Inspection on 05/09/06 for Tullyboy Homes

This inspection was carried out on 5th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tullyboy Homes 01/02/06

Tullyboy Homes 14/09/05

Tullyboy Homes 11/01/05

Tullyboy Homes 19/05/04

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 Tullyboy Homes 2 Inlands Close Pewsey Wiltshire SN9 5HD Lead Inspector Tim Goadby Key Unannounced Inspection 5th & 18th September 2006 09:50 Tullyboy Homes DS0000028632.V301342.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 Tullyboy Homes DS0000028632.V301342.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. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tullyboy Homes Address 2 Inlands Close Pewsey Wiltshire SN9 5HD 01672 562124 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) Tullyboy Homes Mrs Catherine Howie Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st February 2006 Brief Description of the Service: 2 Inlands Close provides personal care and accommodation for five adults who have a learning disability. The home is owned by Tullyboy Homes, a private sector organisation. They run another similar establishment in Wiltshire. Both owners have close involvement in all aspects of service delivery. One of them is also the registered manager for Inlands Close. The house is in a residential area, close to the various amenities available in the large village of Pewsey. The service has been open for over ten years. All five current residents have lived there since it opened. All service users have single bedrooms. Most of these are on the ground floor. There is one bedroom upstairs, which has an en-suite shower. There is a bathroom for general use downstairs. Fees charged for care and accommodation range between £947 and £1172 per week, depending upon the assessed needs of individual service users. Information about the service is available within the home at all times. All of the material produced by Tullyboy Homes itself can also be provided in pictorial format. Copies of CSCI inspection reports are also available in the home. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was completed in September 2006. The inspection process included a review of regulatory contact since the previous main inspection, in February 2006. This was mainly related to a complaint received about the service, which was referred to the provider to investigate. There was a satisfactory response to this complaint, and the actions arising from the investigation were checked during this inspection. In advance of the inspection visits, various documentary evidence was supplied. This included pre-inspection information from the provider, two service user surveys completed with support, and two staff surveys. Fieldwork was carried out over two separate visits. The first of these was unannounced. The second was by appointment, to meet with the registered manager, to conclude the inspection and give feedback. Inspection activity during these visits included sampling records, with case tracking; sampling a meal; discussions with service users, staff and management; and a tour of the premises. What the service does well: Service users can be confident that the home meets their needs and aspirations. Inlands Close is an established service, which has cared for the same group of people since it was first set up. All five service users were at home for at least part of this inspection. Direct access to their views is difficult, because of the nature of their impairments. But all appear settled and confident in their surroundings. The service has developed a detailed knowledge of individual characters and preferences. Strategies are in place to deliver support around these. The home is particularly strong on caring for people’s health needs. The group of users have a variety of issues requiring support. Specialist input has been accessed, where appropriate. There is effective monitoring and review of care, involving all relevant professionals. For developing needs, and deteriorating conditions, there is clear forward planning about the best ways to respond. Service users benefit from the focus on promoting and maintaining the best health possible, enhancing their quality of life. The organisation has good management systems. The owners have close daily involvement with all aspects of the service, applying their own expertise in relevant areas. There are two registered managers within Tullyboy Homes, both qualified to the appropriate level. Another carer is also taking on additional responsibilities, and is working towards a more senior role. Service users benefit from a well run home. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The protection of one service user with needs arising from their impaired mobility needs to be demonstrated by clearer evidence of appropriate support within their care records. This must include suitable guidance for all interventions carried out by staff, and a risk assessment addressing how the hazards from the individual’s tendency to fall are minimised. Protection of service users from unsuitable people being appointed to work with them needs to be shown by evidence of all required recruitment checks in staff records. The sample seen at this inspection showed deficits in one case relating to the necessary written references, especially where these relate to previous employment with vulnerable people. Service users must be confident that the service will notify all relevant events to the Commission, ensuring that the home is conducted in an open and transparent manner. Examples seen at this inspection showed a failure to report some events meeting the relevant criteria, such as an injury to a service Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 7 user, and a period where their personal care needs could not be fully met at Inlands Close. Further improvements in the management of medication would enhance the welfare of service users. Records need to clearly show current evidence of all changes to an individual’s medication, in a place where this can easily be referred to. Service users would also benefit from improvements in some other areas of record keeping. For instance, clear updating and cross referencing in individual files, so that care plans are always linked to the most relevant current information. Also, it is more appropriate to make detailed entries into individual records, rather than in general documents such as a staff communication book. This is so that one person’s record can be kept separate from information about other people. The home’s whistle blowing policy should be amended so that it is clearer for staff about the possible process if they raise concerns about practice. It is not correct for the policy to state that staff will be guaranteed confidentiality if they wish it, as there may be circumstances in which the source of information has to be disclosed to someone else: for instance, if they wish to defend themselves against it. The policy could set out the boundaries around confidentiality and the other protections that are still available to those raising concerns in good faith. Bed sides are in use for one service user who cannot give their own consent for this, and has no suitable representative to do so on their behalf. In these circumstances, to ensure evidence of protection for the individual, the record should show clearly how the decision making process has been shared, and how it is kept under review. 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. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area could not be assessed. Standards relating to admissions to the home were not applicable at this inspection. EVIDENCE: There have been no new admissions to the home since 1993. It is therefore not possible to rate practice under the relevant standards. The organisation has relevant procedures, which have been applied in its other service. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 10 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 was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users have their abilities, needs and goals reflected in their individual plans. These could be enhanced by clearer updating and cross referencing of all relevant information. Service users can make choices and decisions in their daily lives. Service users are supported to take positive risks and access new opportunities, as part of an independent lifestyle. Risks associated with falls and mobility for one service user need to be more clearly documented, to provide clearer evidence of how this need is being supported. EVIDENCE: Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 11 Two sets of service user records were sampled during this key inspection. The home has a comprehensive care plan format. This provides a range of relevant information for each user. Needs are identified. The actions to be taken in response are clearly described. There is also a focus on people’s strengths and preferences. The home’s practice under a range of standards can be seen by reference to these plans. Care plans include a section on goals for each individual. These set out the actions being taken towards these targets. They provide a framework for review. This takes place at regular intervals. Where changes have been made, the previous information is also left visible. This shows how things have developed. Records could be filed and updated more clearly, to ensure that relevant current information is always accessible. Sampled files at this inspection usually included a detailed and up to date entry on key need areas somewhere, but this was not always in the care plan itself, and the plans were not necessarily cross referenced to this important new information. The home promotes people’s rights to make their own choices and decisions, wherever possible. A Users’ Charter sets out their entitlements. Experimentation and exploration are encouraged. The input of the home’s staff team, and other relevant parties, is to ensure that responsible decisions are reached by a process of assessment. Guidelines for the approach taken to particular needs are drawn up with help from other professionals. Systems for the management of service users’ money appear to be efficient. The registered manager is appointee for all five, although some people have the involvement of family or other representatives in respect of certain sums. Appropriate recording is in place to demonstrate the home’s accounting systems. These are open for inspection, if relatives wish it. They are also checked annually by an external accountant. Arrangements for direct payment of service users’ benefits income are in line with guidance set out by the CSCI. The account used for this purpose is kept separate from the main business account of the home, not forming part of its assets. Also, the account records are itemised, to show separately deposits and withdrawals for each individual service user for whom monies are received. A range of risk assessments are in place. They are kept under review. They include topics specific to individual residents. Guidelines for particular areas are drawn up with input from relevant professionals. This is shown clearly on the record. One of the service users whose records were sampled has a number of needs associated with mobility and also has frequent falls. This individual’s record contained some information on relevant areas, but did not cover all aspects of Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 12 the topic. Guidance for staff on how to support the individual was not set out in detail, to explain how to ensure that both service user and staff safety is upheld whilst giving assistance. There was also no risk assessment relating specifically to the issue of falls. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are provided with a range of activities and opportunities, offering them full engagement with their local community. Service users are able to maintain and develop appropriate relationships with family and friends. Service users’ rights and responsibilities are upheld, balanced with appropriate steps to safeguard their welfare. Service users are offered healthy, nutritious and enjoyable meals, in line with individual needs and preferences. EVIDENCE: Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 14 Residents of Inlands Close attend a variety of educational and occupational facilities for a number of sessions each week. There is also some outreach support. The home’s own staff escort service users to daytime opportunities, if that is necessary for the place to be taken up. There is a need to have drivers on duty, to get people to various locations. This has to be borne in mind when compiling rotas. When people are not attending daytime occupation or education, the home ensures that they get one to one input. This enables them to undertake activities. A weekly plan ensures that all service users get equal access to opportunities, and allocates the staff members who will support them. Trips out for activities such as shopping, visiting cafes or having a haircut were taking place for a variety of service users over both days of this inspection visit. Residents at Inlands Close make full use of the range of amenities on offer in Pewsey itself. They also travel further afield to participate in leisure opportunities that reflect their particular interests. The home has its own vehicle. Outings this year have included trips to Bournemouth, Weymouth and Bristol Zoo. At home, users have access to entertainment equipment in their own rooms. There are also a range of games, puzzles, and books available. Outside the home, users attend some local clubs specifically intended for people with learning disability. They also access a full range of integrated activities. People participate in physical exercise, including swimming. All users receive the opportunity of an annual holiday, escorted by staff. These are done in small groups. Some people may only go for short breaks, if they find it difficult to cope with longer periods of absence from familiar surroundings. Holiday destinations have included trips overseas. So far in 2006 all service users except one have been away. Family contact has become limited for the majority of the current resident group. This is chiefly due to the age of relatives, or the fact that they do not live nearby. However, for some individuals there has also been success in initiating contact after many years without any. The home aims to support family links as much as possible, where this is wished for. Some users have specific friendships, and they are helped to maintain these. Visitors to Inlands Close are welcome at any reasonable time. People are generally encouraged to notify the home of an intended visit in advance. This means the home can ensure that the relevant resident will be present, and can be made ready to welcome guests. The importance of allowing users privacy with their visitors is stressed in guidance to staff. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 15 The home also has an appropriate policy statement about residents’ relationships. This balances their rights with staff’s duty of care. There is generally unrestricted freedom of movement for residents. They are expected to respect the privacy of each person’s own bedroom. A limited number of areas are kept locked, for particular health and safety reasons. External access is also made secure overnight. Care plans show the reasons for such steps. There are guidelines on the morning routine for each day of the week. These vary, depending on which service users have to go out. The times that people need to get up are specified, where necessary. Inlands Close has always been found to have a pleasant, homely atmosphere. Positive interactions amongst residents and staff are the norm. There is no sense of barriers between the two groups. All meals are prepared by staff of the home, in line with the known needs and preferences of the service users. Staff receive training in food safety, and the home has recently obtained some updated information on this topic. Menus show that a variety of dishes are served. None of the current residents have any particular special dietary needs, but the advice of a dietician has been obtained on occasions. Some people use adapted cutlery and crockery. An occupational therapist has advised on the most suitable items for the relevant individuals. The household usually dine together. There is a separate table in the conservatory which is sometimes used by one person if they prefer to do so. Staff give support to service users during meals as required, whilst trying to promote each person’s independence as much as possible. The midday meal was sampled at the first of the two inspection visits to the home. This was a main course of omelettes with salad. Dessert was a choice of chocolate mousse, or fresh fruit served with yogurt. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are supported to address their personal and health care needs effectively. Service users are protected by the home’s policies and procedures for dealing with medicines. Practice would be further enhanced by improving the accessibility of updated information about any medication changes. EVIDENCE: All service users need a high degree of support with personal care. People are encouraged to do whatever they can for themselves. Attention is given to ensuring that they maintain a positive image at all times. Any specific issues related to individuals are known about. These are reflected in their care plans and guidelines. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 17 The home has been proactive in ensuring that the health needs of users are identified and addressed. Staff have worked hard to challenge and overcome negative images that may have been associated with people with learning disability in the past. They promote people’s rights to receive necessary treatment. There have been successes in the resolution of some long-term difficulties. A range of professional advice is sought in relation to all the needs of the user group. Some innovative approaches have also been tried. Health needs continue to develop for the group. These may be linked to natural ageing processes, or to the particular conditions that people have. There is ongoing monitoring and review of care. As well as responding to situations as they arise, the home plans ahead for likely future changes. This includes ensuring that staff receive training on any relevant topics. The service has been successful in supporting individual service users to successfully undergo difficult treatment which has brought benefits for their health and quality of life. Decisions about whether or not to intervene on specific issues are taken in consultation with all relevant professional advice, and with due regard for the welfare of the service user concerned. Referrals to national centres of expertise have been made to assist with the management of conditions such as epilepsy. None of the present service user group are self-medicating, so staff are involved in storage, administration and recording of any prescribed drugs. They receive training after they have been in post for six months. Most of this instruction is provided in-house by senior staff. Carers also attend a session provided by the home’s pharmacist, and work through a distance learning package. Training on the administration of one drug by a specific technique is given by the community nurse. There have been significant improvements in the home’s practices for the management of medication over the past year or so. At this inspection, all arrangements for storage and administration were seen to be appropriate. Recording was also being maintained in line with the required standards, but the presentation of information was not done in the most effective way. For instance, one service user was in the midst of a detailed programme for the change of some of their medication, involving a number of changes over a twelve week period. Clear information about this was recorded in the home, but not directly in the person’s own care notes, and it was not being kept with other medication information in the folder of administration record charts. Two other service users had their current medication administration record charts amended from the printed pharmacy instructions. It was not initially clear where the approval for the changed doses had come from. On further questioning, senior staff were able to show evidence in other records of which Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 18 prescribing doctors had made the changes. The link between the different documents needs to be shown much more clearly. Although the service has devised a useful form for noting any changes to a service user’s medication, these were not being kept up to date. This meant that the change information alongside current record charts was not necessarily correct, bringing some risk of the wrong details being referred to. Some medicines available without prescription may be given to service users on occasions. There is an approved list of these, which has been signed by one of the home’s GPs. The approval was most recently updated in July 2006. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected 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 was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are safeguarded by the service’s policies and procedures for complaints and protection. Policies regarding the systems for staff to raise any concerns about practice could be made clearer regarding the boundaries around the confidentiality of such information. EVIDENCE: A complaints procedure is in place. There is a version with symbols and photographs, intended to be more comprehensible for service users. A complaint received by the CSCI around the time of the home’s last inspection was referred back to Tullyboy Homes for their response. The organisation took appropriate steps in relation to this. An external consultant was engaged to look into some aspects of the complaint, whilst the provider responded directly on others. Where the external investigation upheld some elements of the complaint, and made recommendations for action, these findings were accepted and acted upon. This included a review of the complaints and staff grievance procedures. The organisation was also able to show evidence of suitable practice in response to other complaint elements. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 20 A separate allegation of staff misconduct also arose since the last inspection. The service reported this to other agencies as required, including notifying the CSCI. The matter was then investigated appropriately under the service’s own staff conduct procedures, and suitable actions taken in respect of the employee concerned. Inlands Close operates in accordance with local multi-agency arrangements for adult protection. A copy of the relevant procedure is kept in the home. A whistle blowing policy is also in place. The home’s whistle blowing policy should be amended slightly, as it needs to make clear that absolute guarantees of confidentiality cannot be given to staff who raise concerns. If these are acted upon, and lead to investigations or hearings, it may be that the identity of the person making the alert has to be disclosed. Service users at the home may present with episodes of disturbed behaviour on some occasions. This is usually infrequent. But guidelines are in place for any current issues. These have been developed with input from appropriate professionals, and are kept under review. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected 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 was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users live in a clean, comfortable and safe environment, which is suitable to meet their needs. EVIDENCE: All areas of the home were seen during this inspection. The premises are well maintained. There is evidence of regular and ongoing redecoration. Plans for coming months include the replacement of floor coverings and upholstery in the lounge. One of the owners is able to carry out a number of jobs himself, having relevant professional qualifications. Other contractors are engaged as necessary. Records are in place regarding the upkeep of the building. These note problems identified, set timescales for action, and show when they have been resolved. The main desire of the service is to maintain a homely feel. This has been achieved. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 22 Each service user has their own bedroom. Four of these are on the ground floor. All rooms are decorated and furnished to reflect the taste of their occupant. The first floor bedroom has an en-suite shower. Downstairs there is a bathroom, and also an additional separate toilet. Areas of communal space are all on the ground floor. There is a main lounge with dining area. A conservatory in the part of the house linking the original building with an extension has also been turned into a seating area. The enclosed rear garden has a patio which is often used during the summer. Inlands Close has a kitchen, with a separate utility room. A staff office and sleep-in room, with en-suite shower and toilet, is on the first floor. Various adaptations and equipment have been provided for service users with sensory and mobility impairments. Relevant professionals have been involved in providing advice on the most suitable options for each individual. One major recent change has been the provision of an adapted bath seat, which can be automatically raised and lowered. This has helped one less mobile service user to continue to access the bath. Further adaptations to the property are planned, to reflect increased mobility needs of a number of service users as they develop more health problems associated with ageing. These include refitting the ground floor bathroom to provide a shower; and providing ramps or level access where there are currently steps. A special step is also to be obtained that will make it easier for all service users to get in and out of the home’s own vehicle. The home was seen to be clean and hygienic throughout. Records are kept of cleaning schedules, and audited as part of the overall quality assurance process. Care staff carry out all cleaning and household tasks. Many of these are carried out during the week, leaving weekends more free to undertake activities with service users. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are supported by suitable numbers of appropriately trained staff. Service users are placed at risk by failure to provide evidence that all required recruitment checks are completed before new staff begin working with them. EVIDENCE: Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 24 Inlands Close was registered under previous legislation. So it must not regress from the staffing levels in place at 31st March 2002. A minimum of two staff per shift is always maintained during daytime cover. Whenever possible, this is increased to three. Additional staff are provided when this is required, to facilitate particular activities. Four staff were present on both visits during this key inspection, the first of which was unannounced. Staff levels had been increased over recent months due to a period of additional funding for one service user whilst they were recovering from an injury which restricted their access to other opportunities. Rotas for recent weeks showed that three staff had regularly been on duty during the day, up until 6 p.m. Two staff then worked until 10 p.m. Overnight cover consists of one person, who sleeps in. They have access to senior staff, via an on-call rota. There is a mixture of full and part-time staff. Some people work set shift patterns. These vary depending on individual circumstances. There is also a pool of relief staff, and agency cover may be used when necessary. Some care staff are aged under 21 years, and these individuals are never left unsupervised. There is a checklist for all stages of recruitment, selection, and joining the organisation. This is closely linked to the home’s quality assurance system. Records for two recent appointments were checked during this inspection. Most of the required evidence of recruitment checks was in place. But there were deficits relating to the taking up of references in one case. This employee had only one written reference, which was not from a previous employer. The individual had worked in a number of care settings. Information about these posts, and reasons for leaving each of them, was contained in the person’s application. But they had not given their most recent employer as a referee, and the previous care employer who was cited had not yet provided a reference. Service users have informal involvement in the recruitment and selection of staff, as candidates visit the home. Part of the complaint received by the CSCI earlier in 2006 about Inlands Close related to arrangements for the induction and supervision of staff. Both these areas were reviewed at this inspection, and practice was found to be satisfactory. All new starters are subject to an initial probationary period of six months. This may be extended, if it is felt that an employee has not yet demonstrated Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 25 the necessary competence or conduct. Additional supervision arrangements are then put in place. On initial induction, staff are supervised by a senior colleague. A checklist is used to record the various stages that are gone through with each employee. For their first few shifts new staff are not counted as part of the numbers on duty, and they work alongside existing staff, ‘shadowing’ them to learn about the service and its users. Induction of new employees is carried out in line with national standards for people working in learning disability services. One of the organisation’s managers acts as an assessor of employees working in other homes. This helps Tullyboy to earn credits towards putting its own candidates through the training. The home’s training programme looks to access any courses which may be relevant to the needs of the user group. Some learning also takes place inhouse. Talks are occasionally given by some of the professionals with whom the home has contact. Individual training records are maintained for all employees. These include information about any qualifications people may have gained in previous employment. The organisation also has a strong commitment to National Vocational Qualifications. At Inlands Close, five care staff have achieved this award, four of them at Level 3. Two staff have now gone on to study for the Level 4 award, whilst another new employee is working towards Level 3. All staff receive supervision and appraisal, including those who only work a few hours a week. Both of the organisation’s registered managers act as supervisors for a group of staff. Individual sessions are used to focus specifically on a staff member’s own work and related issues. Group sessions are also held, which are used for presentation and discussion on policies and procedures and other topics relevant to the running of the home. Records of supervisions show that they are used to discuss all topics relevant to an individual’s work. This includes following up on any concerns that have arisen about someone’s conduct or performance. Expectations about how to address such issues are made clear. The small numbers of staff employed at the service mean that there are often informal contacts and discussions with managers. Senior staff use a notebook for brief details of any of these conversations which may also form a useful part of the overall record of their advice or instructions to the team. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41 & 42 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. The registered manager is suitably qualified, competent and experienced, so that service users benefit from a well run home. Service users benefit from the leadership of the home, which promotes an ethos of effective teamwork and appropriate conduct. Quality assurance measures underpin service developments, and include actions based on the views of service users. Suitable policies and procedures are in place and are being implemented to promote service users’ rights and best interests. Effective record keeping is maintained, but needs to include notification of key events to the CSCI, to ensure that service users benefit from an open and transparent service. Care should also be taken to keep detailed service user records separate from other material. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 27 Service users’ health and safety are protected by the systems in place. Steps should be taken to provide evidence of appropriate decision sharing to support the use of bed sides with one individual. EVIDENCE: Tullyboy Homes has two registered managers, although it is only Mrs Catherine Howie who is specifically registered as manager for Inlands Close. Mrs Sue Perry is registered in respect of the organisation’s other home. In practice, both registered persons work in each of the homes. They are both qualified to the required levels in both care and management. In addition, Mrs Howie has a professional background in learning disability nursing. Although not practising in this setting, she has maintained her registration through regularly updating her knowledge. The managers attend a range of courses and conferences. Tullyboy Homes is also a member of organisations concerned with developments in the social care field. Usually these two senior staff alternate the weeks when they focus on Inlands Close. The other week will be spent in the organisation’s other care home. However, they are available for advice and support when required. The access to two well qualified managerial staff is of advantage to the service. One carer at this home is also studying towards the NVQ Level 4 award, and taking on additional responsibilities. They will also be able to offer managerial support to both services. Records of the input given to the staff team show evidence of effective leadership. This has ensured that any significant issues around individual staff performance are addressed effectively, to uphold the welfare of service users. It has also been balanced with recognition of the pressures which staff may be experiencing, due to personal circumstances, and an appropriate willingness to take any possible steps to support people in tackling these. Expectations of staff conduct are made clear in relevant policies, and the consequences of misconduct are also explained. An extensive quality assurance system has been devised and implemented by the organisation. It is built around the home’s Statement of Purpose, and tailored specifically to the service. The system enables a comprehensive audit of all areas of performance. Frequencies of review are set at varying intervals: monthly, quarterly, or annually. Staff are allocated different areas to check. Annual review is tied in with the service’s end of financial year. This enables findings to be incorporated into the next year’s business plan. It is also shown who is responsible for checking on various areas. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 28 It is difficult to get feedback from the resident group at Inlands Close, but efforts have been made to get their views via a questionnaire. Policies and procedures of the organisation were criticised in the complaint made earlier in 2006. In response, these were found to be generally satisfactory, but there has also been a thorough programme to ensure that all documents are reviewed and updated. This process is continuing. The service is also able to demonstrate that procedures are presented to and discussed with staff at team meetings, and that they are readily available to refer to when required. Inlands Close maintains all required areas of recording. The home’s record keeping policy reflects the requirements of the Data Protection Act. It makes clear the rights of access of users to the records held about them. Records about service users are generally of a good standard. Entries reflect positive aspects, and include general comment on somebody’s mood, behaviour and state of health, as well as any necessary details about significant incidents. Record keeping needs to also include notification to the CSCI whenever significant incidents occur. The service has been carrying this out in most cases, but examples were found in sampled records at this inspection where this had been omitted. For instance, when one service user was suspected to have sustained a fracture for the second time in a few months; and when the same individual was unable to use the home’s own bathing facilities for a period, and had to go to the organisation’s other care home to have a shower. Care should also be taken to keep individual service user records in separate files. In one example seen at this inspection, the most detailed and up to date entry about an important current element of one person’s care was contained in a general staff communication book. This is not appropriate, as it means that the information is alongside other material that is not part of the service user’s care record. There are effective arrangements to promote health and safety. There is evidence of regular checks and maintenance on key equipment and systems. Policies and procedures are in place for a range of relevant issues. Risk assessments have been carried out, and are kept under review. Staff receive regular training on health and safety topics. This is updated as necessary. The fire log book showed that the prescribed checks, practices and staff instruction are recorded as being carried out and up to date. Records of fire drills include details of how service users responded, as well as staff. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 29 One service user uses a bed side to minimise the risk of them falling out. Guidelines are in place to explain why and how this equipment is used. But there is no information relating to the decision making process. The individual is not able to give informed consent, and does not have a suitable representative to do so on their behalf. Therefore, the care record should make clear which other persons have reached the decision, and how it is kept under review. Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 30 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 N/A 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 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 4 3 X 4 3 3 3 2 3 X Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 31 No Are there any outstanding requirements from the last inspection? 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 YA9 Regulation 12-1 13-4,5 15 Requirement Service user records must include suitable risk assessments and guidance on falls and mobility, where relevant to the care of that individual. These Regulations also apply to the above requirement. Timescale for action 31/10/06 1 2 YA9 YA34 17-1a Sch3-1b 7;9;19 Sch2-3 31/10/06 Staff recruitment records must 18/09/06 include two written references, including, where applicable, a reference relating to the person’s last period of employment which involved working with vulnerable people. The persons registered must notify the Commission without delay of any serious injury to a service user, and any event which adversely affects the wellbeing of any service user. 18/09/06 3 YA41 37-1c,e Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA20 Good Practice Recommendations There should be clear updating and cross-referencing of all documents which make up the current service user record. Current medication guidance for individual service users should be kept in the folder with administration record charts, for ease of reference. The home should ensure that its own form for noting any changes to service user medication is kept up to date for each individual. The whistle blowing policy should be amended to make clear the boundaries around confidentiality when people raise concerns. Detailed records relating to individual service users should be entered in that person’s care record and not be made in the staff communication book. Evidence should be documented to support the decision about the use of bed sides for a service user who lacks the capacity to consent to this, and who has no representative to do so on their behalf. 3 YA20 4 YA23 5 YA41 6 YA42 Tullyboy Homes DS0000028632.V301342.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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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