Care Home: 13a Green Lane

Similar services:

• Clover House
• Parkside
• Park Lodge
• Mere Hall View
• St Bonaventures
• Hudson Road
• Whitewalls
• Home Farm

What the care home does well Information given to service users was helpful, clear and suitable for their needs (with pictures and easy to read writing). A lot of care and thought was taken to make sure new service users, their families and care staff got to know each other. This included having plenty of time to try out the home before coming for their first overnight stay. Families felt involved and appreciated how staff worked closely with them. During their stay, service users were supported to go out and socialise. There was a small, stable staff team, which changed very little. This meant service users, their families and staff all got to know each other very well. Staff were properly recruited, well trained and felt well supported by the manager. The home was attractive, clean, safe and comfortable. What has improved since the last inspection? To keep service users safe at night, two new beds had been bought (with builtin bed rails). CARE HOME ADULTS 18-65 13a Green Lane 13A Green Lane Leigh Wigan Greater Manchester WN7 2TL Lead Inspector Sarah Tomlinson Unannounced Inspection 27th June 2008 10:00 13a Green Lane DS0000035964.V366368.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 13a Green Lane DS0000035964.V366368.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. 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 13a Green Lane Address 13A Green Lane Leigh Wigan Greater Manchester WN7 2TL 01942 673511 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) Wigan Council Social Services Department Jennifer Ann Mills Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home is registered for a maximum of 5 service users to include:up to 5 service users in the category of LD (Learning Disability) The service should at all times employ a suitably qualified and experienced manager who is registered with the CSCI The Registered Manager must spend a proportion of their working hours each week on site to have a clear present in the home, to oversee the running of the home, and supervision of care staff on the premises, to include weekends and times when the service users are presence in the home. This must be reflected on records maintained in the premises. Staffing levels are to be calculated in accordance with the Residential Forum Staffing Guidance (Older People and Younger Adults) by 1 April 2004. 4th December 2006 4. Date of last inspection Brief Description of the Service: 13a Green Lane is a small care home run by Wigan Social Services. It provides a short-term break (respite) service. People usually stay several nights during the week or for a weekend. It is registered with us (the commission) to provide care for up to five people who have a learning disability. 13a Green Lane is in a residential area of Leigh, close to local shops and amenities. It is a purpose built, two storey building (no lift) and is owned by a Housing Association. The home is set back from the road, reached by a long driveway. There is a small amount of parking at the front and gardens to the front, side and rear. There are five, single bedrooms. Two are on the ground floor (accessible for wheelchair users, with ceiling hoists) and three are on the first floor. All have wash hand basins (no en-suites are available). There is a lounge/dining room, a further second lounge, two ground floor assisted bathroom/shower rooms and an unassisted first floor bathroom. During the week, the home is usually unoccupied between 10am and 3pm (as service users are out and staff are not working). The manager is based at a separate office. The current subsidised fees are approximately £10.00 per night (social trips out are extra). 13a Green Lane DS0000035964.V366368.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. The inspection visit, which the home was not told about beforehand, lasted eight and a half hours. We looked around the building and spent time watching how staff supported service users. We met 5 service users and talked to a relative and to staff (the manager and 4 carers). We also looked at some paperwork. We also sent surveys to service users and their families and to staff (in November 2007 and again in May 2008). Eleven relatives and 1 staff member returned them. Their views are included in this report. We have also used information from a form called an Annual Quality Assurance Assessment (AQAA). The home has to complete this each year, telling us what they do well and what they would like to do better. What the service does well: What has improved since the last inspection? 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 6 To keep service users safe at night, two new beds had been bought (with builtin bed rails). 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. 13a Green Lane DS0000035964.V366368.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 13a Green Lane DS0000035964.V366368.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): 1, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New service users and their families received helpful information, with time and effort spent on introducing them to the service. Updating information and reviewing finance arrangements would improve this further. EVIDENCE: We looked at the brochure (Service User’s Guide) given to service users and their families. Good practice was noted, as it was in a format suitable for people with learning disabilities - with pictures, photographs and easy to read, large print text. Minor additions were needed - information about the cost of the service (e.g. the lowest to the highest fee); the number of places provided (explaining how up to four other people may be staying at the same time); plus a description of the accommodation (including an explanation that everybody has their own bedroom (nobody has to share)). Information about how bookings are made and arrangements about the washing of personal clothing would also be helpful. Our contact details also needed updating, plus the statement that we inspect the home twice a year. The Statement of Purpose (which formally advises us and commissioners of the service provided) was currently being updated. As part of this revision, we 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 9 advised the Responsible Individual needed to be identified by name, with their contact details, relevant qualifications and experience included. The complaints section needed amending to confirm a complainant could contact us at any stage of their complaint. A description of the service (explaining the nature of a ‘short break service’), plus its aims, objectives and the number of places also needed to be included. The document would also benefit from being dated (to show when it was reviewed). We were told the service was currently under review and a working party was to be set up with families to look at ways the home could develop (e.g. supporting service users just for an evening as well as for overnight stays). There was a core group of 40 service users who stayed at the home. Their abilities ranged from people who were quite independent to people who had a high level of need and needed full assistance (including people with behaviours that challenged the service). We discussed that new referrals must not be accepted if the manager and staff do not feel they are able to fully or safely meet the needs of a prospective service user (and this might not be apparent until the assessment process was underway). Good practice was noted regarding how new service users were introduced to the home (the ‘getting to know you’ assessment process). A gradual, personalised approach was taken, whereby the needs and wishes of the service user and their family were considered. After a full Social Services assessment was received, the home worked with the service user and their family to arrange a series of visits to the family home and to Green Lane (with several visits for tea taking place before the first overnight stay). We discussed compatibility, regarding the needs and personalities of service users staying at the same time. The service tried to be proactive, with consideration given to friendship groups. However, this was not always possible as families pre-booked the service to reflect their own holidays. A situation had recently arisen between two service users. The manager had cancelled one stay and shortened another to avoid potential conflict. We looked at the home’s service agreement. Good practice was noted, as this was in an easy to read/pictorial format. However, three of the four agreements seen had not been personalised and none explained how much the person had to pay each time they stayed. The home needed to confirm with Wigan Social Services finance department that service users (and/or their families) received clear, personalised and easy to understand fee information. Invoice frequency was also raised by one relative, who said they often received them for several months together, but wanted “monthly bills so I know where my money is up to”. We discussed this with the manager, who said this had been raised and discussed previously with Wigan Social Services finance department. The manager had responded previously by supporting a relative to pay a regular amount in advance (for pre-booked stays). 13a Green Lane DS0000035964.V366368.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 adequate. This judgement has been made using available evidence including a visit to this service. A knowledgeable staff team supported service users. Gaps in the care recording system placed service users at risk of their needs not always being fully understood or met. EVIDENCE: We looked at four care files. Good practice was noted, as there was a lot of personalised and detailed information about service users’ support needs. This included ‘help notes’ for staff use (with service users’ daily routines and how they liked their care to be provided). With regard to reviews, the home participated in regular multi-disciplinary reviews. The home also carried out its own internal six monthly reviews (which focused solely on the service user’s time at Green Lane). These were recorded in a helpful, pictorial/easy to read format. However, these were not always taking place. 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 11 Risk issues were generally being considered and documented. However, some important information was missing. There were no details about one service user’s physical aggression towards staff or their behaviour towards other service users, nor any guidance about how to reduce or manage these risks. Whilst internal incident forms had been completed regarding the physical aggression, we were concerned we had not been notified. A separate log of ‘inappropriate’ behaviours was also kept. The home needed to ensure information recorded in these was monitored locally in the home and acted on; ensuring information was fed back into and updated risk assessments. We confirmed, that unless required by the home’s own policy guidance, we did not expect each staff member to sign to show they had read a service user’s risk assessment (we expected it to detail the name of the person who completed it and the date it was completed). At times, we found care files difficult to use. They contained a lot of information from other parties; the order was unhelpful; no start date had been recorded regarding when the service user had started using the service; and service users’ photographs were often missing. The manager had recently ordered new replacement files. We advised the opportunity was taken to archive some information into overflow files, leaving each service user with a current ‘working file’ for day-to-day use. The manager was also planning to introduce a quick reference guide, whereby each service user’s file had a list of ‘important things’ (particularly for service users who had communication difficulties). Daily diary sheets were completed during a service user’s stay. These included details of what was eaten. This duplicated information recorded in a menu diary and unless a service user’s help notes identified specific dietary issues, we felt was unnecessary. In view of the recently introduced Mental Capacity Act (2005), we discussed ways staff could instead detail how and what decisions they have supported service users to make (e.g. choosing which bedroom they wanted to stay in). Staff spoken to clearly understood the individual needs, personal preferences, and likes and dislikes of the people they were caring for. 13a Green Lane DS0000035964.V366368.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. Service users were supported to take part in ordinary and meaningful activities that reflected their choices and capabilities. EVIDENCE: During the week, service users spent their day away from the home, attending day centres, colleges and other social, educational and therapeutic activities. Service users left after breakfast and returned late afternoon (the home was unoccupied and not staffed between 10am and 3pm). Good practice was noted, as during evenings and at weekends staff were expected to support service users to take part in ordinary leisure activities outside the home (e.g. visiting the local pub, going out for a walk in nearby fields or shopping). The home was currently looking at ways of increasing 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 13 links with local communities, plus organising themed activity weekends (i.e. men’s/women’s/pampering weekends). Good practice was noted, as strong links were maintained with families. Relatives spoke very positively about the service. Two parents described how they appreciated staff clarifying matters and involving them in the care provided, e.g. one staff said staff had contacted them on several occasions “to clarify something my son, who has indistinct speech, has been trying to tell them”. However, one relative felt the regular contact from staff was not so welcome, saying staff “sometimes keep in touch too much when I am having a respite break”. Good practice was noted, as daily routines, particularly during the weekend were flexible. Staff described how service users were encouraged and supported to make decisions about what time to get up and go to bed. Where able, service users were given a key to their bedroom and encouraged and supported to use it during their stay. However, one relative felt the freedom service users were given was detrimental, as “it causes difficulties when [their son] gets home”. We discussed using the home’s internal review to encourage families to raise such issues (and to also confirm the amount of contact desired during their relative’s stay). With regard to meals, shopping and food preparation was the responsibility of staff. There was no fixed menu, as staff prepared meals based on the likes and dislikes of the service users who were staying at the time (with often three different meals provided). Good practice was noted, as staff were expected to eat with service users. We confirmed the menu diary kept in the kitchen was a suitable record of meals provided (service users names could be added against the meals provided if more detail was needed) and enabled staff to plan a varied and balanced menu. (As noted, it was unnecessary to duplicate this information in individual service user files, unless there were specific dietary concerns). There was also no need to routinely record breakfast and supper menus. 13a Green Lane DS0000035964.V366368.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 good. This judgement has been made using available evidence including a visit to this service. Personal care was provided in a respectful and individual manner and to a good standard. Service users’ health was put at risk by medication practices. EVIDENCE: Due to their complex and specialised needs most service users were unable to tell us what it was like to stay at the home. However, relationships between staff and service users seemed warm, friendly, caring and respectful. We observed service users clearly enjoying the company of staff and responding to them by either smiling or making positive gestures or comments. The feedback we received from relatives was very positive about the care provided. One relative said service users were “treated with respect, compassion & care”. Another said the home “looks after my son very well. He looks forward to going”. A third parent said “[my son] is happy going there”. 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 15 At the last inspection, we had been concerned the risks associated with the use of third party bed rails were not being properly considered. The home had addressed this, organising an occupational therapist assessment and had gone on to replace the third party bed rails with two new rise and fall beds with integrated bed rails. At this inspection, a parent praised how the home recently responded to an issue regarding her son’s complex moving and handling needs. She had been invited to the home to observe staff moving her son and to demonstrate possible alternatives/improvements. An assessment from an external moving and handling assessor had also been arranged. The service user’s moving and handling guidance was due to be updated following these visits. With regard to medicines, families completed an information sheet prior to each visit, detailing any current medicines. When a major discrepancy arose, staff had sought clarification from the service user’s GP. However, in the case of a minor issue, clarification had been sought from the family. We advised, whilst families needed to be consulted, formal verification of a service user’s medicines should always be sought from the prescribing doctor. There was a clear audit trail of medicines entering the home, being administered and leaving the home. Details were appropriately recorded on handwritten medicine administration record sheets (MARs). However, these were not being checked and countersigned (on admission and discharge). Also, the MARs was not designed for frequent respite stays (with a potential for error as it was difficult to track information). We also discussed Wigan Social Service’s guidance that required a daily stock check of every medicine. Both the inspector and the pharmacy inspector (who has been consulted about this practice) felt this was unnecessary and a waste of staff time. Medicines were stored safely in a metal cupboard in the staff bedroom. Controlled medicines were however, being incorrectly held in a separate metal tin box. All care homes must now store controlled drugs in a controlled drugs cupboard. The present cupboard may meet the legal requirements (as specified in the Misuse of Drugs (Safe Custody) Regulations 1973). The manager needed to formally confirm this with the supplier. With regard to the particular controlled drug held, we advised whilst it must be stored in a controlled drugs cupboard, it did not need to be recorded in a controlled drugs register, although this was good practice. We discussed the storage of medicines when the service users stay left for a day centre before returning to the family home later in the day. Unused medicines were put in service user’s luggage and we were told day centres were aware of the need to keep these bags locked away. At the last inspection, we had recommended staff receive refresher training in medication. Some staff had completed this. However, discussion with staff at this inspection, indicated medication practices again needed reviewing. We discussed how medicines were actually administered. On occasion, they were 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 16 being ‘dispensed’ all at the same time and then taken downstairs together to be given to service users. We advised this practice was unsafe as there was a high potential for error. We advised medicines must be administered on an individual basis only. We also discussed how staff carried out a stock check of medicines. As most medicines had been dispensed into ordinary containers rather than sealed blister packs, whenever they were counted (which was currently on a daily basis), staff tipped them out onto the desk and counted them with hands. We advised this was unhygienic and must stop. The home did have a tablet counter (a metal counting triangle) but some staff did not know it was there and also did not know how to use it. 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 17 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. Arrangements were in place for protecting service users from abuse or harm and for taking concerns seriously. Safeguarding training would strengthen this system. EVIDENCE: Information about how to complain was in the home’s brochure. Whilst notices were kept to minimum (to promote a more homely atmosphere), a copy of the easy read, pictorial complaints procedure should be displayed (e.g. in a domestic-style, service users’ notice board in the hallway or on the back of bedroom doors). Families knew how to raise any concerns they might have. We discussed a minor complaint regarding laundry made to us by a relative. The manager was aware of occasional difficulties and was about to introduce changes (families rather than staff were to complete the clothes inventory and clothes were to be washed, when necessary, in individual net laundry bags). With regard to abuse awareness, at the last inspection staff had been due to attend safeguarding training. Although one had since done so, the rest of the staff team were on a waiting list. 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 18 Money kept on behalf of service users was stored safely and securely, with appropriate records kept. Details were also kept in the admission and discharge record book. We advised such duplication was unnecessary. 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided an attractive, comfortable and safe place to stay, meeting the specialist needs of service users. EVIDENCE: 13a Green Lane was comfortable, bright and welcoming. There was a very good standard of décor and furnishings, which were domestic and ordinary in style. Wigan Social Services were responsible for the internal décor and furnishing, whilst Progress Care Housing Association who owned the building, were responsible for maintaining the external structure and internal plumbing, heating and electrics. 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 20 Although the kitchen was not designed for wheelchair users, there was a range of adaptations in the home. These included lowered light switches, level access at the front of the home and into the garden at the rear (there was no lift) and two adapted ground floor bathrooms (with domestic tiles to create a warm and ‘un-clinical’ appearance). The two ground floor bedrooms had lowered wash hand basins, ceiling track hoists floor and rise and fall beds. Two first floor bedrooms had double beds. Discreet door alarms were fitted to all bedroom doors to alert staff when a bedroom door was opened. There was no office. Staff had a sleep-in room on the first floor, where medicines were stored. There was a large, lockable walk in cupboard on the ground floor used to store service users’ files. The garden was divided (by wooden fencing) into two areas. The side garden was accessed by staff only and used for hanging out washing and disposal of continence pads. The back garden was accessed from the lounge/dining room and was for the use of service users. Garden furniture was currently being used to block access to a side path. We advised the home requested the housing association to install a wooden gate (which would better meet the needs of service users and allow garden furniture to be used). Since the last inspection, a new dining table and chairs had been provided and the housing association had fitted new kitchen flooring and cupboards. The covers on the settee and chairs in the quiet lounge were looking worn and ‘tired’. The manager was aware of this and looking for suitable replacement covers. We found the home very clean and tidy, and it smelt fresh. Care staff were responsible for all cleaning and housework. Liquid soap and paper towels were provided in communal bathrooms and in the kitchen. 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefited from a rigorously recruited, well trained, well supported and knowledgeable staff team. EVIDENCE: On the day of the inspection enough staff were on duty to meet the needs of service users. There was a small staff team - eight day and three night staff. Shift patterns and staffing levels reflected the needs and activities of service users. As service users were out during weekdays, the home was not staffed from 10am to 3pm, Monday to Friday, but was staffed all day at weekends. A minimum of two staff were on duty. This would rise to four depending on the service users staying (due to their complex needs, some service users required 1 to 1 support). There was a minimum of two staff at night – a day carer slept in, whilst a night carer worked a ‘waking night’ (occasionally two waking night staff were on duty, depending on the needs of the service users). The manager was based 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 22 in a separate building (approximately 20 minutes away by car). An on call service was provided from 5pm weekdays and at weekends. We discussed how staff shared information, as they arrived to an empty building (with no handover). Staff said they shared informally information with each other, monthly team meetings were also held and a communication book was also used. Good practice was noted, as readers of this were referred to individual files for personal and confidential information about service users. Service users benefited from a stable staff team, which changed very little. There were no formal vacancies, although one night carer was currently seconded to another service (since March 2008). Her shifts were being covered from within the team, although the manager was aware of the need to monitor this situation. Bank staff were used to cover other shifts. Formal individual supervisions and annual appraisals were held. Good practice was noted, as in addition to visiting the home on a daily basis, the manager regularly worked shifts alongside care staff (to provide direct support and to monitor care practices). These hours were being recorded on the rota. With regard to training, six of the staff team of eleven had completed their NVQ level 2 award and the remaining five staff were currently undertaking it. One staff member had completed their NVQ level 3 award. Individual staff training files were not kept at the home and were consequently unavailable. Shortly after the inspection, the manager confirmed staff had undertaken annual moving and handling refresher training in the last year. Some staff had also undertaken medicine awareness, challenging behaviour, safe working and fire safety courses. With regard to the latter, the local fire safety officer had recently advised (at minimum) staff must either participate in an annual formal fire drill or attend a formal refresher course. We advised the manager to ensure compliance with this guidance was documented in individual staff training files. All staff also attended two full training days each year that related to the support needs of specific service users (this included basic first aid and life support, manual handling, nutrition, epilepsy and supporting people who are fed artificially (via a PEG system)). The manager was aware of the need to ensure all staff attended at least 5 paid training days pro rata per year. Staff recruitment records were held centrally at Wigan Social Services’ head office. A sample of these was looked at during a visit by two of our inspectors in June 2007. Information seen included a completed application with full employment history, two written references, health information, contracts and criminal record checks. These details had been gathered prior to new staff commencing their employment, ensuring service users were protected. We advised the manager she no longer needed to keep copies of staff recruitment records. 13a Green Lane DS0000035964.V366368.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. Day to day management benefited staff and service users. Gaps in quality monitoring and lack of adherence to reporting procedures put this at risk. EVIDENCE: The Registered Manager, Jennifer Mills, had been in post for nine years. Mrs Mills has an NVQ level 4 in management, holds the Registered Managers Award (NVQ level 4) and has 19 years experience within the learning disability field. Care staff felt well supported by Mrs Mills, who continued to undertake training to update her knowledge and skills. We discussed the need to be clear about her roles and responsibilities as Registered Manager under the Care Standards Act 2000 (e.g. with regard to notifying us of serious incidents). 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 24 Shortly after the inspection, we were informed Mrs Mills would be taking on additional management duties, with temporary responsibility for a second, additional short break service. With regard to how the home monitored the quality of its service, at the last inspection we had advised the need for surveys to be developed. With regard to collecting formal feedback from service users, this was to be gained during the home’s internal six monthly reviews. However, as already identified, these were not always taking place. With regard to relatives, new surveys had been developed and were due to be sent out shortly. We advised surveys should also be developed for use with professional stakeholders (e.g. day centres, community health professionals, transport). The results from these should be collated and published, with action plans developed. Wigan Social Services also has to monitor the home by senior managers carrying out unannounced quality monitoring visits each month. At the last inspection we had been concerned these were not being done regularly. At this inspection we found six of the required twelve visits had been missed in 2007. Four of the required six visits to date for 2008 had been carried out. With regard to safe working practices, first floor windows had restricted opening, radiators were covered and the manager confirmed thermostatic mixer valves were fitted to all hot water outlets. We received formal confirmation in the home’s AQAA that all safety and maintenance checks were up to date. The manager also confirmed the maintenance of the fire alarm system was up to date and a formal fire drill had recently been carried out (with details kept about the overall response and who had taken part). 13a Green Lane DS0000035964.V366368.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 2 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 YA9 Regulation 12 (1)(b) 12(4) 14 (2) Requirement To ensure the safety of service users and staff, risk assessments must include information about physical aggression (with specific guidance about how to reduce or manage any risk). To ensure the safety of service users and staff, all serious incidents of physical aggression (or any event that adversely affects the wellbeing or safety of any service user or staff member) must be reported to CSCI without delay. To minimise the risk of error and ensure safe, hygienic practice, procedures for both administering and counting medicines must be reviewed. To ensure controlled drugs are stored safely, they must be kept in a controlled drugs cupboard. Written confirmation must be obtained (with a copy forwarded to us), to show the medicines cupboard meets the legal requirements of a controlled 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 27 Timescale for action 31/08/08 2 YA9 37 (1)(c)(e) (2) 31/08/08 3 YA20 13 (2) 31/08/08 drugs cupboard. 4 YA39 26 (2) (c), To promote quality and good (3), (4), practice, unannounced (5) (a) monitoring visits must be made to the home each month. (Previous requirement from last inspection). 31/08/08 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 YA1 Good Practice Recommendations To ensure prospective service users and their families get the information they need, the Service User’s Guide should be updated to include the identified additions and changes. As part of the current revision of the Statement of Purpose, the identified additions are needed to ensure adequate information about the service is provided. The Service User’s Guide and the Statement of Purpose should be kept under review and revised where appropriate. CSCI and service users (or their families) should be notified of any revision within 28 days of any change. 2 YA5 The service needs to confirm service users and/or their families receive clear, personalised fee information. To support service users and their families to budget, the frequency of issuing invoices should be reviewed. 3 YA6 To ensure feedback is received from service uses and their care notes are relevant and accurate, the home should carry out its internal six monthly review. To make care files easier to use, old information should be archived. 4 YA6 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 28 To enable issues to be tracked and monitored over time, the date a service user started to use the service should be recorded. To confirm identity, all care files should contain a photograph of the service user. 5 YA20 To ensure service users receive the correct medication, all booking in and discharge entries (on MARs) should be checked and countersigned. To improve efficiency and effectiveness, the daily routine stock check of medicines should stop. 6 YA23 To promote the protection of service users, as planned, all staff should receive formal safeguarding training. 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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 13a Green Lane DS0000035964.V366368.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!