Inspection on 01/09/06 for The Paddock

This inspection was carried out on 1st September 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Paddock 08/01/09

The Paddock 23/01/08

The Paddock 30/08/07

The Paddock 27/07/05

The Paddock 05/10/04

The Paddock 14/04/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 The Paddock The Paddock 80 High Street Lydd Kent TN29 9AN Lead Inspector Michele Etherton Unannounced Inspection 1 September 2006 09:00 st The Paddock DS0000023264.V305081.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 Paddock DS0000023264.V305081.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 Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Paddock Address The Paddock 80 High Street Lydd Kent TN29 9AN 01797 321292 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) Mr Laurence John Waitt Mr Shaun Rigby Waitt Mrs Judy Rees Care Home 19 Category(ies) of Learning disability (19) registration, with number of places The Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residential care for one (1) person with a date of birth of 17.08.1922 Date of last inspection 27th July 2005 Brief Description of the Service: The Paddock provides residential care for 19 service users with learning disability. It is a large detached house set in pleasant gardens. It is situated in the small coastal town of Lydd and the local shops, church and public houses are all within walking distance. The larger towns of Ashford, Folkestone and Hythe are all within easy driving distance and the home provides adequate transport in order to access the available educational, recreational and cultural facilities. In the gardens surrounding the home there is a vegetable plot where the service users are supported to grow some of the fresh produce for the home. Service users access both general and specialist medical and dental services through the local primary health care team. The home supports and encourages the maintenance of family links and friendships The fee range for this service is between £476.79 -£1281.35 The Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection-involved analysis of information and documentation received about the home including a pre-inspection questionnaire completed by the manager. The views of residents, relatives and Health and social care professionals have been sought through pre-inspection survey questionnaires, these are still to be returned and therefore have not be used in the production of this report. An unannounced site visit was also undertaken as part of the inspection process and took place on 1St September 2006 between 9:00 am and 4:00 PM. During the course of the site visit, a tour of the premises was undertaken and time was spent in speaking with and observing individual residents and staff. A range of documentation was viewed during the course of the visit including care plans, assessment information, MAR charts, complaints, accident records, the fire book, staff communication books, staff recruitment, training and supervision records. A meeting with the manager took place at the end of the site visit to discuss findings. Four additional requirements for action to be taken and nine recommendations for improved practice were made as a result of this visit. During the course of the inspection the inspector spoke to and observed ten residents and five members of staff, including the manager, and this has been influential in the compilation of this report. The site visit highlighted shortfalls in some key standards and outcome groups that will effect their quality rating on this occasion, it should be noted however, that in other quality outcome groups the home continued to provide a good level of service. Most residents observed appeared relaxed and settled, with some more vocal residents expressing positive comments about the home and staff, comments ranged from “nice here” “ happy here”, “I’ve been here a long time, it’s OK but I’d like to go fishing more often” “nice boss lady”. What the service does well: The Home makes use of the local community and encourages the community presence of residents. It provides a homely, comfortable and pleasant environment to residents. It offers them opportunities to make choices and decisions in their daily lives. It encourages independence amongst residents. Staffing levels are good. The Home has demonstrated a commitment to the professional development of staff by accessing qualification training for care staff and supporting them to achieve it. The Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 6 The home offers a welcoming and friendly atmosphere. What has improved since the last inspection? What they could do better: There has been significant slippage in a number of key standards. This slippage could compromise the health, safety and welfare of residents, in that: Evidence of assessment of prospective residents and the homes ability to meet their needs was unavailable. The home has not been proactive in finding an alternative programme of activities following the closure of most college courses. Recruitment practices are unsafe. New staff are not in receipt of induction and have not undertaken mandatory core skills training to ensure they are competent to support residents appropriately. Protection of vulnerable adults may be compromised by environment restrictions imposed without evidence of consultation, inadequate risk assessment, and infringements to privacy and dignity through some work practices, Some under reporting of accidents. The manager needs to ensure monitoring of staff competencies and development needs is routinely in place and that a system of quality assurance is implemented in which she takes an active role. The Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Paddock DS0000023264.V305081.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 Paddock DS0000023264.V305081.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,4,5 The overall quality of this outcome group is good. This judgment has been made using available evidence including a visit to the service. The home needs to strengthen its assessment process and ensure that recorded assessment information is routinely available in the home and used for the development of individual support plans. Residents are provided with opportunities to visit the home prior to admission and are given a contract of the terms and conditions of their stay upon admission. EVIDENCE: In response to a previous inspection requirement the manager has made some progress in retrieving residents’ original assessments from head office, and is pursuing the remainder. Three files case tracked provided evidence of assessment information now being kept on file. The manager discussed the assessment and admission procedure and demonstrated a good understanding of the limitations of the service and the importance of compatibility with and impact on existing residents when assessing prospective residents. The manager was unable to provide a blank copy of the assessment form/tool used by the home or provide evidence of assessment of a regular respite resident, and was unclear why this information is not routinely available within the home. The Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 10 The assessment procedure requires strengthening, assessment information must be accessible and used to develop individual support plans to ensure assessed needs’ can be met appropriately. The manager stated that the assessment process allows for opportunities to visit prospective residents in their existing placements and to enable them to visit the home for short visits and trial stays. Service user contracts were noted on those files viewed. The Paddock DS0000023264.V305081.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 The overall quality of this outcome group is adequate. This judgment has been made using available evidence including a visit to the service. Care plans are concise and provide good detail in respect of some routines, and preferences, the home should consider adopting a more accessible person centred style of care plan, and evidence more clearly user involvement and six monthly review. Residents are provided with opportunities to make decisions in their daily lives. The home needs to ensure that risk taking by residents is supported by a robust risk strategy, that evidences assessment of risk and agreement to risk taking by all parties concerned including the resident, a routine review of risks should also be implemented. EVIDENCE: Three resident files were chosen for case tracking. They provided evidence that Care plans were concise and informative in respect of individual needs, but some omissions in recording were noted. One plan viewed did not reflect the care manager assessment in respect of medication management, two files of The Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 12 residents with known behaviours, contained no information or guidance for staff, although it was clear from discussion with the manager that strategies to manage behaviours are informally in use by staff. The home has been proactive in seeking residents consents in some areas but their overall involvement in the development of their support plan could not be evidenced, discussion with one case tracked resident indicated their support plan was not completely reflective of some of their aspirations and interests. Consideration needs to be given to the development of a person centred style care plan that is more accessible to residents particularly those with limited communication skills, and in which they can fully participate. The manager stated that annual reviews’ are undertaken by care management’; there was no evidence on files of six monthly reviewing by the home. It is recommended that the home address these areas for improvement. Residents are encouraged to make choices in day to day routines and this was evident in observing residents choosing lunch, and moving freely around the home, choosing where they wish to be who with etc, discussion with two of the more able residents confirmed they undertake some of their own personal care and select their own clothing without staff support, another resident travels independently in the community, and part medicates some medication. Discussion with the manager, staff and some residents indicated that the home encourages and supports risk taking by residents. Although some risk assessments were noted in files viewed, there was no evidence of appropriate risk assessment and review of a resident who travels independently in the community and also undertakes some partial self- medication. To ensure the safety of vulnerable residents is not compromised the home must ensure that risk taking by residents is undertaken in a safe manner, assessed recorded and agreed by all parties, with evidence of routine review. (See standard 23) The Paddock DS0000023264.V305081.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 The overall quality of this outcome group is good. This judgment has been made using available evidence including a visit to the service. Shortfalls in external opportunities for courses means that the home will need to actively develop a varied range of activities in house and in the community to replace these. Residents have access to and make use of local community facilities. The home supports and facilitates contact with families where these contacts exist. Service users rights are upheld and respected by staff. Residents receive a varied and nutritious range of food. EVIDENCE: Residents previously benefited from an active and varied mix of college courses SEC attendance and activities in the community e.g. allotment, swimming horse riding etc, unfortunately most college courses have now ended and residents have a significant gap in their activity programme, the manager has identified this as an area needing development and has plans to create an activities centre within the grounds. Residents confirmed they attend clubs in the community and also make use of other activities such as The Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 14 swimming, horse riding, and trips out using the minibus. Comments included “happy here” “I go to special Olympics and win medals for running” “I go swimming”. More vocal residents indicated they were bored and missing their college courses. There appeared to be little direction given by staff and no organised activities were observed during the site visit other than an inadequate and inappropriate colouring activity for one resident. Staff’ were ineffective in spontaneously or proactively offering stimulating activities, although there were adequate staff on duty. Staff will clearly need training and support to develop and actively implement an appropriate and stimulating programme of activities. Some residents retain contacts with family and friends, and the home actively supports and facilitates visits and contacts where relationships exist. Where able to residents help around the house and garden, A Resident who smokes confirmed designated smoking areas around the home and described arrangements for disposing of cigarettes responsibly. Some residents have keys to their rooms, others do not, although the home was unable to evidence how some of these decisions have been made and need to improve its recording of risk assessment. Residents have free access to most areas of the home and move freely between house and garden. The cook does not work to a set menu, but produces a range of dishes following daily consultation with residents, taking account of their particular preferences, likes and dislikes and any dietary needs. On the day of the site visit, residents were able to choose from salad, rice, new potatoes cauliflower cheese, a casserole etc, residents go to the counter and choose their own mix of food options, cook was observed offering a choice of puddings to less able residents, to encourage them to make choices. Portion sizes were very good Staff were observed offering occasional support to some residents. Residents made comments such as “nice food”, and “I like cheesecake”. Resident’s food intake is recorded in their individual daily record books. The Paddock DS0000023264.V305081.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 The overall quality of this outcome group is good. This judgment has been made using available evidence including a visit to the service. Residents are supported in their personal routines by staff that would benefit from further guidance to ensure privacy and dignity is not compromised by work practices in the home. Residents are enabled and supported to access routine health care appointments. Systems are in place for the safe management of medication administration, and these would benefit from further development and clarity in some areas. EVIDENCE: Care plans indicated routines for individuals although this did not indicate preferences in respect of bedtimes and getting up. Resident’s personal presentation and dress was appropriate for their age and gender. A key worker system is in place and a staff member spoken with confirmed that Key workers can be moved around if their relationship with their resident is unsuccessful. Two residents spoken with were able to give a clear indication of their routines and were happy with their particular arrangements. There are at present only four female residents and a mixed gender group of staff, it is important that the home develop a cross gender care policy to protect the privacy and dignity of residents, provide guidance to staff and reflect good practice. The Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 16 The home is still to develop a continence management policy and a privacy and dignity policy and it is important that these are progressed to underpin the way in which staff support and work with residents. Resident files viewed indicated that they have access to routine healthcare appointments; weights are recorded regularly. The home has one elderly resident and must ensure appropriate training supports awareness of the health needs’ of older people. Medication administration is undertaken in a safe manner; only trained staff can administer medication, two staff are used to administer and sign for medications administered. The current system would benefit from some minor improvements e.g. the location of where medication is currently administered from affords little privacy and dignity to residents, the home should consider the appropriateness of administering medications from the kitchen and hallway and should look for a more suitable venue within the home where medications may be given in a more private manner. One resident currently has PRN medication, administered only by authorisation of the manager, it is recommended good practice that individual PRN guidelines are developed to support this. It is further recommended that medication profiles are developed for individual residents and that medication arrangements and consents are clearly recorded within support plans and resident files. There is a need for the development of self or part medication risk assessments where full support is not provided by staff. Staff spoken with had an awareness of actions to take in respect of a medication error and where this needed to be recorded. The home should review the medication storage arrangements to ensure they are in keeping with those promoted within the Royal Pharmaceutical society guidance. The Paddock DS0000023264.V305081.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The overall quality of this outcome group is adequate. This judgment has been made using available evidence including a visit to the service. A complaints procedure is in place, and more able residents are assured that their views are listened to and acted upon, the home should consider how less able residents can be enabled to use the complaints system. Shortfalls within systems for staff recruitment, training, risk assessment, management of resident finances, and accident reporting may place residents at risk. EVIDENCE: The manager advised that they have received no complaints since the last inspection. The manager advised that 2 of the more able service users had made complaints previously, The home should consider how they can make the complaints process more accessible to the less able and non verbal clients. A complaint has been received by CSCI since the last inspection and this has been investigated and closed, no further action has been requested of the home other than they review the staff dress code (see standard 31) Significant shortfalls have been highlighted during the site visit in respect of the staff recruitment and induction programmes and residents may be placed at risk as a result, requirements have been issued for improvements in these areas. The site visit highlighted that risk assessments have not been routinely developed for residents who are undertaking self medication and independent The Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 18 travel activities, the home could not evidence how judgements were arrived at, what steps have been taken to minimise risks to residents and whether current arrangements are reviewed and remain safe as a consequence vulnerable adults may be placed at risk of harm The home has a higher proportion of male to female residents and a number of male staff, residents and staff would benefit from clear guidance in respect of personal care giving to members of the opposite sex (see standard 18). Resident files viewed indicated some residents have some behaviour issues, that home staff address by using a range of strategies, these behaviours are not recorded in care plans and behaviour management guidelines have not been established or signed up to by all parties, it is a recommendation that this is addressed to ensure staff receive guidance on behaviour management and implement strategies consistently. A tour of the premises highlighted that two residents in those rooms viewed had taps in their rooms turned off, these arrangements were not recorded in resident files, the manager was not aware of one of the residents being subject to this restriction and there was no indication as to how this had happened. Another resident was locked out of their room, staff’ were unaware how this had happened, the resident did not have a key, although there was no record as to why this was the case. It is the homes responsibility to ensure that any restrictions on rights or freedoms of individual residents’ are discussed in a multi disciplinary forum e.g. review, to ensure there is agreement with the restrictions proposed, and a review date set. The home has been proactive in finding casual employment for several residents who undertake a weekly delivery round together of a free local newspaper and have done so for many years, the monies they receive for this work is put in a general fund for their use towards activities etc. Files viewed provided no evidence of how this decision was reached or that it has the agreement of relevant funding, records of the residents’ earnings jointly are maintained and a copy was provided to the inspector, this is insufficiently detailed to determine if residents are funding the purchase of items they should be. The home must ensure that all relevant parties are in agreement with the current arrangements and records of how monies are spent need to be clearly maintained with receipts to provide an audit trail of income and expenditure, and that residents financial interests are being safeguarded appropriately, The home are required to take action to notify and consult with all parties concerned in respect of restrictions placed on residents, risk assessments, behaviour management strategies or financial arrangements they have entered into and to ensure decisions are recorded on resident files. The Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 19 A review of the staff communication book and resident files cross referenced with the accident book indicated some under reporting of resident accidents, the manager must take action to ensure all staff are fully apprised of their responsibilities and duties with regard to dealing with resident accidents. The Paddock DS0000023264.V305081.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26, 30 The overall quality of this outcome group is good. This judgment has been made using available evidence including a visit to the service. The resident’s benefit from living in a clean, comfortable and homely environment’. Residents are enabled to express their individual tastes and interests within their own personal space; their independence should not be compromised by unauthorised environmental restrictions. EVIDENCE: A tour of the home was undertaken that included all communal areas, five resident bedrooms, and the garden. Communal areas are spacious, decorated to a good standard and furnished in a domestic style. Bedrooms are very pleasant and comfortable, individually decorated and furnished to reflect the tastes and interests of the resident. Some residents have keys to their bedrooms, one resident was observed to be locked out of their room, it could not be established why the room was locked, and no indication as to why the resident had not been provided with a key. All residents should be enabled and supported to have a key to their room unless The Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 21 risk assessed otherwise and this should be recorded clearly within the residents file. A programme of upgrading of bedrooms is underway. There was some inattention to detail noted in some bedrooms viewed where curtains or blinds were down, and a wardrobe door had broken off, the manager needs to ensure that repairs and maintenance issues are reported to her and attended to in a timely manner. Of five bedrooms viewed two had water disconnected to basins of which the manager was unaware and this restriction had not been recorded on resident files or undertaken as part of a multi disciplinary decision. (See standard 23) A previous requirement that the temperature of hot water taps in residents rooms be reduced to an acceptable temperature had been addressed by the installation of new valves, however, on the day of the visit two bedrooms viewed and one bathroom had very hot water, this was reported to the manager who arranged for the maintenance person to take action to reduce the temperatures in these areas, these were retested at the end of the site visit and found to be a temperature of 43c or less. The home has a large accessible garden, with a vegetable plot and plans to incorporate an activities centre in the grounds. Fences around the rear garden are under six foot and residents can see their neighbours and be seen, the manager indicated that the home has a good relationship with the local community and did not feel that residents privacy was being compromised in any way in the garden, it was noted that the fences were showing signs of damage and will need replacing to ensure the safety of residents; replacement of the fences is the responsibility of the local Housing association, and the providers are pursuing them currently to install new fencing. The home was clean and hygienic on the date of inspection. The home deals with a limited amount of soiled laundry; discussion with a staff member indicated a good understanding of the safe management of soiled laundry when it occurs. The Paddock DS0000023264.V305081.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 The overall quality of this outcome group is poor. This judgment has been made using available evidence including a visit to the service. Staff and residents would benefit from further clarification of the staff dress code to be adopted when supporting resident holidays. The home has shown an excellent commitment to developing the staff team through the achievement of NVQ qualifications, this will now need monitoring to ensure staff actively put into practice what they have learned. Levels’ of staffing would be satisfactory if they were more effective in the support offered to residents. Shortfalls in the vetting and checking of prospective staff could place residents at risk. There is no evidence that the competency and fitness of new staff is being adequately assessed through an induction process or that they have achieved mandatory core skills training within six months of commencing employment. There is no evidence that new staff’ are receiving routine or probationary supervision by senior staff. EVIDENCE: The Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 23 A recent complaint against the home highlighted a need for staff supporting resident’s holidays to have a clear guidance in respect of their dress code. The Home must review these arrangements and a copy should provided. It is a recommendation that the home review these arrangements. The home has actively encouraged and supported the staff team to undertake NVQ2 training, achieving a qualified staff level of more than 80 , for which they are to be commended. It was disappointing to note from observations made of some staff resident interactions, that improved staff awareness and knowledge is not actively being implemented within daily work practice in respect of dignity, privacy, adult protection, rights, age appropriate activities etc Staffing levels would be satisfactory to support the current number of residents, if used more effectively, to offer spontaneous rather than task based interactions and be proactive in developing and offering stimulating activities. Three staff files viewed provided no evidence that POVA 1st checks are undertaken on new staff. Documentation viewed in respect of three new staff indicated only 2 had 2 written references. CRB’s were in place for two of them with another outstanding since April 2006, with no evidence this has been pursued. It is a regulation that the home undertakes appropriate vetting of staff to ensure service users are protected. A newer staff member spoken with confirmed they had not been allowed to undertake personal care of residents until their CRB had been received by the home. ID and current Photos in keeping with Schedule 2 of the Care Homes Regulations 2001 were not available on 2 of the three staff records viewed. None of the staff records’ viewed, provided evidence of induction. Two’ staff in post since February and April 06 had received no mandatory core skills training, this is a legal requirement. Training profiles are still to be developed for staff and this is a recommendation. The manager demonstrated an awareness of the new induction standards under ‘skills for care’ and will need to implement them as required. A newer staff member spoken with confirmed they had received an induction but from its description this had not been compliant with ‘skills for care’ induction standards content. Staff spoken with confirmed they received supervision and supervision records were noted for longer serving staff members, no evidence of supervision or probationary interviews/meetings could be produced in respect of the new staff records reviewed. It is recommended that the manager ensure all staff receive the appropriate number of formal supervision sessions and should evidence clearly probationary discussions for new staff. The Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 24 The Paddock DS0000023264.V305081.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40,42 The overall quality of this outcome group is adequate. This judgment has been made using available evidence including a visit to the service. The manager must ensure that she routinely updates her knowledge in respect of regulations and good practice guidance and retains oversight of systems within the home to ensure minimum standard’s previously achieved by the home are maintained. The quality assurance system needs strengthening to incorporate the views of residents. Shortfalls in key areas of policy development, recruitment, staff training and accident reporting must be addressed to ensure the health, safety and welfare of residents is not compromised EVIDENCE: The manager is well qualified and is continuing with her professional development, she is also qualified to carry out NVQ assessments in-house. The site visit highlighted shortfalls in key areas of practice within the home and the manager must ensure that she allows time within her schedule to routinely update her knowledge in respect of current regulations and practice and that The Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 26 she more actively monitors that standards achieved by the home previously are maintained in these areas. Staff find the manager approachable and have been supported by the management team to develop their own professional qualifications. Residents were observed accessing the managers office freely and clearly enjoy being around her and are made to feel welcome, one resident spoken with referred to the manager as a “nice boss lady”. The registered providers ensure that regular quality assurance visits are made and reports of these visits are made available to CSCI. The current annual development plan is focused on environmental improvements and needs strengthening to incorporate overall development of the service. Staff spoken with indicated that resident’s views are taken account of in some decision making e.g. decoration, activities. The manager indicated an awareness of the need to develop the quality assurance process and is currently looking at different models, It is recommended that the home progress the implementation of a quality assurance system, and upon request by CSCI can produce an annual report of quality assurance outcomes. The home is still to implement legionella checks, and to produce policies for staff to work to in respect of privacy and dignity of residents and continence management. Pre-inspection information indicates that the home actively undertakes servicing and checks of electrical, and gas supplies and equipment; a fault in the electrical system has been identified at a recent service and the company is taking action to have this rectified. The fire book was viewed and indicated that the home is actively maintaining a schedule of regular checks, tests and weekly drills. A review of the accident book indicated a low level of accidents in the last 12 months; checks against body maps on case tracked resident files found some did not correspond to recorded accidents; discussion with the manager about these omissions indicated her awareness of some confusion within the staff team as to when and where injuries are to be recorded. The manager was recommended to ensure all Staff are made fully aware of their responsibilities in respect of accident reporting and for her to actively monitor that no under reporting is occurring. The Paddock DS0000023264.V305081.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 2 3 X 4 3 5 3 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 3 25 3 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 2 X 2 X The Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 28 Yes 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 YA2 Regulation 14 & 17 Schedule 3 13 Requirement Hold copies of Care Management or Homes assessment on resident files (previous timescale of 31/12/05 partly met) The home are required to take action to notify and consult with all parties concerned in respect of restrictions placed on residents, risk assessments, behaviour management strategies or financial arrangements they have entered into and to ensure decisions are recorded on resident files. The Home must ensure that a POVA 1st check and two written references are in place before staff commence work at the home All staff must receive an induction that is compliant with ‘Skills for care’ Induction standards All staff are to be provided with mandatory core skills training. Timescale for action 31/10/06 2 YA23 31/10/06 3 YA34 19 Schedule2 04/09/06 4 YA35 18(1) 31/10/06 5 YA35 18(1) 15/09/06 The Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations Home to consider a more person centred format for care/support plan, home to evidence resident involvement in development of support plan and to ensure all relevant needs, aspirations and support information is recorded, home to evidence six monthly reviewing. The home must ensure that risk taking by residents is undertaken in a safe manner that has been appropriately assessed and recorded and agreed by all parties, there should also be evidence of routine review of all risk assessments. The home to develop a cross gender care policy to protect the privacy and dignity of residents, provide guidance to staff and reflect good practice. The home to develop a continence management policy and a privacy and dignity policy The home should consider the appropriateness of administering medications from the kitchen and should look for a more suitable venue within the home where medications may be given in a more private manner. Individual PRN guidelines to be developed Individual medication profiles to be developed for l resident Medication arrangements and consents to be clearly recorded within support plans and resident files. There is a need for the development of self or part medication risk assessments where full support is not provided by staff. 5 YA31 Home to review the staff dress code in relation to staff supported resident holidays, a copy to be forwarded to CSCI. Staff training files to be developed The manager undertakes to ensure all staff receive the appropriate number of formal supervision sessions and evidences clearly probationary discussions for new staff. DS0000023264.V305081.R01.S.doc Version 5.2 Page 30 Quality assurance system to be developed to evidence how residents vies influence service development Home to ensure accidents to residents are recorded in the accident book with corresponding body maps. 2 YA9 3 YA18 4 YA20 6 7 YA35 YA36 The Paddock 8 YA39 9 YA42 The Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Paddock DS0000023264.V305081.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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