Care Home: 111 Crescent Road

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What the care home does well A great deal of the work that the home does well and the improvements made since the last key inspection can be attributed to the management and staff team. They have developed a consistent and stable team of core staff who know the people well and have developed the skills, knowledge and values needed to support them in a positive and affirming way. The staff feel supported by the manager as a member of staff confirmed, `My manager regularly meets with me. We have supervision. We have regular meetings.` People also felt supported by the manager and the staff team. `I would tell the manager or staff I have known for a long time. They support me in going down the right procedures and keeping it all confidential.`The management and staff team have worked closely with the people they support to make sure that they understand people`s needs, goals and how they want to be helped. This knowledge and understanding has been recorded through people`s care plans to make sure that staff know how to support and help people in the way that they want to be helped. Examples were seen of very detailed and person centred care plans that told the reader about a person`s life. This included the important events and people in their lives, their needs and goals and what was important to the person. This included very informative guidance on how a person wanted to be supported with their personal care, their social and leisure interests, the ways that they communicate and make decisions and choices and the relevant aspects of a person`s background and culture that were important to them. The management and staff team have worked closely with people, their families and other relevant agencies to find out about their lifestyle and which activities they value and have the most meaning for them. For example, one person has been supported to resume attending local gospel church services and advice from his family had helped in finding out the meals and foods that he enjoyed and they used local suppliers of Afro-Caribbean foods. During the site visit one person communicated how they went to a weekly arts group and showed us examples of the artwork he had produced and displayed around the house. He also gave us permission to go into his bedroom to show that he had been supported in personalising his bedroom with objects and arts that reflected his taste and cultural background. An area in which the management and staff team had consistently worked well was in maintaining people`s general health and mental wellbeing. People were supported to access local general health services such as the G.P. dentist, chiropodists, etc. At the time of the site visit staff had just arranged for a dentist to make a home visit as this suited the person and met their needs. In addition, people had been supported in a consistent and positive way that meant that incidents of emotional ill health had continued to reduce and this had allowed people to take up more opportunities to participate in activities that they valued and enjoyed. The management and staff team support vulnerable people who need support to live safely in their community. The staff team had showed their awareness and commitment to keeping people safe through developing their skills and knowledge in protecting vulnerable adults and in understanding and responding to people`s emotional ill-health through person centred non physical means. A person commented about the way that staff work with them during difficult times when they said, `The carers listen when I need their support, they talk with me for long periods of time, I can ask them anything I need to know.`111 Crescent RoadDS0000021703.V361996.R01.S.docVersion 5.2Page 7 What has improved since the last inspection? The previous key inspection of June 2007 identified that improvements need to be made in the way that the management and staff team look after and record the administering of medication. These changes had been made and met the requirements made. CARE HOME ADULTS 18-65 111 Crescent Road 111 Crescent Road Crumpsall Manchester M8 5SH Lead Inspector Steve O`Connor Unannounced Inspection 3 and 4th June 2008 12:00 rd 111 Crescent Road DS0000021703.V361996.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 111 Crescent Road DS0000021703.V361996.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. 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 111 Crescent Road Address 111 Crescent Road Crumpsall Manchester M8 5SH 0161 740 9405 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) Southfields Care Homes Limited T/A The Regard Partnership Limited Zoe Anne McCall Care Home 3 Category(ies) of Learning disability (1), Mental disorder, registration, with number excluding learning disability or dementia (2) of places 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user requires care by reason of learning disability. Should this named individual no longer reside at the home then the registration will revert to 3 places for mental disorder (MD) 15th June 2007 Date of last inspection Brief Description of the Service: The care home provides 24-hour accommodation and support for three people who need support because of their mental health problems. In addition one person has additional learning disabilities. 111 Crescent Road is a detached house situated in the Crumpsall area of Manchester. The house is on a main road with access to public transport and local shops. The house has three large bedrooms, two lounges (one of the lounges is a designated smoking area), a bathroom and downstairs toilet plus a kitchen / dining room. There is a small room used by staff as an office and a staff sleepin room. The house has gardens to the front and rear of the property that are accessible by clear pathways. Information provided by the home showed that the fees ranged from £1400 to £1700 per week. Information about the service can be found either at the home or through the main organisation (The Regard Partnership Ltd). 111 Crescent Road DS0000021703.V361996.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 3 star. This means the people who use this service experience excellent quality outcomes. The inspection report is based on information and evidence we (the commission) gathered since the last key inspection in June 2007. Additional information, which has been taken into account, included incidents notified to the commission and information provided by other agencies. Before visiting the home, we asked the manager to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helped us to determine if the management of the home viewed the service they provide the same way that we see the service. Before visiting the home people who used the service and members of staff were sent surveys and asked to comment on the agency. By the time of the visit three people and two staff returned surveys. During the inspection site visit time was spent talking to the two people who now live at the home, to the manager and staff. Documents and files relating to people and how the agency was run were also seen. The inspection was an opportunity to look at all the core standards of the National Minimum Standards (NMS) and was used to make a judgement on the quality of the service provided by the agency and to decide how much work we need to do with them in the future. What the service does well: A great deal of the work that the home does well and the improvements made since the last key inspection can be attributed to the management and staff team. They have developed a consistent and stable team of core staff who know the people well and have developed the skills, knowledge and values needed to support them in a positive and affirming way. The staff feel supported by the manager as a member of staff confirmed, ‘My manager regularly meets with me. We have supervision. We have regular meetings.’ People also felt supported by the manager and the staff team. ‘I would tell the manager or staff I have known for a long time. They support me in going down the right procedures and keeping it all confidential.’ 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 6 The management and staff team have worked closely with the people they support to make sure that they understand people’s needs, goals and how they want to be helped. This knowledge and understanding has been recorded through people’s care plans to make sure that staff know how to support and help people in the way that they want to be helped. Examples were seen of very detailed and person centred care plans that told the reader about a person’s life. This included the important events and people in their lives, their needs and goals and what was important to the person. This included very informative guidance on how a person wanted to be supported with their personal care, their social and leisure interests, the ways that they communicate and make decisions and choices and the relevant aspects of a person’s background and culture that were important to them. The management and staff team have worked closely with people, their families and other relevant agencies to find out about their lifestyle and which activities they value and have the most meaning for them. For example, one person has been supported to resume attending local gospel church services and advice from his family had helped in finding out the meals and foods that he enjoyed and they used local suppliers of Afro-Caribbean foods. During the site visit one person communicated how they went to a weekly arts group and showed us examples of the artwork he had produced and displayed around the house. He also gave us permission to go into his bedroom to show that he had been supported in personalising his bedroom with objects and arts that reflected his taste and cultural background. An area in which the management and staff team had consistently worked well was in maintaining people’s general health and mental wellbeing. People were supported to access local general health services such as the G.P. dentist, chiropodists, etc. At the time of the site visit staff had just arranged for a dentist to make a home visit as this suited the person and met their needs. In addition, people had been supported in a consistent and positive way that meant that incidents of emotional ill health had continued to reduce and this had allowed people to take up more opportunities to participate in activities that they valued and enjoyed. The management and staff team support vulnerable people who need support to live safely in their community. The staff team had showed their awareness and commitment to keeping people safe through developing their skills and knowledge in protecting vulnerable adults and in understanding and responding to people’s emotional ill-health through person centred non physical means. A person commented about the way that staff work with them during difficult times when they said, ‘The carers listen when I need their support, they talk with me for long periods of time, I can ask them anything I need to know.’ 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. 111 Crescent Road DS0000021703.V361996.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 111 Crescent Road DS0000021703.V361996.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at the home had their needs assessed prior to admission to the home. EVIDENCE: Since the last key inspection no new people had been admitted to the home. People had a pre-admission Care Management or Care Programme Approach (CPA) assessment from the relevant purchasing authority. The manager described the referral process whereby they were responsible for undertaking a pre-admission assessment to establish whether the service could meet the person’s needs. A new referral had been received in relation to a vacancy at the home and the manager was planning to visit the person to undertake the assessment. 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Systems were in place to assess and reflect changes in peoples’ support needs, the risk situations they experience and they were supported to make decisions about their own lives. EVIDENCE: Since the previous key inspection the management and staff team have worked with people to further develop the way that people’s needs and goals were being identified and recorded through the care planning process. The current care plans had been reviewed and updated to include more detailed and relevant information and contained person centred guidance for staff to follow in how they work with people. In addition, the staff team were currently working with people to develop a new person centred plan that would look at their individual goals and wishes and what is important to them. 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 11 People’s support was being reviewed on an ongoing basis that depended on a person’s needs, health and support. Examples were seen of where people’s care plans had been updated to reflect their changing needs and support. In addition, people’s needs were reviewed through the local authority purchaser’s own review system of Care Management and/or Care Programme Approach. To support and help people to make more decisions about their lives the management and staff team have worked with people to develop communication aids such as a dictionary of words and phrases that a person uses. This has helped staff to better understand what people are saying and so support them in making day-to-day choices and decision making. In addition, one person has been supported with an independent advocate to make sure that their views and opinions were being heard. The care planning system included a process for identifying and recording risks and hazards that people may experience. Examples were seen where the staff team had worked with specialist healthcare providers to identify risk situations and how the person’s behaviour may challenge them. Together they had developed ways to support people that minimises those risks so enabling them to take part in activities they enjoyed and to make sure that they maintained their mental and emotional health and wellbeing. The majority of the staff team had attended training in how to work with people who presented a challenge to them and the service, and in crisis prevention techniques. To show that they had read and understood the risk assessment guidance each member of staff signed a recording sheet to confirm this. 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. 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. People were being supported and encouraged to participate in activities and establish routines that they valued and enjoyed. People’s families were involved in their lives where this was wanted and they were able to choose meals they enjoyed. EVIDENCE: At the time of the site visit people received 1:1 support throughout the day and night to help them follow their lifestyle choices and to respond to their emotional and mental health needs that could, at times, present a risk to themselves and challenges to the staff team and service. People’s care plans were found to reflect their social and leisure interests, cultural activities, daily routines, family contacts and information regarding nutritional needs. This information was detailed and examples were seen 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 13 where staff had worked closely with a person to try to find out what activities they enjoyed and valued. The person had explained how they enjoyed spending time with family members, swimming, football, darts and how they wanted to spend more time playing cricket, going on day trips, to ride a bike and play the guitar. The level of staff support meant that people were offered more opportunities to participate in the activities that they enjoy both in the house and in the community. People used a mixture of public transport and taxis to access community activities and leisure trips such as a recent day trip to Blackpool. The staff team were maintaining a record of these opportunities and activities offered and whether people took part in them. People were supported and encouraged to undertake domestic tasks to keep the communal and private areas clean and to maintain their own skills. A member of staff on duty was asked how they offered people choices. They explained that even if the person said ‘no’ to the opportunity this did not necessarily mean no and they understood that they needed to make the offer several times and to give the person other options to give them a real choice and to make their own decision. The member of staff was able to describe what activities people enjoyed and how they had learnt to develop the skills and knowledge required to support them safely in the community. Another area where the staff team had worked well with the person, their family and other agencies was in finding out about and supporting a person’s cultural needs as an Afro-Caribbean man. People were supported and encouraged to maintain positive links with their family, where possible, and worked to include people’s families in their lives as much as possible. As people were supported on a 1:1 basis through the day their routines were based on the activities that they enjoyed and were encouraged to participate in and through specific activities and services that people took part in. Mealtimes were not set affairs but based on when people wanted to have their meals and when they were hungry and so was flexible and based on individual needs. The staff team had access to information about people’s nutritional needs and what meals and foods they liked and disliked. People were consulted about the meals they wanted and had developed recipes around people’s cultural interests and goals. Staff followed eating and drinking guidelines developed to keep people safe and had worked closely with relevant health specialists to develop and implement these guidelines. 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 14 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 excellent. This judgement has been made using available evidence including a visit to this service. People’s personal, general and mental healthcare needs were being supported by the staff team to make sure that they remain well. EVIDENCE: People were being supported to maintain their personal care through hands-on help and prompting. For each person the management and staff team had developed clear and detailed personal care guidance that explained to staff members how the person wanted to be helped. The staff team supported people to maintain their health and wellbeing through accessing general and specialist healthcare providers. Records of people’s health needs were clear and detailed in their care plan. General and mental health related appointments and the outcome of those visits were recorded. Medication needs were regularly monitored through the local G.P or allocated psychiatrist. 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 15 Where required specialist health providers such as Speech and Language and Occupational Health Therapist have worked with staff to undertake relevant assessments and to develop programmes and support guidance to maintain people’s health. People were being supported to control and live with their emotional/mental health needs and staff spoken to during the site visit were aware of how illness affects people and how to identify the triggers that show that a person was experiencing problems. The management and staff team had worked with people, families and relevant mental health services to develop clear risk assessments and guidance in how staff respond to and minimise the impacts of people’s emotional ill-health. The medication administration records (MAR) were all signed and accurate. Due to an incident at another care home owned and managed by The Regard Partnership the purchasing authority had requested that all administering of medication be observed and signed by a witnesses. The witness signed on the MAR sheet and it was found that this created confusion, as it appeared that a medication was being administered more than the prescription details. It is recommended that if the administering of medication has to be witnessed by another member of staff that this was recorded using a separate recording format and made clear that this was an observation of administering. The guidance for administering medication prescribed ‘as required’ (PRN) had been reviewed and updated and the number of drinks given that contained prescribed thickener was being recorded. However, it is recommended that staff record the actual time when each thickened drink is taken. Records of deliveries, returns and ongoing audits were being maintained to make sure that people were taking the medication they need to maintain their health. The previous key inspection report in June 2007 had highlighted the need for staff to be competent in their knowledge of the medication administration system. Over the past 12 months the staff team had participated in several training events provided by The Regard Partnership and by the supplying pharmacist. In addition to this staff were currently undertaking a formal qualification in the safe handling of medication provided by a local higher education college. Those staff who were spoken to about the course were knowledgeable and clear in their understanding and application of the medication administration system. 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has the policies and procedures in place and the staff were aware of the practices to respond to peoples concerns and to protect them from harm. EVIDENCE: The management and staff team follow a clear complaint policy and procedure that has set time frames for action. People were provided with an easy read version of the complaint procedure. Families and other relevant people, such as care managers, were provided with information on how complaints and concerns can be raised. Since the last inspection report the CSCI had not received any formal complaints regarding the service. The manager had maintained a record of any concerns raised by people or relevant others and had recorded the actions and outcomes of any investigation into the concern. The home has an Adult Protection Policy and adheres to the Manchester MultiAgency Adult Protection Procedures. The staff members on duty were asked about their understanding of adult protection issues and were able to describe the training they had received and the procedures they would follow in the event of an incident or allegation including the ‘whistleblowing’ procedures. Staff records showed that the team had participated in a range of training around the issues of protecting people including the Protection of Vulnerable 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 17 Adults, working with people who present challenging behaviour and nonphysical crisis intervention techniques. Since the last key inspection the management and staff have had to deal with one incident that related to people’s safety and make a referral to the local authority under the agreed safeguarding procedures. The manager was able to describe these events and the process they followed. Staff supported people to manage their personal finances and benefits. Records were maintained of all spending transactions and regular checks and audits were carried out to make sure the balances were correct. The management team were aware of the introduction and implications of the Mental Capacity Act 2005 in relation to supporting people to make decisions and choices that affect their lives. It is recommended that where decisions to spend people’s money had been taken by the management and staff team that the decision making process be recorded and agreed in writing with the involvement of relevant people. 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 18 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was clean and reasonably maintained and could benefit from continued improvement. The environment was generally safe. EVIDENCE: A tour of the building showed that the home was generally clean and reasonably maintained. The staff team undertake the cleaning of the home and support people to carry out domestic tasks where they can. The layout and use of the house offers people flexibility to allow them use of both communal and private space. People gave us permission to look in their bedrooms and it was found that they had decorated their rooms with personal items based on their own tastes and cultural needs. The bedrooms were clean and well maintained but the decoration was starting to look ‘tired’ and the carpets in the bedrooms and 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 19 other parts of the house was looking worn. At the time of the site visit quotes were being gathered to replace a number of carpets through out the house. The house had gardens to the front and rear. Staff had spent time tidying the front garden so that it looked presentable. The back garden was fully paved but some paving stones were coming loose and broken and others very uneven. It was found that the ground floor toilet would not flush correctly; the 1st floor toilet had broken tiles on the walls and the 1st floor bathroom had discoloured grouting, broken tiles and was in a general state of poor repair and required decoration. A requirement relating to these issues have been made. It is recommended that an audit be undertaken of the current state of the building and gardens and a refurbishment plan be developed and provide the CSCI with a copy. A domestic washing machine, located in the kitchen, was used for all peoples’ clothes and linen. The staff team support people with intimate personal care and staff members spoken to during the site visit were generally aware of the need to wear safety equipment to minimise the risk of infection. The manager was aware of the need to make sure that staff are kept up-to-date with safe working practice around infection control. It was recommended that staff are made fully aware and assessed as being competent in the implementation of safe working practices and their role and responsibilities in minimising the risk of cross infection. 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 20 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 and 35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People were being supported by an effective and established staff team who had the skills and knowledge to meet their needs. EVIDENCE: Since the last key inspection the manager had made a number of changes and the staff team now consists of a core team of around 6 members of staff who provide the bulk of the support. During the day and night two staff were on duty to provide people with a 1:1 support when required. In total the staff team consisted of 12 members of staff who work at the home and at the other two small care homes owned by The Regard Partnership Ltd that the manager has responsibility for. They provide cover for shifts, holidays, training and sickness. This set-up gave the management and staff team more consistency, flexibility and allowed staff to develop the knowledge and skills needed to support people. The manager stated that no agency staff had been used since the last inspection. 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 21 Management and staff met on a regular basis to discuss issues that affect people and the home. Staff were encouraged to raise the issues that affect them and staff meeting minutes showed that subjects such as behavioural guidelines, person centred planning and information sharing were discussed. From discussions with members of staff on duty they were able to show that they had a detailed and thorough knowledge of people’s needs, goals and how to support them in a positive and person centred way. Members of staff were able to describe how they worked with people during times when their behaviour may be challenging and how they update their knowledge through reading and understanding the behavioural guidance and care plans. People were working with staff to develop person centred plans that identified activities and events and people that were important to them and their lives. The plans were reflecting what was important to the person and would show staff how they wanted to be supported to take part in activities that they value. At the time of the site visit a person was spending time with a staff member talking about what was important in their life. They had drawn pictures of pets, activities and meals that they enjoyed. Information provided by the manager stated that around half of the staff team had achieved at least a NVQ Level 2 qualification with several going on to further study for qualifications including management training. The remaining staff members were currently undertaking the NVQ level 2 or awaiting confirmation of the award. We are sampling staff files at a national level to assess whether all the required checks and documentation required through the recruitment process had been obtained. Files that were checked in February 2006 had been seen with completed application forms, references received and a contract of terms and conditions. The manager also kept a record of Criminal Record Bureau certificate numbers and dates, references and identification documentation to make sure that all the required checks had been followed. Members of staff were asked about the training they had participated over the last year and they were able to describe training events such as the Induction Programme, working with challenging behaviour, crisis intervention and various other training events looking at different aspects of mental health such as personality disorder. Staff also accessed core training such as Protection of Vulnerable Adults, Health and Safety, Food Hygiene, Fire Prevention and First Aid when they require refresher training. This key inspection report has highlighted that staff had undertaken and were participating in training events that furthered their knowledge such as the safe handling of medication, person centred planning and understanding learning disability. 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 22 The manager had undertaken an audit of the staff team’s training needs through discussion in supervisions and staff team meeting. They had access to a dedicated training budget that they could use to purchase relevant training from any source. 111 Crescent Road DS0000021703.V361996.R01.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, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management team and operational systems were in place to seek peoples’ views of the service and to maintain their health and safety. EVIDENCE: The manager has several years’ management experience working with people who present a challenge to the service and completed her Registered Managers Award in 2003. The previous inspection of June 2007 identified the need for her to apply to become the registered manager. Since then she had gone through the application process and was now the registered manager with the full roles and responsibilities that the position holds. She had worked with people and the staff team over the past 12 months 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 24 to make the necessary changes in the way they work with people that was much improved and gave people a more consistent and valued level of support. There was also a deputy manager and senior support worker who were allocated certain key tasks and responsibilities to carry out. Both carry out this role in addition to their support role and within their existing allocation of hours and do not have any supernumerary hours to carry out their management role. It is recommended that the role of the deputy manager and senior support worker be reviewed to make sure that they are able to carry out their roles and responsibilities within their allocated hours of work and whether they require any supernumerary hours to achieve this. The Regard Partnership Ltd have their own quality assurance system, including service user surveys, and a Quality Assurance manager who carries out the Regulation 26 visits to the home. Samples of these inspection reports were seen that showed the annual action plan for the service and confirmation on how these actions were being met. A fire log is maintained for visual checks and fire drills. The fire risk assessment had been reviewed. Up-to-date environmental risk assessments had been undertaken in relation to the health and safety of the home. Records for monitoring temperatures of the hot water and fridge/freezer were being maintained. 111 Crescent Road DS0000021703.V361996.R01.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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 4 33 4 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 4 X 3 X X 3 X 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 26 NO Are there any outstanding requirements from the last inspection? 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 YA24 Regulation 23 Requirement So that people live-in and enjoy a good quality environment the repairs identified in the report, are addressed and an action plan supplied to the CSCI within the timescales stated: Timescale for action 11/07/08 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 YA20 Good Practice Recommendations It is recommended that if the administering of medication has to be witnessed by another member of staff that this is recorded using a separate recording format and it is made clear that this was an observation of administering. It is recommended that staff record the actual time when each thickened drink is taken. 2 YA23 It is recommended that where decisions to spend people’s money had been taken by the management and staff team that the decision making process be recorded and agreed in writing with the involvement of relevant people. DS0000021703.V361996.R01.S.doc Version 5.2 Page 27 111 Crescent Road 3 4 AP24 YA30 5 YA37 It is recommended that an audit be undertaken of the current state of the building and gardens and a refurbishment plan be developed. It was recommended that staff were made fully aware and assessed as competent in the implementation of safe working practices and their role and responsibilities in minimising infection control. It is recommended that the role of the deputy manager and senior support worker be reviewed to make sure that they are able to carry out their roles and responsibilities within their allocated hours of work and whether they require any supernumerary hours to achieve this. 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 111 Crescent Road DS0000021703.V361996.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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