Inspection on 23/09/08 for Woodlands

This inspection was carried out on 23rd September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodlands 21/09/09

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOME ADULTS 18-65 Woodlands Leamington Road Barton Hills Luton Beds LU3 3XF Lead Inspector Nicky Hone Unannounced Inspection 23rd September 2008 11:00 Woodlands DS0000071719.V371634.R02.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 Woodlands DS0000071719.V371634.R02.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. Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodlands Address Leamington Road Barton Hills Luton Beds LU3 3XF 01582 564780 01582 564782 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) TACT UK Ltd Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD The maximum number of service users who can be accommodated is 5 This is the first inspection of Woodlands since it transferred to TACT UK Ltd. The last key inspection was on 25/06/07. 2. Date of last inspection Brief Description of the Service: Woodlands is a home for up to five adults with learning disabilities. On 01/03/08 TACT UK Ltd took over as provider of the service from the Bedfordshire and Luton Mental Health and Social Care Partnership Trust (BLPT). The bungalow is owned by MacIntyre Housing Association (MHA), which is responsible for the maintenance and upkeep of the building. The home is situated in a well-established residential area of Luton, with access to local shops as well as to town centre facilities and good public transport links. About 3 years ago, Woodlands was completely refurbished to a very high standard. The building is a large bungalow, which is suitable for people who may have a physical disability. Each service user has their own bedroom with an ensuite bath or shower. Two of the bedrooms also have their own kitchen and lounge facilities. Communal space consists of a large lounge, activity room, music room, and a good-sized kitchen/diner. Office, storage, laundry and additional bathing facilities are also provided. There is a garden to the rear of the building and a number of parking spaces to the side of the home. Full information regarding the fees, including any additional charges, was not known at the time of writing. Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. TACT UK Ltd. took over as provider of the service at Woodlands from the Bedfordshire and Luton Partnership Trust (BLPT) on 1st March 2008. The building is owned and maintained by MacIntyre Housing Association. The manager and staff team have continued to work at the home. At the time of this inspection there were five people living at Woodlands. For this inspection we looked at all the information that we have received, or asked for, since the last key inspection of Woodlands. This included: • The AQAA (Annual Quality Assurance Assessment) that the manager completed and sent to us in May 2008. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living at the home. It gives the manager the opportunity to say what the home is doing to meet the standards and regulations, and how the home can improve to make life even better for the people who live there. The AQAA also gives us some numerical information about the service; Surveys which we sent to the home to give to people who live at Woodlands, to their relatives/carers, and to staff. We received 3 replies from staff, and we spoke with a member of staff on the telephone. What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement; Any safeguarding issues that have arisen; and Information we asked the home to send us following our visit. • • • • This inspection of Woodlands included a visit to the home on 23/09/08. Noone knew we were going to visit on this day. We spent time talking to the manager and some of the staff, and talking to and observing the people who live at the home. We also looked at some of the paperwork the home has to keep including care plans, risk assessments, medication charts, and records such as staff personnel files, staff rotas, menus and fire alarm test records. Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 6 What the service does well: Although we were not able to speak much with the people who live at Woodlands, we saw that they seemed content and comfortable and got on well with the staff. In his brief summary of the comments he made throughout the AQAA, of what the service does well, the manager wrote “clear policies and regulations about how the home is run; the home is safe, spacious and comfortable; communication is good; good at retaining staff and has a full staff complement; staff work as a team; staff team benefits from a good training and development package”. All three staff who returned our survey indicated that they are satisfied with the way the service is run, how they are treated, and how the people who live at the home are supported. One of the staff said “People are well cared for – all their needs are met, and people make their own decisions [about how they live their lives]”. One staff member told us “I’m passionate about my job”. The home keeps a record of any compliments received. We saw three: a relative said “staff at Woodlands are helpful and welcoming. I am happy with the way my relative is looked after, I have no concerns”; the Environmental Health Officer said “the house looked clean and tidy – I would feel comfortable staying in the ensuite room”; and a family member complimented staff on reacting quickly and in an organised way when an unannounced fire evacuation took place. One of the support plans we looked at gave staff good guidance on the way the person wants to be supported, and was written in a ‘person-centred’ way. People are encouraged and supported to make choices about what they do, where they go, what they wear, what they eat and so on. People are offered quite a good range of opportunities for personal development and activities. People know how to complain and can be confident their concerns will be sorted out. Staff have been trained to safeguard vulnerable adults from harm. The house still looks new, is suitable for the people who live here, and is kept very clean. There are usually enough staff on duty each day, and staff have received sufficient training to make sure they can do their jobs properly. The home is managed well, and there is the beginning of a quality assurance system in place to make sure the home is run in the way the people who live here want it to be. Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: We have made six requirements following this inspection, and six recommendations. Ways in which the home must improve include: • Each person must have an up-to-date care/support plan in place so that staff have guidance on the way each person prefers/needs to be supported; Staff must keep clear records to show that each person’s healthcare needs are met; There must always be enough staff on duty to meet each person’s needs; Equipment which each person needs, such as grab rails, must be in place; Staff must have adequate training in fire safety; and The contract between the person and the provider must state clearly what people are expected to pay for. • • • • • As well as the requirements we have made, there are a number of other areas in which the home should still improve so that the people who live at Woodlands have the best possible quality of life. These are detailed in the body of the report, and some are listed as recommendations. 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. Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 People who use this service experience good quality outcomes in this area. Information is available about the service for people thinking about moving here, and assessments are carried out so that people know the home can meet their needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has produced information so that people thinking of moving here will know what the home has to offer. The Service User Guide (SUG) we saw was up to date and included pictures, symbols and good information. One person whose records we looked at had moved to Woodlands at the end of July. The home’s staff had been to the person’s previous home to meet him and carry out an assessment. He had been to visit the home, and had then stayed over night, before deciding he wanted to move in. In the AQAA the manager wrote, “All supported people have a comprehensive needs assessment which is updated regularly”. Usually there are enough staff on duty each day who have been trained to meet the needs of the people who live at the home. There is suitable Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 10 equipment in the house for the people who have lived here for a number of years, such as a special (Parker) bath, hoists and so on. Staff told us that grab rails for the person who moved in recently have not yet been fitted. The manager said the Housing Association are addressing this, but it should have been done before the person moved in. We found a ‘Supported Person’s Contract’ on both of the files we looked at. This is new and has been drawn up by TACT. The contract still does not give sufficient detail about what each person’s care costs, and who pays the costs, but we understand this is being sorted out with the local authority and will take some time. It is still not clear what each person has to pay for themselves, and what is part of the care funded by the local authority. We noticed for example that people pay the PCT each time they uses the snoozelen, they pay for activities such as swimming, horse riding, piano lessons, and for evenings out to discos and clubs. People also have to pay for taxis for doctor and hospital appointments, for their college courses and for their meal if they choose to eat out. We found letters and a licence agreement from the Housing Association quoting the ‘client contribution’ the person would have to pay towards their care: there were three different amounts, which was very confusing for people. There was no evidence that the staff had made any attempt to sort this out. Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, People who use this service experience adequate quality outcomes in this area. One support plan was good, but one person’s plan had not been updated since he moved to Woodlands, so did not give staff good guidance on the ways he wants to be supported in his new home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: For this inspection we looked at the records the home keeps for two people. One person has been at Woodlands a number of years, the other just a couple of months. For the first person we found a very good support plan in place, written in a ‘person-centred’ way. The plan included a ‘pen picture’ of the person, briefly describing all areas of the person’s physical, social and emotional support Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 12 needs. There were daily routines on the file detailing how this person likes to be supported in the mornings and in the evenings. Included in the records was ‘My Support Plan’ which was made up of nineteen plans, each covering an aspect of the person’s support needs, giving staff good, detailed guidance on the way this person prefers to be supported. We also saw detailed guidance for staff on other areas of care, for example when the person transfers to or from their wheelchair, and when they need assistance with daily living skills. The second person’s file also contained detailed guidance for staff about the person’s morning routine. However, this had come with the person from their previous home, and was not relevant for the environment at Woodlands. We discussed with the manager why no care plan had been put in place for this person. He said they were working on it but had wanted to get to know the person first. Staff need a care plan in place, to make sure the person receives the care they need, as soon as the person moves in. The manager told us that risk assessments are being updated to paperwork provided by TACT. Support plans we saw contained some risk assessments, including a risk assessment about the effect on each person of the recent change in staffing at night, and how this is to be managed (see Staffing section of this report). People are supported to make decisions about their lives. Each person has a Link Worker who meets with the person regularly to discuss different aspects of their life, such as which college courses they would like to pursue, where they want to go on holiday, what activities they want to do and so on. The decisions are recorded. People, and their relatives, are also asked to complete an annual survey asking for their views about the service they get, and know they can raise concerns with any staff at any time, if they want to. Woodlands DS0000071719.V371634.R02.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): 11, 12, 13, 14, 15, 17 People who use this service experience good quality outcomes in this area. People are offered a range of opportunities to lead full, satisfying and interesting lives. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: One of the staff told us that there are a number of activities which people can choose to do around the house, depending on what they like doing. For example gardening; watering plants in the house and in the garden; crossstitch work; looking at books, photographs, magazines; listening to music; watching television and so on. People are also encouraged to carry out some household chores, supported by staff. An aromatherapist visits the home weekly and people can pay to have a relaxing aromatherapy session with her if they want to. Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 14 One person loves music and has his own drum kits and other musical instruments in his room. He also has piano lessons weekly, goes to a music course at college, and goes horse-riding. Each person has an activity diary. We looked at the diaries of the two people whose other records we were looking at. The person who had lived at the home for some time had been out to twelve activities in the eleven days before our visit. They had been swimming three times, attended two college courses, done personal shopping, food shopping and been to the bank, enjoyed a tea dance and an evening disco, and met friends at a community centre twice where they played bingo and other games. This person had been out on a total of seventeen out of twenty three days in September. In August however there were seventeen days when no activities had been recorded for this person. We looked at the second diary (a plain notebook). The person had moved to Woodlands at the end of July. The diary had been started on the morning of our inspection so was completely blank. Daily records showed this person had not had many opportunities for activities, either in or outside the home, since he had arrived. This person does not use words to communicate, and has poor sight and hearing. The manager said they were taking things slowly until they worked out what the person likes to do. Staff told us that sometimes if there are not enough staff on duty the activities planned, especially those out of the house, do not happen. We were told that some staff are more enthusiastic than others about making sure activities take place. The home has two vehicles, a mini-bus and a car. Not all staff drive the vehicles, so sometimes activities depend on which staff are on duty. The manager told us he has an ‘opportunities budget’ for activities, however it seems that people pay for most of what they do from their own money (see Choice of Home section of this report). When we visited, staff were discussing holidays with the people they support. Two people had chosen to go to Spain, and three staff had agreed to accompany them. People are supported to keep in touch with their families and friends, and staff told us that the home has got better at involving families in people’s lives. People who live at Woodlands spend time each Tuesday planning the meals they want to eat the following week. Each day the meal is chosen by a different person. Pictures are used for some people to choose what meals they would like, or meal choices are read out for those people who are not able to see the pictures well. People are offered alternatives if they decide they do not want to eat what is on the menu. Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 15 At lunchtime we saw that equipment was provided to enable each person to be as independent as possible. There were spoons with very large handles and plates with high sides or plate guards. One person was fully assisted with the meal by staff; another person was helped ‘hand-over-hand’ so that they could do most of it themselves. Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, People who use this service experience adequate quality outcomes in this area. Records were not good enough to show that people’s healthcare needs are fully met. Staff administer medicines correctly and safely. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The support plan for the person who has lived at Woodlands for some time showed that this person is being supported with personal care in the way they want to be supported. The second person is being supported in the way they are used to, as far as possible, while the staff get to know them. The person who had lived at Woodlands for some years had a Health Action Plan (HAP) on their file. This had not been completed and we had difficulty finding evidence that the person’s healthcare needs were being met. Some information about health appointments was in the file with the support plans, and not in the HAP. We saw that the person had seen a chiropodist in Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 17 February 2008, but we do not know if or when they had seen an optician or dentist, or had their hearing checked if needed. This person’s weight had been recorded, and there was advice from a dietician in the person’s support plan. We saw that the home had referred the person who had recently moved in, to a specialist clinic at the hospital. The ‘All about me’ document in the HAP, which should be ready for when the person goes to hospital, had not been filled in. The manager told us that he had asked the HAP coordinator to visit the home and go through the HAP paperwork. This had happened the week before our inspection and one member of the staff team is going to be trained to complete the HAPs correctly. She will then be able to train other staff, with the help of a computer disc. The manager offered to get a HAP completed for each person by the end of October 2008. None of the people who live at Woodlands manage their own medication. Each person has a medication file which contains their photograph and guidelines for staff on the way they prefer to take their medication. We saw a form on one person’s file, signed by the person’s representative, agreeing that the staff should give the person their medication. We also saw guidelines for the way staff should give ‘as required’ medication. The Medication Administration Record (MAR) charts in use had been started the day before we visited. All medications had been signed for correctly and we saw that the quantity of each medication received had been noted on the chart. The manager had carried out an audit and found that one medication, for use if the person has a seizure, had passed its expiry date. He had made a note “to be replaced immediately” but this had not happened. He told us that the medication is very rarely needed, and the staff know that they must dial for the emergency services if the person has a seizure. Woodlands DS0000071719.V371634.R02.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 People who use this service experience good quality outcomes in this area. People know that their concerns will be listened to and acted on, and that staff are trained to keep them safe from harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager keeps a complaints and compliments record. There were no complaints and three compliments listed. In the AQAA the manager told us there has been one complaint in the past 12 months: this was from a neighbour, about a car parked on the road. The car had nothing to do with Woodlands. There is a complaints procedure in place. A new system has been introduced to make sure people’s money is kept safe, which should be a great improvement. Each person has a pouch with a small amount of their cash which is kept in the safe. The pouch is sealed with a numbered seal, and checked by two staff and re-sealed each time any money is taken out. We checked the pouch for one person and found that the total was short by 50pence. The person had been given £3.50 that morning, but only £3 had been recorded, which the manager and another member of staff had signed. More care must be taken so that this system works as it should. Records showed that all the staff who work at Woodlands, including newly recruited staff, have had safeguarding (SOVA) training. Policies and procedures are in place so that staff know what to do if a safeguarding issue arises. Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 People who use this service experience good quality outcomes in this area. Woodlands offers a comfortable, homely and well-maintained environment for the people who live here. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Woodlands was re-built about three years ago to offer a home to people with learning disabilities, who might also have some physical disabilities. Each bedroom has an ensuite with either a bath or a shower. Two of the bedrooms also have their own adjoining sitting room which has a small kitchenette. The main corridor is wide, light and airy, and everywhere is accessible to people in wheelchairs. The lounge is spacious and comfortably furnished and there is a dining room with a large table so that there is room for everyone to eat together if they wish to. The large kitchen has been designed for people Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 20 with disabilities, so some of the work surfaces are suitable for someone in a wheelchair. There is an office in the middle of the bungalow, and a sleeping in room. A small activities room is used by one of the people who live here for his piano lessons, as well as by other people for different activities. The people who live at Woodlands are supported to have their bedroom as they want it. Staff told us that recently one person had asked staff to help move all the furniture round as they had seen someone else’s room and preferred that layout. In the AQAA the manager wrote that staff have worked hard with people to support them to add items such as pictures and sensory equipment to their rooms to make them more personal. One person has not yet got all the equipment he needs to maximise his independence (see Choice of Home section of this report). On the day we visited, the building was very clean and smelled fresh throughout. Some of the carpets, although new, are beginning to look a little stained. The manager said he plans to hire a carpet cleaner. Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 People who use this service experience good quality outcomes in this area. The people who live at Woodlands benefit from staff that are recruited well, and who have sufficient training so that they can do their jobs properly. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Staff we spoke with said that there are usually three staff in the morning, and three in the afternoon/evening, with another person working a ‘day’ shift (09:00 to 17:00). On Tuesdays, which was the day we inspected, there are five staff on duty because everyone goes out. However, staff told us that sometimes (especially if one of the staff phones in sick) there are not enough staff (at times, only two staff) to support the five people who live here. They said that when this happens most activities outside the house have to be cancelled, and some other things do not happen, such as encouraging one person to walk rather than use a wheelchair, because these things take too much time. Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 22 We were told about a recent change in staffing levels at night. The home had decided that two waking night staff are not needed, so there is now one person awake, and the other sleeping in the building. Staff were still getting used to this change. In the AQAA and in discussion, the manager said that staff rotas have improved in the past few months as they have been arranged more flexibly to fit in with the daily lives of the people who live at the home. He said he is negotiating with TACT about additional staff. The home has to get certain information about new staff before they can start work. For example, a Criminal Records Bureau (CRB) check and two references. We looked at this information for three staff. The information was satisfactory for two of the staff, but there were documents missing for the third person. These were found at TACT’s head office and faxed to the home during the inspection. This information must be kept in the home. Each staff member has a development folder in which they keep evidence of the training they have undertaken. When they join the service, staff undergo an induction, and then have a care skills book to work through. Our discussions with staff, and the training records, showed that staff had received a lot of training in the fourteen months prior to this inspection, and almost all staff are up to date with topics relating to health and safety (that is moving and handling; first aid, infection control, and food safety). All except two new staff have done medication training and almost all staff have had training in PEG feeding (people receiving their food through a tube directly into their stomach), and administration of rectal diazepam. Other courses listed on the training record, which a number of staff have done, include basic physical care; epilepsy awareness; autism awareness; person centred planning; and risk management. All staff, including the new staff have done safeguarding training. The records showed that staff have not done adequate fire safety awareness training (see Conduct and Management section of this report). Staff told us that they have supervision sessions regularly, unless they are on leave. One of the staff said “I don’t stand quiet if I need to say something”. This staff member had confidence that the manager would try to resolve any issues raised. One staff member told us that supervision has improved in the last six months, but supervision records for one staff member showed they had only had supervision in October 2007 and June 2008. Staff meetings are held. Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42 People who use this service experience good quality outcomes in this area. Woodlands is managed reasonably well so that the people who live here have a good quality of life. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Woodlands has not had a stable management team for a number of years. One of the staff told us that there have been six managers in seven years. The current manager, Naguib Fuzurally, has completed his application to be registered with CSCI and at the time of this inspection was waiting for his interview. One of the staff we spoke with said the manager “is very supportive”, and another “he’s quite approachable, pretty good as a manager – Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 24 he’s very concerned about the clients”. One of the staff said the running of the home has improved. We discussed the home’s quality assurance system with the manager. He told us that surveys were given to people in February 2008, before the service provider changed to TACT, and a report was done of the results. The manager told us he hopes to organise a get-together for relatives before the end of the year. Staff spend time regularly with each of the people who live at Woodlands, and discuss with them how they want to live their lives. Records of these discussions, and the decisions people have made, are kept in their files. A ‘house advocate’ from Advocacy Alliance visits occasionally, one person has an independent advocate and another person has a friend who is his advocate. We looked at some of the records the home has to keep. The fire log showed that fire alarms and emergency lights are tested weekly, a fire risk assessment has been completed, and fire drills are carried out regularly so that people will be as safe as possible if there is a fire. The staff rota was not an accurate record of which staff had been on duty. There were three records which all had to be read together to get an accurate picture. This is not satisfactory. Correcting fluid, used in the fire log, must not be used on official records. The Environmental Health Officer (EHO) from Luton Borough Council had visited the home in May 2008 and carried out a Health and Safety inspection. We understand this was satisfactory. Most of the staff have received training in all the topics related to health and safety: moving and handling people, food safety, infection control and first aid. However, from the records we noted that staff have not done adequate fire safety awareness training. The manager must check with the fire safety officer what his requirements are for training. Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 2 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 2 12 2 13 3 14 2 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 3 3 X 2 2 X Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 26 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 YA5 Regulation 5 Requirement Information regarding the fees charged to service users, what they cover, and the cost of all facilities and services not covered by fees, must be made clear for each service user. This information must be recorded in the service user contract, and be agreed with each service user (if appropriate) and/or a suitable independent representative for each service user, so that each person knows what they are paying for. This requirement was partly met. An up to date care/support plan must be in place for each of the people who live at the home so that staff know how the person needs/prefers to be supported in all aspects of their life. The healthcare needs of each of the people who live at Woodlands must be documented and met, so that people are DS0000071719.V371634.R02.S.doc Timescale for action 31/12/08 2 YA6 15 31/10/08 3 YA19 13(1)(b) 31/10/08 Woodlands Version 5.2 Page 27 supported to be as healthy as possible. Health Action Plans (or the equivalent) must be in place and fully completed within the timescale. 4 YA29 23(2)(n) Equipment must be in place to meet each person’s individually assessed needs. Grab rails must be fitted where needed, and any other equipment provided, so that people can remain as independent as possible There must be a sufficient number of staff on duty at all times to meet the needs of the people who live at the home. Staff must receive adequate training in fire safety so that they know what to do to keep people safe in the event of a fire. The manager must find out, within the timescale, what training the fire service requires, and put this in place. 31/10/08 5 YA33 18(1)(a) 31/10/08 6 YA42 23(4)(d) 31/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA12 Good Practice Recommendations Opportunities for activities and development, both in and out of the home should continue to improve, so that each person can lead a full and satisfying life. Staff should take more care when dealing with people’s money so that no mistakes are made. All the information required by the regulations which must be obtained before staff start to work at the home, should DS0000071719.V371634.R02.S.doc Version 5.2 Page 28 2 3 YA23 YA34 Woodlands be available for inspection. 4 YA36 The number of supervision sessions offered to staff should continue to improve so that all staff have the recommended six sessions every twelve months. The manager should continue to find ways to make sure that the quality of the service offered at Woodlands is as good as it can be, and the service is what the people who live at the home want and need. Correcting fluid should not be used on any official records. 5 YA39 6 YA41 Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Woodlands DS0000071719.V371634.R02.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!