Inspection on 26/02/07 for West Farm Road, 36

This inspection was carried out on 26th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

West Farm Road, 36 15/02/09

West Farm Road, 36 07/10/05

West Farm Road, 36 15/05/05

West Farm Road, 36 30/11/04

West Farm Road, 36 22/06/04

West Farm Road, 36 03/02/04

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 West Farm Road, 36 36 West Farm Road Howdon Wallsend Tyne & Wear NE28 7AY Lead Inspector Glynis Gaffney Key Unannounced Inspection 26 & 27 February and 4 & 7 March 2007 17:00 West Farm Road, 36 DS0000033090.V322769.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 West Farm Road, 36 DS0000033090.V322769.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. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service West Farm Road, 36 Address 36 West Farm Road Howdon Wallsend Tyne & Wear NE28 7AY 0191 2007161 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) Susan.Redpath@northtyneside.gov.uk North Tyneside Council Mrs S Redpath Care Home 6 Category(ies) of Learning disability (6) registration, with number of places West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may provide respite care at any time for up to three adults with a learning disability who are also wheelchair users. The maximum number of people cared for at any time must not exceed 6. 7th October 2005 Date of last inspection Brief Description of the Service: West Farm Road is set in a residential street in the village of Howden. It consists of a single storey building that has been designed to meet the needs of adults with learning and physical disabilities. The home provides short stay residential care breaks for about 50 adults and their families. The Community Learning Disability Team provides nursing care to a small group of residents. A bus route, pub and local shops are within easy walking distance. Service users are able to access all parts of the premises, including a small garden area to the rear of the building containing a selection of garden furniture. The home has a kitchen, a laundry, a lounge, a dining area, a sit-down shower/toilet and an assisted bath/toilet. There are six single bedrooms some of which contain adjustable beds. There is a ramp to the front entrance of the home and a small front garden. Street parking is available. Fees range from £11.35 per night to a maximum of £295 per week. The amount paid by each service user is subject to a financial assessment carried out by the local authority. The fees charged do not cover any expenses incurred by service users when joining in activities outside of the home such as meals, entrance fees and public transport. The home’s service user guide contained information about how to access a copy of West Farm’s last inspection report and its policies and procedures. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over eight hours and involved one inspector. A range of evidence has been used to support the judgements reached in this report, including interviews conducted with the home’s manager, members of her staff team and some of the service users present at the time of the inspection. The premises were inspected, as was a sample of care records, policies and procedures. A small number of service users were surveyed as part of the inspection. Comments from the returned surveys have been included in this report. The inspector also attended a handover meeting, where outgoing staff shared information about their shift with carers coming in for the afternoon shift. What the service does well: West Farm had devised an easy to understand service user guide that contained photos to help service users better understand the facilities and services offered at the home. Staff observed during the inspection appeared to have developed warm and caring relationships with the people in their care. Service users were satisfied with the care and support provided at the home. The home maintains regular contact with the people that use its services. Staff visit each service user and their carers on a twice yearly basis to ensure that their support plan reflects any changes in care needs that have taken place between visits to the home. These visits are also used to plan future respite care dates, possible outings and activities. Service users and their carers are consulted about the quality of care provided at the home during each review. Staff have been provided with opportunities to gain a qualification in care. All staff have either obtained, or, are in the process of obtaining, such a qualification. The home provides opportunities for the staff group to meet on a quarterly basis to discuss practice matters. The staff team have developed ways of working with service users that takes account of each person’s ability to communicate. The care records examined were of a good standard. The staff group had invested time and effort in reviewing the National Minimum Standards (NMS) and how they could be met within West Farm. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 6 Staff meetings are held on a regular basis ensuring that staff are kept up to date with developments happening within the home and the learning disability service. Time is also given to discussing service users’ needs. The home had prepared a simplified version of its complaints procedure, which was written in plain English and included helpful pictures to aid understanding. The home had devised a comprehensive questionnaire to ask service users (and their families) what they thought about the care and support they received at West Farm. All staff at West Farm have their own email address and over a period of time have become computer literate. What has improved since the last inspection? Concerns identified in the last inspection about the home’s gardens were addressed. The West Farm Team identified that the following improvements had also been made: • • • • • • • New documentation had been introduced to help staff keep a record of the quantity of medication held in the home at each staff handover; Only relevant and recent information is now kept in service users’ care records. This has made it easier for staff to use the files on a day to day basis; The staff team had spent a considerable amount of time looking at how risks associated with independent living can be minimised and better managed; The team had adopted the use of Task Grids to enable it to better monitor the progress made by service users as they move towards independent living; Charts are now used to monitor the frequency of service users’ epileptic activity. This has enabled them to provide their health colleagues with better quality information; The home’s brochure had been updated and is now available in written and pictorial formats; The team has placed greater emphasis on providing service users with healthier food. Staff are trying to encourage more service user involvement in the kitchen area. The lower bench working top is now better utilised; There is a comfy chair, television and lamp in each room; Carpets had been replaced in some bedrooms; • • West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 7 • The team continues to work towards implementing the recommendations that arose out of its review of how well the home was meeting the National Minimum Standards. 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. West Farm Road, 36 DS0000033090.V322769.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 West Farm Road, 36 DS0000033090.V322769.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): 2 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are only admitted into the home following an assessment of their needs by relevant professionals. Service users’ care records contained the required documentation and this provides staff with the information they need to safely care for people visiting the home. The home’s manager and her staff team were able to demonstrate that they had the skills and knowledge required to meet service users’ needs. EVIDENCE: Admissions into the home had not taken place until a full assessment of need had been carried out. In each of the care records examined, West Farm had obtained copies of social service assessments and care plans. Once the home has received an assessment and care plan, staff arrange to visit a prospective service user and their family to share information about West Farm and to talk about the level of support that would be required when staying at the home. Prospective service users and their families are provided with a service brochure and a pictorial guide to the home. One of the service users West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 10 interviewed said that she thought her family had received information about West Farm. Another service user said that he was not sure. A package of support is only provided if the manager and her staff team are confident that they have the skills and training necessary to meet each service user’s needs. Staff interviewed felt that they had the skills and knowledge required to care for service users who not only had complex social care needs, but who displayed behaviours that were sometimes very challenging to work with. A decision about whether to offer respite care is then made and the family are informed. The inspector observed staff communicating with service users in a way that built upon each individual’s strengths and abilities. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were clear care planning and review processes in place. This meant that staff were clear about how they should meet service users’ needs and how they should involve them in this process. Staff respected service users’ needs and wishes regarding privacy, dignity and independence. This meant that service users felt valued and able to retain control over the way they wanted to live their lives, in as far as they were able to do so. Satisfactory arrangements were not in place to assess the risks posed to service users when practising independent living skills whilst staying at the home. This might mean that service users are not able to learn and practise independent living skills in a safe environment where potential risks have been minimised. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 12 EVIDENCE: The care records of three service users were examined. Service users’ support plans and risk assessments had taken account of information supplied to the home by social services. Each service user had a support plan that covered their health, personal and social care needs. For example, one service user’s support plans covered areas such mobility, bathing, communication, daily routines and behaviour management. None of the support plans examined were available in alternative formats that might make it easier for service users to understand. Confidential information had been secured in a locked cupboard. Support plans set out what each service user was able to do for themselves and what assistance was required from staff. Support plans had been built around each service user’s strengths, abilities and the decisions that they are able to make. A member of staff said that where a service user was unable to make any, or very few decisions, staff would consult with their carers about how best to provide care. A key worker system was in place. Staff had a good understanding of their role as a key worker and felt that it enabled them to develop stronger relationships with service users and their families. With one exception, the support plans examined had been reviewed during 2006. A member of staff confirmed that service users’ support plans were reviewed during annual home visits carried out by key workers. The manager said that the home usually received the required risk assessment information prior to a service user’s first stay at West Farm. She also said that the home then completed its own in-house risk assessments taking account of the information supplied by other individuals involved in caring for the service user. However, individual risk assessments had not been completed in any of the care records checked, even though all required some degree of assistance, with bathing. A member of staff told the inspector that he was in the process of establishing what risk assessments were required for a service user that he acted as a key worker for. There was evidence that the manager and her staff team understood the importance of residents being supported and encouraged to take control of their own lives and make their own decisions and choices. For example, one service user said that they chose: • • • • Who they made friends with; What they wanted to eat; When they had a bath; How to spend their time. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 13 There was evidence during the inspection that staff guided and influenced service users to make safe choices and decisions. A member of staff was seen counselling a service user about what would happen if they made a particular decision. Alternative options were given in a positive and supportive manner. The approach adopted by the staff member worked well and the risk to the service user was minimised. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to form friendships with each other and, to take part in activities both within and outside of West Farm. Service users’ rights are respected and their involvement in the home’s daily routines encouraged. This means that service users are able to enjoy a full and stimulating lifestyle when staying at the home and are provided with opportunities to develop social and independent living skills. Service users are provided with opportunities to join in local activities and to make use of community facilities. This enables them to participate in, and be a real part of, everyday community life. Although service users are encouraged to form relationships with staff and other people staying at the home, their right to privacy is recognised and respected. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 15 Service users are offered a healthy diet that takes account of personal likes, dislikes and special dietary needs. Service users enjoy the meals served at the home. EVIDENCE: On the day of the inspection, staff were observed encouraging and supporting service users to visit the local shops for household items. A service user said that staff were always happy to take her out for a meal or to visit a pub. Another service user said that he didn’t mind staying in or going out as long as staff and his friends were with him. With the support of their families and staff, service users are supported to make a decision about whether they wish to continue their day care placement whilst attending West Farm. All service users staying at the home during the inspection had chosen to go to work or attend their day care placement. There was evidence that service users were supported and encouraged to build relationships, wherever possible, with both staff and other people staying at the home. Staff said that every effort is made to plan service users’ stays at the home in such a way as to take account of each person’s need for support. Staff also try to arrange for service users to visit whilst friends they have met when visiting West Farm are also attending. A staff member said that service users were supported to maintain contact with their family where a desire to do so has been expressed. Family members are encouraged to contact West Farm to inquire after the well being of their relative whilst they are resident at West Farm. Staff visit service users and their carers twice a year to ensure that the home’s support plan includes any changes in care needs that have taken place between visits. Service users and their families are consulted about the quality of care provided at West Farm during these visits. Service users said that staff respected their privacy and treated them in a kind and gentle manner. One service user said that staff always asked if it was okay if they came into her bedroom. She also said that she had a key to her bedroom and staff always knocked on her bedroom door before entering. Opportunities were available for service users to join in everyday household chores. A member of staff was observed encouraging a service user to help out in the kitchen. This person was asked to help lay the dining table and get everything ready for dinner. There were some service users who were unable to participate in such activities due to the significant level of their disability. There was a diet and nutrition policy that described how the home ensured that service users received a good diet when staying at West Farm. Information about service users’ dietary needs and assistance required with eating and drinking had been obtained prior to their first respite care stay. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 16 There was evidence that healthy eating was promoted. Staff had a good understanding of the dietary requirements and personal likes and dislikes of the service users in their care. Each week’s menu is built around service users’ individual preferences and, on what information has been obtained from their carers, or any professionals working with them. Service users said that they were happy with the meals served. Support plans covering service users’ dietary care needs and assistance required at meal times were in place. The kitchen was clean, tidy, attractive and hygienic. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. Staff demonstrated a good understanding of how to meet service users’ personal support needs. This meant that service users could feel confident that care staff would meet their need for personal support in a sensitive and responsive manner. The systems in place to support the safe administration, storage and disposal of medication within the home were satisfactory and promoted residents’ good health. EVIDENCE: The home’s statement of purpose included information about how service users’ health care needs would be met. Staff spoke knowledgeably about how service users were supported to maintain their good health whilst staying at the home. Staff said that service users would be supported to attend medical appointments where the home had been asked to do so by their family. Staff were clear about what action they would take to safeguard a service user’s well West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 18 being. The inspector did not directly observe staff providing personal care. But, staff described how personal and intimate care was provided and this fitted with best practice guidance. Where appropriate, support plans had been put in place that set out how service users’ care needs were to be met. These covered areas such as bathing, nighttime routines, personal hygiene and health care. Since the last inspection, ‘round the clock’ health care provided by specialist learning disability nurses to a small number of service users with complex care needs had been withdrawn. Responsibility for providing this care was then changed to the local community nursing team. During the inspection, staff expressed concern over the length of time some service users had had to wait to receive the health care support they required. For example, the inspector was told that one service user had had to wait an unacceptable amount of time to receive support with artificial feeding. Also, the community nursing team was unable to ensure that only a small group of nurses would be involved in providing the required health care in order to ensure continuity and consistency of care. The inspector was advised that the matter was still under review and it was likely that specialist nursing care would be provided up to 10pm on site, when certain service users stayed at the home. There was evidence that staff had received training in meeting residents’ health care needs. For example, some staff had completed training in the following areas – personal relationships and sexuality, administration of rectal diazepam and the use of oxygen. Most staff had completed a relevant qualification in care that covered meeting service users’ health care needs. A Medication Policy was available. Individual guidelines were in place to ensure that emergency medication was properly administered. It is the home’s practice to obtain consent from service users, or their carers, to confirm that it is acceptable for staff to administer their medication. Service users’ medications are verified at the beginning of their stay to ensure that the home has been provided with the correct details regarding their medicines. A selection of service users’ medication records was examined and these were considered satisfactory. Identification photos had been attached to each service user’s medication record. A record of medicines received into the home had been kept. All medicines were safely locked away. There were no service users administering their own medication, or taking controlled drugs, at the time of the inspection. There was evidence that all but one member of staff had received accredited training in the handling of medicines, including the giving of emergency medication. The acting manager confirmed that arrangements were place for staff to update their training in May 2007. Hand wash facilities were not available in the medication room. The following concerns were identified: West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 19 • • Staff had been asked to place a small amount of medication into an envelope and send it with the service user to their day care placement. This practice is considered to be unsafe; A service user had been transported to his day care placement at about 10.30am and, because their day care centre declined to administer his medication, he was returned to West Farm at about midday so that staff could administer his medication. This practice is not considered to be person centred in its approach. The acting manager took prompt action to resolve both of the matters referred to above and did so to her satisfaction. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 20 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. The arrangements in place for handling complaints were satisfactory and service users and their families were confident that any complaints or concerns would be listened to, taken seriously and acted upon. Satisfactory arrangements were in place to protect service users from harm or abuse. This meant that service users could feel safe and protected at the home. EVIDENCE: The provider had a detailed complaints procedure that was up to date, clearly written and easy to understand. A simpler version of the procedure containing pictures had been produced for use with service users. The manager confirmed that advice would be sought from the local authority’s specialist care management teams if the home needed to make its complaints procedure available in other alternative formats. Service users and their families had been given a copy of the procedure during service review visits. A record of this had been recorded on the service review visit form. The service users interviewed said that they would feel comfortable about talking to staff if they had any complaints or concerns. Neither the home nor the Commission had received any complaints since the last inspection. During previous inspections West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 21 it was confirmed that staff had reviewed the way the home handled complaints to ensure that it was complying with the National Minimum Standards. The provider had a comprehensive vulnerable adults policy that complied with relevant legislation and good practice guidance. Staff spoken with were clear about what action they would take to protect service users from potential harm. Those staff whose files were checked had completed certificated protection of vulnerable adults training. Neither the home nor the Commission had been notified of any adult protection concerns. Service users said that they felt happy with staff and trusted them. The manager was very clear that concerns about the well-being of a service user would be addressed immediately. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 22 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 standard of the environment was good providing residents with an attractive and homely place to live. The overall quality of the furnishings and fittings was good. Satisfactory hygiene practices were in place. This meant that residents were able to live in a safe, well-maintained and comfortable environment, which encouraged independence. EVIDENCE: The premises were safe, comfortable, bright, cheerful, airy and clean. There were no unpleasant odours. The home had been adapted to meet the needs of the service users visiting West Farm. The environment was well-maintained and provided specialist aids and equipment to meet service users’ needs. For example, height adjustable beds had been provided in two bedrooms. Service West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 23 users needing to bathe had access to a level access shower or a specialist height adjustable shower bed. The bedrooms visited were clean, tidy and domestic in appearance. The home had a separate laundry that had wall and floor surfaces that were easy to clean. The home was in keeping with the local community and there were no outward signs identifying it as a care home. West Farm was nicely decorated and its furnishings and fittings were of a good standard. Service users had access to single bedroom accommodation. The provider had an infection control policy that had been recently revised. The staff whose files were checked had received training in the control of infection. No infection control concerns were identified during this inspection. The provider’s infection control policy was last reviewed in 2006. No requirements were made following the most recent visit carried out by the fire service. Following a visit carried out by the local environmental health officer, a fly screen was fitted to a kitchen window. There were no other requirements. The acting manager said that a written planned maintenance and renewal programme for the fabric and decoration of the premises had not been prepared for 2007. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were sufficient staff rostered on duty to meet the assessed needs of service users. This meant that service users could be sure that they would get the help and support they needed to live independently. The arrangements for ensuring that staff regularly updated their training in key areas were unsatisfactory. This could mean that staff might not have the skills and knowledge required to satisfactorily meet service users’ needs. Sufficient documentary evidence that robust pre-employment checks had been carried out for staff working at the home was not available at West Farm. This meant that it was not possible to confirm that satisfactory arrangements had been put in place to prevent unsuitable staff being employed at the home. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 25 EVIDENCE: There was a robust system in place for devising the home’s rotas that worked well for both staff and service users visiting West Farm. For example, when planning the rotas, the acting manager said that careful consideration was given to ensuring that the right balance of male to female staff had been achieved. Ms Richards also said that staff were always prepared to be flexible by changing their working hours to meet the needs of service users visiting the home. Rotas showed that consideration had been given to the need to ensure that extra staff were available during busy times of the day. This approach also helped to ensure that there were enough staff rostered on duty to support residents to be independent both within the home and out in the local community. The home’s rotas contained the necessary details with the exception of staff designations. Although agency staff had not been used within the home, West Farm had used staff from the Council’s pool of sessional staff on a casual basis. The staff used had been trained to meet the needs of adults with learning and physical disabilities. Levels of staff turnover were low as were sickness levels. Generally, staff felt that they had the skills and knowledge needed to care for service users attending the home, with the exception of meeting the needs of those individuals with complex nursing health care needs. Over 50 of the staff team had obtained a relevant qualification in care. This training covered equality and diversity issues. A comprehensive training programme was available to West Farm staff and is updated every three months. The programme covered mandatory training courses and training aimed at developing staffs’ knowledge in specialist areas such as personcentred planning. All staff had completed accredited training in managing physical intervention and had undertaken training in working with people who displayed behaviours that were difficult to work with. Service users interviewed felt that staff looked after them very well. A sample of two staff records was examined and it was noted that: • • • • Staff had received fire instruction at the frequency recommended by the local fire service; Staff had completed training in infection control and food hygiene; For one member of staff, there was no evidence that they had undertaken moving and handling training in the previous 12 months; For one member of staff, there was no evidence that they had completed training in – the safe handling of medication and first aid. Neither was there evidence that they had completed moving and handling training in the last 12 months. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 26 The manager confirmed that there was an element of health and safety awareness in each of the mandatory courses that staff working in the learning disability service were expected to complete. It was also identified that: • • • • Staff files held at the home contained evidence of verification of identification and job descriptions; In one staff file, there was no evidence that written references had been obtained; A copy of one staff member’s contract of employment and evidence that they had been subject to a Criminal Records Bureau check had not been placed on their file; Copies of staff application forms were not available on any of the staff files checked. The inspector was therefore unable to confirm that: - a full employment history had been obtained; any employment gaps explored; staff had provided a statement as to their physical and mental well-being or confirmed whether or not they had any convictions or cautions. The acting manager confirmed that North Tyneside Council kept the above information centrally. Regular staff meetings had taken place throughout 2006 and minutes had been kept. Service user meetings had not taken place due to the nature of the home. The acting manager confirmed that service users would be consulted where necessary over such matters as how the home’s amenity fund money should be spent. Staff interviewed said that they received supervision on a regular basis. But, written supervision records were not available at the time of the inspection. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were suitable arrangements in place for consulting with service users and their families about the care and support provided at West Farm. Although a suitable quality assurance plan had been drawn up, the arrangements for reviewing the implementation of it were not fully satisfactory. This meant that the home had not fully evaluated the progress that had been made in developing the service or obtained the views of relevant professionals about this. Steps had been taken to promote the health and well being of service users and to protect them from potential hazards. This meant that service users were able to stay in a home where health and safety concerns were taken seriously and promptly addressed to prevent them being harmed. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 28 EVIDENCE: The home’s manager had been temporarily relocated to another service. Temporary management arrangements had been agreed with the Commission. The acting manager had worked at the home for approximately six years and had completed a management qualification. Although Ms Richards had up to date infection control, food hygiene, fire prevention and first aid training, she needed to complete refresher training in the following areas – medication and moving and handling. She had also obtained a Higher National Certificate in in Social Care and had recently completed risk assessment training for managers. Mrs Richards said that she had been supplied with a copy of her job description. There was evidence that the acting manager and her team worked very hard to improve the quality of life experienced by service users when staying at the home. Staff felt that the acting manager had continued running the home in an open and transparent manner as had been established by the previous manager. The home offered care that was service user focussed and staff worked well in partnership with families and other professionals. The acting manager was aware of current developments in her own field and was interested to know more about the Commission’s ‘Inspecting for Better Lives’ programme. A sample of health and safety records was examined and generally found to be up to date. A tour of the premises identified no health and safety concerns. There was a wide range of workplace risk assessments covering areas such as – the use of electrical appliances, security of the building and the prevention of legionella. All of the risk assessments had been recently updated. The acting manager said that a ‘lone’ working risk assessment had not been completed. An audit of the home’s fire records confirmed that the majority of the required fire prevention checks had been completed. For example, the home’s emergency lighting and fire extinguishers had received monthly visual checks. Staff had participated in a minimum of two fire drills during the last 12 months. A fire risk assessment was in place. This had last been updated in 2006. An up to date gas safety certificate was in place. The home’s specialist bath had been serviced twice during 2006 and a brand new mobile hoist had just been purchased. Service users’ finance records were well maintained. Staff had signed each of the transactions recorded on service users’ balance sheets. The balance of money held on behalf of service users matched the financial records kept by the home. No concerns were identified. Where possible staff had encouraged service users to sign their financial balance sheets. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 29 The home’s service user guide contained helpful information about how West Farm obtained service users’ views of the quality of care provided. The guide emphasised that service users’ opinions, and those of their families, were welcome. It also included comments made by individual service users about how West Farm could improve the services it offered. A book for recording service users’ suggestions was available within the home. A system to assess the quality of care and services provided at West Farm had been devised. The quality assurance format was based upon the National Minimum Standards (MNS) and covered such areas as leisure activities, health and nutrition. Staff had played an important role in assessing whether the home was complying with the NMS. But, the action plan that had been produced was undated and there was no evidence that it had recently been reviewed. Professionals involved with the home had not been surveyed about their opinions of the home. Service users and their relatives had been asked to comment upon the quality of care provided at West Farm during the service review visits carried out by staff each year. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 30 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 3 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 2 25 X 26 X 27 X 28 X 29 x 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 3 2 X X 3 X West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 31 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Timescale for action The acting manager must ensure 01/11/07 that where possible support plans are made available in a format that can be understood by each service user in as far as this is possible. The provider and acting manager 01/04/08 must ensure that: • An assessment of the risks faced by service users when learning independence skills is undertaken; Risk assessments are carried where service users require assistance with moving and handling, including getting in and out of a bath or other type of bathing facility. Requirement 2. YA9 13(4)(5) • 3. YA20 13(2) The above risk assessments must be carried out for all service users either before, or during, their next visit to the home. The acting manager must ensure 01/07/07 that hand wash facilities are available in the room within DS0000033090.V322769.R01.S.doc Version 5.2 Page 32 West Farm Road, 36 which medications are stored. (The timescale for complying with this requirement expired on 01/01/07) 4. YA24 23(2) The provider and acting manager 01/07/07 must prepare a written planned maintenance and renewal programme for the fabric and decoration of the premises. Once completed, a copy of the plan must be forwarded to the Commission. 01/07/07 The provider and acting manager must ensure that the following information is available at the home: • Copies of the written references obtained for each member of staff prior to their employment; A copy of each staff member’s application form and written evidence of any gaps in employment being explored; A statement from each applicant confirming their physical and mental health and whether they have any convictions or cautions. 5. YA34 18 • • (The timescale for complying with this requirement expired on 01/01/06) • Documentary evidence that each member of staff has been subject to a Criminal Records Bureau check. 6. YA35 18 The provider and acting manager 01/11/07 must ensure that all staff: DS0000033090.V322769.R01.S.doc Version 5.2 Page 33 West Farm Road, 36 7. YA37 9 8. YA39 24 Update their moving and handling training on a yearly basis; • Complete training in the following areas – first aid, safe management of medicines. The acting manager must update 01/07/07 her training in the following areas - medication and moving and handling. The acting manager must ensure 01/11/07 that: • Professionals visiting West Farm such as GPs and Community Nurses, are consulted about the quality of care and services provided at the home; The home’s quality assurance development plan is dated and reviewed on a yearly basis. • • RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA19 Good Practice Recommendations The acting manager should consider completing an ‘OK’ health assessment for each service user as part of the next review visit carried out. The acting manager should review the home’s medication policy to ensure that medication is only kept and transferred in the container in which the pharmacist has dispensed it. The acting manager should ensure that the staff rotas DS0000033090.V322769.R01.S.doc Version 5.2 Page 34 2. YA20 3. YA33 West Farm Road, 36 4. YA42 specify each staff member’s designation. The acting manager should complete a ‘lone’ working risk assessment for the home taking into account the guidance issued by the Health and Safety Executive. West Farm Road, 36 DS0000033090.V322769.R01.S.doc Version 5.2 Page 35 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. 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