Inspection on 23/01/08 for The Paddock

This inspection was carried out on 23rd January 2008.

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 3 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 30/08/07

The Paddock 01/09/06

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 23rd January 2008 10:30 The Paddock DS0000023264.V352854.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.V352854.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.V352854.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.V352854.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 30th August 2007 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 per week. The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate, quality outcomes. An inspection of this service has been undertaken and included an appraisal of information received by CSCI about the home and from the home since the last inspection in August 2007. An unannounced site visit, has also been carried out on 23rd January 2008 between 10.30 am and 5.00 pm. All key inspection standards have been assessed for this inspection. The site visit incorporated a joint visit with an expert by experience and their supporter to look at the lifestyle experiences of people living in the home, this included a tour of some bedrooms with the permission of the residents concerned. A tour of the communal areas and ground floor was also undertaken. The expert by experience reported receiving an unwelcoming reception initially upon entering the home from one staff member in particular, but generally found staff accepting of their presence and receptive to questions asked during the course of the visit. Samples of documentation including support plans, risk assessments, medication administration records (MARS), and staff recruitment files were examined. People living in the home were observed and spoken with throughout the site visit, discussions were also undertaken with support staff, the manager and area manager and their responses have been influential in the compilation of this report. Findings from the site visit have been subsequently discussed with the manager. What the service does well: The home continues to provide a pleasant, clean and comfortable environment to the people who live there but would benefit from the planned upgrading. People who live in the home have their own bedrooms, these are spacious and they are supported and encouraged to individualise these. The home is well located within the town and encourages the community presence of residents. The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 6 The home has facilitated opportunities for some residents to be more independent. The home is supportive and enabling of the maintenance of family links and friendships for people living in the home. The home has maintained its commitment to the professional development of staff. People who live in the home are asked about the food they enjoy eating. What has improved since the last inspection? What they could do better: Inconsistencies and lack of clarity in recording is still an issue and is not always reflective or supportive of staff practice. The rationale for some restrictive practices remains unclear and the approval for these to be implemented has not been obtained through consultation with all parties at review, despite this requirement being re-issued at this and the The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 7 preceding two inspections; the Commission will undertake a review of the service and decide whether enforcement action is to be taken regarding this matter. Activities although reviewed have not provided a sufficiently stimulating programme for individuals and remains an area for improvement. There remain concerns at the lack of health and safety considerations for residents where planned works are underway. Good practice recommendations remain for improvements to care plans, medication, staff dress code and staff training files and matrix, in addition to implementation of a quality assurance system. 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 Paddock DS0000023264.V352854.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.V352854.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): 2,5 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service consults information provided to them to see if they can meet the needs of new people referred to the service, before they accept an application for admission. Evidence suggests that future referrals will receive a needs assessment by the home before admission. People living in the service have an individual statement of terms and conditions of their placement. EVIDENCE: Although no new admissions to the home have been made in the last two years, the manager has previously advised that she is actively involved in referrals, and assessment of whether the home will be able to meet the individual needs of those referred. This will incorporate visits to the current placement, liaison with current placement staff, and arrangement for trial visits and stays to the Paddock where the prospective resident can cope with this. Every resident file has been examined. Approximately half of those files viewed have core assessment information on file; the home has in response to a previous requirement actively sought to retrieve assessment and background reports missing from files and this is now in place. The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 10 There is evidence that some past admissions have been agreed without reference to a needs assessment, and overall recording of the assessment and admission process has been negligible. In response to these findings the home has developed a comprehensive assessment form for use with all future referrals. All files viewed had terms and conditions information in place, although this was not in a format that is accessible to residents and the home should consider developing this in varied formats. The Paddock DS0000023264.V352854.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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home have support plans that mostly reflect their preferred daily routines and the risks they may incur. Inconsistencies in staff practice and omissions in information available to inform this, means that outcomes for some people are not as good as they could be. People living in the home have opportunities for some decision making in their daily routines. EVIDENCE: Care plans have improved in their style and content, are more reflective of individual preferred routines but lack identified goals and aspirations. An examination of care plans highlighted that the home has identified a diversity issue for one resident; this has been handled sensitively by the home with positive outcomes in that there may be some correlation between the onset of the resident being enabled to express their diversity and a reduction in challenging behaviour. The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 12 Methods of communication are still not clearly supported with guidance for staff. There is an over reliance on longer term staff interpreting needs for those with no verbal communication leaving newer staff or other people who may wish to engage in communication with them without the means to do so in a consistent manner that ensures quality of life is maintained. There are inconsistencies in understanding between the manager and staff as to why practice is being undertaken in a specific manner, with contradictory understanding regarding the abilities and characteristics of some residents, that impacts on the daily quality of life they experience. There remains a need for the home to promote a culture of capacity. The management of challenging behaviour is not clearly reflected in care plans, and some important information provided at admission has not been incorporated into care plan or risk assessment information. There is evidence in case files viewed that the home actively pursues funding authorities to undertake reviews. There is evidence to suggest that people are involved in some decision making about the home such as day to day living and social activities. Risk assessments have been reviewed to take account of other factors that may impact on the welfare of residents e.g. nutrition, skin integrity. Risk assessments viewed are relatively basic and are designed to keep people safe, they are not always well thought through particularly where a risk has been identified as a justification for imposing a restriction. The capacity of residents to manage their own medication has recently been assessed in response to the mental capacity Act 2005. These assessments do not currently allow for residents to have any involvement in their medication regime even under staff supervision. Clearly most people living in the home can play a more active role in their medication administration to varying degrees and the home should now actively review this for every individual, this remains an area for improvement. The Paddock DS0000023264.V352854.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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service Staff awareness of social, emotional, communication and independent living skills of the people living in the home could be improved upon, and be effective in providing a stimulating, and enabling lifestyle in which people in the home take an equal and active role. EVIDENCE: The expert by experience and their Personal Assistant (PA) expressed disappointment at the negative and hostile reception they initially received upon arriving at the home from a member of the domestic staff. The expert by experience has undertaken a comprehensive review of the lifestyle and activities’ experienced by people living in the home currently, and has been helped by their PA to prepare this report of their findings. The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 14 Report by Andy Law (Expert by experience) on The Paddock, 80 High St, Lydd, Kent When I arrived at the house, I rang the bell and the door was answered by a lady who we found out was a member of the domestic staff. I introduced my P.A. and myself and explained why we had come. She was very unfriendly and annoyed and said that we should have asked the residents if we could come and inspect the home. My P.A. and I were shocked by her attitude and the way she was talking in front of many residents, who by their behaviour, we could see had complex problems. My P.A. had to ask her quite firmly if we could come in. Later, while we were being shown his room by one of the residents [who had been very happy to do this when we asked him, and was happy and relaxed the whole time], the same member of staff came in very annoyed and told us off for coming up with the man without a member of staff. We were again very shocked and felt her attitude and the way she spoke was very bad. She said, in front of the resident, that he can get very agitated; what she was saying and how she said it could have made him agitated; he did not get upset though and we carried on our interview with him and another member of staff present [it went very well]. I think the home really needs to look at the attitude of this staff member and the effect it is having on the home, and sort it out. It did affect my P.A and me and made it more difficult to do the inspection. I was asked to report on how the home is for the people with less good communication and who are difficult to engage. I asked questions, looked at what was going on, tried using some pictures and asked people to show me their rooms. I also spoke with some staff. How Staff are with Residents Good Things; Most staff seemed friendly towards the residents and I saw several of them helping people do activities; 2 women were doing puzzles just before dinner with a member of staff helping them in a pleasant, friendly way. The team leader seemed to have a good, relationship with many of the ‘less able’ people and gave me lots of examples of what staff did with them e.g. Going out in their people carrier for drives, walks, sport events [including Special Olympics] and taking part, visiting local shops and buying sweets, visiting pubs in the area and going to discos. Using the grounds in the better weather for sport, games and social events, going on holiday including abroad. When I saw staff talking to the residents it was friendly and respectful. They asked them if they would show me their rooms and did not force anyone to and were respectful how they talked to them and helped them show us their The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 15 rooms. They knew about people’s likes and dislikes, interests etc and helped explain things. The team leader said how they were very careful not to let people bully others and gave an example of how he had dealt with one problem. The team leader helped a resident talk to us and show us how she could count to 10. Areas where improvement is needed Communication/Interactions The Domestic staff member said she had not been told we were coming. It seemed that she was used to behaving like she did [she did not hesitate to speak to us like that in front of staff and residents] so it worries us that the team leader had not told her what was happening and taken steps to make sure she was not the person to meet us at the door. A lot of the residents have communication problems. The big, open rooms and hallway had lots of people wandering around and I did not see them talking or communicating with each other much. I did not see staff encouraging this and most of what happened was through the staff. This meant that lots of the less able residents spent a lot of their time waiting for staff to do something with them. It also means that people had to do things to get attention and it doesn’t help their behaviour problems. I did not see pictures, symbols or signing being used by any staff with any of the residents, yet the team leader said some residents could use them. There were very few pictures on the walls and very few things that people could use as aids to communicate with. The one picture board I saw was very battered and some pictures had fallen down. In people’s own rooms, the ‘less able’ people had much fewer things up on the walls or to look at or things that looked like ‘theirs’; so had less things they could use to communicate with, but the ‘more able’ had lots of pictures and things up. I think staff need to help the less able people to find ways to communicate for themselves. With few things to do on their own [or with each other], while waiting for staff to do things with them, people seemed bored and wandered around; it did not seem a good place for them. Personal Freedoms. Privacy, Dignity and Choice Good things; People have their own rooms, which are pleasant, tidy and clean, and with things in that are their own. Staff asked people if we could see their room and did not make people show us. At least one man has his own key [he was ‘more able’]. I did not see The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 16 people being restricted in their movements around the downstairs rooms [although no residents went in the kitchen]. I saw a picture board in someone’s bedroom that showed him what he did on different days. The team leader said there were resident’s meetings where they discussed things like; holidays, the menu, outings, problems. 4 people do a paper round and control what they do with their own pay [have their own tins and keys] staff help then do the round. The team leader said that residents could look through their own files if they request it and have help to understand what is there. Things that need improving; Most of the rooms were painted white, including the 4 bedrooms we saw; it looked like people may not have been able to make a choice there. Most bedrooms were locked and people who had less ability could not easily get in their rooms, so there was very little privacy for them. Staff said that one resident spent most of the day in the toilet; this maybe because it is the only easy place to get to that is private? One bedroom [that I saw] did not have a lock on. I was at the home for nearly 3 hours and in that time did not see any resident being asked to make any choice [apart from whether to show us their rooms]. Residents said they did not have friends to stay [but some had family visitors and spent time living with relatives]. Friends were usually ex staff members; this is good but also bad that people are not helped to make their own friends. It is unlikely that the ‘less able’ residents would ask to see their files, so are unlikely to know what is in them. The home has a very institutional feel. The kitchen does not look user friendly for the residents; no one mentioned cooking as an activity for the people living in the home, or self-care/home care skills help. The lounge has no coffee tables or other tables and with the chairs and sofas all the way round the outside is not a cosy place. One person could easily dominate the room, not many people used it while I was there. I was told that some residents had been very damaged by being in some badly run institutions; this did not seem to be a place that could really help them get over this; it felt like an institution and was too big. One man did say [with help] that he liked it better than the place he used to be in [the staff said it had been really bad and the man seemed to fear the old place], but he was ‘more able’ and still wandered around waiting for staff to tell him what to do. The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 17 One resident uses the corridor area outside the office as a base, this is very busy, and there is very little privacy there. This is so through all the main rooms of the house. The team leader did not talk about any activities that the home offers that are helping people become more independent and in control of their own lives. It seems that he would not see this as possible. Residents do not have advocates. The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 18 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service Evidence suggests that People mostly receive personal care support in the way they prefer, and that they have access to routine healthcare. These activities are not always documented, or recorded in a consistent manner. Systems for the safe administration of medication would benefit from greater consistency in recording to better safeguard residents. People in receipt of medication should be enabled to become more involved. EVIDENCE: The content of care plans suggest a more individualised approach to the delivery of personal care, and some people where the home has assumed capacity undertake their own personal care. It is unclear how involved residents are in the development of their routines. There is a lack of information to support effective staff communication with some people in the home, and a need to make clear capacity judgements and restrictions compromises the quality of personal support some people receive. The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 19 All files were given a cursory examination but three in particular were looked at in more detail, these provided evidence that standard health checks are taking place according to review information and some records viewed. Systems for the recording of these activities are inconsistently completed and in some cases i.e. chiropody, two systems are running alongside each other. Records viewed suggest the expected frequency of some routine healthcare checks may have slipped or have been recorded elsewhere and this needs to be standardised. There is evidence that Hospital appointments are being supported by the home, and health needs monitored. Letters from health professionals also indicate that there is a dialogue and activity happening in respect of these individuals. The home has identified and obtained an aid for one physically frail resident to promote pressure relief. Discussion with staff confirmed that weights are recorded monthly for the majority of residents, or where a need is identified for this to happen more frequently. There is some evidence that there are inconsistencies in where this information is recorded; also that the frequency may not be maintained owing to the dependency of this activity being the responsibility of the key worker only. The manager needs to review this arrangement to ensure weight monitoring is undertaken consistently. Staff were observed routinely completing daily records in respect of individual residents. The home has maintained previous medication administration improvements, and this is now more personalised and privately undertaken. An examination of MAR sheets indicated these to be up to date and completed appropriately, with receipt of medications into the home recorded appropriately also. Examination of these records has highlighted some inconsistent practice in that some handwritten entries are being signed and dated and others are not. Changes in dosage requested by the prescriber have not been amended on the MAR sheet in keeping with good practice guidelines, and the manager is advised to refer to the Royal Pharmaceutical Society Guidelines for Administration of Medication in Care homes. Two instances were noted where prescribing instructions had been changed to PRN without accompanying signature and date, discussion with the manager indicated these had occurred as a result of a change in instructions from a psychiatrist and a GP in two separate cases. This was not supported in written evidence in GP or health professional contacts section of Care plans, the manager did not confirm whether these changes had also been recorded in the staff communication book. The manager was reminded that it is essential to record all such changes, who made them, when etc to support changes to the MAR as this could lead to errors and place people at risk. Otherwise, completion of the mar sheets indicated no omissions. The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 20 The home has risk assessed residents in respect of their capacity to self administer medication, these have been discussed with the manager who agrees that under supervision some people could take a more active role in their medication regime and the assessment of capacity should reflect this. She has agreed to review this area again. The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 21 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service An updated complaints procedure is in place, but not in an accessible format for most people living in the home. Staff are unclear of the complaint recording procedure. Improved systems are in place to safeguard residents from abuse, but these would benefit from further review of restrictions and a wider consultation and approval of these by all parties. EVIDENCE: The manager has reviewed the complaints procedure and re-issued it; a copy is filed in every user file. This is not produced in a range of accessible formats, whilst acknowledging the diverse range of abilities within the home the manager should consider developing a more accessible version of this for people living in the home. Discussion with a staff member indicated that all complaints are directed to the manager or area manager and that staff do not get involved. Residents’ concerns if expressed, are not routinely recorded and are dealt with immediately by staff wherever possible. Staff spoken with about the complaints process are unaware that the manager has implemented a complaints recording book for staff and residents and need to be made fully aware of the changed procedure. The manager reported that no new complaints have been received since the last inspection. A previous adult protection has now been closed, with no further action for the home to take. The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 22 Discussion with staff and the manager confirmed that more than half of the staff team have received adult protection training since the last inspection and that further courses are planned to ensure all staff receive this training. There was evidence that some previous restrictive practices highlighted at the last inspection have been reviewed and changed e.g. toilet paper and paper hand towel is now provided in toilet and washing areas noted downstairs in fixed dispensers. A restriction previously placed on a client in respect of access to the kitchen has been reviewed, discussion with a staff member indicated that access is allowed with staff supervision. Some restrictions still exist, and the rationale for these is still unclear, and have been discussed with the manager who has been asked to review them again. Examination of review documentation indicates that these restrictions are not routinely discussed and recorded at review with care managers and other stakeholders, and that for the most part the home has implemented these in isolation, it is not considered therefore that this requirement has been addressed and new timescales for doing so of three months have been agreed with the manager. The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 23 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): 24,26,30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service People live in a comfortable clean and generally safe environment that will benefit from the planned programme of upgrading. The health safety and welfare of people living in the home would be better safeguarded by planned implementation of all internal and external works and an accompanying risk strategy for this EVIDENCE: People live in a pleasant environment that is generally maintained to a good standard of cleanliness. They have their own bedrooms and previous visits have found these to be personalised although access issues, the assessment of capacity and the ability to hold their own bedroom key remains an ongoing issue for most people living there. Routine maintenance is carried out and the home would benefit from upgrading particularly in communal areas. A programme of redecoration is underway, that will include new furnishings in some bedrooms and communal The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 24 spaces. The dining room currently has a mixture of furniture including some garden chairs because the dining furniture has broken, staff reported that they understood new dining tables and chairs are on order, New flooring in the hall and dining room have been undertaken and repainting of some bedrooms has taken place, one client confirmed he had participated in choosing the colour for his room and he was pleased with it. Some bedrooms have also been identified as needing new furniture and staff reported that this is also on order. No firm timescales have been given as to when this furniture may be delivered. Discussion with staff indicated an awareness that an upgrading programme is underway but no clear understanding of what the plan for this is and what this covers and the timescales included, timescales suggested at previous inspections for achieving some of these improvements have slipped further. A staff member commented that they were looking forward to the development of a day care unit in the grounds but were unclear whether this has even been approved by planners at this stage. A listed garden wall blew down in the recent high winds and as a consequence residents do not currently have access to the garden for safety and security reasons. During the site visit it was noted that minor works were being undertaken in the presence of unsupervised residents. Discussion with the handy person, staff and the manager confirmed that no planning or risk assessment had been undertaken to ensure that the welfare and safety of people living in the home had been taken into consideration prior to these works commencing. These discussions indicate that it is currently not routine practice for the handyperson to discuss planned work schedules with the manager routinely to afford time to develop risk assessments and plan for the relocation of people in the home if necessary from affected areas or to put in place appropriate safeguarding measures. It is not considered that the home has addressed this outstanding requirement and residents could still be placed in danger by a failure to identify potential risks, this remains an outstanding requirement. The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 25 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service There are enough staff on duty but their deployment does not always allow for them to give quality support and attention to residents. The recruitment procedure ensures that all necessary checks and vetting of new staff are undertaken, but recording of evidence to support this is inconsistent. There is a renewed commitment to staff training and where gaps exist the manager has identified these and plans to deal with them. EVIDENCE: The site visit highlighted that whilst there are enough staff on duty their deployment to other tasks e.g. escort to college, hospital, cleaning, internal meetings means that quality time with the majority of less able people is limited and inconsistent impacting on the overall quality of care and support they experience. It is important for the manager to keep this under review. Documentation for three new staff was examined this evidenced that all necessary vetting checks are now being undertaken. The organisation of recruitment documentation is a little chaotic and the manager indicated this is an area she has identified for improvement. ID for staff was attached to The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 26 disclosure information but current photographs were absent. There is no recorded evidence that gaps in employment history noted on some applications and discussion between the manager and prospective applicants concerning specific health issues also noted on one file are routinely explored and fully documented. Discussion between the manager and area manager in respect of recruitment decisions are also not routinely recorded and the manager was reminded of the need to clearly evidence how judgements have been arrived at. Since the last inspection the home have developed and implemented with new staff an induction package that takes account of LDAF and skills for care, staff workbooks for this are currently marked by the area manager. The home has taken action to update the core skills training programme for staff, although infection control has not been offered specifically and is an area for further development. Discussion with staff and examination of certificates on new staff documentation confirms that a planned programme of training is now happening. It is important for the manager to encourage and develop staff practice to ensure skills and knowledge gained through training are reflected in their everyday practice and improved outcomes for people in the home. The home is still to develop individual training profiles and update the training matrix and these remain recommendations. The home has maintained a commitment to the formal qualification training of staff and has exceeded 50 of trained staff, a visiting NVQ assessor commented on the support and commitment shown by the home towards formal staff training stating, “this is one of the good homes”. The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 27 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): 37,39,41,42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service The manager has an awareness of service shortfalls and is taking action to address these. EVIDENCE: The manager has taken on board previously highlighted shortfalls and has begun to address them complying with five of eight required actions. She is implementing and delivering a training programme to update core skills for staff. Improvements to the assessment procedure for new residents, staff training and recruitment and a review of restrictive practices have been implemented; some restrictions however, still lack a clear rationale and this has been dealt with elsewhere in the report. The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 28 The manager takes on board responsibility for all of the development and changes within the home and consequently her time for doing so is limited, unsurprisingly there is evidence to suggest that amendments to e.g. care plans, risk assessments are not always thought through. It is important for the manager to be involving other staff in service development as well as residents and to delegate some tasks, thus enabling her to look objectively at issues. A quality assurance package has been purchased and is to be implemented soon. This should aid the manager in undertaking a self audit of systems and service quality including evidencing clearly consultation with residents, and make improvements as needed. It is important that the manager in implementing changes makes these known to the staff team and can evidence that this has occurred. Policies and procedures are in place and updated, two policies in respect of continence management and privacy and dignity have recently been developed but were not available to view on the day, we have now been provided with copies and the manager must ensure these are now disseminated to staff. Records viewed during the site visit provided evidence that these are generally updated and staff were observed writing up daily records. Gaps and inconsistencies in recording compromise the robustness of some systems in place and this needs monitoring and improvement and has been highlighted in the specific outcome areas affected. A review of accident levels indicates that these are minimal for both residents and staff. The last inspection highlighted concerns that the dignity, safety and welfare of people in the home are not taken account of when internal or external upgrading works are being undertaken. The manager and area manager have reported that these concerns have been taken seriously and are being addressed. This view is partly substantiated by the prompt and decisive response of the home to safeguard residents following damage to a garden wall in high winds. Disappointingly, the site visit found that minor internal works were being undertaken in the presence of unsupervised residents, one being specifically assessed as having no sense of personal danger. This raises issues of concern at the lack of planning and warning given to the home when works of this kind are to be carried out, and this has been discussed at the site visit with the area manager who has stated that she will undertake to ensure that future works follow an agreed process of planning and dialogue with the home manager in advance of them occurring. It is not considered that the home has addressed this outstanding requirement. The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 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 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 X 2 X 2 2 X The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 30 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 YA23 Regulation 13(7) Requirement 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. (Not met in timescale of 31/10/06 and 30/11/07 The home is required to develop a varied programme of activities that takes account of the interests, abilities and views of all people living in the home. (Not met within timescale of 30/11/07) Timescale for action 23/04/08 2. YA12 16(2) n 23/04/08 3. YA42 13(4) a The manager must ensure that 23/04/08 the health safety and welfare of residents is taken full account of in the planning of all internal and external upgrading works (not met within timescale of 30/09/07 The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 31 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, goals/ aspirations and support information is recorded. 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. 2. YA20 3. YA31 Home to review the staff dress code in relation to staff supported resident holidays, a copy to be forwarded to CSCI. 4. 5. YA35 YA39 Staff training files to be developed Quality assurance system to be developed to evidence how residents vies influence service development The Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Paddock DS0000023264.V352854.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!