Inspection on 07/08/06 for The Mount

This inspection was carried out on 7th August 2006.

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

Other inspections for this house

The Mount 09/08/07

The Mount 09/01/06

The Mount 07/06/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Mount Main Road Whiteshill Stroud Gloucestershire GL6 6JS Lead Inspector Mr Richard Leech Key Unannounced Inspection 7th & 9th August 2006 10:00 The Mount DS0000062415.V307352.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 Mount DS0000062415.V307352.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 Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Mount Address Main Road Whiteshill Stroud Gloucestershire GL6 6JS 01453 757291 01453 757291 grapevinecareadmin@gmail.com 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) Grapevine Care Ltd To be Appointed Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th January 2006 Brief Description of the Service: The Mount is a care home for adults with learning disabilities who may also present with mild challenging behaviour. The home opened in August 2003. At the time it was registered for up to four people, but a variation was successfully applied for, increasing the registered numbers to six. The home is a large, renovated Georgian property on the outskirts of Whiteshill, near Stroud. There are two bedrooms on the second floor, three on the first floor and one bedroom on the ground floor. There are two lounges and a separate kitchen/dining area. The home is set in large, attractive grounds and has views over the surrounding countryside. Prospective service users and others involved in their care are provided with information about the home including a copy of the Statement of Purpose and Service Users Guide. The manager reported that the fees averaged just under £1000 per week. Further information about what is covered by fees is in the Service Users Guide and terms & conditions document. The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began on a Monday morning, lasting until late afternoon. A follow up visit took place on the Wednesday of the same week. During these visits several members of the staff team and most of the service users were met with. Various records were checked including examples of care plans, risk assessments, medication charts, daily notes, healthcare records and staffing files. Before the inspection survey forms were sent out for service users and other people involved in their care. A good response was received. The manager also completed a pre-inspection questionnaire. What the service does well: There was much positive feedback from service users and also from other people involved in their care. Examples included: ‘[Service user] is really happy living at the Mount…we are more than pleased with everything.’ ‘The care and support seems very good.’ ‘The home considers the needs of [service user]…we like the varied activities he is encouraged to take part in…’ Service users were particularly positive about the activities, the food served in the home and the staff team. The manager has a good understanding of what steps need to be taken when somebody may be moving to the home. Care plans and risk assessments are clear and thorough (although some were beginning to need review and changes). Service users feel listened to, valued and respected. They are treated as individuals, have flexible routines and are offered choice and control in their lives. They lead busy, active lives and are also helped to stay in touch with family and friends. Good support is provided for meeting people’s personal and healthcare needs. There are good systems in place for checking the quality of the service and for making improvements. The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 6 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 Mount DS0000062415.V307352.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 Mount DS0000062415.V307352.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users can be confident that an appropriate assessment of their needs will take place in order to establish as far as possible that the service would be appropriate. EVIDENCE: There had been one new admission since the last inspection. The person had moved from another home run by the same organisation, having only moved there relatively recently. Appropriate background and assessment information was available in the home. The manager talked through the admission process which had included visits and also some staff moving across from their former home. A review was planned for later that week. The manager described the admissions policy and procedures and demonstrated a good understanding of the appropriate steps to take in the event of a vacancy. The service has an assessment tool. A community care assessment from the placing authority is also obtained for each admission. The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A good care planning framework operates in the home although there is scope for developing this further in line with current best practice principles so that service users continue to be at the heart of the process. Service users are empowered to make decisions, helping them to feel in control of their lives. People are supported to take appropriate risks in a managed way, encouraging them to lead full lives and take advantage of opportunities. EVIDENCE: Care plans for two people were checked. These provided clear guidance about people’s support needs and how staff should aim to meet these. There was written evidence of regular review on file (although in a few cases it was not clear who had conducted the review as there was just a date). It was noted that there were very few changes to care plans and that those in place had been written by the previous manager. The new manager said that she felt The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 10 confident revising care plans and creating new ones as necessary and described her intention to do this in some cases where people’s support needs were identified as having changed. Care planning will be revisited in future inspections. In the last report it was suggested that the team begin to consider how original assessments of need would be kept up to date, as these should form the basis of care planning for each individual. The manager said that she would be taking on this responsibility. There was also a discussion about person centred planning. The manager was not familiar with this concept. It was agreed that some research some be done and the principles of person centred care planning and examples of the tools that can be used. Consideration could also be given to attending training on this. The Statement of Purpose refers to people making decisions and having choices. Service users spoken with confirmed that they were offered choices, for example, about diet and activities. Staff were observed offering choices to people throughout the inspection and respecting service users’ wishes. Care plans and other guidance noted some restrictions such as the need for accompaniment in the community in order that people stayed safe. People’s right to make choices which may be considered unwise was seen to be respected (such as choosing to smoke), although the manager said that appropriate guidance and encouragement was also offered. Some records of service users’ finances were checked. These appeared to be well organised and fully in order. It was agreed that one person’s possible entitlement to gross interest on a savings account (as opposed to net interest) could be checked. Examples of risk assessments were seen. There was evidence of regular review, although in some cases (as with care plans) it was not clear who had conducted these. Risk assessments viewed covered appropriate areas and provided guidance for staff about managing the risk. However, in some cases the guidance was becoming cramped, extra notes having been written. In such cases the assessment should be fully reviewed and rewritten. Risk assessments provided evidence of an approach whereby people were supported to take risks in managed way rather than being risk averse, although some feedback was obtained through comment cards that activities were sometimes restricted on health and safety grounds. Ideally care plans and risk assessments should be typed in order to make them more legible as well as easier to update. The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to take part in a wide variety of activities in the home and community and encouraged to lead full and active lives. Contact with family and friends is facilitated, helping service users to maintain their relationships with important people in their lives. People’s rights are respected, helping to contribute to a culture where people are valued and treated as individuals. A varied, balanced diet is offered which responds to individual preferences, contributing to people’s health and wellbeing. EVIDENCE: Service users spoken with were very positive about their activity programmes. Staff described people having plenty of activities and seeming to enjoy how they spent their time. Throughout the inspection service users were seen to be The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 12 busy and to be offered trips out, or the chance to relax at home if they preferred. Daily records provided further evidence of people leading very active lives full of varied activities. At the time these were more leisure based since it was summer. The manager described plans for people to return to college in the autumn having enrolled on courses in advance. Examples of activities included sailing, horse riding, attending church, going to pub, cafes and shops, bike riding, visiting local attractions, skate boarding, walking, using a hot tub and sensory room facility, bowling and dancing. Although service users expressed satisfaction with activities, there was some feedback from family members that more could be done to promote people having active lives, particularly in respect of physical activity. Some service users described regular contact with family and also seeing friends. Daily records, comment cards from relatives and discussion with staff provided further evidence that this contact was promoted and supported as far as possible. Important birthdays were noted in people’s care planning files and there was evidence of family being involved in care planning and review. As noted, there was evidence of people’s rights being respected. Service users were observed moving freely around the home and garden. Some people have a key for their room. The manager said that in all other cases people had elected not to have one or had been assessed as not being able to manage a key. It was agreed that this needs to be kept under regular review. People’s preferred form of address was recorded on their files. Staff spoken with demonstrated awareness of this. Service users were seen to get up at different times and have breakfast of their choosing. During lunch they were observed helping themselves to drinks and desserts as well as spontaneously helping to clear up. A two-weekly menu was seen in the kitchen. This appeared to offer reasonable variety and balance. There was reference to individual likes and dislikes. Discussion with service users along with checking individual food records and general observation provided evidence that people’s preferences were catered for and that they did not have to eat what was on the menu. Records of residents’ meetings showed that people’s satisfaction with the food was regularly discussed. Service users spoken with said that they liked the food. Meals were observed to be relaxed and convivial, with people’s wish to eat in different locations respected. The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal care is provided in a way which respects people’s individuality and preferences. People are supported to access healthcare according to their needs, promoting their health and wellbeing. Whilst a reasonable framework is in place for the handling of medication there is scope for improvement in order to make some practices safer. EVIDENCE: Service users had care plans covering personal support needs. These included reference to issues around privacy and dignity. Notes in daily records and the communication book provided evidence of flexibility and of adapting to people’s individual preferences around issues such as the gender of the carer and the order of a routine. Some monitoring devices are in use. There were protocols about these. Healthcare records provided evidence that people were being supported to access routine and specialist healthcare in accordance with their needs. At the time of the inspection one person was unwell and was receiving specialist The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 14 input. A regulation 37 notification should have been forwarded about this. The manager agreed to forward one and to provide updates when there were significant developments. Related to this it was agreed that in view of the person’s primary needs an application for a variation in registration would need to be submitted. Some questions were raised through comment cards about staff knowledge of particular medical conditions (see ‘staffing’). Medication administration records appeared to be in order although it was suggested that the allergy section of the charts be completed, even if this is to state ‘none known’. Also the author of any handwritten entries on the MAR sheets needs to be clear and, ideally, a second designated person should check the entry for accuracy and countersign. The manager and staff described how they administered medication. This appeared to accord with policies and guidance. PRN protocols are in place where appropriate. One person who was in hospital at the time of the visit was expected to have a more complicated medication regime upon their return. It was agreed that the manager and staff need to be absolutely clear about this and should seek as much guidance and support as is necessary to provide appropriate care. A jar with a handwritten label which gave only limited information contained a significant amount of PRN medication. The manager said that this had been taken out of the MDS packs received in the home, but that this medication was now arriving in the home separate from the MDS packs. It was agreed that the loose medication in the jar should be returned to the pharmacy. The following is an extract from recent CSCI guidance (available on the CSCI website): “…a further safeguard is that care workers only give medicines to residents from the container that the pharmacist or dispensing GP has provided…Repackaging medicines into another container with the intention that a different care worker will give it to the resident at a later time is called ‘secondary dispensing’.“ The manager said that staff were receiving training in the safe handling of medication both internally and from a pharmacy (although one person who was handling medication had just had in-house training). Some staff had also undertaken a more in-depth college course. Guidance from CSCI (also available on the website) indicates that staff are unlikely to reach the required level of competence through one training source alone. All staff should receive external training to supplement in-house training in the safe handling of medication. Ideally all staff should take both the shorter practical course and the in-depth distance-learning module. The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 15 The guidance from CSCI states that care providers need to establish a formal means to assess whether each care worker is sufficiently competent in medication administration before being allowed to give medicines and that this process must be recorded in the care worker’s training file. The home/organisation should therefore create an appropriate written competency framework for each person. The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A reasonable framework exists for service users to express concerns and complaints, helping them to feel valued and listened to. Suitable procedures are in place to help to protect service users from the risk of harm and abuse, although greater understanding from staff of this area would further promote people’s safety. EVIDENCE: The manager reported that all service users had been given a copy of the complaints procedure and that this had been talked through with them. She said that there had been no complaints in the last 21 months. Comment cards suggested that service users knew who to speak with if they were dissatisfied with something. Service users spoken with indicated that they knew how to complain and would do so if they were unhappy. They also expressed confidence that they would be listened to and that action would be taken. Staff described how they knew if particular service users were unhappy and how they responded. The manager felt confident that relatives knew how to complain, though survey forms indicated that several were not familiar with the home’s complaints procedure. This should be addressed. The manager was not aware of whether there were versions of the complaints procedure in different formats. It was agreed that the team should consider The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 17 whether any of the service users would find an alternative format more appropriate and, if so, adapt the existing procedure for them accordingly. A copy of the document ‘No Secrets’ is available in the home along with the local Adults at Risk procedure. Some changes have been made to the service’s adult protection policy to make it more comprehensive. Staff spoken with had heard of the whistle blowing policy and were aware of their responsibility to report concerns. However, some expressed uncertainty about the definition of abuse and felt that it could not happen at the Mount. It is good practice for all staff to have training in adult protection and the prevention of abuse. The manager was planning this for the autumn. This should be taken forward. Comment cards provided evidence that the service users felt safe in the home. The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Whilst some parts of the environment are beginning to show wear, in general the Mount is clean, homely and pleasant, promoting service users’ comfort and wellbeing. EVIDENCE: The Mount was seen to be homely and attractively decorated throughout. The building is very spacious and airy. Service users expressed satisfaction with their rooms and the communal areas. For example, in a comment card one person wrote, ‘I really like my bedroom’. One person’s room was becoming slightly cluttered and it was suggested to the manager that the person could be offered some additional shelving. As well as the main lounge there is a pleasant smaller lounge with a computer available for people to use. There is a substantial garden which includes outdoor furniture. Some points were noted about the environment as follows: The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 19 • • • • A bathroom on the first floor had a note on the mirror with information and a care plan about one person’s oral hygiene. It was agreed that this was a breach of the person’s confidentiality and that alternative arrangements should be made for monitoring this. The light shade in this room and some other communal areas needed cleaning. Paint was beginning to peel from the roof in a first floor shower room. The carpet in the lounge was becoming quite stained and required either cleaning or replacing. However, overall a high quality environment is maintained. The manager said that she had risk assessed a new activity centre in the garden. The home has a cleaning schedule and an additional tasks sheet for completion during shifts. The home appeared to be clean throughout. Service users spoken with felt that the home was kept clean and fresh. It was noted that fridge temperatures were on the high side (8-10°C or higher). The manager thought it may be related to the location of the thermometer and had just changed its position. This needs to be monitored and action taken if this accurately reflects the prevailing temperature. Positive feedback was obtained from family members about the physical environment and cleanliness of the home. The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is scope for further staff training and professional development in order to improve aspects of care and communication. Shortfalls in the understanding of requirements around employment could place service users at unnecessary risk. EVIDENCE: Staff use a handover sheet for the shift change to supplement a verbal handover. The communication book indicated that there were good systems for passing on information in the home. Staff spoken with felt that communication within the team was good. The majority of relatives/visitors to the home reported that communication from the team was good. However, there was some feedback from more than one source about the home (and in particular keyworkers) not always being very proactive at keeping in contact with family and passing on important information or consulting. Service users were very positive about the staff team in their survey forms and also in conversation. Whilst general feedback from family members completing surveys was also positive, some felt that staff should know more about the particular conditions experienced by service users. In the last report a The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 21 recommendation had been made about this. This is repeated and the management team should consider where there may be individual or collective gaps in staff knowledge. For example, in discussion some staff felt that they would benefit from knowing more about mental health issues, although there was some information about a range of conditions available in the office. The application for a variation in categories of registration should note any additional training planned for the staff team. Some of the staff team are related to each other. It was agreed that it would be appropriate to devise a policy which formally outlines the organisation’s approach to this. Such a policy could include, for example, issues around who conducts supervision, disciplinary matters and practices around working patterns (avoiding as far as possible people working on shift together). In conversation, some staff likened the care work to providing support for children. Whilst there may be some parallels, caution needs to be exercised in making this comparison since it may result in staff not fully acknowledging people’s rights and needs as adults and also their life experiences. This may be a training/supervision issue. According to information from the manager nearly 50 of the staff team have qualifications in care to NVQ level 2 or above. Induction records showed that staff are given a copy of the GSCC code of practice when they join the team. The manager described her experience of recruitment and selection and her understanding of the accompanying principles and procedures. Interviews are conducted to set format. At the time of the inspection there were no vacancies. The home was operating on a staffing level of three people in the morning and afternoon and one person at night. The manager was aware of the importance of fulfilling all contractual obligations around staffing (notably for dedicated one to one time) and of being able to demonstrate this. The manager expressed some uncertainty about what steps to go through if a Criminal Records Bureau check came back with some information on. This was briefly discussed. The document ‘Safe and Sound’, available on the CSCI website, was also pointed out as a reference. Some staffing files were checked. These appeared to be in order except that one person had started work in March 2006 with neither a PoVA-First nor a CRB check in place. A risk assessment had been done but this stated that a PoVA-First check was in place, which was not so. The manager had understood that this was acceptable provided the person was shadowing/supervised. It was pointed out that staff cannot be employed in a care position regardless of the supervision arrangements without having been checked against the PoVA list as a minimum. Unless there are exceptional circumstances staff must not The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 22 start work until a satisfactory CRB check is returned (with all other necessary documentation also in place). The home has an induction format which covers a number of key areas. An example of a completed induction was seen. Ideally the service should be providing staff with an induction which corresponds to LDAF standards (i.e. specific to learning disability). Failing this, the format should at least be mapped to the Common Induction Standards set by ‘Skills for Care’. These are available through their website. Training records provided evidence of staff being generally up to date with mandatory training. Where gaps had been identified the manager described plans to address these in the near future (principally around moving & handling and food hygiene). As noted some staff appear to have training needs in areas such as adult protection, particular conditions experienced by some service users and in the safe handling of medication. The manager also described plans for staff to attend training in the management of challenging behaviour (although she said that there was no restrictive physical intervention used in the home) and in continence. There was a brief discussion about supervision and appraisal. Whilst the manager felt confident with the former, she expressed uncertainty about conducting appraisals and said that these were on hold. The manager’s training needs in this area should be addressed and an appraisal system brought back into operation. The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good (although some points are made about health & safety). This judgement has been made using available evidence including a visit to this service. The home is generally well run although the service should improve further as the manager develops more experience and undertakes appropriate qualifications. Systems are in place for service users and others involved in their care to give feedback about the home, helping them to feel listened to and involved. Aspects of health and safety could be improved, further promoting service users’ wellbeing. EVIDENCE: Staff and service users spoken with were positive about the management of the home. Comments included that the manager was approachable and handson. Around the time of the inspection the manager was registered with CSCI. The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 24 As part of this a mentoring plan was agreed which will involve regular meetings with a more experienced colleague. The manager had completed NVQ level 3 in care though was waiting for this to be assessed. She was hoping to begin the Registered Manager’s Award in September 2006 and to move on to the NVQ level 4 in care in due course. In the meantime she was undertaking a short management course with some project work attached. The manager acknowledged that she was relatively inexperienced and was glad of the mentoring and support arrangement. Some of the issues picked up during the inspection, such as around recruitment, suggest learning needs in particular areas. In addition, the standard cannot be assessed as met without the relevant qualifications having been obtained. However, in general there was evidence that the home is being well run and that the manager was committed, caring and motivated. Quality assurance in the home was discussed. The manager said that there were regular residents’ meetings. Minutes were seen and service users talked about these meetings. The manager said that monthly one to one meetings between individual service users and their keyworkers were to be introduced to discuss issues around care planning and also to provide another way for people to give feedback about the home/service. The manager said that there were regular staff meetings. She also said that family members and others involved in service users’ care were invited to review meetings and offered the opportunity to feed back. It was reported that there is an annual review of the Statement of Purpose and that the organisation is gradually going through the policies and procedures to review and update them. A regulation 26 report had been received for June 2006. The manager said that these would now definitely be forwarded monthly, this having ceased for a while. Finally, the manager described plans to send out satisfaction surveys to people involved in service users’ care. It was agreed that this could form a valuable part of the home’s overall quality assurance strategy provided the results were fully reviewed and an action plan devised if necessary. Staff spoken with felt that their health and safety was promoted and that home was a safe place to live and work. PAT testing in the home was seen to be up to date. The fire logbook provided evidence of alarms and emergency lighting being tested at suitable intervals. The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 25 Drills were taking place regularly, although it was noted that the length of time it took to evacuate the building could also be noted. There were two incidents where the same person did not leave during a drill. This may need further review and a strategy developed to promote the person’s safety in the event of a fire. This could be done as part of reviewing the fire risk assessment, which was seen to be quite brief (the copy seen was also undated). New guidance about fire risk assessments in the context of changes to regulations is available at the following site: http:/www.communities.gov.uk/pub/886/ResidentialCarePremisesfullguide_id 1501886.pdf (Or through: www.communities.gov.uk) Records of other routine health and safety checks were viewed. CoSHH sheets about chemicals in use in the home were seen. Emergency telephone numbers were on display in the office. A first aid kit in the office contained some out of date antiseptic wipes. Checking the contents of these could be included in periodic routine checks around the home. There was a discussion with the manager about plasters. The manager understood from guidance through a first aid course and other sources that it was now considered inadvisable to put plasters on service users unless they had made a clear, informed choice themselves to use one. This related to the possibility of an allergy, although other first aid would be given as necessary. Whilst this may be justifiable in some ways it also presents risks to service users. It was suggested that the manager: • • • Seek clarification from sources such as a first aid trainer, GP, district nurse and/or pharmacist. Obtain some non-allergenic plasters or equivalent. Check with families and staff in former care settings to try to establish whether any service users have any known allergies to plasters. In response to a recommendation in the last report the manager said that a radiator cover had been fitted in one person’s bedroom in accordance with an assessment of risk. The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 2 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 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 3 x x 2 x The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 27 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 *RQN Regulation Care Standards Act & National Care Standards Commission (Registration) Regulations 2001. Requirement An application for a variation must be submitted in respect of one person’s primary needs which relate more to mental health than learning disability. Address the issues about the environment noted in the text. Staff must not start work in a care position until a satisfactory PoVA-first check has been returned (as well as all other necessary documentation being in place). Staff should only start on a PoVA-first basis (pending return of full CRB check) in exceptional circumstances. Timescale for action 31/10/06 2 3 YA24 YA34 23 19 31/10/06 31/08/06 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 • Ensure that it is clear who has conducted a care plan review. DS0000062415.V307352.R01.S.doc Version 5.2 Page 28 The Mount 2 3 YA7 YA9 4 YA20 5 YA22 6 YA23 7 8 YA30 YA32 Research the principles of person centred care planning and examples of the tools that can be used. Consider attending training on this. • Review and update original assessments of need to underpin best practice in care planning. • Ideally care plans should be typed in order to make them more legible as well as easier to update. Where people are in receipt of net interest on savings accounts check whether they are entitled to gross interest and, if so, assist them to claim this. • Ensure that it is clear who has conducted a review of a risk assessment. • Rewrite risk assessments where additional notes have made the guidance cramped and harder to interpret. • Risk assessments should also be typed in order to make them more legible as well as easier to update. • The allergy section of medication administration records should be completed, even if this is to state ‘none known’. • The author of any handwritten entries on the MAR sheets should be made clear and a second designated person should check the entry for accuracy and countersign. • Return the PRN medication discussed during the inspection to the pharmacy. • All staff should receive external training to supplement in-house training in the safe handling of medication. Ideally all staff should take both the shorter practical course and the in-depth distancelearning module. • Create an appropriate written competency framework around medication for each staff member, as per CSCI guidance. • Consider whether any of the service users would find an alternative format for the complaints procedure more accessible. If so, adapt the existing procedure for them accordingly. • Ensure that service users’ families are aware of the complaints procedure and have a copy. • All staff should receive suitable training/input about adult protection and prevention of abuse. • Ensure that all staff are aware of the whistle blowing policy and the principles and law underpinning this. Monitor the temperature of the kitchen fridge. Take action if the readings continue to be too high. • Consider the feedback about communication which indicated that staff may not always be sufficiently DS0000062415.V307352.R01.S.doc Version 5.2 Page 29 • The Mount 9 YA35 10 11 YA36 YA42 proactive with keeping in contact with family for general updates and important events. • Devise a policy which formally outlines the organisation’s approach to issues around staff members who are related to each other, as described in the text. • Consider whether there are any additional training needs identified, either individual or as a team, related to conditions experienced by service users. This might for example include input on autistic spectrum conditions and on mental and physical health issues. Provide staff with an induction which corresponds to LDAF standards (i.e. specific to learning disability). Failing this, the format should at least be mapped to the Common Induction standards set by ‘skills for Care’. The manager’s training needs around appraisal should be addressed and an appraisal system brought back into operation. • Note the length of time it takes to evacuate the building in fire drill records. • Fully review and update the fire risk assessment in the light of new guidance and regulations in this area. • Regularly check the contents of first aid boxes/kits. • Follow the suggestions about giving plasters to service users as per text. The Mount DS0000062415.V307352.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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