Inspection on 08/02/06 for Yew Bank

This inspection was carried out on 8th February 2006.

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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Yew Bank 07/12/09

Yew Bank 08/08/07

Yew Bank 11/01/07

Yew Bank 02/08/05

Yew Bank 31/01/05

Yew Bank 15/06/04

Yew Bank 01/03/04

Yew Bank 05/11/03

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Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Yew Bank 19 Huckleberry Close Purley on Thames Reading Berkshire RG8 8EH Lead Inspector Stephen Webb Unannounced Inspection 8th February 2006 10:00 DS0000011170.V279786.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 DS0000011170.V279786.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. DS0000011170.V279786.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Yew Bank Address 19 Huckleberry Close Purley on Thames Reading Berkshire RG8 8EH 0118 9427608 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) Purley Park Trust Limited Mrs Bernadetta Johnson Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (5) of places DS0000011170.V279786.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd August 2005 Brief Description of the Service: Yew Bank is one of the three original outlying houses within the Purley Park Trust, and is now one of eight separate small units within the estate. The unit now accommodates five adults of either gender, with a learning disability, in a pleasant unit providing each service user with their own individualised bedroom. Communal accommodation consists of a shared lounge/kitchen/dining area, with comfortable furnishings, bathroom and toilets. The staff work together with service users on various aspects of the day-to-day running of the unit. DS0000011170.V279786.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out between 10.00am and 2.00pm on the 8th of February 2006. The inspection included the examination of key records and policies, a review of progress on previous requirements, discussion with the support worker on duty, a tour of some of the premises and discussion with the service users. The inspector also had lunch with the service users, the feedback from whom was very positive about their experience in the unit. They were positive about the support and care provided by staff and the activities made available to them. They knew who to complain to if they had a concern. This was a positive inspection. The manager was off duty but the support worker on duty effectively met the needs of the service users whilst supporting the inspection process. All of the previous requirements had been addressed. The unit has had an unsettled period with several changes of staff, and had experienced the death of one of the staff. Some of the service users came and went to activities during the inspection. Service user feedback about their care was positive and the observed relationships between them and the staff were positive and relaxed. In the longer term, there are proposals to replace the unit with a new one purpose-built to the new standards and including a lift. What the service does well: The service users are very relaxed within the unit, which they clearly see as their home. Several are able to have quite a high level of autonomy, and two are in paid employment. They have access to a good range of activities, both organised by the in-house day services, and by unit staff, and can spend time alone or in the group. They are involved in day-to-day decision-making and can influence aspects of their lives and make choices. Some can go off campus without staff support. Service users are involved in various aspects of domestic tasks and cooking in this unit. Service users have access to an appropriate complaints procedure and can also raise any concern through other forums. Service users were effectively supported through the death of one of the staff team, and were enabled to attend his funeral. DS0000011170.V279786.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. DS0000011170.V279786.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 DS0000011170.V279786.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): EVIDENCE: None of these standards were inspected on this occasion. Standards 2 and 4 were inspected at the previous inspection and were met. DS0000011170.V279786.R01.S.doc Version 5.1 Page 9 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, 10 The individual care plans reflect the needs and goals identified with service users, though their level of understanding of these documents would vary. Service users make appropriate decisions about their lives and are supported according to individual needs. Service user’s information is appropriately handled and stored securely. EVIDENCE: Each service user has an individual Essential Lifestyle Plan (care plan), and the level of detail within these has improved, to make them an effective tool. In one, for example, there are now details of how to communicate effectively with the service user. The care plan files also include appropriate individual risk assessments, details of any contact with speech and language therapists etc. However, there is limited evidence of goals set with/for service users, and how these are worked on between reviews. These could be identified in reviews and progress noted within daily record sheets if they were adapted. DS0000011170.V279786.R01.S.doc Version 5.1 Page 10 Completed consent forms were on file for individual’s preference of whether to have a bedroom door lock and key, and the details of individual’s funeral preferences were also recorded. In some cases the available reviews indicated an annual process, when each should receive at least six-monthly review. I was unclear whether this was down to absent records or reflected the frequency of reviews. Individual service users make day-to-day choices about their clothing, activities, times of getting up and going to bed and participation in daily household tasks. A variety of such occasions were observed during the inspection. One service user gets up early for work five days per week and another two days per week. Three of the service users can go off-site to visit the local pub or elsewhere, without staff support, while two require support. Service users decide what activities they wish to be involved in and also take part in decisions about holiday locations. Each service user has their own bank account and personal allowance is kept in individual wallets. Consent forms are in place for whether individuals hold their own monies. Those who are able, countersign for their money. Although the unit has no office, confidential records are appropriately stored in a locked cupboard. From discussion it is evident that staff understand the boundaries of confidentiality, and are especially aware of the issue given the absence of an office in which to hold confidential discussions. DS0000011170.V279786.R01.S.doc Version 5.1 Page 11 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, 16, 17 Service users have appropriate opportunities for personal development and access to an appropriate range of activities. Their rights are respected and they take responsibility for appropriate aspects of their day-to-day lives. Service users are offered an appropriate diet, which is being improved with an increased focus on healthier eating. They enjoy the food provided and take part in menu planning and meal preparation. EVIDENCE: Service user reviews indicate positive developments in social and communication skills, and some goals are set within reviews, for example, to cook a meal with support. However, as already noted, there is no consistent and effective ongoing record of work towards goals. Service users have their spiritual needs met and most choose to attend bible studies and church regularly. DS0000011170.V279786.R01.S.doc Version 5.1 Page 12 Two of the group have jobs, one full-time and one part-time, and the others have a weekly schedule of regular activities either run by the in-house daycare service or supported by unit staff. They can also attend on-site courses run by Reading College in the clubhouse, and two go to off-site supported voluntary work at a garden centre. Daily routines in the house are flexible to meet the needs of individuals, who get up and go to bed according to their preferences and work commitments, and the main meal is in the evening to accommodate service users schedules. Each is offered a key/bedroom door lock and a written record kept of their preference in this regard. Mail now comes to the unit unopened and is give to the addressee to open. The relationships between staff and service users are relaxed and positive, and were observed to be supportive. Service users can move about the campus freely and often visit friends in the other units. Some are able to go off-site without staff support following risk assessment. The unit has a four-week menu which was devised with the involvement of the service users and changes seasonally. Staff are working with the group to introduce some healthy alternatives and healthier versions of requested items, and reduce the tendency of some to eat inappropriately late at night. One day per week, the main evening meal is specifically chosen by service users in turn. The accessibility of the menu to some service users, has now been improved by the addition of pictures of each meal, which is a positive development. The service users take part in cooking and cleaning and a rota has been devised to ensure this is fairly done. They are happy with the menus and confirmed that they enjoy the meals provided. DS0000011170.V279786.R01.S.doc Version 5.1 Page 13 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 Service users receive personal support as they wish, in accordance with their individual needs, and their individual physical and emotional needs are met. EVIDENCE: Individual support is offered via keyworkrs, and each individual’s likes, dislikes, preferences etc are recorded within their essential lifestyle plan. Any personal care support provided is carried out behind closed doors, as is treatment from healthcare professionals, though service users are usually taken to the GP for appointments, as they are able to do so. Same gender care is not always possible given the current gender mix of the staff team, but is not an issue for the current service users. If it were, arrangements would be made for staff to come from other units on-site to address personal needs. The service users indicated that they were happy with their care. Each service user has a healthcare section in their file, which contains details of any specific needs or issues. DS0000011170.V279786.R01.S.doc Version 5.1 Page 14 There are separate recording sheets for contact with a range of health professionals, which indicate appropriate frequency of contact, with the exception of the chiropody records, which need details of individual consultations rather than a general statement of planned frequency. Service user weight check records are held collectively for ease of access and filed individually once complete. DS0000011170.V279786.R01.S.doc Version 5.1 Page 15 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 Though there is an appropriate complaints procedure in place it was not possible to examine its operation, as there were no recorded complaints. The feedback from service users indicated they had no complaints on the day of inspection, and were happy with the care of the staff. The unit effectively protects service users from abuse, but some staff required refresher training on the protection of vulnerable adults. EVIDENCE: The unit has an appropriate complaints procedure in place. The complaints log had no recorded instances of complaint, so it was not possible to examine the procedure in operation. Conversation with some of the service users during the inspection indicated no issues about which they might wish to complain. There is a version of the procedure in symbol form, on each service user’s file. Service users could also raise any concerns within the infrequent resident’s meetings, the frequency of which are to be improved. They also have access to the head of care and Chief Executive who both work on-site and make themselves freely available to service users; and to the Regulation 26 monitoring visitor, although these visits have not been taking place monthly as required. (Requirement made under Standard 39). DS0000011170.V279786.R01.S.doc Version 5.1 Page 16 The unit has an appropriate vulnerable adults protection procedure in place, though several staff need updates to vulnerable adults training, which should be provided annually. A programme of staff training on non-violent crisis intervention is being provided to all staff. The financial management systems in place protect the service users from financial abuse. DS0000011170.V279786.R01.S.doc Version 5.1 Page 17 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, 30 The service users live in an environment, which is homely comfortable and safe for the most part, and individual bedrooms meet the needs of their occupant. The unit is maintained in a clean and hygienic condition. EVIDENCE: The unit is pleasantly decorated and homely, and has a relaxed atmosphere within which service users feel at home. The bedrooms are individualised to reflect the individual interests of their occupant. Two service users have been consulted about swapping bedroom so that one can avoid having to manage the stairs owing to his increasing frailty. There are plans to develop new purpose built units at some point, which will include lifts. The lounge carpet is, however, stained and in need of replacement. Some consideration should also be given to improvements to the lighting around the campus. The unit was in a clean and hygienic condition and a previous requirement to fit a self-closer to the laundry door, had been addressed. DS0000011170.V279786.R01.S.doc Version 5.1 Page 18 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, 36 Service users are supported competently by the staff, and despite a number of staff changes, there is a positive relationship between staff and service users. Good progress has been made with NVQ and though some gaps in core training were noted, these are due to be addressed within the organisation’s training programme. At present the level of support to staff in their role, via supervision and team meetings is not sufficient, which could compromise their ability to maximise the quality of the care provided. EVIDENCE: The staff relate well to service users, and despite a number of changes of staff over the past year, there remains an appropriate level of engagement with the service users. Service users have been appropriately supported through the grieving process, following the death of a staff member and all were supported to attend his funeral. Examination of the training records indicated some gaps in core training, which are due to be addressed within the organisation’s training programme. DS0000011170.V279786.R01.S.doc Version 5.1 Page 19 It was felt that the various training record sheets on file were potentially confusing, and it is suggested that only the latest, up-to-date version is retained in the staff training file for clarity. Good progress is being made with NVQ, with one staff having level 3, two doing level 2 and one doing level 4. Staff supervision has not been as regular as organisational expectations, and although there had been a team meeting recently, these had also not been held monthly, and the minutes could not be located. The monthly all-service meetings have, however, taken place. DS0000011170.V279786.R01.S.doc Version 5.1 Page 20 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): 39, 42 The views of service users have been sought as part of a developing quality assurance system but the resulting report has yet to be produced. Regulation 26 monitoring visits are also not taking place with the required monthly frequency, reducing service user access to another party with whom they could share their views and any concerns. The health, safety and welfare of service users are promoted and protected. EVIDENCE: At the time of inspection no quality assurance report was available, though it is understood that QA questionnaires have been made available to service users, families and medical practitioners, and are awaiting analysis. A summary report of the QA feedback should be produced and made available to interested parties. An annual cycle of QA surveys and reporting, should be established to inform the annual review and annual development planning for each unit, when DS0000011170.V279786.R01.S.doc Version 5.1 Page 21 combined with feedback from complaints, inspection reports and Regulation 26 reports. An annual development plan in the form of a spreadsheet was posted on the inside of the records cupboard door, but contained limited information. The development plan should cover staffing issues, training priorities, premises issues and other areas, and it may be that the spreadsheet format could be supplemented with a written document detailing the aims and developmental aspects of the plan. Examination of Regulation 26 monitoring visits indicated that these were not taking place monthly as required. Two new governors are due to be appointed in April and it is intended that they will carry out these visits. Copies of reports of these visits should be made available in the unit, to the manager and for inspection. Health and safety-related certification was in place and up to date, and electrical appliances had now been tested. Fire alarm testing had been increased to weekly and more regular fire drills were being held. DS0000011170.V279786.R01.S.doc Version 5.1 Page 22 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 X 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 2 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X X 3 LIFESTYLES Standard No Score 11 3 12 3 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X X X 2 X X 3 X DS0000011170.V279786.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard YA23 YA24 YA36 Regulation 18(1)(c)(i) Requirement Timescale for action 10/05/06 10/06/06 10/05/06 4. YA39 5. YA39 6. YA39 The manager must ensure that all staff receive annual POVA training. 23(2)(g) The manager must arrange for the lounge carpet to be replaced. 18(2) The manager must ensure that all staff receive regular supervision, and that regular opportunities are made available to brief staff and receive direct feedback from them. 24(2) The registered provider must produce a report of the findings of the service user survey, and make it available to interested parties 24(1)(2)(3) The registered provider must establish an annual quality assurance and review system in accordance with Standard 39, and make the resulting reports available to interested parties. 26(2)(3)(4) The registered provider must (5) ensure that the unit is visited in accordance with Regulation 26 and reports are produced. 10/05/06 10/08/06 10/05/06 DS0000011170.V279786.R01.S.doc Version 5.1 Page 24 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 3 Refer to Standard YA6 YA19 YA24 Good Practice Recommendations The registered provider should consider ways to identify individual goals for service users and how best to record progress towards these. It is suggested that individual dated records of chiropodist visits are maintained in line with other health records. Consideration should be given to improvements to campus lighting to improve safety. DS0000011170.V279786.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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 DS0000011170.V279786.R01.S.doc Version 5.1 Page 26 - 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!