Inspection on 19/11/07 for Willes Road

This inspection was carried out on 19th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Willes Road 18/07/08

Willes Road 04/07/07

Willes Road 11/07/06

Willes Road 29/11/05

Willes Road 19/05/05

Willes Road 26/10/04

Willes Road 14/05/04

Willes Road 03/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Willes Road 26 Willes Road Leamington Spa Warwickshire CV31 1BN Lead Inspector Martin Brown Key Unannounced Inspection 19th November 2007 09:30 DS0000058002.V354895.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 DS0000058002.V354895.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. DS0000058002.V354895.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willes Road Address 26 Willes Road Leamington Spa Warwickshire CV31 1BN 01926 336437 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) www.turning-point.co.uk Turning Point vacant post Care Home 6 Category(ies) of Learning disability (6) registration, with number of places DS0000058002.V354895.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th July 2007 Brief Description of the Service: This house is home to five young people who have significant learning difficulties, impaired communication skills and complex behaviours. All are able bodied. The service offers 24-hour staffing and high levels of intensive support and personal care. 26 Willes Road is a Georgian detached house that has been divided into two separate, self-contained dwellings. The top two floors provide three bedrooms (one with en-suite), two lounges, one dining room, kitchen, laundry, one bathroom and separate toilet and staff office, all for three people with severe learning difficulties. The basement provides accommodation for two young men with learning disabilities. There is a rear entrance, two bedrooms, one bathroom, a small lounge and a small kitchen. There is a storage space that has been converted into an office come laundry. The fees currently range from £1,430 to £2,501. There are additional charges for transport; a £400 allowance is made towards an annual holiday. DS0000058002.V354895.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been made using evidence that has been gathered by the Commission for Social Care Inspection. The inspection visit was unannounced and took place on 18th November, between 9.30am and 5.30pm. Additional telephone contacts with relatives of three service users were made following the inspection. All service users were seen and spoken over the course of the inspection, as were staff on both the morning and afternoon shifts. A tour of the premises was made, relevant documentation was looked at, and observations of the interactions between residents, staff and their environment were made. Policies and procedures, and care records were examined, and three service users were ‘case tracked’, that is, their experience of the service provided by the home was looked at in detail. Specific elements of other service users’ care were also looked at in detail. The Annual Quality Assurance Assessment, the most recent ‘regulation 26’ report of a visit by the manager of the service, and the improvement plan, following the previous inspection in July 2007, also informed the inspection. Staff were welcoming and helpful throughout the inspection. What the service does well: What has improved since the last inspection? Some improvements to the environment have been made. The outside area has been tidied up, and is now far more accessible. There has been refurbishment in bedrooms. DS0000058002.V354895.R01.S.doc Version 5.2 Page 6 Medication administration has greatly improved, with additional staff being trained to always ensure that there is a suitably trained person on duty to dispense medication. The system for looking after service users’ finances has recently improved. Although there is still a relatively small permanent staff team, and a correspondingly high use of agency staff, the use of agency staff is far more selective, resulting in the use of consistent agency staff who are far more confident and competent with service users. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000058002.V354895.R01.S.doc Version 5.2 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 DS0000058002.V354895.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been no admissions to this service for several years, and any future admissions to the service in its present configuration is unlikely. Documentation from the organisation indicates that, in the unlikely event of a proposed admission, a prospective service user may be confident that their aspirations and needs would be suitably assessed. EVIDENCE: There have been no new admissions since the last inspection, and no further admissions are anticipated. Turning Point has a referral assessment policy in place, with comprehensive risk assessments, as detailed in the Annual Quality Assurance Assessment returned by the service. This notes that “We have a service user guide and statement of purpose that the service user would be given identifying his rights and expected behaviour of all who live at the service. We support the service users to lead their own lives through PersonCentred Care Planning (PCP), making their own choices, creating opportunities to experience wishes and dreams as well as new opportunities, including choice of home. We support our staff by providing a comprehensive training and development package, regular supervision and appraisal in which is discussed PCA, Protection of Vulnerable Adults (POVA) and reflective practice.” DS0000058002.V354895.R01.S.doc Version 5.2 Page 9 DS0000058002.V354895.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can be confident that, once all revisions and reviews are completed, individual care plans will provide a clear, informative guide to their assessed current needs and personal goals, how individual risks are managed, and how they are supported in making and expressing decisions. Observation showed staff aware of and working to existing guidelines regarding needs and wishes. Service users will be more confident that information concerning their wishes and needs is more highly regarded if the service ensures that care plans are secure, and that ‘back up’ copies of information is available. Service users cannot benefit from care plans and other guidance that is not readily accessible. EVIDENCE: Individual care plans are currently being extensively revised, following the introduction of new formats by the organisation, and reviews by social services. These plans were seen in various stages of readiness. Staff advised that they were to be completed by the end of the month, ready to be checked DS0000058002.V354895.R01.S.doc Version 5.2 Page 11 by a manager from another area of the organisation. Individual staff each ‘key work’ one service user, and therefore have responsibility for their reviews and care plans. A sample of three care plans were looked at. Care plans have previously been in service users’ rooms, but in some instances, these have suffered damage or loss, and several are now kept either in locked areas in rooms, or in the office. One plan could not initially be located; staff expressed frustration at such work going astray. When it was located, this plan showed evidence of good work in comprehensively illustrating the needs of the service user with good use of photographs, and individually expressed wishes. Included were personal statements such as ‘I want my own flat’ and ‘‘be near my parents’. Active support plans detailed regular activities planned for the weeks. These were compared with activities taking place, and found to be accurate, except where service user wishes, or other circumstances, such as sickness, had changed plans. Daily recordings evidenced activities and appointments taking place as planned. Another care plan seen was also in the process of being updated. This contained good clear details of likes, dislikes, and support needs, including how risks were managed. Staff spoken with showed a good knowledge of these needs, and how to manage them. Although the guidelines in many instances stated that the last review was in 02/06, the ‘key worker’ for this person advised that these are now being reviewed with outside professional support. Observation of staff/service user interactions showed that the guidelines were still current. In one instance, a service user made himself a cup of tea, in line with guidelines, with the only difference being the level of staff supervision. Another service user has had a review postponed owing to illness. This was due to be re-scheduled. A communication book was seen for this person, giving a good informative and clear guide to care needs. Further information, detailing ‘my life now’ and a ‘person centred approach’ to current needs, was to be completed following the re-arranged care review. A section of this person’s care plan ‘What I do now’ was particularly useful and clear, but suffered from having no date on it, to help facilitate future reviews. At the last inspection, a guide for new agency workers was seen. This could not be located initially, but was later found to have been put in a storage box. This contains useful information for those unfamiliar with service users needs. Daily records and diaries for service users showed a good record of how needs and wishes were being met on a daily basis. These were kept in the lounge, on top of a cabinet, and posed a potential compromise of confidentiality. Staff spoken with concerning this acknowledged they may be more appropriately stored in a cupboard, but it was also noted that unlike other documentation, these were always accessible, and never got mislaid. After further discussion, DS0000058002.V354895.R01.S.doc Version 5.2 Page 12 staff agreed that there was a cupboard in that room that could be used, enabling the daily records to be stored to maintain confidentiality, whilst also keeping them accessible to staff for updating as required. DS0000058002.V354895.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing arrangements for Service users are variable depending on individual needs. Therefore not all individual activities are able to take place on a day-to –day basis. Service users enjoy a variety of meals, although some may benefit from a higher emphasis on healthy eating options. EVIDENCE: The service is located favourably to facilitate ‘spontaneous’ activities, such as walks by the river, in the park, and to local shops and cafes. Good staffing ratios enable service users to go out regularly, escorted by staff. Two service users were supported by two staff to go shopping, go for haircuts and have lunch. They were to go to a local ‘Gateway’ club in the evening. One relative queried the fact that his son no longer goes to college, saying that he used to benefit from this a number of years ago, when an ‘enabler’ from the service used to accompany him, and wondered if this could be re-instated. DS0000058002.V354895.R01.S.doc Version 5.2 Page 14 One relative commented that staff changes over the past few years had unsettled his son, who had more recently ‘got used to this,’ although he found it difficult to build relationships with ever-changing staff members. Staff expressed concern that one person, who staff were clear required two staff to accompany him when out, did not now get out as much as previously, as staffing ratios had been reduced to 1 to 1 for all service users in the home. This person is often highly selective as to when he chooses to go out. Some staff felt he had been more settled lately, others felt he had been showing signs of frustration. There had been fewer recorded incidents involving this person recorded in recent months. Family contact continues to be supported, with regular visits and stays to families being supported. One relative had not been happy some months ago, when his son was unable to visit and he was told this was because there were no staff to support him. He says the situation has since improved. Menus showed a variety of food being offered, with service users’ preferences being heeded. There are currently no special diets, other than the need to encourage healthy eating. This is particularly applicable to one person for whom a dietician has been involved to support weight loss, to be achieved through more ‘healthy eating’ and greater exercise. Two staff spoken with expressed a wish for more training in regard of providing healthy meals. They felt that, at present, the emphasis on service user choice was not adequately balanced by the need for particular individuals to eat more healthily. One service user, who often prefers to eat separately, and sometimes at unpredictable times, started to help himself to some cereals late in the afternoon. A member of staff supported him, with limited success, to manage this sitting down, and in a way that produced less mess and waste than might otherwise be made. One key worker spoke enthusiastically of how one service user was supported to help prepare a meal, and how this helped not only to embellish food preparation skills being learnt at college, but also helped reduce his wish to ‘snack’ for at least the duration of the meal preparation. Staff explained that shopping for major items took place once week, and that staff on duty that evening prepared and cooked meals. A number of service users had eaten out that day, and one staff member was preparing the evening meal for all. Service users had previously been observed enjoying meals. DS0000058002.V354895.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from a core group of staff who show a good awareness of their health and personal support needs and how to meet them. An enlargement of this team and less reliance on agency staff would enable service users to be confident that their needs were being consistently met at all times. Service users’ social and living skills will be properly enhanced only if good practice in managing challenging behaviour is consistently established and practiced by all staff in accordance with agreed guidelines. Service users can be confident that medication is being administered by sufficient suitably trained staff at all times. . EVIDENCE: Staff were observed interacting in a warm and friendly manner, for example, one staff commenting in a reassuring manner on seeing a service user for the first time that day – “You look nice; what a nice big cardigan”. DS0000058002.V354895.R01.S.doc Version 5.2 Page 16 One staff member returning from an early morning walk with a service user informed me that this was now an established routine that he enjoyed as a way of helping him settle prior to breakfast. Other staff confirmed that he was ‘calmer’ now, and he appeared more relaxed than on previous inspections. One service user took a cup of tea that did belonged to another resident; two staff were promptly able to calmly and swiftly empty this cup to ensure his actions were not reinforced by directly benefiting from the drink. Staff expressed frustration that such policies were not always adhered to by all staff. One service user has been identified as having potential visual difficulties. The key worker was able to detail strategies and specialist involvement in attempting to resolve these, outlining responses and difficulties. Medication records were checked. Following the last inspection, more staff have received medication training, ensuring there is always someone on duty who is suitably trained to administer medication. Most medication is dispensed via pre-packed medication ‘blister’ packs. Records were seen to be accurate. However, one tablet was missing from the final compartment of one pack. The acting deputy explained it this was standard practice to use a tablet from the end of the pack if a tablet had been dropped or damaged, and that the damaged or dirty tablet would be returned in an appropriately labelled and sealed envelope to the pharmacy, who would replace it with an additional one. However, there was no ‘returns’ book available in which to document or otherwise evidence this. The deputy agreed to establish such a book and ensure all staff were aware of the need to record any returned medication in it. The service manager later advised, in a telephone discussion, that there is a returns book available in the home for this use. ‘Non–blistered’ medication was seen to be accurately recorded, and records of medications left tallied with actual amounts of tablets remaining in boxes. There also accurate records and amounts numbers recorded of PRN (‘as required’) medications being stored and administered. It was noted that one topical cream was prescribed as apply to skin as required, without any guidance as to specifically where and why. The staff member explaining the medication procedures was able to explain the exact circumstances around this medication, but agreed that this information should be recorded. One staff member’s main concern regarding medication was that the staff team of permanent full time staff was still relatively small, so that, even with them all trained to give medication, the numbers were still small, and that sickness, plus training days, might leave the home with insufficient permanent staff to dispense medication. Other staff were clear that the needs of the service users took precedence over training, and that if such a circumstance arose, then staff would have to forego training to ensure that staff were available to administer medication. DS0000058002.V354895.R01.S.doc Version 5.2 Page 17 DS0000058002.V354895.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ views are listened to and acted on; sometimes the service has difficulty interpreting these views when they are expressed in terms of complex behaviour. The service is addressing the need to have consistent staff who are familiar with service users’ communication methods. Service users can be confident that incidents of self-harm and allegations of abuse are investigated and addressed by the service, and may be optimistic that staff and service awareness of these will reduce or eliminate them. Service users can be confident that the system for looking after their finances is now more robust. More comprehensive training in managing challenging situations may help the service manage challenging behaviour in a consistent way. EVIDENCE: Service users have high communication needs and continue to be dependent to a high degree on staff interpreting their views and wishes, using their knowledge, experience, and existing communication guides. Service users are able to make their views known with a mixture of gestures, one word responses, and in one instance, with a ‘light writer’ device – a light weight, portable, speaking typewriter. DS0000058002.V354895.R01.S.doc Version 5.2 Page 19 Staff were observed to respond to views and wishes and using their familiarity and knowledge of them to respond. Communication guides, recordings in daily reports, observations during the inspection, and discussion with staff all evidenced an environment in which service user views and choices were respected, within a context of trying to improve social skills and overall quality of life. Warm and friendly responses took place, and where behaviour was challenging, calm, unflustered responses were observed. One staff commented that the home would benefit from more training on responding to challenging behaviour, to help ensure a consistent and confident response from staff on all occasions. She did not feel that abusive staff practice was an issue; rather, the concern was that unacceptable behaviours, such as taking someone else’s drink, may not be challenged by staff on some occasions if they did not feel confident to do so safely. There has been an incident where service users’ monies went missing. The police were involved, but the matter was never satisfactorily resolved. Service users’ money was promptly reimbursed, and the previous security system was changed. Staff were able to explain the new system, involving double signatures, checks on finances at every change over, and limits on amounts of money. A sample check on two service users’ monies showed amounts, expenditure, and receipts all to be accurate and in good order. Receipts are now regularly archived, making checking of current finances easier. There has been a history of Vulnerable Adult issues at the home over the past few years, and staff are very aware of whistle-blowing and issues of abuse, with a number of staff having either made allegations in the past, or been the subject of them. The service manager had advised the previous week that investigations into allegations have now been completed, disciplinary actions, where appropriate, had been taken, and that there are now no outstanding allegations. All allegations made against staff had been made by other staff. Relatives spoken with said they had concerns over the frequency of staff turnover, and the high use of agency staff in recent years, rather than with the quality of permanent staff, which they felt to be good. Their main concern was the use of staff unfamiliar with the needs of the people living at the home. Those able to comment felt that things may have slightly improved in the past few months in this respect. DS0000058002.V354895.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All service users, bar one, who has a smaller room, continue to benefit from bedrooms that are spacious, and well furnished. The home was tidy and safe, including dangerous household objects being secured. The garden area is accessible ensuring service users can use all this area of the home safely. The hallway, with plain walls and areas in need of renovation, remains uninviting. EVIDENCE: Individual bedrooms continue to be spacious and pleasantly furnished, reflecting individual wishes and personalities. The one smaller bedroom has had a new floor, and is in the process of being redecorated. The basement continues to be improved, with rooms being refurbished, with no trace of damp, which has previously been a problem. The fire door to the kitchen now had a magnetic, alarm-activated closure on it. Staff advised that the lounge and stair carpets in this area, which are badly worn, are about to be replaced. Flooding from the nearby river remains a long-term risk. DS0000058002.V354895.R01.S.doc Version 5.2 Page 21 The laundry was tidy, with all machines in operation during the inspection. Although it could benefit from repainting, it was uncluttered by objects unrelated to its functions, and staff were seen ensuring items were promptly laundered and returned to service users, or supporting service users to get items. The garden area has been improved with, the staff advised, the help of community service workers. In particular, the rear exit downstairs has been tidied up and made far more accessible. The hallway is bare, with areas of wallpaper remaining ripped. Staff advised that this is where fire and similar notices were put up and pulled down by a service user, ripping the wallpaper underneath. The deputy advised that renovation work was planned inside, with repainting and wall renovation to take place, using the workers who had renovated the garden. The lounge remains bright, and homely, benefiting from a variety of pictures. The dining area is missing a few pictures, leading the walls to look a little bare. The rear lounge still has no specific use, with some lighting suggesting its use as a ‘snoozelum’ to help service users ‘chill out’, but with other items such as a cupboard, and files, suggesting its use as a storeroom. Staff spoken with said it had no particular use at present, and wasn’t used by service users. There were two radiator covers that were broken; staff advised that these had been damaged by a service user and that the ‘handyman’ was to repair these. One relative spoke of concern over the poor quality of the décor in the home. Toilets and bathrooms were seen to be clean and tidy; one toilet had no toilet roll. Staff had mentioned, in a different context, that one service user will sometimes put toilet rolls in the toilet, causing a blockage. No risk assessment was seen regarding this. The home was free from unpleasant odours. DS0000058002.V354895.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from a core group of dedicated staff who are aware of their needs and how to meet them. They can be more confident that agency staff used in support are familiar with their needs and how to meet them. Workers are appropriately recruited, but the service may leave service users vulnerable unless it clearly records that appropriate checks have been made. EVIDENCE: The service was sufficiently staffed to provide one-to-one cover. Rota showed that this was always the case. Bank and agency staff are used as necessary. On the morning of the inspection two agency staff were used in the morning, and two in the afternoon. I was advised by staff that the service now requests specific agency staff, so that only staff who have demonstrated that they are familiar with and able to work effectively with service users are used. Agency staff spoken with were able to demonstrate their knowledge of service users’ needs and how to meet them. Observation showed them working confidently and appropriately with individual service users. Staff advised that agency workers are now being involved in training. DS0000058002.V354895.R01.S.doc Version 5.2 Page 23 Relatives spoken with expressed concerns over the number of staff changes in recent years. One relative commented that staff changes over the past few years had unsettled his son, who had more recently ‘got used to this,’ although he found it difficult to build relationships with ever-changing staff members. Relatives commented favourably upon the better consistency in the use of agency staff. ‘They seem to know what they’re doing now’ was one comment. There were concerns expressed by staff regarding the staff ratio for one service user now being one to one, rather than two to one, resulting in other staff having to assist at key points, and with opportunities for this person to go out, which still requires a two to one staffing ratio, being more limited. The deputy advised that rotas are arranged to try and give additional cover at key points to support this service user, in opportunities to go out, which may not always be taken up by the person concerned. There are agency proformas for ensuring that agencies confirm essential details, such as the details of their Criminal Records Bureau check, of people used by the service. Records of these were seen, but there were not in place for the two most recent agency workers. When this was pointed out, an acting deputy manager sent the request to the agency, and was able to inform me the following day that these had been satisfactorily returned. A sample of three staff files were examined. Recruitment practices were seen to be in order, except that confirmation that Criminal Records Bureau checks had been seen to be satisfactory were not recorded on individual files. The deputy was able to respond promptly to this, requesting and gaining confirmation from the organisation’s central office that these checks had been satisfactorily completed. One of the acting deputy managers spoken with concerning staffing advised that supervision is taking place, and notes of a recent supervision demonstrated a supportive exchange of views, with staff able to raise concerns, and being complimented on positive work. The deputy advised that the service manager is also supporting with supervision. One staff member had taken on responsibility for staff training, and was drawing up clear records of training completed, and planned. These, combined with discussions with staff, evidence of certificates, demonstrated ongoing refresher training in core and specialist areas. One staff felt that specialist training in managing challenging behaviour should involve all staff. At present, only a small proportion of staff had benefited from a particular training session. Staff advised that no one had undertaken National Vocational Qualification level 2,and that this was something a number of staff wished to do, to demonstrate and add to their competencies. The service manager later advised that staff were registered for this, but that staff had been unable to progress as yet. DS0000058002.V354895.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from a committed and competent team that is taking on additional duties to run the home effectively and safely in the absence of a manager. Service users can be confident that previously identified safety concerns have been addressed, but may feel safety is compromised if fire safety measures are not clearly documented. The arrangements for the good running of the home are currently compromised as there is no registered manager. At present, the service is progressing through the hard work of senior staff and the support of the service manager and the wider organisation. EVIDENCE: The service currently has no manager, following the abrupt departure of the previous manager at the last inspection. Turning Point senior management DS0000058002.V354895.R01.S.doc Version 5.2 Page 25 advise that they have so far been unsuccessful in recruiting for this position, and have re-advertised to fill this position. At present, two staff are acting as deputies, with other full-time staff taking on specific responsibilities. Discussions with them, and watching interactions with service users, showed these individuals to be motivated, able, and demonstrating excellent practice. They are supported by the service manager, and from managers in nearby homes. At present, a lot of work is being done up-dating care plans and reviews, with key workers being given responsibility for tasks concerning ‘their’ service user. While it was apparent that staff ‘acting up’ in management roles were working exceptionally well to make good deficits in the service, they also spoke of the need for a manager to move the service forward. A great deal of good practice, and no poor practice, was observed during this inspection, with challenging behaviour being managed calmly and de-escalated. One relative spoke positively of the support role the service manager provides for the service. One deputy noted a lack of reported incidents for one service user, and, knowing that these incidents were unlikely to have stopped, reminded all staff of the need to report all such incidents as part of monitoring them as part of being aware of his well-being and the service meeting his needs. This resulted in these incidents being recorded once more, as a tool demonstrating his particular needs and well–being, and in this instance, demonstrating management effectiveness in ensuring a consistent staff approach. One staff has taken on the role of co-ordinating training, and is producing a clear and up-dated guide to training that has been undertaken and is planned for all staff. One staff has taken on a health and safety role. One task to be completed is the establishment of a clear fire risk assessment. Staff spoken with were all clear on fire procedures, but there was no readily available evidence of these being clearly recorded as part of a fire risk assessment. Details of recent fire equipment tests were seen on fire equipment, but no paper record could be found. The testing of the fire alarm system was due this month. The deputy advised this would be booked in. As on a previous inspection, the fire alarm was activated by cooking in the kitchen during the inspection. Staff were aware of what to do, and commented that the alarms are frequently set off by cooking. Particular health and safety shortcomings noted at the previous inspection were not apparent this visit, with knives stored safely, doors housing hazardous substances locked, and fire doors have suitable closures on them, and no inappropriate door wedges being used. DS0000058002.V354895.R01.S.doc Version 5.2 Page 26 General risk assessments are currently being updated; one staff member has taken on responsibility for this. A number of items were marked ‘needs review’ Risk assessments covered activities of general risk with service users, such as going shopping, bathing, and cooking. Specific risks with particular service users are covered in guidelines for those service users. Staff spoken with, including agency staff, showed a good awareness of risks in respect of activities with service users, particularly outside the home. Staff showed a good knowledge of ‘triggers’ for behaviours, and how to avoid these, how to defuse them, and how to seek and offer additional support. Several potentially difficult situations with service users were managed by staff in a calm and deescalating manner during the inspection. Staff expressed a wish for more comprehensive training in managing challenging behaviour being made available for all staff, as a tool for establishing a consistent approach to supporting service users in learning more socially acceptable behaviours. Regular regulation visits by the service manager take place, and staff and relatives discussed the family forum that took place recently, and where information and views about the service was shared. DS0000058002.V354895.R01.S.doc Version 5.2 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 2 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 2 x DS0000058002.V354895.R01.S.doc Version 5.2 Page 28 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 Standard YA20 Regulation 13 (2) Requirement There must be an accessible record of any medication returned to the pharmacy, so that service users can be confident that all medication handled on their behalf is being handled properly and can all be properly accounted for. There must be a protocol for the use of all ‘as required’ medication, so that service users can be confident that staff are clear how and when it should be given. The service must ensure that toilet roll is available in toilets with minimum risk of toilet rolls being misused, so that service users are supported to maintain hygiene and dignity. Timescale for action 22/12/07 2 YA20 13 (2) 22/12/07 3 YA30 13(3) 22/12/07 4 YA35 18(1)(c) The service must demonstrate 22/02/08 that it can support at least 50 of staff to undertake the National Vocational Qualification level two in care, so that service users can be confident they are supported by properly trained staff. DS0000058002.V354895.R01.S.doc Version 5.2 Page 29 5. YA42 23(4) The service must ensure that it has a clear and accessible fire risk assessment that includes details of any evacuation procedure, and full records of fire equipment and alarm tests. 22/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The service should ensure that all necessary care records are up to date, stored appropriately, and are accessible, to support the well being of service users. Information concerning service user needs should be dated, to facilitate reviews and the maintenance of up-todate guidance. Service user confidentiality should not be compromised by daily recordings being accessible to anyone other than staff or the individual service user. A decision should be made as to whether the ‘sensory’ is to be used for that, or for some other, purpose, so that rooms are used for the maximum benefit of service users. The service should consider whether the basement is a suitable environment, and whether the service itself, in its present configuration, adequately meets the needs of some, or any, of the people who currently use it. The service should ensure that the walls in the hallway are refurbished and steps taken to reduce damage to walls caused by a service user. All staff should have specialist training on managing challenging behaviour, to ensure service users displaying challenging behaviours are supporting in consistent and effective ways. 2. YA6 3. YA10 4. YA24 5. YA24 6. YA24 7. YA35 DS0000058002.V354895.R01.S.doc Version 5.2 Page 30 8. 9. YA37 YA42 For the service to properly support and benefit the service users and their development, a registered manager is needed. The service should discuss with the fire alarm system contractors ways to reduce ‘false alarms’ to minimise inconvenience to service users, and not compromise fire safety responses by over familiarity with the alarm sounding. DS0000058002.V354895.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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