Inspection on 20/06/07 for Victoria House

This inspection was carried out on 20th June 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 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Victoria House 09/06/08

Victoria House 11/12/06

Victoria House 02/03/06

Victoria House 13/09/05

Victoria House 28/02/05

Victoria House 12/10/04

Victoria House 23/03/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Victoria House 10 & 11 Victoria Terrace Bedlington Northumberland NE22 5QA Lead Inspector Alan Baxter Key Unannounced Inspection 20 , 21 and 27th June 2007 13:30 th st Victoria House DS0000000556.V338234.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 Victoria House DS0000000556.V338234.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. Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria House Address 10 & 11 Victoria Terrace Bedlington Northumberland NE22 5QA 01670 828396 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) Mr F Haley Mrs R Haley Mrs R Haley Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 1 place can be used to accommodate a named service user who has a mental disorder (excluding learning disability or dementia). 11th December 2006 Date of last inspection Brief Description of the Service: Victoria House was originally two terraced houses and work had been carried out to form one well-equipped house that can provide accommodation for up to six people. A conservatory has recently been built at the rear of the building. At the time of the inspection the Home accommodated six adults with learning disabilities. The accommodation was domestic in nature and was comfortably furnished and appointed. There is a small garden area/patio area to the rear of the property. Victoria House is situated within walking distance of Bedlington town centre and is therefore close to a range of local amenities. The fees charged are £456.43 per week. Information about the home, including inspection reports, is available on request. Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. How the inspection was carried out Before the visit: We looked at: • Information we have received since the last visit on 11th December 2006. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on 20th, 21st and 27th June 2007. During the visit we: • • • • • • Talked with people who use the service, relatives, staff, the manager & visitors. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the last visit. We told the manager/provider what we found. What the service does well: The needs of the ladies who live in the home have been well assessed, and are clearly written down. Any possible risks are also carefully assessed. Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 6 All the ladies attend college courses several days each week and they do a variety of courses. The ladies are asked what courses they want to do next. The ladies are involved in their local community and use neighbourhood shops and services during the day. The ladies have regular contact with their families and friends, who are made welcome when they visit the home. Some of the ladies go out with their families sometimes. The ladies say that they all enjoy living in the home. They say that they feel safe there, and that they would tell the staff if they were unhappy about anything. The health of the ladies is carefully watched, and any health problems are quickly reported to their doctor or consultant. Any complaints are taken seriously and properly recorded and sorted out. The building is kept clean and tidy. All the ladies have their own single bedrooms that they have arranged to suit themselves. What has improved since the last inspection? The ladies have been asked their opinions on some important issues since the last inspection, and the staff have acted on what they said. There are more evening activities put on for the ladies. These include an increase in the number of trips out to theatres and other places of entertainment, and more activities in the home, such as crafts, bingo and board games. The ladies said that they enjoy having more fun with the staff. The daily routines for the ladies have been made a little less strict, and they are beginning to be encouraged to take a few more decisions themselves, especially in the evenings. Staff are now recording things in the care records in a more thoughtful way. This shows that they are thinking more about the ladies being given respect and having their views taken into account. New menus have been brought in, after discussion with the ladies. These menus show that the ladies are now being given a healthier diet, and more choice as to what they eat. There has been more staff training since the last inspection. All staff have now either got National Vocational Qualification (NVQ) level 2 in care, or are Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 7 working towards this. All staff have been trained in the protection of vulnerable adults. Other training has also been given. The systems for making sure that the home is giving the service that it says it will have been improved, with more regular staff meeting, meetings with the ladies, and questionnaires being sent out. Some building problems seen at the last inspection have been sorted out. 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. The summary of this inspection report can be made available in other formats on request. Victoria House DS0000000556.V338234.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 Victoria House DS0000000556.V338234.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): Standard 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are assessed before they are admitted to the home. EVIDENCE: Each resident has an up to date assessment of her needs carried out by the responsible NHS Trust. In addition, each resident has an ‘Assessment for Good Care Planning’, drawn up by the home manager. This has been introduced only recently. It is not clear that this is a validated assessment format, but it appears to be quite comprehensive, covering physical and mental health needs, social needs and preferences, risk assessments etc. Victoria House DS0000000556.V338234.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): Standards 6,7,8 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans do not give staff the necessary detail of how they are meeting all the assessed need of each resident. Consultation with the ladies on issues affecting them has improved, but is still an occasional, rather than a regular, process. Good quality risk assessments have been carried out for each resident. EVIDENCE: Residents’ Care Plans: It was a requirement of the last inspection report that each resident’s care plan must be re-drawn, with each identified area of need being addressed with its Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 11 own care plan. Also, that the format must highlight areas of care and support, have measurable outcomes and space for evaluation of the progress towards each goal. Finally, that residents’ care plans must be working documents, available to staff and residents at all times, and used as the main focus for recording progress. This has been partly carried out. New assessment and care planning documentation has been purchased (see standard 2, above) and this has been completed in a thorough and thoughtful way. However, the layout of the documentation does not give enough space for recording a detailed plan of care, particularly in the section ‘staff actions’. It must, therefore, be amended to give sufficient space for this (an acceptable layout was sketched for the manager), and the care plans re-drawn. It is also laid out in a format that prompts the need for monthly evaluations of care and for six monthly formal reviews. In the last inspection report it was recommended that current assessments and the associated care plans should be kept on one file, to demonstrate that both elements are in place at any one time. This has been carried out. Assessments and care plans are held together on each resident’s file, and these are kept in the kitchen area, accessible to all staff at all times. It was a further requirement of the last inspection report that residents who present challenging behaviour must have a detailed individual behavioural care plan, focussing on positive behaviour, ability and willingness, agreed with the care manager and based on current best practice; that positive guidelines for responding to challenging behaviours must be introduced for staff; and that appropriate training in the positive management of challenging behaviours must be given to staff. This has been only partly carried out. No detailed individual behavioural care plans have been drawn up. The manager said that she would be seeking advice from the behavioural psychologist who is involved with several of the residents. The newly introduced ‘guidelines for responding to challenging behaviours’ still do not clearly set out the need to describe the build up to incidents of challenging behaviours, nor the consequences or outcomes of such behaviours. A brief record is now being kept of such incidents. This needs to be further developed, and must show that staff are responding to challenging behaviours in the agreed ways, as set down in individual care plans (yet to be introduced). Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 12 Also, these guidelines still rely on using ‘time-out’ as the only sanction, when this has previously been discredited by insensitive and inappropriate use. Mrs Haley said that she would discuss these issues with the consultant who treats the residents. With regard to the requirement to give appropriate staff training in the management of challenging behaviours, Mrs Haley said that this had been done before the last inspection. She said that staff had been given a full day’s training in this area with the local Behaviour Analysis Intervention Team (BAIT), and had also covered the same areas in both their ‘Learning Disabilities Award Framework’ (LDAF) training, and as part of their National Vocational Qualification (NVQ) level 2 in care. This being the case, it becomes a management issue to model how this should be implemented and to ensure that staff are applying such training in their daily work. Since this inspection, three staff who are undergoing LDAF training have been booked on a one-day BAIT training course on 18th September. Decision Making: It was a requirement of the last inspection report that a clear written record must be kept of all examples of residents being given choices and being consulted on the running of the home. This has been partly carried out. The minutes of consultation meetings with the residents were seen. These showed that some important consultation has taken place since the last inspection. This includes asking them how they wish to be described and addressed (the consensus was ‘first name’ as individuals, and ‘ladies’ when described as a group). There was evidence of the ladies being involved in the recruitment interviews of two potential new staff members; and of the ladies being involved in discussions about bedtimes and changing into night wear. There was also evidence of their opinions being asked about holiday destinations and a small number of social activities. However, there were some long gaps between consultation meetings (one of ten weeks between January and April), and little evidence of the ladies being involved in day-to-day decision making in the home. This must also be recorded. Generally, there was evidence that less rigid approach to daily/nightly routines is gradually taking effect. There is a need to keep clear records (e.g. of the ladies’ bedtimes) to demonstrate that this more flexible approach to their care is continuing and expanding. Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 13 Risk Assessment: Risk assessment and risk management plans are very good. The plans promote choices, independence, rights and inclusion. Victoria House DS0000000556.V338234.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): Standards 12,13,14,15 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff support and encourage the ladies to continue their education, training and/or work placements. The ladies are well integrated into their local community during the day, and increasingly during the evenings, with more outside social activities and trips out being provided. The ladies are also being offered more and better-structured social and recreational activities in the home. Staff help the ladies keep close and regular contact with their families and friends, who are made welcome when they visit. The daily routines for the ladies have been made less rigid, and staff are beginning to support a greater degree of individual choice about those routines. Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 15 More thought has been put into the ladies’ diet, and there is now more variety and better nutritional content, with more choice being given. EVIDENCE: Education and Occupation: The ladies are encouraged to continue their education and training. All attend college, several days each week, and are involved in a variety of courses, including social skills, literacy and numeracy, and drama. One person has a one-day a week work placement. There was documentary evidence of the ladies being consulted on what college courses they wished to apply for in the future. Community Links: It was a requirement of the last inspection report that staff must support service users to become part of the local community during the evenings as well as during the day, and use the normal range of leisure opportunities. Sufficient staff must be made available to allow this. This is in the process of being carried out. There was documentary and verbal evidence that the ladies are well integrated into their local community during the day. There are many references in the daily diary to service users popping down to the local shops or going to the library. There were occasional references to lunches out and to going swimming. Once a week, four of the six ladies attend the local Gateway club, which is a club for adults with a learning disability (Gateway also organise occasional day trips). Since the last inspection, there has been an increase in the frequency of evening contacts with the local community. Activities records showed that most of the ladies attend a bi-monthly evening disco in Whitley Bay. Since the beginning of the year, there have been four theatre trips, two outings to other entertainment events and one meal out. Staffing levels are increased, where necessary, to allow for these events. Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 16 Leisure Activities: It was a requirement of the last inspection report that In-house leisure activities must be made more structured and varied, with staff taking a more active role in promoting quality activities such as baking and ‘pampering’ (this requirement is outstanding from 31/03/06). This has been carried out. A structured activities plan has been introduced. It includes a craft session twice a week (these have proved very popular), bingo and board games, and occasional ‘pamper’ sessions (again, very popular). There was anecdotal evidence of staff being more involved with the ladies around these activities. This, in turn, seems to be leading to a reduction in challenging behaviours from individual residents. Relationships: Staff support service users to maintain family links and friendships. The daily diary shows that families and friends are made welcome in the home, and can see their relatives in their bedroom, if they so wish. Daily Routines: It was a requirement of the last inspection report that daily routines and house rules must promote independence, individual choice and freedom of movement, subject to restriction only where agreed as part of the care plan. Also, practices such as changing into nightwear in the early evening; having one set time for all service users to go their bedrooms, with a set time for ‘lights out’; and the frequent use of isolation for prolonged periods in bedrooms as a sanction must be rethought and changed. This is in the process of being carried out. The care records, other documentation and anecdotal evidence all showed that there has been a gradual slackening of the rigidity and structure in the home. There is evidence of slightly more flexibility in the times that the ladies change into their nightwear, go to their rooms in the evening, and when they go to sleep. The need for the manager and staff to actively encourage choice and flexibility was discussed, as was the fact that the ladies may take time to adapt to having more choice in their habits. (As noted in standard 7, above, clear records must be kept to demonstrate the progress in this area.) Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 17 The use of long periods of isolation has been dropped, it was stated. It was noted, however, that this practice is still a possible sanction, according to the home’s own ‘Guidelines on Behaviour’. The lack of carefully thought out care plans for each individual, noted in standard 7, above, is also relevant here. Mrs Haley stated that she will be asking for individual advice and guidance from the relevant Consultant about how staff should best respond to ‘difficult’ or ‘challenging’ behaviours from the ladies. Meals and Mealtimes: It was a recommendation of the last inspection report that a four-week cycle of menus is recommended, to maximise choice and variety. This has been carried out. A three-week menu, drawn up with input from the ladies, has been introduced. It offers a cooked breakfast up to three times per week. It gives a choice of both lunch and the main evening meal (on an ‘either/or’ basis, with a vote at breakfast time). There is also a range of hot and cold desserts, and the menu states that individual ladies may ask for an alternative to the printed menu. There is an awareness of individual residents’ personal dietary needs, and these form part of the new assessment documentation. Records of meals show that the menu is generally being followed. Overall, there appears to be an improvement in the degree of choice, an increase in variety and an improvement in the nutritional content in the ladies’ diet. Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 18 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): Standards 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. Staff have improved the manner in which personal support is given to the ladies, and the manner in which it is recorded. However, as detailed plans have still not been drawn up, the home is not able to fully demonstrate that the ladies are being treated in ways that maximise their dignity, independence and control over their lives. Service users’ healthcare needs are recognised and met. The ladies have all chosen to let staff look after and give them their medicines. Staff are to receive further training in this area. EVIDENCE: Personal Support: It was a requirement of the last inspection report that staff must provide sensitive and flexible personal support and care to maximise service users’ Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 19 privacy, dignity, independence and control over their lives; and that all recordings must follow the home’s own policy that staff should “talk about each person with care and respect, representing them in a positive/competent light”. This has been partly carried out. The daily record book that was previously found to reflect a less than professional approach to the care of the ladies has been discontinued as a focus for recording the ‘everyday’ detail of events in the home. It is now used as a more general overview of the day, and has now got clear instructions at the front of what is acceptable recording practice. Each lady now has her own ‘care plan diary’, in which the recording is professional and avoids the previous errors. It is also rather brief and stilted, as if staff are now uncertain as what to record. The introduction of detailed care plans will give staff the necessary basis on which to focus their recording. Also, as noted above in standard 16, staff must record clearly the progress being made towards increasing the independence of the ladies and their ability to make decisions about their lives. It was a recommendation of the last inspection report that service users should be consulted on how they should be referred to. This has been carried out. At a meeting of all the ladies in the home in January this year, they decided that they would like to be called individually by their first names, and to be called ‘ladies’, when being talked to as a group and in recordings. The care records show that this has been largely put into practice. Healthcare: There was evidence that service users’ physical health needs are properly assessed and met. Documentary evidence was on file regarding referrals of various service users to a range of medical specialists. Risk assessments were in place regarding one service user at risk of injury through falls connected with a medical condition, and evidence that several staff had been given appropriate training to meet the service user’s needs. Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 20 Medication: It was a requirement of the last inspection report that the Medication Administration Record (MAR) must be improved by making sure that all handwritten entries are signed; by completing the sections entitled “commenced/route/received/quantity/by”; by dating amended entries; and by drawing up a list of the full names of each member of staff involved in administering medicines, along with the initials they use to record in the MAR, to be kept in the front of the MAR as an aid to auditing. This has been carried out. The Medication Administration Records were up to date and fully completed. Each of the ladies has given her written permission for staff to administer their medicines to them, and this is reviewed every six months. Risk assessments have been carried out. The proprietors, only, have had training in the safe handling of medicines. All staff administer medicines when on duty, and training in this important area is being arranged via Ashington Technical College. Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 21 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): Standards 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users feel that the staff listen to their views and act upon them. All care staff have had recent training in the protection of vulnerable adults from abuse. EVIDENCE: Complaints: Two complaints, only, have been logged in the past twelve months. Both were complaints by one resident against another and both were quickly resolved by staff intervention and counselling. The ladies are frequently asked if have any complaints. This was confirmed in the minutes of residents’ meetings. In discussion, the ladies confirmed that they would speak to the staff if they were upset or concerned about something. They said that the staff would listen to them and treat their concerns seriously. The home has yet to fully demonstrate that there is an open culture that encourages residents to express their views (see standard 37, below). Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 22 Protection: It was a requirement of the last inspection report that all staff must be given regular training in the Protection of Vulnerable Adults (POVA). This has been carried out. All care staff have attended an appropriate training course arranged by the Care Alliance training organisation and have received certificates to demonstrate this. The home’s proprietors have yet to attend this course. Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 23 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): Standards 24, 26 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The building is suitable for its purpose. The home is well maintained and safe. Minor repairs noted as being needed at the last inspection have been done. The ladies’ bedrooms are pleasantly furnished and decorated and are well personalised. All areas of the home were clean and tidy. EVIDENCE: The Premises: It was a requirement of the last inspection report that a paper towel dispenser is needed in the conservatory W.C., the cistern of which needs repair. Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 24 This has been carried out. It was a further requirement of the last inspection report that an external light must be fitted by the front door to illuminate the small step at the front of the building. This has been carried out. Individual Bedrooms: It was a requirement of the last inspection report that running water must be made available to service users’ wash hand basins at all times. This has been carried out. All now have running water available at all times. Bedrooms were clean and tidy and have been personalised by their occupants. Each had her own television set. Hygiene: All areas of the home were clean and tidy. Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 25 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): Standards 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. Staff are being given training to enhance their competencies, but this process has not yet been completed. Staff recruitment practices are not robust enough. Staff training has been given in many areas but induction training and equal opportunities training have not been given. Further training on dealing with challenging behaviours is planned but has yet to be received. EVIDENCE: Staff Competencies: It was a requirement of the last inspection report that staff must demonstrate that they have knowledge of the disabilities and specific conditions of service users; have the specialist skills to meet service users’ individual needs, including skills in communication and in dealing with anticipated behaviours; Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 26 and have understanding of physical and verbal aggression and self-harm as a way of communicating needs, preferences and frustrations. This is in the process of being carried out. As noted in standard 6, above, staff have already had some training in dealing with challenging behaviours, and further training has been booked with the Behavioural Analysis Intervention Team in September this year. The recordings in the care records have improved significantly, in that inappropriate language and terminology are no longer used. However, there is still no convincing evidence that all staff now know how to respond properly and positively to challenging behaviours, or how to properly record such incidents in their proper context. Specific care plans are still lacking, and there has been no evidence offered that specialist, individual input has been sought or received in this important area. There was evidence of a staff training needs analysis has been carried out and that staff annual appraisals include the setting of training needs, but the benefit of such training will be more obvious in the medium /long term. Two staff hold National Vocational Qualification (NVQ) level 2 in care, and another three staff are currently studying to achieve this. One carer holds NVQ3. Staff Recruitment: Study of the recruitment records of the last two staff members employed showed that most of the required elements were in place, including Criminal Record Bureau checks, proof of identity and written references. However, one had not fully completed the job application form, including the section asking for a declaration regarding any previous offences. The proprietors were advised, also, to take legal advice about the wording of this part of the form. Staff Training: It was a requirement of the last inspection report that new staff must be given formal induction training within six weeks of starting employment; and foundation training within six months. Only verbal evidence was offered that this had been carried out. Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 27 This requirement is repeated in this report. It was a further requirement of the last inspection report that individual and group training needs analyses must be kept up to date and all training needs identified must be met within a reasonable time; and that Equal opportunities training must be given to all staff. This has been partly carried out. Improvements were noted in the individual and group training analyses, and there has been a lot of training planned, with an emphasis on NVQ, LDAF and mandatory training. However, the requirement to give all staff training in equal opportunities has not been carried out, and is repeated. Staff Supervision: It was a requirement of the last inspection report that all staff must be given formal, recorded supervision at least six times each year. This is in the process of being carried out. Supervision records showed a clear two-monthly pattern of supervision for some, but not all, staff. This issue will be looked at again on the next inspection, to check that all staff have had six supervision sessions over the twelve monthly period. Good records are kept of supervision sessions. It was a further requirement of the last inspection report that all staff must have input into their annual appraisal; and that this must be recorded on the appraisal form, which should be signed by both parties. This has been partly carried out. In recent examples seen, the minutes have been signed by both parties, but there was no internal evidence that there is any real input by the staff member being appraised. Also, not all appraisals have had the person’s training and developments needs clearly identified. Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 28 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): Standards 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. The manager is experienced and qualified. She is working on improvements that will show that the home is run in such a way that it complies with its statement of purpose. There are systems in place to check that a quality service is being given. Some ‘safe working’ practices are not being carried out frequently enough. Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 29 EVIDENCE: Day-to day Operations: It was a requirement of the last inspection report that the Registered Manager must ensure that, at all times, the home is run in such a way that it complies with its statement of purpose. This is in the process of being carried out. This was discussed at length with the proprietors. The many improvements noted since the last inspection were acknowledged. These include better assessment of needs, more professional recording, more staff training, some areas of consultation, some loosening of the rigidity of daily routines etc. However, important issues such as properly informed and professional care plans have yet to be introduced. Also, many of the problems identified in the last inspection seemed to be well-established practices that will take time to change. As an example of this during this inspection, when the inspectors had given feedback to the registered manager about the ladies’ views, the manager called one resident through and effectively told her off for giving an ‘incorrect’ answer to the inspectors. This was a very uncomfortable situation for both the resident in question and for the inspectors, and again raised potential concerns as to the culture in the home. Quality Assurance: It was a requirement of the last inspection report that the home’s “Evaluation of the Service provided at Victoria House”, based on comments from service users, families and involved professionals, must be continually updated; that the quality assurance questionnaire for relatives and professionals must be revised, as this contains sections with multiple-questions, to which there is currently only a single ‘yes/no’ response possible; that regular staff meetings must be held; and that regular service user meetings must be held. All of these requirements have now been carried out. Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 30 Safe Working Practices: An inspection of the home by the local environmental health officer in August 2006 required “no further action”. An inspection by local Fire and Rescue Service officers found fire safety arrangements to be “satisfactory”. A current ‘Landlord’s Gas safety’ record, and a valid ‘Employer’s Liability’ certificate are displayed. Testing of portable electrical equipment was arranged in the course of this inspection, and evidence of this has been sent through since. The accident book showed nine entries in the past six months, all to the same lady. This person has a medical condition that makes her prone to falls, and she has been assessed and advised by the Falls Clinic. The fire logbook showed that fire alarms are tested weekly, and emergency lighting and fire extinguishers tested monthly. However, fire alarms and emergency lighting had not been serviced for more than a year, and this requires prompt attention (evidence of this has since been received). Also, carers all take turns at ‘sleeping in’ when on duty, so all are effectively night workers, for the purposes of fire instruction. However, they are receiving fire instruction only every six months, instead of three-monthly, as is required. Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 31 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 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 3 X X 2 X Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 32 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. Standard Regulation 1. YA6 15(2) Requirement Each resident’s care plan must be redrawn, with each identified area of need being addressed with its own care plan. The format must highlight areas of care and support, have measurable outcomes and space for evaluation of the progress towards each goal. Residents’ care plans must be working documents and used as the main focus for recording progress. (This requirement is outstanding from 31/03/07.) 2. YA6 15(1) Residents who present challenging 31/08/07 behaviour must have a detailed individual behavioural care plan, focussing on positive behaviour, ability and willingness, agreed with the care manager and based on current best practice. Positive guidelines for responding to challenging behaviours must be introduced for staff. Appropriate training in the positive management of challenging behaviours must be given to staff. Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 33 Timescale for action 31/08/07 (This requirement is outstanding from 31/03/07.) 3. YA7 12(2) A clear written record must be kept of all examples of residents being given choices and being consulted on the running of the home. (This requirement is outstanding from 31/01/07.) 4. YA16 12(4) Daily routines and house rules must promote independence, individual choice and freedom of movement, subject to restriction only where agreed as part of the care plan. Staff must continue to support and encourage the residents in making individual choices about their daily lives, and must clearly record the progress being made in achieving age-appropriate choices such as when to retire for the night. 5. YA18 12(5) Care plans and other care records must show that staff are providing positive and flexible personal support and care to maximise service users’ privacy, dignity, independence and control over their lives. All recordings must follow the home’s own policy that staff should talk about each person with care and respect, representing them in a positive/competent light. (This requirement is outstanding from 31/01/07.) 6. YA32 18(1) Staff must demonstrate that they have knowledge of the disabilities and specific conditions of service users; have the specialist skills to meet service users’ individual needs, including skills in communication and in dealing with DS0000000556.V338234.R01.S.doc Version 5.2 31/08/07 31/12/07 31/08/07 30/09/07 Victoria House Page 34 anticipated behaviours; and have understanding of physical and verbal aggression and self-harm as a way of communicating needs, preferences and frustrations. (This requirement is outstanding from 31/03/07.) 7. YA34 19 All sections of job application forms must be completed in full, and a record must be made to demonstrate that any omissions are discussed with the applicant. New staff must be given formal induction training within six weeks of starting employment, and foundation training within six months. (This requirement is outstanding from 31/12/06.) 9. YA35 18(1) Individual and group training needs analyses must be kept up to date and all training needs identified must be met within a reasonable time. Equal opportunities training must be given to all staff. (This requirement is outstanding from 30/04/07.) 10. YA36 18(2) All staff must be given formal, recorded supervision at least six times each year. All staff must have input into their annual appraisal. This must be recorded on the appraisal form, which should be signed by both parties. Training and development needs must be identified and recorded. (This requirement is outstanding from 31/12/06.) 11. YA37 Victoria House 31/08/07 8. YA35 18(1) 31/08/07 30/09/07 31/12/07 24(1) The Registered Manager must ensure DS0000000556.V338234.R01.S.doc Version 5.2 31/08/07 Page 35 that, at all times, the home is run in such a way that it complies with its statement of purpose. (This requirement is outstanding from 31/12/06.) 12. YA42 23(4) Fire alarms and emergency lighting systems must be serviced at least annually. All care staff who do ‘sleep-ins’ as part of their duties must be given fire instruction at least every three months. 13. YA16 13(6) No sanctions restricting the rights of residents may be imposed unless such restrictions have been agreed as part of a multi-disciplinary review of the care of a named individual resident. All care staff must be given accredited training in the safe handling of medicines. 31/07/07 31/07/07 14. YA20 13(2) 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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 Victoria House DS0000000556.V338234.R01.S.doc Version 5.2 Page 37 - 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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