Inspection on 02/04/08 for The Wren

This inspection was carried out on 2nd April 2008.

CSCI found this care home to be providing an Adequate service.

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 Wren 02/04/09

The Wren 24/04/07

The Wren 20/10/06

The Wren 03/03/06

The Wren 23/08/05

The Wren 06/02/05

The Wren 22/04/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 The Wren 92 Carlton Road Whalley Range Manchester M16 8BE Lead Inspector John Oliver Unannounced Inspection 2nd April 2008 10:00 The Wren DS0000021630.V361987.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 Wren DS0000021630.V361987.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 Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Wren Address 92 Carlton Road Whalley Range Manchester M16 8BE 0161 881 8658 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) Mrs Margaret Monteith Mrs Margaret Monteith Miss Dorna Monteith Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th December 2007 Brief Description of the Service: The Wren is a care home providing personal care for a maximum of eight people with learning disabilities who may also have a physical/sensory disability. The Wren is a detached property set within its own grounds. The home is three storey, with a basement area used for offices, storage and laundry facilities. The residents’ bedrooms are on the ground and first floors. All the bedrooms are single; three of the rooms have shower facilities. There is a kitchen and dining room on the ground floor with a lounge situated on the first floor. There is a small lounge area situated on the first floor for the use of relatives of residents when visiting. This enables the resident and their relatives to spend time together in privacy, if required. There are toilets and bathrooms situated on both the ground and first floors. These are accessible and meet the identified needs of the residents. The home is situated in a residential area in Whalley Range, within easy reach of public transport links into Manchester City Centre. The home is a family run business. The fees for the home are based on individual assessment of needs. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection was undertaken as part of a key inspection, which includes an analysis of any information received by us (the Commission for Social Care Inspection) in relation to the home prior to the site visit. This visit, which the home did not know was going to happen, took place over the course of Wednesday, 2nd April 2008 and Thursday, 3rd April 2008, and involved a total of ten hours. During the course of the site visit we spent some time talking to the residents, the registered manager, the owner and staff on duty to find out their view of the home. Before the site visit we sent the manager of the home an Annual Quality Assurance Assessment (AQAA) document for them to complete and return to us with information about the service they provide. This was returned before the visit took place but contained very little information to help us assess the service being offered by the home. Again, before the site visit we sent questionnaires to residents, relatives and staff for them to complete and return to us to tell us what they think of the service being provided. A number of these were returned before the visit took place and contained information that helped us to assess the service being offered by the home. Manchester City Council Contracts Unit and the Joint Commissioning Team are also monitoring the service and their representatives visited The Wren on 1st February 2008 in order to carry out a Quality Audit of the service. A report of their findings was also supplied to us before our visit took place. What the service does well: It was seen that the relationships between residents and staff were good and that staff respected the privacy and dignity of individual residents when assisting them with personal and physical support. Both the management team and care staff have an understanding of the specific needs of the residents. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There is currently no service user guide, statement of purpose or any other form of information available to give to prospective residents and/or their relatives. People looking for suitable accommodation and services need such information to be available to them in order to assist them in making an informed choice about where to live. Information in files was found to be inconsistent and some files used by staff had no current care plan in place. Lack of such important information being available to staff at all times could place the resident at risk of their needs not being met in the most appropriate way. No up to date policy was in place for the administration of medication in the home. Lack of such information for staff to follow could result in residents being placed at risk of medication being administered incorrectly. No formal complaints policy and procedure was available for residents/relatives to follow should they have any concerns/complaints. It is important that a user friendly version is also developed to support those residents with communication difficulties. Some areas of the home are looking tired and in need of some redecoration and replacement of carpets and furniture. It would be good if a programme of renewal and refurbishment were in place in order that such work could be monitored and prioritised for completion, as and when required. Staff training records had not been kept up to date and it was difficult to assess the actual training individual members of staff had each participated in. Policies and procedures used in the home had not been reviewed or updated for quite some time. It is important that all staff have appropriate and up to date information in place to support them in the job that they do. The Wren DS0000021630.V361987.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 Wren DS0000021630.V361987.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 Wren DS0000021630.V361987.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): 1 and 2 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Systems are in place to assess people’s needs before being offered a placement in The Wren. Written information is not available about the home to give to prospective residents and/or their relatives/advocates. EVIDENCE: The manager told us that no new residents had been admitted into the home since the last key inspection visit in April 2007. Evidence was available on the files of existing residents to show that Community Care Assessments had been carried out prior to their admission into the home. We discussed with the manager the admission process for the home and she told us that she would go out to assess the needs of any prospective new resident before any admission took place. We sent out surveys to people who use the service and the Commission received two back. Both surveys had been completed with the support of the relatives of the residents and were positive about the service being received. When asked ‘Did you receive enough information about this home before you moved in …’ one survey stated ‘No’ and comments included ‘… had no choice when placed in this home. Neither was I consulted’. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 10 The service had not produced any information to give out to prospective residents and their relatives to describe the level of support that is offered and what people could expect from the service should they receive care. Lack of such important information could make it difficult for someone to make a considered choice about coming to live in the home. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Care plans required further information including in them to focus on the needs and goals for people. EVIDENCE: Each person had a main file that was kept in the downstairs office. This file is used to keep information such as financial information, medical appointments, and a copy of the current care plan. Each person also has a small file that is kept upstairs and is accessible to staff. The content of these files was inconsistent and difficult to follow and only two of the six files examined had a current care plan in place. This could place the residents at risk of their needs not being met in the most appropriate way by staff. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 12 The manager told us that she has the responsibility for developing the care plans and that the format of the care plans has been developed from a standardised template provided by a professional consultancy. Some information within the care plans was difficult to follow, for example, one care plan developed in June 2007 was reviewed and re-written in February 2008 but information that was still relevant to support the individual had not been transferred into the new care plan. This could put the resident at risk of their needs not being met. Other than some parts of the plan being written in the first person, there was very little evidence of Person Centred Planning taking place, although in some files there was a copy of another care plan called ‘My Person Centred Plan’. The one we examined was dated February 2007 and contained information that did not relate to the information contained within the current care plan on the file. This is not only confusing for staff but could result in inappropriate care being delivered. It would be better if one care plan format were developed that was based on Person Centred Planning. Also on each file is a ‘Grab Sheet’ that has been produced. This sheet includes a photograph of the resident and relevant information should the resident need to be taken to hospital in an emergency situation. Some risk assessments were in place but the management of the identified risk was not always clear and did not provide any proactive or reactive strategies that could be used. One example being where a resident has hit out at staff and other residents without warning. The management strategy was clear about what staff should do to minimise the risk to them but no strategy was in place to minimise the risk to other residents. A number of residents living in the home have complex health conditions and because of this, information contained on files needs to be clear and up to date. It is important that where other healthcare professionals, such as Community Nurses, have completed assessments for an individual then these assessments should be incorporated into the current care plans and risk assessments. This will help minimise the risk of inappropriate support being given to the individual resident. We saw that one resident had an Epilepsy Care Plan in place and it was recorded on the Epilepsy Record Sheet that this resident had a seizure on 2nd February 2008 that lasted two minutes. We examined the daily recording notes for this resident and found that appropriate information had been recorded to inform all staff of the details of this incident. Each file contained a record of visits from other healthcare professionals such as General Practitioners, District Nursing Services and Chiropodist. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 13 A number of files contained a Continence Monitoring Record. We saw evidence that some of these records were not being maintained on a regular basis. For example, one record we examined had not been completed from 5th March 2008 until 11th March 2008 and then again nothing was recorded until 19th March 2008. If a resident’s care plan indicates that such records need to be in place it is important that they are completed consistently in order to promote and monitor the health and well being of that individual. In the two surveys returned to us by relatives they told us ‘from what I observe, the staff appear willing to accommodate …’s wishes where appropriate to his well being’ and ‘… is able to exercise his freedom of movement, as much as he wants, within the realms of his safety…’ The Wren DS0000021630.V361987.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. People’s involvement and participation in activities, both in-house and in the local community, are limited which could prevent choice and independence being maintained. EVIDENCE: Of the six residents currently living in the home, we were told that four regularly attend day care facilities provided by the local authority. This means that the number of people living in the home ranged from two to six on any particular day of the week and the routines and staffing of the home were based on this factor. On the first day of our visit four residents were attending day care centres and two residents were in the house. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 15 The supervisor has overall responsibility for arranging things such as social activities and outings into the local community, according to the resident’s preferences and choices. This also depends on the availability of staff, which does place restrictions on how often activities can take place. We looked at the activity file and there was evidence to show that people were being supported to visit and participate in the local community and following such visits, a brief report is written to indicate how the activity went, whether it was enjoyed and the outcome for the person. People living in the home have limited use of a motor vehicle owned by the home, which is used for such things as transport to day care centres and outings into the local community. Since the last key inspection visit in April 2007 more people living in the home are being supported and encouraged to maintain choice and independence by way of shopping and purchasing their own clothes. This should continue to be encouraged and further developed. From our discussion with the staff working in the home it appears residents do not participate in any household chores, although it was considered that at least three of the more able residents could carry out simple tasks such as putting away their clean laundry. This should be actively encouraged for those residents in order to maintain some independence and control over their daily lives and routines. Mealtimes in the home are catered for on a daily basis, although menus are in place. We saw that a wide variety of choices were available and the supervisor was able to demonstrate how choice is offered. He has recently put together a ‘picture pack’ of relevant foods to enable those people with limited communication to be able to choose from. This appears to be working well, although one resident has to be discouraged from choosing fish and chips each day. Relatives continue to visit the home on a regular basis and one relative told us in the survey questionnaire returned to us “I receive a wonderful welcome from them all (staff). This good rapport I have with them all can only be good for …, as he can see that …(all staff) communicate with myself”. The Wren DS0000021630.V361987.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Improvements are needed in the way in which records are kept and in the way medication is administered to minimise potential risks to people living in the home. EVIDENCE: During the visit we watched staff interacting with the people living in the home. We saw that the member of staff on duty supported the residents sensitively and maintained their dignity and we saw that she assisted people with their personal care within the privacy of their own bedrooms. We saw that care plans contained information relating to the individual support needs of the person. In some instances, this information was difficult to follow as files varied in the way they had been put together and this made it difficult to link information. For example, three of the files used by care staff did not contain a copy of the current care plan and those care plans examined varied in the detail about how assistance should be offered to the individual resident. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 17 Inconsistencies in such information could place the health and wellbeing of the individual resident at risk from inappropriate support being offered or given. This was fully discussed with the manager. We saw that information was available that indicated some residents needed support with more complex health needs, such as epilepsy. Again, information needs to be maintained in a more consistent way, as some details were difficult to follow. We spoke to one resident living in the home who told us that he liked to watch television in his room and that he likes the staff. When asked about the staff he said, “I like her” pointing to a carer who had been helping him to complete a jigsaw. Comments from relatives (within returned surveys) said “The overall impression I have is that all staff from the management to the part-time carers have an excellent attitude to the care and well being of the residents, showing great patience and good humour” and “My role as a parent is and always has been respected, by Margaret Montieth and all of the staff. Any worries or concerns regarding … are always handled in a caring and sensitive manner, which is important. Our aim together is for …’s well being, comfort and happiness, and we do work together”. Medication is administered in the home using a Monitored Dosage System (MDS) that is provided by a local pharmacy. Medication is stored in two wall cabinets in the main office in the basement area of the home and on the day we checked medication neither cabinet was locked (only one could be locked). We discussed the possibility of the manager obtaining a suitable lockable medication trolley from the supplying pharmacy to resolve the situation. When managers are not on duty care staff are not allowed into this office and this prevents medication being accessible at all times. Having such a trolley would mean that it could be anchored to the wall outside the office and remain accessible to those staff that can administer medication. There was no medication policy in place and this was fully discussed with the manager who said that she would develop a suitable policy within the next month. It is important that all staff with the responsibility for administering medication have suitable and appropriate guidelines in place to help minimise risk to residents from poor medication practice taking place. The manager told us that all staff with the responsibility for administering medication had received training in the safe handling of medication from an external trainer. It would be good if specimen signatures of these people were kept on the medication administration file for reference. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 18 Since the last inspection visit the manager now checks all prescriptions before they are sent to the pharmacy for dispensing and a record is kept of medication received into the home. We looked at the Medication Administration Records (MAR) for those residents prescribed medication and, in the main, these were found to be correct. Some details had been handwritten onto the MAR sheets and it is recommended that where this is done a second signature be obtained from a member of the staff team to witness the entry and help minimise the risk of any errors in recording occurring. A number of residents are on medication to be given ‘as and when’ required such as Paracetamol and we randomly selected a number of this type of medication to check. We found that in most instances balances were correct although there was some where balances from the previous month had not been carried forward and so there was no clear audit trail. All balances of medication should be able to be checked at any time. We saw that a number of residents sometimes needed medication to be given covertly in order to maintain their health. Since the last key inspection visit the manager has contacted the general practitioner for each resident where this is required in order that an assessment could be carried out and appropriate permission be granted to do this. Letters from one General Practitioner were seen to confirm this. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 19 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 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The systems, policies and procedures in place to protect people need to be more robust to fully protect them. EVIDENCE: We saw that a notice in the hallway of the home provided limited information about making a complaint. The guidance also stated that anyone wishing to make a complaint should refer their concerns direct to us, the Commission for Social Care Inspection, which is not correct. It is important that the manager develops a policy and procedure in a suitable format that directs and supports residents through the steps of making a complaint or raising a concern should they wish to do so. The manager told us that no complaints had been received by the home since the last key inspection visit in April 2007. No complaints register is kept and this was fully discussed along with the importance of maintaining appropriate documentation. In the two survey questionnaires returned to us before this visit took place both indicated that the resident knew how to make complaint or raise any concerns they may have. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 20 It was confirmed by the manager that most staff have now completed training in the Protection of Vulnerable Adults (POVA) and we saw that a number of staff had been booked to attend the next course being run by Manchester Local Authority on 18th April 2008. A copy of the Local Authority’s guidance on protecting vulnerable people, ‘No Secrets’, was available for staff in the communication book. It is important that the manager develops a suitable policy and procedure that directs staff to use and follow this guidance in the event of an allegation of abuse being made. Staff spoken to during the visit were clear about what action they would take should an allegation of abuse be made to them. There has been one safeguarding referral made to the local authority since the last key inspection visit in April 2007. We carried out a Random Inspection visit to the home on 17th December 2007 to check that no breaches of regulations had taken place and a report of that visit was produced. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 21 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. In the main, the environment was clean and tidy but some areas of the home could place residents at risk. EVIDENCE: Since our last key inspection visit to the home in April 2007 very little maintenance work or updating of furnishings and fittings has taken place and the environment is beginning to look ‘tired’. Some rooms are personalised but others are minimal in their contents and when asked about this the supervisor said that this was from resident’s choice. We saw that furnishings and decoration in most rooms were showing significant signs of wear and tear and the supervisor told us that he intended to develop a maintenance programme for the home and would be prioritising the work required to be carried out. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 22 In one vacant bedroom we noticed an unpleasant smell. We were informed that a damaged sewer pipe from a neighbouring property had caused a leak into the cellar area of the home and the smell was coming up through the shower base waste pipe into the room. The leak had been dealt with but the cellar area still needs to be appropriately disinfected and the supervisor said that he has been in touch with the Utilities Company about this. Environmental Health, during a recent visit to the home also recommended that this be dealt with as a matter of priority. Failure to do this could place the health of residents and staff at risk. We were told that some areas of the home had been repainted since our last key inspection visit but it was difficult to tell where as most areas are in need of repainting again. The seating in the upstairs lounge area is worn and in poor condition and must be replaced with enough suitable seating for those residents who require it. The carpet in this lounge has worn through in places and has the potential for slips, trips and falls to occur and must be replaced. There was a very stale odour in this room and this appeared to be coming from the carpet. Carpets throughout the home are showing signs of wear and tear. Although a professional cleaning company regularly cleans them this is now having little effect on their appearance and consideration should be given to replacing carpets in order of priority. The supervisor confirmed that risk assessments were in place for all uncovered radiators and that these assessments were in the process of being reviewed. In two survey questionnaires completed by relatives they told us they were happy with the standards of cleanliness in the home and comments included “I do notice my surroundings wherever I may be. I have always regarded how tidy and clean, The Wren is kept. The carpets are always kept free of any dropped foodstuffs…’s own room is clean, as are the bathrooms which occasionally I have had the necessity to use” and “I visit … regularly on a weekly basis plus other impromptu visits. It has always been my observation that … is clean, his clothing is clean and fresh, as is the bed linen in his room. This also seems to be the case with all other residents I come into contact with”. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 23 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, 34, 35 and 36 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 staff training and supervision to further enhance the support provided to residents. EVIDENCE: Staff spoken to were able to demonstrate an understanding of the needs of people living in the home and appropriate interaction between one member of staff and two residents was seen to take place. We looked at staff rotas and these demonstrated that enough staff were deployed to meet the needs of those people living in the home at the time of our visit. The staff rota did not show what roles staff are employed in and we had a discussion with the manager about reviewing the rota sheet so that it clearly shows staff on duty and the role they carry out, e.g., manager, care assistant and night care assistant. The manager also confirmed that staffing levels were flexible according to the needs of the people currently living in the home and that rotas are reviewed on a daily basis. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 24 Staff training record sheets had been put on each personnel file but had not been fully completed for each member of staff. There was some evidence of training that had taken place and training that had been arranged but this was difficult to assess as the method used to record such information was inconsistent. It is important that all staff receive regular training that helps them carry out their job safely and efficiently. One member of staff spoken to during our visit told us “I have received training such as health and safety, moving and handling, abuse, safe handling of medication and I am currently doing my NVQ level 2”. It was confirmed by the manager that since the last key inspection visit in April 2007 only one new employee had joined the staff team. The file of this individual was made available and was found to include all relevant and appropriate documentation. At the time of our visit the manager told us that she was in the process of reviewing and updating the recruitment and selection policy and procedure for the home. In the two returned survey questionnaires completed by relatives comments included, “The overall impression I have is that all staff from the management to the part-time carers have an excellent attitude to the care and well being of the residents, showing great patience and good humour” and “Any worries or concerns regarding … are always handled in a caring and sensitive manner, which is important”. The manager told us that staff were receiving formal supervision on a more regular basis and we saw evidence of supervision notes on individual personnel files. One member of staff spoken to during the visit also confirmed that she received one to one supervision “about every two months”. It was difficult to assess if all staff were receiving regular one to one supervision sessions. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. More consistency is needed in the management procedures to ensure the home is run in the best interests of residents. EVIDENCE: Until very recently, the management team of the home consisted of two registered managers, Mrs Margaret Montieth and Miss Dorna Montieth. Mrs Margaret Montieth terminated her registered manager’s role from 31st March 2008, but still remains the owner, which leaves Miss Dorna Montieth as the sole registered manager of the service. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 26 As there had previously been some conflict of management styles, resulting in inconsistency in administrative and other management processes it is hoped that this will now have been resolved. Mrs Montieth told us that she intends to leave full management of the home to her daughter (registered manager) and her son (supervisor) and that she intends to work in the home as a carer. There are two offices in the basement area of the home that are used for administration purposes. Both these offices have large amounts of ad-hoc paperwork, files and other things stored in them making it difficult for the manager to use the offices appropriately and for their intended purpose. Mrs Montieth told us that she has decided to clear out both offices to enable the registered manager to have appropriate office space available to her. The supervisor has the responsibility for health and safety throughout the home and also does much of the cooking, food purchasing and maintenance. When asked about the management of the home one member of the staff team told us “Dorna is a good manager and is very understanding, very helpful and you can ask her anything and she will help”. In one survey questionnaire returned to us by a relative it said “I feel that … has received excellent care whilst a resident at The Wren care home. It is a great senses of relief I feel to know his welfare is so well looked after in this environment by such a responsible and co-ordinated team of staff”. There is still no particular system in place to undertake quality monitoring of the service and this was fully discussed with the manager. There is a policy and procedure file in place but this had not been reviewed or updated for quite some time. It is important that staff have appropriate and up to date information in place to support them in the job that they do. This was fully discussed with the manager. Within the Annual Quality Assurance Assessment (AQAA) returned to us before the inspection visit took place the manager told us that regular servicing and maintenance of equipment was taking place. We randomly selected a number of records to check and found them to be correct. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 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 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 2 X X 2 X The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 28 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 YA1 Regulation 4&5 Requirement An up-to-date statement of purpose and service users’ guide must be available to give to all prospective service users’. Each person living in the home must have a written plan as to how his or her needs in respect of health and welfare are to be met and this plan must be available to staff at all times. a) A policy and procedure for the receipt, recording, storage, handling, administration and disposal of medicines must be developed and be available for staff. b) Where medication is administered to people who use the service it must be clearly and accurately recorded and records must clearly demonstrate that all medication can be accounted for. After consultation with the environmental health authority, suitable arrangements must be made to eradicate the unpleasant odour present in the DS0000021630.V361987.R01.S.doc Timescale for action 27/06/08 2 YA6 15 (1) 30/05/08 3 YA20 13 (2) 30/05/08 4 YA24 16 (2) (j) & (k) 30/05/08 The Wren Version 5.2 Page 29 5 YA24 13 (4) (a) bedroom identified to the supervisor. a) The carpet in the upstairs lounge must be replaced to minimise the risks to resident’s from potential slips, trips and falls. b) The carpet in the bedroom identified to the supervisor must be replaced to minimise the identified risk to the person whose room it is. (Previous timescale of 16/06/07 not met). Adequate and appropriate numbers of chairs/seating must be provided for those resident’s who sit in the upstairs lounge area. 27/06/08 6 YA28 23 (2) (g) 27/06/08 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 2 3 Refer to Standard YA6 YA6 YA6 Good Practice Recommendations Information in care plans should be consistent with the current identified needs of the individual resident. It should be considered that only one care plan format be used that is based on Person Centred Planning. Risk assessments should include specific details of how the identified risk is to be managed and that the risk assessment(s) link to individual care plans for consistency of such information. Detailed records monitoring health care needs e.g. continence management should be completed consistently and in accordance with the individual care plan. Consideration should be given to encouraging those people who are able, to participate in household chores to further promote independence. Specimen signatures should be kept on record of those DS0000021630.V361987.R01.S.doc Version 5.2 Page 30 4 5 6 The Wren YA6 YA16 YA20 7 8 YA20 YA22 9 10 11 12 13 YA23 YA24 YA35 YA36 YA41 staff with the responsibility for administering medication in the home. Where it is necessary to hand write information onto a medication administration record it should be witnessed by another member of staff who should also sign the record. Information regarding complaints should be reviewed and updated to include all relevant guidance and be made available in suitable formats. A record of complaints should be kept that includes the nature of the investigation, the outcome of the investigation and whether or not the complainant is satisfied. The policy and procedure relating to the protection of vulnerable adults should direct staff to use the local authority’s guidance ‘No Secrets’. A programme of renewal and refurbishment of the premises should be developed and put in place. All staff training should be reviewed and arrangements made for staff to receive training that is appropriate to the jobs they do with records of such training being kept. All staff working in the home should receive regular, recorded supervision meetings with their line manager. All policies and procedures should be reviewed and updated where necessary and that such information is made available to staff at all times. The Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Wren DS0000021630.V361987.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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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