Inspection on 12/07/07 for The Old Vicarage, Easton

This inspection was carried out on 12th July 2007.

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

Other inspections for this house

The Old Vicarage, Easton 10/07/09

The Old Vicarage, Easton 18/07/08

The Old Vicarage, Easton 28/12/06

The Old Vicarage, Easton 29/01/06

The Old Vicarage, Easton 18/03/05

The Old Vicarage, Easton 25/10/04

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 The Old Vicarage 8 All Hallows Road Easton Bristol BS5 0HH Lead Inspector Sarah Webb Key Unannounced Inspection 12th & 13th July 2007 09:30 The Old Vicarage DS0000020336.V339445.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 DS0000020336.V339445.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 DS0000020336.V339445.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Address 8 All Hallows Road Easton Bristol BS5 0HH 0117 9399910 0117 9399910 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) www.brandontrust.org The Brandon Trust Mrs Susanne Burch Care Home 9 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (1) of places The Old Vicarage DS0000020336.V339445.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 9 Adults with Learning Difficulties aged 18 - 64 years Staffing Notice dated 01/06/1999 applies Manager must be a RN on parts 5 or 14 of the NMC register May accommodate one named person over 65 years old. Will revert when named person leaves. 28th December 2006 Date of last inspection Brief Description of the Service: The Old Vicarage is a large building converted to house 9 people with learning difficulties but has recently downsized to provide a service to 7 people. There are two large communal areas and 9 single bedrooms in the home. The home is in the process of converting one of the extra bedrooms into a second lounge. The home is surrounded by garden, has its own off-road parking and is situated in a quiet road near to a cycle path. The home is in Easton, Bristol and near to local amenities. There are recreational facilities, shops and services near to the home. The home provides nursing care but with a social focus. Fees payable range from £1044.00 to £1,088.62 per week. The Old Vicarage DS0000020336.V339445.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key Unannounced Inspection that took place over one and a half days. The inspector met 6 of the people using the service and four of the care team. The previous Manager has recently left the home; the Commission has been informed of the current management arrangements in place. The Assistant Manager who is currently acting Manager for a 3-month period was also available during the inspection. He said a review of the service is to be carried out in the near future in relation to a change to the ‘nursing ‘aspect of registration. As part of the inspection process records were viewed including those in relation to care and support plans, risk management, the administration of medication, and staff training. Further information was also provided through the Annual Quality Assurance Assessment. A tour of the home was undertaken and interaction between staff and the people using the service was also observed during the lunchtime period. As part of the inspection process surveys were received by 1 relative and with 1 from Health Care Professionals and 1 from an external advocate. Comments were generally very positive in the care and support offered to people living at The Old Vicarage. Pictorial questionnaires were received by people using the service; the inspector would like to thank people for completing these to the best of their knowledge as they omitted written information in helping them to be completed. What the service does well: People using the service are happy and settled and there is a good rapport with staff. The home supports people with complex needs and strives to promote peoples independence and encourages people to make decisions that affect their lifestyle. The home has good links with local health and social care professionals asking for advice when needed. The Old Vicarage DS0000020336.V339445.R01.S.doc Version 5.2 Page 6 Staff have a good knowledge and awareness of peoples needs that helps to contribute to their wellbeing and treat people with dignity and respect. Staff work hard to support people in accessing the local community for those individuals who are supported through restrictive interventions. What has improved since the last inspection? What they could do better: The Statement of Purpose needs to be updated in line with the current service provided and the changes in staffing. Care planning must be updated to include current support needs and how staff support people. These updates must also include the management of those people who present challenges. Care planning would be improved with accessible information included for some people so that they are involved in the planning of their care. Risk assessments must be implemented for those individuals who are supported through restrictive interventions to help ensure their safety and protection and also for an individual who may choke whilst eating. The home must consider ways of providing suitable transport for people to continue to access their planned activities. ‘As required ‘ medication must state direction for use and the maximum dosage to be given in 24 hours so that peoples health and safety is protected. The outcome of all complaints must be recorded to help evidence that people are listened to and that appropriate action is taken. People would benefit from incidents being recorded in detail that are challenging so that peoples behaviour can be monitored. The home must notify us of future incidents so that we can also monitor the homes practice. The home must provide suitable resources for people so that they can be supported safely during any physical interventions. The Old Vicarage DS0000020336.V339445.R01.S.doc Version 5.2 Page 7 People would benefit from their bedrooms being redecorated, repairs being carried out, and the home being cleaned on a regular basis. This would provide people with a more homely environment. The home must update the staff training records to help evidence that the staff are competent and are suitably trained to support peoples needs. 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 DS0000020336.V339445.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 The Old Vicarage DS0000020336.V339445.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, & 5. Quality in this outcome area is good. Prospective people are assessed so that the home knows their needs can be met. However current information must be updated so that people can make a choice whether to move to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose describes the range of people the home provides a service to including the aims and values of the home. However this document must be reviewed so that people have up to date information about the home. There has been a change in the number of people a service is provided to and also a change in the management and staffing. The inspector explained that the Statement of Purpose will be a key document in future inspections and will need to be expanded in its content. There have been no new people admitted to the home. Peoples care files included assessments of need that had been completed before people had been admitted to the home. This helps ensure that the home has suitable information in deciding that people’s needs can be met. The Old Vicarage DS0000020336.V339445.R01.S.doc Version 5.2 Page 10 Peoples care plans had been reviewed; this area is recorded in more detail in Standard 6. People have been issued with a statement of terms and conditions for their stay. The Trust informs people every year if there is a change to their fees. The Old Vicarage DS0000020336.V339445.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is adequate. Although staff demonstrated a good knowledge of peoples needs, care plans and risk assessments must be improved in documenting specific areas of support and up to date guidance to help enable staff to support people consistently. People would also benefit from a review of the home’s accessible so that they are involved in their care planning in a meaningful way. People are encouraged to make decisions about their lifestyle. The home has risk management procedures in place to ensure individuals are supported safely in taking risks but the home must to improve in providing risk assessments for those individuals who are supported through restrictive interventions. This judgement has been made using available evidence including a visit to this service. The Old Vicarage DS0000020336.V339445.R01.S.doc Version 5.2 Page 12 EVIDENCE: Care plans observed contained some useful information to help support staff with peoples care. Although care plans had a recent review date it was evident that there were several areas of individuals care plans that need to be updated with relevant information. This is essential in ensuring all staff follow consistent practice. The previous manager had completed an Annual Quality Assurance Assessment which was received prior to this inspection; this stated that care plans had been simplified. It was evident that this had been implemented and information was basic. One persons care plan did not have up to date and current information regarding a change in their daily activities. Another persons care plan must include specific support with their personal support needs as this could impinge on the health and safety of others if they became agitated. Incident records also showed that this was an area that staff needed to respond to. Although one person is supported with some pictorial formats to help them understand their daily life, discussion was had with the acting manager about ways and methods of making care planning more accessible to people. Observation of interaction between people using the service and staff demonstrated that they have built good relationships; staff spoken with had a good knowledge and understanding of peoples needs. The home completes monthly summaries of peoples care, however these were inconsistent and not up to date. This is an area that has been identified for development through information sent in the Annual Quality Assurance Assessment. The home have house meetings with people so that peoples views can be heard and discussed and also to encourage people in making decisions in the running of the home and aspects of their lifestyle. This was identified by both written minutes from meetings and was confirmed by people spoken with. Although there were relevant risk assessments in those care files examined there were some risk areas that had no written assessment evidencing that people are supported to take risks safely. A recent assessment by a specialist service identified that an individual needed specific support with their meal times. However through discussion with acting manager and examination of care files it was evident that there was no risk assessment for this person in relation to the possibility that they may choke during eating. The Old Vicarage DS0000020336.V339445.R01.S.doc Version 5.2 Page 13 Further examination of incident reports also identified a situation when staff had to support an individual with their behaviour. There was no risk assessment with regard to their behaviour and how staff should support them. Risk assessments must also be in place for those individuals who present behaviour that challenges and link into the care planning system, to include triggers for challenging behaviour, diffusion techniques, and restrictive interventions. This is seen as central for safe and effective care planning and is in accordance with the Department of Health guidance. These therefore need to be implemented by the home and form part of relevant care plans. The Old Vicarage DS0000020336.V339445.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, &17 Quality in this outcome area is good. The majority of people are supported in having active life styles including as living as part of the community; there are occasions when this is restricted relating to lack of transport and staffing levels. People are involved in the routines of the home and are provided with a healthy, well balanced diet This judgement has been made using available evidence including a visit to this service. EVIDENCE: People are supported in taking part in meaningful activities, including farm placements, going to college, shopping and local venues. Some people have day service support from the Trust and are taken out on a 1:1 basis. Daily records also identified differing activities people had attended and two people spoken with said they went shopping and enjoyed visiting the local pub. The Old Vicarage DS0000020336.V339445.R01.S.doc Version 5.2 Page 15 A recommendation to make arrangements for the rapid replacement of the mini bus has not been met. Staff have continued to support people in accessing their ongoing activities although there are times when this is difficult and peoples’ activities are restricted. Staff spoken with said that transport has continued to be an ongoing issue and staff cars are often relied upon to help support people to activities. Not all staff are drivers and consideration need to be taken in that a qualified member of staff always needs to be on site. One person has the use of a mobility car that is in their name. However this is being reviewed with them, as full use of their car is not being made. One person had used a considerable amount of his money on taxis recently. A further recommendation is made for the home to provide people with suitable transport so that people can go to both their planned activities and have further opportunities to access other venues. People have had opportunities to go on holiday this year. One person has been supported on 2:1 basis for a holiday in Wales whilst two others shared a house. People are supported in maintaining relationships with families and friends. Staff explained that one person moved into the home as this was their local area they had lived in prior to moving into the home, and that they have close links with the local community, friends and family. They are also supported by staff to attend a specific group in line with their cultural needs. A survey returned from a relative indicated that one of the areas the home does well is ‘ to let each person express their thoughts, interests and hobbies and to give people a certain amount of independence.’ The inspector spoke to several staff; one of who is in the process of changing their role in the home from support worker to domestic/cook. They said that people would benefit from a more structured approach in the planning of meals. There was a range of dishes recorded as being available for each day. There was evidence seen that demonstrate people’s likes and dislikes are included when menus are planned. There was a varied choice of meal options available for the people who use the service. Meal options included a range of nutritional meals including those that reflected differing cultural backgrounds. Interactions observed during a midday snack was positive with staff communicating warmly both verbally and signing. It was evident that people are encouraged to be independent in the daily routines of the home; people were observed making a drink and preparing their snack. The Old Vicarage DS0000020336.V339445.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. People are supported with both the monitoring and maintaining of their health needs through both local and specialist services. People are treated in a respectful manner by staff. The management of ‘as required’ medication still needs to be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people using the service are registered with the local surgery and health care records identified that people are supported through the Community Learning Difficulty Team with access to specialist services such as psychiatrist, dietician, physiotherapist and psychologist. People are supported with their mental health needs; records indicated that these are reviewed regularly. A survey returned from a specialist service indicated that the management and staff consult regularly with the Community Learning Difficulty Team for advice, and that the home manages people with complex needs well. The Old Vicarage DS0000020336.V339445.R01.S.doc Version 5.2 Page 17 Records also indicated that people’s health is monitored through support in attending appointments including those with optician, and dentist. People were observed getting up at different times during the morning, which helps to demonstrate how their choices and different preferences are respected. Interactions observed during the inspection identified that staff are respectful of people’s privacy and dignity. The procedures and systems in place for administration, storage and disposal of medication were checked to monitor if the systems are safe. There are policies and procedures for the administration, storage, and disposal of medication. The medication administration charts of three people who are administered with their medication were looked at. Medication profiles contained a photograph with the drug records to ensure medication is dispensed safely. Up to date records were kept of medication received into the home and the medication administration charts were legible and up to date. A requirement has been met to record disposal of medication and since this inspection the home has secured an appropriate bin to store drugs securely awaiting disposal. A recommendation to ensure bottles of ‘As required’ medication state the actual directions for use and the maximum dosage to be given in 24 hours has not been met. This was discussed with the acting manager and is carried forward as a good practice measure. Only senior, qualified staff administer medication; training records verified that they complete regular training to enable them to do this safely. This was also confirmed by staff. The Old Vicarage DS0000020336.V339445.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 adequate. People benefit from a complaints procedure; the recording of the outcome of complaints needs to be improved. The home must improve in providing clear strategies for the management of peoples behaviour. People would also benefit from challenging incidents being recorded in detail so that they can be monitored on a regular basis to help ensure peoples safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home follows the organisational complaints procedure. Since the last inspection there has been 1 complaint recorded; this included the details of the complaint. However, there was no record of the outcome of the investigation. Two peoples personal monies were checked and the balances corresponded with their financial records. The home has policies and procedures to follow in supporting people with their finances. The Annual Quality Assurance Assessment received prior to the inspection identified that the home has behaviour management plans for all people using the service. Through examination of peoples care files it was evident that not all people had specific behaviour management plans in place. One care planning record showed that physical intervention had been used and staff confirmed they have received the appropriate training. The Old Vicarage DS0000020336.V339445.R01.S.doc Version 5.2 Page 19 Not all people had individualised strategies in place. This must be put in place and include any known triggers, diversionary tactics to help to diffuse difficult situations as well as when and how to use the approved restraint methods. This must also clearly link to an individualised risk assessment. (This has previously been recorded in the text of Standard 9). Records of incident are recorded in daily records and on incident sheets. However recording of an incident should describe the incident, include antecedents, setting conditions and the exact time during incidents when physical interventions are used. Also the diffusing techniques used, and staff members involved. An improvement in this area may help to provide additional protection for service users and staff and benefit the review of behavioural approaches by providing more information from staff regarding each incident. A requirement is made for the home to send in monthly incident reports in order that these can be monitored by the Commission. Examination of recorded incidents identified that the home still needs a 2seater sofa to support staff when dealing with the management of an individual’s behaviour through specific physical intervention. This was also confirmed through discussion with the manager who said when the new first floor lounge is decorated and refurbished then this will need to be in place. Examination of a care file also identified a specific practice used by staff to encourage an individual to get up in the morning. Discussion was had with the acting manager that this strategy could be deemed as abusive; however it was evident that the person would benefit from the outcome of this strategy and have more opportunities to external activities during the day. It would also help them with having a more regular sleeping pattern and fewer disturbances for others during the night. This was discussed with the acting manager, who was also advised that the individuals placing authority should be alerted to this practice. Training records identified that staff have attended training courses related to the protection of vulnerable adults from abuse. The Trust also has procedures in place relating to protecting vulnerable adults; this helps staff understand their responsibilities to protect vulnerable adults in their care. The Old Vicarage DS0000020336.V339445.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 adequate. Although some repairs and redecoration has been carried out there are still areas that are in need of improving so that people benefit from living in clean and homely environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Old Vicarage is a converted older property, built over two floors, which can be accessed by stairs only. A large attic space is used for storage. The home comprises of nine single rooms, a lounge, dining room, kitchen, laundry and bathrooms. With the home down sizing to providing a service to 7 people, one of the bedrooms is in the process of being converted to a second lounge space on the first floor. It was evident that this would be beneficial to people in having more space and supporting both staff and people in dealing with difficult situations that may arise. The Old Vicarage DS0000020336.V339445.R01.S.doc Version 5.2 Page 21 It was evident that the home will benefit from the new domestic/cook post. There were areas of the home such as stairways and hallways that were in need of being vacuumed and cleaned. People were seen sitting in communal areas such as the lounge and kitchen; they looked comfortable and at ease in the environment. The home has identified through their Annual Quality Assurance Assessment that plans for improvement extend to the regular redecoration of peoples bedrooms and communal areas. This was evident when visiting some peoples’ rooms. Recent flood damage to a person’s bedroom ceiling still needs to be redecorated and another person’s bedroom was in need of redecoration. Another area identified for improvement was regular ongoing redecoration plan. The manager was advised to remove a gate from the office door, as this had been a restriction for an individual who no longer lives at the home. The ground floor bathroom has been refurbished meeting a requirement. Carpeting in the hallway has been replaced. The home supports a person with a hearing impairment with their safety in providing them with specialist equipment so that they are alerted to fire alarms being sounded. There is one person who smokes and there are arrangements for them to smoke away from the other people who are non-smokers. The Old Vicarage DS0000020336.V339445.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, & 35 Quality in this outcome area is good. People benefit from an experienced and qualified staff team. Staff have attended relevant training to meet peoples needs but records need to be improved to evidence staff have attended statutory training and updates. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing team consists of the manager, 3 senior staff (who hold a nursing Qualification) and 9 staff who work varying hours. The current number of staff on duty reflects the reduction of people using the service for 9 to 7 people. Staffing rotas indicated that there are generally 3 staff on duty to cover both early and late shifts. The acting manager advised that two further qualified secondments have been advertised internally through the organisation. The Old Vicarage DS0000020336.V339445.R01.S.doc Version 5.2 Page 23 The home uses the Trust’s bank staff and the acting manager indicated that there are two regular bank workers who have a good understanding of peoples needs. A survey returned from a relative indicated that their view of staff was that they are very good and that they had ‘nothing but praise and gratitude to the staff’. All new staff completes a Trust induction programme including the Learning Disabilities Award Framework and progress to NVQ level 2 awards. The majority of staff have completed the level 2 award. Part of the homes induction is also for new staff to shadow regular staff. Training records are in need of being updated as information was sporadic; records identified that not staff have attended statutory training in first aid, fire, and food hygiene and it was unclear when updates had taken place. However records indicated that staff have attended a range of training including the Mental Capacity Act, SARI Race Awareness, Positive Response, sensory awareness, autism, and positive communication. Staff are also due to attend Advocacy training. Staff records are kept at the Brandon Headquarters and have not been looked at during this inspection. An employee records checklist held on all staff had not been completed by the management of the home. This checklist includes those documents such as police checks and references and that they are in place in the headquarters. The Old Vicarage DS0000020336.V339445.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. People benefit from a management team who promote an open and inclusive style of management. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mr Dodsworth is a registered nurse in learning disabilities and is acting up as manager for a 3-month period. He has worked at the home for many years and demonstrated his knowledge of peoples needs. There are 3 other senior staff who also share the management responsibilities and tasks associated with the monitoring of the home are delegated to all staff. Through observation of both staff and people using the service it was identified that there is an open culture; there was a relaxed atmosphere with people chatting freely. The Old Vicarage DS0000020336.V339445.R01.S.doc Version 5.2 Page 25 There are monthly meetings for people, and participation is encouraged. The Trust also has processes in place for consulting with people through quality monitoring. Annual Health and Safety Audits are carried out by the Trust and monthly inhouse checks carried out. The fire logbook record was checked and showed the required weekly and monthly tests of the fire alarms and the fire fighting equipment were being carried out and were up to date. Records identified that staff have attended fire training; fire drills had taken place. The acting manager provided the inspector with an electrical safety inspection meeting a previous requirement. The Trust carries out Regulation 26 visits on a monthly basis to monitor the management of the home; copies of these reports are sent to us. The Old Vicarage DS0000020336.V339445.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 2 2 3 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 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 DS0000020336.V339445.R01.S.doc Version 5.2 Page 27 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 YA1 Regulation 4 &5 Requirement The Statement of Purpose and Service User Guide must be reviewed to include changes to the home so that any prospective people are well informed about the home. Care plans must be updated with peoples current support needs so that staff know how to support people in meeting their needs. Risk assessments must be completed for those individuals who are in need of physical intervention and for an individual who may choke whilst eating so that their safety is protected. When a complaint is made it must be clearly recorded as to action taken and the outcome in order to monitor that appropriate action is taken and followed up. When physical interventions are used on any person using the service a detailed record must be kept so that in incidents can be monitored and people are protected. Timescale for action 31/10/07 2. YA6 15 31/10/07 3. YA9 12(a) 30/09/07 4. YA22 22(4) 16/08/07 5. YA23 Shed 3 16/08/07 The Old Vicarage DS0000020336.V339445.R01.S.doc Version 5.2 Page 28 6. YA24 12(1)(b) 7. YA26 23(2) Suitable furniture must be 30/08/07 provided for people when specific physical interventions are required so that people are protected and supported in a safe manner. Bedrooms must be decorated 31/12/07 and repairs carried out to an individual’s room so that they live in a homely and safe environment. 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. 2. Refer to Standard YA6 YA20 Good Practice Recommendations Investigate ways of involving people in the planning of their care through accessible formats. Ensure bottles of As required medication state actual direction for use and the maximum dosage to be given in 24 hours. Make arrangements for rapid replacement of the mini-bus. Sign and date care documentation so that care can be monitored effectively. Update staff training records to help evidence that people are supported through a competent team 3. 4. 5. YA13 YA6 YA35 The Old Vicarage DS0000020336.V339445.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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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