Care Home: 198 Rossendale Road

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What the care home does well Before people are admitted to the home their needs are assessed. This is to make sure offering a placement is right for individuals and that the home has sufficient staff expertise, enough staff employed, and right equipment necessary to provide support. Admission to the home is planned giving people enough time to settle in and find out how their support would be provided. They were also given a written contract so they knew what was expected from agreeing to stay there. There was evidence that the service did understand the right of the resident to take control over their own life and make their own decisions and choices. Person centred care planning meant people using the service were cared for as they wanted and needed. Staff worked to a key worker system, which supported individuals in having personalised care. Staff also knew how to help people take reasonable risks safely in everyday living. Written comments from individuals considered staff listened and acted on what they said. They were able to do what they wanted within their limitations throughout the day, evenings and at weekends. People had specialist support such as speech, language, and physiotherapy. Staff worked with specialists to support individuals to improve their well being in these areas. Records kept showed people`s healthcare needs were monitored, and staff worked as a team with other medical professionals for their benefit.People living in the home were given information such as the homes policies and procedures that helped them understand for example, what to do in the event of a fire, how to keep safe and the homes ruling on smoking, alcohol and drugs. Individuals who sent written comments for this inspection gave a positive view of opportunities to take part in activities. Those people with limited recall had pictorial evidence to support their recall of events and activities they had enjoyed. The home was managed in a manner to avoid any institutional routines. Observations of staff at work showed they treated individuals with respect. `Residents meetings` were very good in how they enabled individuals to have their say. Relatives and friends were made welcome to the home, and individuals were supported to develop and maintain family relationships. For example, `Dates to remember` were recorded, such as relative birthdays. Meals provided were to individual choice, preference and need. Sensitive support was given to individuals who required support with feeding. People knew how to raise any issue of concern they may have or were unhappy. Comments included, `If I have any problems I mention them to staff who do their best to resolve them.` `I would tell a member of staff`. Complaints received at the home were dealt with efficiently. Staff were clear of their responsibility and obligation to follow correct procedures in reporting poor practice and had been trained in `protecting vulnerable adults`. The overall provision of specialist equipment and facilities in the home was of a high standard. Most people using wheelchairs could access their bedrooms via automatic door openers. New facilities provided included a gym, a therapy room, and a television room with sky TV installed. The home provided a clean, well-maintained, comfortable environment for people living there. The atmosphere in the home between staff and people living in the home was very good. Records showed people living in the home were cared for by competent, qualified, and trained staff that was supervised in their work. The skill mix of staff meant that at all times a senior support worker was on duty. The new manager is qualified, experienced, and is registered with the Commission. Information received at the Commission stated the home was run to respect individuals` rights and ensure their best interests are safe guarded. Quality assurance had been carried out. Comments from this included ``The meals are good`, `laid back, homely and friendly atmosphere, staff make you feel welcome`, and `staff can`t do enough for you`. Staff considered `This198 Rossendale RoadDS0000060125.V362675.R01.S.docVersion 5.2Page 7service makes sure that staff work together as a team and that service users needs are met.` Information required for this inspection was received when we asked them. Improvements required at the last inspection had been made. What has improved since the last inspection? Assessments had sufficient detail to help plan care to meet individual needs. People had a care plan to make sure their needs are met in the right way. Care plans were reviewed so that peoples changing needs are identified and changes made to the level of support they need. The type of care planning used allowed individuals the opportunity to agree short-term goals that would support them to reach their desired long-term outcome. People who have poor memory recall are supported to recall life experiences with pictorial evidence, helping them to know they live their life to the full of their potential. To maintain individuals confidentiality, envelopes are provided for the pre paid post cards, to alert senior management of Voyage regarding sensitive issues, such as not being happy, or problems they may have. Staff have been trained in adult protection procedures to help them recognise abuse and keep people using the service safe. Induction records for staff were completed and staff had been trained in first aid, food hygiene, moving and handling, infection control, and other essential topics to protect themselves and the people they care for. People were consulted individually as part of quality assurance and at group meetings how improvements could be made both in the home and in their personal care to make sure their life experience is better. CARE HOME ADULTS 18-65 198 Rossendale Road 198 Rossendale Road Burnley Lancashire BB11 5DE Lead Inspector Mrs Marie Dickinson Key Unannounced Inspection 19 & 20th June 2008 10:00 th 198 Rossendale Road DS0000060125.V362675.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 198 Rossendale Road DS0000060125.V362675.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. 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 198 Rossendale Road Address 198 Rossendale Road Burnley Lancashire BB11 5DE 01282 425668 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) Voyagecare.com Voyage Ltd Mr Philip Howard White Care Home 13 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (13), Physical disability (13), Sensory of places impairment (13) 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The staffing levels in the home must at all times consist of a minimum of 1 staff member to 2 service users during the day, on average, and 1 waking watch and 1 sleep in staff member at night. With no more than 10 people sharing a staff group. The home is registered for a maximum of 13 service users to include: Up to 13 service users in the category of MD (Mental Disorder, excluding disability or dementia) Up to 13 service users in the category of PD (Physical Disability) Up to 13 service users in the category of SI (Sensory Impairment) Date of last inspection 19th April 2007 2. Brief Description of the Service: 198 Rossendale Road is registered with the Commission for Social Care Inspection to provide personal care and accommodation for thirteen people. The home is operated specifically as a specialist provision for adults who have an acquired brain injury. Voyage Limited, which is part of Paragon Healthcare Group, owns and operates the home. Accommodation offered is in thirteen large specially adapted single occupancy bedrooms. All rooms are en suite, and some include a small kitchen and dining area. Specialist equipment required to support service users in daily living is provided in all rooms. There are several spacious lounges and dining and kitchen facilities. Specialist modern bathing facilities are also provided. The upper floor can be accessed by a passenger lift. Staff support is based on individual needs of service users living at the home. Information about the service is available from the home. Cost of stay at the home is individually assessed due to service users complex needs requirements and may range from £1250 upwards. 198 Rossendale Road DS0000060125.V362675.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. A key unannounced inspection was conducted in respect of 198 Rossendale Road on the 19th & 20th June 2008. The inspection involved getting information from an Annual Quality Assurance Assessment completed by the manager, staff records, care records and policies and procedures. It also involved talking to residents, staff on duty, the manager, and an inspection of the premises. Areas that needed to improve from the previous inspection were looked at for progress made. The home was assessed against the National Minimum Standards for Younger Adults. What the service does well: Before people are admitted to the home their needs are assessed. This is to make sure offering a placement is right for individuals and that the home has sufficient staff expertise, enough staff employed, and right equipment necessary to provide support. Admission to the home is planned giving people enough time to settle in and find out how their support would be provided. They were also given a written contract so they knew what was expected from agreeing to stay there. There was evidence that the service did understand the right of the resident to take control over their own life and make their own decisions and choices. Person centred care planning meant people using the service were cared for as they wanted and needed. Staff worked to a key worker system, which supported individuals in having personalised care. Staff also knew how to help people take reasonable risks safely in everyday living. Written comments from individuals considered staff listened and acted on what they said. They were able to do what they wanted within their limitations throughout the day, evenings and at weekends. People had specialist support such as speech, language, and physiotherapy. Staff worked with specialists to support individuals to improve their well being in these areas. Records kept showed people’s healthcare needs were monitored, and staff worked as a team with other medical professionals for their benefit. 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 6 People living in the home were given information such as the homes policies and procedures that helped them understand for example, what to do in the event of a fire, how to keep safe and the homes ruling on smoking, alcohol and drugs. Individuals who sent written comments for this inspection gave a positive view of opportunities to take part in activities. Those people with limited recall had pictorial evidence to support their recall of events and activities they had enjoyed. The home was managed in a manner to avoid any institutional routines. Observations of staff at work showed they treated individuals with respect. ‘Residents meetings’ were very good in how they enabled individuals to have their say. Relatives and friends were made welcome to the home, and individuals were supported to develop and maintain family relationships. For example, ‘Dates to remember’ were recorded, such as relative birthdays. Meals provided were to individual choice, preference and need. Sensitive support was given to individuals who required support with feeding. People knew how to raise any issue of concern they may have or were unhappy. Comments included, ‘If I have any problems I mention them to staff who do their best to resolve them.’ ‘I would tell a member of staff’. Complaints received at the home were dealt with efficiently. Staff were clear of their responsibility and obligation to follow correct procedures in reporting poor practice and had been trained in ‘protecting vulnerable adults’. The overall provision of specialist equipment and facilities in the home was of a high standard. Most people using wheelchairs could access their bedrooms via automatic door openers. New facilities provided included a gym, a therapy room, and a television room with sky TV installed. The home provided a clean, well-maintained, comfortable environment for people living there. The atmosphere in the home between staff and people living in the home was very good. Records showed people living in the home were cared for by competent, qualified, and trained staff that was supervised in their work. The skill mix of staff meant that at all times a senior support worker was on duty. The new manager is qualified, experienced, and is registered with the Commission. Information received at the Commission stated the home was run to respect individuals’ rights and ensure their best interests are safe guarded. Quality assurance had been carried out. Comments from this included ‘‘The meals are good’, ‘laid back, homely and friendly atmosphere, staff make you feel welcome’, and ‘staff can’t do enough for you’. Staff considered ‘This 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 7 service makes sure that staff work together as a team and that service users needs are met.’ Information required for this inspection was received when we asked them. Improvements required at the last inspection had been made. What has improved since the last inspection? What they could do better: Individuals should be given the opportunity to hold a copy of their care plan for reference. This will help them to know what staff will do for them to support them achieve their aims. When reviewing care, people living in the home should have the opportunity to invite significant people who are involved in their lives to support them to make informed decisions about their future care and lives. 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 8 Care should be taken to make sure medication is signed only when given. This will keep records in proper order and monitor if people are taking their medication. Sufficient staff must be employed to make sure peoples needs are fully met. This includes personal care and cleaning. Recruitment of staff must be completed properly by making sure two references are received prior to staff working in the home. 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. 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 9 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 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 10 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): 2,4,5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The admission process ensured people’s needs were properly assessed. This helped everyone involved, decide if the facilities and services could meet needs and preferences of individuals and support a decision to offer a placement in the home. Contracts issued, protected individuals legal rights. EVIDENCE: The home offers permanent placements to adults with ‘Acquired Brain Injury (ABI). Since the last inspection four people had been admitted to the home. Records showed people had an assessment of their needs. This was carried out by health and social care professionals involved in supporting people to access this specialist care. Assessment of need is quite complex, however at the initial stage of assessment an overview of past history, present needs and support required in residential care was recorded. This assessment included for example, communication, physical and mental health, and social care needs, and known associated risks people experience in every day living. As part of the admission process, before a place is offered a member of the 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 11 management team visits the person requiring a placement and independently assesses their needs. This helps to decide if the facilities of the home and the staff expertise can support the decision to offer a placement in the home. The specialist service of the home does limit peoples choice. Social workers involvement with family often influences placement, as people may not be fully aware of their needs because of their brain damage. Written comments from residents living in the home included ‘We came for a visit and then I was moved here.’ Information received at the Commission indicated ‘Unannounced visits are encouraged, enabling a realistic view of how the home is run’. Most admissions are planned admissions. People can spend time in the home, look at the facilities, meet with staff and other people who live there. A short stay of three months is offered followed by a review when everyone involved meets together to discuss if living at the home is satisfactory and the care given is suitable. Voyage agrees a contract with placing authorities regarding individual care packages requested. People living in the home were given a contract with the terms and conditions of residence from Voyage Ltd. These contracts were detailed, individualised, and signed by both parties. 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 12 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 a visit to this service. Care planning supported people to take control of their lives, and make good decisions and choices in achieving this. EVIDENCE: There was evidence that the service did understand the right of the resident to take control over their own life and make their own decisions and choices. Since the last inspection care planning had been reviewed and new formats used, taking a more person centred approach to care provided. Care planning linked to assessment of need and referred to people in the context of ‘I’. For example, money management, ‘When I go out to buy things, I have my own wallet with some of my money in. I need support to make sure I don’t buy things I don’t need’ and ‘you will have to remind me I live at 198 Rossendale road’. 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 13 Management complete care plans with residents and guidance written for staff in providing support was clear. Short term and long term goals were listed. Short term goal setting improved the possibility of being able to demonstrate measurable achievements for residents. Residents did not have a copy of their care plan. The key worker system allowed staff to work on a one to one basis with residents. There was no evidence however to show a full key worker role in being involved in the care planning process, such as during reviews, and written comments from staff indicated the care plans were not always available to read. However those staff on duty during inspection was knowledgeable about the needs of the people living in the home, and had specific key worker duties. Other specialist assessments, for example speech and language, physical disability and psychiatric, helped make sure all these special areas of need was considered and people had access to the correct support within their agreed plan of care. Care plans were reviewed regularly, kept up to date and focused on how individuals will develop their skills and considers their future aspirations. However individuals should be given the opportunity to involve their representatives if agreed, for example work placement representative or college tutor, and other specialists. Each care plan viewed included risk assessments that were reviewed regularly. Acceptable risk taking had been considered. Risk management was clear for staff with a protocol to follow in managing identified risk safely. Where limitations were necessary these were agreed with the individual involved and recorded. House rules such, as drinking and drugs not being allowed is made clear and agreed prior to an individual being admitted. Decision-making was said to be encouraged and individuals were given time to consider choices they made. They had the benefit of one to one discussions with staff, and residents meetings. Records show the quality of these meetings in addressing individual needs, and review of the service was very good. There are procedures in place to ensure that people using the service are informed of their rights to confidentiality. Written into individual records is the right for ‘confidentiality’ and ‘sharing of information’, informing them, of circumstances when staff may have to share personal information. 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Individuals had a degree of independence and opportunity to take part in chosen activities, access community resources and keep in touch with families and friends. The meals provided were sufficient in providing for their tastes, choices, and diet. EVIDENCE: There was evidence the service has a strong commitment to enabling people who use services to develop their skills, including social, emotional, communication, and independent living skills. Records of people living in the home show how they are supported to identify their goals, and work to achieve them. This is done through care planning, and key workers have an active role in supporting individuals accomplish this. 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 15 Written information from the service indicated they did well by providing individual timetables that were flexible. This meant individuals had access to a wide range of leisure activities according to interests, and capabilities. Care planning showed how individual routine was organised such as, when individuals cleaned their room, went to different venues, and went out shopping. A person centred daily living plan was recorded for people indicating what time they liked to get up, what they had for breakfast, activities they would do in the morning, afternoon and evening and what time they would like to go to bed and the support they needed to accomplish this. For example ‘I have my own menu, which staff helps me plan on Sunday nights. I like to eat fresh foods etc. In the evening I like to go for a social drink. I go to bed between 22 and 24 hours’. The service user guide states the aim of the home is to make sure service users are given maximum choice on matters relating to their daily lives including opportunities to take reasonable risks. Also included is a recognition of individual ethnic, religious and social needs that are characteristic of service users and care to be provided appropriate to these. Individuals who sent written comments for this inspection gave a positive view of opportunities to take part in activities. They did what they wanted to do and what they were comfortable with. One person said, ‘Just that I’d like to go out for day trips, different places at random more often.’ Residents meetings showed how this was supported with an action plan written up. Transport was provided to accommodate wheelchair users. Another person said ‘I am quite content sitting in my chair and wish to remain here’. Individuals had pictorial evidence to support their recall of events and activities they had enjoyed. The home was definitely managed in a manner to avoid any institutional routines. Observations of staff at work showed they treated individuals with respect. Residents preferred name was recorded on their plan. Residents had ‘house rules’ they had agreed to follow as a condition of residency. Written into individual contracts was the provision of a short holiday of choice. All bedrooms had locks on their doors and individuals managed their own keys. To support whhelchair users access their bedrooms independently, automatic door openers had been fitted. These enabled them to be less reliant from staff support in managing their own personal needs. Relatives and friends were made welcome to the home, and individuals were supported to develop and maintain family relationships. ‘Dates to remember’ were recorded, such as relative birthdays. Individuals, who have a limited capacity to socialise independently, and form friendships outside the home, should be supported to do so, for example joining a club for people who have similar needs and to access information and specialist guidance about issues such as intimate relationships. 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 16 Menus showed service users were offered variety and choice. The manager said menus were changed every four weeks. Part of learning life skills for individuals involved nutritional needs. Records showed how budgeting skills, shopping, preparation, and cooking food were managed. Care staff were observed as being sensitive to the needs of those individuals who find it difficult to eat and required assistance with feeding. Meals were unhurried and times flexible. 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 17 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 a visit to this service. Individual preferred routines, likes, and dislikes allowed people to enjoy personal care in a non institutional and dignified way. Healthcare was monitored which supported individuals to maintain their general well being. EVIDENCE: Records showed people using the service were registered with a General Practitioner and that appointments had been made and kept. Appointments had also been kept with care coordinators, consultants, and community health services as required. Healthcare was recorded and written with short term and long term planning, such as dental visits and routine medical checkups. Personal care was given according to need identified and individuals wishes. Care planning was person centred and written in the ‘I’ context. For example, ‘I can say if I am not well. I need support in making healthcare appointments. I need advice and support on specific areas of maintaining a healthy lifestyle’. 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 18 Long term goals are ‘I will know when healthcare appointments are required. I will attend appointments by self. I will be able to identify appropriate healthy lifestyles’. Risk assessments were completed to support this. Guidelines were written for staff on how support was to be given, such as ‘prompting’ and ‘assisting’. Individuals were encouraged to be independent and take responsibility for their personal care needs as much as possible. Written comments from individuals indicated staff listened and acted on what they said and were available when needed. Staff worked with individuals on specialist programmes such as speech and language and physiotherapy. A physiotherapy room had been created with equipment for individuals to use, as the lack of this facility had been a concern from the previous physiotherapist. The home currently does not have an employed physiotherapist. Every person in the home had technical aids they needed to assist in personal care such as overhead tracking from bedroom to en suite facilities and staff were trained in their use. Staff working in the home was trained in Acquired brain Injury. This was given as part of induction training and the manager said he was looking to provide more training in this area. The home operated with a monitored dosage system for medication. Records of individuals medication was kept, and included information about the medication, and what staff should be aware of if someone was not well. Those staff responsible for administering medication had been trained. Individuals are given support to self medicate following an assessment to make sure this would be safe. Medication storage was secure. Records showed more care was needed to ensure only medication given was signed for. 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 19 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 a visit to this service. The complaints procedure provided guidance on raising complaints that supported individuals to raise any issue of concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues. This meant individuals rights, safety, and welfare was promoted. EVIDENCE: The complaints procedure had been reviewed and made available in large type, was user friendly and had relevant contact details on. It was displayed in the home and a copy had been given to all individuals. Individuals spoken to during inspection said they had no complaints. Those who sent written comments for this inspection said they knew who to speak to if they were not happy such as ‘Jo or Phil, managers’. And ‘If I have any problems I mention them to staff who do their best to resolve them.’ ‘I would tell a member of staff’. The cards available for use to send direct to Voyage in the event of individuals being unhappy, have envelopes provided to ensure confidentiality. People could use advocacy services if required. Complaints received at the home were dealt with efficiently. 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 20 Policies and procedures for safeguarding adults were available for staff reference. Staff had been trained in Protection Of Vulnerable Adults as part of induction training and their terms and conditions of employment includes protection issues such as gifts and confidentiality. Staff on duty were clear of their responsibility and obligation to follow correct procedures in reporting under POVA should this be necessary. Records showed one referral made had been managed appropriately. 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home provided a clean, well-maintained, comfortable environment for people living there. EVIDENCE: Since the last inspection some improvements had been made to the environment. These included redecoration of the lounge and some bedrooms. Communal rooms had been utilised better such as a gym room, a therapy room, and television room with sky TV installed. The grounds of the home were in a state of some maintenance and development with borders planted with seasonal bedding plants. Some work was required to bring out a more desirable area. The planters with bedding plants improved the appearance of the entrance. However more work was required in keeping pathways even and free from weeds. The rear garden area 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 22 is quite private and had been developed for the benefit of the residents who held and enjoyed barbeques and were able to sit outside safely. The home has been tastefully furnished. The dining table had been replaced and one provided to accommodate wheelchair users. The overall provision of specialist equipment for physical disability was to a high standard. Bedrooms were equipped with individual aids and wheelchair users could access their bedroom without the assistance of staff. This impacted on them very much and the manager said more of these openers were to be installed. Some rooms were equipped with cooking facilities necessary to support people learn independent living skills. Individuals were involved in choosing colour schemes when rooms were redecorated. The overall standard of hygiene in the home was very good, however communal areas still require domestic input during the day to support care staff. This is because individual needs regarding spillages of food and drink are relatively high, and toilets require constant monitoring. Laundry facilities were very good and individuals had access to, and used the washing machines and driers as part of re learning daily living skills. Staff were equipped with protective clothing such as disposable gloves and aprons. 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 23 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 a visit to this service. The skill mix of staff, and training provided promoted an effective, consistent, and person centred approach to individual care. Recruitment practices were generally good in protecting people who lived in the home. EVIDENCE: Since the last inspection there were a number of new staff employed. The manager said the current level of staffing was linked to the needs of the people living in the home. Individuals who sent written comments for this inspection considered staff treated them well. Individuals consulted during inspection spoke favourably about the staff. They were not however directly involved in the interview and selection of new staff. Staff recruitment procedures had improved. The home operated an equal opportunity policy. Application forms had been completed, references applied for, and Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) register check had been applied for, prior to employment. Employees 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 24 were given job description and a contract of employment. More care was required to make sure files are kept up to date as one staff file had no references available, and records showed in other incidents only one reference recorded as received. In the event of any verbal reference being accepted this must be recorded properly. Interview notes were not always taken. A training agreement was signed. Induction given to new staff had been completed and those staff who sent written comments to the Commission considered they were recruited properly, given induction and training right for the work they do. Records showed staff training covered all essential mandatory training such as moving and handling. Part of the management role is to organise training for staff. Topics included mandatory training, acquired brain injury, abuse, National Vocational Qualification (NVQ) in care training and other work related topics. Staff had the opportunity and time for computer-based training, and other training was accessed at external venues. The home had achieved above 50 of staff trained in NVQ level two and above. The numbers of staff on duty supported individuals with planned programmes for daily living. Assessments of individuals showed in one instant night care required the attendence of two carers every hour. This was not adequately provided as the home employed one staff waking watch and one staff to sleep in. In addition to this the dependency of individuals living in the home was relatively high. There was no domestic support in the home. Night staff complete main domestic duties in communal areas, time permitting. Staff supported people to keep their bedrooms clean as part of lifeskills. Staff on duty said they enjoyed their work and the training provided. The skill mix of staff meant that at all times senior support workers were on duty. Staff worked to a key worker system and this involved helping people with personalised goals such as independent living skills, and one to one support. They were given supervision and had good opportunities for working alongside other professionals, such as physiotherapist and speech and language therapist. This helped them to continue to support individuals with planned programmes for their care. 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40,41,42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home was managed and run in the best interests of the people living there. EVIDENCE: Since the last inspection a new manager had been appointed and registered at the Commission. He has 32 years experience in variety of care settings and holds RMNS status and has qualifications in managing health and social services. Since the last inspection the area manager of Voyage had also changed. The manager was able to demonstrate changes into service delivery, the environment, and staffing issues as required in last inspection. A budget was provided for operational purposes and improvements had been dealt with 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 26 as requested. The general budget covered every aspect required to manage the home efficiently. A deputy supported the manager, and an area manager from Voyage had visited monthly as required to monitor management performance. Supervision was arranged and the regulation 26 management visits were unannounced. Information received at the Commission stated the conduct and management of the home ensures it is run effectively, respecting individuals’ rights and ensure best interests are safe guarded. This was achieved by enabling service users to have their say and their views underpinned monthly monitoring and annual reviews. Quality assurance had been carried out. The results of the most recent one were available. This included, choice of food, personal support/care, daily living, your home, management of your support service and information. The outcome was very positive. Individuals commented, ‘more activities during the day, and night staff are helpful.’ ‘The meals are good’, ‘laid back, homely and friendly atmosphere, staff make you feel welcome’, and ‘staff can’t do enough for you’. Staff meetings were held and attended by all staff groups. Minutes of these meetings were available. Expectations of standards had been discussed, and the importance of having a well motivated team. Issues for management input were also relayed and action required dealing with this. Staff were given appraisals of their work. They had commented on their achievements. ‘I know how to work as a team’, and ‘I learned a lot of food safety, personal hygiene hazards, recognising abuse’. ‘I learned a lot about moving people, including hoists and how to work with vulnerable adults.’ Staff who provided written comments regarding the home said, ‘This service makes sure that staff work together as a team and that service users needs are met.’ Voyage had also been reviewing policies and procedures in the home and those reviewed were available for staff. Confidential records were locked away, and sharing of information with relevant people had been agreed with each person living at the home. Record keeping and filing systems had improved as notes and information required for reference was mostly accessible. A random check of individuals money held at the home for safekeeping showed good monitoring in place to protect people requiring this service. Health, safety, and welfare of people living and working in the home is a shared responsibility between Voyage and the manager. Weekly checks on the environment safety were carried out for example water temperature checks, fire alarms and emergency lighting. Information received at the Commission showed regular maintenance of services such as heating and electrical equipment had been carried out. Training in health and safety was also provided for staff. The commission has been kept informed of all significant events as and when they occured. 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 27 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 3 5 3 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 3 3 3 X 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 28 YES 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 YA33 Regulation 18(1)(a) Requirement Sufficient staff must be employed to make sure peoples needs are fully met. Previous timescale of 31/05/07 not met. Recruitment of staff must be completed properly by making sure two references are received prior to staff working in the home. Previous timescale of 17/08/06, 31/05/07 in part met. Timescale for action 30/08/08 2 YA34 19 Schedule 2 31/07/08 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA8 Good Practice Recommendations Individuals should be given the opportunity to hold a copy of their care plan for reference. It is recommended people living in the home have the opportunity to actively involve significant people in supporting them to make decisions about their lives, when reviewing their care needs. People with limited physical ability and communication skills should be actively supported to pursue making relationships with people not living in the home. More care should be taken to sign for medication only when given. 3 YA15 4 YA20 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.northwest@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 198 Rossendale Road DS0000060125.V362675.R01.S.doc Version 5.2 Page 31 - 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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