support to live an independent lifestyle. The registered person should review and amend the health action plans and recording methods to ensure that they are kept up to date and are effective. The registered person should ensure that the registered manager has competed the NVQ level 4 in care and the Registered Manager’s award. DS0000064078.V337453.R01.S.doc Version 5.2 Page 31 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 DS0000064078.V337453.R01.S.doc Version 5.2 Page 32 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!