Inspection on 19/06/07 for The Old Vicarage

This inspection was carried out on 19th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Vicarage 15/08/06

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 The Old Vicarage 75 The Greenway Uxbridge Middlesex UB8 2PL Lead Inspector Sarah Middleton Key Unannounced Inspection 19th June 2007 09:00 The Old Vicarage DS0000061744.V339099.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 Old Vicarage DS0000061744.V339099.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 Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Address 75 The Greenway Uxbridge Middlesex UB8 2PL 01895454710 01895454711 anthony.motyka@the-old-vicarage.org 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) Autism Consultants Limited Manager post vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th August 2006 Brief Description of the Service: The Old Vicarage is located in a large house that has been adapted to offer the space and homely environment for the residents to live in. It is near to a main road that leads into the local town Uxbridge where there are good transport links into London. The service has its own house car and is located near to the college that some of the residents access. The Old Vicarage is a service that can offer accommodation for adults with Autism and or associated disorders. It is registered for adults with an age range of 18-65 years old. Formerly this service was registered at The St Mary’s Centre. The residents and staff moved to the Old Vicarage in November 2005. The Registered Provider is Autism Consultants Limited. The Registered Provider provides schools and a college for people with Autism and associated disorders. They also own an agency, which provides staff to various services. The residents living at the Old Vicarage are able to access this college. The staff team consists of a Registered Manager, Deputy Manager and support workers. Additional regular bank staff also work in the home. At night the home has a sleeping-in member of staff who is available for residents. There is also an oncall person, usually the Registered Manager or the Deputy Manager who is available to offer additional support and advice. Fees vary depending on whether residents receive one to one support, (this is reviewed on a regular basis) and whether they attend the college owned by the Registered Provider. The residential fees range from £77,870-£118,088 per resident, per year. This does not include the college or one to one fees. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The term service user has been replaced and the term resident is now used in this report and refers to the people living in the home. This was an unannounced inspection carried out as part of the regulatory process. The inspection visit was from 9am-6.30pm. The Inspector viewed a range of documents such as residents’ files, staff employment files and maintenance records. Three residents and three members of staff were spoken with and the Inspector received postal surveys from residents, care managers and family members. Any relevant contributions have been included into this report. The Manager Designate has been in post for several months and was previously the Deputy Manager. He is due to leave in the forthcoming weeks. The home now has a new Deputy Manager and she will be the temporary Manager Designate until a new Registered Manager is appointed. The home has received one complaint that is ongoing and the home is responding to the complainant with the hope that this will be resolved in the near future. The home had two resident vacancies at the time of the inspection. Equality and diversity issues are considered and addressed by the home and any significant comments have been included. The four previous requirements were met and four new requirements were made at this inspection. All of the key Standards were inspected. What the service does well: The home encourages the residents to gain independent living skills. Staff recognise residents’ abilities and preferences and seeks to support residents to develop new skills for every day life. Residents often receive one to one support where they can take part in various activities both in and out of the home. Staff show a commitment and understanding when supporting the residents. The Old Vicarage DS0000061744.V339099.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 summary of this inspection report can be made available in other formats on request. The Old Vicarage DS0000061744.V339099.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 Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are assessed prior to moving into the home to ensure the home has the relevant and necessary information about the resident. The home aims to meet the needs of a prospective resident. EVIDENCE: The Inspector met with the Director and Manager Designate and discussed the pre-admission process. This is in light of an outstanding complaint, (See Standard 22 for further details), where some of the concerns raised in the complaint queried the home’s procedures when assessing a prospective resident. A care manager, who completed a postal survey and another family member, who the Inspector spoke with on the telephone, also raised questions about the pre-admission process. The previous Registered Manager had assessed the newest residents that had been admitted into the home in 2006 and so was not present to discuss the pre-admission assessment that they had completed. The Manager Designate and Director felt that every attempt was made, at the referral and assessment stage, to gather information, from family, professionals and the prospective resident. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 9 The Inspector viewed some of the documentation regarding a resident who moved into the home last year. The College and the home had met with this resident, prior to the move into the home and had assessed his needs. In addition, the family had completed a parental questionnaire. The Inspector was satisfied that the home has systems and procedures in place to meet with and assess a prospective resident. The pre-admission documentation viewed covered a wide range of areas, such as, looking at the prospective residents needs, abilities and behaviours. The Manager Designate has recently updated the pre-admission policy to include full details of the referral and assessment process and the transition period when a prospective resident moves into the home. The home always encourages trial visits and overnight stays and each transition into the home will vary depending on the needs of the resident. The home has a staff team who have a diverse range of experiences and abilities. Staff are adaptable and recognise that some residents are more independent than others. In addition, the home accesses training and information on the specialist subject of Aspergers and Autism and a Psychotherapist visits the home to meet with residents on a regular basis. The home seeks to offer a place to a prospective resident only once they feel the home would be able to meet their needs. One placement had been terminated and another is likely to end in the next few weeks. The Manager Designate described how there had been meetings with the resident, family and staff to review these placements and notice had been given when it was felt the home could no longer meet the residents’ needs. The Inspector acknowledged the difficulties in fully assessing the impact a new resident might have on the other residents and how stressful it can be for a new resident moving into a new home. The home is aware that new residents might find the move into the home stressful. As there have been concerns raised by parents of some of the residents mentioned above, the home should carefully consider and reflect on the pre-admission process for future prospective residents, to ensure the home feels confident in meeting the needs of a new resident. The Old Vicarage DS0000061744.V339099.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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are assessed and recorded onto a care plan. Residents are supported to make decisions for themselves. Risk assessments are completed and take into account residents’ rights to lead an independent life. Information on residents is now safe and secure and not available for other residents. EVIDENCE: The Inspector viewed a sample of resident’s files and care plans. Overall these were comprehensive and up to date. Care plans are completed by keyworkers and cover a range of needs such as personal care and social needs, along with cultural and dietary needs. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 11 Care plans are updated every six months or when there has been a change in identified need. Monthly summaries are also completed and these look at and record any significant events that have occurred. Each resident can contribute to their care plan and make comments about their identified needs. Reviews also take place usually in conjunction with Social Services. The resident, along with anyone they wish to invite, also attends these reviews. In the office on a notice board the Inspector viewed some of the residents’ preferred routines for the morning and evening. These routines guide staff to support the resident appropriately. The Inspector viewed a sample of daily records and these outlined what a resident had done each day, such as, events, health and recreation. The Inspector also viewed some behaviour guidelines completed by the Psychotherapist. Staff spoke of their understanding that some residents find it easier than others to make decisions. Staff described how they encourage residents to be as independent as possible and to make daily decisions for themselves. Residents do not have advocates but all have family members who have an active role in the residents’ lives. One resident spoke of being in touch with other people in the community with similar needs. Where able, residents are supported to manage their own finances. Residents meet every month and discuss issues relating to living in the home. The Inspector viewed an agenda that is placed in the communal computer room. Residents are encouraged to contribute to this agenda. Following on from the residents’ meetings, the Manager Designate responds to any comments made and copies of the minutes are given to each resident. Samples of risk assessments were viewed. These are monitored and updated whenever there is a change in the identified risk. Where particular risks are noted the Manager Designate responds to the potential risk, for example providing an additional sleeping in person in the home each night and ensuring that these two members of staff are not both female. A separate risk assessment was viewed where a resident had been informed that they would be moving on from the home. The Manager Designate had recognised that this information could cause anxiety and stress to the resident concerned. Another resident had stayed out overnight and had not informed staff of his whereabouts. His risk assessment had been updated and he had been informed to tell staff if he was not retuning to the house at night. The Inspector spoke with this resident who confirmed that he had not told staff when he had gone out overnight. He was aware that in future he should make every attempt to make contact with the home. Other aspects of this resident’s life suggested that some of the choices he has made could lead to potential risks to his safety. The Manager Designate had information on this resident’s file for staff to be aware of the risks and side effects of the activities this resident has engaged in. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 12 A family member, just prior to the inspection, informed the Inspector that a resident had accessed confidential files on the main communal computer. This resident, had they chosen to, could have accessed information about the other residents. The Inspector spoke with the Manager Designate who had been made aware of this problem and this had been dealt with as soon as he had received this information. Confidential files could no longer be accessed on the communal computer as security measures, that should have been installed, were now on the computer. The home needs to be vigilant to ensure this does not happen again, as residents need to know information about them will not be shared amongst others. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents take part in a wide range of appropriate activities during the day and evening. Social relationships are encouraged and staff support residents to maintain contact. Residents’ rights and responsibilities are respected and noted by the home. Residents are involved in the meals they eat and preferences are balanced with healthy meals provided in the home. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 14 EVIDENCE: Residents take part in a variety of activities during the day. Some attend the local College, where they engage in different subjects such as, cooking, gardening and computers. One resident is studying a Masters degree and another is studying a degree. The Inspector saw a resident going out to do voluntary work at a garden centre for adults with Aspergers. This resident accesses this work twice a week and is accompanied by a member of staff from the home. The home has a large garden where residents have been supported to grow vegetables. The home also has a games room in the garden and the back of the garden is to be levelled off to provide a sports area. Residents can choose the activities they take part in and some prefer not to attend certain activities, which is respected by the staff team. One member of staff spoke of introducing a woman’s night to the female resident living in the home. Another resident has a maths tutor who visits him in the home. Some staff felt there was some room for improvement regarding the activities offered in the evening. Most residents respond positively to structure and routine, however it was suggested by some staff that alternative activities could be introduced to provide even more diversity to the home. Those residents asked said they were happy with how they spent their time, both in and out of the home. The home has occasional “themed” parties where family and friends are invited. This provides residents with the opportunity to socialise with people. The home has its own transport, but as the home is located near to the main town, with good transport links, public transport is often used. One resident spoke with the Inspector about the problems they are having in receiving a freedom pass. As he has to travel into central London to visit the University he informed the Inspector that he is trying to get a freedom pass, as he feels he is entitled to one. Contact with family varies and depends on each resident and their family. Most residents have regular contact, either through visits, speaking on the telephone or via email. The Inspector spoke with one family member on the telephone and he queried how much information staff are able to pass onto family members. The Inspector brought this to the attention of the Manager Designate, who said he would ask the keyworker to discuss this with the particular resident. The Manager Designate described how staff respect residents’ wishes and do not pass information on to the family if the resident has specifically requested this. The home does need to be mindful of what information is important and necessary for family members to know whilst balancing this with the wishes of the resident. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 15 Residents sometimes visit family at weekends and go on holiday with them. One resident spoke with the Inspector about their different friends and the girlfriend they see whenever they can. They are able to come and go and see the important people in their life when they so choose. All residents have keys to their bedrooms and to the front door. The residents can read and receive their own personal mail. Staff were seen to interact with the residents and not exclusively with each other. If they are able to, residents can come and go as they so please. Staff recognise that each resident has a different level of need with some residents requiring space whilst others need occupation and supervision for the majority of the time. The Inspector viewed the kitchen, which was a bright and spacious room. Each resident has particular needs when it comes to preparing and cooking food. One resident chooses to order their food online using the Internet and then prepares and cooks her own food. Another resident, due to his specific needs, usually cooks meals using a microwave in his room. Occasionally he will have a takeaway meal or meals prepared by staff. Staff are aware of his cultural and religious needs and Kosher foods are purchased for him, either by the home or by his family. Residents are encouraged to assist in the preparation of a main meal for everyone once a week. One resident told the Inspector that they enjoy cooking a main meal for everyone on a selected evening. Each resident has a cupboard for their dried food items and food is labelled with resident’s names in the fridge and freezer. Once a week a member of staff asks residents to contribute to the weekly menus so that preferences are catered for. The Inspector viewed the foods on offer and saw there was plenty of fresh produce available. The evening meal was briefly observed and this was an unhurried and relaxed time for the residents. Fridge and freezer temperatures are taken on a daily basis and these were within an appropriate range. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Where needed, residents are supported with their personal care in their preferred way. Residents’ health needs are recorded and were being met. Staff had not been checking and counting loose medication. Devising a robust medication system could safeguard residents. EVIDENCE: The majority of the residents carry out their own personal care on their own. One resident has family who visit and they wash his hair once a week. Staff support residents as and when they request assistance, such as accompanying them to get their haircut or to buy clothes. Residents go to bed or get up when they so choose. One resident spoke to the Inspector about the problem they have in getting out of bed in the morning. The resident went on to say that he needs staff to remind him to get up, as he had “poor time management”. Another resident described female staff supporting her to straighten her hair and wear make up. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 17 Residents’ health needs are recorded onto care plans. The health appointments attended are recorded onto a form that indicates any treatment or outcome of the appointment. All residents have a GP, Optician and Chiropodist. As mentioned earlier, a Psychotherapist visits the home to meet on a one to basis those residents that benefit from this type of support. The Inspector viewed a health action plan whereby staff had supported a resident to think about his health needs and to comment on where he saw that he needed assistance. The resident had to consider aims and objectives in order to have good health. One resident spoke with the Inspector and said they currently did not have a local Psychiatrist. He is seeking to obtain a Psychiatrist to carry out a medication review. Some residents attend health appointments without staff. The expectation is that when this occurs the resident will inform staff of any significant outcomes. The Inspector viewed a sample of medication. The majority of medication is in blistered packs. The Manager Designate carries out audits on the medication but this did not involve counting the loose, un-blistered medication. The home also has homely remedies that are not blistered that must be checked. A requirement was made for the medication audits to be more detailed and include counting all loose medication. One medication, Dydrogesterone 10mg, had been taken out of the blistered pack and placed into a bottle to be returned to the Pharmacist, as it had not been administered. The Medication Administration Records did not indicate that this had happened or why. Medication records must clearly indicate if medication has been administered or discarded. A requirement was made for medication records to be completed appropriately. Staff receive medication training and staff work through books from the Pharmacist that the Manager Designate checks and signs off once a member of staff has completed them correctly. The Manager Designate is aware that staff are due for refresher training on this important subject. One resident is currently self -medicating. The home introduces residents to selfmedicating on a gradual basis. The procedure is to give the resident only a few days medication and this is then increased on a gradual basis until they receive one month’s supply. Residents sign for the medication and keep it in locked storage in their bedrooms. Risk assessments are completed to ensure the home and the resident feel it is the right time to introduce self-medicating and that potential risks have been considered and recorded. The home does not have controlled drugs in the home. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to voice their concerns and feel they would be listened to. Systems are in place to safeguard the residents. EVIDENCE: The home has one outstanding complaint that the CSCI was made aware of towards the end of 2006. The Inspector spent time with the Director and Manager Designate discussing the issues that have arisen from this formal complaint. The Director has been responding to the complainant, who is a family member of a resident who no longer resides at the home. So far the matter is unresolved but the Director and Manager Designate are hopeful that the complaint will be satisfactorily dealt with in the near future. The Inspector was satisfied that the home has responded to the complainant on a regular basis and that the home’s complaints policy was used to address the initial complaint. In addition, the concerns raised by another family member relating to a different resident were also discussed. The Manager Designate records any complaint made and any confidential information is kept in secure and locked storage. Those staff asked, were confident that residents could make a complaint to a member of staff. The Inspector spoke with some residents and they all said they would speak with staff, if they were unhappy. The Inspector viewed the complaints policy that is located in the communal computer room. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 19 The home had made referrals to the Local Authority’s Safeguarding adults’ coordinator. The referrals were made to keep the relevant professionals informed and aware of some of the issues the home had been facing, such as a resident staying out over night, without the home knowing where he was. The Safeguarding adults co-ordinator was satisfied with the home’s internal investigations. There have been no allegations of abuse and the Inspector was satisfied that the home has procedures in place if they have a concern. The home has the Local Authority’s safeguarding adults’ policies and procedures and literature such as the Department of Health’s “No Secrets” document. Staff receive training and information on adult abuse and how to identify signs of abuse. The majority of the residents manage their own personal finances. Staff support and keep two residents’ monies. These monies are locked in individual cash tins and kept in the locked safe. The Inspector counted and checked two residents’ monies and found these to be correct. Residents sign their account book when financial transactions take place. The residents’ money and petty cash is counted on a daily basis. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. The carpet on the ground floor is stained and marked in certain areas of the home. Cleaning or replacing this would provide a more pleasant place to live in. Overall the home was clean, tidy and free from offensive odours. EVIDENCE: The Inspector carried out a tour of the home. Overall the home was clean, modern and very spacious. It was noted that the light carpet in the communal areas of the hall and living room were marked and stained in certain places. This was brought to the attention of the Manager Designate, who was aware of this problem. The Inspector was informed that the carpets are cleaned, however this had not removed the marks. The Inspector made a requirement for the flooring to be cleaned again or replaced with more practical suitable flooring that is still in keeping with the décor of the home. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 21 The Manager Designate informed the Inspector that new sofas had been ordered for the living room. The home provides residents with many different areas to relax in, such as the conservatory, where meals are sometimes taken and also a separate dining room. Residents can access the computer in a small room or play games in a separate building in the garden. Staff and residents carry out cleaning duties in the home. Residents are encouraged to do their own personal laundry and laundry facilities are located in a separate room. Staff receive training on health and safety, which includes information on infection control procedures. The home has protective clothing to be used when necessary. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 22 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. A competent and effective staff team support the residents. Robust recruitment procedures are in place. The training programme did not fully meet the needs of the staff team and consequently the residents. EVIDENCE: The staff team is small and other than the new Deputy Manager and some new bank staff, the staff team have worked together for some time. The majority of staff have obtained an NVQ and staff are encouraged and supported to study for an NVQ at level 3. The Manager Designate spoke about the bank staff and whether they needed to have an NVQ. The Inspector advised it would be good practice, but acknowledged the difficulty in enrolling bank staff onto a longterm course, when they might only work occasionally in the home. Those staff spoken with and observed were committed, knowledgeable and aware of the residents’ individual needs. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 23 One family member spoken with on the telephone spoke highly of the staff team and said they were “flexible” and understood his daughter’s needs. The Inspector was made aware through the current complaint and concerns voiced by another parent, that questions had been raised as to the knowledge the staff team had with regards to Aspergers and Autism. The Inspector spoke with staff about the residents and those asked could describe how they aim to meet residents’ needs. The staff were conscious of the need to be sensitive and understand the issues residents face in their daily lives. The residents living in the home have a wide range of needs that staff are able to consider and work with to support the residents appropriately. The Inspector was satisfied that the staff team has the necessary range of experience and knowledge to support the residents effectively. There are sufficient numbers of staff working in the home at any one time. Currently there are no staff vacancies and bank staff work the vacant hours, usually due to staff holidays or sickness. The home does not use external agency staff. Staff meetings take place every two months and more frequently if there are issues within the home that need discussing. The Manager Designate told the Inspector that these meetings are used to also discuss particular topics that are relevant to the home. The staff team is a mix of ages, gender and cultural backgrounds, thus reflecting the diversity of the residents and the community. As indicated earlier, at times residents can receive one to one support from staff. Some staff spoke positively regarding how the team works well together, whilst others suggested there were some inconsistencies amongst members of staff. As the Manager Designate is due to leave the home in the next few weeks, it is even more important for the staff team to work together closely and communicate effectively so that the home continues to run well. The Inspector viewed three staff employment files on the newest members of staff that joined the staff team. These contained completed application forms, Criminal Record Bureau Checks, two references and health declarations. The home had also involved a resident in the recruiting of the new bank staff and this resident had sat in on the interview and asked questions. The Inspector viewed the induction and training staff receive. The home uses a checklist for new members of staff to work through when they initially start working in the home. This covers the basic information they would need to know about the running of the home and the residents. The Manager Designate has also introduced a more detailed induction that takes place over a longer period of time, approximately six weeks. This is worked through and signed off by the new member of staff and the Manager Designate. This detailed induction covers areas such as principles of care and looking at communication and abuse. The Inspector spoke with a new member of staff who confirmed they had received a detailed induction and been given time to shadow existing members of staff. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 24 The Manager Designate had carried out an analysis of the training needs of each member of staff, including bank staff, as they also receive training and supervision. Staff complete a form once they have attended training that records the topics covered and what they feel they learnt from the training. Staff were in need of training on medication and adult abuse this year, but so far this had not been booked. The new members of staff were also in need of mandatory training, that the Manager Designate was aware of but had not booked the courses. A requirement was made for staff to have up to date necessary skills and information they need to meet the diverse needs of the residents. In addition, the Inspector made a recommendation for staff to have information and training on the new Mental Capacity Act 2005 that has just become legislation. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 25 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. Residents benefit from a well run home. The home obtains the views of the residents and reviews the care provided in the home. Robust regular health and safety and maintenance checks are carried out and protect the welfare of the residents. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 26 EVIDENCE: The Manager Designate has worked in the home for several years. He is in the process of completing the Registered Managers Award and the NVQ level 4 in care. He has been the Manager Designate for almost a year but has now decided to move on and leave the home. The new Deputy Manager will act as temporary Manager Designate whilst the post of Registered Manager is advertised. It is hoped that the departure of the existing Manager Designate will not have a detrimental effect on the home. The Registered Provider will need to be aware of the impact that can occur due to several changes happening at a similar time, such as residents moving on and a change in management. The Inspector was satisfied that the home can manage the changes if staff work together and receive the support and guidance they need. Questionnaires have recently been sent out to residents and family members. These are sent out on an annual basis and responses are then considered by the home. The questionnaires ask for comments on various topics, such as the quality of the food, staffing and community. The Manager Designate also developed a summary report outlining how the home meets the National Minimum Standards. This report outlined some identified areas where the home could make improvements and the Inspector advised the Manager Designate to also consider aims and objectives for the forthcoming year. The CSCI receives the reports from the monthly Regulation 26 visits that take place. The Inspector viewed a sample of maintenance records. The Gas Safety record and the servicing of the fire equipment were up to date. The home had been visited by the local fire officer in May 2007 and had found no areas of concern. The Manager Designate had also completed a detailed fire risk assessment. The fire drills had been held at regular intervals and recorded the names of the residents and staff who attended. Risk assessments are completed on those residents who do not respond to the fire drills or fire alarm being set off. The Inspector made a strong recommendation for the fire drills to be held at different times of the day and night. The Manager Designate had completed a risk assessment to minimise the risk of Legionella being present in the home and checks such as de-scaling the showerheads and taps occur on a regular basis. The home carries out monthly health and safety checks, where a member of staff carries out a tour of the home. It is then documented where areas of the home need attention and a risk assessment is completed to ensure the shortfalls do not have an impact on those living and working in the home. The home has a maintenance person who visits the home to carry out any minor works. The Inspector viewed the water temperatures that had been taken and recorded in all areas of the home. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 27 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 3 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 3 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 3 33 3 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 3 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 The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 28 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. 2. Standard YA20 YA20 Regulation 13(2) Requirement Timescale for action 22/06/07 19/06/07 3. YA24 4. YA35 In order to safeguard the residents’ medication audits must be robust and detailed. 13(2) Medication Administration Records must be completed when medication has been administered or discarded. 23(2)(d) The carpet that is stained and marked on the ground floor needs to be cleaned or replaced so that the flooring is appealing for the residents living in the home. 18(1)(a)(c)(i) The training programme must provide staff with the necessary skills to support the residents appropriately. 31/08/07 30/09/07 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 YA35 Good Practice Recommendations It is strongly recommended for the home to obtain literature on the Mental Capacity Act 2005 and for staff to DS0000061744.V339099.R01.S.doc Version 5.2 Page 29 The Old Vicarage 2. YA42 receive training and/or information on this legislation. It is strongly recommended for fire drills to be held at different times of the day and evening. The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 The Old Vicarage DS0000061744.V339099.R01.S.doc Version 5.2 Page 31 - 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. 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