Care Home: 10 Tanners Walk

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What the care home does well Tanners Walk continues to provide a valuable respite care service for adults with a learning and physical disability in a supportive, caring and safe environment. The people who use the service said in their surveys they enjoyed their stays in the home and are always well treated by the staff team. The relatives who responded by survey said the home does meet the needs of each individual and provides the care and support they expect. The health professionals who responded by survey said peoples` needs are well met, their privacy and dignity respected and they are well supported during their stays. The home promotes a person centred approach and remains committed to improving the service it provides wherever possible. Relevant information about each person who uses the service continues to be collected systematically and is well kept. The home is well run and there is a strong core of staff who remain committed to providing a good quality service to each person who stays at Tanners Walk. What has improved since the last inspection? Fire safety training has now been provided by an accredited trainer and each member of staff has attended manual handling update training. This helps to ensure all staff are suitably trained to support individuals in a safe and consistent manner. All risk assessments are now regularly reviewed and updated. This promotes the welfare and safety of people who use the service and staff members. The home continues to develop its progress in adapting information into accessible formats for people who use the service. This supports them to make informed choices and determine their own service. What the care home could do better: Each prospective user of this service must be provided with up to date details of the services the home is able to provide. This would support individuals to decide if this is the right service for them.To ensure individuals who stay at the home receive a safe, consistent and responsive service, each member of staff must be provided with training in relation to responding to challenging behaviour. The planned improvements to the environment must be carried out to ensure a homely, comfortable and safe environment is maintained for people who use the service. The home should complete the review of the risk assessments which support individuals to take risks as part of their lifestyle. The home should consider providing staff with accredited medication administration training to support them in their professional development. Each member of staff should be provided with regular supervision to ensure they are supported to provide a good quality service. CARE HOME ADULTS 18-65 10 Tanners Walk Off Newton Rd Twerton Bath Bath & N E Somerset BA2 1RG Lead Inspector David Smith Unannounced Key Inspection 26th February and 11th March 2008 10:00 10 Tanners Walk DS0000008194.V359842.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 10 Tanners Walk DS0000008194.V359842.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. 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 10 Tanners Walk Address Off Newton Rd Twerton Bath Bath & N E Somerset BA2 1RG 01225 331192 01225 331192 robin.carr@dimensions-uk.org www.dimensions-uk.org Dimensions (UK) Ltd 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) Mr Robin Carr Care Home 5 Category(ies) of Learning disability (5), Physical disability (5) registration, with number of places 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 5 persons aged 18 years and over with physical and learning disabilities for respite care. 8th May 2006 Date of last inspection Brief Description of the Service: Tanners Walk provides respite care for up to five people who have a learning difficulty or physical disability. It is operated by Dimensions (UK) Ltd, which is a voluntary organisation. The home is a purpose built, split level building located in Twerton, two miles from the centre of Bath. Accommodation is modern and the home is accessible to those using wheelchairs. The home consists of two floors, an upper entrance level and a lower ground floor. The upper floor has three single bedrooms, with a further two bedrooms in the lower ground floor. There is a communal lounge area, a kitchen diner and a laundry area on the upper floor and a communal lounge with a small kitchen on the lower ground floor. Parking is available to the front of the Home. 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced visit to the home as part of a Key Inspection of this service. The review of evidence and pre-inspection planning involved reviewing the report of the last Key Inspection carried out in May 2006 and the service history, which details all contact with the home including notifications of significant events which they have reported to us. We (the CSCI) provided the home with their Annual Quality Assurance Assessment (known as an AQAA, pronounced as ‘aqua’) and a range of survey forms for people who use this service, their relatives, carers, advocates and health professionals prior to our visit. The AQAA was completed and returned, together with twenty surveys. We have examined staff personnel records at the organisation’s Bath offices, where all personnel records are now stored. We gathered additional information during this visit through informal discussions with the Manager and other staff members. A limited amount of interaction and communication between staff and individuals was observed and we have had a number of surveys completed by people who use this service and their families, which clearly describe the good quality of care and support provided by Tanners Walk. Care plans and associated records were examined together with Risk Assessments, complaints procedures, medication administration, menu plans, staff supervision and training records and health and safety records. We also viewed all communal areas of the home and each of the bedrooms people use during their stay. The people who use this service wish to be described as “people”, or “individuals”, rather than service users. Dimensions (UK) Ltd generally uses the term “people we support”. This terminology has therefore been acknowledged and replaced the term “service user” in this report. 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Each prospective user of this service must be provided with up to date details of the services the home is able to provide. This would support individuals to decide if this is the right service for them. 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 7 To ensure individuals who stay at the home receive a safe, consistent and responsive service, each member of staff must be provided with training in relation to responding to challenging behaviour. The planned improvements to the environment must be carried out to ensure a homely, comfortable and safe environment is maintained for people who use the service. The home should complete the review of the risk assessments which support individuals to take risks as part of their lifestyle. The home should consider providing staff with accredited medication administration training to support them in their professional development. Each member of staff should be provided with regular supervision to ensure they are supported to provide a good quality service. 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. 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not currently provide up to date information to assist people in making an informed choice of whether the service is suitable for them. Each individual knows their needs and aspirations will be assessed and met by the home and that they will have the terms and conditions of their stays explained to them. EVIDENCE: The home does have a Statement of Purpose, however this is no longer up to date. This still refers to New Era, which has become Dimensions (UK) Ltd, the National Care Standards Commission, which is now the Commission for Social Care Inspection and to staff who no longer work for the Dimensions organisation. The Manager agreed this document did require updating and also explained the home hoped to provide guides to the service in more accessible formats such as on DVD or through the organisations’ website. 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 10 Care plans examined show that full assessments of the needs of those using the service are undertaken. The service provided at Tanners Walk remains contracted out to Bath and North East Somerset Council with the Community Learning Disabilities Team making referrals to the home. We examined the records of a number of individuals who have recently started using this service. These show that each person’s introduction to the home is tailored to them and, following an initial visit, people generally continue to visit, have meals in the home and meet the staff team prior to their first respite stay. Each person who uses the service is provided with their own guide. This provides information on the services provided, help and support, charges, house rules and how to complain. These continue to provide an easy to read agreement between each individual and the home. The guides we examined have been signed either by the individual who uses the service (or their parents) and the home manager. This is good practice. Individuals who use this service said in their surveys they had enough information to enable them and their relatives to decide if this was the right service for them. 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that the service provided to each individual takes into account their changing needs and personal goals, supported by both written information in care plans and risk assessments which are subject to ongoing review. EVIDENCE: We examined six individual’s care plans during this visit. These records are contained in two separate files; The ‘Care Plan’ contains assessments, individual’s history and archived information. The ‘Support Guidelines’ contain the information staff need to provide the appropriate care and support for each individual when they use the service. Each plan is written in an person centred way and covers key areas of support people require, such as communication, personal care, healthcare, eating and drinking and how they wish to spend their leisure time. 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 12 The home is keen to develop accessible formats for each plan, so that individuals may be involved in their care planning as much as possible. The organisation has now identified one member of staff who will offer support in this area and it is hoped that this will have a significant effect on the progress towards this goal. Regular reviews are held, which include people who use the service, their families, Social Workers and Keyworkers. The home reviews each care plan internally as well as attending these multi agency reviews, often in partnership with day services. These are clearly recorded and the outcomes used to update individual care plans. We observed some interaction and communication between staff and people who use this service during our visits. We also received a number of surveys from individuals and relatives regarding the service provided by the home. Those individuals who responded by survey said they are ‘always’ treated well by staff who listen to them and act on what they say, make decisions about what they would like to do each day and felt that they generally do the things they choose. One person said “I like going there” and another said “I love going there, the staff are fantastic and caring”. There are person centred Risk Assessments in place, which are clear and concise. These support each person to take risks as part of an independent lifestyle. Each of the Risk Assessments we examined have been reviewed regularly, however the format used within the home is now being changed to the one used throughout the Dimensions organisation. Staff are therefore in the process of updating each assessment. Each individual’s records are well looked after, being kept securely in the main office. There are formal agreements relating to confidentiality, which are kept as part of each individual’s contract with the home. 10 Tanners Walk DS0000008194.V359842.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 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each individual has opportunities and appropriate support to access leisure and educational facilities. Family and personal relationships are supported during each individual’s stay. A healthy and balanced diet for each individual is promoted. EVIDENCE: Most of the people who have regular respite stays have day care services organised that continue while they are staying at the home. There remains a close relationship and ongoing communication between the home and each individual’s day service. It was evident from records, discussions with staff and from the observations of the interactions between staff and people using the service that each 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 14 individual continues to be given opportunities and encouragement to develop personally during their stays. Staff spoken with explained that they work hard to ensure each person is provided with opportunities to do things which they enjoy. Each person is seen as an individual and is respected as such. Individuals who responded by survey said they were able to choose how to spend their time in the home and generally were able to do the things they wished to do. The home continues to have a good liaison with family members with regular communication with parents and carers taking place. Staff spoken with feel they provide a valuable service for parents and carers. They are also asked for and provide advice to them, as well as providing respite care for their relatives. The relatives who responded by survey said the home provides the support and care they expect and it supports people to live the life they choose. One relative said “I am very pleased with all aspects of this home” and another said the home “gives me confidence that my (relative) will be well looked after while I have a break from caring”. The health professionals who responded by survey said the home does support people to live the life they choose, respects individual’s privacy and dignity and is good at meeting individual’s differing needs. One professional said “they are very good at supporting people to experience new opportunities”. Each person who stays at Tanners Walk is given a choice of what they would like to eat. The menus show a wide range of food, which provide both a healthy and balanced diet. Each person’s likes, dislikes and cultural needs are known and clearly recorded. People eat their meals in the kitchen diner, which looks out over front garden. The kitchen is generally clean, tidy and well organised, however the home should consider refurbishing this and redecorating once the subsidence issue has been resolved. Individuals would also benefit from a new dining table and chairs, as the ones currently used appear to be quite old and showing signs of considerable wear. 10 Tanners Walk DS0000008194.V359842.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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person is supported in their preferred manner and their personal and healthcare support needs are well met. The policy and procedures relating to administration of medication ensures individuals’ welfare and safety. EVIDENCE: The care plans in place for individuals provide clear guidance for staff on how they should support each person with their health and personal care. People who use Tanners Walk retain their own General Practitioner; GPs are requested to visit the Home if needs be though in most situations, a person’s relative or carer could be asked to take that person to their GPs surgery if this was necessary during their stay. Other specialist services are contacted when an identified need arises. These are provided by Bridges Community Learning Disability Team (known as 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 16 ‘CLDT’). The home continues to have a close working relationship with Bridges CLDT as this provide a valuable resource to assist the home in providing a specialist service for a large number of individuals with diverse needs. The health professionals who responded by survey said the home meets each person’s health care needs, seeks their advice and acts upon this to manage and improve individual’s health care. One professional said the home provides “a warm, friendly and supportive environment” and staff are good at “identifying where needs may have changed and communicating this”. Another said the home “responds flexibly and sympathetically to the needs of individuals. Staff clearly care about the people who use the service”. There is a core of experienced staff who have a good knowledge of individuals’ healthcare needs. Any changes, which may cause staff concern, are noted and acted upon. It remains evident that the management and staff spoken with are sensitive to the personal, healthcare and emotional needs of those using the service. The home has an effective, efficient system of medication administration and storage. Each individual has a medication profile. This details the current prescribed medication, dosage and times. The home ensures this is regularly updated by each person’s GP and this update is kept as part of each person’s care plan. Each person who uses the service will come in with his or her medication. Generally the medication will only be sufficient to cover the length of their stay, although occasionally extra medication may be provided. This is checked and booked in when the person arrives. The medication is stored securely in the medication cabinet, which is in the main office. When medication is dispensed by staff, two staff members sign the records. When the respite stay comes to an end, the medication records are again checked and any extra medication is booked out and returned to the individual concerned. Each member of staff is provided with a comprehensive ‘in-house’ medication assessment and these were last completed in November 2007. This process involves direct observation of their work practice and a written test. The home’s Manager oversees each assessment. 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 17 At present there is no formal ‘accredited’ medication administration training provided to staff. The home should consider providing this to support staff in their professional development. The health professionals who responded by survey said the home does support individuals to administer their own medication and manages it correctly where this is not possible. 10 Tanners Walk DS0000008194.V359842.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 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each individual is supported to communicate their views and they can be confident that they will be listened to and their views acted on if necessary. Clear policies and procedures are in place in order to protect individuals from the likelihood of abuse, neglect and self-harm. EVIDENCE: The home has a formal Complaints Policy, an Adult Protection Policy and a Whistle Blowing Policy, which staff can use in confidence to raise any issue or concern they have regarding the service. The guide provided to each person who uses the service also explains how to make a complaint. This process is described as ‘Making a complaint or speaking out’. There has been one complaint since our last visit, which was taken seriously and investigated in accordance with the home’s policy. We have not had any concerns or complaints direct regarding Tanners Walk. The individuals who responded by survey said they know who to speak to if they are unhappy, know how to complain and confirmed that they felt safe during their stays at the home. They feel that staff listen to them and act on what they say. 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 19 Relatives who responded by survey said they know how to make a complaint. Both relatives and health professionals feel the home has responded appropriately if they have raised any concerns about the care provided by the home. Due to the diverse abilities and needs of the people who use the service, staff would need to advocate for a number of individuals, who would not be easily able to complain or use the formal complaints procedure. Staff spoken with do remain clear about the advocacy role they have. Due to the vulnerability of some of the people who use the service, they would rely on staff raising concerns on their behalf. Most of the staff team have attended Protection of Vulnerable Adults (‘POVA’) training provided by the Local Authority and the Manager and his Deputy are both trained to ‘investigator’ level. Newer staff are now provided with POVA training as part of Dimensions induction training called ‘Our Approach’. The home does provide a service for a small number of individuals who may present behaviours which can be perceived as challenging the service provided by the home. This can include people being verbally aggressive as well as throwing items, pinching or hitting staff and occasionally their peers. These behaviours, together with how staff should respond, are clearly described in these individual’s care plans. The home is also supported and guided by the Behavioural Nurse Specialist from Bridges CLDT. Staff have not yet had formal training in understanding and responding to these behaviours. The staff spoken with and the home’s Manager feel this training is now essential to ensure staff have the necessary knowledge and skills to respond to this type of behaviour in an effective and consistent way. The home is therefore planning to train staff to use ‘Positive Response Techniques’ (known as ‘PRT’). The British Institute of Learning Disabilities accredits this approach and it is hoped the training will commence shortly. The home maintains clear records of all accidents and incidents and notifies us of any significant event which occurs. 10 Tanners Walk DS0000008194.V359842.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, 25, 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Tanners Walk provides a reasonably homely and comfortable environment for individuals during their stays. EVIDENCE: Tanners Walk is a purpose built, split-level building located in Twerton, two miles from the centre of Bath. There are car parking spaces available at the front of the home. The upper level of the home is fully accessible to wheelchair users. There are three single bedrooms one of which is en-suite with an overhead track hoist and fully assisted bath. The other two bedrooms have washbasins. There are two other single bedrooms on the ground floor, also equipped with washbasins. There is a through floor lift to the ground floor, although wheelchair users generally use the bedroom located on the upper floor. 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 21 There is a communal lounge area, a kitchen diner and a laundry area on the upper floor and a communal lounge with a small kitchen on the lower ground floor. We did view all of the communal areas of the home, together with the bedrooms people use during their stays. Although the home was generally clean and tidy on both days of our visit, it is showing signs of the general wear and tear. This is to be expected due to the varying support needs of the people who stay at the home and the use of specialist equipment to support them. Most of the carpets in the home now look worn and some remain stained despite the home’s best efforts to clean them. There are areas of paintwork that are badly scuffed and some walls where plaster has been damaged. The bathrooms and toilets require redecoration and the flooring in the en-suite bathroom must be replaced as this is split and is no longer safe. This work had commenced on the second day of the inspection. Some of the furniture is in need of replacement, particularly in the lounge on the first floor and in the dining area, as previously mentioned in this report. The subsidence of the home remains a problem. Some work has already been carried out in relation to this and this has been reasonably successful. More work does need to be completed to finally resolve this issue and it is hoped this will be carried out within the next few months. The home’s AQAA confirms improving the environment is an important part of the development plan for the next twelve months. These improvements must be carried out so that a homely, comfortable and safe environment can continue to be provided to the people who stay in the home. 10 Tanners Walk DS0000008194.V359842.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): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The clarity of staff roles and responsibilities along with staff training and supervision are designed to provide a consistent approach to the support of staff and people who use the service. The home’s recruitment policy promotes individuals’ rights and their safety. EVIDENCE: There have been some changes within the staff team since our last visit to the home. New staff have been recruited to fill existing vacancies and the home currently has a full compliment of staff. A core of well-established staff remain, who have varying skills and abilities which enables them to meet the needs of each individual who uses the service. The newer staff members have had a thorough induction to working in the home and have also attended the organisations’ induction programme, known 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 23 as ‘Our Approach’. One newer member of staff spoken with said their induction was very good and that the staff team had been very supportive. The members of staff spoken with said that the staff team remains extremely open, honest and supportive. Each commented that it continues to be a nice home to work in. They felt well supported in their roles and are able to discuss issues in an open and honest way. Each individual who responded by survey said they are treated well by staff that listen to them and act on what they say. Relatives who responded by survey said they felt the staff did have the right skills and experience to look after people properly. One family said the home has “very caring and dedicated staff” and another said “all of the staff are most helpful, very kind and pleasant”. Health professionals who responded by survey said the staff team do have the right skills and experience to support people. One professional said “there is a core team of experienced staff who work well together”. The staff team continues to meet regularly and staff members said they are able to discuss any issues they wish as these can be added to the agenda. If staff are not able to attend the meeting, they read the minutes to ensure they remain up to date. The home operates a robust recruitment process and the records we examined included a photograph of each member of staff, application forms, health declarations, two satisfactory references, documents confirming proof of identity and Enhanced Criminal Record Bureau Disclosures. Staff are provided with a variety of training opportunities. Training is provided either by the organisation or external training providers. The records examined show that staff are provided with mandatory training such as health and safety, first aid, safe moving and handling techniques, food hygiene and fire safety. Staff are also provided with more specialist training to enable them to meet the current and changing needs of the people who use the service. This includes ‘Intensive Interaction’, understanding the Mental Capacity Act, supporting people through loss and bereavement and the organisations’ approach to supporting people. The home supports staff to attain a National Vocational Qualification (known as an ‘NVQ’). The home’s AQAA confirms that six members of staff are currently working towards their awards, which represents 50 of the staff team. 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 24 Each member of staff is provided with formal supervision. This is a 1:1 meeting with their supervisor. Staff spoken with felt this is valuable and they are able to have open and honest discussions with their line manager. The records examined show that some staff are not being provided with regular supervision and there are occasions when meetings are several months apart. This was discussed with the Manager who agreed some improvement is needed in this area. 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 25 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, 40, 41, 42 and 43. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well-run and individuals benefit from the ethos, leadership and management approach of the home. Each person’s views are sought, as far as possible, in relation to the monitoring and review of the service provided by the home. Each person’s rights and best interests are promoted by the home’s record keeping and the organisations’ policies and procedures. The health, safety and welfare of people staying at the home is promoted and protected. 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 26 EVIDENCE: The Registered Manager, Mr.Carr, has worked at Tanners Walk since 1991 and has been its Manager since 2000. Records show that he has a RNMH qualification, a City and Guilds 325.3 Advanced Management in Care Award, a NEBS Supervisory Management Qualification, Registered Manager’s NVQ Level 4 and NVQ Assessor awards. He also undertakes periodic training to maintain his knowledge and update his skills and level of competence. The management approach, by both the manager and his deputy, remains open and positive. This is a clear sense of direction and leadership. Staff spoken with praised the home’s management, said their views are listened to, and that they are well supported in their roles. One relative who responded by survey said the manager is “a very caring leader, always positive”. One health professional said in their survey “the management structure always appears sound with strong leadership” and another said the home has “a very able manager”. The manager is keen to develop and improve the service where possible. There are a number of areas where improvements are planned and these are described in the AQAA. The views of the people who use the service, or their relatives, are sought as much as possible. Their views are seen as central to the ‘person centred’ approaches used in the home and the monitoring and development of the service. This is an area where the home wishes to improve and this will be focused upon during the next Key Inspection process. Tanners Walk has a current development plan, a copy of which is displayed prominently in the home. This has been completed using a person centred planning method known as a ‘path’ and was devised by the team during their team day in November 2007. It is clear that each goal is focused upon improving the service and facilities available for the people who stay at or work in the home. This method of planning and review is used as an important part of the home’s quality assurance system. There are efficient management systems and structures in place to ensure the home runs effectively. The quality of record keeping in the home is good, with all records required during our visits easy to access and stored securely when not in use. 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 27 The organisation has a number of policies and procedures, which are designed to ensure it complies with the law and remains aware of good practice guidelines. Full details of each policy were provided by the Manager as part of the AQAA he completed for us as part of this Key Inspection process. The registered provider’s representative makes regular visits to the home, and produces a comprehensive report of his findings, which continues to be sent to us each month. The recording systems in place to support the maintenance of health and safety in the home are being used consistently. Staff members have delegated responsibilities in relation to monitoring health and safety within the home. The home’s fire log was examined and this shows that the alarm system is tested each week, regular fire drills are carried out and the Fire Risk Assessment is regularly reviewed. Staff have now been provided with formal fire safety training by an external trainer. The home’s AQAA confirms that the safety tests on portable electrical appliances, hazardous substances used within the home, the home’s lift, heating system and its electrical wiring are all up to date. The home has a number of general Risk Assessments to support safe working practices. These were all last updated in May 2007. 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 28 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 2 3 4 5 CONCERNS AND COMPLAINTS Standard No Score 22 23 2 3 X 3 3 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 3 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 2 28 2 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000008194.V359842.R01.S.doc LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 10 Tanners Walk Score 3 3 3 X 3 3 3 3 3 3 3 Version 5.2 Page 29 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 YA1 Regulation 4 5 6 Sch 1 13(6) 13(7) 18(1)(c) Requirement People who may wish to use this service must be provided with accurate information regarding the services the home can provide. To ensure individuals who stay at the home receive a safe, consistent and responsive service, each member of staff must be provided with training in relation to responding to challenging behaviour. The planned improvements to the environment must be carried out to ensure a homely, comfortable and safe environment is maintained for people who use the service. Timescale for action 26/05/08 2. YA23 26/05/08 3. YA24 23(2) 26/08/08 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 30 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 home should continue to review progress in developing accessible formats for people who use the service to ensure they are supported to make informed decisions and determine their own service. The home should complete the review of the risk assessments which support individuals to take risks as part of their lifestyle. The home should consider providing staff with accredited medication administration training to support them in their professional development. Each member of staff should be provided with regular supervision to ensure they are supported to provide a good quality service. 2. 3. 4. YA9 YA20 YA36 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 10 Tanners Walk DS0000008194.V359842.R01.S.doc Version 5.2 Page 32 - 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. 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