Inspection on 10/09/07 for Ventana

This inspection was carried out on 10th September 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ventana 30/09/08

Ventana 13/09/06

Ventana 05/10/05

Ventana 03/05/05

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 Ventana 33 Florence Road Boscombe Bournemouth Dorset BH5 1HJ Lead Inspector Heidi Banks Key Unannounced Inspection 10th September 2007 09:30 Ventana DS0000061762.V350339.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 Ventana DS0000061762.V350339.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. Ventana DS0000061762.V350339.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ventana Address 33 Florence Road Boscombe Bournemouth Dorset BH5 1HJ 01202 390209 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) Ventana Homes Ltd Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Ventana DS0000061762.V350339.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th September 2006 Brief Description of the Service: Ventana is a home for up to eight younger adults with learning disabilities and who may also have a physical disability. The home is situated in a residential area within five minutes’ level walk of the shopping centre of Boscombe, which has good public transport links to other areas including Bournemouth and Christchurch. The building is a large detached family house converted for use as a care home. There is a garden to the rear of the property. Bedroom accommodation for people is provided on the ground and first floors and all service users have single rooms with en-suite toilet facilities. Four bedrooms have additional ensuite bathing / shower facilities while the remaining four share communal bathing / shower facilities. The communal space comprises of a large lounge / dining area, a conservatory, a kitchen/ diner and a quiet space on the landing upstairs. All ground floor facilities are accessible to those using a wheelchair and the ground floor bedrooms have aids and adaptations suitable for service users with physical disabilities. The home is staffed 24 hours a day and provides a range of day-time activities both on the premises and in the community. At the time of the inspection, individual fees at the home ranged from £1100 to £1600 which is inclusive of day care provision. Fees do not include personal items such as toiletries or hairdressing costs. Further information on fee levels and fair terms of contracts can be obtained from the Office of Fair Trading; www.oft.gov.uk. Ventana DS0000061762.V350339.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection of the service. The inspection took place over approximately eleven hours on 10th and 17th September. The purpose of this inspection was to assess the home’s progress in meeting the key National Minimum Standards since the last key inspection of the service in September 2006. At the time of this inspection there were seven service users living at Ventana. During the inspection we were able to take a tour of the home, meet most of the people who use the service and observe some interaction between them and staff. Discussion took place with the home’s proprietor, Paul Greenwood, and some members of the staff team. A sample of records was examined including some policies and procedures, medication administration records, health and safety records and service user and staff files. Prior to the inspection, an Annual Quality Assurance Assessment (AQAA) was completed by the provider and submitted to the Commission. Surveys were distributed by the home to people who use the service, their relatives, care workers in the home, care managers and health care professionals on behalf of the Commission. A total of seven surveys were received and information from these sources is reflected throughout the report. A total of twenty-one standards were assessed at this inspection. What the service does well: The home responds well to the individual needs of people who use the service, ensuring there is a good amount of information available in care plans to promote consistency of support and ensure people’s needs and wishes are met. People are supported to lead an ordinary life in their home and community with individuals undertaking a wide range of activities to meet their personal needs. There is a good attention to detail with regards to provision of personal care and people are enabled to access appropriate health care services so that their well-being is promoted. Procedures and training are in place to promote the protection of the service users and ensure that they are kept safe from harm. The home provides a clean, comfortable and homely place to live, the ground floor of which is accessible to people who use wheelchairs. Surveys received from two visitors to the home commented on its welcoming and homely atmosphere. Ventana DS0000061762.V350339.R01.S.doc Version 5.2 Page 6 Care workers receive appropriate training to provide them with the knowledge and skills they need to work well with service users. Staff told us that communication in the home is good and they receive the support they need to do their jobs well. They are encouraged to put forward ideas and contribute to the home’s development. Although the post of Registered Manager is vacant, one of the home’s proprietors is currently taking responsibility for the day-to-day management of the home and providing a clear line of accountability for people who use the service. What has improved since the last inspection? What they could do better: As a result of this inspection, two requirements and six recommendations have been made. One requirement is being repeated from the last inspection of the service where the regulation has not been fully met. During this inspection, some shortfalls were identified in relation to medication procedures. The provider must review their medication procedures to ensure that they are fully robust and protect people who use the service. A requirement in relation to recruitment procedures is being repeated as not all staff records showed evidence of two written references having been obtained for them prior to them starting work at the home. Ventana DS0000061762.V350339.R01.S.doc Version 5.2 Page 7 Although risk assessments in place contained some useful and relevant information, they need to show evidence of regular review. This will ensure that they continue to contain valid information about service users’ needs. Records of meals eaten by individuals are currently not detailed enough to provide a full account of people’s food intake, for example, vegetables, fruit and snacks. This should be reviewed by the provider to ensure that anyone reading the record can identify whether it meets people’s dietary needs. The home has a complaints procedure but this would benefit from review to ensure that it contains accurate contact details for the Commission. The home should ensure that everyone who uses the service, including relatives, are aware how to make a complaint and that there is a system in place for documenting concerns and ensuring positive outcomes for people. Although the home has an annual development plan that is based on an internal audit process it is recommended that the home looks at ways in which they can obtain the views of people who use the service, their relatives, advocates and other visitors to the home. This will help ensure that people’s views are central to the development of the home and that it continues to be run in people’s best interests. It is recommended that the provider reviews some aspects of fire safety in the home to ensure that they have nominated a ‘competent person’ to oversee fire safety procedures and that everyone in the home has regular opportunities to participate in practice evacuations. This will help ensure that, in the event of an emergency, staff know what to do to promote the safety of the people they support. 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. Ventana DS0000061762.V350339.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 Ventana DS0000061762.V350339.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): These standards were not assessed at this inspection. EVIDENCE: Of the seven people living in the home at the time of the inspection, none had been admitted since the last inspection. Therefore this standard was not assessed on this occasion. However, the standard was met at the last inspection in September 2006. Ventana DS0000061762.V350339.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service benefit from a person-centred approach that takes account of their needs, preferences and choice. EVIDENCE: Inspection of a sample of people’s care plans showed good attention to detail with regards to their support needs and preferences; ‘X tends to wake between the hours of 7am and 8am…X likes to have sugar on his cereal and a cup of warm milky tea or coffee…X can use a cup with a spout.’ Plans were written in a person-centred style and included reference to people’s choices and preferences. In particular, care plans contained some detailed information on how individuals with non-verbal communication may communicate their needs so that staff are able to respond appropriately. Plans showed consideration of people’s goals and a system is in place for monitoring people’s progress towards achieving these goals. Some gaps were Ventana DS0000061762.V350339.R01.S.doc Version 5.2 Page 11 noted in recording so it was not always clear whether goals had been met, or if not, the reasons for this. However, a system for reviewing goal plans is in place which provides an opportunity for this information to be recorded. All five care workers responding to the survey indicated that they always have up-to-date information available to them about the needs of the people they support. One care worker commented that this information was ‘very clear, precise and helpful, always relevant’. Staff also told us they feel that offering choices to people is something the home does well and this was echoed by a relative who indicated that the service meets the specific needs of their family member. A sample of risk assessments was seen. It was evident that these showed consideration for promoting people’s independence with due regard for their safety. For example, where one person likes to make a hot drink it has been noted that opportunities to do this with support should be encouraged by staff. There was also evidence that where an incident had occurred which put one person at risk this had been risk assessed and measures put in place to minimise the risk of reoccurrence. However, guidelines on file had not been signed or dated. Two risk assessments seen had been written in June 2006, one stating that a review should take place after six months. There was no evidence that these assessments had been reviewed in the past year. Ventana DS0000061762.V350339.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported to have a lifestyle that meets their individual needs and respects their rights. EVIDENCE: Inspection of service users’ daily records and discussion with staff indicated that people are given opportunities to undertake a range of activities in their home and community. This includes courses at college, art and crafts, walks to the seafront and visits to local parks, shops, cafes and pubs. Goal planning documents were seen to take account of people’s personal wishes, for example, visits to a local leisure centre for swimming sessions, although there were gaps in recording where this had not taken place in the few weeks prior to the inspection. The proprietor confirmed that this activity was due to be resumed the following day and would continue on a fortnightly basis. At the Ventana DS0000061762.V350339.R01.S.doc Version 5.2 Page 13 present time the home does not have its own vehicle to enable community access. Discussion with the provider indicated that this was being given consideration. Observation of activity in the home during the inspection indicated that there were sufficient staff on duty for people who were at home to engage in activities of their choice with some service users going shopping, one going to the seafront and others engaging in a craft activity at home. Lists of individuals’ particular preferences were available in support plans. Records showed that visits from and to friends and relatives are encouraged and this also formed part of people’s goal plans. A survey received from a relative indicated that the care home did well at helping the service user keep in touch with them; ‘All the staff are very pleasant and always make us welcome’. Observation of people in their home showed that they are able to access all communal areas and their own bedrooms without restriction. People were able to come into the office area and talk to the proprietor and inspector as they wished. Discussion with the proprietor and staff showed sensitivity to people’s diverse needs and where people want to be more independent, for example to assist with mowing the lawn, risk assessments had been completed to enable this to happen. Arrangements for people’s ownership of keys to their home and bedrooms and arrangements for managing money had been documented on people’s files. A health care professional visiting the home commented in a survey that the home always respects individuals’ privacy and dignity. Care plans gave comprehensive information about people’s needs in relation to eating and drinking. Where one person requires assistance the level of support had been detailed and a goal plan had been put in place with regards to this. Observation showed that one individual was enabled to eat their breakfast at a different time from others with one-to-one support, this indicating that routines are sufficiently flexible to accommodate people’s needs. Likes and dislikes had been clearly documented on file. Records in relation to meals eaten by service users are maintained but it was noted that they do not always give enough information. For example, a record for one service user over a three day period made no reference to vegetables or fruit consumed with evening meals being documented as ‘pork chops’, ‘fish pie’ and ‘chicken curry’. Some meals had also been referred to as ‘free choice’ with no additional information to indicate what the person had chosen. Ventana DS0000061762.V350339.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a person-centred approach to personal care and ensures that people access generic and specialist health care services to meet their needs. However, practices around the administration of medication need improvement to ensure systems are robust and people are fully protected. EVIDENCE: Inspection of a sample of care plans indicated that people’s needs and preferences in relation to their personal care had been identified, for example, ‘X likes to have her bath and hair washed at about 9 or 9.30am…X does not like to be rushed.’ The need for staff to ensure the person’s privacy and dignity is respected during personal care had also been highlighted; ‘It is important to make sure X’s curtains are closed if the light is on to ensure privacy’. Observation of interactions between staff and people who use the service during the inspection showed that they were treated with respect in relation to Ventana DS0000061762.V350339.R01.S.doc Version 5.2 Page 15 their personal care, for example, a care worker ensuring that a service user changed their top when it had become soiled. One relative responding to the survey commented ‘The care X receives at ‘Ventana’ is excellent…my husband and I are completely satisfied with X’s care’. Examination of a sample of people’s health care records indicated that they attend a range of health care appointments to meet their needs including their general practitioner, specialist psychiatry services, dentist, optician, physiotherapist and occupational therapist. For an individual with epilepsy there was evidence of a specific care plan on file in relation to this giving information about what staff must do to respond appropriately. For another service user with non-verbal communication there was comprehensive information on how they may express pain or discomfort and strategies that staff should use to respond to this. The care plan in place in relation to a service user with specific eating needs was discussed with the proprietor. This contained some useful information for staff regarding the consistency of food but it was suggested that specialist advice is sought to inform the current plan and ensure risks are minimised. A health care professional stated in a survey that they feel the home always seeks advice and acts upon it to manage and improve individuals’ health care needs; ‘The staff are always quick to seek advice and inform me of any changes in clients’ conditions’. The home’s medication procedures were reviewed. The home has a policy on the administration of medication which covers the storage of medicines, the ordering and receiving of medication, risk assessment, disposal of medicines and the procedures to be followed in the event of a drug error. Medication is supplied by a pharmacy in monitored dosage systems and boxes. Medication administration record (MAR) charts are also printed by the pharmacy. Inspection of a sample of MAR charts against monitored dosage systems indicated two gaps over the previous weekend where medication had been given but not signed for by the care worker. On one MAR chart, dosage instructions had been handwritten on the chart by a care worker. It was recommended that any handwritten additions to the chart are signed by two care workers to ensure that the information is accurate. Although incoming medication had been recorded on the MAR chart the audit trail for boxed medication was not clear. It was recommended that the provider sets up a clear system for auditing medication on a regular basis. It is also recommended that the ways in which each person needs and prefers their medication to be administered to them is clearly documented in their care plans to provide information to care workers about this task. Ventana DS0000061762.V350339.R01.S.doc Version 5.2 Page 16 Inspection of training records showed that staff access medication training which is facilitated by the pharmacy. Guidance from the Commission’s website regarding training requirements for care workers has been supplied to the provider so that they can ensure the current training programme is sufficiently robust. During the inspection a medication error occurring the previous week was discussed with the proprietor. This had not been recorded on the MAR chart and there was no evidence of an incident report having been completed since the error was made which meant there was no written evidence at the time of the inspection to indicate what had happened. Discussion indicated that the proprietor had been contacted at the time of the incident by the care worker and the British National Formulary (medication manual) had been consulted for advice. However, the home’s policy, which states that medical advice should be sought in the event of an error, had not been followed. Since this has been highlighted, the provider reports that appropriate action has been taken to review procedures and training in the home to ensure that they are robust. Ventana DS0000061762.V350339.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that complaints and risks of harm to people who use the service are responded to appropriately. EVIDENCE: There is a notice on the door of the office in the home stating that people should speak to the proprietors if they have any worries or complaints. The notice also alerts people to the fact that they can contact the Commission about their concerns and gives the Commission’s telephone number. The home’s complaints policy was seen, this stating that the all complaints to the home will be dealt with quickly and investigated thoroughly and fairly by senior staff or the proprietor. It was discussed that the procedure could be made more specific in terms of expectations around timescales for responding to a complaint and should give the contact details for the Commission’s local office. Throughout the inspection it was evident that service users were able to approach the proprietor to discuss things that were important to them. Discussion took place with the provider about making the procedure as accessible as possible to people who use the service who have non-verbal communication. The provider has stated in their Annual Quality Assurance Assessment (AQAA) document that they plan to introduce three-monthly Ventana DS0000061762.V350339.R01.S.doc Version 5.2 Page 18 service user meetings chaired by an external advocate in the next twelve months to ensure that service users have regular opportunities to express their views independently of staff. One relative who responded to the survey indicated that they could not remember how to make a complaint about the care provided by the home but also indicated that where they had raised any concerns about their relative’s care these had always been responded to appropriately. This was echoed by a health care professional who also stated that any concerns they had raised had been dealt with effectively. All five care workers responding to the survey indicated that they were aware what to do if a service user or relative expressed concerns about the home. The proprietor confirmed that they have not received any complaints about the service since the last inspection. No complaints have been received by the Commission. It was suggested to the proprietor that the home looks at ways in which concerns which may be raised on a day-to-day basis are documented to evidence how they are dealing with issues that arise and promoting positive outcomes for people who use the service. A sample of training records inspected showed that care workers have attended formal training in safeguarding adults. A copy of the multi-agency guidance ‘No Secrets’ was available for reference at the home. Discussion with the proprietor indicated that he is aware of his responsibilities with regards to safeguarding adults. The provider informed us in their Annual Quality Assurance Assessment that there have been no adult protection concerns occurring in the home in the past twelve months which have required referral or investigation. Ventana DS0000061762.V350339.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a clean and pleasant place for people to live that meets their individual needs. EVIDENCE: A tour of the home indicated that it is well-maintained and furnished in a comfortable way. Individual bedrooms have been decorated and personalised to meet people’s needs and preferences and people have access to their own bedroom at all times. Where there are risks of people self-harming this has been given consideration in their bedroom environment and discussion with the proprietor indicated that they have strived to implement the least restrictive means necessary to promote people’s safety. The provider has told us in their Annual Quality Assurance Assessment that they have made a number of improvements to the home environment in the past twelve months including installation of a new cooker, boiler, carpets, flooring and washing machine. Ventana DS0000061762.V350339.R01.S.doc Version 5.2 Page 20 At the time of the inspection, the home presented as clean with no offensive odours. The provider has told us in their Annual Quality Assurance Assessment that they have a policy for preventing infection and managing infection control and that nine care workers at the home have received training in this area. Inspection of a sample of care workers’ records confirmed this. Ventana DS0000061762.V350339.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are supported by appropriately trained staff but a shortfall in recruitment procedures indicates that systems are not always robust enough to ensure they are fully protected. EVIDENCE: Discussion with the proprietor and surveys from staff indicated that there is an induction training programme in place for staff which they undertake on commencement of their employment. Information on file showed that this covered information about their role, the philosophy of care in the home, health and safety procedures, medication procedures and an introduction to policies. One care worker commented that the induction was ‘very good…I was clearly informed of all tasks, regulations and home values’. Discussion with the proprietor indicated that five out of eleven care workers employed at the home have a National Vocational Qualification (NVQ) in Care. Ventana DS0000061762.V350339.R01.S.doc Version 5.2 Page 22 The recruitment documentation for three care workers was examined. These were well-organised with each file showing evidence of an enhanced disclosure from the Criminal Records’ Bureau (CRB) and suitable proof of identity. One shortfall was identified where for one care worker there was evidence of only one written reference being received prior to them starting in post. All five staff responding to the survey indicated that they were aware the home had carried out CRB disclosures and obtained references before they started in post. A sample of training records was seen. These showed that staff have been supported to attend a range of training courses to meet the needs of the service user group. In addition, some staff had attended training in total communication approaches, foot care and epilepsy which reflect the needs of individuals using the service. Discussion with the proprietor indicated that he has made links with local training providers and initiatives to ensure that access to training is promoted. All five staff responding to the survey indicated that they were being provided with training that is relevant to their role and helps them understand and meet the needs of individual service users. A relative of a service user indicated that they felt care workers have the right skills and experience to look after people properly and this was echoed by a health care professional who noted that there is good attendance at training events by all staff and that staff demonstrate a good awareness of people’s diverse needs. Ventana DS0000061762.V350339.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although systems are in place to promote the efficient running of the home some areas for improvement were noted that will ensure a more robust approach to quality assurance processes and health and safety. EVIDENCE: At the time of the inspection the post of Registered Manager in the home was vacant. However, Mr Greenwood is currently managing the home on a day-today basis and has submitted an application to the Commission for registration as manager. The two breaches in regulation found at this inspection, one of which is repeated from the last inspection, were discussed with the provider. He has Ventana DS0000061762.V350339.R01.S.doc Version 5.2 Page 24 expressed his commitment to develop more robust systems to monitor practice and compliance in these areas to ensure that procedures in the home fully meet the regulations. Since the inspection the provider has informed us that appropriate action is being taken in response to this. Surveys received from care workers in the home indicated that they feel wellsupported by the management of the home and that communication between management and staff is good. One care worker commented that the service ‘is always striving to review…and improve’ and another care worker told us that management allow workers freedom to input ideas. A copy of the home’s service development plan for 2007 was seen. This states that the plan is based on the findings of a quality audit that took place in January 2007. Areas covered in the plan included community participation, person-centred planning, health and well-being, promoting involvement of friends and relatives, preventing abuse, advocacy and rights, choice and decision-making, the home environment, staff support and health and safety. Discussion with the proprietor indicated that at present the home does not survey service users and others who have contact with the home as part of their quality assurance process. It is recommended that this is done to ensure that the views of people who use the service are central to the home’s development. A sample of health and safety records was inspected on the first day of the inspection. These included records of checks on fire call points, hot water temperatures and servicing records. It was noted that there were some gaps in recording over the past month and the annual inspection of gas safety in the home was three weeks overdue. The proprietor agreed to address these shortfalls immediately and by the second day of the inspection was able to evidence that appropriate checks had been resumed and a gas safety inspection had been carried out. Fire evacuation records were seen. The most recent fire drill had been carried out in April 2007. Staff and service users present for the drill, the time of the drill and time taken to evacuate had been documented. It was not clear from records that all staff working in the home, including night staff, had participated in a practice evacuation. A sample of records indicated that care workers are given regular fire instruction to help them understand procedures in the home. Records showed that this had been delivered by the previous manager of the home. The provider has been advised to identify a ‘competent person’ to take responsibility for fire safety in the home. Ventana DS0000061762.V350339.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 X 2 N/A 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 2 X X 2 X Ventana DS0000061762.V350339.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Timescale for action The registered person shall make 30/11/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The provider must review procedures for administering medication and record-keeping to ensure that they are robust and fully protect people who use the service. 2. YA34 19 The registered person must obtain all information and documentation as specified in Schedule 2 of the Care Homes Regulations 2001 prior to care workers commencing employment in the home. This refers to two suitable written references being obtained for all care workers prior to their commencement of employment in the home. This requirement is repeated Ventana DS0000061762.V350339.R01.S.doc Version 5.2 Page 27 Requirement 30/11/07 from the last inspection as the previous timescale of 30/11/06 was not fully met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA9 Good Practice Recommendations Risk assessments should be reviewed on a regular basis to ensure that they continue to be robust and service users are fully protected. Meals eaten by people who use the service should be clearly documented in sufficient detail so that the reader can determine the nutritional content of individuals’ diets. Where medication / dosage instructions are handwritten by care workers on the MAR chart the instructions should be signed by two members of staff to ensure their accuracy. There should be clear documentation in individual support plans to specify people’s medication requirements and the arrangements in place to ensure that these are met. The provider should review training in medication administration to ensure that all care workers who take responsibility for this task are competent to do so. The complaints procedure should be reviewed to ensure that it gives the contact details for the relevant office of the Commission for Social Care Inspection. The provider should ensure that all relatives are aware how to make a complaint. The provider should ensure that the complaints procedure is fully accessible to people living in the home. The provider should look to identify ways in which concerns may be documented to show evidence how dayto-day issues are responded to by the home and positive outcomes for service users are achieved. The provider should consider ways in which the views of service users and other interested parties can be obtained DS0000061762.V350339.R01.S.doc Version 5.2 Page 28 YA17 YA20 4. YA22 5. YA39 Ventana 6. YA42 to inform the home’s annual development plan and ensure that it is based on the needs and wishes of people who use the service. The provider should review fire drills in the home to ensure that all people who use the service and staff have regular opportunities to participate in evacuations. Fire drills should be carried out at variable times of the day and, in particular, at times when staffing levels are reduced to ensure that the home can be evacuated safely. The service should identify a ‘competent person’ to take responsibility for all aspects of fire safety and training in the home. Ventana DS0000061762.V350339.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Ventana DS0000061762.V350339.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. 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