Inspection on 27/09/06 for Urmston House

This inspection was carried out on 27th September 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Urmston House 18/10/05

Urmston House 04/05/05

Urmston House 05/11/04

Urmston House 11/05/04

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 Urmston House Hareclive Road Hartcliffe Bristol BS13 0LU Lead Inspector Sandra Gibson Key Unannounced Inspection 27th September 2006 09:00 Urmston House DS0000020367.V303505.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 Urmston House DS0000020367.V303505.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. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Urmston House Address Hareclive Road Hartcliffe Bristol BS13 0LU 0117 9642616 0117 9642662 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) Shaw Healthcare (Specialist Services) Ltd Miss Carolyn Jane Booth Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Staffing Notice dated 13/09/2000 applies Manager must be a RN on parts 5 or 14 of the NMC register Date of last inspection 18th October 2005 Brief Description of the Service: Urmston House is a purpose built residential care home registered with the Commission for Social Care Inspection to provide nursing care for 5 people with a learning disability in the age range 18 to 65 years. The home is owned and operated by Shaw HealthCare (Specialist Services) Ltd, a subsidiary of Shaw Homes, and was established to provide person centred care for adults with special needs in the community. The property is situated in a residential suburb of Bristol with local shops and amenities close by. Accommodation is arranged over two floors. The upper floor of the accommodation is office and staff facilities. There are five single bedrooms, all with en-suite bathrooms, and kitchen facilities. Each room has individual access to the garden area. Communal facilities include a lounge, snooze /therapy room, and a hot tub room. The home provides nursing care for five people with complex health and communication needs. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was unannounced key inspection conducted midweek between the hours of 9:00am and 5:30pm. Evidence was gathered from: Examining previous correspondence with the home including Regulation 37 (Death, illness, other events notifications), inspection reports, Regulation 26 reports of monthly made by the nominated responsible individual, information from pre-inspection questionnaire, relatives comment cards (3), talking to/observing residents, talking to the team leader /talking to and observing staff, observing and case tracking two residents, examining records, policies and procedures. What the service does well: What has improved since the last inspection? Measures in place to ensure that residents are protected from abuse have improved since the last inspection. The information in place is now up to date which ensures that residents are protected from risk of harm at all times. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 6 What they could do better: The information provided to prospective residents and current residents and their representatives is in need of attention to ensure that people have the full information they need to make an informed choice about where to live and that they are kept up date with information about the support and services that are provided by the staff. Residents’ needs are fully assessed to ensure the home is suitable to meet individual requirements. Minor improvements are required to ensure that residents and their representatives where appropriate are fully consulted during the process. Staff have a satisfactory awareness of individuals specialist needs and rights and treat the residents in a warm and respectful manner. However, further attention is required to ensure that residents’ health and safety are promoted. The complaints procedure remains satisfactory with some evidence that the service users representatives feel that their views are listened to and acted upon. However, action must be taken to ensure that all representatives are made aware of the procedure and who to complain to in the absence of the registered manager. The standard of the comfort in this home is satisfactory. However, urgent attention in respect of the health, safety and security of residents and staff is required to ensure that measures are in place to protect people, who live, work and visit Urmston House and work from risk of harm. Staffing levels have deteriorated since the last inspection. Urgent action must be taken to ensure that residents’ dependency needs are met at all times. The procedures for the recruitment of staff are likely to be satisfactory as the system in place ensures the protection of residents accommodated at Urmston House. However arrangements need to be in place to ensure this information is available for inspection Staff training has remained satisfactory since the last inspection. However, further attention to specialist training is required to take place to ensure that all residents’ individual needs are met and that staff have an awareness and understanding of equality and diversity. Support to care staff is not satisfactory. There has been deterioration since the last inspection. Further improvement in the formal support system is needed to ensure that residents benefit from staffs that are appropriately supervised. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 7 The home is going through a transition period following the temporary secondment of the registered manager. The management arrangements must be kept under review to ensure that communication between the acting manager and the staff team improves to ensure the health, safety and welfare of residents and staff are promoted and protected at all times. The systems in place to promote the health safety and welfare of residents and staff has improved since the last inspection. However, further work is required to ensure that this information is available at all times. 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. Urmston House DS0000020367.V303505.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 Urmston House DS0000020367.V303505.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): 1,2,3,4,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The information provided to prospective residents and current residents and their representatives is in need of attention to ensure that people have the full information they need to make an informed choice about where to live and that they are kept up date with information about the support and services that are provided by the staff. Residents’ needs are fully assessed to ensure the home is suitable to meet individual requirements. Minor improvements are required to ensure that residents and their representatives where appropriate are fully consulted during the process. Residents’ individual specialists needs are on the whole met in this home. EVIDENCE: The home provides long term nursing care and accommodation for five individuals. Admission to the home is normally through the care management approach, and the procedure involves trial visits, including overnight stays if appropriate. There have been no recent admissions. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 10 The service has developed a statement of purpose, which sets out the aims and objectives of the home. There is also a residents’ guide, which provides basic information about the service. There was no evidence to confirm that this guide has been provided to all current residents / or their representatives in a format they can understand. Four relatives commented that they were “Not aware of the complaints procedure, not aware of inspections and that they do not have access to inspection reports”. These documents are out of date and need to be reviewed and updated with the changes that have taken place since they were compiled. Residents have been provided with a contract/statement of terms and conditions according to the team leader on duty but this information was not available for inspection as there was no key holder to the secure storage present. Written evidence demonstrated that prospective residents have a needs assessment carried out before they are admitted to the home. Information seen at the inspection confirmed that the service consults the assessment and any other information to see if they can meet the prospective residents needs before they make the decision to accept the application for admission and offer a placement. The majority of residents have been living at the home for over five years. It was pleasing to see very detailed assessments in place for all residents completed by the staff in consultation with the resident and their representative where appropriate. However the resident’s representative had not signed the majority of those seen. Evidence confirmed that the majority of staff has the necessary basic skills and ability to care for residents who live in the home. There was also evidence of specialist training that had been provided to staff during the last couple of years to support them to work with residents with complex needs such as sensory impairment and behaviours that challenge the service such as selfinjuries behaviour. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The assessment and care planning system in place is good .It ensures that all aspects of personal, social and healthcare needs are met. Staff have a satisfactory awareness of individuals specialist needs and rights and treat the residents in a warm and respectful manner. However, further attention is required to ensure that residents’ health and safety is promoted. Confidentiality safeguards are in place, which safeguards resident’s interests EVIDENCE: Each resident is allocated a key team of support workers, led by a team leader, who implement the details of the care plan. Positive relationships have been developed, which enables key staff to understand and use complex communication methods to determine the likes, dislikes, choices and needs of the residents. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 12 Each resident has a comprehensive personal portfolio and person centred assessments, which means that staff put the views, wishes, likes and dislikes of each resident at the centre of all care provided. The information for each resident was very informative and useful enabling staff members to instantly provide the appropriate care to support their health and social needs. Support guidance covering all aspects of daily living was comprehensive and indicative of a person centred approach. The guidance for care provision was supported by detailed risk assessments, providing adequate information to minimise any risk to the residents. Advice is sought from the Community Learning Disability Team (CLDT) in developing behaviour management strategies and this was evident from records reviewed. In one care file sampled, the use of the Locked Door Policy (LDP) has been agreed through the assessment process. Following a requirement made at the last inspection this information has now been reflected in the individuals risk assessments. The locked door policy has been used with one individual as a behaviour management strategy. When this strategy is used a Behaviour Management Form is completed following guidance provided by the CLDT. There is also a monitoring system in place to ensure the use of the LDP was appropriate in all cases. This information is not currently sent to The Commission for Social Care Inspection under Regulation 37 notification Written evidence confirmed from a sample of portfolios examined that they continue to demonstrate a great knowledge and understanding of all residents’ emotional and psychological needs. Hospital appointments, visits to the General Practitioner and any other professionals are recorded to provide a history and quick reference guide. Residents continue to be supported to take risks as part of living a supported independent lifestyle. Examining a sample of residents care files and talking to staff members evidenced this. Residents’ personal files are held securely and staff demonstrated how they respected individual residents rights for privacy and confidentiality. Relatives’ surveys confirmed that resident’s confidentiality was respected. Urmston House DS0000020367.V303505.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): 11,12,13,14,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents enjoy a range of activities and are supported to live as fulfilling life as possible in and out of the home. Visitors are made very welcome and meals are well managed and provide daily variation, and good nutrition for people. EVIDENCE: All four residents were observed during the inspection. The inspector arrived at 9.00am when residents were in the process of getting up with the support of care staff or they had chosen to remain in bed. Two of the residents receive intensive day care three times a week from an external day care provider. They are supported to participate in activities such as visiting the airport, going out for coffee etc. Urmston House staff to go out in the community escorts one of the other residents who do not receive day care. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 14 Staff explained that the fourth residents needs have increased as a result of a chronic health need and evidence confirmed that staff were finding it difficult to meet this residents individual socials needs at this time. Following the last inspection in October 2005 two residents have enjoyed a holiday with the support of staff. One resident enjoyed a trip to Bream and another resident has had the opportunity to enjoy three-day trips including visits to The Maze, Bristol Zoo and Weston Super mare. According to the staff two more day trips are in the process of being planned. Residents are able to enjoy listening to music, watching television / DVDs in the privacy of their own rooms or in the communal lounge. Aromatherapy and Indian Head massage is also provided in this home. Some residents also attend a club on a Wednesday. All permanent staff on duty were observed as having a good humoured, warm mannered rapport with all residents. Evidence confirmed that this care was often provided under very difficult circumstances where staff are frequently hurt as a result of residents complex needs, which challenge the service. This information is not always sent to the Commission for Social Care inspection in the format of Regulation 37 notifications. Agency staff were also observed during the inspection and it was noted that they were not as responsive to residents as the permanent staff. Relatives comments included “Staff are always polite and ready to help” and “residents are cared for very well at Urmston House.” It was evident from the menus that they have produced a varied healthy diet plan. Alternatives are also made available and flexibility in meals was evident. Residents currently eat in their individual own rooms. According to staff spoken to during the inspection this is a result of individual’s complex needs, which can affect each other if meals are held communally. On the day of the inspection residents enjoyed lunch which consisted of a vegetable lasagne or home made chips and egg and a dessert. Both hot and cold drinks were available. Evidence confirmed that staff in the home support residents to eat a healthy diet. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 15 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 the service. Residents continue to be well supported to meet their physical and emotional health needs, they are monitored effectively and action is taken promptly when concerns arise so that residents may be confident that their needs will be met. The medication administration system and practice is satisfactory. The system in place ensures that residents and staff are fully protected. EVIDENCE: A sample of care files were reviewed and provided evidence that personal support and intimate care is provided with the residents preferences recorded as an integral part of the care provision. Guidance in relation to personal hygiene, clothing, hairstyles and choice of personal possessions in individual rooms was evident. The Inspector had the opportunity to observe a couple of residents and their interaction with staff. It was clear that their views, wishes and choices were listened to and acted upon by the staff members involved in their care. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 16 Following the last inspection a recommendation was made to ensure each residents file contained an up to date list of personal possessions, for example television set, stereo, furniture bought by the resident. There was evidence to confirm that this information is now available. There were satisfactory systems in place for monitoring each residents well being, and concerns about health were quickly addressed. Each resident had a health care file, and this provided evidence that support and guidance from other professionals was accessed ensuring a multi-disciplinary approach to the provision of care. Individual support is provided for residents to attend all health care appointments, and detailed consultation sheets are completed to ensure consistency of care. However, it came to of the inspector that several of the care staff had been concerned about one resident’s physical health, which was in the process of being reviewed by the medical team. Evidence received during the inspection indicated that the staff team were not always kept fully informed by the acting manager of multidisciplinary decisions that affect the day-to-day management of resident personal care needs. This lack of information had caused tensions within the staff team between support workers and the management team. This will be discussed further in the management section. The home provides nursing care, and all team leaders have a nursing qualification During the course of the inspection the General Practitioner was contacted by the member of staff in charge about one resident who had been observed by the staff as not being his/her usual self and had also not wanted to get out of bed. The General Practitioner consulted during the inspection spoke very positively about the care provided at Urmston House. A clinical psychologist consulted said “I have found particular members of the staff team and the home manager to be cooperative with assessments by professionals from the Community Learning difficulties team. They have been willing to attend meetings and training events in order to work in partnership to deliver interventions to a particular resident.” The qualified staff members administer medication, within robust policies and procedures. A sample audit of medication administration records was carried out and they were found to be up to date and accurate. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 17 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 the service. The complaints procedure remains satisfactory with some evidence that the service users representatives feel that their views are listened to and acted upon. However, action must be taken to ensure that all representatives are made aware of the procedure and who to complain to in the absence of the registered manager. Measures in place to ensure that residents are protected from abuse have improved since the last inspection. The information in place is now up to date which ensures that residents are protected from risk of harm at all times. EVIDENCE: A detailed complaints procedure is in place. Each resident is allocated a key team who co-ordinate and deliver individual care, and ensure the resident is aware of how to complain. Key team members advocate on behalf of the resident and make their views known. Records reviewed indicated that staff members promoted individual needs and choices, and confirmed that residents had been made aware of the policies in place. The organisation has in place a programme of abuse training, and staff members spoken with confirmed attendance. A staff member based in another home who has received training from the Local Authority provides abuse training for staff. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 18 The policies and procedures in relation to the reporting of alleged incidents of abuse are comprehensive and detailed. Guidance for staff has been updated since the last inspection to reflect the local authority protocols in place. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The standard of the comfort in this home is satisfactory. However, urgent attention in respect of the health, safety and security of residents and staff is required to ensure that measures are in place to protect people, who live, work and visit Urmston House are protected from risk of harm. EVIDENCE: An environmental tour was undertaken in communal areas, individual rooms, and laundry and garden area. The accommodation was found to be clean, tidy and well furnished. Adaptations were in place to meet the needs of each resident. Each resident has an individual apartment located on the ground floor. The apartments consist of en-suite bathing and kitchen facilities, with individual access to the garden. All rooms were viewed and had been personalised and adapted to meet the needs of the person accommodated. The decor and furniture was in good condition, and the apartments were clean and homely reflecting individual style and taste. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 20 There is a new maintenance person who works in the home. He confirmed that the maintenance log is in place and is functioning well. A review of this record indicated quick response times when maintenance issues arose. The records provided evidence that staff members were proactive in maintaining a homely, safe environment for the individuals accommodated. The home was clean, tidy and well furnished and unpleasant smells are kept to a minimum by regular cleaning and good hygiene standards. The domestic assistant was on duty at the time of the inspection However, during the course of the inspection it was observed that there were sharp items including tools, art equipment and sewing equipment that were being stored in the hallway which would place residents, staff and visitors at risk if residents were to throw or try to swallow theses items. An immediate requirement was made to remove these items. Large items such as cleaning equipment and a hose were being stored in the ground floor bathroom, which not only looked unsightly but also would make it difficult for residents and staff to access the bath. This bathroom also looks very institutionalised and would benefit from being made more homely an immediate requirement was made to remove this equipment. It was also noted that the snooze room was being used as a storage room and was no longer accessible to residents to enjoy. Improvements to the garden area have been made, and it was noted individual tastes were included particularly in the small garden areas adjacent to each residents room. Raised flowerbeds, plants, trellis and garden furniture to suit individual needs and choices have been purchased. One resident has a garden swing, another has decking, and generally the garden area has been improved. Each resident has access to the garden area from his or her apartment. A raised pebbled area is also being made for all residents but in particular one resident with a sensory impairment to enjoy enjoying. The security of the building and exterior lighting needs to be urgently review with a view to protecting residents and staff. A full risk assessment of security needs to be conducted to look at security issues at night and during the day. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Staffing levels have deteriorated since the last inspection. Urgent action must be taken to ensure that residents’ dependency needs are met at all times. The procedures for the recruitment of staff are likely to be satisfactory as the system in place ensures the protection of residents accommodated at Urmston House. However, arrangements need to be in place to ensure this information is available for inspection Staff training has remained satisfactory since the last inspection. However, further attention to specialist training is required to take place to ensure that all residents’ individual needs are met and that staff have an awareness and understanding of equality and diversity. Support to care staff is not satisfactory. There has been deterioration since the last inspection. Further improvement in the formal support system is needed to ensure that residents benefit from staffs that are appropriately supervised. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 22 EVIDENCE: There was evidence to confirm that staff were working long shifts to cover the gaps in the staff rota and staff who are on leave of absence. Agency staff are also used in this home, which does not provide consistency to resident that have very complex needs. Evidence confirmed that the home is currently in the process of recruiting staff from overseas to fill the staff vacancies. The recruitment process could not be examined, as there was no key holder present during the inspection. It was noted that arrangements were in place to conduct, Protection of vulnerable adults checks and a CRB (Criminal Records Bureau) disclosure. There have been no new members of staff since the last inspection. Staff training records showed that staff receive mandatory training on food hygiene, Protection of vulnerable adults, fire, first aid, health and safety and manual handling. Evidence of specialist training is taking place in this home but there no evidence found of equality and diversity training. There is a staff-training plan in place. All staff are either receiving NVQ training or have just completed training and wish to progress. Evidence confirmed that supervision in the past year including one person who had not received any supervision since they started working in the home. Written evidence confirmed that staff meetings have been taking place on a regular basis. Each resident is allocated a key team of support workers, and it was evident from records reviewed that staff within the key team advocated on behalf of the resident their views, choices and needs. One staff member explained the key team developed a good understanding of the individuals communication method, and were then able to advocate at review meetings on behalf of the individual. A new system to verify the recruitment checks and training provided to agency staff that are used by the home has been introduced. This ensures all agency staff carry identification when they attend the home, and written confirmation of the necessary employment checks is obtained prior to acceptance of the staff member. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 23 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): 37,38,39,40,41,42,43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is going through a transition period following the temporary secondment of the registered manager. The management arrangements must be kept under review to ensure that communication between the acting manager and the staff team improves to ensure the health, safety and welfare of residents and staff are promoted and protected at all times. The systems in place to promote the health safety and welfare of residents and staff has improved since the last inspection. However further work is required to ensure that this information is available at all times. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 24 EVIDENCE: The new registered manager is on secondment at care another home operated by Shaw Health care. This manager is due to return to Urmston House but staff were unclear about time scales and there were evidence of tensions between staff team, the acting manager and nominated responsible individual. Staff told the inspector that morale is low.” They said that they do not feel listened to and that there is no thanks from senior movement team”. A relative commented that Shaw Health care do not appear to look after their staff. Morale is very low at the moment” The acting manager was not present during the inspection due to annual leave. Evidence indicated that the systems of communication between staff and the management team such as staff handovers, staff meetings and supervision had deteriorated since the last inspection. The majority of staff members spoken to say the level of support had declined, and that they felt the manager was not always approachable and their views were sometimes not listened to. The Area Manager visits the home monthly and carries out an audit (Regulation 26). These reports are regularly sent to The Commission for Social Care Inspection. Staff spoken to say that they were not consulted during these visits. The nominated responsible individual explained that she has recently set up staff meetings, which staff have chosen not to attend. There are financial systems in place to safe guard resident’s finances. These arrangements were not checked during this inspection, as it was not possible to access the information There are robust systems in place for the maintenance of health and safety. On the whole Regulation 37 notifications are sent to The Commission of Social Care inspection regarding significant events that affect the health and safety of residents. However it was noted that they are not completed when the locked door policy is used or when staff are hurt as a result of residents’ challenging behaviour as discussed earlier in the report The fire logbook indicated that the relevant tests are being carried out at appropriate intervals. All historical information has now been removed from the fire logbook and stored appropriately as recommended at the last inspection was made. Evidence confirmed that the information recorded in relation to fire drills and training is held on the staff-training matrix, and monitored by the organisation as part of the quality audits in place. However, this information was not available for inspection. The organisation has in place robust policies and procedures providing comprehensive guidance to staff in relation to all aspects of service delivery. Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 25 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 2 2 3 3 3 4 3 5 3 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 1 25 3 26 3 27 2 28 2 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 1 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 2 1 2 3 2 2 3 Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 26 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 YA1 Regulation 6 Requirement The statement of purpose and service users guide must be reviewed on a regular basis to ensure that it is up to date and accurate. All resident/representatives must be supplied with a copy of the service users guide in a format that is suitable to them The complaints procedure must be provided to all resident/representatives in a format they can access All sharp objects including tools, art equipment and sewing equipment must be removed from the hallway The hose pipe and the carpet cleaning equipment must be removed from the ground floor bathroom and the area made more homely The residents snooze room must be put back into operation again and not used as a storage area Timescale for action 31/12/06 2. YA22 22 31/12/06 3. YA24 13(4) 27/09/06 4. YA27 23(2) 31/10/06 5. YA28 23(2)(l) 30/11/06 Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 27 6 YA24 23(2) 7 YA33 18 8 YA41 17 9 10 11 YA35 YA36 YA42 18 18 37 12 YA38 12(5) 13 YA39 26 The security of the building and exterior lighting needs to be urgently reviewed with a view to protecting residents and staff. A full risk assessment of security needs to be conducted to look at security issues at night and during the day. The staffing levels must be reviewed and urgent action must be taken to ensure that the staffing levels are met at all times. A plan of this action must be sent to CSCI Arrangements must be in place for all records outlined in Schedule 2 and 4 to be made available for inspection All Staff must be provided with equality and diversity training Supervision must be provided to all staff at least four times a year Regulation 37 notifications must also be sent to CSCI when the locked door policy is used or when staff are hurt as a result of residents challenging behaviour The relationship between the management team and staff team must be urgently reviewed to improve communication and staff morale Regulation 26 monthly visits must take place unannounced and residents /staff members must be observed and consulted during these visits 30/11/06 15/11/06 31/12/06 31/01/07 31/12/06 27/10/06 27/11/06 27/11/06 Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Urmston House DS0000020367.V303505.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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