Care Home: 120 Feckenham Road

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What the care home does well It is very homely and friendly at Feckenham Road and people living there are settled and get on well with staff. One relative says "They all seem very happy and well cared for" and another "A stable home with a family atmosphere. Each person living at the home has a care plan they are involved in making. Plans show their needs, likes and dislikes, any possible risks and their personal goals. They show staff how best to support them and how to keep them safe. People who are living at the home can make choices in their daily lives. Their independence is encouraged by staff to help them develop their life and social skills. They are also supported to take part in activities they enjoy and go out in the community and to keep in touch with their families and friends. Staff ensure that all the personal and health care needs of people who live at the home are met. They also manage their medicines safely on their behalf. 120 Feckenham Road is an ordinary house, which has helped the people who live there to become part of the community. It also offers them a secure, wellkept and very comfortable home that is near shops and other facilities.Staff receive training about how to keep the home and people who live there safe. Also so they understand and have the skills to meet their special needs. People living at the home and their relatives can express their views and any concerns are listened to and acted upon. Necessary checks are also taken up on new staff to make sure they are suitable. This all helps to protect them. The home gives good individualised care to the people who live there. The quality of the service is regularly checked and plans are made for it to keep on improving as people living there wish and/or for their benefit. What has improved since the last inspection? Staff have continued to develop a "person centred" way of care planning. This means goals of people living at the home are identified and they are supported to achieve them to promote their individuality and make more choices. Some parts of the house have been redecorated with new flooring and carpets fitted. Some people also have new furniture, bedding and curtains etc in their bedrooms, which they have chosen. This makes the home nicer for everyone. What the care home could do better: It will be good when all staff have received training on infection control so they should understand better the importance of good hygiene in the home. The home plans to involve people who live in the home in the selection of new staff. This will give them more choice about who supports them. CARE HOME ADULTS 18-65 Feckenham Road, 120 120 Feckenham Road Headless Cross Redditch Worcestershire B97 5AG Lead Inspector Christina Lavelle Unannounced Inspection 23 & 26 October 2007 1.45pm- & rd th Feckenham Road, 120 DS0000018481.V344112.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 Feckenham Road, 120 DS0000018481.V344112.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. Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Feckenham Road, 120 Address 120 Feckenham Road Headless Cross Redditch Worcestershire B97 5AG 01527 401974 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) h5mo19@mencap.org.uk www.mencap.org.uk Royal Mencap Society Mrs Laraine Ellis Care Home 5 Category(ies) of Learning disability (5), Physical disability (3) registration, with number of places Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. This home is for people with learning disabilities, but may accommodate up to 3 people with additional physical disabilities. The Home may also accommodate one person with additional dementia illness. The home may also accommodate one person with an additional visual impairment. 21st August 2006 Date of last inspection Brief Description of the Service: Feckenham Road is operated by the Royal Mencap Society, which is also a registered charity and one of the largest providers of services for people with learning disabilities in the United Kingdom. Mencap’s mission statement for its service users is “To fulfil our ambitions, experience lots of things and make our mark in the world”. The registered manager for this home is Mrs Laraine Ellis. The home provides accommodation and personal care on a long-term basis for five adults who have learning disabilities that could be mild to severe. Three people living at the home may have an additional physical disability, dementia and/or a visual impairment. The main aim of the home is stated as being that “All the people who live here are encouraged to reach their full potential. We support them to try new ideas and become a member of the local community”. 120 Feckenham Road is located in a pleasant residential area of Redditch about three miles from the centre of the town. There are also shops, pubs, parks and other facilities locally. The home was formerly a large family house that has been adapted to its present purpose. The property is owned by Golden Lane Housing Association and is leased to Mencap. The house has a level, enclosed garden at the rear and garden and parking spaces at the front. People who live there have their own bedroom, two of which have an en-suite bathroom or shower room. Two bedrooms are on the ground floor and so are suitable for people with mobility difficulties. There are two sitting rooms, a kitchen/diner, and two bathrooms for everyone to share as well as an office and staff room. Information about the service is provided in a statement of purpose document and a service users’ guide. This guide is available in an easy read format and includes a photograph of the home. The current fee for the service ranges from £636.14 up to £1188.20 per week. People living at the home also have to pay for their own clothes, toiletries & personal items, social activities, college fees, newspapers & magazines, some travel expenses, private Chiropody & Opticians and the cost of their holiday accommodation and transport. Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a key inspection of the service provided at 120 Feckenham Road. This means all the Standards that can be most important to adults who live in care homes were assessed. The first visit was made without telling anyone at the home beforehand. Time was spent talking with the people who are living there and to some of the staff. During the second visit the way the home is run and any changes made since the last inspection were discussed with the manager. Some survey forms were left at the home for staff and people who live there asking for their views of the service. Other surveys were sent to their families and to five health or social care professionals who are involved with their care. Feedback from those surveys that were returned is referred to in this report. The manager had also completed an annual self-assessment form before these visit. This asks them to say what they think their home does well and could do better, what has improved and their plans to improve the service. It includes information about the people living there, staff and other aspects of the home. Various records kept by the home were checked and the house looked around. All information received by the Commission about Feckenham Road since the last inspection is also considered, such as events affecting people living there. What the service does well: It is very homely and friendly at Feckenham Road and people living there are settled and get on well with staff. One relative says ”They all seem very happy and well cared for” and another “A stable home with a family atmosphere. Each person living at the home has a care plan they are involved in making. Plans show their needs, likes and dislikes, any possible risks and their personal goals. They show staff how best to support them and how to keep them safe. People who are living at the home can make choices in their daily lives. Their independence is encouraged by staff to help them develop their life and social skills. They are also supported to take part in activities they enjoy and go out in the community and to keep in touch with their families and friends. Staff ensure that all the personal and health care needs of people who live at the home are met. They also manage their medicines safely on their behalf. 120 Feckenham Road is an ordinary house, which has helped the people who live there to become part of the community. It also offers them a secure, wellkept and very comfortable home that is near shops and other facilities. Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 6 Staff receive training about how to keep the home and people who live there safe. Also so they understand and have the skills to meet their special needs. People living at the home and their relatives can express their views and any concerns are listened to and acted upon. Necessary checks are also taken up on new staff to make sure they are suitable. This all helps to protect them. The home gives good individualised care to the people who live there. The quality of the service is regularly checked and plans are made for it to keep on improving as people living there wish and/or for their benefit. 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. Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. Thorough assessment and admission procedures are in place to help to ensure the home would suitably meet the needs and wishes of potential service users. EVIDENCE: Required information documents about the home are provided, which include a statement of purpose and a service user guide. The guide is called “A Promise to You” and contains a photograph of the home, pictures and simple language so that it should be easier for people with learning disabilities to understand. Mencap have an admission criteria that states people are selected depending on their wish to live at a home and whether they would get on with others in that home, whose wishes would be taken into consideration. As would other relevant factors such as contacts in the area, benefits to them, skill levels, age and gender. Referrals will first come to the manager who would decide with their service manager, support staff, relevant professionals and other people, but Mencap reserve the right to say no if it is felt the home is not appropriate to meet their needs. Prospective service users would come for teatime visits to meet people living at the home, followed by overnight stays and a 6-week trial period. They would then receive a license agreement showing their costs and responsibilities along with a copy of the service user guide. Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 9 Although there has not been any new people admitted to Feckenham Road since the last inspection the manager confirmed the assessment & introductory processes the home would follow should a referral for a possible placement be made. They would first receive a community care assessment completed by a social worker. The manager would then visit the prospective service user at their current residence to meet them and assess their needs. Following this at least three or four introductory visits to the home would be arranged and if these were successful they could move in for a trial stay. The importance of monitoring and obtaining the views of people already living at the home about possible new residents is clearly recognised. Staff would therefore try to obtain feedback from them and observe during visits if they seem to get on with each other and are compatible. Relevant other people (e.g. families) would be fully involved in the assessment and introduction of a new person to the home. A review meeting would be held at the end of the trial stay to decide on the suitability of the placement, which would involve the new people themselves, their family, social worker and home staff. Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. People who live at the home all have a care plan reflecting their needs and preferences, with risk assessments to minimise safety risks. They are enabled to make choices in their daily lives and routines and their plans now also focus more on their personal goals, showing any support needed to achieve them. EVIDENCE: A sample of care records kept by staff for the people living at the home was looked at. Each person has an up to date care plan showing their preferences and all their needs in relation to relevant areas. They include physical care, mobility and exercise, continence, education and occupation, communication, domestic skills, behaviours and finances. Their individual goals are also being identified with any action needed to meet them specified. The home is implementing an appropriately “person centred” (PC) approach to care planning. This aims to involve each person in planning their own care and making choices to the extent they are capable. The PC plans had been drawn Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 11 up with their input as much as possible by their keyworker who is allocated to them from the care staff team. Significant other people in their lives, such as relatives, other staff and professionals are also consulted if they want them to be, or when they are unable to specify their needs and goals themselves. Two people also have external advocates to represent them if and when necessary. An important aspect of PC planning is that staff know people living at the home well so they understand their needs and what they like & dislike and enable them to express their views and make choices and decisions about their lives. It is good therefore that keyworkers are actively involved in care planning and can spend some individual time supporting them. They are also helping them all to develop life books, which show their history and the people and things in their lives that are important to them. Some people were clearly very proud of their life books and the photographs and other information in them. Part of the PC process is facilitating communication and the home has started to use pictures and objects of reference to promote choice making. One person also has a speech and language plan and Mencap and the manager are developing such methods as using wall charts and symbols to help them to choose their social activities and meals etc. Their daily routines are flexible (especially at weekends when there are no set activities) and staff are being deployed around their activities. House meetings are held regularly when they discuss such as menus, staffing, holidays and other issues relating to the dayto-day running of the home. One or two staff also attend these meetings to facilitate the discussion, take minutes and ensure their views are acted upon. One resident is also a committee member of the Speak Easy advocacy group Plans are being reviewed regularly and/or updated as needs change and it is good that people can choose who they wish to invite to attend a more formal annual review, and if they want to participate themselves. When plans are reviewed the home should also make sure they reflect if their goals are being achieved with the outcomes detailed and any benefits to each person (or not). Risk assessments are also being carried out that primarily relate to minimising safety hazards, and so they also need to become part of the person centred plans and focus on promoting an independent lifestyle. Regarding issues of equality and diversity the home’s philosophy and practice clearly focuses on individuals’ needs. Whilst there are no ethnic or cultural differences amongst current residents the particular physical needs of some people have been considered and relevant specialist input sought. The staff induction programme includes a module called “Value Me” and staff will receive guidance on the Mental Capacity Act. This should ensure the home is aware of the process of setting up best interests groups when a person is not able to make informed choices so that decisions are made by appropriate others Feckenham Road, 120 DS0000018481.V344112.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 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including these visits to this service. People who live at the home are supported to take part in activities they enjoy and to mix within the community and maintain links with their families. Staff respect their individuality and encourage them to develop their social and life skills. The home provides food people like whilst healthy options are promoted EVIDENCE: People living at the home have active lifestyles that are planned around their assessed needs and wishes. Their plans include a social and weekday activity schedule, which includes college courses, work placements and day services. Records are kept of their outings and activities they have taken part in. Each person also has a home training day when they have one to one support from their keyworker to pay their rent, go shopping, clean their bedroom, do their laundry etc. This also helps them to develop their daily living skills, which should be linked to their personal goals with the outcomes reviewed. Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 13 Leisure activities include swimming, horse riding, music sessions and going to local pubs, to Church and for walks and shopping. Special outings and an annual holiday are arranged and some people go to a social club for people with learning disabilities. The home has its own vehicle to provide transport and they try to use public transport to promote community access. One of the manager’s plans is for the home to network more within the local community. Mencap have developed a family charter, which has been distributed to family members who are actively involved in service users’ lives. It is confirmed that people living at this home are supported to maintain links with their family and friends. Most have regular input from their relatives and a record is kept of contacts and visits. Relatives and an advocate make positive comments about the home. They say they are always kept up to date about important matters and the home supports people to live the life they choose. One person regularly meets up with their advocate and some relatives come to the home for meals. Staff also arrange special birthday parties on request when families and friends are invited. One person said they have retained former friendships and received a letter from one of them, which had been left for them to open. Regarding food provided by the home weekly menus are drawn up and pictures of food and recipe books are used to help people who live at the home choose their own meals. Shopping is planned around their choices and those able to are involved in this and preparing meals, making packed lunches etc. Menus seen show a variety of mostly traditional meals such as cottage pie, corned beef hash and fish & chips. Staff promote more healthy eating with fresh fruit and vegetables and by restricting puddings. They know individuals’ likes and dislikes and any special dietary needs. One person has a weight issue and so advice was sought from a nutritionist and their weight, food & fluid intakes are recorded to monitor their progress and walks and exercise are encouraged. Mealtimes seem to be relaxed social occasions when everyone eats together. Feckenham Road, 120 DS0000018481.V344112.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 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. People living at the home are supported to meet all their personal and health care needs and staff ensure that necessary health care input is obtained. Their medicines are also managed safely in the home by trained staff on their behalf. EVIDENCE: Each person living at the home has a detailed personal care plan that shows the support and/or guidance they need. Staff also encourage their self-care and independence as much as possible and respect their privacy and dignity. Everyone was seen to be well presented and suitably dressed and choose and shop for their own clothes and personal items supported by their keyworker. One person’s advocate comments, “Our friend is very well dressed and clean”. Care records include information about their specific and general health related conditions and they all have a Health Action Plan (HAP), as recommended by the Department of Health for people with learning disabilities. The HAP is in a user-friendly format so they can be involved in managing their own health care when capable. HAPs show they have regular, routine and preventative heath checks ups as well as specialist input e.g. for special shoes and a hearing aid. Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 15 Records are kept of all visits, input sought and/or treatment received from the various health care professionals and specialists. Whenever necessary physical checks are also made by staff, such as weight, with records kept. It is good that training was arranged for staff in relation to one person’s particular health related needs. Also that the home has guidance available in a simple format and a video to help people understand about health checks e.g. blood tests. Regarding medication the home has a clear policy and procedures that include guidelines on homely remedies. Everyone living at the home has a medication profile with details of their medication, reason they are prescribed and possible side effects. No one is assessed as able to self-administer. Al staff receive training as part of their induction and go on to complete accredited training on safe handling of medicines. Regular audits of medication are carried out by the home and by the Pharmacist company that provides the monitored dosage system used by the home. The home’s audits have identified two medication errors made by staff since the last inspection. The manager felt that these errors were due in part to staff changes but it is positive that they were dealt with appropriately through individual supervision and disciplinary processes and also discussed in staff meetings. There is suitable and secure storage for medicines and administration records are being maintained appropriately. Feckenham Road, 120 DS0000018481.V344112.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): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. People who live at the home are enabled to express their views and they are dealt with appropriately. Systems are in place to manage complaints about the service and to promote their welfare and safety to ensure they are protected. EVIDENCE: The home has a complaints procedure available in a user-friendly format or with audio instructions. This is displayed in the home and everyone has a copy that is explained to them. A stamped/addressed postcard can also be sent to Mencap’s area manager if they have concerns. Mencap is introducing a system to identify indicators of abuse of people with profound learning disabilities and limited communication. The home plans to use this so concerns can be picked up more effectively and relevant people will be given a copy of the procedures. An open rapport was observed between staff and people who live at the home and one person said they would feel able to raise any worries and can talk to the staff and manager and in house meetings. Relatives say they are always kept informed about important issues and any concerns raised are dealt with appropriately. No complaints have been received by the Commission or home since the last inspection and the home would record any made, with outcomes. Staff receive training about complaints and are clear about managing them and about their responsibility to protect vulnerable adults from abuse and neglect, including managing their money safely. They are aware of Mencap’s policies & procedures and flowcharts are on display with contacts and out of hours on call support. The home also has copies of local multi-agency POVA procedures. Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. The accommodation suitably meets the needs of people living there and offers them a comfortable, safe and well-kept home. Appropriate arrangements are in place to keep the house safe, clean and fresh and so promote good hygiene. EVIDENCE: 120 Feckenham Road is three miles from the town centre of Redditch in a nice residential area. There are shops, pubs, parks and other amenities in walking distance and the home is on a bus route. The house is a detached and large family sized property, which has a driveway with parking spaces in the front garden. The back garden is private, well kept and very pleasant with a patio area and garden furniture etc. The home offers five single bedrooms; two are on the ground floor and so are more suitable for people with limited mobility. Two have en-suite facilities and the other three wash hand basins. There are shared bathrooms on each floor, a kitchen/diner and two sitting rooms; one used for activities and/or privacy. Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 18 The overall impression is of a very homely and well-maintained property with a good standard of decor, furnishings, floor coverings and fittings. Since the last inspection two bedrooms have been refurbished in line with their occupants choice of colours, bed linen and curtains etc. and are well personalised. There is also new flooring in two bathrooms and on the stairs and landing areas. All areas of the house visited were observed to be clean, tidy and fresh. Staff take overall responsibility for cleaning and cooking although keyworkers also support people who live at the home to keep their bedrooms tidy and involve them in domestic tasks and cooking to help them develop their daily life skills. A comprehensive infection control policy is in place and the home provides disposable aprons and gloves for staff. There are now paper towel dispensers in shared bathrooms and near sinks in the utility room and kitchen sinks. The manager and deputy have received specific infection control training and it is good it is planned for all staff to complete this training in due course. Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. People living at the home are supported by sufficient, appropriately trained and well supported staff who work as a team to provide an individualised service. Thorough recruitment procedures also help to ensure that only suitable staff work at the home, for the protection of the people who live there. EVIDENCE: It is confirmed staffing levels are being maintained at an appropriate level to meet the personal and social needs of the five people living at the home. Two staff left during the last year however and it took a while to fill the vacancies. The home has now recruited new staff and has relief staff to cover the home. Although they have had to deploy agency staff occasionally they use the same personnel so they become familiar with people and the home. The staff team comprises of eleven care staff plus the manager and deputy (three are men). Staff are clearly committed to providing a good quality service and work well together and with management. This is also recognised by other people and one relative says “They really are carers with a genuine interest in meeting our needs” and one social care professional comments “Through my observations I have always felt that all the staff I have met display a high degree of care”. Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 20 Mencap provides robust policies & procedures for the selection and recruitment of care staff. Records seen of a new staff member confirm that a police (CRB) check and two written references were taken up (one from their last employer) and that these checks are obtained and must be satisfactory before new people are allowed to start work at the home. Copies of relevant documents are also held and application forms completed, which include a full employment history (with any gaps explored) and a statement about their health. Although the manager says the views of people who live at the home are already sought when selecting staff it is planned to involve them more actively in recruitment. All new staff undertake a probationary period before their employment at the home is confirmed. During this time they complete Mencap’s comprehensive induction programme in their first six weeks followed by six months foundation training. This takes them through all aspects of supporting service users and this induction process is appropriately accredited to a Learning Disability Award Framework (LDAF). This should make sure that all staff have the underpinning knowledge in relation to caring for people with learning disabilities. One new staff member confirmed they had completed this induction programme as well as core health & safety training and care related topics such as Respect and Values, Person Centred Planning and abuse. They also spent many hours with the manager and deputy going through policies, procedures and care plans etc. Staff then move onto do an NVQ qualification in care and service user specific training that is relevant to people with learning disabilities and those living at individual homes. It is good that more than half of this staff team had already achieved an NVQ and another two are in the process of doing so. A training matrix for the team and individual training plans are also kept by the home so that training can be arranged and/or refreshed as and when necessary. Staff confirm they receive regular individual supervision, with records kept and they also have an annual performance review. They say there is good, open communication within the team, who work well together, and that monthly staff meetings are held. They feel well supported overall both from Mencap and home managers and have opportunities to complete relevant training. Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. People who live at 120 Feckenham Road receive good individualised care at a well run home. The quality of this service is monitored and reviewed so it continually develops as they wish and/or for their benefit. Policies, procedures and staff working practices help to protect the people who live and work there. EVIDENCE: The manager of this home (Laraine Ellis) is suitably qualified and experienced and has an NVQ 4 qualification in social care & management. Mrs Ellis has also completed training in relevant health & safety topics and management related areas e.g. supervision, performance appraisal and report writing. Management duties and responsibilities for the home are shared with a deputy manager who has also now completed the Registered Managers Award qualification. Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 22 This key inspection confirms the staff team are committed to providing a good quality service and there is a good team work ethic. Staff say managers are approachable and there is an open and positive approach whereby problems are sorted out appropriately and their suggestions are taken up. The manager feels well supported by external management overall and has opportunities for training, supervision and to attend monthly service manager meetings. Mencap operate a formal system to monitor, review and assure service quality. This includes required monthly visits from an area manager when all aspects are checked and/or audited periodically and a plan is made to keep improving the service with actions and timescales specified. The views of people who live at the home must be reflected in homes’ annual development plans and so questionnaires have been sent for them to their families and involved outside agencies so they can offer support to complete them. The manager would also like to produce the home’s annual plan in a user-friendly format, which would be good and should show how their views and wishes are being included. Regarding health & safety staff training is arranged in all the mandatory topics such as first aid, food hygiene, fire safety and moving & handling. The following was also confirmed:• • • • • • Electrical circuits are regularly checked & PAT tests are carried out. Staff complete all required fire safety checks at the specified intervals. There is a fire emergency action plan for the home. The fire safety system and equipment are serviced regularly. The heating system & gas appliances are serviced regularly. Risk assessments are carried out (including COSHH) There were also no safety hazards identified during these visits. Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 24 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 persons meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the registered provider to consider carrying out. No. Refer to Standard Good Practice Recommendations Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Feckenham Road, 120 DS0000018481.V344112.R01.S.doc Version 5.2 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. 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