Inspection on 08/06/06 for West Street, 36

This inspection was carried out on 8th June 2006.

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

West Street, 36 09/05/07

West Street, 36 12/01/06

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

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

CARE HOME ADULTS 18-65 West Street, 36 36 West Street Wombwell Barnsley S73 8LA Lead Inspector Mrs Sue Stephens Key Unannounced Inspection 8th June 2006 09:30 West Street, 36 DS0000065298.V290623.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 Street, 36 DS0000065298.V290623.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 Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service West Street, 36 Address 36 West Street Wombwell Barnsley S73 8LA 01226 757269 01226 759573 none www.milburycare.com Milbury Care Services 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) Mrs Karen Armitage Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service user as identified on the variation application dated 14.9.05 (who is over the age of 65 years) may be accommodated at the home. 12th January 2006 Date of last inspection Brief Description of the Service: 36 West Street is a new purpose built home set in its own grounds. It provides care and accommodation for people with learning disabilities. The lay out and equipment at the home is suitable for people with physical disabilities. There is a passenger lift providing access to both levels. On the ground floor there is a lounge, activities room, dining area and purpose built kitchen. The four bedrooms have direct access to a bathroom or shower area. On the first level floor there are two self-contained flats. The bedrooms and shared spaces exceed the National Minimum Standards for room sizes. There are good amenities, for example shops, pubs, a church and leisure facilities close to the home. Wombwell shopping centre is a short walk from the home and there is public transport into Barnsley town. The manager provided the information about the homes fees and charges on 8th May 2006. Fees range from £1475 to £1675 per week. Additional charges include hairdressing, toiletries, flowers, newspapers and magazines. There is a supplement charge for incontinence pants. Prospective residents and their families can get information about 36 West Street by contacting the manager. The home will also provide a copy of the statement of purpose and the latest inspection report. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was unannounced; it took place between 9:30:am and 3:30pm. The inspector sought the views of the service users, 3 relatives, and 2 staff. The manager was unavailable and the deputy manager assisted with the visit. Checks were made on samples of documents relating to the residents care and safety. During the visit the inspector also looked at the environment, and made observations on the staffs manner and attitude towards the residents. The inspector had tried to contact visiting professionals about their opinion of the home, unfortunately no one was available on this occasion. (The manager and relatives were contacted by phone after the inspectors visit to the home). Residents used Verbal and sign language to tell the inspector what they thought about their care. The inspector also took time to observe residents who were unable to say what they thought about the home. The inspector checked a sample of records. These included three assessments and care plans, three medication records, three staff recruitment files, and training records. The inspector looked at other information before visiting the home, this included reports made by the provider about the home, and the pre inspection questionnaire, which was requested from the Commission for Social Care Inspection (CSCI). There had been no concerns, complaints or allegations about the home made to the commission. Six residents lived at 36 West Street, and the home was fully occupied at the time of the visit. Questionnaires had been issued via the home to staff. No surveys had been received back to the commission at the time of writing the report. This was the homes second inspection; the inspector checked all key standards as part of this inspection. The inspector would like to thank the residents, family members and staff who contributed to the inspection. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 6 What the service does well: Each resident had an assessment before they moved into the home; the home did their own assessment with the residents. This gave the home good information about each person’s special needs, choices and preferences. Residents (who were able, helped develop and agree their own care plans. They said they were pleased about this, and were “very involved”. People who had complex needs had care plans that told staff clearly how to look after them. Residents said they felt well supported to make choices and decisions about their own lives. One resident said they were happy because they had asked for something special and had “got what I wanted” they said the staff had been very supportive. The staff understand the residents diversity needs, and help them. For example to find a suitable church or local services. Two relatives spoke highly about time spent in a pub with some residents and staff, they said it was “fantastic” and “every one was happy”. The residents were able to choose what they wanted to eat and could help themselves to snacks and drinks. Two residents said they enjoyed their meals. Some residents were able to cook their own meals with help from staff. Residents said they felt “Well looked after here” and that staff helped them with their health care. The residents and relatives said staff were kind and treated people with dignity and respect. The staff were positive, friendly and caring, this made the residents feel well looked after and settled. The home looked after people’s medication well. There was good information to tell staff about the different kind of medicines, and the records were clear and tidy. The residents liked their environment; it was clean and spacious and had the right kind of furniture and equipment to make people safe and comfortable. There was a nice garden where the residents could sit, or spend time; the garden was easy to get to. The residents got support from staff to furnish and manage their own rooms they way they wanted. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 7 All staff get an induction, the induction tells staff the right way to look after the residents and keep them safe. The organisation, Milbury Care, check the home regularly, they ask the residents and staff what their opinion of the home was and they write a report about what they have found. What has improved since the last inspection? What they could do better: The home needs to look at how it can support people better in the kind of daily routines and activities they prefer; and how to make sure people get enough individual attention. For some people it is very important to them that they can get out into the community very often, the home needs to get better at how they support people to do this. This is about improving person centred care for people; looking at their needs and making sure there are enough staff at the right times for the residents. The staff need to get regular training so that they have good skills at supporting people with changing and complex needs. To promote person centred care the home needs to get better at writing more about what enjoyable things the person has done in the day. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 8 The home needs to provide better menus and choices of foods for people who need extra nutrition to help keep them healthy. People need to be able to easily find a complaints procedure so that they know what to do if they want to complain or raise a concern. Staff need to be able to find the adult protection procedures easily in case they need to check what they must do if they are worried about a resident. The home must get better at telling the Commission for Social Care Inspection when there are concerns about someone’s welfare. A resident needs a better mattress for their comfort and dignity. The home needs to check employment gaps when they are recruiting people, this will help the home to make sure they employ suitable people. The bad weather grit box needs to be kept in a safe place, so that people do not trip over it or touch it and harm themselves. 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. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 9 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 Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The quality outcome of this area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Residents are involved in their assessments; this makes sure the home can meet individuals’ needs and aspirations. EVIDENCE: Each care plan included a full needs assessment. Residents had their needs assessed before coming to live at the home. In addition to this the home had carried out their own assessment and looked at the specific needs of the residents. One resident said they were involved in their own assessment; they said people asked them what they liked and disliked and gave the resident choices about moving into the home. The resident said about their assessment “people asked me what I wanted”. West Street, 36 DS0000065298.V290623.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 The quality outcome of this area is good. This judgement has been made from evidence gathered both during and before the visit to the service. The care plans reflect the residents’ care, specific needs, and associated risks. The home encourages residents to make choices and decisions about their own lives. EVIDENCE: The care plans had improved; they had good information about the residents needs. The plans set out in careful detail special and specific needs, for example complex behaviours. These included what the resident may do and what they like and dislike; this was followed by clear instructions for staff about how to approach and care for the person. This meant that the residents could receive consistent care at times when they may be distressed or anxious. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 12 There were good practice guidelines in the care plans for residents who needed physical aids to prevent themselves from harm. For example, a professional multidisciplinary team agreed the plans and reviewed them regularly. One resident, when asked about their care plan said “Yes, I have a lot to do with it, and they put my medical notes in it”. The care plans recorded peoples identified risks and how to minimise these. The daily records about individuals had good descriptions about their behaviour; however some of the records did not record events such as family visiting, outings and what the person had done that day. This did not promote a person-centred approach for the individuals. Two residents said they got good support to make decisions and choices. One said they were very pleased and satisfied with this. One resident gave an example and said: “I said I wanted a budgie when I moved in”, “staff took me to (a garden centre)” and “I got what I wanted”. Another resident said they could tell staff what they wanted to do and staff were “ok” about it. The inspector noted that staff frequently asked the residents their opinion, for example, what did they want to do, when did they want to go shopping; and what did they prefer at that moment in time if they were anxious or unsettled. The inspector also noted that when a resident was not sure about a choice, for example whether to go out to buy themselves a treat, the staff were patient and kept returning to the resident using positive prompts and waiting for the resident to respond. The care plans recorded when a resident had limitations on their freedom to make a choice; for example when it would result in harm to the resident. The staff members interviewed had a good understanding about this, and they were mindful about the residents’ welfare. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 The quality outcome of this area is poor. This judgement has been made from evidence gathered both during and before the visit to the service. The home did support some residents to follow suitable activities and routines. However some residents did not always get the opportunity to visit the community and follow their daily routines and activities as often as they needed. This did not promote some individuals’ aspirations and wellbeing. The lunchtime menu was insufficient to meet the needs of some residents who needed nutritional support. EVIDENCE: One resident told the inspector they were very satisfied with their lifestyle and daily routines. They gave examples of the things they were involved in, which included, visiting and helping at a bird centre, shopping, going for walks and enjoying a weekly pub lunch. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 14 Two relatives said they had met the residents and staff in a local pub. They said the occasion was “fantastic”, “the staff and residents were socialising, we were happy to be with them, and they were so happy”. The deputy manager was liaising with a local authority co-ordinator to secure gardening and other activity places at a local day centre. The home had also agreed extra support to enable a resident to attend one of the sessions. The inspector observed the routines of other residents, and residents were free to choose where they wanted to spend their time in the home. The home supported residents to maintain friendships; friends could visit or staff would support the resident to visit their friends if they wished. After breakfast the home began to ‘bustle’ with activity. The office is between the main lounge and the dining area. Some residents chose to spend their time between the rooms and sitting in the office. This created a busy area for residents and staff; as a result staff gave attention to the residents congregating in this area, but there were other residents elsewhere who needed attention and were unable to seek it. It was also not in the best interest of the residents who need calm, and staff attention, away from the hive of activity. One relative who said they were concerned that their family member was not getting their favourite activity often enough. They gave examples, which included visiting the local community regularly and trips out in the homes transport. One resident’s work plan, agreed at the time of assessment, identified regular trips out. A relative felt this did not happen for the resident as regularly as was intended. The family member felt there had been some improvement because staffing had improved; but there were still not enough drivers and this affected the opportunities for the residents to go out on trips. On occasions residents had been unable to go out as they wished because there was not enough staff. Staff said they would like to see this improved. Two residents said they were happy with the meals provided. They could choose whether to eat in company or alone. Staff supported them to make meals and this was sometimes in their own self-contained flats. One resident said, “I enjoy my meals because I cook my own”. The residents had free access to the kitchen where they could get drinks and help themselves to snacks. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 15 Some residents care plans identified that they needed nutritional supplements. The main meal was served in the evening, and this was substantial for example spaghetti bolognaise or Shepard’s pie. At lunchtime the meals were ‘light’ for example sandwich or soup or pot noodle. The lunchtime menu did not provide residents needing additional supplement with a choice of foods that would encourage the additional nutrition through good diet rather than supplements. A relative said they felt the lunchtime menu was not enough for their family member. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. The quality outcome of this area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. In the main the residents receive good support with their personal and health care needs. However individual support for some residents needs to be better managed, this will help develop their emotional health and wellbeing. The staff deal with the residents’ diversity needs with dignity and respect, and medication is well managed. EVIDENCE: Two residents said they were happy with their care. They said staff were kind and helpful. Residents made comments which included “yes, I’m well looked after here” “staff take me to the doctors when I need to go” and “they (the home) have made a special referral for me”, “staff help me and keep an eye on me”. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 17 The inspector asked two residents “do staff treat you kindly, with dignity and respect?” both residents replied with a firm “yes”. A relative asked the same question about their family member replied “absolutely” and “we have nothing but praise for the staff”. Relatives said they were mainly happy with the care of their family members. Some said they thought the care had improved recently, and that this was because there were better staffing levels. One relative said they had worked close with the staff team and manager to meet their family member’s complex needs. They said the manager and staff were “very obliging”. Staff were aware of, and took action for residents with diversity needs, for example staff offered support to a resident who wanted to find a church of their preference. The inspector made observations on some of the residents care. Staff were friendly and caring; they were positive and cheerful in their approach. One staff member made careful observations to a resident’s facial expressions, so she could understand what the resident wanted. Staff dealt with complex behaviours in a calm and positive manner, however sometimes the atmosphere was lively and noisy, and this made it difficult to support the individuals in a calm environment. One relative told the inspector they felt their family member did not get enough one-to-one attention to meet the resident’s emotional needs; and that they would like to see this increase because it would improve their family members happiness and wellbeing. (See section on lifestyles for related information). The medication storage and records were in good order. The manager had provided very good information about each individual’s medication, for example it’s purpose and possible side effects. The information was easy to refer to; this made the medication systems safe and dignified for the residents. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The quality outcome of this area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. To make sure people can raise concerns and to make sure the residents’ safety is protected the complaints and protection procedures need to be made accessible. EVIDENCE: The home had a complaints procedure, however this was not on display in the home in a place easy for residents, relatives and visitors to refer to. Both residents and relatives said they were confident they could raise concerns and the manager and staff would listen and take action. Staff training records showed that staff received adult protection training as part of their induction. Staff confirmed this and said they understood the training. The home’s and local authority’s adult protection procedures were not available to staff. This meant that staff, especially those left in charge, did not have clear guidelines and contacts numbers to take immediate action if they suspected a resident was at risk of harm. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The quality outcome of this area is good. This judgement has been made from evidence gathered both during and before the visit to the service. The home is clean, comfortable and homely; in the main it suits the needs of the residents. However to maintain their comfort and dignity one resident needs a more suitable mattress. EVIDENCE: In the main the home was clean and well maintained. Furniture was comfortable and the décor and fittings were homely and suitable for the residents’ needs. The staff follow a schedule, this made sure the home was kept clean and tidy and that repairs were reported. The residents said they were happy with their rooms and they had everything they needed in them. There was specialist equipment provided, and wheelchair users could access the rooms easily. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 20 There was access to spacious gardens with patio area and good quality garden furniture. There was an activity room for residents where residents could relax or do activities, for example crafts. The residents received support and encouragement to personalise their rooms. One resident said they were very unhappy about their mattress; the mattress was a specialist mattress that the resident felt was not necessary for their needs. The resident said it was “hot and uncomfortable”; it bothered them that they had such a mattress. The resident asked for a new mattress. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 and 35 The quality outcome of this area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. The staff need more frequent training; it needs to be related to the residents complex needs, so that the residents continue to get appropriate support to develop their emotional health, independence and wellbeing. EVIDENCE: All new staff had received Induction training; they had completed their induction training within the past 9 months, and some staff had completed LDAF training (Learning Disability Award Framework). There was no evidence of further training events for staff. One staff member said they had received no training since their induction. For some staff it was their first experience working in the care sector, and they had minimal knowledge about complex needs. Some staff had identified that they need learning disabilities and mental health training; this was very relevant to the needs of some residents. There were no immediate plans to provide this. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 22 Three out of a staff team of 11 had achieved a National Vocational Qualification (NVQ) in care. The National Minimum Standards state 50 of care staff should achieve an NVQ qualification; this would provide a better trained staff team to support people’s complex needs. A relative and a staff member both stated that some of the staff at West St were very new to caring for people with learning disabilities. The needs of the residents at West St are very varied and complex. Staff need continued guidance, support and training, (for example in diversity needs such as ageing, mental health needs, challenging behaviours, alternatives to restraints and NVQ in care) to ensure that the staff can meet the needs of the residents with very complex care needs. Robust training and support should enable the issues raised in the sections for Lifestyles and Personal and Health Care Support to improve. The relatives and staff said they felt staffing levels had improved, and there was more staff to meet the care needs of the residents. However both relatives and staff said that sometimes the residents’ daily activities did not get the activities, which were important to them. One person gave an example and said because a resident had a hospital appointment another resident could not go out on their activity. The activity was very important to the resident and was an important part of improving their health and wellbeing. In the main the recruitment checks were robust, however there were unexplained employment gaps in two recruitment files. It is important that that the home checks all employment gaps. This will help to protect the residents and help to select suitable people to work with the residents. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 The quality outcome of this area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. The running of the home can improve to benefit the resident’s welfare and emotional and complex needs. The homes self-monitoring benefits the residents. In the main the home promotes health and safety for the benefit of the residents. EVIDENCE: The manager demonstrated her fitness through the Commission for Social Care registration process in 2005 and the manager has significant experience in supporting people with learning disabilities and complex needs. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 24 The manager had made good improvements following the last inspection and is commended for the hard work put into this. For example the care plans and the cleanliness of the home had improved. The manager needs to improve the good running of the home. The manager and the organisation need to look at how to develop individual care and attention to residents, maintain essential activities, and have regular support and training events focussed on the complex needs of the residents. (Evidence about why this is needed has been provided in the relevant sections of this report). The inspector spoke to the manager after the visit to the home. The manager said she is aware that the home needs to improve the residents’ daily routines and individual care; and how people use the kitchen, office and lounge areas. The manager said that she now had a full staff team and would be able to concentrate on these improvements. Milbury Care carried out regular checks on the home and provided the Commission for Social Care Inspection with information about how the home was performing. This shows that the home receives quality audit checks, which allows the home to identify good practice and areas for improvement. The recent difficulties the home had experienced were not included in the provider reports. The manager, staff and relatives said some of the difficulties the home had experienced included: Recruiting staff, staff turn over, new staff understanding the needs of the residents and staff availability to go on training. The manager said staffing levels were now sufficient and stable, and residents’ activities and individual attention should improve. The home had not informed the commission about some accidents which had resulted in hospital admissions for some residents. Registered care homes are required to inform the Commission for Social Care Inspection about events that affect residents’ wellbeing, this allows the commission to monitor the safety and wellbeing of the residents, and allows the home to demonstrate it is taking appropriate action to keep people safe. Staff and residents said they felt the home was a safe place. One staff member said maintenance for equipment such as lifts and fire doors was prompt. An uncovered box of bad weather grit with shovel had been left outside the entrance; this was unsightly and was a tripping hazard. The contents are an irritant to skin and should not be accessible to the residents who do not understand not to touch it. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 X 15 3 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 2 X 2 X X 2 X West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA12 Regulation 12,16 Requirement Timescale for action 31/07/06 2 YA13 12,16 3 YA16 12,16 4 YA17 16 Systems must be put in place to make sure that all the residents get the appropriate activities they need. This must be recorded and regularly reviewed. Systems must be put in place to 31/07/06 make sure all residents can access the community as often as is necessary to meet their needs. Systems must be put in place to 31/07/06 make sure that daily routines are designed to meet the needs of the all individuals. 31/07/06 The homes menu, including lunch options, must be reviewed. The residents must be provided with suitable, wholesome and nutritious food that is varied and adequate to meet the dietary needs of the residents. Systems must be put in place to 31/07/06 make sure that all residents get enough regular attention to meet their needs. The complaints procedure must 31/07/06 be on display for people to refer to. DS0000065298.V290623.R01.S.doc Version 5.2 5 YA18 12 6 YA22 22 West Street, 36 Page 27 7 YA23 13 The homes and local authority’s adult protection procedures must be made available in the home. Staff must receive guidance on how to follow the procedures and this must be recorded. The home must purchase a suitable mattress for the resident who is uncomfortable with the existing one. Appropriate levels of staff must be made available, and at the right times, to meet the needs of the residents. Written explanations about employment gaps must be recorded as part of the homes recruitment procedures. A staff training and development programme must be produced to meet the aims of the home, and to meet the complex and changing needs of the residents. The provider and manager must review how to improve the management and development of the residents’ complex needs, daily routines and staff training. The home must notify the Commission for Social Care Inspection without delay any events that affect residents’ wellbeing. The grit box must be removed to a safe place. 31/07/06 8 YA24 16 31/07/06 9 YA33 18 31/07/06 10 YA34 19 31/07/06 11 YA35 18 31/07/06 12 YA37 10,12 31/07/06 13 YA39 35 31/07/06 14 YA42 13 31/07/06 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 YA6 Good Practice Recommendations The daily records should contain more detail about the DS0000065298.V290623.R01.S.doc Version 5.2 Page 28 West Street, 36 2 YA32 3 YA39 events in people’s days. A plan should be put in place to make sure at least 50 of the care staff achieve a National Vocational Qualification in care. The plan should include timescales and the action needed to achieve the target. The provider visit checks should be reviewed. The reports should include better audits, which identify the homes difficulties and action plans for improvements. West Street, 36 DS0000065298.V290623.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 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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