Inspection on 10/04/06 for Whites

This inspection was carried out on 10th April 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Whites 17/05/07

Whites 28/11/05

Whites 04/05/05

Whites 19/06/04

Whites 13/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Whites Station Lane, Muller Road Horfield Bristol BS7 9NB Lead Inspector Nicky Grayburn Unannounced Inspection 10th & 11th April 2006 11:30 Whites DS0000026557.V289042.R01.S.doc Version 5.1 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 Whites DS0000026557.V289042.R01.S.doc Version 5.1 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. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Whites Address Station Lane, Muller Road Horfield Bristol BS7 9NB 0117 951 6407 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) Freeways Trust Ltd Mr. Gerald Padfield Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th November 2005 Brief Description of the Service: Whites House is operated by Freeways Trust Limited and is registered to provide accommodation and personal care for up to eleven people who have a learning difficulty. Primarily they accommodate people who have complex behaviour that can challenge the service provided. The home itself is situated in large grounds, which is set apart from a busy main road. This provides a secure area to which residents can have unlimited access. A cat also lives at the property. It is close to local amenities, including shops and public houses. It is also near to a main bus route. Whites benefit from having a van that is regularly used by residents to access community facilities. Freeways hold copies of all inspection reports, and Whites hold their individual reports. The home has an available Statement of Purpose and Service User Guide, which is user friendly. Freeways have a website which can be accessed to find out more information about the organisation as a whole. The day centre based at Leigh Court (head office of Freeways) also produces a newsletter for residents and their supporters. Freeways calculate their fees on a weekly basis. As of 3rd May 2006, the range of fees is from £656.11 to £1,182.58 per week. Additional charges apply to transport costs. If the resident is on the lower rate of mobility allowance the charge is £8.50 per week. If the resident is on the higher rate, the charge is £19.50 per week. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was White’s Key inspection, which was unannounced. The inspector examined the previously made requirements and recommendations; looked at key documents, and undertook a tour of the property. The inspector also spent time with the residents both during the day and for the evening meal; spoke at length with the manager and spoke informally with members of staff. During time with the residents, the inspector used a ‘picture book’, which was viewed by the manager prior to using it. Prior to the inspection, telephone conversations were held with relatives of some of the residents. Previous records and reports held at the Commission for Social Care Inspection were also read and form part of this report. Four residents were case tracked. Verbal and written feedback was given at the end of the inspection to the manager. What the service does well: What has improved since the last inspection? Many of the previously made requirements and recommendations have been met. Areas of the environment have improved, such as the general cleanliness. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 6 Risk assessments have been reviewed and updated to ensure that any possible harm is minimised. There is less use of calorie controlled ‘oven’ meals and more ‘home cooking’. Key Worker reports are generally written on time now and are informative about the residents’ past month’s activities and behaviours. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 7 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 Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 8 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): 1, 2, 4, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have information to make an informed choice and can be assured that their needs will be assessed to ensure that the home will meet their needs. Contracts will reflect current terms and conditions ensuring that residents and the provider are aware of their responsibilities in providing the service. EVIDENCE: Whites have a Statement of Purpose in place and the manager has recently updated the staff details. There have been no new residents at Whites since 2003. There is a policy in place for planned; ‘fast track’, and ‘temporary’ placements, which were inspected at the last inspection. Prospective residents would be offered to ‘test drive’ the home by visiting the property; having an overnight stay, and if necessary, further visits would be undertaken. A review of the placement would occur after the first and third month ensuring that their needs are being met. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 9 Within the Lifestyle Plans, Service User Guides were found. These are kept locked but residents can ask staff for access to them. A requirement was made at the last inspection regarding residents’ contract agreements. Even though this has not yet been completed, the manager confirmed that they are being updated in line with the new financial year. Where appropriate, residents will sign their individual documents. This will be followed up at the next inspection. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from having their individual plans reviewed regularly. Further support needs to be gained to ensure that residents can make decisions about their lives and to ensure that residents are consulted on their lives in the home. Residents are supported to take risks in their lives. EVIDENCE: Four residents’ were case tracked. Individual plans are reviewed at least annually and residents’ key workers write monthly reports. These were generally up-to-date, and many had the current reports completed for the previous month earlier than required. However, for one resident, there was no report since January 2006. It is again recommended that key worker reports be written regularly; within the timescales required by the manager. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 11 Reactive strategies are in place for residents with specific behaviours. There was detail on how to minimise the harm that could be caused, such as what to do prior to going out and what to do whilst out in the community. These are also reviewed regularly. Relatives confirmed, and it is noted on the review minutes that they are invited and attend where possible. It was observed that some residents were aware of who their key worker was and had formed positive relations with them. Some relatives were concerned that the resident’s key worker seemed to change frequently. This was discussed with the manager and case tracked through the reports. Often changes are required due to natural personality clashes or the risk of a level of dependency being formed. As some residents do not have any family or outside relations, it is recommended that the manager make contact with external advocacy organisations to ensure that all residents can make informed decisions and are consulted on their life in the home. Information was passed to the manager from the inspector. It was observed that residents were able to make decisions about their lives on a day-to-day basis. It was discussed with the manager how he is trying to involve residents more in the home (see standards 22 and 39). Residents’ finances were examined. This is fully inspected under Standard 23. None of the residents are assessed as being able to manage their monies. The manager said that when residents go shopping, staff often give the resident the money to hand over the counter to encourage recognition and to involve the resident in the process of buying their things. A requirement had been made concerning the reviewing of risk assessments. This has been met. Current risk assessments are kept in the residents’ Lifestyle Plans and had been reviewed recently. There is also a table of when the assessments should be reviewed for each individual and for the generic house assessments. Assessments would further benefit staff if they showed which level the risk is assessed at. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have opportunities for personal development; take part in activities; and are part of the local community. Staff assist residents to maintain relationships with their supporters. Residents are offered a healthy diet and have enjoyable mealtimes. Residents are respected, but would benefit from more interaction with staff. EVIDENCE: Most residents access local day centres during the week. Each resident also has a Life Skills day when they spend time with their key worker and are supported to carry out their chores (such as cleaning their rooms). Some residents are able to clean their rooms and some demonstrated to the inspector what they would do. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 13 The home has access to a van to transport the residents. Relatives spoke positively about the amount of trips the residents go on. The Key Worker reports further evidenced this. During the evenings, some residents go out for walks or to a local pub. This was observed on the evening of the inspection, and some residents told the inspector about their activities. Staff told the inspector how some residents must go out at least once during the day as part of their care plan. The inspector spoke with a number of relatives prior to the inspection. Relatives were positive regarding maintaining relationships. One relative said that “staff are very good at bringing *** up to visit”. Another relative explicitly said that staff “make me so welcome”. Another relative said that during visits, a member of staff is made available to escort them out into the community. Reminders of phone calls to relatives are kept in the diary, and relatives confirmed that some residents have a specific day to call. Within residents’ Lifestyle Plans, areas that are ‘essential’ and ‘important to me’ include family visits and phone calls. Details of when the resident had contact with their relative are noted in their Key Worker reports. Residents showed the inspector photos in their bedrooms of family relatives. Some residents do not have any family contact. As noted under standard 8, it is recommended for advocacy services to be approached. All residents need full staff support to access the community; therefore, it is difficult for relationships to be made outside of the home. It was evident through observations that residents can make decisions about their day and staff respect them. The manager also gave examples of this. Staff are aware of behaviours, which indicate feelings and the ways in which residents communicate their decisions. Relatives commented that “most staff are really nice”; “lots of lovely people”. Overall, relatives stated that their relatives were well cared for. It was observed how staff generally interact with most residents. However, whilst in the lounge reading documents, and throughout the day, the inspector noted that staff did not interact with some residents for a considerable amount of time. A relative also raised a concern that staff do not interact enough with residents, and were seen to be either doing paperwork or watching television. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 14 Staff must be reminded that they must continue with their role despite an inspector being there. This was discussed with the manager and a requirement has been made to ensure that residents’ social needs are met through stimulation, which suits their needs. Some residents have keys to their rooms. The inspector saw that all residents have voting cards for the forthcoming local elections. The manager is yet to decide how staff will support residents to partake in this vote. Two requirements were made at the last inspection regarding residents’ diets. Menus were viewed and showed a healthier diet. Relatives spoken with said that their relatives were well fed and had seen good meals being offered, inclusive of roast dinners on Sundays. The inspector joined the residents for their evening meal and observed the mealtime preparation. There are two dining tables where residents have their specific places and staff offer good support. Staff were aware of residents’ individual routines and respected these. Some residents present obsessive behaviours around food and hot drinks. Therefore, the fridge and some cupboards are kept locked. However, it was observed how some residents could access tea and coffee facilities by asking support staff. The manager confirmed that he had made an enquiry to the local GP concerning referrals for dietary assessments. However, he is still awaiting information. Therefore, this requirement remains. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 15 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, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive personal support in the way they prefer. Residents’ health care needs are met. There is a robust medication procedure in place to protect residents. EVIDENCE: Four individual’s Lifestyle Plans were read. These are written with a personcentred approach. There are personality profiles detailing the residents’ likes and dislikes; strengths; essentials; leisure, and work/training. There is also detail on how the residents require support with daily living, such as their morning routine and ‘Things you need to know/do to support me’. These were written in good detail and very informative for the reader. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 16 Key Worker reports note when the resident last visited their relevant professionals who are involved in their care such as the optician, dentist, chiropodist, and General Practitioner. These were all up-to-date. Some residents also visit the Community Learning Disability Team for further support. Residents have psychiatric and medication reviews through this service. One identified resident is awaiting a referral appointment. This will be followed up at the next inspection. Some residents have epilepsy. Seizures and absences are monitored. Staff have had training in what to do for the resident. Risk assessments are in place to further protect the resident. Relatives said that they are informed of seizures. The Head of Personnel is trying to establish contacts for more regular training for staff. All relatives told the inspector that staff are good at keeping them informed of changes to health needs and/or if the resident is unwell. Residents appeared to be wearing their own clothes, jewellery and hairstyles, which reflected their personality. Whites use a monitored dosage system, which uses blister packs to aid ease and clarity. The medication file was examined and was found to be in good order. Each resident has a ‘medication profile’, which is clear and detailed. Some residents have ‘as and when necessary’ (PRN) medication, which was checked and the balances were correct. New members of staff undergo training at Freeway’s head office, and then observe administration, and then are observed themselves. Lists of these were on the inside of the medication cupboard. No errors have been reported to the Commission for Social Care Inspection. A recommendation was for Whites to receive their technical check from their pharmacy. This is still to be arranged. The recommendation remains. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A more robust system of gaining residents’, and their supporters concerns and complaints would ensure that they are listened to and acted upon. Residents are protected from abuse; however, more attention to residents’ personal monies would further protect them. EVIDENCE: The complaint’s procedure is stated in the Service User Guide and Statement of Purpose. Due to the communication levels of residents living at Whites, it was discussed with the manager as to how the staff team ascertain complaints. The manager confirmed, and it was observed, that some residents communicate their grievances through their behaviour. The manager explained certain triggers for particular residents. This has been a subject of discussion for the manager recently is he is trying to formulate a more robust system. The complaints book was read and there have been no recorded complaints since 2005. The inspector was told that residents’ meetings are not a forum used to gain any concerns or complaints, as many residents do not often stay for long in the meetings. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 18 Relatives told the inspector of a few concerns which they had raised in the past with staff. These were not recorded in the log. Concerns and complaints are a good form of monitoring the views of resident’s supporters. Staff must be aware of what constitutes a concern or complaint and record these duly. Staff files document that Enhanced Criminal Records Bureau checks are sought prior to starting work. Refresher training in Protection of Vulnerable Adults for staff was due to take place the following week by another manager from Freeways. This will be followed up at the next inspection. The manager confirmed that he and his assistant are going on the Manager’s training in the very near future. Further, the manager was planning to attend the ‘lunchtime discussion group’ held by Bristol City Council. A previously made requirement was to keep accurate records of all financial transactions. Residents’ personal monies were checked and one out of the four was incorrect. The manager explained that an internal investigation will take place, and a financial incident log will be submitted to head office. This requirement has stood for the past three inspections. Enforcement action will be considered if improvement is not made. The manager informed the inspector that an internal audit was carried out on 23rd May and a copy of the e-mail to the Executive Director was sent to the CSCI. This confirmed that the missing monies were rectified the following day. It was discussed with the manager about reporting of incidents and the language used when recording them. Recent incident reports were read. All incidents regarding residents presenting physical behaviour, verbal aggression (inclusive of bullying) towards another resident, or a member of staff must be reported. It is required that staff must be aware of when to report an incident to their management team, and then for it to be reported to the Commission for Social Care Inspection. This was discussed and agreed with by the manager and the inspector. Whites DS0000026557.V289042.R01.S.doc Version 5.1 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, 25, 26, 27, 28, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ bedrooms are personalised and suit their needs. Bathrooms provide privacy. Residents enjoy the range of shared spaces. Maintenance in areas of the home would make the environment comfortable and homely. The home is generally clean. EVIDENCE: A full tour of the property was undertaken at the last visit and a shorter tour was done on this visit. Whites is located up a track away from the main road and has a gate at the front of the property in order to protect the residents from any road hazards. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 20 It is a large house and has 11 (single occupancy) bedrooms for residents and one staff sleep-in room. There are also two comfortable adjoining lounges and a separate smaller dining room. There are limited pictures on the walls due to some of the behaviour presented by the residents. There are two sets of stairs accessing the first floor. The kitchen is functional but is starting to look a bit old and the staff do well to cook for at least 11 people with limited work surfaces. Further, considering the amount of use it has received since being installed, it has been well maintained. There are also two porta cabins on the land (one used to provide a day service for residents). The manager confirmed that it is not in use at the moment due to the weather but will be re-established in the warmer months. Staff must ensure that it is a safe place prior to using it again due to previously found safety hazards in the cabin. Residents at Whites benefit from quite a big garden. A gardener has recently been employed and has started work in the area. It was observed that residents could access all the shared areas at any time, and it was evident that residents enjoyed being in the garden. Eight bedrooms were looked at, some with the resident or the manager. Nearly all of the doors have the residents’ photos on in an individualised frame. All were personalised and generally clean. Some relatives mentioned their concerns over cleanliness and presentation in their relative’s bedrooms whilst visiting. This was discussed with the manager, and how the daily checklist for staff needs to be followed with names against the specific task. It was noted in key worker reports, and some relatives told the inspector that the resident had chosen colours of their bedroom. Photos, pictures, music and toys in the rooms reflect personal needs and lifestyles. There are three bedrooms on the ground floor located near a bathroom, which is often used by the residents as a quiet space. A number of requirements were made at the last inspection regarding the environment. These had mostly been met, which have improved the home. A few maintenance issues have arisen again, which the manager was well aware of, and many had already been reported to head office for approval. The response to this report indicated that many of the problems have been repaired and/or replaced. This will be followed up at the next inspection. The shower room upstairs still needs re-grouting. The base of shower unit is blackened. The manager said that he himself had done this in December, but the mould has re-grown. The downstairs bathroom’s toilet’s seat was against the wall and needs refitting. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 21 Above the back door, the lintel appears damp and is speckled with mould. These issues have been reported to Freeways by the manager. A resident’s wardrobe door needs repairing as it is sloping to one side and they can’t open that side. Another resident’s bedside table needs stabilising as it was leaning sideways and was unsafe. A kitchen cupboard needs fixing as it was very loose and could cause harm. The extractor fan in the shower room needs repairing, as it was not working. In the back ground-floor bathroom, rubbish was found at the back of the bath and needs a thorough clean. The front upstairs bathroom looks jaded and the grouting around the bath is disappearing which can lead to further problems. Underneath one kitchen unit, the panel is broken and a build up of dirt has accumulated in the open area. This was highlighted at the last visit. The unit must be fixed to ensure kitchen hygiene is maintained. Requirements have been made regarding these issues and were raised with the manager during feedback from the inspector. A requirement had been made regarding the general cleanliness and hygiene of the home. This has been partly met. This was discussed with the manager at length and staff’s supervision notes were read regarding this issue. A timetable of chores has been devised to ensure that all areas of the home are cleaned on a regular basis. The manager must continue to closely monitor this on-going issue. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 22 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, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents would benefit from staff being fully inducted and qualified. An effective staff team supports residents. A good recruitment practice ensures that residents are protected. Residents would benefit from a well-supervised and trained staff team. EVIDENCE: Whites has a staff team of 24 members and two specific bank staff, inclusive of a domestic and a driver/gardener. There is a manager, deputy manager, one senior support worker and one team leader. There is good staff retention at Whites. No recruitment agencies are used. The staff team reflects the cultural composition of the residents and of the surrounding area. Specialist services are sought meeting residents’ needs. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 23 Four new members of staff have started at Whites since the last inspection. Their individual personnel files were examined. One member of staff had started very recently and not all of his documents were on the premises. The manager confirmed that he had been told that all his documents were at head office. It must be noted that staff should have their documents on the premises prior to starting work. The other three files had a completed application form; three written references, and details of their Enhanced Criminal Records Bureau check. Two members of staff had not yet completed their induction programme within six weeks of their appointment. Further, only seven members of staff have completed or are enrolled onto an NVQ programme. The manager said that there are no more than three staff at a time doing their NVQ. After staff’s induction, they are required to complete their Learning Disability Assessment Framework (LDAF). The manager confirmed that staff are given time whilst on shift to complete the assignments. Probationary periods, for staff who have not completed the assignments within the specified time frame, are extended. Senior management have become involved in specific issues. Some of the new members of staff have undertaken statutory training. The manager confirmed that training in First Aid; Fire Safety, and Manual Handling is planned for in May/June 2006 to ensure that all members are up-to-date. Some staff are also Appointed First Aiders. All staff receive annual refresher updates in first aid. Both the manager and deputy are supervisors to the large staff team. There is a matrix on the wall for when staff’s supervisions are due. The inspector read some of the supervision notes and were in good detail. The manager receives regular supervision and the past two records were offered to the inspector to read. Some staff are due and some are overdue supervision. Two new members of staff started in January 2006 and have not yet had supervision. The monthly visit report from February states that appraisals are planned for the middle of this year. It is required that staff receive regular and meaningful supervision. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 24 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, 40, 41, 42, 43 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well managed and residents benefit from an open ethos. Residents and their supporters would benefit from being involved in a formal review of the home. Records are well maintained and are kept secure. Policies and procedures safeguard residents, however, should be reviewed and updated more efficiently. The health and safety of residents and staff is promoted, however, repairs need to be carried out more efficiently. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 25 EVIDENCE: The Registered Manager was available throughout the inspection and was very informative and knowledgeable about the service provided by Freeways and each of the individual residents. Mr Padfield has worked at the home for four and a half years and has his Registered Manager’s Award and City and Guilds Advanced Management in Care. One relative commented, “Gerald is excellent”. The inspector met the deputy manager during the previous inspection and has completed his NVQ Level 3 in Care. The manager has a limited control over the home’s budget. This was discussed during the inspection, and a breakdown of the monthly expenditures is on an office pin board. Freeways have an internal auditor who works with the manager to ensure that budgets are kept to. It was understood at the last inspection that Freeways, as an organization, are devising a quality assurance system within their Business Strategy Plan. Freeways are awaiting further information from the Commission for Social Care Inspection to ensure that their quality assurance system meets the needs of all concerned. There is no formal gathering of views from the residents or their supporters. As stated under Standard 22, the manager is seeking ways to ensure that the residents at Whites are able to raise concerns and complaints in an effective manner; and to have an effective input into the home’s development. Some of the relatives did not know that they had access to these reports. The Principal Care and Development Manager, and the Head of Personnel and Training undertake the monthly visits to comply with Regulation 26. The format changed earlier in the year and is much improved. However, the Commission for Social Care Inspection had not received a report since January 2006. The manager confirmed that the visits had occurred. Since the inspection, the CSCI has received February and March’s report. The inspector spoke with senior management in Freeways and the response to this report states that these reports are sent back to the home and the CSCI within the first two weeks of the following month. There are three large folders containing the policies and procedures for the running of the home. It was evident that some re-organisation had occurred but there were still old and out-of-date policies within the folders, which could cause confusion. It was discussed how a staff handbook could be developed for quick reference. The recommendation remains. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 26 A previously made requirement regarding the security of residents’ Lifestyle Plans has been met. A new padlock has been bought and staff are now aware that the cupboard has to be kept locked. Records are generally kept up-todate and are well-maintained. The fire log and health and safety log folders were examined. Nearly all the tests and checks had been carried out within the appropriate timescales. The emergency lighting tests had not been carried out since 22/2/6. The manager wrote to confirm that a contractor had visited in 17/2/6 for a six monthly maintenance inspection. It was reported a month later that the test switch had been broken, and is waiting to be repaired. This must be done to ensure that the residents are kept as safe as possible. Staff undergo fire safety training and the manager explained the robust procedures and test they do. The manager was reminded that night staff must undergo this training every 3 months as dictated by the Avon Fire Brigade. Fire drills occur and are recorded with any identified areas of concern. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 27 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 3 2 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 1 25 3 26 3 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 2 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 3 3 2 3 Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard YA5 YA16 YA17 Regulation 5(1b,c) Requirement Timescale for action 31/05/06 31/05/06 31/05/06 Residents’ contracts to reflect current situations. 16(m) Assess residents’ social interaction needs. 12(1a)13(1b)16(2I) Residents to receive dietary assessments prior to going on a diet. (previous timescale 31/01/06) 4. 5. YA22 YA23 22(3) Sch 4(8) All concerns and complaints to be recorded. Keep accurate records of all financial transactions. (Improvement made but requirement remains) (Previous timescale 04/05/05) 30/04/06 30/04/06 6. 7. YA24 YA24 23(2b) 23(2) Send the internal report to the CSCI. Dampness above back door to be dealt with. a) The shower room’s grouting needs replacing. (outstanding requirement, previous timescale 31/01/06) 30/06/06 31/05/06 b) Downstairs bathroom’s toilet seat to be repaired. c) Extractor fan in shower room to be repaired Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 29 8. YA26 23(2c) 9. 11. YA36 YA42 18(2) 23(4)(a)(ciii)(cv) d) Ground floor bathroom to be deep cleaned. e) Front upstairs bathroom’s bath grouting to be replaced. f) Kitchen cupboard to be secured. g) Kitchen unit’s panel to be repaired. a) Resident’s wardrobe 30/04/06 door to be repaired. b) Resident’s bedside table to be repaired. Staff to receive regular 31/05/06 supervision from their line manager. The emergency lighting 30/04/06 must be tested monthly, and also checked on a daily basis as stated by Avon Fire guidelines. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 2. 3. Refer to Standard YA6 YA8 YA20 YA40 Good Practice Recommendations Key Workers to fulfil their role of completing the monthly reports. Advocacy services to be contacted and involved with residents. Tower Pharmacy to continue with the 6 monthly technical checks. Policies and Procedures to be updated and dated, to show the most current policy in use. Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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. Extracts may not be used or reproduced without the express permission of CSCI Whites DS0000026557.V289042.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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