Inspection on 24/10/06 for Thistle Close (24, 30 & 33)

This inspection was carried out on 24th October 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Thistle Close (24, 30 & 33) 11/01/06

Thistle Close (24, 30 & 33) 05/07/05

Thistle Close (24, 30 & 33) 03/02/05

Thistle Close (24, 30 & 33) 21/06/04

Similar services:

Aston Court Nursing Home

Breme

Ravenhurst

Westmead

Ashcroft Hollow Nursing Home

Bricklehampton Hall Nursing Home

Briar Hill House

Radbrook Nursing Home

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

CARE HOME ADULTS 18-65 Thistle Close (24, 30 & 33) 24, 30 and 33 Thistle Close St Peter the Great Worcester Worcestershire WR5 3DP Lead Inspector Christina Lavelle Unannounced Inspection 24 & 30 October 2006 3.35pm th th Thistle Close (24, 30 & 33) DS0000018693.V316777.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 Thistle Close (24, 30 & 33) DS0000018693.V316777.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. Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thistle Close (24, 30 & 33) Address 24, 30 and 33 Thistle Close St Peter the Great Worcester Worcestershire WR5 3DP 01905 611147 01905 612958 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) SCOPE Mr Andrew Joseph Deakin Care Home 6 Category(ies) of Physical disability (6) registration, with number of places Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home can accommodate no more than 1 resident in 24 Thistle Close, 3 residents in 30 Thistle Close & 2 residents in 33 Thistle Close. The home is primarily for people with physical disabilities but may also accommodate people with associated learning disabilities. The home can accommodate one person in the category PD/E). 11th January 2006 Date of last inspection Brief Description of the Service: Thistle Close (24, 30 & 33) is run by SCOPE and is part of a scheme called 1st Key Worcestershire, which was set up in 1993. Their head office is at Unit 3 Lowesmoor Wharf, Lowesmoor, Worcester, WR1 2RS, (Tel no. 01905 611147) and the registered manager of the service (Mr Andrew Deakin) is based there. The stated aim of 1st key is to provide a community based service with a range of living options for people with cerebral palsy and other associated disabilities and to empower them to lead their own lifestyle. 1st Key runs nine properties (eight in Worcester and one in Tenbury Wells), which together can support up to seventeen people. Thistle Close offers accommodation with personal care to six adults (men and women), one of who may be aged over sixty-five. The home is about two miles from Worcester city centre within easy reach of the M5 motorway. Thistle Close is a cul-de-sac on a large housing estate and comprises of three bungalows next to each other, which fit in well with other housing. It is in a good place for local shops and pubs etc. The bungalows were adapted and are equipped for people with mobility difficulties and so they have such as ramps, wide halls & doorways and shower/bathrooms with hoists. Bungalow 30 is for three people, 33 is for two and 24 for one person. Service users can have their own bedroom, which are rather small and do not have ensuite facilities. There are assisted shower and bathrooms. 30 has a kitchen and a dining/sitting area but now has a new conservatory giving extra sitting room space. 24 and 33 each have separate kitchens, sitting and dining rooms. Information about the home is provided in a statement of purpose and service users guide, which are available at the home and through SCOPE. The current fee for the service ranges from £42,411 to £61,118 per year, depending on service users’ needs and as agreed with their funding authorities. Items not covered by their fee include private chiropody, hairdressing, personal telephone calls & travel, newspapers/magazines, toiletries and other personal shopping. Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. These visits are part of a key inspection of Thistle Close. This means that the inspector checked all the Standards that have most impact on service users. The first visit was made unannounced in about three hours on a late Tuesday afternoon. The second visit was arranged during the first visit so that time could be spent discussing the service with the manager and looking at some records he had been asked to bring from the 1st Key office. This visit was made on the following Monday during the daytime and took over four hours. The inspector spoke with four service users in private to find out what they feel about living at Thistle Close. Two care workers were also interviewed on their own and asked how they got the job, about their experience, training and the support they receive from managers. Service users’ care and their lifestyles were also discussed. Everyone was very helpful and gave useful information. Only one service user and one service user’s relative returned a survey form showing their views of the home. Two professionals who have contact with the home had also completed comment cards. Some things they say are referred to in this report, although most feedback is from talking with service users. Various documents and records kept by the home were checked and the three bungalows were looked around. All information received by the Commission about the home since the last inspection is also considered. This includes a questionnaire the team leader had completed before the inspection visits with details about the current service. Also notifications of events that had affected service users and copies of reports made by a manager from SCOPE following their monthly visits to check if the home is being run well. What the service does well: There is written information about the home that new service users are given. The manager meets possible service users and they would then try out the home before moving in to check it could suitably meet their needs and goals. Service users have a written plan to help staff know their personal care needs and how to meet them. They receive individual support from a keyworker who is chosen from the staff team. Keyworkers spend more time with these service users to get to know them, what they like and dislike and their needs better. They help them to arrange their activities, to go out and do their shopping etc. Service users make decisions about what they do each day and are enabled to take part in activities and go out if they want to. They choose their meals, and staff encourage healthy eating and support them with any special diets. Staff help service users keep in touch with their families, who are made welcome in the home and kept informed and involved in their care if they want them to be. Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 6 Staff support service users to stay in good health and manage their medicines safely. The home has links in place with relevant health care professionals. Thistle Close provides a stable and comfortable home for service users. It has given them an opportunity to live in ordinary housing and so become part of the community, and is also in a good place for local shops and pubs etc. The bungalows have been adapted for people who have mobility difficulties and staff make sure service users have any other aids and equipment they need. SCOPE arrange for staff to receive training needed to keep service users safe. Necessary checks are taken up on new staff to ensure they are suitable, for the protection of service users, and they have a good introduction to the home. The staff team work well together and receive appropriate support. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 7 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 Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 8 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&2 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. The home provides information to help prospective service users decide if they might like to live at Thistle Close and if the home could meet their needs. There are thorough assessment procedures in place to help to make sure the home would suitably meet the needs of prospective service users. EVIDENCE: SCOPE has produced appropriate documents in respect of the home, including a statement of purpose and a service users’ guide. One service user indicated in a survey form they had been given this information when being asked about moving to the home. SCOPE provides written guidance on the assessment of prospective service users’ needs for when referrals are made to the home, including a care profile tool to complete and a placement procedure flow chart. The manager described the assessment and admission process he would follow for prospective service users. This would include him visiting their current residence to meet them and assess their needs, having received a copy of their community care assessment made by a social worker. Introductory visits to the home are then arranged e.g. for tea and overnight, followed by a trial stay. Review meetings are held after three-months with all relevant people involved, before the placement would be confirmed and the fee & support level agreed. Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including these visits to this service. Service users receive support from staff who help them plan their care and to minimise some risks to their safety and welfare. Service users’ plans need to be reviewed and updated with them to ensure they include all their current and changing needs and any possible risks, and also reflect their wishes and goals. Service users are able to make some decisions in their daily lives and routines. EVIDENCE: A sample of service users care records were looked at; two in detail. Each has a written care plan covering relevant areas of need with objectives and action needed to meet them. They include physical health, activities of daily living, communication, expression & cognition, emotional wellbeing and relationships. Every area of need has space to include service users’ goals and wishes and their allocated keyworkers from the staff team are expected to go through the plans with them and incorporate their views. Service users who are able to sign their own plans have done and although one service user was unsure if they could have a copy of their plan the manager said they can do if they wish Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 10 One plan had been drawn up in April 2005 and although some areas had been revised it does not include any information about their activities or emotional wellbeing. The manager said their plan is under review with them and so it should be ensured that all their needs and any goals are reflected. Another plan needs revising as their needs had changed recently and some aspects of need do not include their views. Service users should be fully involved in care planning and review so their wishes and goals form the basis of their plans and are as “person centred” as possible. Action specified to meet any goals should also be followed up and their care records show if they have been met or not. Staff complete a communication book daily for each service user showing the personal support they receive, their mood, activities, any events and visits etc. Information sheets are also kept for such as health care input with details of advice and treatment given. They provide an ongoing picture of service users’ wellbeing and daily lives, which should be helpful when their care is reviewed. SCOPE expect care plans to be reviewed at least six monthly by the home (or on request and when there are changes in need). An annual service review is also held with funding authorities to review the appropriateness of placements and contract terms. Families and relevant other people are invited to attend these review meetings and service users are involved and attend if they wish. Service users all have a designated keyworker and a back-up worker from the support staff team. Keyworkers are responsible for making sure their allocated service users’ personal and health care needs are being met. Staff interviewed are clear about their role as keyworkers and know this includes care planning and reviews. They spend individual time with service users so they can get to know them and their likes/dislikes better and obtain feedback for discussion in their reviews. The manager said it is planned that keyworkers will soon have to complete a monthly outcome sheet with the service users. This is good as it will allow information to be readily available for the six monthly reviews and to update plans more often if necessary. Service users spoken with know and like their keyworkers. One person thinks their keyworker is good but wishes they worked more often so they could spend more individual time together. Moving & handling risk assessments and plans are in place for service users. However, although some service users clearly have behavioural issues and there could be other possible safety hazards that affect them and other people, risk assessments are limited. There should also be specific management plans in place so that staff know how to deal with issues consistently and can also help to minimise risks. These areas should also be considered in care reviews. Service users make decisions about their lifestyle, although some service users say the choices they are able to make in their daily lives and routines can be restricted. This is due to the nature of their disability and so dependence on staff assistance. In this situation agreements are made with them about their preferred daily routines i.e. the time they would like to get up, go to bed and have their meals, so staff can meet their choices to the extent that is feasible. Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. Service users are supported to pursue activities they choose and to go out in the community. This would be demonstrated more clearly if their plans are reviewed and include their social needs and goals and how they are being met. Staff support service users to maintain contact with their families. They make them welcome in the home and keep them informed and involved in their care. Service users choose their meals, although staff encourage healthy eating and monitor special diets. Mealtimes are flexible and staff provide support needed. EVIDENCE: Each service user has a support package drawn up to facilitate their chosen activities, outings and holidays, which include the funding and support needed. keyworkers also help service users to identify and access activities they may like to take part in. However care plans include limited information about their assessed social needs and interests. Some service users do not participate in Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 12 any specific activities in or out of the home. The manager said they know they could enrol on college courses and do other things but most do not want to, preferring to stay at home or have 1 to 1 time with their keyworkers, which two service users confirmed. Care records should include how they spend their time and if they have enjoyed, benefited from and/or refused activities or to go out. Also to show that staff do encourage meaningful activities and would support them to take up opportunities to develop their skills and/or pursue various leisure activities both at home and in the community if they wished to. Two service users attend sessions at a local college, one doing numeracy and computer skills. Most other activities discussed are going out to local shops, pubs and occasionally individual outings with keyworkers. Staff provide some support with activities and one person is deployed flexibly daily for outings, shopping and to cover keyworker time. Staff feel they have enough time to support service users’ activities and they go out enough and usually as often as they want to. 1st Key also employs a community development worker and a driver/enabler to facilitate activities and participation in the wider community who provide a varying amount of planned time for individual service users. The home provides two suitable vehicles and one service user has a car and said he goes out init quite a bit. Staff said service users who like to go out are well known to people in the local community and at the superstore and pub. Staff are aware of their role and do support service users to keep in touch with their families if they want to. They can use the home telephone or have their own line and one person has regular holidays with a relative. Managers and keyworkers keep families informed about significant events in service users’ lives and they are asked to attend and be involved in annual care reviews. They are made welcome in the home and invited for special occasions/socials. Regarding food provision service users have their own housekeeping money and staff support them to shop locally or use a list to get their individual food. They can eat what they want, which service users confirmed and also that they have chosen their preferred mealtimes and staff make them drinks and snacks on request. The three people in bungalow 30 usually choosing to have their main meal together and everyone has a roast dinner on Sundays. Staff said they always promote healthy food options and encourage service users to have such as fresh vegetables and fruit, yoghurts and wholemeal bread. Menus are not produced; instead an individual food record is kept of the meals each person has had. One service user has health problems, which may mean they will need a special diet and staff were monitoring their food intake until a diagnosis is confirmed. Another person is supported by staff with their special diet and the home had appropriately involved a Dietician who is monitoring their progress and weight. A mealtime was seen and was relaxed, with staff providing any assistance needed. Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. Service users’ personal and health care needs are being met with staff support and their medicines are managed safely in the home. EVIDENCE: Service users’ plans include a checklist of their personal care needs, with the level of support they each need from staff. Staff interviewed are fully aware of service users’ personal care needs and say they encourage them to retain as much independence as they can. Service users confirmed staff provide the personal support they need. It is good that the diverse needs of service users are recognised and dealt with appropriately. One service user needs the same gender staff to provide personal care and the home ensures this is arranged. Service users care records have information about their medical history and of any ongoing health issues. They are supported by their keyworkers to have an annual health care check, when their medication is also reviewed. Input is obtained when needed from relevant health care professionals, including GPs, community nurses (who regularly visit two of the service users), a Psychiatrist and Physiotherapist. A referral had recently been made for one person to an Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 14 Occupational Therapist (OT) who had visited their bungalow to reassess their needs and recommended new equipment, which staff had since obtained. This OT gave positive feedback about the home in a survey. Records are kept of health care input sought and obtained with information sheets detailing any support and treatment received. Advice or guidance for home staff is specified when necessary. The manager said staff had received direct instruction from community nurses in respect of some aspects of service users’ medical needs. Service users’ medicines are safely stored in locked drawers in their bedrooms and there is a lockable box for when medicines need to be kept in the fridge. 1st Key provides procedures for managing medicines and there are also copies available of general SCOPE policies and of the Royal Pharmaceutical Society guidelines for medicines in care homes. The home has a medical reference book and keeps information leaflets, although it is advised that homes should have a current copy of a British National Formulary. The records of medicines administered are being maintained appropriately. New staff receive instruction relating to medicines during induction from the staff member who is delegated responsibility for medication. They also attend accredited training from an external trainer before they are allowed to administer service users’ medicines. Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. There are systems in place to support service users and their representatives to raise any concerns. Staff receive instruction and there are procedures and policies available to help them to protect service users from abuse. EVIDENCE: SCOPE provides a written complaints procedure and the organisation employs a Complaints Resolution Officer to deal with complaints outside of the home if necessary. Service users and one relative confirmed they are familiar with the complaints procedure and they would know who to raise any concerns with. No formal complaints have been received by the home and no concerns or vulnerable adults issues raised with the Commission since the last inspection. There are protection policies in place, which cover abuse and whistle blowing and also appropriately refer to the Worcestershire multi-agency procedures for Protection of Vulnerable Adults. SCOPE employs a designated Adult Protection advisor who provides training for staff. One new staff member had not yet received instruction, and should do so as part of their induction. The manager also plans to arrange a refresher session for the staff team soon. Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including these visits to this service. Thistle Close offers ordinary, comfortable housing to service users within the community that has been adapted and equipped to meet their special needs. Some parts of the accommodation and gardens still need improving to make the home look nicer and more homely and provide better storage and facilities. Arrangements for cleaning and keeping the home tidy need to be reviewed to make sure that a consistently good standard is maintained. EVIDENCE: Thistle Close is a small cul-de-sac located on a large, modern residential housing estate. It is about two miles from Worcester city centre and in easy reach of the M5 motorway. There are shops, public houses and a superstore with café nearby and the home has two adapted vehicles to provide transport for service users further afield. The properties are owned by a social landlord (Branford Housing Association) and leased to SCOPE. The housing association has responsibility for some aspects of the premises maintenance and fabric. Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 17 The home comprises of three ordinary bungalows next to each other. They are adapted for people with physical disabilities and wheelchair users, with ramps, rails, wide doorways & corridors and aids e.g. bath hoists. There is an internal and external call bell system and various equipment to meet individual service users needs. Two bungalows have a separate kitchen, sitting and dining room, providing sufficient space for three service users. The other bungalow has a kitchen, dining and sitting area in one room, but recently a brick conservatory was built on. This provides pleasant additional communal space for the three service users to sit and watch television and will soon also have new furniture. Apart from the new conservatory and some redecoration, parts of the home still need upgrading. In particular two kitchens refitting, areas redecorating and refurnishing and more storage space provided. The gardens are not well planted and overgrown and need some landscaping. Requirements were made previously about the quality of some aspects of the accommodation and the manager had drawn up a planned programme for the improvements. However most timescales to complete this work have slipped, including putting up a shed for storage. A revised plan must be submitted to the Commission. The first impression of bungalow 30 was as untidy and not overly clean. Work surfaces in the kitchen were cluttered and the communal area/sleep in room needed vacuuming. One bathroom is used to store cleaning equipment and whilst the conservatory is new and the communal area is to have new carpets this does detract from its homeliness and appearance. Bungalow 33 looks bare and shabby and new skirting boards had been fitted in the sitting room a few days ago and bits were still on the floor. The spare bedroom contains a tumble drier and cleaning stuff but also unused furniture and aids. Two service users said the home is not always very clean. Staff that they feel they can usually manage day-to-day cleaning but do not have time for more thorough cleaning and gardening and some staff spend more time cleaning than others. Cleaning arrangements should be monitored and reviewed and efforts made to tidy up and/or make some areas more homely. Service users can have single bedrooms and some have well personalised them and have their own TVs, music centres etc. Bedrooms have a wash hand basin but not en-suite facilities, and all are under 12sq metres, which is the least space the Standards specify for wheelchair users. Whilst current service users have agreed to live at the home and so accept the space available, one person recognises their room size is restrictive and would like the basin moved to make it easier to use. Bedroom sizes would have to be considered if any vacancies occur to ensure space available is appropriate to meet prospective service users mobility needs. The home would be expected to arrange for an Occupational Therapy assessment to obtain confirmation that the environment is suitable. The home’s information documents should also state that the bedrooms do not meet National Minimum Standards for wheelchair users and not just that they have room for transfers, as they currently do. Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. Service users are supported by sufficient staff who receive training to help them keep service users safe and are appropriately supervised. The staff team skills and knowledge should improve when more staff are qualified and if more training opportunities are offered relating to service users’ special needs. The home’s recruitment procedures are thorough overall and so help to make sure that only suitable staff work at the home, for service users’ protection. EVIDENCE: The manager confirmed that the home is now fully staffed, including two relief support workers to cover leave. The staff team comprises of nine community support workers, a senior support worker and a team manager responsible for supporting the seniors in 1st Keys three care homes. Rotas show there are always three staff on duty in the mornings and two in the afternoon/evenings, with one person sleeping in on call at night. Another staff member works a flexible shift daily to facilitate activities and keyworker time. Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 19 Staff feel staffing levels are adequate although one service user and a relative say there should be more staff for social support and another service user that more than one staff should work at night in case of an emergency. However there is no evidence to support the view that service users are at risk at night, although more social time could be beneficial and allow more cleaning time. In relation to recruitment two recently appointed staff confirmed that the home had obtained a CRB/POVA check and two references before they started work in the home. They are now working a six-month probationary period and are doing the SCOPE induction programme which is accredited and will be followed by an appraisal. Their induction also appropriately included going through all SCOPE policies & procedures and undertaking all core health & safety training. One person had read up on cerebral palsy. When doing shadow shifts at the home they were expected to familiarise themselves with service users’ plans, finances, medication and activities. Their records from the 1sy Key office were checked and include copies of required documents, a CRB/POVA check and two suitable written references. The manager was advised however that any gaps in their employment history on their application forms must now be explored. Regarding training, SCOPE requires all staff to complete core safety training. Some topics relating to care and service users’ special needs are also covered in induction, although more training opportunities such as supporting people with learning disabilities, management of challenging behaviour and effective communication would be of benefit. The SCOPE induction programme leads on to doing an NVQ, which only two staff have achieved to date although another two are in the process. The service manager, team manager and two other staff are NVQ assessors, which is good as the NVQ programme should continue so that at least half the staff team are qualified, as the Standards specify. Staff interviewed say they receive sufficient information about service users and their care needs. They feel that communication within the team is good, through the daily reports, shift handovers and monthly team meetings. Also the staff team work well together and they are able to express their views. They understand the keyworker role and their responsibility for supporting service users’ with their personal and health care and for care planning and reviews. Two health/social care professionals indicated in comment cards that the home communicates clearly with them and that staff understand service users’ needs and follow up their advice. Staff appropriately receive individual supervision two monthly. Each person also has an annual appraisal and a training record. SCOPE provides a format for supervision sessions to monitor their work performance and training needs, covering core competencies, objectives and a personal development plan. Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 20 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 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. The home is generally well run, although management arrangements are not usual. It is positive that new processes to monitor and review the home are to be introduced. This should improve the quality of the service and result in a plan for the home’s continual development, based on what service users want. There are systems in place to keep the home safe and which make sure that staff work in ways that safeguard and promote the welfare of service users. EVIDENCE: The registered manager is Mr Andrew Deakin, who is suitably experienced. He is currently working to achieve the Registered Managers Award, which is NVQ level 4 and the qualification specified in the Standards for care managers. Mr Deakin is the community service manager for 1st key Worcestershire and the Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 21 management arrangements for this service are unusual as he is based at the 1sy Key office and does not run the home day-to-day. He is responsible for 1st key’s business plan, finance, service performance and policies & procedures. A team manager (also not based at the home) is responsible for monitoring the service delivery and quality at three 1st Key care homes and a senior support worker manages the home’s staff team, service users’ needs and records. Service users know the manager and are clear about his role. They say they can always ask to see him to raise any issues, although he does not spend dedicated time in the home. Staff feel they are kept informed and receive support from managers through visits, meetings and they are available on-call. In light of recent changes to how care services are to be regulated there is now an onus on registered providers and managers to self regulate. As there will be longer gaps between inspections they will be required to provide evidence to the Commission about how they are reviewing the quality of their service and promoting good outcomes for service users. Also how their quality assurance processes will result in the continual development of the service, based on the views of service users and other stakeholders. The manager discussed that a quality assurance system is to be implemented by SCOPE and a development plan should be produced by next April. Service users will be asked to complete an annual survey, supported by a relative or advocate of their choice. Other relevant people will also be involved through such as placement reviews. The way SCOPE monitor their services will also change. The required monthly visits to check how the home is being run are now made by regional managers, however community service managers will probably carry out these visits soon. This would be a better arrangement as registered managers could demonstrate their input to the home to provide evidence that they are monitoring the way seniors are running the home on a day-to day basis. Consideration should also be given to how they communicate with the Commission. In this context the reports made following the monthly visits need to be more detailed. Currently they are brief checklists and it was noted some aspects had not been audited in the last six months. Some action points were not followed up in subsequent visits and feedback from service users is limited and staff views not reflected. In respect of health & safety all staff are expected to undertake mandatory training during induction and refreshers at specified intervals. SCOPE employ a trainer to provide training in relevant areas and there is a moving & handling trainer on the 1st key staff team. Video packages are also available for instructing staff in fire safety & infection control. The pre-inspection questionnaire confirm there is a written fire risk assessment for the home and fire drills are arranged regularly. The fire log showed required tests and checks were recorded as being carried out. Information about the regular servicing of equipment, gas installations, central heating is also detailed. There were no safety hazards identified in the environment during the visits. Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 22 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 X 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 3 X Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 23 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 persons meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider must comply within the given timescales. No. Standard 1 YA6 Regulation 15 Requirement Service users plans should reflect all their current needs, personal goals and possible risks. Plans should be reviewed regularly with service users involvement and updated as their needs change with any changes agreed. Upgrading must be undertaken to improve the quality of some aspects of the environment. The work needed should be recorded in a planned renewal programme for the fabric and decoration of the premises, with timescales. This was a requirement from previous inspections, with the last timescale being 30/06/06. Limited progress has been made and so the timescale is extended again and a revised programme must be submitted to the Commission. Timescale for action 31/12/06 2 YA24 23 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the registered provider to consider carrying out. N Refer to o. Standard 1 YA30 Good Practice Recommendations Arrangements for cleaning and keeping the home tidy should be monitored and reviewed, to ensure staff have sufficient DS0000018693.V316777.R01.S.doc Version 5.2 Page 24 Thistle Close (24, 30 & 33) 2 3 4 5 6 YA32 YA32 YA34 YA39 YA39 time and a consistently good standard is maintained. The programme for staff to undertake an NVQ should continue so that at least half the staff team are qualified and those not qualified are suitably experienced to that standard. Opportunities for staff to undertake training relevant to the special needs of service users should be sought and arranged to enhance the knowledge and skills of the staff team. A full employment record should be obtained by the home for all new staff, with any gaps in their employment explored. The home should produce a plan with aims for the continual development of the service in the year ahead. This should reflect the views of service users and significant other people. Consideration should be given to how the registered manager could demonstrate his input to the home and ensures its effective day-to-day running. Also how this information could be shared with the Commission. Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Thistle Close (24, 30 & 33) DS0000018693.V316777.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!