Inspection on 31/10/06 for The Walled Garden

This inspection was carried out on 31st October 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Walled Garden 09/10/08

The Walled Garden 01/12/05

The Walled Garden 09/05/05

The Walled Garden 06/12/04

The Walled Garden 15/06/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 The Walled Garden Calcot Grange, Mill Lane Reading Berkshire RG31 7RS Lead Inspector Stephen Webb Unannounced Inspection 31st October 2006 11:15 DS0000011145.V308560.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 DS0000011145.V308560.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. DS0000011145.V308560.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Walled Garden Address Calcot Grange, Mill Lane Reading Berkshire RG31 7RS 0118 945 1712 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) walledgarden@btconnect.com Residential Community Care Limited Mrs Cate Lovelock Care Home 10 Category(ies) of Learning disability (10) registration, with number of places DS0000011145.V308560.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st December 2005 Brief Description of the Service: The Walled Garden is a residential care home offering twenty-four hour personal care to ten adults of both sexes who have learning and associated behavioural difficulties. The home is a two-storey building and is not able to provide a service to people with severe physical disabilities, as there is no lift access to the first floor. The home has eight single and one double bedroom but the double bedroom is used as a single and will be for the foreseeable future. The bedrooms have wash hand basins but do not have en-suite facilities. The home is situated in a quiet residential area approximately five miles from Reading Town Centre. There are local facilities within walking distance of the home. The home has its own vehicle and service users are able to access public transport, as appropriate. Fees at the time of inspection ranged from £87,500 - £250,000 per annum. DS0000011145.V308560.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit from 11.15am until 6.15pm on 31st of October 2006. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from limited conversation with residents, who have limited verbal communication, though one resident was able to answer some questions. The manager, one staff members and the visiting music worker, were spoken to as well as one visiting relative. The inspector also examined the majority of the premises, and ate lunch with residents, as well as making informal observations of interactions between staff and residents at various points during the inspection. Indications from observation of interaction between the residents and staff were that the residents were relaxed and enjoyed interacting with the staff and the activities provided. Staff were able to communicate via a range of individualised methods, as indicated within care plans. The residents are encouraged to have some involvement in the day-to-day operation of the home in terms of household routines, and to make daily choices and decisions for themselves with support and prompting by staff. The home had a relaxed and calm atmosphere but it was evident that residents were involved in various activities. What the service does well: The home makes positive efforts to involve residents in developing userfriendly information and polices/procedures, which improves the quality of information available to future prospective residents. Residents have various opportunities for their wishes to be heard. The needs and preferences of residents are reflected in their care plans, which also indicate how each individual communicates their wishes. They are involved in day-to-day decisions about their lives. Residents have access to a wide range of activities within the unit and the local community. Efforts are made to address any barriers to resident involvement, and the home works actively to develop the skills of residents to access the community. DS0000011145.V308560.R01.S.doc Version 5.2 Page 6 Transport is made readily available through the employment of a dedicated driver for the unit vehicle, as well as developing the skills of individual residents to utilise public transport. Contact with family is actively encouraged and supported. Residents are involved in daily routines in the home and encouraged to make decisions about their preferences. They are encouraged to be involved in menu planning, food shopping and preparation, and receive a balanced diet. Cultural needs are addressed where necessary and the views and preferences of individuals regarding their culture are respected. The physical and health needs of residents are met effectively by the home and medication management is appropriate. One resident is working towards taking greater responsibility for self-managing his medication. Positive attempts have been made to provide an accessible version of the complaints procedure and other policies/procedures. Staff receive appropriate training and there is a system in place to address POVA issues and protect residents from harm. Residents live in a homely, safe and well-maintained environment, and have input into the choice of décor of their surroundings. They are supported by a competent and trained staff team, who understand their individual needs. Good progress is being made on NVQ in the team. The residents are protected by the home’s thorough recruitment and vetting procedure which includes some very good practice. The views of residents and others are taken into account and there is a detailed quality assurance and annual development cycle in place. The results of quality assurance surveys are made available to participants. Systems are in place to protect the health and safety of residents and staff. What has improved since the last inspection? Improvements have been made to day-care provision. Areas of the home have been redecorated, after consultation with residents about the colour scheme. Handrails have been fitted throughout the downstairs areas. Contracts have been provided to residents in a pictorial format, which they had a part in designing. DS0000011145.V308560.R01.S.doc Version 5.2 Page 7 Ongoing improvements have been made to staff training on the communication methods of individual residents. The feedback format for residents to indicate their experience of the support from their keyworker has been developed. The service has been working with Skills-2-Care to identify staff training and development needs. All staff have received CPI training to help them see any verbal aggression as communication and to provide de-escalation techniques. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000011145.V308560.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 DS0000011145.V308560.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): 1, 2 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home makes positive efforts to involve residents in developing userfriendly information and polices/procedures, which improves the quality of information available to future prospective residents, when deciding about a possible move. The needs and aspirations of residents are established and recorded in order to meet their needs, EVIDENCE: The home’s statement of purpose was reviewed recently. The home has produced a service user guide with much of the text replaced by pictures chosen as meaningful, by the residents. Residents have also chosen a number of key policies and procedures, which have been re-written in more accessible format using pictures, following discussion with them. The resident’s fire evacuation procedure was an example of this, and was devised with the support of the fire brigade. It is displayed prominently beside the front door. DS0000011145.V308560.R01.S.doc Version 5.2 Page 10 A pictorial version of the placement agreement was also present on individual files, which had been designed by the residents. The manager indicated that there were also plans to develop a resident-friendly service user charter, which was available in text format only at present. Assessment documents were present in the files examined. Individual files included assessments of basic abilities, which provide a baseline against which progress can be reviewed subsequently. Records include evidence that the views, likes, preferences and wishes of residents have been obtained and recorded. DS0000011145.V308560.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs and preferences of residents are reflected in their care plans and associated documents, and residents are involved in their review. Residents are involved in making day-to-day decisions about their lives and their views are sought about the décor and environment. Residents are supported to take appropriate risks and to be as independent as possible. EVIDENCE: The care plan documentation includes a social plan detailing likes and dislikes, a health action plan and details of preferences in the event of death. Any agreed limitations as to freedom of movement, are recorded. There is also a personal profile, within an essential lifestyle plan, detailing preferred communication methods, interaction and relationships, and a new DS0000011145.V308560.R01.S.doc Version 5.2 Page 12 format detailing things the resident wishes to continue to do, but which present them with difficulties. There are also individual guidelines on responding to inappropriate behaviour, which link to the de-escalation techniques taught in the CPI training. The assessments of basic abilities such as self-care, dexterity etc. set a sound baseline of knowledge from which to work to develop skills, and are reviewed every six months. There are also individual goal plans, detailing goals set at reviews, which are also reviewed subsequently. Care plans and other key documents are read to residents to aid their understanding, and, where possible, they sign to confirm this. Each resident has a review every six months, with in-house reviews alternating with statutory ones. Residents, relatives (if appropriate) and care managers are invited to in-house interim reviews. The musician employed to undertake individual and group music sessions with residents, is also invited to contribute a report to reviews. Residents were observed to be encouraged to make day-to-day decisions and choices for themselves, with encouragement and support from staff. Residents had also been involved in choosing aspects of the decor in the house. One resident explained how he had access to part of his allowance directly each week to spend as he wanted, and was helped to save up for Christmas, etc. by the home saving some of his money for him, with his consent. He also received reward incentives for not using inappropriate behaviours, which provided him with Argos vouchers for him to save up and spend on items he wanted. He explained how he enjoyed this freedom and found it helped him to control his behaviour. An appropriate range of risk assessments was in place indicating a robust approach to risk assessment, but the freedom of residents was not overly restricted as the result. Risk assessments for two of the service users do indicate the need for the use of wrist straps when out in the community, to support staff in maintaining their safety, but this decision was taken in consultation with the psychologist and others. In one case the wrist strap is rarely used now and in the other it has to be used every time the resident is out in the community, though this was reportedly handled with discretion, to maximise the resident’s dignity. There was evidence that a recent short-term crisis admission to the unit, (from another unit operated by the provider), which was outside of the unit’s normal DS0000011145.V308560.R01.S.doc Version 5.2 Page 13 ethos, was made only after thorough risk assessment of the risks and benefits to both the new admission and the existing residents. The individual temporarily admitted, was familiar to the group, and their placement was supported by the psychologist and the CTPLD. The placement was considered to have been a success by the manager, as the individual had returned successfully to her previous unit after three months. There are possible plans to develop a separate unit attached to the home, to provide a greater degree of day-to-day independence for the three most able residents, whilst still providing support from familiar staff when required. DS0000011145.V308560.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents have opportunities to take part in an extensive range of on and offsite activities, including college attendance and positive attempts are made to address barriers to them accessing these. Contact with family is encouraged and supported, and the rights and independence of residents are supported appropriately, with staff advocating where necessary on behalf of residents. Residents are encouraged to be involved in day-to-day decision-making and household tasks. They are offered an appropriate diet and are involved in the planning of the menus, shopping and meal preparation as appropriate within a risk assessment context. DS0000011145.V308560.R01.S.doc Version 5.2 Page 15 EVIDENCE: Each individual has a day-care timetable within their care plans, which indicates regular planned activities. There is a summerhouse in the garden where residents can engage in art and craft with staff. There is also a sensory room in this building. A second outbuilding is being developed to contain a permanent model railway layout, with the active involvement of one resident and his father. Residents are involved in maintaining the garden and had recently pruned the bushes in preparation for the winter, and were going to shred the prunings with staff support. The manager plans to develop an area of sensory garden to benefit one resident who is partially sighted. One resident attends college one day per week doing art, literacy and numeracy, which he confirmed he enjoyed doing. Staff worked with him over a period of a year to develop his confidence and he now travels to and from college on the bus alone. He also enjoys fishing and the home has provided a shed for him to store his fishing equipment securely. He also described going out for walks and going into town with the staff, and talked about having enjoyed the summer holiday to the New Forest in September with two other residents and two staff. A driver is employed to provide ready availability of the unit vehicle, (a sevenseater people carrier), irrespective of the staff on duty, and one member of the care team is also able to drive. One resident also has their own car, for which one parent and one staff member are insured as drivers, to enable it to be used to enhance community access. External activities include swimming, bowling, skating, trips to the local pub, cinema, flower arranging, Thames Valley adventure playground, train spotting and shopping for personal items or food. Two residents are members of the local rambling club. Two places have also been applied for at the local PHAB club, and one resident wants to go to belly-dancing classes. One resident has a phobia of dogs and a desensitisation programme is under way to address this to reduce its impact on their access to the community. The home employs a musician to undertake individual and group music sessions with residents, including playing instruments and singing. They also contribute reports of the progress of individuals to their reviews, and feedback to staff after each session. Staff sit in on these sessions too. DS0000011145.V308560.R01.S.doc Version 5.2 Page 16 One visiting relative confirmed that there was a good range of activities provided by the home. Where identified, the spiritual and cultural needs of individuals are supported. Where conflict has arisen between the wishes of a resident and their family in this area, the home has advocated positively for the rights of the resident to make choices for themselves. Residents are expected to have some involvement in cleaning their bedrooms and some also contribute elsewhere, though the home employs a cleaner for the communal areas, who also undertakes periodical cleaning in bedrooms to ensure health and safety standards are maintained. All but one of the current residents has some family contact either through visits to the unit or visits to home. Contact is supported and actively encouraged by the home. Keyworkers phone family regularly to maintain contact and keep them informed appropriately. In one case the manager has made changes to the funding arrangements for family contact to protect the resident’s finances, and the home now funds the travel costs for specific visits. One resident has also been supported to develop the confidence to travel to a home visit alone by bus and train. In another case the home has funded the purchase of a similar mattress and bedding to that available in the unit, for when the resident visits family, to provide familiarity to help them settle well during home visits. The staff take the lead on meal preparation, and four of the residents take some part in the process, though the others show little interest, or their risk assessment precludes their access to the kitchen. One resident confirmed that they were involved in deciding the menus and making choices about food. One resident likes to clear the dining table and sweep the floor after meals, while others load or empty the dishwasher. The menus are compiled from the residents’ choices with a staff overview and the advice of a dietician having been taken. Specific dietary requirements are provided for where necessary, with suitable alternatives being made available. Staff use laminated cereal packet fronts and other items to assist residents in making choices. Some residents are prescribed vitamins to balance their dietary intake. DS0000011145.V308560.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ views and preferences are taken into account in the provision of their care, in addition to their needs. The physical and health needs of residents are met effectively by the home. Residents’ medication is managed appropriately on their behalf, though work is being undertaken with one resident to develop self-medication skills. Further clarification is required on the use of “Epi-pens” by staff in emergency. EVIDENCE: A new service user charter has been drawn up, which spells out the rights of residents and the care they should receive. The document addresses dignity, choice, empowerment and the giving of information. No adaptations to the physical environment were felt to be necessary to meet the current needs of residents. The resident who is partially sighted, has been there a long time and is very familiar with the home’s layout. As noted earlier, the manager plans to develop a sensory garden to enhance their enjoyment of the garden area. DS0000011145.V308560.R01.S.doc Version 5.2 Page 18 The plans to develop a distinct unit as part of the home, to provide greater independence for the three most able residents, would enhance their experience and opportunities, whilst retaining the benefits of familiar staff to provide any necessary support. Residents’ individual essential lifestyle plans identify their communication methods and other information, which together with care planning documents and behaviour management guidelines, enable staff to meet their needs effectively on an individualised basis. As already noted, wrist straps are used to support one resident at all times when out in the community to ensure their safety, and on occasions for another individual. The decision was taken after appropriate consultation and discussion with relevant parties, which is good practice. Another example of good practice was the delay in making a new admission, following the death of a previous resident, to enable staff to work with residents to come to terms with the death, and be prepared for the positive introduction of a new resident. The unit has sought independent advocacy for residents, and support from external professionals for families, where specific issues have arisen, such as differences of opinion over care practice between the unit and family. The daily routines for one resident, who is autistic, are put up on a whiteboard with the resident each day to support them. Another resident who reacts negatively to male carers has a specifically female care team of individuals to whom she relates well, and specific individuals from this group provide all her care input throughout the day. They wear identifiable ‘t’-shirts, to support the resident and minimise her anxiety. All staff in the unit receive CPI training, from the manager, who is an accredited trainer, and also provides regular updates to the training. It focuses mainly on effective de-escalation techniques although restraint training is included. The manager’s policy is one of no restraint, except in emergency and there had only been one instance of restraint use in the past three years. Feedback from one relative who visited during the inspection was mostly positive about the care provided by the staff, and the level of involvement of the manager in the day-to-day operation of the home. Each resident has a health action plan on file together with health care notes, a health questionnaire and a weight chart. DS0000011145.V308560.R01.S.doc Version 5.2 Page 19 The home has positive relationships with a range of external healthcare professionals whom it calls upon when required. The unit manages the medication for all of the residents, but one resident is working towards self-medication and now received his tablet medication one day at a time to lock in a cupboard in his room. He takes this at the specified times with staff present to unlock the cupboard and complete the record. The plan is to gradually increase the level of personal responsibility taken for the medication as the resident becomes more confident. There is an appropriate medication management system in place, including a written policy/procedure and appropriate records, which are initialled by two staff for each dosage administered. Medication administration records are completed appropriately, and include a record of medication quantities received into the unit, and a returns log is completed for items returned to the pharmacist. Laminated photos of each resident are kept in the medication cupboard and the relevant one is taken by the staff with the medication to be administered, as an additional step to reduce the risk of distraction errors. The unit has received conflicting advice regarding the appropriateness of staff receiving training in the use of “Epi-pens”, and further clarification of this needs to be obtained. At any event written authorisation for their use should be obtained from the relevant medical practitioner and it is advisable to obtain the written consent of the next of kin. The advice of the home’s insurers should also be obtained, and appropriate risk assessments and written guidance in the use of “Epi-pens” should be in place. Staff should receive training in their use as they would for administering insulin, and named certificates of competency should be obtained. DS0000011145.V308560.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Positive attempts have been made to provide an accessible version of the complaints procedure for residents, who also have other forums where any concerns can be raised. In most cases the support/advocacy of staff would be required to pursue a complaint. Systems are in place to provide protection for residents against abuse, and staff receive training in POVA issues. EVIDENCE: The unit has a written procedure and a version for residents, using pictures, which was written with residents’ involvement. There is also a video version of the procedure available which residents were involved. The complaints log indicates two complaints in 2006, both from neighbours, both of which were appropriately addressed. One resident indicated he was aware of how to complain and who he could speak to about any concerns. All of the staff see a training video on POVA issues as part of their induction, and the issues are discussed regularly within staff meetings. An external accredited trainer is also due to provide POVA training to all staff in November, related to the local multi-agency protocol. DS0000011145.V308560.R01.S.doc Version 5.2 Page 21 There is a three-monthly residents’ forum meeting during which POVA and bullying issues are discussed. The meetings are minuted. Residents’ have also helped to compile a “keeping safe” policy. DS0000011145.V308560.R01.S.doc Version 5.2 Page 22 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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a homely and safe environment which is well maintained, and they have had input into the décor. The home is clean and hygienic. EVIDENCE: The home was attractively decorated to a colour scheme chosen largely by the residents, who have also been involved in choosing some of the furniture and pictures. One resident described having his own CD player, TV and video in his room, which he could watch when he wanted. Handrails are provided in key areas to support the partially sighted resident, but no other environmental adaptations were necessary to meet current needs. There are plans to possibly develop a separate semi-independence unit on site, to enable the three most able residents to have a greater degree of independence. DS0000011145.V308560.R01.S.doc Version 5.2 Page 23 As noted earlier, good use is made of various garden buildings to broaden the range of options for residents and meet individual needs, and residents are involved in maintaining the large, enclosed garden. There are plans to develop a sensory garden to meet the needs of one resident who is partially sighted. The laundry is small and has domestic machines at present. The manager did not feel there was yet a need for a machine with a sluice cycle. The standard of cleanliness and hygiene in the home, were good. DS0000011145.V308560.R01.S.doc Version 5.2 Page 24 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): 32, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by a competent and trained staff team, who understand their individual needs. Good progress is being made on NVQ. The residents are protected by the home’s thorough recruitment and vetting procedure which includes some very good practice. EVIDENCE: Fourteen staff have attained NVQ level 2, and two have level 3. A further seven are undertaking level 2, and two are doing level 4. Three of the staff have equivalent other qualifications. The unit is working with Skills-2-Care to develop a less academically-based NVQ where competencies are judged primarily through observations and witness statements. The feedback from one resident about the staff was very positive, and observations of the interactions between residents and staff indicated warmth and familiarity with individual needs and means of communication. This was echoed by the views of a relative. DS0000011145.V308560.R01.S.doc Version 5.2 Page 25 As previously noted, a designated driver is employed to try to ensure that a driver is available much of the time to drive the unit vehicle. Daily staffing is five or six care staff throughout the day from 8am until 10pm and two waking night staff each night. Specific care staff teams are allocated to two residents. The individual staffing arrangements in place for specific residents are positive evidence of a planned staffing strategy to address the needs of the residents. The home does not use agency staff as this would unsettle the residents and shortfalls are covered from within the team. The home operates a thorough recruitment and vetting system, and the required records are retained securely on-site to verify this. References are routinely verified and a photo of the applicant is sent with the reference request as an extra identity confirmation. This is very good practice, as is the retention of interview records. Applicants also meet the residents (supervised at all times), and are observed interacting with them, as part of the interview process, and residents are asked for feedback on their impressions. Staff receive a thorough induction which is now documented in the new induction booklets provided by Skills For Care. The staff training spreadsheets indicate good progress being made in providing the necessary core training to all staff. Fire safety training is updated annually by an external accredited trainer and staff also view a video. POVA training by an external trainer was also due in November for staff who had not received it. The manager is accredited to deliver CPI training to staff on interventions to de-escalate inappropriate behaviours, and also teaches limited restraint techniques, though the home’s policy is not to restrain except in emergency. An ex-staff member provides staff training on Makaton. The staff are supported through regular supervision and annual appraisals and Skills–2-Care undertake an annual training needs analysis. DS0000011145.V308560.R01.S.doc Version 5.2 Page 26 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, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a well run home which focuses on their needs. The views of residents and others are taken via a variety of forums and they are actively involved in the day-to-day operation of the home. The results of quality assurance reviews are made available to participants, which values their contribution and encourages openness. The home promotes the health and safety of residents. EVIDENCE: The home has an experienced manager who is actively involved in the day-today operation of the home. The manager has her NVQ level 4 and Registered Manager’s Award. DS0000011145.V308560.R01.S.doc Version 5.2 Page 27 Staff are supported through regular supervision and annual appraisal and have a comprehensive set of policies and procedures to guide them in their day-today work. The home meets the needs of residents effectively and maintains detailed records of this and of the support needs of individuals. The home has undertaken a cycle of quality assurance, including questionnaires completed with the involvement of residents, about their experience of their keyworker, day-care provision and staff strengths and weaknesses. Questionnaires have also been sent to relatives, advocates and relevant external professionals. The results were collated into a summary report in September 2006, and a version to assist feedback to residents was also produced. There is also an annual development plan in place for the home, due for review in December. The provider undertakes monthly Regulation 26 monitoring visits and produces reports, which are copied to the manager and filed in the home. On examination, some of these were missing and should be replaced. It is notable that residents have been involved in drafting accessible versions of key policies and procedures and are involved in decision-making in some areas. Residents were involved in the production of an accessible fire evacuation procedure, in consultation with the fire brigade, which is posted beside the front door. Fire drills/evacuations are held periodically involving residents, and there are regular discussions about fire safety with residents in monthly residents’ meetings. A sample of health and safety-related service certification indicated that checks were up to date. The fire brigade visit annually to monitor the access to the home and help desensitise residents to their input. The manager plans to arrange for the local beat police officer to visit to address the desensitisation issue as well. Accident forms are completed when necessary and filed collectively for monitoring as well as being copied to the relevant individual’s care records. DS0000011145.V308560.R01.S.doc Version 5.2 Page 28 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 4 2 3 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 4 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 4 X X 3 X DS0000011145.V308560.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 YA20 Good Practice Recommendations The manager should obtain further clarification on the use of emergency “Epi-pens” by care staff, and should ensure that appropriate safeguards are in place, for both residents and staff, if they are used. DS0000011145.V308560.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Oxford Office Burner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 DS0000011145.V308560.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. 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