CARE HOME ADULTS 18-65
Valley View Highfield Street Swadlincote Derbyshire DE11 9AS Lead Inspector
Brian Marks Unannounced 27 April 2005 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 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 Stationary 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. Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Valley View Address Highfield Street, Swadlincote, Derbyshire, DE11 9AS 01283 218076 01283 218076 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) United Health Christine Looms Care Home 8 Category(ies) of LD - Learning Disability, 8 registration, with number of places Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 15 September 2004 Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 5 Brief Description of the Service: Valley View was opened in 2001 and is a purpose built home set in a large bungalow with gardens, registered to offer 8 places for adults with a severe learning disability; the commissioned purpose of the home was to provide accommodation to service users with substantial physical, sensory and learning disability. The physical environment of the home was designed to a high standard, and is spacious and comfortable with a high level of equipment and specially adapted facilities; it was not designed to accommodate people with behaviours that challenge. Because of the levels of disability in the resident group, the home offers an intensive package of support on a 24 hour basis, and staffing levels are accordingly very high. The registered manager is a qualified nurse. Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced visit that took place at the home over half a day. Additionally, time was spent in preparation for the visit, looking at previous reports and other documents. At the home, apart from examining documents, care files and records, time was spent looking around the building and speaking to 5 staff who were on duty and to the manager. The residents were not able to do verbally respond to the inspection but they were observed throughout the visit, being cared for by staff. What the service does well: What has improved since the last inspection?
Standards of staff training have improved and new staff now receive guidance on the control of infection and protection of residents from harm at an early point of their employment. Aspects of health and safety training have also been brought up to date and a number of staff have been on an extensive package of training in relation to the management of medicines. The quality of documents and information that is held about individual residents has been improved and a process of revising all of this has been started; this ensures greater consistency in the help given by staff. The
Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 7 manager has introduced surveys for all the people who have an interest in the home and this has given the home’s owners information on where things might be improved. Bedroom carpets have been cleaned and the look of the home has been improved. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 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 standard(s) 2 Residents’ needs were met following a system of assessment, carried out both before and after coming to the home; this formed the basis of the way staff cared for them in a consistent and individual way. EVIDENCE: None of the current residents had been admitted to the home in the past 12 months but information received from previous inspections and from discussion with staff indicated that residents had extensive assessments of their requirements carried out before they came to the home. The case files examined also had documents from care managers and other professionals involved with residents, indicating that the difficulties faced by the residents had continued to be examined. Staff at the home had used these assessments and added their own to develop care plans that laid out the practical help to be given to residents on a day-to-day basis. One file examined indicated that the programme of help had been looked at again, and the document revised within the past six months. Others examined showed that only parts of these ‘care plans’ had received this attention, which could lead to help being given that was founded on out of date information. The files also contained documents that highlight risk areas in residents’ lives and ways in which these risks are overcome (risk assessments). These risk assessments had been looked at and reviewed as required at the last inspection. All of these documents are individual to the resident concerned.
Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 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 standard(s) 6, 7 and 9 Detailed individual ‘care plans’ have been developed at the home so that consistent patterns of support can be given and the welfare and safety of residents maintained. Most residents have poor verbal communication skills and staff have developed individual ways of understanding what they want from their lives at the home. EVIDENCE: Examination of case files indicated that all residents have a care plan, referred to in the last section, which included aspects of personal and health care activity put together from the assessments that had taken place. Staff commented that these documents helped them get a clear picture of the residents and showed them how to provide consistent and individual help. It was noted that a varying amount of revision of the amount of documentation held within these files had been started. Again staff commented that this had helped them work more efficiently as the revised care plans were easier to follow. Within the documentation there was some indication that care plans had been reviewed regularly by the staff, although this was carried out over varying periods. Records indicated that arrangements had been looked at with care managers and other key people on an annual basis.
Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 11 All of the residents of the home have great difficulty with verbal communication, and staff were observed making use of a number of ways of understanding individual requirements, such as simple verbal prompts and gestures. Staff also described how body language and individual reactions also contributed to their understanding of choices being made by residents; one resident had recently acquired a communication board that transmits vibrations and sounds to help overcome his individual disabilities. Staff described how newly appointed staff would ‘shadow’ more experienced staff in order to observe care practice with the residents. Some elements of the care plans include risk assessments, which indicate key areas of concern and ways in which staff can minimise or eliminate any problems in order to ensure individuals did not come to harm, and to guide staff in safe ways of working. Examples of the problem areas covered included skin sensitivity, poor walking ability and the use of bedrails Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 12 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 standard(s) 12, 13, 14, 15 and 16 Because of the capability of the group of people who live at this home Standard 12 does not apply. Residents were encouraged to enjoy a range of activities both inside and outside of the home and to keep in contact with their families. EVIDENCE: Whilst three of the residents attended a local day centre for part of the week, indoor activities within the home remained a major part of the day and a ‘sensory’ session involving 3 staff and 5 residents was observed during the inspection. Staff stated that this offered both relaxation and stimulation and helped improve communication through 1-to-1 contacts. Two of the residents were at a local zoo during the inspection and the activity programmes for the residents indicated regular use of local facilities and services. Staff also described arrangements being made for holidays away from the home; these were sometimes for groups of residents and sometimes for individuals, depending on circumstances. Records and information from the
Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 13 manager indicated that people living at the home were encouraged to maintain family links and these varied from weekly contacts to just attendance at the annual review meeting. It was clear from discussion with staff that the complex natures of the disabilities experienced by these residents forces them to live isolated lives; staff are central to the experience of friendships and human contact. Observation of the daily programme at the home indicated that it is not over structured and staff stated that residents were assisted to do things at an individual pace, for example, most residents continued to spend periods of time alone in their rooms, particularly in the afternoons and 1 does this to enjoy music. At all times during the inspection staff were respectful in their communication with residents and privacy of service users was respected by the closing of doors, particularly bathrooms. Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 14 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 standard(s) 18, 19 and 20 Problems with residents’ health and personal care are well managed by the staff at the home and they are able to get the assistance of outside professionals when they need it. They are also able to obtain special equipment for certain individual residents that is used to make their lives easier. The administration of medicines by staff is well organised but some aspects of staff training need looking at to ensure complete safety in this area. EVIDENCE: Information in individual care plans indicates how staff at the home would care for and support residents, all of whom have a combination of complex physical, sensory and learning problems; the care plans are laid out in sufficient detail and clarity to ensure that they do so with consistency. Specialist equipment and furniture that had been supplied to individuals was seen in use and in bedrooms, and a new mobile hoist has been purchased for general use. Staff described how they had been instructed in using all the equipment and how resident lives were made easier. Records also showed how outside professionals were able to help residents; a physiotherapist, occupational therapist and a consultant specialist in rehabilitation are currently involved with the residents whose files were looked at. Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 15 Some of the residents have regular health problems and staff are assisted by the local GP practice to deal with these; these include epilepsy and problems arising from physical disability. Records on individual files indicated regular contact with the dentist and optician and routine visits to a number of outpatient clinics, both locally and in Derby. There are no residents who manage their own medicines and systems operated by staff at the home were satisfactory; a specialist pharmacist inspector had visited the home in 2003 and all of the requirements and recommendations made at that time had been subsequently complied with. The majority of staff had received formal training in the administration of medicines and the others instruction by the manager. Other ways of doing this were discussed to ensure that all staff are carrying out this task safely. Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 16 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 standard(s) 23 The home has robust policies and procedures in place to protect the residents from harm; these have been successfully put to practical use in the past. EVIDENCE: Policies and procedures for protecting from harm are well established at the home and training on the subject is included in the restructured programme of induction to the home for new staff. It is also covered for those staff that are getting training in a National Vocational Qualification (NVQ). There has been a recorded incident involving a resident since the home opened that involved the Statutory Procedures being put into operation, involving the local Social Services Department. The management and staff of the home were seen to act swiftly in order to protect the residents. Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 17 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 standard(s) 24 and 30 The home is equipped, furnished and maintained to a high standard and offers homely and spacious facilities for residents to enjoy. This is both a valued and valuing environment in which to live and work. EVIDENCE: The home was purpose built for people with the sort of difficulties experienced by the current residents. It is spacious and its corridors and rooms are large, although staff said that occasionally, when all the residents are in the lounge together there is little space to spare. It was supplied with a good range of equipment, furniture and fittings of a style that could be expected in an ordinary domestic setting, and security against intruders is covered by a keypad system. The home is near the town centre of Swadlincote and the home’s transport offers good access to local amenities. The maintenance programme of the home has been continued and all of the bedrooms visited had been decorated to suit individual tastes and styles; new furniture had been purchased for 2 residents to increase storage and all bedroom carpets have been successfully cleaned as required at the last inspection. The lounge carpet remains heavily stained but this is due for replacement within the redecoration programme for later this year. The area between the lounge and dining area
Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 18 has been fitted out for activities and this has improved the way that staff can work with residents. The home continued to benefit from the services of a maintenance person who ensures that all repairs are completed quickly and who is also responsible for a number of health and safety activities. The domestic assistant on duty described the cleaning programme for the home and how the deputy manager supports her and her colleague to maintain standards. The home has a well-equipped laundry, with care staff responsible for the personal laundry and bedding of residents. Standards of cleanliness and hygiene were high at the time of the inspection Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, and 35 The home is well staffed with experienced, skilled and knowledgeable people who are supported to work effectively by management and the staff peer group. EVIDENCE: Records on staff files showed that 11 care staff had completed or were completing an NVQ qualification at a minimum of level 2, and this is above the required proportion of 50 of staff. All the staff on duty had been at the home for more than 12 months and those spoken to were positive about the way they worked as a team to support residents. All of them were very committed to their work at the home and high levels of job satisfaction were talked about. They described the care that went into working out the best ways to individually support each resident and how they had learned how to communicate with the residents. Information from the staff rota indicated numbers of staff on duty in excess of the required standard. There had been little turnover of staff since the last inspection, and little need for the use of agency staff on daytime shifts, the manager relying on existing staff taking extra shifts. The staff meet together on a regular basis and those meetings were recorded.
Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 20 Staff stated that had enjoyed regular access to training and development opportunities, and examination of records indicated this to be the case although some important areas had not been covered in relation to key health and safety subjects for all staff (see next section). Examination of an induction workbook for a recently appointed staff member indicated improvements in the topics, although the manager confirmed that this had not been done within nationally agreed guidelines of the Learning Disability Award Framework (LDAF), as the NMS recommended. Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42 The manager, a qualified nurse, has begun a system of assessing the overall service of the home through the use of surveys and formal feedback. Safety of the home had been improved through specific aspects of staff training, but the latter process is not yet complete. EVIDENCE: The manager is a nurse with a learning disability qualification and has extensive experience of working with people with this type of difficulty. She has completed a Registered Manager’s course (NVQ4) with a local training outlet. The manager had introduced a company survey that had been completed by the residents’ key family members or supporters and this contributed to an overall assessment of the home against expected standards of quality. The manager and staff had also produced a bi-annual newsletter that is for circulation to all visitors to and supporters of the home. An annual plan had not been developed for the home, as required at the last inspection, and some advice was given regarding this requirement.
Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 22 Staff records indicated that training in relation to fire safety for staff had been carried out as required at the last inspection but not all staff, particularly those recently appointed, had received training in all of the important aspects of health and safety practices. As mentioned before in this report the maintenance person has a number of responsibilities in relation to health and safety at the home but his records were not examined at this inspection. Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23
ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x 4 Standard No 11 12 13 14 15 16 17 x N/A 3 3 3 3 x Standard No 31 32 33 34 35 36 Score 3 3 3 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Valley View Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 2 x
Version 1.30 Page 24 C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Yes 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. 2. Standard YA6 YA20 Regulation 15(2) 13(2), 18(1) Requirement The care plans of all residents must be reviewed regularly and at least every six monyths. All staff that administer medication must receive training from a pharmacist or appropriately qualified person. (Previous timesacle of 30.09.04 not met) The stained lounge carpet must be cleaned to eradicate marks. If the marks cannot be eradicated then the carpet must be replaced. (Previous timescale of 30.09.04 not met) An Annual Development Plan for the home must be developed. (Previous timescale of 30.09.04 not met) All staff at the home must receive training or instruction in emergency first aid and basic food hygiene. Timescale for action 31.10.05 31.08.05 3. YA24 23(2) 31.09.05 4. YA39 24(1-3) 30.08.05 5. YA42 13(3), 18(1) 31.10.05 Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA35 Good Practice Recommendations The training programme offered to staff including induction and foundation training must meet standards set by the Learning Disability Award Framework (LDAF). Valley View C52_C02_20112_ValleyView_224214_270405_Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection South Point, Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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