Inspection on 18/08/06 for Tregonwell Lodge & Two Wells

This inspection was carried out on 18th August 2006.

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

The inspector 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tregonwell Lodge & Two Wells 02/08/07

Tregonwell Lodge & Two Wells 04/01/06

Tregonwell Lodge & Two Wells 24/08/05

Tregonwell Lodge & Two Wells 24/03/05

Tregonwell Lodge & Two Wells 07/09/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Tregonwell Lodge & Two Wells Salisbury Street Cranborne Dorset BH21 5PU Lead Inspector Heidi Banks Key Unannounced Inspection 18th August 2006 15:20 DS0000034481.V309159.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 DS0000034481.V309159.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. DS0000034481.V309159.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tregonwell Lodge & Two Wells Address Salisbury Street Cranborne Dorset BH21 5PU 01725 517458 01725 517918 cranborne@regard.co.uk 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) The Regard Partnership Limited Mrs Violet Rosetta Alcock Care Home 16 Category(ies) of Learning disability (16) registration, with number of places DS0000034481.V309159.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2006 Brief Description of the Service: Tregonwell Lodge and Two Wells is owned by The Regard Partnership, which is a national organisation with several residential homes around the country. This organisation took over ownership of the home in April 2003. Tregonwell Lodge and Two Wells provide accommodation for 16 adults. The home specialises in providing care and support to people who have a learning disability. The current age range of service users living at Tregonwell Lodge is 20 to 44 years old. Tregonwell Lodge is a large country property in extensive grounds in the rural village of Cranborne in Dorset. Two Wells is a separate house next door to Tregonwell Lodge. Staff and service users can easily transfer between the two premises. The home is situated in the middle of the rural village, and has easy access to the local shop, pub, post office and restaurant. The accommodation comprises of the main lodge, which has ten bedrooms, communal lounge, kitchen, dining room and bathrooms, and a staff sleep-in room. In the courtyard is a further accommodation block, providing three bedrooms and one bathroom. One of these bedrooms has been arranged as a bed-sit. Two Wells is a four bedroom property, providing accommodation to three service users, a staff sleep-in room, lounge, dining room, conservatory and kitchen. The grounds include extensive vegetable plantings, greenhouses, lawn areas, woodland trails, ducks, courtyard with seating, toilets and workshops for carpentry. Current fees for the service range from £884.28 to £1596.62 per week. DS0000034481.V309159.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that took place across two days on 18th and 21st August 2006 over a period of eight hours. The purpose of the inspection was to assess the home’s progress in meeting the key National Minimum Standards and achieving good outcomes for service users. There are sixteen permanent residents living at Tregonwell Lodge and Two Wells at the present time. During the course of the inspection the inspector was able to talk with four service users and meet seven members of the care team. The inspector was assisted by the Registered Manager of the home, Violet Alcock, throughout the inspection. A sample of records was examined including some policies and procedures, medication administration records, health and safety records and service user and staff files. Interactions between staff and service users were also observed. A guided tour of the premises was also given by the Registered Manager with access to the bedroom of one service user with their consent. Eleven completed service user surveys were received prior to the inspection. A pre-inspection questionnaire completed by the Registered Manager was also supplied. Information obtained from these sources is reflected throughout the report. Twenty-two standards were assessed during this inspection. What the service does well: Service users are admitted to the home on the basis of an assessment undertaken by a senior member of the staff team so that they can be confident it will be suitable for them and meet their needs. Service users have detailed, written care plans which set out their personal, health and social needs and which are regularly reviewed. A process for person-centred planning is in place which enables service users to consider their dreams and goals and look at ways these can be achieved with support. Opportunities for service users to be involved in decision-making through residents’ meetings and individual time with their key worker are in place and there was evidence that where service users have expressed a wish to do something they are given support to follow it through. Risk assessments are in place for individual service users to ensure that they are given appropriate support to maximise their independence and remain safe. Service users achieve positive lifestyle outcomes with evidence that they are engaged in meaningful activity during the day and are able to make choices about how they spend their leisure time. There was evidence in daily records DS0000034481.V309159.R01.S.doc Version 5.2 Page 6 that service users are enabled to access their local and wider community on a regular basis and the home has put emphasis on maintaining a fleet of vehicles to ensure that this happens. Service users are empowered to build networks of support and maintain fulfilling relationships with their family. Their rights and responsibilities are respected by the home in terms of being involved in making choices and decisions, participating in care planning and review processes and being encouraged to set and meet personal goals. Service users are provided with meals that meet their needs and preferences and discussion with one service user indicated that she is supported to make appropriate choices so that she maintains a healthy weight and keeps well. There are satisfactory systems in place to ensure that service users have opportunities to air their views and service users responding to the survey indicated that they would talk to staff if they were unhappy. Procedures are in place to protect service users from abuse and staff receive training on abuse awareness to promote their understanding and knowledge of abuse and how to report it. Plans are in place to refurbish certain areas of the home to ensure that it remains in good decorative order and provides a homely environment for service users. Service users are able to personalise their private accommodation according to their individual tastes and preferences. The home has extensive and attractive grounds so that service users can enjoy peace and privacy. Care staff are selected fairly and on the basis that they have experience of working with vulnerable adults and are fit and suitable for the post. Inspection of recruitment records showed that procedures in this respect are robust and that appropriate checks are carried out prior to care workers commencing employment. This ensures that service users can have confidence in the people who care for them. All staff undergo induction training and have access to ongoing training, including NVQs, to build their competence in their work with service users. The home’s manager is registered with the Commission as fit and suitable to run a care home. There is a clear management structure in place at the home which ensures that there is adequate support for staff and service users. Interim arrangements for managing the service while the Registered Manager is on maternity leave are in place. There are systems in place to formally consult with service users, relatives and health / social care professionals about the quality of care and services provided at the home. An annual development plan is in place to ensure that service users’ needs are central to the home’s development. Health and safety practices in the home are generally good but a small number of gaps in staff receiving timely updates in mandatory training have been identified. DS0000034481.V309159.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The Registered Manager must ensure that all staff receive timely updates in health and safety training, including fire safety and moving and handling. This will ensure that practices within the home maintain the safety of service users. This requirement is repeated from the last inspection of the service. It was evident from records that the Registered Manager has already taken steps to address this issue by implementing a monthly audit of training. This will help ensure that any gaps in training are identified and that training for staff who have not received their updates can be arranged promptly. Some recommendations have been made with regards to medication practices in the home, in particular that accredited training is provided to all staff who take responsibility for administering medicines to service users. The home’s complaints procedure should be expanded to include the reporting and recording of concerns. This will help provide evidence on how the home responds to issues that are raised informally by service users and staff and ensure that positive outcomes are achieved. Following a recommendation made at the last inspection of the service, the Registered Manager has confirmed that the home is looking to refurbish certain areas of the home to create a more homely feel and ensure the environment remains in good decorative order. The times of day that fire drills are carried out should be recorded on the fire drill record and varied to ensure that they occur at times when staffing levels are reduced, for example, in the evenings and at weekends. This will help ensure that staff can evacuate the home safely when the ratio of staff to service users is lower. DS0000034481.V309159.R01.S.doc Version 5.2 Page 8 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. DS0000034481.V309159.R01.S.doc Version 5.2 Page 9 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 DS0000034481.V309159.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that a comprehensive assessment is undertaken prior to the service user’s admission, with their participation, to ensure that their needs and aspirations can be met by the service. EVIDENCE: Since the last inspection of the service one service user has been admitted to the home. The service user’s records were examined for evidence of assessment of his needs taking place prior to admission. An assessment was seen which had been undertaken by the Registered Manager in January 2006, four months prior to the service user’s move to the home. This contained information on the service user’s diagnosis, general health, medication, personal care needs, communication, community participation, mobility, finance, personal relationships, sexuality, work occupation and leisure activities. Information recorded on the assessment documentation incorporated some detail about potential risks to the service user. The Registered Manager confirmed that the service user himself participated in the assessment process with the support of those well-known to him and that a period of transition was arranged for the service user to visit and stay at Tregonwell Lodge. Evidence of this had been documented on file. DS0000034481.V309159.R01.S.doc Version 5.2 Page 11 The service user’s records also contained an assessment that had been undertaken by the Local Authority providing further information about the service user’s needs. DS0000034481.V309159.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have individual plans in sufficient detail to ensure staff know their personal care needs and how these are to be met. A system of personcentred planning is also in place to ensure that service users’ goals and wishes are central to the care process and that they have plans that are in a format meaningful and accessible to them. Service users are given opportunities to participate in decision-making about things that are important to them so that they have some control over their lives. Risk assessments are in place to ensure that appropriate support is given with a view to maximising independence with due regard to safety issues. DS0000034481.V309159.R01.S.doc Version 5.2 Page 13 EVIDENCE: For the service user case-tracked, an individual plan was in place which included information about the service user’s personal care needs and how these could be met by staff. For example, ‘I need staff to help me to take off my hearing aid…at night…and to wash around my hearing / ear implants’. There was also detailed information on how staff should perform this task, ‘over the sink using warm water and brush’. The plan contained information about the service user’s need for help with running a bath and testing the water temperature taking account of his preferences with regards to this. Communication needs were also covered specifying ‘I need to be facing you so I can hear and see what you are saying to me’ and there was information about eating and drinking requirements as the service user requires food to be cut up into small pieces to avoid the risk of choking. There was evidence that this plan was due to be reviewed with the service user in September. The records showed that six weeks following admission to the home a review had taken place which had looked at how the service user was settling in to his new home, future activities, medical needs and referrals to be made to Speech and Language Therapy and the dentist. Discussion with four service users indicated that they are encouraged to make decisions about their lives. One service user stated that she would like to lose weight and that staff support her with making healthy diet choices to help her achieve her goal. Another service user talked about how he had put together a Person Centred Plan supported by his key worker. This included information about what he wanted to achieve in the future, how he could use his personal strengths to meet his goals and overcome difficulties and his preferences in terms of family contact and holiday arrangements. Residents’ meetings are held on a regular basis, the minutes of which were seen to include contributions about the home, trips out and choice of activities. A sample of risk assessments were seen to include information about the hazard and how risks were to be minimised. For one service user who has swallowing difficulties, a risk assessment is in place around choking which specifies that staff must stay with him while he is eating, that consideration must be given to the texture of his food and that certain food had been identified as causing him to vomit and therefore should be restricted. There was evidence on file that a referral had been made to Speech and Language Therapy for further guidance around eating and drinking. Risk assessments were also in place around risks of falling in the home and in the community, swimming and personal safety in a fire. For another service user, discussion with the Registered Manager and a member of the care team demonstrated that risks around her ability to DS0000034481.V309159.R01.S.doc Version 5.2 Page 14 maintain her safety in her personal relationships were being managed through additional staff support being available to her at appropriate times. Liaison with the service user’s Care Manager had taken place with regards to this issue. There was evidence that where one service user’s behaviour had posed risks in recent months, a risk assessment had been undertaken to minimise the impact of these risks on other service users. Appropriate referrals had been made to the Community Learning Disability Team for specialist advice and incidents had been reported to Social Services and the Commission. DS0000034481.V309159.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to make choices about the activities they undertake in the home and community to meet their personal goals. They are enabled to maintain valued relationships and social networks and identify ‘circles of support’. Their rights and responsibilities are respected in the home so that they are encouraged to lead ordinary lives and make choices and decisions about what they do. There is a commitment to offering nutritious meals in the home that meet service users’ needs and preferences and help them to maintain good health. EVIDENCE: Discussion with service users and review of daily records indicated that service users are given opportunities to take part in activities that interest them and help them with achieving their personal goals. DS0000034481.V309159.R01.S.doc Version 5.2 Page 16 The home provides day services for residents and non-residents, both on-site and in the local community. The home’s leaflet indicates that service users are able to choose what they do as part of their day service programme but this could include swimming, drama, cooking skills, information technology, rambling, gardening, weaving, literacy and numeracy, arts and crafts and fit club. The Registered Manager reported that service users are also encouraged to access courses at local colleges. There is a flexible timetable during the summer period. During the course of the inspection it was evident that service users were engaged in a range of activities around their home including gardening tasks, cooking and individual time with their key worker to review their individual Plans. Two service users have been involved in delivering training in Person-Centred Planning to other establishments in the Regard organisation for which they had received payment. One service user spoken to stated that he had enjoyed this. Daily records showed that, in their leisure time, service users regularly access their local and wider community including trips to nature reserves, the cinema, shops, a local market, a boat trip, the New Forest and Poole Quay. For one service user who had expressed an interest in flying a kite there was evidence on file that he had been supported to purchase a kite and then had been taken to a suitable area to fly it a few days later. Also for one service user who has a particular interest in sea creatures a trip to ‘The Oceanarium’ in Bournemouth had taken place with his key worker. The home has four vehicles for use by service users and the Registered Manager reported that the majority of staff drive which enables service users to have regular access to their community. All service users responding to the survey indicated that they are able to do what they want to do in the evenings and at weekends. The person-centred plan for one service user had given consideration for his aspirations in terms of work. He discussed that he wanted to be a security guard. A link had been made with a specialist employment agency to help him work towards this goal and it had been identified that he could start by finding some work experience. The service user had also expressed an interest in working with animals so he had been encouraged to take part in dog-walking and a placement was being sought with an animal rescue charity. There was evidence in his Plan that his ‘dreams’ were being worked towards – for example he wanted to purchase a DVD player so his key worker was supporting him with budgeting so that some money is put aside on a regular basis to help him fulfil his goal. He also discussed that he likes going to musicals and had been supported to go to local theatres to see them. Regular holidays are planned with service users. For one service user who wanted to go to Disneyland a trip to Euro Disney had been arranged with his peers later this year. Other groups of service users had gone on holiday to Tuscany and Portugal earlier in the year. DS0000034481.V309159.R01.S.doc Version 5.2 Page 17 Discussion with the Registered Manager indicated that several service users were due to visit their families over the weekend. One service user spoken to stated that he makes regular telephone contact with his family and another stated that he visits his family on a regular basis and goes on holiday with them once a year which he enjoys – this formed part of his person-centred plan. One service user who has a partner who does not live at the home is supported to maintain regular contact with him and a short holiday had been organised for them both with staff support available to meet the service user’s needs. Another service user reported that he has a girlfriend who also lives in the home and who is part of his ‘circle of support’. Information supplied in the pre-inspection questionnaire by the Registered Manager indicates that two service users at the home have advocates to extend their network of support. Service users’ rights are respected in the home with their participation in review meetings being promoted and a person-centred approach to care planning being in place. Observation of interaction between service users and care workers demonstrated that service users are treated with respect with a clear and friendly rapport existing between service users and staff. Service users have access to all communal areas of the home and are offered keys to their bedroom doors to promote their privacy. Service users were observed to help themselves to drinks in the kitchen as they wished and make choices about what they wanted to do. Service users are encouraged to take responsibility for their home environment, for example, helping with meal preparation, clearing up after the meal and tidying their rooms. Service users’ independence is promoted with regards to how they spend their money and there was evidence that one service user who wanted to save towards purchasing a specific item was being given support with budgeting to save money each week. There was evidence in the minutes of a recent residents’ meeting that one service user who had wanted t change rooms had been supported to do so and was happy with the outcome. One staff member commented ‘The opinions of the service user are always in the front of the decisions made’. Meals and meal-times were discussed with one member of the care team. Planning of meals was reported to take place with service user involvement and healthy options are encouraged. The week’s menu was seen on display on the kitchen wall and indicated that a good range of fruit and vegetables was offered to service users. The home takes advantage of its rural location and source food products from local farm shops where possible but a supermarket is also used for other items. The member of care staff spoken to stated that she is committed to ensuring that meals are home-cooked as much as possible and there was evidence during the inspection that service users were being involved in preparing apple and berry pie with fruit they had picked that day. There were bowls of fresh fruit available around the home for service users to help themselves to. One service user requires a gluten-free diet which was also on display on the kitchen wall. The Registered Manager reported that she DS0000034481.V309159.R01.S.doc Version 5.2 Page 18 is making contact with the Coeliac Society to request a speaker to talk to staff about Coeliac disease and gluten-free diets. A framework for recording the food intake of service users was also seen to be in place. One service user spoken to reported that she was receiving support from staff to eat a balanced diet and achieve a healthy weight; ‘Staff help me to make healthy choices and look after myself’. Two service users spoken to stated that the meals they are offered at the home is good. Service users eat together in the dining room. One service user’s room was seen to have a ‘kitchenette’ facility with a kettle and microwave. The service user stated that she often makes herself drinks and can heat up foods using these facilities which promotes her independence in the home. DS0000034481.V309159.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are offered appropriate and sensitive support with their personal care needs which promotes their dignity and independence. Service users’ physical and emotional health care needs are met through liaison with generic and specialist health care services as appropriate. Systems are in place to safeguard service users in relation to medication administration but a recommendation has been made that all staff undertake accredited training in this area to ensure their competence. EVIDENCE: Service users preferences and needs with regards to their personal care are clearly documented on their individual support plans. Where service users require specialist support there was evidence that referrals to health services such as Physiotherapy and Speech and Language Therapy have been made. In addition, discussion with the Registered Manager indicated that contact with service users’ Care Managers is made where there are changes in their support needs or any concerns arise about their welfare. DS0000034481.V309159.R01.S.doc Version 5.2 Page 20 Discussion with service users indicated that they each had a key worker. This appeared important to them with one service user stating ‘my key worker helps me meet my goals’. There was evidence from conversation with one service user that where she wanted a change in key worker this was being actioned. Another service user’s Person-Centred Plan was clearly his own work with pictures, photographs and leaflets of things that are important to him and written statements about the support he needs from staff in his daily life to maximise his independence and promote his welfare. He had been supported to identify his ‘circle of support’ as part of his plan, that is to say, those people he wants to help him achieve his goals, to ensure that he has a network of support both inside and outside of the home. Observation of interaction between staff and service users demonstrated that service users needs are responded to with sensitivity, for example one service user who was observed to touch a member of staff inappropriately was quietly reminded of appropriate boundaries by the care worker. Information supplied in the pre-inspection questionnaire by the Registered Manager indicated that, where service users require health care support this is accessed through primary and specialist health care teams. Incident reports received by the Commission evidenced that support from the GP and Psychology team had been obtained for one service user whose behaviour and emotional state had caused concern. Medical appointment records also showed that service users access the optician, audiology clinic and chiropody as necessary and the Registered Manager confirmed that all service users have a dental check-up every six months to maintain good oral health. Not all entries in service users’ appointment records were signed. One service user who stated that he wanted to see his GP was encouraged by his key worker to make the appointment himself with support. A medication policy is in place at the home and was updated in February 2005. Medication is stored in a lockable cupboard in the dining room. The home uses a combination of monitored dosage systems and boxes / bottles. Medication is collected from the pharmacy on a monthly basis by the Deputy Manager and is checked in. A framework is in place to record medication entering and leaving the home. Medication administration records (MAR charts) are provided by the pharmacy. A sample of medication was checked against the MAR charts and this indicated that it had been given as prescribed. The Registered Manager stated that she believed an audit trail was in place but there was no record to support this and dates of opening of medication boxes and bottles had not been recorded. The Registered Manager reported that there are no homely remedies used in the home as it is the organisation’s policy that all medication must be prescribed for the individual. Where one service user’s relative wishes them to use herbal remedies the Registered Manager stated that a GP’s advice had also been sought on this issue. There was some information on file about the most commonly used medications within the home although it is DS0000034481.V309159.R01.S.doc Version 5.2 Page 21 recommended that patient information leaflets are also kept on record for reference by staff. Staff are given in-house training to administer medication and records showed that some staff have undertaken accredited training. The Registered Manager stated that it is the home’s aim to ensure that all staff access accredited training to ensure their competence in this area. A sample of staff records were inspected and showed that all staff had undertaken training in epilepsy and the administration of rectal diazepam to be able to respond effectively to service users who experience epileptic seizures. There are currently no photographs on medication administration records to help with the identification of service users. During the inspection one service user had a seizure for which rectal diazepam was administered. A doctor was called to give the service user a check-up following the seizure. Each service user at the home has their own nail clippers and nail file. The Registered Manager confirmed that only staff who have undertaken training in foot care are permitted to support service users with nail care. DS0000034481.V309159.R01.S.doc Version 5.2 Page 22 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are satisfactory arrangements in place to enable service users and relatives to make their views known but expansion of the complaints record to include concerns will give a more comprehensive picture of how positive outcomes for service users are achieved. Policies, procedures and staff training in abuse awareness are in place to ensure that care workers have the necessary knowledge to identify abuse and know how to report it. EVIDENCE: The home has a complaints procedure which has been converted into symbols to promote understanding. This advises service users to speak to someone if they are unhappy, for example, their key worker, Social Worker, parents or the Registered Manager. The contact details of the Commission for Social Care Inspection are also on the procedure. Of the eleven surveys received from service users all indicated that they knew who to speak to if they were unhappy. The majority of service uses indicated that they would speak to their key worker. Five of the eleven service users, however, indicated that they did not know how to make a complaint. There was evidence that service users are supported to air their views at residents’ meetings and also through monthly surveys that ask them for their views on the various aspects of the service. DS0000034481.V309159.R01.S.doc Version 5.2 Page 23 The home’s complaints record was seen and discussed with the Registered Manager. There has been one complaint since the last inspection of the service to which the Registered Manager had responded in writing. It was suggested that the Registered Manager follow up the letter with a telephone call to ensure that the complainant is satisfied with the home’s response to the issues raised. It was not clear from the complaints record how the home responds to concerns that are raised informally by service users, their relatives and representatives. It is therefore recommended that the home documents details of concerns to give a comprehensive account of how issues raised are responded to and ensure that positive outcomes are achieved. Information supplied by the Registered Manager in the pre-inspection questionnaire indicates that the home has a policy on adult protection and the prevention of abuse which was updated in May 2006. The home also has a copy of the local multi-agency policy. The procedures clearly state that any incidence or suspicion of abuse should be reported to Social Services, the Commission, the manager or manager-on-call and recorded appropriately. A whistle blowing policy is also in place. The home has forwarded incident reports as appropriate regarding events at the home where service users have been at risk and these indicate that Social Services have been informed. The home’s training record shows that regular training courses in abuse awareness, by the Regard Partnership, are arranged for staff and of the five staff records reviewed all showed evidence of them having undertaken this training. Some staff have also attended training organised by Dorset Social Care and Health. The pre-inspection questionnaire states that regular training courses are organised for staff on physical intervention with the most training dates being in February 2006 and future dates organised for October and November this year. The Registered Manager confirmed that the last time physical intervention was required in the home was in January 2006 and that generally, the intervention required from staff is that of diffusing a situation using verbal prompts and distraction. DS0000034481.V309159.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Consideration is being given to updating the home environment to create a more homely and comfortable feel for service users. Systems are in place to maintain good hygiene in the home and reduce risks to service users. EVIDENCE: The home is in a rural location on the outskirts of the village of Cranborne. It provides a generally homely environment for service users and access to a service user’s bedroom showed that she had been able to choose the colour of the décor and personalise the room as she wished. At previous inspections of the service a good practice recommendation has been made for furniture in the lounge of Tregonwell Lodge to be replaced to create a more homely and comfortable feel. A recommendation was also made at the last inspection to replace carpets in communal areas that are showing signs of wear and tear are replaced. Discussion with the Registered Manager confirmed that these had been given consideration; lounge furniture is currently on order and was due to be delivered the month after the inspection DS0000034481.V309159.R01.S.doc Version 5.2 Page 25 and new carpets have been purchased for the hallway and landing areas. A tour of Two Wells showed that new sofas and armchairs are in place and the Registered Manager confirmed that consideration is being given to a general update to the décor of the home. Discussion with staff indicated that the environment is most suitable for service users who enjoy living in a rural setting and who benefit from the spacious grounds and opportunities this offers to service users in terms of gardening and looking after the animals. The home presented as clean during the inspection. A part-time cleaner is employed by the home and the home accesses the services of a maintenance person as required to ensure that the premises are maintained in satisfactory order. Of the eleven service users responding to the survey, the majority indicated that they felt the home was ‘always’ clean. The home has a policy on communicable diseases and infection control which was reviewed in March 2006. DS0000034481.V309159.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Training for nationally recognised qualifications is offered to staff to ensure their continued competence and development in their work with service users. Robust recruitment procedures are in place to ensure that staff are suitable to work with vulnerable adults in a care setting. Access to ongoing training is good so that staff are equipped with the specific skills needed to work with individual service users and meet their needs. EVIDENCE: Inspection of staff training records showed that out of twenty-three care staff employed at the home, eleven have completed their NVQ Level 2 and three have completed their NVQ Level 3. A further four members of staff are working towards their NVQ Level 2. The Registered Manager and Deputy Manager have both completed their Registered Manager’s Award qualification. On the second day of the inspection, interviews for care staff were taking place at the home. Discussion with senior members of the staff team who were conducting the interviews indicated that they were seeking a person with experience of working with vulnerable adults and who showed a positive, enthusiastic and person-centred attitude towards people with learning DS0000034481.V309159.R01.S.doc Version 5.2 Page 27 disabilities. An important consideration was also for the new recruit to be a team player who would be able to work flexibly and meet the demands of the post. The records for two recently recruited members of staff were examined. Both showed evidence of an application form with a full employment history, suitable proof of identity, two written references, one of which had been verified by a telephone call to the referee and enhanced disclosures from the Criminal Records’ Bureau (CRB) which included POVA checks. From the dates on the documentation it was evident that the checks obtained for both staff had been completed prior to the commencement of their employment at the home. The Registered Manager reported that the organisation is looking to renew staff CRB checks every three years as good practice. Information provided in the pre-inspection questionnaire indicated that the home does not use agency staff but employs their own team of bank workers to promote consistency of care for service users. Discussion with the Registered Manager indicated that an induction process is in place for all new staff. The induction programme comprises of first aid training, fire safety, risk assessment, food hygiene, moving and handling, customer care, health and safety and employment issues. Workbooks have been produced to meet the new Common Induction Standards and videos are also used to illustrate aspects of care. The manager confirmed that workbooks are taken away by staff and worked on when the opportunity arises. It is suggested that evidence of staff’s progress with their induction training is also kept in the office. Inspection of staff training records showed that a range of courses are available to care workers to meet the needs of the service user group, some of which are organised by the Regard Partnership and some of which are externally accredited. This included staff training on person centred planning, personal relationships, epilepsy, physical intervention and communication. The Registered Manager confirmed that three staff will be undertaking total communication training in the near future with a view to cascading this to all staff in the home. Certificates from training undertaken by staff had been kept on file. DS0000034481.V309159.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are clear lines of accountability within the home to ensure that it is wellmanaged. Satisfactory systems for monitoring the quality of the service are in place to ensure that it can be improved for the benefit of the service users. Procedures for managing health and safety in the home are generally robust but shortfalls with regards to a minority of staff receiving timely mandatory training updates have been identified and must be addressed for the overall outcome group to be rated as ‘good’. EVIDENCE: The Registered Manager has been in post for two years. She has achieved her NVQ Registered Manager’s Award and is currently working towards a Diploma in Management. At the time of the inspection the Registered Manager was due to start her maternity leave the following week. Interim arrangements are in place to provide effective management of the service in her absence and there DS0000034481.V309159.R01.S.doc Version 5.2 Page 29 was evidence at inspection that a handover was taking place to ensure that the acting manager has the information she needs to manage the service. The acting manager will continue to be supported by the home’s Deputy Manager and senior staff so that there is continuity for service users. There is a clear management structure in the home which comprises the Registered Manager, the Deputy Manager, and four Senior Support Workers. The manager is supported by an Area Manager and a team which is based at the organisation’s Head Office in Kingston-upon-Thames and which takes some responsibility for financial management, quality assurance and training within the service. There is a ‘manager on-call’ service available to staff outside of normal office hours. There is ample evidence to show that the home is making progress in meeting the Regulations and National Minimum Standards. One member of staff commented that the home has an open and inclusive atmosphere and a welcoming team. Satisfaction surveys had been distributed to staff, service users’ relatives and social / health care professionals in June 2006 to obtain feedback about the service provided. Information collated from the relatives’ survey had been put into the form of a graph and accompanying letter that was then sent out to all relatives. Where issues had been highlighted, for example lack of awareness about the home’s complaints procedure, a copy of the procedure had been distributed and a reminder that reports from inspections by the Commission could be accessed at the home and via the Commission’s website. The Registered Manager reported that service users are given a feedback form on a monthly basis which asks them for their views on the home environment, their bedroom, staffing, choices, activities and the personal care they receive. An annual development plan is in place at the home. This was seen to cover issues of importance to service users, for example, improving access to work experience and paid employment, provision of weekend outings, general refurbishment of the premises and update to the home’s fleet of vehicles. The home’s fire safety records were reviewed. Records showed that the premises were inspected by Dorset Fire and Rescue in August 2006 and that, at this time, the existing fire precautions were being ‘satisfactorily maintained’. Records also indicated that weekly testing of alarms and fire doors and monthly checks on portable fire-fighting equipment and emergency lighting were up-to-date. Fire drill records were examined for five staff and two service users, all showing evidence of having participated in fire drills in the past six months. It is recommended that the time of day drills are carried out are indicated on the DS0000034481.V309159.R01.S.doc Version 5.2 Page 30 record to ensure that fire drills occur at various times of the day including those times when there are reduced staffing levels. The Registered Manager confirmed that scenarios are used during drills to test the ability of staff and service users to respond to changes that may occur in the event of a fire. It is suggested that scenarios used are documented to provide evidence of this. Provision of fire training was discussed with the Registered Manager. There is a rolling programme of formal fire training sessions organised at the home. However, it was evident from records that a small minority of staff had not attended this training within the required timescale due to sickness or annual leave. It was also noted that bank staff may not always attend regular training due to their other commitments. A requirement was made at the last inspection in relation to the timely provision of mandatory training for staff and will be repeated at this inspection as it is essential to ensure that all staff attend regular training in health and safety, including fire safety, for service users to be fully protected. The Registered Manager has already implemented a monthly training audit within the home to identify staff members who require training updates. Records showed that a monthly health and safety check is carried out at the home. This involves a visual inspection of the premises to ensure that they are safe. There was evidence that where concerns had been noted, for example, obstruction of a fire door and damage to a radio cassettes player, these had been addressed immediately. The home’s health and safety procedures state that ‘hot water temperatures should be between 39 and 43 degrees Centigrade’. There was evidence on file that temperatures are monitored on a monthly basis. The most recent record of temperatures tested on 3rd July 2006 showed all temperatures as being between 38 and 44 degrees Centigrade. Temperatures of the home’s refrigerator and freezer were seen to be recorded by staff twice daily to ensure the safe storage of food. DS0000034481.V309159.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X DS0000034481.V309159.R01.S.doc Version 5.2 Page 32 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 YA42 Regulation 23 Requirement All mandatory training must be completed within the required timescales. This refers to Manual Handling, Health & Safety & Fire Prevention. Please note this refers to only a minority of staff who have not attended when training sessions have been running. This requirement is repeated from the last inspection of the service as the previous timescale of 31/01/06 was not met. Timescale for action 31/10/06 DS0000034481.V309159.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations Guidance from the Royal Pharmaceutical Society should be followed with regards to the receipt, recording, storage, handling, administration and disposal of medicines. All staff with responsibility for administering medication to service users should undertake accredited training. Patient information leaflets regarding service users’ medication should be included in their records to provide information for staff. The date on which packs or bottles of medication are opened should be recorded to provide an audit trail. A photograph of each service user on their medication administration record is recommended to support staff with the correct identification of residents when they are administering medication. 2. YA22 The home’s complaints procedure should be expanded to include the reporting and recording of concerns to ensure that positive outcomes are achieved for service users. The registered person should ensure that all service users within the home are aware how they can make a complaint about the service they receive. 3. 4. YA24 YA42 Consideration should be given to the general refurbishment of certain parts of the home. Fire drills should be carried out at variable times of day including times when there are reduced staffing levels, for example, in the evenings and at weekends. DS0000034481.V309159.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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