Inspection on 20/05/08 for White Barn

This inspection was carried out on 20th May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

White Barn 24/05/07

White Barn 08/12/05

White Barn 20/07/05

White Barn 15/12/04

White Barn 09/08/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 White Barn 45 Cressingham Road Reading Berkshire RG2 7RU Lead Inspector Stephen Webb Unannounced Inspection 20th May 2008 10:00 White Barn DS0000011070.V363311.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 White Barn DS0000011070.V363311.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. White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service White Barn Address 45 Cressingham Road Reading Berkshire RG2 7RU 0118 987 3190 0118 986 4415 paula.cox@kingwood.org.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Kingwood Trust Miss Paula Marie Cox Care Home 5 Category(ies) of Learning disability (5) registration, with number of places White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th May 2007 Brief Description of the Service: White Barn provides twenty-four hour residential care to five service users, of both sexes, who have learning and associated behavioural difficulties. The home is a large two-storey building with all the individual accommodation on the first floor. The building is owned and the care provided by the Kingwood Trust, a charitable organisation. White Barn is situated a few miles from Reading Town Centre and there are local facilities within walking distance. The home has its own vehicle and it is on a main public transport route. At the time of this inspection, the charges as range between £ 1448.13 and £1921.82 per week. There are no additional charges. White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection included an unannounced site visit from 10.00am until 6.00pm on the 20th of May 2008. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with the manager, senior support worker, and briefly with some of the other staff members on duty during the day. Residents provided very limited verbal feedback but the inspector also observed the interactions between residents and staff at various points during the inspection. Inspection surveys were completed on behalf of three of the residents, (by parents), and by four staff members. The inspector examined the majority of the premises, including one resident’s bedroom, with their consent. Feedback on behalf of the three residents was broadly positive and some of the comments included “the staff talk to me about what I want to do”, “I can’t always do what I want, when I want to, but at some point I do it”, “I can let them know if I’m unhappy”, “I am very happy, I like the staff”, “my mum says it’s a wonderful place with very caring and supportive staff”, “my conversation skills are limited, and the care staff know when I need something”, “this is a fantastic place” and “the staff are very professional”. The majority of the feedback from staff members was also mainly positive. Any issues raised were communicated to the manager in broad terms for consideration. What the service does well: The needs and wishes of residents are identified at assessment, incorporated into the care plan, and subsequently reviewed on a regular basis in order to ensure the service meets individual’s needs. Residents are supported to make decisions in their daily lives and to take appropriate risks, in pursuit of a fulfilling lifestyle, in the context of any cultural or spiritual needs which are identified. White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 6 Residents are offered opportunities to take part in a range of activities and to access events and facilities in the local community, to enable them to have a fulfilling lifestyle. Contact with family and friends is encouraged and supported. Residents are offered an appropriately varied and flexible menu. Staff meet the health needs of individual residents effectively. Though none of the residents is able to manage their own medication, the home has appropriate systems in place to manage this on their behalf. The staff were observed to work effectively with residents, during the inspection, and demonstrated good knowledge of their individual needs. The provider has an appropriate core-training programme in place to equip staff with the necessary skills to support residents‘ needs. On a day-to-day basis, the home is run in the interests of the residents, by an appropriately qualified and experienced manager, who manages and supports the staff team effectively. The health, safety and welfare of residents are promoted, for the most part. What has improved since the last inspection? What they could do better: The manager should ensure that all staff sign the behaviour management plans and other relevant documents to maximise the consistency of approach and provide accountability on the part of staff. There were no recorded complaints so it was not possible to evaluate the operation of the complaints procedure in practice, in order to evidence how residents’ views are listened to and acted upon. Though the home has procedures in place to protect residents from abuse, these needed to be updated to ensure that current guidance was in place. Though the majority of the home provides a homely and safe environment for residents, some areas are in need of work to bring them up to a satisfactory White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 7 standard. Most of the home was found to be clean and hygienic, but some issues remain to be addressed with regard to one toilet which has a strong odour of stale urine, and the manager needs to discuss appropriate infection control measures with environmental health, with respect to laundry provision. The levels of NVQ attainment by staff are beneath the Government target, as a result of staff turnover and newer staff having to complete their induction and probationary period before commencing on NVQ. Though the manager gave assurances that an appropriately rigorous staff recruitment and selection process was in place in order to support and protect residents, this could not be evidenced from records within the home. Residents are also not currently involved in any part of the recruitment procedure for staff, and at times, the manager may not be part of the interview panel for staff who come to the home. No overview of the current position with respect to the training received across the team was readily available within the service. The on-site records of the staff recruitment and selection process need to be improved. A number of the policies and procedures had not been reviewed for several years. All of these documents need to be reviewed on a regular basis. The complaints procedure and the up-to-date vulnerable adults’ safeguarding procedure should be readily available in the staff office. Despite the limitations on verbal communication, additional effort needs to be made to establish the views of residents in a systematic way to inform the home’s ongoing development. The quality assurance process is currently not comprehensive enough. The provider must ensure that the required monthly monitoring visits to the home are undertaken every month and that a copy of the resulting report is forwarded to the manager to be filed in the home. The fire risk assessment for the home needs to be reviewed to ensure it is relevant, and the damaged fire door needs to be repaired or replaced promptly. 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. White Barn DS0000011070.V363311.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 White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs and wishes of residents are established and subsequently reviewed in order to ensure the service meets individual’s needs. EVIDENCE: All of the current residents have lived at White Barn for a number of years and original assessment documents had been archived. The available preadmission assessment procedure was dated 1997, though it was appropriately focused on identifying whether the needs of an individual could be met by the service. There was also a later document, which was a review of the referral policy, dated 2003. Given the plans for the closure of the home it is unlikely that any new admissions will now be made, and evidence from the current Essential Lifestyle Plans (care plans) indicates that residents needs have been identified in detail, together with their wishes and preferences. Examination of copies of reviews on file also confirms that care plans are reviewed on a regular basis. At the time of inspection, the parents and care managers of residents had been notified of the plans to close the service, though it was felt that residents would be best informed once a definite date had been established, to avoid unnecessary uncertainty and anxiety. White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 10 The manager said that once a date for closure is set, this will enable individual planning for the transition to supported living, for each resident. Discussion of the planned closure was also evident from the minutes of one of the recent reviews, attended by the parents and care manager. The provider has prepared a “Re-provision Project Plan”, of which a copy was provided to the inspector, which identifies areas of the planning for the transition towards the home’s closure. White Barn DS0000011070.V363311.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): Standards 6, 7 and 9: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs and preferences of residents are reflected within their essential lifestyle plans, which are regularly reviewed, in order to identify how staff should support residents in their day-to day lives. Residents are supported to make decisions in their daily lives and to take appropriate risks, in pursuit of a fulfilling lifestyle. EVIDENCE: Each resident has an Essential Lifestyle Plan (ELP), which identifies their needs, wishes, likes and dislikes and how these are addressed and supported by staff, as well as identifying goals which the resident is supported to work towards. The plans include a detailed record of the resident’s preferred method(s) of communication, since residents have only limited or no verbal speech, and also identify things that are important to the individual in terms of their lives and how they should be supported, in order to maximise their wellbeing. White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 12 Known triggers and signs of anxiety are also recorded to enable proactive intervention by staff. There is good cross-referencing to specific behaviour management plans where appropriate, in order to maximise the consistency and appropriateness of response. Detailed records of instances of identified behaviours of concern are made, to enable later analysis to monitor the ongoing effectiveness of the current approach to managing the behaviour. It is understood from the manager that the provider is in the process of reviewing the care planning and support record systems across their services. A schedule of planned reviews was posted on the notice board in the office and examination of two resident’s files confirmed that regular reviews had taken place, and that the resident and/or relevant family members are invited to take part. The recent review minutes confirmed that the planned closure of the service was part of the agenda. The files also contained evidence of periodic review of the care plans by management and the identification and follow-up of any omissions. Daily notes are made within individual bound diaries, though new skills or issues, the meals eaten, specific behaviours etc. may also be separately recorded. Records are also maintained of participation in planned activities and what alternatives might have been offered where activities were declined. Residents are encouraged to take part in the daily routines of the household and to make decisions and choices in their day-to-day lives. During the inspection, staff were observed offering the residents choices about activities, food etc. Records and observation indicate that staff may re-offer options after a short time to check whether the resident has changed their mind. None of the residents is able to manage their own personal allowance monies but the service has appropriate systems to support them and protect their funds. Residents have their own bank account, and within the home, appropriate records of individuals’ funds and expenditure are maintained, including a running balance and retention of receipts for any expenditure. Balances are checked at least once every day as part of handover. Examination of a sample of recent expenditure records indicated appropriate items and the manager confirmed that the fees include the provision of appropriate activities and any necessary supporting staff. This was confirmed by observations of the operation of the system during the inspection. The provider should, however, ensure that the contract clearly identifies any additional items which residents will be responsible for funding over and above the specified fees. Each resident’s file contains individual risk assessments on key aspects of their lives, including such areas as participation in household routines, accessing the community and use of the locks on bedroom doors. The risk assessments are appropriately enabling and include guidelines for staff on how to minimise risks White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 13 appropriately. The risk assessments are under regular monthly review, as evidenced by their attached review records. White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 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. Residents are offered opportunities to take part in a range of activities and to access events and facilities in the local community, to enable them to have a fulfilling lifestyle. Contact with family and friends is encouraged and supported, Residents are encouraged to make decisions and take part in the daily living tasks in the home, to respect their dignity and rights and provide for their emotional wellbeing, and are offered an appropriately varied and flexible menu. EVIDENCE: Residents each have a weekly activities schedule detailing their regular activities. Copies are posted on the notice board in the office for staff reference, and another copy of each is kept alongside a parallel record of any refusals or alternative activities that have been offered. White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 15 Three residents attend day-care services provided by an external organisation, whose workers also visit the home twice a week to provide the service to the other two residents. Examination of a sample of activity plans indicates a range of regular activities, both in the home and within the local community, and it was evident that alternatives were often offered when a resident declined to take part in the planned activity. During the inspection residents had various opportunities to take part in activities and to go out in the community and the senior support worker, who initially supported the inspection in the absence of the manager, maintained an appropriate focus on the needs and planned activities of the residents. One resident has part-time supported employment one morning per week. None of the residents are reported to have indicated a wish to fulfil spiritual needs or visit places of worship, though it was not clear whether this had been checked recently. Residents have at least an annual holiday, either going alone with staff, or in pairs where two want to go together. One resident was previously supported to go to New York, though most holidays are closer to home. The service has its own people carrier, though there were only three designated drivers at the point of inspection, which could be a limiting factor. However, there is a bus route running past the home, and some local facilities are within walking distance. Four of the residents are reportedly happy to use public transport. Contact with families and other significant people is encouraged, through planned sessions on letter writing supported by the staff, and the Essential Lifestyle Plans identify important contacts and relationships with family and friends. Parents and other family members are invited to reviews where appropriate. Residents are encouraged to take part in household routines and personal cleaning and laundry as much as possible and some do take some part in shopping for food and assisting with meal preparation, table laying and clearing. Individuals are expected to clean their own bedroom with support from staff. It was noted that tea and coffee making ingredients were kept secured in the larder and only accessed with staff, which could be seen as overly restrictive of choice. However, the manager explained that this was based on preventing over-consumption by two of the residents, on health grounds. Also, since all of the residents need support from staff to make hot drinks, in reality it has a minimal impact upon residents’ freedom of choice. White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 16 Menus are based on a four weekly cycle and tend to change mainly on a seasonal basis. The manager indicated they are compiled based on the known preferences of the residents. Alternatives are offered where an individual is known not to like what is being prepared, and residents can always opt for something else of their choosing at the time. Residents also choose in turn, what they have for lunch, and can choose their preferred breakfast, daily. Nutritional records are maintained to record the diet of individual residents. White Barn DS0000011070.V363311.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): Standards 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 have sufficient information available to them to enable them to provide the support needed by residents with due regard for residents’ individual wishes and preferences as to how it is provided. Staff meet the health needs of individual residents effectively. Though none of the residents is able to manage their own medication, the home has appropriate systems in place to manage this on their behalf. EVIDENCE: Staff have the information they need to enable them to provide individualised support to residents. As noted already the Essential Lifestyle Plans and records of preferred daily routines contain good detail with regard to how staff should support individual residents, with respect to their needs and their known preferences. There is also a good level of detail with regard to residents’ preferred communication and how individuals indicate their feelings, where verbal speech is not present. Residents may use other vocalisations and body language to communicate their needs. White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 18 There is also an attempt to identify the desirable characteristics for staff to have in order to provide support with personal care to individuals. Some residents use Makaton to communicate and all staff were reported to have received Makaton training to support residents in this. Relevant risk assessments are also on file around specific activities and aspects of personal care support such as bathing. Where aspects of behaviour can be challenging, information is available to help staff identify triggers and early signs of distress in order that they can step in and provide support to enable the residents’ needs to be met. There is some degree of understanding of specific behaviours as communication, though this is not always made explicit within the management plans. Staff record instances of specific, identified behaviours in order to enable later analysis and review, to establish the success of planned interventions. The behaviour management planning, and review process is supported by an inhouse behavioural practitioner. In some cases the behavioural support plans and other documentation had not been signed as having been read and understood by all of the staff. This should be addressed in order to maximise consistency and provide accountability on the part of staff. Over the next few months the priority will be for a focus on supporting each individual resident through the proposed transition to supported-living settings, due to the planned closure of the unit. Initial discussions have already taken place with care managers and families during reviews, and there are plans for a discussion forum with families to further address their questions and anxieties. Residents each have a “My Health” booklet, though in one case this had been completed in March 2006, and would benefit from review to ensure the content was still relevant. The manager indicated that the healthcare recording system was also currently under review by the provider. Individual record sheets are maintained of healthcare appointments, which are separated by practitioner, to enable ease of tracking. Healthcare appointment records in the two files examined were appropriately detailed, and included recent appointments, or refusals to attend appointments, though there had been some gaps between appointments in the past. In one situation where a resident had refused to attend a recent dental appointment, this had been followed-up with a request from staff for a home visit by the dentist. This is good practice. Weight charts were also in evidence within the files examined. None of the residents is able to manage their own medication and the home has an appropriate procedure in place to manage this on their behalf, via a monitored dosage system. White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 19 The signatures and initials of medication administrators are provided within the medication file, together with detailed guidelines on the use of PRN (as required) medication for each individual. In one case the Medication Administration Record (MAR), sheet contained insufficient information on one “as-required” medication. All of the relevant information regarding each medication must be included on the MAR sheet, and should be entered by the pharmacist for all regular medication. White Barn DS0000011070.V363311.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): Standards 22 and 23: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was no evidence available of any concerns having been raised about the service, so it was not possible to evaluate the operation of the complaints procedure in practice, in order to evidence how residents’ views are listened to and acted upon. Though the home has procedures in place to protect residents from abuse, these needed to be updated to ensure that current guidance was in place. EVIDENCE: The service has an appropriate complaints procedure, within the policies and procedures file, which was located in the manager’s office. A version in symbol format is also available, though it is acknowledged that it would be difficult to produce the procedure in a format that would be of use to all of the residents. Two of the current residents would be able to make a verbal complaint; others would need the support of a staff member or another party to advocate on their behalf. The complaints log contained no recorded complaints, so it was not possible to evaluate the operation of the procedure in practice. There was no copy of the procedure available in the shift office or within the complaints log. It is suggested that a copy be made readily available for staff reference. No residents’ meetings are currently held in the home, to seek the views of residents as it is felt that they would not be able to contribute effectively within such a forum. Residents’ families are, however, invited to reviews and are White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 21 surveyed annually as part of the quality assurance process to seek their views on the service. No complaints have been received by the Commission to be referred to the service for their investigation, since the last inspection. A copy of the local multi-agency vulnerable adults safeguarding procedure was present in the home, which dated from 2001. The most up-to-date version should be obtained to ensure that the information available is current. The manager stated in the pre-inspection information, that all staff attend safeguarding training, though the records provided, only covered the training provided in 2008 and thus, did not confirm this. She also stated that there had been no safeguarding referrals relating to the home since the last inspection. The Commission has also received no safeguarding notifications relating to the home since the last inspection. The staff receive training on “breakaway” techniques and the policy of the service is to avoid the use of physical interventions wherever possible. The senior support worker indicated that all staff had received this training but again this could not be confirmed from the recent training records provided. The senior support worker stated that there had been no recent instances of the use of physical interventions. As already noted, the service also has an appropriate system in place to safeguard residents’ funds from abuse. A requirement regarding the maintenance of appropriate records of staff training is made later under Standard 35. White Barn DS0000011070.V363311.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): Standards 24 and 30: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The majority of the home provides a homely and safe environment for residents, but some areas are in need of work to bring them up to a satisfactory standard. Though the majority of the home was found to be clean and hygienic, some issues remain to be addressed. EVIDENCE: The building is large and rooms have plenty of natural light. The main communal areas are a large, attractively decorated and homely lounge, a separate dining room and a further sensory/chill-out room. There is also a small quiet room, though the furnishings therein were not in as good condition, and the carpet was worn and torn, presenting a potential health and safety hazard. The potential health and safety hazard needs to be addressed, irrespective of the planned closure of the unit. White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 23 It was evident during the inspection that there had been some delay in obtaining a replacement for a damaged fire door. This is a fire safety issue and must be pursued with appropriate urgency. One resident showed the inspector his bedroom, which was appropriately personalised and reflected the interests of its occupant. Physical adaptations to the home are not currently needed. Most areas of the home were redecorated in the recent past, though due to the home’s planned closure, some work has not been done. For example the stair carpet is worn and stained in some areas. Whilst it presents no immediate health and safety hazard, its replacement should be considered if the home is to remain operational for a significant period. The bathrooms have been refurbished since the last inspection, though they remain rather basic, and not especially homely facilities. One of the toilets presents an unacceptable level of odour of stale urine. The manager indicated that new flooring had previously been provided, in an attempt to address this, but this has not been successful. Appropriate steps must be taken to address the strong residual odour in this area. Standards of general hygiene elsewhere in the home were observed to be good, and the remainder of the home was free of unpleasant odours. The home has a large and fairly secluded garden, mostly consisting of lawn, which is said to be well-used by the residents. The home has a laundry room equipped with domestic machines, however there is no sluice facility available and the washing machine has no sluice cycle. Given that some incontinence issues are present, the manager must seek the advice of the environmental health department about how best to address the potential infection-control issues. White Barn DS0000011070.V363311.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): Standards 32, 34 and 35: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff were observed to work effectively with residents, during the inspection, and demonstrated good knowledge of their individual needs, but levels of NVQ attainment are significantly below the Government target. Though the manager gave assurances that an appropriately rigorous staff recruitment and selection process was in place in order to support and protect residents, this could not be evidenced from records within the home. The provider has an appropriate core training programme in place to equip staff with the necessary skills to support residents‘ needs, but the current position regarding training attendance across the team was not readily available within the service. EVIDENCE: Staffing levels during the day are said to be a minimum of four staff throughout the day, divided into early and late shifts. In addition the manager is usually present during the day on weekdays. The deputy manager also works two or three shifts per week, including weekends, as well as some administrative shifts. White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 25 Staff are familiar with the needs of the residents who have been settled together as a group for a number of years. At night the staffing is one waking night and one staff member sleeping in. The waking night cover is by agency staff, familiar to residents, on three nights per week, and permanent team members on other nights. A permanent staff member is reportedly on sleep-in duty every night. The interactions observed between staff and residents were positive and enabling, and the staff were seen to offer choice and encourage positive and appropriate activity. Staff also maintained an appropriate focus on the priority needs of residents during the inspection. Staff confirmed that they had been informed about the planned closure of the home and had been assured of a continuing job within the organisation. This appeared to have provided some reassurance and avoided the risk of losing significant numbers of the permanent staff team in the lead up to closure. Some staff were said to be keen to continue to support the residents through the transition to supported living and beyond. At the point of inspection the home had one full-time equivalent vacancy, plus two another members of staff off for extended periods, though agency staff usage was relatively low, being mainly to cover the waking nights. Staffing shortfalls are mostly covered by members of the permanent team, working overtime, and by bank staff from the provider’s other services. The rotas examined indicated that this could result in some staff working long hours, and often having split days off, but the manager said this was their preference and that she monitors the level of overtime individuals undertake to avoid this becoming excessive. The staff team is diverse in terms of their cultural origins, and includes both male and female staff to maximise choice in terms of the gender of staff providing personal care. NVQ attainment within the team is low, though the exact figure was not available, as the manager did not have the figures for bank and agency staff. Of the fourteen permanent staff only four have NVQ level 2 or above, with a further two in progress. The provider should have been working towards a higher percentage of staff having attained NVQ. The manager indicated that recruitment is handled centrally by the provider, which can mean that staff are appointed to a home that have not been interviewed by the home’s manager, although one of the organisation’s home managers is always on the interview panel. This approach also precludes the White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 26 involvement of residents in the recruitment process, which is desirable at whatever level is appropriate and possible. The provider should explore how recruitment might be more targeted to the individual home and how to involve residents in some aspect of the process. The provider indicated that service user person specifications have now been compiled to help support the interview system. The manager stated that the provider has an appropriately thorough recruitment and selection process in place, though recruitment records held within the service, were acknowledged to be incomplete. The manager indicated she was seeking more complete records. Appropriate evidence of recruitment checks must be available for inspection at all times within the unit. The provider has a detailed staff training programme, a copy of which was supplied, which indicated an appropriate core programme. However, the manager did not have access to a training needs analysis for the team or a collective record of when each staff had received their training, so this information was not readily available without reading the individual training records for each staff member. It is good practice to maintain an up to date overall record of training across the staff team to enable ready monitoring of any updates and omissions. The pre-inspection information highlighted that only 60 of staff has a current food hygiene certificate. The manager said she was planning to address this. Copies of the records of training received by all staff, covering the previous three years should be provided to the commission, to evidence the core training received by staff over that period. White Barn DS0000011070.V363311.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): Standards 37, 39 and 42: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. On a day-to-day basis, the home is run in the interests of the residents by an appropriately qualified and experienced manager, though the degree to which the home’s stated aims and objectives are met, could be compromised by the presence of some out of date policies and procedures. There is insufficient evidence that the views of residents are sought in any systematic way to inform the home’s ongoing development. The health, safety and welfare of residents are promoted, for the most part, though could be compromised by the need for an up-to-date fire risk assessment. White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 28 EVIDENCE: The manager is appropriately qualified and experienced to run the service, having an NVQ level 4 and Registered Manager’s Award and a City and Guilds Management for Care. She has sixteen years experience in the residential care field and has been manager for four and a half years, so is very familiar with the service. She is working with the staff and residents’ families, to manage the planned closure of the service and the transition of residents into supported living settings. At present the residents have not been told of these plans in order not to raise anxiety, though this has been discussed at their reviews. A plan has been prepared by the provider, setting out the proposed timeline for the closure of the service. The manager holds regular team meetings, (evidenced from the team meeting minutes), to support and develop the staff and has put improved levels of supervision in place, since the last inspection. The management office is separate from the main home with a separate entrance, which is not ideal but does provide for greater confidentiality for supervisions and meetings. The rotas only showed the manager as working office hours Monday to Friday, but do not identify the periods when her managerial responsibilities for the provider’s other services take her out of the home. The manager was clear that these other managerial duties do not take her away from the unit for long periods, and felt these other duties were not detrimental to her ability to manage White Barn effectively. The rotas should clearly detail when the manager is not available within the unit, and the manager agreed to ensure this was the case in future. The AQAA pre-inspection self-assessment document for this inspection was returned late to the Commission, which is now an offence, which could lead to prosecution, should this happen in the future. Examination of some of the policy and procedure documents produced by the provider, indicate that they have signature sheets for staff to confirm they have read and understood the documents. However, not all were up to date and some staff still need to sign these to provide accountability. Some of the policy documents also date from as long ago as 1997, and not all appear to have been reviewed more recently. The provider should ensure that policies and procedures are subject to regular review to ensure their content remains relevant and legally appropriate. The manager indicated that this was in hand with the provider. The provider has a quality assurance system in place but this is not sufficiently comprehensive in scope. The manager indicated that residents’ families are White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 29 sent annual surveys, but not care managers or other interested parties. Residents are also not currently asked for their views as part of this process, which is an inappropriate omission. Notwithstanding the communication difficulties involved, the views of residents should be sought as part of the quality assurance process, using whatever communication tools are appropriate. There are also no residents meetings or other forums for them to express their views. Though there has been improvement in the provider’s performance in undertaking some monthly Regulation 26 monitoring visits, there is still a failure to undertake these on a monthly basis, which could lead to enforcement action by the Commission. Of the eleven monitoring visits that should have taken place since the last inspection, only six reports of visits could be found in the service. Others appear to have been booked but have not taken place. The manager did indicate that the Chief Executive has undertaken two qualitymonitoring visits per year, separate from this process, but reports were not available for these. As already noted, an appropriate risk assessment system is in place, providing individual risk assessments, which are subject to monthly review. Examination of a sample of health and safety-related service certification indicated that equipment is subject to regular servicing and maintenance. The home has a fire risk assessment, which was dated 9/1/07, which is overdue for review. The fire risk assessment should be reviewed annually or whenever any significant changes are made to the environment or the usage of areas of the building. Regular fire drills have been held in the past year, and there have been two instances of a service user refusing to evacuate. This should be discussed with the fire authority as an individual fire evacuation risk assessment may be needed, as well as some work with the individual on the importance of responding to the fire alarm. Appropriate accident record systems are in place for resident and staff accidents, based on the new tear-off format. White Barn DS0000011070.V363311.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 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 2 STAFFING Standard No Score 31 X 32 3 33 X 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 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 2 X X 2 X White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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. 2. 3. Standard YA24 Regulation 23 16 23 Requirement The manager must ensure that the damaged fire door is promptly repaired or replaced. The manager must ensure that the unpleasant odour in the identified toilet is addressed. The manager must consult with the local environmental health department with regarding the potential infection control issues presented by incontinence, in the absence of sluice facilities or a sluice cycle on the washing machine. Their guidance should be obtained in writing. The manager must ensure that up-to-date records of staff training are maintained within the home to enable effective monitoring and planning of training needs. The provider/manager must ensure that appropriate evidence of recruitment checks is available for inspection at all times within the home. The provider/manager must provide evidence to the Commission, of the training received by all of the permanent DS0000011070.V363311.R01.S.doc Timescale for action 20/06/08 20/08/08 20/07/08 YA30 YA30 4. YA35 18 20/07/08 5. YA34 19 and Schedule 2 18 20/07/08 6. YA35 20/07/08 White Barn Version 5.2 Page 32 staff within the past three years. 7. YA39 24 The provider must establish a quality assurance system, which seeks the views of all interested parties, on the operation of the service. The provider must ensure that monthly monitoring visits take place and that copies of the resulting reports are provided to the manager for filing in the home for inspection. A copy of the report of the June visit must be forwarded to the Commission for monitoring. 20/08/08 8. YA39 26 20/06/08 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 YA18 Good Practice Recommendations The manager should ensure that all staff sign the behaviour management plans and other relevant documents to maximise the consistency of approach and provide accountability on the part of staff. The manager should ensure that all relevant information is provided within the medication administration record sheets, preferably typed at source, by the pharmacist, in order to ensure the safety of residents. The manager should ensure that a copy of the home’s complaints procedure is readily available in the staff office for reference. The manager should obtain a copy of the up-to-date MultiAgency safeguarding procedure for vulnerable adults and make this available to staff. The manager should take steps to address the potential health and safety risk presented by the torn carpet in the quiet room. Consideration should be given to the replacement of the worn and stained areas of stair carpet, should the home remain open for a significant period. DS0000011070.V363311.R01.S.doc Version 5.2 Page 33 2. YA20 3. 4. 5. 6. YA22 YA23 YA24 YA24 White Barn 7. 8. YA34 YA35 9. 10. YA37 YA42 The provider should explore how recruitment might be more targeted to the individual home and how to involve residents in some aspect of the process. It is good practice to undertake a training-needs analysis and maintain an up to date overall record of training across the staff team to enable ready monitoring of any necessary updates. The manager should ensure that all staff countersign to confirm they have read and understood the policies and procedures, in order to ensure appropriate accountability. The fire risk assessment should be reviewed to ensure that it remains relevant and appropriate, and the issue of nonevacuation by one resident should be discussed with the fire authority. White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI White Barn DS0000011070.V363311.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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