Inspection on 12/09/07 for The Old Rectory (Trowbridge)

This inspection was carried out on 12th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Rectory (Trowbridge) 04/01/10

The Old Rectory (Trowbridge) 29/06/06

The Old Rectory (Trowbridge) 05/10/05

The Old Rectory (Trowbridge) 06/05/05

The Old Rectory (Trowbridge) 24/09/04

The Old Rectory (Trowbridge) 28/05/04

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 Old Rectory (The) 27 Stallard Street Trowbridge Wiltshire BA14 9AA Lead Inspector Tim Goadby Key Unannounced Inspection 12th September 2007 09:10 Old Rectory (The) DS0000028608.V343136.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 Old Rectory (The) DS0000028608.V343136.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. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Rectory (The) Address 27 Stallard Street Trowbridge Wiltshire BA14 9AA 01225 777728 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) oldrectory.dcc@craegmoor.co.uk www.craegmoor.co.uk Parkcare Homes Limited Mr Ean Rayton True Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th June 2006 Brief Description of the Service: The Old Rectory provides care and accommodation for up to eight adults with a learning disability. Service users have autistic spectrum disorders. The home is part of Craegmoor Healthcare, a private sector organisation with four registered care homes for this client group within Wiltshire. The property is in a residential area of Trowbridge. A range of amenities are available in the town itself. Larger centres, such as Bath and Bristol, are within reasonable travelling distance. The service has been in operation since the mid 1990s, initially under different ownership. A number of service users have lived there from the beginning. The current group is well established. They are all men. All service users have single bedrooms, some on the ground floor. Two bedrooms have en-suite facilities and more are now being provided. The others have bathrooms and toilets nearby. Communal areas are on the ground floor. There is a large enclosed garden. Another plot is used to grow vegetables. An adjacent building is used for daytime activities. The fees charged for care and accommodation vary depending on the assessed needs of service users. Information about the service is displayed on noticeboards in the home. CSCI inspection reports are also publicised when they are received. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was completed in September 2007. The process included a review of what we know about the service since its last inspection in June 2006. Various events have been reported to us as required. The service has also provided updates on its refurbishment programme. The home completed an Annual Quality Assurance Assessment (the AQAA). We also sent out survey forms and received replies from a service user, five relatives and four members of staff. The service user was supported by staff when completing their form. An unannounced visit then took place to the Old Rectory, combined with an inspection of a smaller home nearby which has close links to it. These lasted for a total of just over seven hours. This fieldwork included meeting service users and staff on duty; sampling records; touring premises and sampling a meal. Where appropriate, findings which relate to both services have been included in each report. What the service does well: The Old Rectory is a well established service, which has retained its existing strengths in areas such as the provision of activities and community participation. Service users with complex needs benefit from access to a range of experiences which enhance their quality of life. Choice and independence are promoted for service users, in line with their individual capabilities. Routines of the home are kept flexible to recognise the rights of each service user. High ratios of staff to service users are maintained throughout the day and well into the evening. This ensures that people with high support needs still have opportunities to participate in a range of activities at home and elsewhere. Suitable steps are taken to meet health care needs, upholding service users’ well being. Programmes of activities include a health promotion element, with regular opportunities for exercise. Recognised and developing health problems are supported with access to relevant medical advice. There is an effective response to any issues regarding protection. Concerns are referred to the local multi-agency procedure. The home works in partnership with these other agencies to identify and implement actions that will help to minimise risks to service users. Service users’ relatives are able to have regular contact with the home, and those that do are confident about the service it provides. Survey responses Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 6 are particularly complimentary about the approach of the staff team. This is described as “kind” and “helpful”. Overall, one relative concludes “It’s an excellent residential home”. What has improved since the last inspection? What they could do better: More progress is needed on the refurbishment of the home to ensure that service users live in a comfortable, clean and safe environment. Craegmoor need to continue negotiating with the local planners to secure approval for suitable improvements. Some areas of the property are currently not in a reasonable state of repair. Parts are not clean and some are affected by unpleasant odours. All these issues need resolving to provide service users with a good quality of life. The response to significant events which may affect the safety and well-being of service users and others must include notification of the CSCI. This is required by Care Homes Regulations and ensures that the service continues to operate in an open and transparent manner. Service users who are prescribed medicines ‘as required’ must be confident that staff will give these appropriately. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 7 Guidelines must set out how medicines are to be used, ensuring that this is in line with the prescriber’s intentions. Such guidelines must then be followed correctly on each occasion. Judgements about the recruitment of staff should be documented where circumstances make this appropriate. Decisions should then be supported by a suitable risk management framework, which can make clear the measures for induction and supervision of such employees. This will help to provide effective protection for service users. 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. Old Rectory (The) DS0000028608.V343136.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 Old Rectory (The) DS0000028608.V343136.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): Quality in this outcome area was not assessed. Standards relating to admissions to the home were not applicable at this inspection. EVIDENCE: The Old Rectory has not had any new admissions since 2003, so the key standard could not be assessed at this inspection. Craegmoor has suitable procedures regarding admission which would be applied should a vacancy arise. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs and goals are reflected in their individual care plans. Service users are supported to exercise choice and control in all aspects of their daily lives. There are effective systems to manage risks so that service users can benefit from social and leisure opportunities which they enjoy. EVIDENCE: Craegmoor has introduced a new person centred planning format. All service users’ records are in the process of being reviewed and transferred to this. The manager of the Old Rectory is the local champion for this initiative. Two service users’ files were sampled in depth. Both show assessment and life history information. Care plans and risk assessments are in place for a relevant range of areas. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 11 Issues identified as important to an individual have clear information and support guidelines. This includes showing the ratios of staff to service users needed for different situations. Issues of choice and autonomy are also addressed. There is a focus on promoting independence. The majority of service users do not have speech. Strategies for enabling them to communicate are set out in their individual plans. There is also an appropriate recognition of the impact of service users’ autism. This is explained clearly within individual records. If restrictions are imposed as part of overall care, there are clearly documented reasons. Service users participate in the day to day running of the home. They contribute to all the practical tasks that are carried out. Craegmoor also has residents’ conferences. This gives some people an opportunity to comment more widely on the organisation’s conduct. Risk assessments show the balance of harms and benefits that may arise from particular activities. Management plans place emphasis on the support needed to enable an opportunity to be undertaken. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 12 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, 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 have frequent opportunities to undertake a range of activities, both at home, and within their local community. Service users are supported to maintain personal and family relationships. Daily lives for service users have an appropriate balance between necessary routine, and individual choice. Arrangements for the provision of meals promote independence, choice and social inclusion. EVIDENCE: The Old Rectory has an adjacent building where different daytime activities are provided. It includes a workshop and a sensory room. Examples of the various activities undertaken by people are on display. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 13 The home has been successful in getting service users to access this facility, including individuals with a history of not engaging in activities. Some service users also attend the local college, supported by staff. Service users are regularly supported to get out and access a range of opportunities. Staffing levels reflect this. The home has two vehicles. One service user spoke about the activities they enjoy doing. During the day people went out for various reasons, such as shopping or having lunch. Service users are also supported to have days out and holidays. Some service users were away on holiday when this inspection visit took place, with others due to go the following week. Links are maintained with service users’ families. Key information is shared, where appropriate. Visitors can come to the Old Rectory, or service users can go and stay with family or friends. One spoke about looking forward to seeing their relatives on the weekend after this inspection. All but one service user have weekly timetables on display. These are produced in pictorial form, to promote understanding. They show that each individual has a range of planned activities to fill the week, both at home and elsewhere. There is also a daily shift plan to assist staff in achieving all necessary tasks. However, flexibility is built in, especially where needed to reflect an individual’s needs. Service users regularly use local amenities, and have friendships and contacts in the local community as a result. Menus have been reviewed, with a conscious effort to include more healthy options, such as increased use of fresh fruit and vegetables, and fish dishes; and reducing the number of desserts. Individual care plans also strike a balance between service users’ preferences, and support to advise and encourage about variety. Where appropriate, they include information about specific dietary needs. The home has also researched the effects of diet on people with autistic spectrum disorders and is keen to review its menus again to reflect some of this information. Records are kept of what service users eat and drink, to monitor that they are receiving suitable quantity and variety. One service user has successfully been supported to lose weight. One service user is more independent, usually buying and preparing his own meals. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 14 For the rest of the group different menu options are prepared, including a vegetarian dish. All care staff participate in meal preparation and some service users also enjoy helping out. Some groceries are ordered via the internet and delivered to the home. Other items, particularly fresh produce, are shopped for on a day to day basis, involving service users. The home also grows some of its own vegetables. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 15 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 & 20 Quality in this outcome area is good overall, but improvement is needed in one aspect of medication practice. This judgement has been made using available evidence including a visit to this service. Service users are supported to address their personal and health care needs effectively. Service users are mostly protected by the home’s policies and procedures for dealing with medicines, but some may be placed at risk by lack of clarity about the use of ‘as required’ prescriptions. EVIDENCE: Service users’ personal care needs are set out in their individual plans. Abilities and needs vary widely amongst the group. Some are fairly independent and need only advice or prompting. Others are more dependent and require assistance with all relevant tasks. The level of support given is tailored appropriately, with guidance set out in records. Service users have various health needs, and records show that appropriate steps are taken to respond to these. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 16 People are supported to access input from relevant professionals. This includes regular review from a consultant specialising in learning disability and mental health issues. Health is promoted through a focus on exercise and an active lifestyle. Opportunities such as swimming and walking are offered to each individual, appropriate to their own abilities and needs. No service users are self medicating, so staff take on the responsibility for storage, administration and recording of medication. The home’s procedure sets out all the relevant information about how this is managed. Arrangements for storage are appropriate and secure. These will be affected slightly by the planned redevelopment of the office, as the medication cabinet will need to be moved from its present location. Administration is carried out by a senior carer, with another staff member witnessing. All care staff receive training via the pharmacy which supplies the home. Further external training courses are also now being booked. The medication protocol is also used as part of the in-house training programme. Staff sign to indicate that they have read and will abide by this. The medication folder contains a section on each service user. This includes their administration record chart; a care plan on how they take medication; information about any reviews or changes of prescription; and individual guidelines for any drug which is prescribed to be taken ‘as required’. The home reports any medication errors which occur, and takes appropriate actions in response. Medication is reviewed by appropriate medical professionals. Any advice or changes to prescriptions is recorded, and cross referenced to the administration record chart if necessary. Sampled records show that one service user is prescribed two different medicines which may be given ‘as required’. Individual guidelines set out that one of these should only be given as a last resort, and only after the other medicine has already been given. However, a recent entry indicates that the second medicine was given alone, in breach of the agreed approach. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 17 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 & 23 Quality in this outcome area is good overall, but could be enhanced by effective reporting of all notifiable events. This judgement has been made using available evidence including a visit to this service. Service users are safeguarded by the home’s policies and procedures for complaints and protection. But these safeguards must extend to include notifying the CSCI of all significant events. EVIDENCE: Complaints information is included in the Service User Guide, in a format designed to be more easy to understand. The complaints procedure is also prominently displayed within a public area of the home. It has been circulated to all service users’ relatives and is due to be redistributed, in response to the findings of the most recent relatives’ questionnaire. Recording systems are in place. No complaints have been received since the previous inspection. The Old Rectory has made referrals to local vulnerable adults procedures, when required. By being open about any incidents that occur, the home has access to support from other agencies. This process has assisted in identifying actions to minimise the risk of service users coming to any harm. All staff receive training in abuse awareness as part of their overall induction. This includes information about how to record and report concerns. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 18 Each staff member is issued with a copy of the booklet which summarises the multi-agency adult protection process in Wiltshire. There is also information about Craegmoor’s procedures for staff wishing to raise any concerns about practice. Some service users have complex and challenging needs. These can include issues arising from personal relationships. Relevant professionals such as a behaviour nurse specialist are involved in giving support to these individuals, and in supporting the home to develop suitable approaches for management of difficult situations. All staff are given suitable training, to assist in the effective management of service users who may present challenging behaviour. There is a focus on defusing and de-escalating potentially difficult situations. Some instruction in physical interventions is also given. There are clear parameters around the level to which this may be practised. One set of service user records contains a number of incidents where the individual’s behaviour has affected their own well-being or that of staff. These situations appear to have been well managed, and there is clear guidance in the service user’s individual plan about how to support these needs. However, such incidents must also be notified to the CSCI, which had not been done. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 19 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Progress is now underway on a major refurbishment of the home. Further improvements are required to the quality of service users’ living environment. EVIDENCE: Previous inspections have highlighted the need for significant improvements to the Old Rectory premises. Craegmoor have acknowledged the need for major investment. A large scale refurbishment has been authorised and funded. The Old Rectory is a listed building, which means that all the proposed changes need planning approval. This has contributed to a number of delays in getting the refurbishment programme underway. Work has now commenced, but approval has not yet been obtained for all the proposed changes. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 20 Craegmoor has allocated a project manager to oversee the refurbishment programme. This person was also visiting the Old Rectory on the day of this inspection visit, and was then due to have a meeting with the local planners. Improvements made to date include replastering walls and ceilings; painting; laying new flooring; and provision of new specially made furniture. Some areas of service user accommodation are already benefiting from such changes. Others have yet to be completed. Some items are being stored until they can be put into finished rooms. Each service user has a single bedroom. One person has an individual flat, with separate access internally. Two service users have en-suite bathrooms at present, and planning permission has been obtained to provide two more. The staff office and sleep-in room will also be given an en-suite shower, with the possibility of redesignating this room for service user occupation when there is any future change to the group. There are two lounges on the ground floor. One of these is not in use at the moment whilst refurbishment work is ongoing. The kitchen has previously been completely refitted, giving service users and staff much improved facilities in this area. The utility room is to be refitted as well, including installing a new sink and sluice. A cleaner is employed for a number of hours each week. Service users and other staff also take part in relevant tasks. Some parts of the home are difficult to keep clean, due to the need for refurbishment. For instance, there are patches of damp in some rooms which need to be addressed. One service user’s bedroom had a number of stains on the ceiling and window frame, which appeared to have been caused by spilled drinks. An offensive odour was also noticeable in parts of the home. The deputy manager said that it is hoped to resolve this problem by replacing flooring in the affected areas. The garden is well maintained, and attractively landscaped. The home is looking into ways to try and improve perimeter screening, for added privacy and security. This is another issue which has been made more difficult by planning restrictions. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 21 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 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 by suitable numbers of appropriately trained staff. Service users are protected by the home’s recruitment process. EVIDENCE: The home was suitably staffed on the day of the inspection. Cover is maintained at high levels of staff to service users. There are a minimum of four staff on duty during daytime hours, if all service users are at home. The usual aim is to have six staff on a morning shift; and five in the afternoon and evening, up until 22.00. Some service users need one-to-one support for much of the time. This responsibility is shared amongst the staff on duty. Night time cover consists of one waking and one sleeping member of staff. There is a separate team of waking night staff, although other carers may also occasionally cover these shifts. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 22 Staff working at the Old Rectory also take turns to deliver support to service users at the smaller nearby home which is jointly managed. Some activities may be jointly undertaken by service users from the two homes, in which case staff support may be combined. There were some staff vacancies at the time of this inspection visit. Recruitment was ongoing. Records for three recently appointed staff were seen. The required evidence of recruitment checks was in place. Nobody had commenced employment until it was verified that their name does not appear on the national list of those judged unsuitable to work with vulnerable people. Interviewing and selection of candidates takes place locally. Service users contribute to this process, as applicants visit the home and their interactions are observed. Craegmoor has a central human resources department which oversees other elements of the process, including criminal records and health checks; and taking up references. If there are additional issues to consider when deciding whether to appoint new staff, records show that there is an appropriate process of consultation and decision making. This involves the human resources department and senior managers. However, there is not any documented risk management framework for supporting such employees and recording judgments about their suitability once in post. Craegmoor has an organisational induction and foundation programme, linked to national standards for the social care workforce. After induction, staff go on to undertake a range of other training relevant to their jobs. Some of this is done via self directed learning, using packs which have been developed by the company. Staff are given time whilst on duty to read through these, and then have to complete a test paper to demonstrate what they have learned. A recently employed member of staff confirmed that they are undertaking a range of training during their induction. They are supported through this by a team leader. The home’s deputy manager acts as training co-ordinator. Records are maintained for each employee, showing which courses they have attended, and what they need to do. There is also an overall plan of what training is required over coming months. Each staff member has an annual appraisal which includes identifying their training needs. These may include update sessions as well as new courses. The training programme includes information about specialist needs of the home’s service users, such as autism. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 23 The Old Rectory has a resource pack on this topic. Conferences have been held and it is hoped to arrange more. Craegmoor also has an organisational lead person specialising in this area. Training sessions are often held in the hall next to the Old Rectory, with trainers from Craegmoor or other companies coming in to deliver these. All support workers are expected to study for National Vocational Qualifications (NVQs) in care. The Old Rectory is above the 50 minimum target for care staff with this award at Level 2 or higher. In total, 14 people have achieved at least Level 2, and all team leaders have achieved Level 3. Craegmoor has set up its own NVQ centre, so that the company supplies its own assessors to work with candidates studying for the award. Four staff are working towards Level 2, with others due to enrol. One staff member commented that they have worked in other care settings, and since joining Craegmoor they have received a better quality of training. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 24 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 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager is suitably qualified, competent and experienced, so that service users benefit from a well run home. Quality assurance measures underpin service developments, and include actions based on the views of service users. Service users’ health and safety are protected by the systems in place. EVIDENCE: The home’s registered manager is Mr Ean True. He has worked at the Old Rectory for a number of years, and was previously the deputy manager. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 25 He has obtained his Level 4 NVQ in management and the Registered Managers Award. Mr True is also the registered manager for a smaller nearby home for three service users, and oversees the staff team in supporting both services. The home’s deputy manager also has NVQ Level 4. Craegmoor’s services are extensively audited by the organisation. The manager is required to submit various weekly and monthly reports. There are also visits to the home by senior managers. The purpose of these is to ensure that all establishments achieve a minimum standard of performance, and to promote them to move beyond this to reach a level of excellence. Craegmoor has a ‘Clinical Governance’ team which oversees quality throughout its registered services. Clinical Governance audits are conducted by this team, and the Old Rectory is due to receive one of these soon. The organisation has linked all of its services via a computerised intranet. Using this, each home can access up-to-date information about its own performance. It also means that organisational information, policies and procedures can be obtained online. Consultation also takes place as part of the overall approach to quality assurance. Service users’ relatives are surveyed. The home also tries to get service user input a couple of times a year, although this is more difficult. Service user meetings are held. Some service users have also attended Craegmoor area conferences. The service completed an Annual Quality Assurance Assessment (the AQAA) for us as part of this key inspection. This demonstrates that they have audited themselves, identifying their own strengths, areas of improvement and future development targets. The current service development plan has targets for the continued implementation of person centred planning, the ongoing refurbishment of the home and the promotion of staff knowledge and skills through training. Health and safety is overseen by the home’s maintenance man. Records are kept of the regular checks performed in house, and of any servicing or repairs carried out by external contractors. Issues such as gas safety and testing of electrical appliances were seen to have up to date certification. A survey and report on asbestos in the property was carried out in December 2006. All staff undertake training on a range of health and safety topics. These include infection control, food hygiene and the control of hazardous substances. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 26 All checks and instructions relating to fire safety were recorded as being carried out, and up to date. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 27 The property’s fire risk assessment was reviewed in December 2006. There is also individual information about each service user and their likely response in an emergency situation. Old Rectory (The) DS0000028608.V343136.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 X 2 N/A 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 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 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 3 X 3 X X 3 X Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 29 No Are there any outstanding requirements from the last inspection? 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 YA20 Regulation 13-2 17-1a Sch3-3m 37-1e Requirement There must be clear guidance on the criteria for administration of medication prescribed on an ‘as required’ basis. The persons registered must notify the Commission without delay of any event which adversely affects the well-being or safety of any service user. Timescale for action 31/10/07 2 YA23 12/09/07 3 YA24 23-2b The planned renewal programme 31/03/08 for the fabric and decoration of the premises must continue, with records kept. An updated report must be provided to the Commission by the date shown. All parts of the home must be kept free of offensive odours. 31/10/07 4 YA30 16-2k RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 30 No. 1 Refer to Standard YA34 Good Practice Recommendations Risk judgements about the employment of staff should be supported by a documented management plan for their induction and supervision. Old Rectory (The) DS0000028608.V343136.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue BS1 4UA Bristol National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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