Inspection on 30/08/07 for The Paddock

This inspection was carried out on 30th August 2007.

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

The inspector found 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 8 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 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 Key Unannounced Inspection 30th August 2007 09:20 The Paddock DS0000023264.V345831.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.V345831.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.V345831.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.V345831.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 1st September 2006 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.V345831.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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, including an expression of concern from the public and a current adult protection alert. The home has also provided pre-inspection information about the home in the form of an Annual Quality Assurance Assessment (AQAA), this has been completed to a reasonable standard and recognises the need for development in some areas of the service but lacks insight into shortfalls identified at the site visit. A site visit to the service was conducted on 30/8/07 between the hours of 9:20 am and 15:20 pm; the manager of the service was not present. A tour of the premises was undertaken that took in both communal spaces and bedrooms. A sample of some documentation was reviewed including support plans, medication administration sheets, a staff communication book, risk assessment information, and a staff-training matrix. Residents of the home were observed and spoken with throughout the site visit and support staff were interviewed individually and in groups their experiences and views have influenced this report. Findings from the site visit have been subsequently discussed with the manager. Survey information has been distributed but has not been returned in time to inform this report. What the service does well: The home provides a pleasant, clean and comfortable environment to the people who live there. Individual residents have their own rooms, these are spacious and residents are supported and encouraged to individualise their rooms. The home is well located within the town and encourages the community presence of some residents. The home has facilitated opportunities for some residents to be more independent and to participate in a paper round to earn extra money. The home has demonstrated a commitment to the professional development of staff. People who live in the home are consulted about the food they eat and enjoy a varied and wholesome diet. The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Limited progress has been made in addressing the majority of outstanding requirements issued previously in respect of assessment, clarity of recording and approval of restrictions, behaviour management strategies, finances, and core staff training. The manager and staff have reported improvements to the staff recruitment and induction procedures but this could not be evidenced at this time. The site visit highlighted further concerns in respect of the lack of activities for residents, staffing levels that may support restrictive practices, and restrictive practices that impact on the dignity and quality of life of residents. There are concerns at the lack of health and safety considerations for residents where planned works are underway, as a consequence four new requirements have been issued. Whilst some recommendations for improved practice have been partly or fully implemented; the majority of those in key areas remain outstanding and two new recommendations have been made in regard to health care risks for older residents, and adult safeguarding training for all staff. The manager must demonstrate a commitment to improving the quality of life experienced by people in the home and address identified shortfalls within established timescales. There is an expectation that the manager will influence change through leadership and actively identify areas for improvement and address them. It is important that the home develops a culture where capacity is assumed until proven otherwise and every opportunity is taken to support residents capacity to be involved in aspects of their care and support however limited that may be. The Paddock DS0000023264.V345831.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 summary of this inspection report can be made available in other formats on request. The Paddock DS0000023264.V345831.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.V345831.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Feedback from the home indicates that people referred to the home have their needs assessed prior to admission; however, recorded assessment information has not routinely been made available on files to evidence this or inform dayto-day care and support. EVIDENCE: No new admissions to the home have taken place since the last inspection; therefore, further review of the assessment procedure cannot be made at this time. A sample of four existing resident files were viewed and highlighted that preadmission assessment information was missing on three out of four. Progress to rectify this has been disappointingly slow but remains a requirement, to ensure that support plans accurately reflect assessed needs. Where the home is experiencing difficulty in retrieving previous assessment information consideration should be given in those cases to undertaking a full reassessment of needs. The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are needed to support plans to fully reflect needs, aspirations and goals. People in the home have some limited opportunities for decisionmaking. Strategies are in place for the assessment of risk to individuals from and in the environment, but this needs to also reflect risks to the person from other factors. EVIDENCE: A sample of four resident files viewed provided good evidence of health care contacts and interventions by professionals. There is a concern that some advice from health professionals has not been followed through into support plans for two individuals and these omissions could impact on the quality of life they experience in the home. The home has made progress in reviewing and developing individual support plans but has not fully addressed a previous recommendation to improve The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 11 shortfalls in detail, there remains a lack of clarity around some key areas i.e. Communication, Behaviour, Health needs of older residents and Continence. Support plans lack information regarding goals and aspirations and the capacity of individual residents to be involved in all aspects of their daily lives, however limited including medication, finances etc. In keeping with the Mental Capacity Act 2005, the home needs to promote a culture that assumes capacity rather than incapacity and should evidence more clearly within support plans how incapacity has been assessed. Identified shortfalls in key areas have an impact on the opportunities people living in the home have to make choices and decisions about their daily routines, at present these are limited. Improvements have been made to the risk assessment process, in addition to some established risk assessments for environment and individuals; risk is assessed on a daily basis for all activities outside of the home. It is suggested that the home take account of other factors that impact on the health and safety of individuals particularly health care risks for older residents e.g. nutritional, skin integrity, falling etc, and this is a recommendation. The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People in the home would benefit from the development of a stimulating programme of activities and interests and a review of some restrictions they experience in daily routines. Contact with families and friends is facilitated by the home where this exists. People in the home are consulted about what they eat and enjoy a varied and wholesome diet. EVIDENCE: The home has made progress in accessing college courses for some people, and one person who attends confirmed they “do numbers and writing at college”, the home has also actively encouraged interested people to attend disabled sports activities and Olympics events. There has also been an increase for some more able people in activities outside of the home in the community with one person indicating that they had enjoyed a trip out “black berrying” recently. The majority of people living in the home however, lack a stimulating and varied activity programme. Limited activities are available to one or two people The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 13 but fail to fulfil the needs of the majority. Activity planners viewed in three out four files were out of date and in some instances following discussion with individual staff, unrealistic. Whilst it is acknowledged that progress in achieving planning permission for an activity centre in the grounds has been a source of some frustration; and discussion with staff indicated there is some enthusiasm for the new centre and signs of limited progress in resourcing it. The presence or not, of a defined space should not in itself limit the capacity of the home and staff to develop interesting and varied things for people to do. 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. Staff reported that only a limited number of people in the home retain contact with their extended families, where this exists the home facilitate and enable the maintenance of these contacts through visits and telephone contact. Two people who live in the home confirmed they have regular contact with a relative. There are some restrictions in place in respect of free access to bedrooms for some people, and use of some standard toiletries that impact on privacy and dignity issues and for which the rationale is unclear (the use of restrictions are dealt with elsewhere in the report). The home has made some progress in facilitating keys to bedrooms for more people, and this needs to be continued where possible. Residents are consulted daily about their menu and are provided with a good wholesome and varied diet using fresh produce. They clearly enjoy the meals they receive and the cook demonstrates a good insight into personal preferences, and monitors intake, dietary needs etc, no special diets are currently catered for; a record of food intake is kept. The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements made to the recording of personal care routines, will benefit from additional detail and take account of some restrictions. Residents are enabled and facilitated to access routine and more specialised healthcare; healthcare needs of older residents needs to be promoted. Improvements in medication storage, administration and recording have been implemented to safeguard residents. EVIDENCE: Staff reported that there is a cross gender care policy and procedure in place. A good start has been made on the development of personal care information but this will benefit from additional detail, including the promotion of independence. The key worker role and responsibilities is under review as it does not work as well as it should, with some omissions in care needs noted but not acted upon by a key worker in some instances. The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 15 Health care information is generally well recorded and there is evidence of regular weighing and interventions and appointments with health staff, some health advice noted in correspondence has not been reflected in support plans and the manager should seek to establish systems to minimise such omissions. The home has some aging residents whose healthcare needs as older people need to be clearly understood by staff, risk assessed where necessary and monitored. Whilst the manager has ensured some training for staff; risk assessment and routine monitoring are not in place. A recommendation to develop policy and procedures for continence and pressure area care remains outstanding, placing both residents and staff at risk of poor, inappropriate and uninformed practice. The home has made good progress on the storage administration and recording of medication. Medications are now administered from a more suitable and private location in the home, and more sensitive to the privacy and dignity needs of individual clients. Administration is only by a trained team leader and one other staff member. Staff indicated their support for the current system and feel more in control, the introduction of routine medication audits at shift handover is also seen as a positive improvement. The development and introduction of individual medication profiles, and PRN guidelines, would aid the quality and consistency of administration. Staff practice would be better supported by consents to medication and associated risk assessments for partial or self medication being clearly recorded, and these remain recommendations for improvement. The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A complaints procedure is in place but this is not in an accessible format for most residents, systems for recording complaints need strengthening and made familiar to staff. The home has acted appropriately in respect of safeguarding issues, but must address restrictions in daily routines that impact on the dignity and freedom of residents EVIDENCE: The home has reported that no complaints have been recorded since the last inspection. Feedback from staff however, indicates that this is not the case and that at least one complaint has been made by a resident that was supported by whistle blowing of a number of staff, and the successful referral by the home of a former staff member to the POVA register. The home manager must ensure that complaints are appropriately recorded as such, Discussion with staff highlighted a lack of awareness of any specific complaints record and an understanding that complaints are recorded initially in the staff communication book, there is a danger in such a system that the anonymity and privacy of individuals could be impacted upon and this arrangement needs to be reviewed, as does the complaints procedure which is not easily accessible to the majority of people in the home. Since the last inspection CSCI has received one expression of concern regarding a paper round undertaken by some people living in the home and money earned from this, the home have satisfactorily responded to concerns The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 17 raised and has as a result of the previous inspection reviewed arrangements for the disbursement of earnings. An adult protection alert is currently open following an accident to a resident, the home has responded well to some environmental concerns and has implemented several improvements to further safeguard the resident concerned and others. Discussion with staff during the site visit indicated that they had good insight into adult protection issues, and had used the whistle blowing procedure effectively in the past. It became equally apparent that some staff are less able to grasp the subtleties of different types of abuse or understand their reporting responsibilities, and should be prioritised for adult protection training, which not all staff have yet received, this is a recommendation. The behaviours of some people in the home and the strategies used by staff to manage them are not clearly recorded in support plans. There are some restrictive practices in place and the rationale for these is unclear, but likely to be as a result of staffing issues that limit the time staff can spend in supervising and monitoring residents throughout the day. Restrictions ranged from access to bedrooms to provision of toilet rolls and hand towels. Such restrictions impact on the rights and freedoms of individuals and are demeaning to their privacy and dignity. An urgent review of such restrictions is required and this has been discussed subsequent to the site visit with managers. It could not be evidenced through discussion with staff or a review of team meeting minutes that a previous recommendation to review the staff dress code resulting from a complaint has been addressed. The home has taken on board previous concerns in respect of the recruitment procedure and has strengthened the vetting and checking process, how effectively this has been carried out could not be assessed as no new staff have yet been processed and commenced employment. The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 18 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): 24,25,26,27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable clean and generally safe environment that will benefit from a planned programme of upgrading in which their health and safety must be considered, and their independence should not be compromised by unauthorised environmental restrictions. EVIDENCE: People live in a pleasant period property that is generally maintained to a good standard of cleanliness. Routine maintenance is carried out and the home has made progress in addressing some environment improvements highlighted at the last inspection and as the result of a recent adult protection alert. These are the replacement of fencing around the rear garden, and the securing of a gate to the car park. The installation of a gate to the bottom of a fire escape and the alarming of fire doors. The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 19 Communal spaces and areas are subject to wear and tear and the need for replacement furnishings and floor coverings in some areas has been identified and ordering is underway. Bedrooms are of a good size and all pleasantly furnished and individualised. Water temperatures in bedrooms are regulated and tested weekly. A planned programme of upgrading is underway, the site visit highlighted this to be poorly planned with no evidence that the impact on residents and health and safety risks have been sufficiently considered for safeguards to be put in place, there is a danger that such an attitude could be extended to more complex works where residents may come to harm, and a requirement has been issued under the health and safety standards within this report in respect of all upgrading works. Concern was expressed that a residents damaged wardrobe highlighted at the last inspection had not been attended to, the manager felt that this was an oversight and was asked to look at current key working and maintenance arrangements to ensure this does not happen routinely. There are continence issues within the home and discussion with staff indicated a good awareness of infection control and the management of soiled laundry. The home has obtained some pressure relieving equipment for one resident and will also need to consider in the absence of a lift, accessibility issues within the home for aging residents or those with restricted mobility to ensure they can make full use of the home and freedoms are not impacted upon. The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 20 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): 32,33,34,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has demonstrated a commitment to the professional training of staff, but a review of staffing numbers is needed. Improvements made to the staff recruitment procedure could not be assessed at this time. A programme of core skills training is in place for staff but shortfalls in this could compromise staff practice and place residents at risk. EVIDENCE: The home manager has indicated in pre inspection information that more than 75 of the homes staff has an NVQ2 qualification or exceed this, those remaining are registered to undertake the course. whilst clearly the home has achieved a very good percentage of qualified staff it is important that staff demonstrate through practice what they have learned, some of the shortfalls highlighted in this report indicate this is not the case. Staff commented that they found staffing levels to generally be satisfactory, whilst acknowledging occasional pressure points. Observations of staff and residents highlighted that much of staff time is devoted to other duties around the home such as cleaning and laundry, in addition to escort and driver duties. The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 21 When this happens this leaves a reduced number of staff to monitor and supervise residents and it is unsurprising therefore that a number of restrictive practices have developed to make overall supervision of residents easier. The home is required to review staffing levels with particular reference to peaks and troughs within daily routines, and demands placed on staff outside of care duties that take time away from supervision and support of residents. In the absence of the manager at the site visit, improvements made to the recruitment procedure could not be assessed on this occasion. Discussion with a newer staff member indicated that they had experienced induction into their new role but found the induction package provided was not relevant to learning disability. Senior staff confirmed that a new induction package that incorporates LDAF and is in keeping with skills for care has been purchased and will be implemented with new staff. This could not be evidenced on this occasion and remains an outstanding requirement. A staff training matrix viewed at the site visit indicates that not all staff have completed basic core skills training and refresher training is overdue for others. Adult protection training is outstanding for a number of staff as are equality and diversity and health and safety. In view of some of the findings of the inspection and some lack of awareness of dignity, privacy issues restrictive practice and some safeguarding issues, shortfalls in staff training in these areas could compromise the general welfare and health and safety of residents, and this remains an outstanding required action to be addressed. Staff confirmed in discussion that they now have access to 1-1 sessions with the manager and that these sessions are minuted. Regular team meetings are also held and minutes of these were noted. The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 22 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): 37,39,40 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager must demonstrate that she has an awareness and oversight of day-to-day practice within the home and her own knowledge and skills are updated. The development of quality assurance measures needs to be progressed and must evidence that the views of residents are taken account of. Some policies and procedures to inform staff practice are not in place. Shortfalls in key areas of resident care and support and staffing levels and training must be addressed to ensure the health, safety and welfare of residents is not compromised EVIDENCE: Discussion with staff and a review of the pre inspection information indicates some progress has been made in addressing some of the requirements and The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 23 recommendations issued at the last inspection, although overall progress has been disappointingly slow. Shortfalls identified within the service highlight a need for the manager to take a more active lead in establishing principles of good practice for staff, to evidence observation and monitoring of work practice as part of supervision and to take a more proactive approach to identifying shortfalls and addressing them. Pre inspection information indicates that the home has not addressed an outstanding recommendation to develop a policy for pressure care or incontinence (St 18), it is an important safeguard for both residents and staff that work practices are appropriately supported by informed policy and procedures at all times. The manager has reported through pre-inspection information that some quality audits to support the quality assurance process have been introduced, other than an audit introduced for medication these improvements could not be evidenced. It is difficult to judge from planned developments whether there is a development plan and how residents and staff have influenced this. The site visit highlighted concerns at the apparent lack of planning with regard to the impact on residents of upgrading works, several were seen to have paint on their person and their clothes and this impacted on their dignity and the way they are perceived by others. The area undergoing repainting was not made safe or isolated from residents during works, as a consequence the Home is required to ensure that the health, safety, welfare, privacy and dignity of residents are taken fully into consideration when undertaking any upgrading works either inside or external to the house. The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 24 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 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 2 29 2 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 N/a 35 2 36 3 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 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 2 X 2 2 X 2 X The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 25 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 Requirement Hold copies of Care Management or Homes assessment on resident files (previous timescale of 31/12/05 and 31/10/06 partly met) 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. All Restrictive practices are to be reviewed and a clear rationale developed to support those that are retained, 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 The Home must ensure that a DS0000023264.V345831.R01.S.doc Timescale for action 30/11/07 2 YA12 16(2) n 30/11/07 3 YA23 13 30/11/07 4. YA23 13 30/11/07 5. YA34 19 30/09/07 Page 26 The Paddock Version 5.2 Schedule2 POVA 1st check and two written references are in place before staff commence work at the home (in absence of new staff could not assess if implemented within timescale of 4/9/06) new timescale All staff must receive an 30/11/07 induction that is compliant with ‘Skills for care’ Induction standards (partly met in previous timescale of 31/10/06 All staff are to be provided with mandatory core skills training. (Partly met within previous timescale of 15/9/06) new timescale The manager must ensure that the health safety and welfare of residents is taken full account of in the planning of all internal and external upgrading works 30/11/07 6. YA35 18(1) 7. YA35 18(1) 8. YA42 13(4) a 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 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. The home should develop risk assessment process to take account of other factors that impact on the health and safety of individuals including health care risks for older residents e.g. nutritional, skin integrity, falling etc, and this is a recommendation. 2. YA9 The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 27 3. YA18 The home to develop a continence management policy and a privacy and dignity policy 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. 4. YA20 5 6. YA23 YA31 Manager to ensure all staff have received Training in safeguarding adults and awareness of their role and responsibilities in this respect. 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 Quality assurance system to be developed to evidence how residents vies influence service development 7. 8 YA35 YA39 The Paddock DS0000023264.V345831.R01.S.doc Version 5.2 Page 28 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.V345831.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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