Inspection on 24/08/07 for Valona

This inspection was carried out on 24th August 2007.

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

Other inspections for this house

Valona 30/06/06

Valona 09/01/06

Valona 16/02/05

Valona 10/05/04

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 Valona Valona Cockles Rise Crediton Devon EX17 3JB Lead Inspector Belinda Heginworth Unannounced Inspection 24th August 2007 09:15 Valona DS0000048550.V343904.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 Valona DS0000048550.V343904.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. Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Valona Address Valona Cockles Rise Crediton Devon EX17 3JB 01363 776331 01363 776998 patrickvln2@aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Regard Partnership Ltd Mrs Joleen Ann Marie Troake Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th June 2006 Brief Description of the Service: Valona is a small two-storey house, with a basement area, in a residential area of Crediton. It has nothing to distinguish it as a residential home and is close to the amenities of the centre of the town. It currently provides care and accommodation for three adults with a learning disability and is registered for four adults. The home is run by The Regard Partnership Limited who have many homes in various parts of the country. The average cost of care is £1000-1200 per week at the time of inspection. Additional costs, not covered in the fees, include massage, hairdressing and personal items such as toiletries and outings. One to one support is charged at £28 per hour. Money is put aside by Regard Partnership each year for the residents’ holiday. Current information about the service, including CSCI reports, which are accessible in the kitchen, are given to prospective people and/or their representatives. Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place during a weekday starting at 9.15am and lasting 5.75 hours. The manager was present throughout. Prior to the inspection the manager completed a self-assessment, which provides information about the people living at the home, staffing and confirmed that necessary policies and procedures are in place. It also provided information about how the home monitors and considers the care they deliver and how they intend to improve. This information helps the commission to prepare for the inspection, send out surveys to appropriate people and helps the commission form a judgement on how well the service is run. Some of the information provided is reflected throughout this report. Surveys were sent to the people living in the home, staff, relatives and healthcare professionals. One survey was returned from someone living in the home, five staff, one relative and two health professionals also responded to surveys. Comments from the surveys have been included in parts of this report. During the inspection we spoke to some of the people living in the home and made observations throughout. Some of the people living in the home have limited verbal communication skills; therefore some of the evidence came from staff and observations. We spoke with two staff during the inspection, read some documentation, this included fire safety records, staff recruitment files and systems to review the quality of services provided. We also looked around the building. We looked in depth at 3 files relating to the people living in the home. This meant we read all of the information from the time of admission to the present, we spoke to the staff about them, checked staff had the skills to meet those peoples’ needs, met with those people, visited their bedrooms and checked medication practices. What the service does well: The people living in the home had no assessments of need completed before admission, however there is now a good admission process for any future people coming to live at the home. There is detailed information recorded about each person, which helps staff to understand and meet peoples’ needs. However, some improvements are needed in this area. (See what they could do better) The staff team are very supportive to the people living in the home. They treat people kindly and respectfully. The staff work hard to ensure people attend appropriate activities and gain access to the local community. Some staff had developed an excellent communication system for one person living in the Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 6 home, which is reported to be very successful. The staff are now recruited appropriately meaning that checks to ensure they are safe to work with vulnerable people are now completed. A wide range of training is provided which helps staff to understand and meet peoples’ needs safely. Peoples’ health needs are monitored closely and staff support people to attend appropriate appointments when necessary. All staff receive training in medication practices although some improvements are needed in this area. (See what they could do better) The house is homely although in need of some re-decoration, peoples’ bedrooms are personalised, bright and cheerful. What has improved since the last inspection? What they could do better: Information about the services the home provides needs to be updated to ensure people are provided with accurate information. Care plans are not organised in such a way that it makes it easy to find information, there is also a lot of information that is no longer relevant. Care plans and action plans are confusing and could lead to inconsistent care. Daily records do not reflect action plans and therefore it is not always clear if peoples’ goals have been met. It is not always clear there are risk assessments relating to a person’s care. If care plans were cross referenced with risk assessments it would ensure staff were aware of the need to read them to ensure they care for people safely. One care plan also needed more guidance on health issues. The home should ensure where care plans have guidance on restraint, the manager should seek appropriate professional advice. This would ensure the restraint, if used, is appropriate for someone with a learning disability and consent and capacity issues have been considered. Staff make decisions on behalf of people, however it is important that such decisions are made in the person’s best interest. To achieve this a multidisciplinary is always recommended to ensure the process is open and Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 7 transparent. An example of this would be when staff decided to use someone’s money to buy their own furniture and bedding. This is normally supplied by the home within the fee structure. The storage of medication is not safe or secure and must be addressed as soon as possible. Other medication practices need to be reviewed to ensure peoples’ safety, health and welfare are fully protected. It should be clear if peoples’ monies are managed in an appropriate way, from how it is paid to people, how it is spent and receipts kept. This is to ensure people are protected from financial abuse. Some areas of the home are in need of decoration and the replacement of kitchen units and some carpets. Levels of staffing should be reviewed to ensure peoples’ needs can be met safely. The atmosphere in the home and staff’s confidence in the manager needs to be resolved to prevent it having an impact on the people living in the home. Systems that check the quality of care delivered to the people who live in the home needs to be more robust. This will ensure there is a formalised system that staff are aware of and responses to surveys help the home develop and improve. Risk assessments relating to fire need to be reviewed to ensure they remain relevant and appropriate. Records relating to staff fire safety training needs to be accurate to ensure staff who require training have received it. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Valona DS0000048550.V343904.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 Valona DS0000048550.V343904.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be assured their needs will be met through good admission processes. Minor amendments to the information provided by the home will ensure people are fully aware of the services. EVIDENCE: The people living in the home have done so for a number of years. Full assessments of need were not carried out before admission. However, the home now has good admission processes. This will ensure the home gathers enough information before admission to ensure needs can be met. The home has a statement of purpose and service user guide. This is information provided to people before admission that tells them about the services the home offers. The service user guide does not enough information about fees and extra costs. The manager said she would up date this. The service user guide is in a pictorial format to help people with some communication difficulties understand the information. Some of the information in the statement of purpose is not up to date. For example the cost of extra staff support states in the statement of purpose to be £12.50 per hour. The manager said it is actually £28 per hour. The garden Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 10 is not easily accessible to people with mobility problems, this needs to be included in the statement of purpose and service user guide. Valona DS0000048550.V343904.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People would benefit from staff having more accessible information that is accurate, current and up to date. This would ensure peoples’ needs are met safely and consistently. Decision-making processes need to be recorded to ensure they are discussed within a multidisciplinary setting and made in the person’s best interests. EVIDENCE: The people living in the home were unable to discuss their care plans due to their complex needs and communication difficulties. This evidence came from reading care records and risk assessments, responses from surveys, talking to staff and the manager and making some observations. Staff spoken with demonstrated an excellent understanding of peoples’ needs and risks. One staff member spoke about the information in the care plans and they updates they had been completing. Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 12 Each person living in the home has a file that contains a lot of information and this helps staff to understand peoples’ needs and risks. Each file has an action plan on areas of need that require specific action from staff to meet the need. In addition each person has a separate care plan, which also has actions to meet needs. These two documents do not always tie up with each other, making it confusing to understand what plan of action is appropriate and relevant. The files were large containing old information that was no longer correct. These large files made it harder to find information easily. Much of the information in the files has been recorded as being up dated in February 2007 but there was no record that any changes were made to the information. We found some of the information was no longer relevant or accurate and did not always provide enough guidance. For example, one person’s plan that provided guidance about how to meet a particular health need, did not include information about calling the emergency services. Staff had explained that medical intervention should be, to administer medication, but because staff have not received training on this, they call 999. Another example was with someone with complex behaviour. A detailed risk assessment / plan of care had been drawn up. The information stated what measures should be taken if the behaviour became dangerous. This included some restraint practices that are no longer seen as good practice to use with people with a learning disability. The manager said they have never had to use this type of restraint. The care plans should therefore be up dated to reflect this. The manager should also seek professional advice on appropriate and up to date forms of restraint when working with people with a learning disability. This advice should also consider consent and capacity issues. This will ensure the home is up to date with appropriate methods of managing people with complex needs. The same plan described that a minimum of two staff were needed when taking this person out and when carrying out any “restraint”. However, the manager said that the majority of the time another person living in the home would go out with this person with two staff. This could place everyone at risk if staff had to “intervene” if behaviours became unmanageable. (see section 31-36) Another example gave guidance when using the home’s car but the home now has a mini bus. This information should be updated to provide accurate guidance to staff. The majority of daily records did not reflect that work had been carried out to meet the action plans. For example, one person’s plan gave guidance on how to reduce the fear of heights and uneven slopes. The plan said to encourage walking and gradual introduction of slopes. Daily records read for a 2 week period made no mention of this work being carried out. Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 13 The manager said that decision-making processes are done in consultation with relatives and care managers. However, there were no records kept of decision made on behalf of people. For example, the decision to spend someone’s money on bedding and furniture that should be supplied by the home. (See section 22-23) Risk assessments have been completed for areas of risk, however these are kept separately from care plans. The care plans do not always indicate there is a risk attached to an activity and therefore do not point staff to read the appropriate risk assessment. Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from accessing the local community for activities. People are offered choices of well balanced meals. EVIDENCE: The staff team work hard to ensure people use local facilities for activities. These range from using day centres, reflexology, aromatherapy, trips to the beach, shops, cafes and church. On the day of the inspection one person had asked to go shopping, another was going to a day centre and one wanted to stay in watching TV. Trips are arranged, as much as possible, on an individual needs basis rather than in groups. However, as highlighted previously sometimes people go out together, which may not always be appropriate (See section 6-10) Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 15 A relative who responded to a survey was “delighted” that her relative “got out and about” so much. A response from a health professional said “although one person tends to dominate life choices – the care team endeavour to maximise the other service users’ right to make choices”. A staff member who responded to a survey said “we are always looking for new activities and new ways to improve our service users’ communication needs and life. We the staff team work hard to make sure their lives are enjoyable and give them full support”. Another staff, when asked what the home does really well, said, “individual day service programmes based on service users needs, constantly identifying new experiences”. Throughout the inspection staff were observed and heard speaking with people respectfully and in a caring manner. Individual menus were displayed. However, staff said these were not accurate as people chose what they wanted on a daily basis. The manager said the menus were about to be up dated to incorporate healthy eating plans which will include activities that consider a healthy life style. Daily records showed a wide range of meals were provided. Valona DS0000048550.V343904.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Peoples’ dignity and privacy is fully respected and people benefit from their health needs being closely monitored. Some guidance to help staff understand some health needs does not provide enough information. Some medication practices do not fully protect peoples’ health and welfare. EVIDENCE: Staff were observed supporting people in a caring and respectful manner. The staff have recently devised an excellent communication system for one person. This has been very successful in helping manage this person’s complex needs. Staff have a good knowledge of how people prefer to be spoken with and supported. Staff were observed and heard using appropriate forms of communication and supporting people well. Care plans provide information on peoples’ needs and communication. Health care records, on the whole, provided evidence of good health monitoring and staff support people to attend appointments. One person, with Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 17 a particular health need had limited guidance recorded on triggers that may set off that health need. The manager agreed to seek professional advice on this to ensure staff are aware of what to do to try to prevent this health need. Medication is supplied in monitored dosage packs, bottles, liquids and boxes. It is stored in a kitchen cupboard in the office / sleep-in room. The cupboard is locked through brackets with padlocks attached. However, when the padlocks are locked the doors can still be pulled out enough to get hands in. Although it might be difficult to pull out medication, the doors could be pulled open very easily. This is not a secure and suitable method to store medication. One medication is a controlled medication. Advice was obtained from the CSCI pharmacy manager about the storage of this medicine. The home is advised that although the medication that needs to be available in case of emergencies, can be stored with the other medication, any extra stock of the controlled medication must be stored in an appropriate controlled storage. There should also be a system to record when the controlled medication leaves the building and comes back. The home uses some un-prescribed medication bought “over the counter”. The Homely Remedy Policy does not include some of this medication. The home has obtained authorisation from GPs for the home to give “over the counter” medicines. However, it would be good practice to inform the GP of the particular medication they intend to give, especially given it is not included in the Homely Remedy policy. All staff have received training on medication administration, the manager said a more in-depth medication has also been arranged in the Autumn. The manager has not carried out assessments of staff’s competencies to ensure they remain competent to administer medication. Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Relatives and people living in the home are assured they are listened to and complaints are dealt with appropriately. There are systems in place to ensure people are protected from abuse. However, some financial records could indicate people are not fully protected from financial abuse. EVIDENCE: Staff spoken with described how they would know when someone with communication difficulties was unhappy. Their knowledge of peoples’ needs helps them to be aware of signs of unhappiness and therefore act and respond quickly. The home has a complaint’s procedure, which is in a pictorial format to help people with communication difficulties understand how to complain. However, the manager and staff explained that it is the staffs’ knowledge that is more effective at identifying when someone is not happy. Even with a pictorial complaint’s procedure, the people living in the home would not be able to understand it. A relative who responded to a survey said they had never had cause to complain but felt if they did, it would be dealt with quickly and properly. Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 19 The majority of the staff team have received abuse awareness training, those who haven’t are booked to attend later on in the year. Two staff spoken with on the day of the inspection, demonstrated an excellent understanding of types of abuse and what to do if they suspected any. The records of peoples’ monies were inspected. The organisation has set up individual building society accounts. Regard act as “trustees” of the accounts with some staff from the home as signatures to operate them on a day-to-day basis. Peoples’ benefits are paid to Regard then a cheque is made out for peoples’ own monies to be paid into their building society accounts. Statements of the organisation’s bank account were not available for inspection, therefore it could not be established if the money paid from the benefits formed part of the organisation’s assets. The manager was unaware of why the benefits could not be paid directly to peoples’ own building society accounts. Good financial records were kept of day-to-day spending with receipts kept. However, £200 was taken for one person’s building society account and no record was made in the home’s records what the money was spent on and no receipt could be found. The manager felt sure it was to pay for a bath chair for this person but was unable to find the receipt. This must be looked at to ensure peoples’ monies are fully protected from financial abuse. It was also found that people had purchased their own bedding and some furniture. The statement of purpose and service user guide provides no indication that this is an extra cost. There was no record that spending money on items like this was discussed and agreed with relatives, care managers or advocates. This would ensure that the spending of peoples’ money is done so appropriately and in their best interests, therefore protecting them from financial abuse. Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with clean and homely surroundings that, on the whole, meets their needs. The garden is not fully accessible to people with poor mobility. EVIDENCE: The house is on three levels with one bedroom with en-suite facilities on the basement level, another bedroom on the ground floor and two more on the second level. There is a bathroom on the ground floor and toilet on the second level. To access the lounge people have to go through the kitchen / dining room. All but one bedroom has suitable locks, the manager said the one without the suitable lock is to be replaced soon. However, none of the people living in the home are able to use keys. The front door has a coded keypad lock which is connected to the fire alarm system. This means if the fire alarms go off the front door will automatically open. Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 21 The hall and stair are in need of re-decoration and replacement of carpets. The kitchen units are looking very “tatty”, the manager said quotes have been obtained to have these replaced. On the day of the inspection, people were observed moving around the home freely. The house was clean, tidy and homely. Peoples’ bedrooms are decorated and furnished in a personalised way. The garden at the back of the house is on a slope with some steep steps and a railing down the side. People with poor mobility would find this area difficult to manage. Further to the back of the house is a level paved area with table and chairs, however to get there, people have to walk up a sloped area with no railings. Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are supported and protected with experienced staffing, who are recruited appropriately. Some peoples’ safety may be compromised through staffing levels that might not always be suitable. EVIDENCE: The home provides a minimum of three staff on duty in the mornings, during the week. The afternoon and evening has two staff with one staff sleeping-in at night. Staff spoken with during the inspection, raised concerns about the out of hours on-call arrangements. They said the manager was rarely available. The manager said that Regard have on out of hours on call manager system, which was displayed in the office. In addition, there was a note that stated that the staff member who was on a late shift in the evening, but not doing a sleep-in would be available on call. It also stated that the manager could be available if this did not suit the staff. However, staff said, the reality was that a more regular staff would be called before the manager. These issues need to be resolved which may happen when the team get together for a “team dynamics day”. (See section 37-43) Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 23 The people living in the home have complex needs and one in particular requires a lot of the staff time. The care plan for this person states he/she requires two staff when out but the reality is that often another person living in the home has to go as well. This potentially places people and staff at risk. The manager said the funding does not allow one-to-one support 24 hours a day. Discussions took place about ensuring the care plans are accurate about the support required and that staff numbers are reviewed to ensure peoples’ needs can be met safely. Staff talked about the training they have attended, which included induction, mandatory health & safety training, report writing, choice and communication. Over 50 of the staff team have completed a National Vocational Award (NVQ) level 2 or above. Staff felt they were provided with a good range of training but felt they received limited support from the manager. They said supervision was irregular and they are not listened to, or things they bring up are not acted on. The manager said supervision has become more regular recently and she is working through issues raised. Recruitment files were inspected, we found that fairly recently employed staff had appropriate checks completed before starting work. Staff who had been employed since early 2005 did not have appropriate checks completed before starting work. However, we felt confident that the new recruitment processes ensures people are protected from potential abuse. Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The strained atmosphere between staff and the manager is not beneficial to the people living in the home. Staff’s lack of confidence in the support given by the manager could impact on peoples’ lives. The systems to check the quality of care delivered to the people living in the home are not robust enough to ensure the work needed is carried out effectively. Peoples’ safety and welfare is not fully protected. EVIDENCE: Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 25 The manager has many years of experience of working in learning disability services. She is currently undertaking NVQ level 4 and the Registered Manager’s Award. Responses from staff surveys and when talking with staff during the inspection raised some serious concerns about the management style. The Commission has written to the organisation separately about these issues. During the inspection two staff were spoken with separately and in private. They repeated similar concerns, they felt the manager was not available out of normal working hours. They said she had falsified documentation and gave an example of a staff’s fire training record and supervision notes. They also said they had raised concerns about some staffs’ working practices and felt nothing had been done about it. They said the organisation had completed an investigation into their concerns with regard to the supervision notes. They said the result of this was a “team dynamics day” has been arranged, which they felt was because they were not believed. During the inspection the fire logbook was read and was found to be up to date. However, one staff member was recorded by the manager as having received fire drill training, when in fact the staff member was not on duty. The manager could not give any explanation as to why this had been recorded. Fire risk assessments were in place but had not been updated since April 2006. Discussions took place with the manager about staff’s comments. It was clear through responses from surveys and talking to some staff that there is not a happy working atmosphere between staff and the manager. This could impact on the people living in the home and needs to be addressed as quickly as possible. The manager felt the initial concern re supervision notes had been investigated fully and the investigation had found in her favour. The manager felt the “team dynamic day” might resolve some of the other issues. However, the organisation should also look into the other issues. For example, the fire records and supervision notes of staff to ensure staff’s concerns are being recorded and appropriately managed and resolved. The manager has many systems that check the quality of care being delivered to the people living in the home. Examples are – Health & safety audits, care plan reviews, staff supervisions and meetings, satisfaction surveys to relatives, GPs and other outside professionals involved in the home, audits by the organisation and staff training. However, regular staff supervision has only recently begun, reviews of care plans and peoples’ records are not always accurate, staff feel no action is taken at meetings and satisfaction survey results are not acted on by the home. The organisation collates the information from the surveys and produces a leaflet with the overall results within all their homes. The Manager should have a system that takes actions on how to improve services as a result of the surveys. A more formalised quality assurance system would also ensure time scales are included with people Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 26 responsible. This would ensure this work could be completed in the manager’s absence. A questionnaire and self-assessment was completed by the manager prior to the site visit. This provides information about the people living in the home, staff, and indicates whether necessary policies are in place. The information helps the commission prepare for the inspection and send surveys to appropriate people. It is also used to help the commission form a judgement as to whether the home is being run appropriately and safely. In this instance this information, the site visit and responses to surveys indicates the home is going through an unsettled time. Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 27 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 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 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 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 2 2 X 3 2 2 X 2 2 X Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 28 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 YA20 Regulation 13 (2) Requirement The home must make arrangements for the safe keeping of medicines. The medication cupboard is not secure and suitable to store medication. Suitable storage must be found for stock of any controlled medicines. A system to record when controlled medicines leave the premises and return must be devised. GPs must be told what unprescribed medicines are given by the home to ensure it is suitable, particularly when the medicine does not form part of the Homely Remedy Policy. 2. YA23 13 (6) The manager must make arrangements to ensure people living in the home are protected from financial abuse. This relates to money that was unaccounted for. The home must provide people DS0000048550.V343904.R01.S.doc Timescale for action 28/09/07 28/09/07 3. Valona YA24 16 (2) (c) 30/09/07 Page 29 Version 5.2 with adequate furniture and bedding for the people living in the home. 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 YA1 Good Practice Recommendations The service user guide and statement of purpose should be updated to include accurate information about the costs of fees and any extra charges. They should also include information about the garden being less accessible to people with poor mobility. Care plans should be organised in such a way that makes finding information easer. Irrelevant information should be taken out of the working plans. The manager needs to ensure there is one working care plan that is up to date and accurate. The information in the care plans should cross referenced with any documents relevant to help meet peoples’ needs safely, for example, risk assessments. The home should seek professional advice on appropriate methods of restraint, taking into account consent issues and their capacity. When decisions are make on behalf of people, for example, when deciding to spend peoples’ money on furniture and bedding, that would normally be provided by the home, a multi-disciplinary approach should be used. This would ensure the decision-making process is open and transparent and made in the person’s best interest. Risk assessments should cross referenced with care plans to ensure staff are aware that the activity they are about to undertake may have risks attached. The home should seek professional advice to compile guidance on how to meet some health needs, e.g. trigger factors to reduce the risk to someone with epilepsy. The manager should carry out regular checks on staffs’ competencies for administering medication. This will ensure staff remain competent to give out medication and therefore protect peoples’ welfare. The manager should ensure that monies belonging to the people living in the home, but which are paid directly to DS0000048550.V343904.R01.S.doc Version 5.2 Page 30 2. YA6 3. YA7 4. 5. 6. YA9 YA19 YA20 7. YA23 Valona 8. YA24 9. 10. 11. 12. YA33 YA36 YA38 YA39 13. 14. YA41 YA42 Regard, do not form part of the organisation’s assets. The hallway and stairs is in need of re-decoration and replacement of stair and hall carpets. The kitchen units and works tops need to be replaced to make the house more homely for people to live in. Staffing levels should be reviewed to ensure peoples’ needs can be met safely at all times. Staff supervision should be effective and supportive to staff. The poor atmosphere between management and staff should be improved to ensure it does not impact on peoples’ lives. Quality assurance systems should be well organised to ensure everyone is aware of the work that needs to be completed and by when. The home should devise a system that uses feedback from surveys in an effective manner, which helps the home come up with ways to develop and improve its services. Records relating to fire safety training for staff should be accurate. Fire risk assessments should be reviewed and updated. This will ensure the information is relevant and therefore protect people’s safety and welfare. The last review was held in April 2006. Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Valona DS0000048550.V343904.R01.S.doc Version 5.2 Page 32 - 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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