Care Home: 1a Daubeney Gate

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What the care home does well An admission procedure is in place to ensure that prospective service users are assessed prior to admission. Detailed service user plans are in place, which ensures service users personal and health care needs are identified and met. Service users are supported to make choices and be involved in the decision making process. Records are maintained to support this. Some aspects of equality and diversity are identified in care plans and met. Up to date individual risk assessments are in place.Service users are supported to pursue leisure interests and access community resources. Service users are supported to maintain contact with family and friends. Service users` privacy is promoted. Varied balanced meals are provided. Systems are in place to deal with complaints and to ensure the protection of service users from abuse. The home is clean, well maintained and homely The home has a well established staff team who work well together to benefit service users. They are suitably inducted, trained, supervised and supported in their roles. Staff appear confident in their roles and are committed to the aims and objectives of the home. Safe recruitment practices are in place and service users are being supported to become involved in the recruitment process. Effective monitoring systems are in place to ensure the home works to the required standard. Systems are in place to ensure health and safety is monitored and to promote service users safety and well being. The manager is proactive in addressing issues within the home, meeting requirements and is committed to developing the service further to benefit service users. What has improved since the last inspection? Staff have attended safeguarding of vulnerable adults training, fire safety, manual handling and makaton training. Bedroom furniture has been replaced. Staff have worked hard in developing some documentation in a service user format and aim to further develop this to include health plans and other relevant documentation. What the care home could do better: Service users plans must clearly outline action to be taken to deal with a medical emergency. Challenging behaviour training must be made available for more staff to ensure that there is sufficient staff on duty at all times with this training. Staffing levels must be reviewed to ensure that sufficient staff are available to support individuals with their choice of activity in particular in the evenings and at weekends. Service users risk assessments should be filed securely. Some areas of practice in relation to daily routines around access to the home, managing post and use of service users preferred form of address should be reviewed to further promote service users rights. Some improvements are required to medication practices to further safeguard service users. All complaints should include evidence of being addressed. The organisation should consider how stakeholders are to be consulted as part of the annual quality audit. CARE HOME ADULTS 18-65 Daubeney Gate (1a) Shenley Church End Milton Keynes Bucks MK5 6EH Lead Inspector Maureen Richards Key Unannounced Inspection 7th February 2008 09:45 Daubeney Gate (1a) DS0000015054.V359054.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 Daubeney Gate (1a) DS0000015054.V359054.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. Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Daubeney Gate (1a) Address Shenley Church End Milton Keynes Bucks MK5 6EH 01908 505245 01908 505246 mail@macintyre-care.org www.macintyrecharity.org MacIntyre Care 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) Mrs Sally Charrington Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th February 2007 Brief Description of the Service: 1A Daubeney Gate is a purpose built care home for adults with learning disabilities located in a residential part of Shenley Church End, Milton Keynes. The home is close to local shops and is a short drive from the city centre and public transport networks are close to the home. The property is owned and staffed by MacIntyre Care Services. Each service user has a single bedroom and these are decorated and arranged to reflect different interests and tastes. The home has a good size lounge with patio doors leading to a large enclosed garden. There is a separate dining room next to the kitchen and laundry and staff sleeping in and office facilities on the ground floor. The home has ample toilet and bathroom facilities. Service users have a cat called Jessie. Service users of both sexes were being cared for at the time of the inspection, with a range of personal care needs. Fees range from £46931.04 to £53567.29 per annum. Daubeney Gate (1a) DS0000015054.V359054.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 people who use this service experience good quality outcomes. This unannounced key inspection was conducted over the course of a day and covered all of the key National Minimum Standards for younger adults. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion. Comment cards were distributed to service users, relatives, visiting professionals and staff prior to the inspection. Replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of examination of some of the homes required records, observation of practice, an informal discussion with service users, discussions with the registered manager, staff on duty and a tour of the premises. Feedback on the inspection findings and areas needing improvement was given to the manager during the inspection. Four requirements from the last inspection have been complied with and this inspection has resulted in a further three requirements. The manager, staff and service users are thanked for their co-operation and hospitality during this unannounced visit. What the service does well: An admission procedure is in place to ensure that prospective service users are assessed prior to admission. Detailed service user plans are in place, which ensures service users personal and health care needs are identified and met. Service users are supported to make choices and be involved in the decision making process. Records are maintained to support this. Some aspects of equality and diversity are identified in care plans and met. Up to date individual risk assessments are in place. Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 6 Service users are supported to pursue leisure interests and access community resources. Service users are supported to maintain contact with family and friends. Service users’ privacy is promoted. Varied balanced meals are provided. Systems are in place to deal with complaints and to ensure the protection of service users from abuse. The home is clean, well maintained and homely The home has a well established staff team who work well together to benefit service users. They are suitably inducted, trained, supervised and supported in their roles. Staff appear confident in their roles and are committed to the aims and objectives of the home. Safe recruitment practices are in place and service users are being supported to become involved in the recruitment process. Effective monitoring systems are in place to ensure the home works to the required standard. Systems are in place to ensure health and safety is monitored and to promote service users safety and well being. The manager is proactive in addressing issues within the home, meeting requirements and is committed to developing the service further to benefit service users. What has improved since the last inspection? Staff have attended safeguarding of vulnerable adults training, fire safety, manual handling and makaton training. Bedroom furniture has been replaced. Staff have worked hard in developing some documentation in a service user format and aim to further develop this to include health plans and other relevant documentation. Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 7 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. Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. The home has an admission procedure in place, which should ensure that the home is able to meet individuals assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no new admissions to the home in the past twelve months. The Annual Quality Assurance Assessment document outlines that the home would refer to the “MacIntyre Getting to Know You Assessment” which fully involves the individual, family and relevant professionals to ensure the best service is found to support the individual. Transition planning is in place to ensure that any move is well planned with an adequate time period allowed for the move. Feedback from relatives indicates that they usually get enough information about the home to help make decisions. They feel the home usually meets their relatives’ needs. Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. Service user plans are in place which outlines service users needs, support with choices and management of risks, which promote continuity of care and service users well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three service user plans were viewed. The service user plans included personal details information, with reference to date of birth, religious needs and next of kin details and birthday lists. The plan was developed in a pictorial format which was accessible to service users. Service user plans included detailed support plans in relation to the management of behaviours, life skills and personal care. The support plans included a date of implementation and review and a statement to indicate that the plan was put together with staff working with individuals on a day to day basis. Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 11 Service user plans included specific communication guidelines and an outline of individuals’ morning, afternoon and evening routines. Each service user has a separate daily log book which was informative and related to the care provided as outlined in the care plan. The service user plans seen included an up to date monthly summaries. Service users are supported to make choices. The care plans seen outlines how individuals make choices in relation to aspects of their daily lives. Service user plans outlines the support required with managing finances. Monthly service user meetings are held and minutes seen indicate discussion on a wide range of topics that affect individuals. None of the service users have advocacy involvement but the home is looking for a befriender for one service user. Service user risk assessments are in place in relation to personal care, managing behaviours, specific tasks and the risk of financial abuse. The risk assessments were up to date and showed evidence of review. The service users risk assessments are filed on a shelf in the office. The manager should consider filing service users risk assessments separately or in service users plans in a secure place to ensure confidentiality. Feedback from relatives’ feels that the home always give the support and care that is expected and agreed. Service users confirmed in feedback that they make decisions about what they do each day, they can do what they want during the day, evenings and at weekends. Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. Service users are supported to have an active lifestyle, which reflects their interests, provides them with nourishing meals and allows them to have contact with family, friends and the community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of service users have a weekly programme of day centre activities, with all of the service users having a one to one social activity once a week. Pictorial records are maintained of social activities with photographs displayed around the home, which evidences that services users are supported to access community resources, including a local nightclub. The home has it owns transport and the Annual Quality Assurance document outlines that service users also access public transport with staff support. Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 13 The home has one service user with specific care needs which impacts on the other service users being able to pursue leisure interests in the evenings and at weekends. This will be referred to under the staffing section of the report. Service users have the opportunity to go on annual holidays including holidays abroad. At the time of the inspection staff were discussing with service users their choice of holidays for this forthcoming year. Service users are supported to maintain family contact and service user plans evidence this with specific support plans in place to support service users to maintain family contact to visit or keep in touch by telephone. All of the service user plans seen includes relatives birthday and special occasions lists and the service users are supported to send cards and gifts as appropriate. The Annual Quality Assurance document confirms that families are invited to social occasions and service user reviews and they are sent copies of all Corporate Publications. Feedback from relatives confirm that staff always support the service user to keep in touch. Service users plans indicate that service users are supported to develop skills and promote independence. Staff enter service users’ bedrooms with their permission and this was evidenced during the inspection. Service users do not have a key to the front door or their bedroom and a risk assessment should be put in place to support this decision. Staff confirmed that service users are given their own post and staff support them to deal with it. Service user plans should make reference to this. Service user plans do not make reference to service users preferred form of address and during the inspection it was noted that service users’ names were abbreviated or they were referred to as “Mr”. This should be addressed. Service users can choose when to be alone or in company and service users have access to all areas of the home and grounds. Service users have three meals a day with snacks and drinks available as required as was evidenced during the inspection. Service users are involved in menu planning on a weekly basis with pictorial aids provided to assist in decisions and choices. The menu seen indicate that service users have a varied and balanced diet with alternatives provided for individuals as required. Service users are supported to be involved in the shopping, preparation and cooking of meals if they wish and dependant on their abilities. Individual service user plans outlines the support required at mealtimes. Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 14 The Annual Quality Assurance document outlines that staff have access to a healthy lifestyle manual and the support of a health specialist if required. Service user plans seen indicate referral to a dietician where required. Feedback from relatives indicates that they feel the staff always support the service user to live the life they choose and support different needs. Feedback from service users confirm that staff always treats them well and they always listen to and act on what they say. Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. The health and personal care needs of people living at the home are met however some improvements are required to medication practices to further safeguard service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service user plans outline support required with personal care, including support with personal hygiene. Times for getting up are dependant on day time activities that service users are scheduled to attend. Times for going to bed, bath and meals are flexible. Service user plans outline support required with making choices in relation to clothes and appearance. Service users have access to specialist services if required. Staff act as key workers to individuals and service user plans outline service users preferred routines. Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 16 Service user plans include a health action plan which outlines health professionals involved and their contact details. It outlines the support required in meeting health care needs and a record of health care appointments and outcome of visits. This record evidences that service users have access to a wide range of health care professionals including specialists and outpatients. Service users are weighed monthly and changes in weight are acted on. The Annual Quality Assurance document indicates that the aim is to develop the health action plans in a user friendly format which will make it more meaningful and accessible to service users. None of the service users self medicate. Service user plans outline the support required by individuals in taking their prescribed medication. Staff are responsible for the administration of medication. The medication is stored in a locked cabinet situated in the office. Homely remedies are stored in a separate locked cabinet in the office. The home uses a monitored dosage system and have printed medication records with a photograph of each service user in front of their medication administration record. The printed administration record was of small print with the instructions for medication administration over lapping on to the next box. This should be addressed with the supplying pharmacy. Records of drug administration were found to be in reasonable order with one gap evident alongside prescribed dose times. The home has a record of receipt of medication into the home with two staff now checking and signing medication received, in response to a recent drug error. The home has a record of disposal of medication back to the pharmacy. At the time of this inspection the home had no controlled drugs being administered. The home uses homely remedies and have received a letter from the General Practitioner that confirms that staff can administer paracetamol, cold remedies and all homely remedies as per pack instructions. This is not specific to individuals. The manager should devise a list of all homely remedies being used and discuss further with the prescribing General Practitioner to confirm that the homely remedies on the list does not interact with service users prescribed medication. The home has service users on prescribed rectal stesolid. The organisation has contacted the local Primary Care Trust to access training for staff on the administration of rectal stesolid but the Primary Care Trust have been unable to provide this. Guidelines are in place on individual’s files signed by the Psychiatrist to confirm that if staff are confident they can administer rectal stesolid. Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 17 A letter is on file from Milton Keynes NHS to confirm that the epilepsy awareness training and the administration of rectal Diazepam medication training is adequate to provide staff with the knowledge and skills to administer medication. However this does not confirm individual staff’s competency to administer this invasive medication. The manager confirmed that to date service users have not gone into status epilepsy and it has not been required for them to use this medication. In the event of this happening staff would call the paramedics. In the absence of staff being appropriately assessed and deemed competent to administer rectal stesolid service users’ plans must be updated to outline the required action by staff in dealing with status epilepsy and all staff made aware of this. The Annual Quality Assurance document confirms that all staff have completed the distance learning medication course with Milton Keynes College. New staff are inducted into medication procedures and assessed prior to administering medication on their own. A completed medication assessment was seen to support this. The Organisation has a medication policy in place, which the manager confirmed was currently under review. Feedback from relatives confirms that they are usually kept up to date with important issues affecting their relative. Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. Systems are in place to ensure service users views are listened to and acted on and to safeguard service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Annual Quality assurance document indicates that the home has had three complaints in the last twelve months. The complaints log seen supports this. One complaint logged was dealt with by the area manager and does not include an outcome. This should be included to indicate that complaints are responded to appropriately. No complaints have been received by the Commission since the previous inspection in respect of this service. Service user plans include a pictorial copy of the complaints procedure and service users are given the opportunity to raise issues of concern at monthly meetings. The Annual Quality Assurance document indicates that picture boards are available for service users to indicate how they are feeling. Feedback from relatives confirms that they know how to make a complaint and that concerns raised are acted on. Feedback from service users indicates that they know who to speak to if unhappy and that staff would support them to make a complaint. Feedback form staff confirms that they know what to do if a service user or relative raised a concern about the home. Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 19 The Annual Quality Assurance document indicates that there has been three safeguarding of vulnerable adults referrals and one investigation. Records seen support this. Staff on duty were clear of their role in reporting bad practice and abuse. A requirement was made at the previous inspection that the registered manager is required to ensure that where necessary safeguarding of vulnerable adults training is updated for all staff. The training records indicate that all staff except one has had this training and this individual is booked to go on the next safeguarding of vulnerable adults training. The home has policies in place on the management and prevention of physical and verbal aggression. Service user plans outline guidelines on the management of challenging behaviours Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. The home is clean and homely which provides a comfortable environment for service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home consists of a two storey building. One bedroom and communal areas are on the ground floor with five bedrooms, bathroom and showers on the first floor. The home has a separate sitting room and a modern kitchen with an adjacent dining room. The home has a separate laundry, one bathroom, two showers and a single toilet. Those areas where found to be clean, nicely furnished and homely. Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 21 Two of the service users’ bedrooms were viewed. The bedrooms seen were personalised with one bedroom decorated to include a sensory area. A requirement was made at the previous inspection that the registered provider is required to provide appropriate bedroom furniture to replace existing broken or inappropriate bedroom fixtures. The manager confirmed that this has done. The home has a large enclosed well maintained rear garden. The home has limited parking and plans are in place to extend the parking at the front of the house, which will not impact on the garden. Staff are responsible for the cleaning at the home and systems are in place to support this. On the day of the inspection no maintenance issues were highlighted and maintenance issues are dealt with as they arise. The home has recently received a four star rating from Milton Keynes Council Environmental Health agency and staff are keen to maintain this standard. Feedback received from service users confirms that the home is always fresh and clean. Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 Quality in this outcome area is good. Staff are appropriately trained and recruited to meet service users needs in a safe and consistent way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff were observed to be accessible to, approachable by and comfortable with service users. The Annual Quality Assurance document indicates that there are nine permanent staff. Two staff have achieved a National Vocational Qualification and a further seven staff are working towards a National Vocational Qualification. Eight staff have attended makaton, epilepsy, autism, and infection control training. All staff have attended Mental Capacity Act training with three staff having attended communication training. The Organisation has appointed a communication practise development advisor who has been working with senior carers in developing communication for service users. The seniors will be responsible for cascading their training to Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 23 staff in the homes. The impact of this training on practice will be assessed at future inspections Three staff have attended challenging behaviour training and further training in challenging behaviour is scheduled to take place this year. The manager must ensure that sufficient staff have challenging behaviour training to ensure that there is at least one staff member on each shift with this training. Staff confirmed that they have built good working relationships with other professionals. No feedback was received from professionals as part of this inspection. The home has an established staff team with low rates of turnover. Regular team meetings take place and records are maintained to support this. The rota indicates that there are two staff on each day time shift with a third staff member for part of some morning shifts. There is one sleep in staff at night with back up on call available if required. Staff were clear of the on call rota and how to contact a senior manager if required. The home has one service user who requires one to one staff ratio for trips out in local areas and two to one staff for trips further a field. This impacts on other service users being able to have activities out of the home in the evening or at weekends or to pursue activities of their choice. This must be addressed. Feedback from some staff confirm that activities can be limited due to only two staff on duty and service users cannot do their choice of activity. Eight staff recruitment files were viewed which included permanent and relief staff files. The files seen contained a photograph and a completed proforma which confirmed that two references and a criminal records bureau check had been obtained. Permanent staff files contained a copy of the application form, copy of passport, birth certificates, fitness to work declarations and residency permits where applicable. The home had confirmation of references and criminal records bureau checks for agency staff. The files were well organised with the required information easily accessible. The Annual Quality Assurance document outlines that two service users have been involved in the corporate inclusive recruitment workshops with the aim being for service users to become more actively involved in the recruitment process. The progress with this will be established at the next inspection. The manager confirmed that all new staff are inducted into the home. A completed induction record for one staff was seen which confirms this. Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 24 The home has a copy of the training programme for the year and the manager is proactive in putting staff forward for the required training. The manager has a training matrix, which identifies what training staff have had and highlights when updates are due. A requirement was made at the previous inspection that the registered manager is required to ensure that all staff receive up to date fire and manual handling training. This has been complied with the two remaining staff who require fire training are booked to go on this training in February 2008. Staff have up to date first aid and food hygiene training. Staff confirmed that they feel supported in their roles. Formal supervision takes place regularly and records are maintained to confirm this. The Annual Quality Assurance document confirms that performance reviews have taken place for all staff. Feedback from relatives confirms that care staff always have the right skills and experience to look after people properly. They commented that staff are approachable and communication is excellent. Any issues raised are investigated fully. Feedback from staff confirm that the induction covered all aspects of their job. They are given training relevant to their roles, they are kept up to date with changes in service users. They get regular support from their manager and staff work well together as a team. Daubeney Gate (1a) DS0000015054.V359054.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): 37,39,42 Quality in this outcome area is good. The home is well managed with systems in place to monitor the quality of care and promote a safe environment for safe users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager was about to complete the National Vocational Qualification level 4 and is then enrolled on the Registered Managers award training. Four requirements from the last inspection have been complied with and the manager is committed to the continued development of this service. Staff commented that they feel the home is well managed and the manager is approachable and supportive. Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 26 The Annual Quality Assurance document outlines changes they have made and areas where improvements are required. The records required for Regulation are well maintained with the information kept up to date, reviewed and accessible. Monthly monitoring visits take place and copies of Regulation 26 reports were available to support this. The Annual Quality Assurance document confirms that monthly financial checks and audits are completed. These were not viewed at this inspection. The organisation carries out an annual audit referred to as the “Big Respect” Audit. The last audit for this service was carried out in February 2007. The manager confirmed that stakeholders were consulted as part of the audit but responses were not received from all of the stakeholders contacted. A sample of health and safety records were viewed. The home carries out a series of weekly and monthly health and safety checks, including water temperature checks, fridge and freezer temperature checks and daily food temperature checks. The home has records in place to confirm that fire exits, emergency lighting, fire extinguishers checks are carried out and fire drills take place on a regular basis. Last recorded fire drill took place on the 11th November 2007.A recent fire inspection took place and all aspects of fire safety were found to be satisfactory. The home has records in place to confirm that the fire equipment, fire alarm, boiler and electrical appliances had been serviced. The home has accident and incident records in place. Generic risk assessments are in place and showed evidence of review and updating. Staff have up to date mandatory training. Daubeney Gate (1a) DS0000015054.V359054.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 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 3 x x 3 x Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 YA20 2 YA23 18 Standard Regulation 13 Requirement The manager must ensure that service user plans include clear guidelines for staff on the management of status epilepsy. The manager must ensure that sufficient staff have challenging behaviour training to ensure that there is sufficient staff on each shift with this training. . The organisation must ensure that sufficient staff are provided to allow individuals to pursue leisure activities and trips out. Timescale for action 15/03/08 30/05/08 3 YA33 18 31/03/08 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. YA9 2 3 YA16 YA16 Refer to Standard Good Practice Recommendations The manager should ensure that service users risk assessments are filed securely to promote confidentiality. A risk assessment should be put in place to support the decision for service users not to have a key to their home. Service user plans should outline support required with post. DS0000015054.V359054.R01.S.doc Version 5.2 Page 29 Daubeney Gate (1a) 4 5 6 YA16 YA20 YA20 7 YA22 Service users plans should include service users preferred form of address, The manager should contact the supplying pharmacist with a view to them providing clear medication administration records. The manager should review the homely remedies list and seek further clarification from the General Practitioner on the use of homely remedies with individuals prescribed medication. All complaints should include an outcome Daubeney Gate (1a) DS0000015054.V359054.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Daubeney Gate (1a) DS0000015054.V359054.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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