Inspection on 05/07/06 for The White House

This inspection was carried out on 5th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The White House 19/06/07

The White House 25/01/06

The White House 20/07/05

The White House 08/12/04

The White House 17/05/04

The White House 09/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 White House (The) 4 Walpole Road Boscombe Bournemouth Dorset BH1 4EZ Lead Inspector Stephanie Omosevwerha Key Unannounced Inspection 5th July 2006 09:30 DS0000032243.V303833.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 DS0000032243.V303833.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. DS0000032243.V303833.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service White House (The) Address 4 Walpole Road Boscombe Bournemouth Dorset BH1 4EZ 01202 399471 01202 390473 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) Steadway Care Limited Mrs Sheila Mary Stimpson Care Home 7 Category(ies) of Learning disability (7) registration, with number of places DS0000032243.V303833.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Further work needs to be undertaken to the window in Bedroom 8 prior to the registration of this room. Following the recommendation made by Dorset Fire & Rescue Service in their letter dated 28 August 2002, careful consideration needs to be given to the choice of service user who can be accommodated in the top floor rooms such that these service users should be able to evacuate the building unaided. Service users who have significant personal care needs or who present with very challenging behaviour will not be offered places. Two named persons (as known to the CSCI) to be accommodated in the category LD to be provided with one to one care. 25th January 2006 3. 4. Date of last inspection Brief Description of the Service: The White House is a large property on a corner plot in a residential area of the Boscombe. It is conveniently located for all the amenities of Boscombe that includes shops, restaurants, cafes, post office, library and places of worship. These are within a few minutes level walk of the home. Public transport is readily accessible close to the home and Bournemouth town centre is approximately 1 mile from the home. The home has its own transport that enables service users to conveniently access some of the towns leisure facilities, particularly when group activities are arranged. The homes mission statement states that that it aims to support and care for adults with autism along the path towards independence. The White House has three floors and there is bedroom accommodation on the first and second floors i.e. 2 on the second floor and 5 on the first. All bedrooms are single rooms and have en-suite WCs and baths and the décor and furnishings are the choice of the person occupying the room. Communal space is on the ground floor and comprises two lounges, a dining room, a large kitchen and a WC. Recent extension work has provided a larger management office, additional staff office and separate laundry room. The paved external garden area is accessible from one of the lounges and the dining room and contains a summerhouse. The current weekly fees are between £1842 and £2486, which are inclusive of day care activities provided during the week. Additional charges are made for hairdressing, toiletries, and some activities. DS0000032243.V303833.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection of the home and took place over approximately 7 hours. It was carried out as part of the planned inspection programme for care homes undertaken by CSCI and to address the requirements and recommendations made at the previous inspection. This inspection was a key inspection and therefore, assessed all identified key national minimum standards for care homes for adults (18-65). The inspector initially spent time with the registered manager of the home and examined various records and documentation including care plans, risk assessments, staffing records, medication records, health and safety and maintenance records. The inspector had the opportunity to speak to the home’s training co-ordinator and view the home’s training plan. The inspector conducted a tour of the premises viewing all communal areas of the home and all service users’ bedrooms. Most service users were unable to give verbal feedback due to the nature of autism, so the main evidence gathered for the outcomes of service users living in the home was from observation of activities and interaction with staff. The inspector did spend time talking with one resident whilst they were undertaking their afternoon activity. Additional information received by the inspector prior to the inspection was also taken into account. This included 6 service user surveys, 3 relative surveys and 3 professional surveys and any other information such as information gathered at previous inspections, monthly monitoring visit reports from the responsible individual of the home and any notification made under Regulation 37 of the Care Homes Regulations 2001. What the service does well: There is a clear leadership structure throughout the home with all staff demonstrating an awareness of their roles and responsibilities. For example the manager’s and deputy manager’s responsibilities are clearly set out and the home employs a training co-ordinator to organise staff training and a day care co-ordinator to organise daytime activities for service users. The home is well organised with a high ratio of staff on duty to meet the assessed needs of service users. There is a mix of male and female staff and the rota is organised so that senior members of staff work with newer members of staff to ensure a good distribution of skill mix during shifts. Observation on the day of the inspection showed there were 5 care staff on duty including one senior responsible for the shift. This enabled 5 service users to go out with 3 members of staff and one service user to be accompanied by 2 members of staff in the community as per their care plan. DS0000032243.V303833.R01.S.doc Version 5.2 Page 6 The home demonstrates a commitment to providing good quality training and all staff have the opportunity to complete a number of courses that reflect the homes aims and meet service users needs. There was further evidence that a high percentage of the staff team were working towards NVQ qualifications ensuring that they achieved the skills and competencies necessary for their work within the home. Care planning systems are very effective ensuring staff have a very good understanding of service users personal care and health care needs. Additional information is available such as vocabulary lists, skills monitoring assessments and techniques to managing behaviour promoting consistency of care. A great importance is placed in assessing individual risks to ensure these are well managed protecting service users from potentially harmful situations. The home is well located and is just a short, level walk from the local shops. Residents are able to access the local community regularly and observation during the inspection showed they enjoyed going out with staff support both on an individual basis and in small groups. The home offers a range of daytime activities making use of their own allotment, local leisure facilities and amenities. The home provides comfortable accommodation with all service users having their own room with ensuite facilities. A good standard of hygiene is maintained and the home was observed to be clean and tidy. What has improved since the last inspection? What they could do better: Some of the maintenance records had not been kept up-to-date and did not indicate when things in the home had been repaired. The home had also failed to arrange PAT testing in the agreed timescale further placing residents at potential risk. There have been some breaches in staff recruitment procedures that need to be addressed to ensure good standards of recruitment are maintained and to safeguard the welfare of service users in the home. Two members of staff had commenced employed prior to a full CRB being obtained and with no evidence DS0000032243.V303833.R01.S.doc Version 5.2 Page 7 that a POVA first check had been sought. Another member of staff had only one written reference and another member of staff needed to provide a valid work permit to ensure they were legally entitled to work in the UK. The home must ensure that all required documentation/information is in place prior to recruiting new members of staff. If staff are to commence employment prior to the receipt of a full enhanced CRB check, the home must obtain a POVA first check and commence a structured induction period with that member of staff who must be supervised at all times by a designated member of staff who is clearly identified on the rota. No evidence was provided on the day of inspection of any plan setting out aims and objectives for future service development meaning there was no indication of how effectively the home is reviewing the quality of care service users receive. The home needs to ensure that contracts are available for all service users to ensure they and their representatives are clear about the terms and conditions of occupancy. Improvements to medication records are needed when handwritten changes are made to pre-printed medication sheets, a note should be made of who authorised the change so this can be cross referenced with the service user’s file. The registered manager needs to complete the Registered Managers Award and the home needs to achieve a target of 50 of staff achieving a NVQ Level 2 qualification or above. However, the manager is currently undertaking her RMA and there are 17 care staff currently working towards a NVQ qualification meaning the home is well on target for fulfilling these requirements. 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. DS0000032243.V303833.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 DS0000032243.V303833.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home makes thorough assessments of prospective service users’ needs taking into account information from other professionals and families/carers to ensure any new resident’s care needs can be met. The home needs to ensure that contracts are available for all service users to ensure they and their representatives are clear about the terms and conditions of occupancy. EVIDENCE: The home currently has one vacancy and one resident is leaving the home in July 2006 meaning there will be two vacancies in the home. There had been no new admissions to the home since the previous inspection. Previous inspections had found that full care management assessments and care plans were in place for all service users prior to admission. The home has clear procedures for admission including carrying out their own assessments for prospective service users. These are very thorough and involve meeting the service user; their families/carers and relevant professionals involved in the service users’ current care packages. DS0000032243.V303833.R01.S.doc Version 5.2 Page 10 A sample of two residents’ files was examined as part of the inspection. The inspector noted that one of these residents did not have a contract on their file. The inspector also noted that copies of the service user guide had not been given to this resident. This was discussed with the deputy manager who said that the social worker might have taken the home’s copy of the contract by mistake and she would chase this up at the service user’s forthcoming review. She also said that the service user guide had not been given to the resident as they would more than likely tear it up. They were waiting till the service users forthcoming review when all the necessary documents could be given to and signed for by the service user’s relatives. DS0000032243.V303833.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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a comprehensive and clear system of care planning in the home that provides staff with the information they need to ensure service users needs are met. Service users are supported and encouraged to make decisions where they are able with any restrictions being clearly recorded and evidenced in care plans as to why they are necessary. A great importance is placed in assessing individual risks to ensure these are managed effectively safeguarding the welfare of service users by reducing/minimising potentially harmful situations. DS0000032243.V303833.R01.S.doc Version 5.2 Page 12 EVIDENCE: A sample of 2 service users individual records was examined as part of the inspection. Each service user had a personal profile and an individual service user plan that addressed a whole range of needs including health care needs, personal care needs, communication, personal relationships, social and work/occupation/education needs, risk/safety factors, financial needs, domestic tasks, behaviours and routines. Individual needs were clearly identified and comprehensive guidance given about the staff support required. There was further evidence that regular reviews were undertaken by the home and one resident’s review had been held in February 2006 and the other in May 2006. There was evidence that service users were consulted prior to their reviews and had the opportunity to talk to their keyworker beforehand about any issues they wanted to raise in a pre-review questionnaire. The inspector observed service users’ files also contained additional information to further inform staff about residents’ care needs. These included vocabulary lists, skills monitoring assessments and techniques to managing behaviour. There is also a staff information file that is updated on a weekly basis that contains information including changes to service user care plans, policies and procedures and training information to ensure staff are kept informed of any developments in the home. Staff sign to confirm they have read this. Due to the nature of autism, some service users are only able to make limited choices in their daily lives. The home has to impose some restrictions to ensure service users safety, which are clearly documented on individual files. For example due to lack of independent skills, awareness and behaviour it was unsafe to leave some residents unsupported in the community. The staff work with service users to encourage them to make decisions where possible such as choice of clothes, decorating their rooms and the activities they take part in. One relative commented that “X’s overall understanding of the world has improved, as has X’s communication since being at the White House” providing further evidence that the home is promoting service users’ independence. The home had a comprehensive risk management framework with clear assessments and action plans in place to minimise risks. Assessments were carried out on a number of activities including personal care, domestic activities, community activities, social activities, physical intervention, aggression and communication. There was evidence to show that risks to the individual and other people had been considered and also any other risks such as damage to property. Proposed action plans were clear, e.g. two to one staffing needed whilst out in the community. DS0000032243.V303833.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of social and educational opportunities is provided with good links to the local community supporting and enriching service users lives. Service users are encouraged to maintain contact with their families although due to the nature of autism, service users find it difficult to form independent relationships and links outside the home relying heavily on support and guidance from the staff. Service users are encouraged to participate in the daily running of the home and their responsibilities for chores are clearly set out. Dietary needs of service users are well catered for with a balanced and varied food selection available that takes into account service users tastes and choices. DS0000032243.V303833.R01.S.doc Version 5.2 Page 14 EVIDENCE: The home provides a daytime programme to all of the residents and employs a day care co-ordinator whose role it is to specifically organise residents’ week time activities. Individual service user’s activities were recording on their files. The activities varied and included craft, walks, recycling, music, trampolining, swimming, bowling, going to the gym and working on an allotment owned by the home. One service user was supported to undertake a weekly paper round and the resident was observed during the inspection collating the leaflets to go inside the papers. The activity programme includes accessing the local community and residents go to the local shops, beaches, parks, cafes and leisure centres. On the day of the inspection residents were observed going out to a local beach and going to the supermarket. Although service users were unable to give verbal feedback about their daytime activities, observation showed they enjoyed going out into the community. The home is able to provide a high staff ratio and on the day of the inspection there were 5 care staff on duty as well as the deputy manager, training co-ordinator and day care co-ordinator. This ensures that service users are able to access the community on a regular basis with staff support. It also allows service users to go out individually or in smaller groups. The home own a MPV vehicle that service users can use to go on longer journeys. Service users family contacts are clearly recorded on their files. The statement of purpose confirms visitors are welcome to the home although they do prefer these to be set up by arrangement in order to ensure they do not interfere with service users daytime programmes. This was confirmed by a relative who commented “we are always welcome at the home but they do like us to tell them beforehand that we are coming.” All visits to family are noted on service users files and service users are also supported to contact their families e.g. by telephoning them. Due to the home specialising in adults with autism, service users find it difficult to establish independent friendships or links outside the home and rely heavily on the staff for support and guidance. Service users responsibilities within the home are clearly set out in the Statement of Purpose and Service User Guide e.g. “service users will be expected to take care of their personal hygiene and to keep their own space to an acceptable standard.” Staff support is available for service users that have difficultly in these areas and more specific needs are detailed on their individual care plans. Weekly rotas are drawn up in the home to ensure everyone does their fair share of chores such as cleaning, washing up, laying the table and shopping. Observation during the inspection showed that one service user was supported to clean her room, other service users helped with DS0000032243.V303833.R01.S.doc Version 5.2 Page 15 unpacking the weekly shopping and another service user helped to make the salad for dinner. A sample of weekly menus was viewed. These were varied, offering a balanced diet taking into account individual service user choice. The weekly food shopping was delivered during the inspection and service users were observed helping to unpack the shopping. This contained a varied selection of fresh foods providing further evidence that a good diet was offered to residents. DS0000032243.V303833.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal support is offered in a way that promotes service users independence and takes into account their likes and dislikes. The health needs of service users are well met with evidence of multidisciplinary work taking place to provide further advice and expertise. The systems for the administration of medication are satisfactory with comprehensive arrangements in place to ensure service users medication needs are met. EVIDENCE: Personal care needs were well documented on care plans and information was included concerning toileting, washing, bathing, washing hair, cleaning teeth, dressing, shaving, nails, hands and hair care. Observation of practiced showed staff supported service users to complete tasks independently wherever possible rather than doing things for them. DS0000032243.V303833.R01.S.doc Version 5.2 Page 17 Health issues were clearly identified on care plans e.g. hearing impairment, high blood pressure and mental health issues. There was evidence that service users were attending at least an annual health check and visits to G.P.’s, dentists and opticians were clearly recorded. There was further written evidence that referrals had been made to other healthcare professionals where necessary such as psychiatrists, psychologists. There were also letters on file from healthcare professionals such as the community nurse liaising over service users care. A comprehensive policy and procedure concerned with the management and administration of medication was seen. Additional policies were in place concerned with the management of specific conditions such as epilepsy. No service users were assessed as being able to self-administer their medication. Medication was stored securely in a locked metal cupboard in the staff office. Records were checked and these were found to be accurate and up-to-date. It was recommended though that when handwritten changes are made to preprinted sheets, a note is made of who authorised the change is made so this can be cross referenced with the service user’s file. A specimen of all staff signatures was kept so these could be easily identified. There were also clear procedures for recording out/in medication for service users absent from the home e.g. whilst they were staying with relatives. DS0000032243.V303833.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Q uality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had clear procedures for dealing with complaints including regular verbal reinforcement, although the extent to which some service users could participate in the process was limited due to the nature of autism. Staff receive clear information and training to ensure they are aware of Adult Protection issues providing a safe environment to protect service users from harm. EVIDENCE: The home had a detailed written policy and procedure about complaints in its operations manual. A leaflet had been produced both in written format and an accessible format using pictures. A copy was prominently on display on the home’s notice board, however, the extent to which service users could feedback on the service and complain is difficult due to the nature of autism. There had been no complaints to the home since the previous inspection. . The home has written policies and procedures on the protection of vulnerable adults including abuse procedure, managing challenging behaviour, management of service users’ money and service user going missing. The inspector spoke to the home’s training co-ordinator who confirmed that there is a rolling programme to ensure all staff receive training in adult protection procedures. The home currently uses a training course that is run by the local authority. The training co-ordinator has also organised training courses in managing behaviour and breakaway techniques. DS0000032243.V303833.R01.S.doc Version 5.2 Page 19 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The White House is well maintained and provides the residents with a comfortable and homely environment. Standards of hygiene in the home are good with systems in place to control the spread of infection. EVIDENCE: A tour of the premises was carried out as part of the inspection. All communal rooms were seen including the two lounges, dining room, kitchen and laundry room and all service users bedrooms. The premises were well maintained and decorated in a comfortable, homely way that was suitable for its stated purpose, i.e. providing care and support to adults who have a diagnosis of autism or whose problems state an autistic spectrum disorder. Service users bedrooms were observed to be personalised to each individuals taste with plenty of space for personal possessions. DS0000032243.V303833.R01.S.doc Version 5.2 Page 20 On the day of the inspection the home was observed to be clean and hygienic. The home has a separate laundry room that is sited away from the kitchen where food is stored, prepared and cooked. The home has a comprehensive health and safety file that includes information on infection control. The home provides staff with protective clothing such as gloves and antiseptic wipes and staff are given training in the control of infection as part of their induction training. Additional training is also provided in the home in the form of a video and accompanying questionnaire. DS0000032243.V303833.R01.S.doc Version 5.2 Page 21 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 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff have a very good understanding of their roles and service users benefit from a high staffing ratio offering them excellent opportunities for individual attention. There have been some breaches in staff recruitment procedures that need to be addressed to ensure good standards of recruitment are maintained and to safeguard the welfare of service users in the home. The home demonstrates a commitment to providing good quality training and all staff have the opportunity to complete a number of courses that reflect the homes aims and meet service users needs. EVIDENCE: The home employs senior support workers, support workers and night support workers, in addition there is a member of staff employed to co-ordinate staff training and another member of staff employed to co-ordinate day time activities for service users. Detailed job descriptions are in place specifying both “staff centred” and “service user centred” responsibilities and discussion DS0000032243.V303833.R01.S.doc Version 5.2 Page 22 with staff during the inspection confirmed they were clear about their roles in the home. Staff records showed there had been minimal turnover of staff since the previous inspection with 2 long standing members of staff leaving and 6 new staff being employed. Analysis of the rota and observation during the inspection demonstrated the home is well organised with a high ratio of staff on duty to meet the assessed needs of service users. There is a mix of male and female staff and the rota is organised so that senior members of staff work with newer members of staff to ensure a good distribution of skill mix during shifts. Observation on the day of the inspection showed there were 5 care staff on duty including one senior responsible for the shift. This enabled 5 service users to go out with 3 members of staff and one service user to be accompanied by 2 members of staff in the community as per their care plan. In total the home has 27 care staff and of these 4 have achieved NVQ Level 3, 2 have achieved NVQ level 2 and a further 17 staff are currently working towards a NVQ qualification meaning the home is well on track to achieving a target of 50 qualified staff. Comments received from surveys sent to CSCI prior to the inspection spoke highly of the staff such as “the staff I meet are very caring and motivated to provide the best possible care” and “all the staff that I have had the pleasure of meeting are always professional, kind, caring”. A sample of 3 staff records was examined. These showed there had been breaches in the recruitment procedure, as two of the staff had commenced employed prior to a full CRB being obtained and with no evidence that a POVA first check had been sought. Another member of staff had only one written reference and another member of staff needed to provide a valid work permit to ensure they were legally entitled to work in the UK. The home must ensure that all required documentation/information is in place prior to recruiting new members of staff. If staff are to commence employment prior to the receipt of a full enhanced CRB check, the home must obtain a POVA first check and commence a structured induction period with that member of staff who must be supervised at all times by a designated member of staff who is clearly identified on the rota. Staff are issued with contracts specifying terms and conditions and a copy of these were on staff files. The home has a grievance and disciplinary procedure and subscribes to a professional organisation that is able to give advice on employment matters. All staff are subject to a six month probationary period and there was evidence that this was reviewed in supervision sessions and the outcome recorded, i.e. whether to extend it or if it had been passed. The inspector spoke to the training co-ordinator who showed the inspector the training plan for the home. In addition to the home’s plan each member of staff has a training needs assessment carried out and a profile of any training covered is kept. Records showed staff had attended a number of training DS0000032243.V303833.R01.S.doc Version 5.2 Page 23 courses including first aid, health and safety, food hygiene, fire training, prevention of abuse, medication, manual handling and infection control. It was noted that as well as the required courses ensuring safe working practices the home promotes additional courses that reflect the home’s aims and service users needs such as epilepsy, autism and challenging behaviour. The training co-ordinator has also set up a 12 week induction package as per Skills for Care guidance for all new staff who commence employment in the home. DS0000032243.V303833.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a clear leadership structure throughout the home with all staff demonstrating an awareness of their roles and responsibilities. No evidence was provided on the day of inspection of any plan setting out aims and objectives for future service development meaning there was no indication of how effectively the home is reviewing the quality of care service users receive. Maintenance records had not been kept up-to-date and did not indicate when things in the home had been repaired. The home had also failed to arrange PAT testing in the agreed timescale further placing residents at potential risk. DS0000032243.V303833.R01.S.doc Version 5.2 Page 25 EVIDENCE: Sheila Stimpson is the registered manager of the home and has many years of experience of working with service users with autism. She is currently undertaking her NVQ 4 Registered Managers Award and holds a certificate in supervisory management. A detailed written job description and person specification describing the post are available, and the managers and deputy manager’s individual roles and responsibilities in the home are clearly defined. Previous inspections have demonstrated the home has a quality assurance system in place and questionnaires have been designed for service users, staff and relatives. The manager also carries out monthly management checks that look at service user issues, general issues and personnel issues. These checks form the basis on a six monthly report that the manager completes. The Commission receives monthly reports from the responsible individual of the home, which provides further information about the quality of the service provided. Unfortunately the annual improvement plan was unavailable on the day of the inspection as the manager said she had been working on it at home. The inspector asked if the report could be sent to the Commission, however, no report was received prior to writing this report. An annual development plan, therefore, needs to be made available providing action points/targets to further improve the quality of service in the home. Records showed that the home was meeting the requirements of other agencies such as Dorset Fire and Rescue Service and Environmental Health Department. Certificates were in place demonstrating that equipment and facilities were regularly serviced and maintained, apart from PAT testing that was outstanding. This needs to be chased up as a matter of priority. A written health and safety policy for the home has been completed and records are maintained evidencing the home carries out checks for example fire precautions log book, water temperatures and a weekly vehicle check. The inspector noted that some maintenance jobs that had been logged in April 2006 had not been signed off. These included the toilet not flushing and the oven not working. The manager confirmed these jobs had been done but not signed off in the log as the job sheets were still in the filing system. It is recommended that the maintenance log is kept regularly up-dated to avoid it looking like maintenance work has been left uncompleted. DS0000032243.V303833.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 2 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 2 33 X 34 1 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 1 X X 1 X DS0000032243.V303833.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 YA5 Regulation 5 Requirement The registered person must develop and agree with each prospective service user a written and costed contract/statement of terms and conditions between the home and the service user. The registered person needs to achieve the target of at least 50 of care staff achieving a NVQ 2 qualification in care. The registered person must obtain all information and documentation as specified in Schedule 2 of the Care Homes Regulations 2001 prior to care workers commencing employment in the home. Specifically POVA first checks, 2 written references and work permits. The registered manager needs to complete NVQ 4 registered managers award. The registered person must make an annual development plan available to CSCI providing action points/targets to identify further improvement that could be made to the quality of service in the home. DS0000032243.V303833.R01.S.doc Timescale for action 01/09/06 2. YA32 18 01/12/06 3. YA34 19 31/08/06 4. 5. YA37 YA39 9 24 01/01/07 01/10/06 Version 5.2 Page 28 6. YA42 23 The registered person must 31/08/06 ensure that PAT testing is carried out within the specified timescale. 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 It is recommended though that when handwritten changes are made to pre-printed medication sheets, a note is made of who authorised the change is made so this can be cross referenced with the service user’s file. It is recommended that the maintenance log is kept regularly up-dated to avoid it looking like maintenance work has been left uncompleted. 2. YA42 DS0000032243.V303833.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 DS0000032243.V303833.R01.S.doc Version 5.2 Page 30 - 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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