Care Home: 2 Cowley Way

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What the care home does well The residents enjoy their life at Cowley Way. `I m very happy living here` was how a resident put it.Residents have their own individual interests and the staff do their utmost to support them in their chosen lifestyle. Relatives spoke highly of the staff at the home. `X is very well cared for. He loves Cowley Way and always wants to go back after a visit. They are very kind and caring.` `Very caring and understanding. No concerns about x when we go away as I know he is well cared for, and x is very happy in the care home.` `x now does a lot more things in the house than he used to, i.e. going to his room to listen to music, and helping to clean his room. He attends armchair aerobics and rambling and enjoys doing all of the things that the home has offered him.` `We could not ask for better care and support. x is very happy there.` `There is good insight into x`s needs.` `They help and support X to meet his full potential.` `It was beyond my hope that we would find a place for x that suits him so perfectly. He is very happy and content and holds the carers in high regard. He has also progressed well becoming more independent and assertive, and gets on well with his `housemates.` Residents are empowered to make decisions. They are involved in aspects of running the home such as meal planning. They have some involvement in staff recruitment. Regular meetings are held with them when their views about the running of the home are sought. The men living at Cowley Way know how to complain if they are not happy about something. `I have a pictorial complaints procedure. I have made a complaint.` Another said `I would speak to the manager if I wasn`t happy.` The residents` health care needs are being met. Residents attend routine health checks and are supported to keep any health care appointments. 1 resident has taken part in an `expert patient` programme. The staff are all very aware of each person`s needs. There is a low turnover of staff. There is enough staff on duty at each shift to meet the needs of the residents. It was very clear from speaking to the staff that they are committed and want the residents to have the best possible lifestyle.2 Cowley Way,DS0000008213.V358264.R01.S.docVersion 5.2Page 7Staff are very well trained. The manager is well qualified and liked by both residents and the staff. Staff said that she has an open and approachable management style. What has improved since the last inspection? There were no improvements required at the last inspection in February 2007. What the care home could do better: This is an excellent service and no requirements have been made at this inspection. 3 recommendations have been made. These are seen as good practice developments to further improve the service and the home is asked to consider these: To further develop the individual resident`s person centred plans in other formats than symbols, such as the inclusion of photographs, to enable them to be more readily understood by the individual. The manager had also identified that the residents could more easily understand pictures and photographs. Find ways of involving residents even further in the recruitment and selection of staff, to support them in gaining greater control over their lives. Keep the staffing levels under regular review, particularly to support evening activities. CARE HOME ADULTS 18-65 2 Cowley Way, Bentilee Stoke-on-trent Staffordshire ST2 0RB Lead Inspector Irene Wilkes Key Unannounced Inspection 21st January 2008 09:30 2 Cowley Way, DS0000008213.V358264.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 2 Cowley Way, DS0000008213.V358264.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. 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 2 Cowley Way, Address Bentilee Stoke-on-trent Staffordshire ST2 0RB 01782 596047 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) cowleyway@choicesha Choices Housing Association Limited Mrs Andrea Abbotts Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (2) of places 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd February 2007 Brief Description of the Service: 2 Cowley Way is a detached purpose built domestic style property that is registered to provide 24-hour care for up to eight adults with a learning disability. The home provides accommodation on two floors, each currently for four gentlemen. The ground floor of the home comprises a lounge/diner, domestic kitchen, laundry, four single bedrooms each with a wash-basin, a shower room/WC and an assisted bathroom/WC. It has been designed throughout this level to meet the needs of people with a physical disability. The first floor is a replica of the ground floor, save for the absence of a laundry and there is a standard bathroom/WC. Grab rails have been fitted throughout the home as required. There is a small private garden and off road parking. The design and location of the building fit in well with the other surrounding properties. The home is on the edge of a large housing estate and there is good access to shops and a local supermarket. There is easy access to the main bus route to Hanley and Longton town centres. The costs of the service were not available at this inspection. Individual costs were determined when the gentlemen moved into the home a number of years ago, via a contract with the health authority. 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This was a key unannounced inspection. This means that all of the national minimum standards that the commission for social care inspection consider most greatly affect the health, safety and welfare of the residents were looked at. The inspection took place over a six hour period. 7 of the 8 residents were at home at different times in the day and they were each spoken with. A longer conversation was held with 2 of the residents to gain their views about living at the home. 7 resident survey forms were returned, and 3 survey forms were received from relatives. 10 staff submitted completed survey forms. The manager was on duty throughout the day and provided support to access the home’s records. She also liaised in an open and transparent way to assist in the inspection process. The deputy manager and other care staff also assisted at various times. The inspection included examination of 3 residents’ files and a sample of health and safety documentation. The arrangements for administering medication were looked at. The menu plans for the home were seen. The recruitment procedures were looked at as well as the training provided to the staff. This included inspection of 2 staff files. A tour of the home was undertaken. The commission requires each provider to submit an AQAA (Annual Quality Assurance Assessment). This is a legal requirement in which the home has to undertake its own review of the quality of its services and its strengths and weaknesses. Some statistical information is also required. The AQAA was returned by the manager at Cowley Way in a timely way and was also used to inform the inspection process. What the service does well: The residents enjoy their life at Cowley Way. ‘I m very happy living here’ was how a resident put it. 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 6 Residents have their own individual interests and the staff do their utmost to support them in their chosen lifestyle. Relatives spoke highly of the staff at the home. ‘X is very well cared for. He loves Cowley Way and always wants to go back after a visit. They are very kind and caring.’ ‘Very caring and understanding. No concerns about x when we go away as I know he is well cared for, and x is very happy in the care home.’ ‘x now does a lot more things in the house than he used to, i.e. going to his room to listen to music, and helping to clean his room. He attends armchair aerobics and rambling and enjoys doing all of the things that the home has offered him.’ ‘We could not ask for better care and support. x is very happy there.’ ‘There is good insight into x’s needs.’ ‘They help and support X to meet his full potential.’ ‘It was beyond my hope that we would find a place for x that suits him so perfectly. He is very happy and content and holds the carers in high regard. He has also progressed well becoming more independent and assertive, and gets on well with his ‘housemates.’ Residents are empowered to make decisions. They are involved in aspects of running the home such as meal planning. They have some involvement in staff recruitment. Regular meetings are held with them when their views about the running of the home are sought. The men living at Cowley Way know how to complain if they are not happy about something. ‘I have a pictorial complaints procedure. I have made a complaint.’ Another said ‘I would speak to the manager if I wasn’t happy.’ The residents’ health care needs are being met. Residents attend routine health checks and are supported to keep any health care appointments. 1 resident has taken part in an ‘expert patient’ programme. The staff are all very aware of each person’s needs. There is a low turnover of staff. There is enough staff on duty at each shift to meet the needs of the residents. It was very clear from speaking to the staff that they are committed and want the residents to have the best possible lifestyle. 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 7 Staff are very well trained. The manager is well qualified and liked by both residents and the staff. Staff said that she has an open and approachable management style. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 2 Cowley Way, DS0000008213.V358264.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 2 Cowley Way, DS0000008213.V358264.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): Standard 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. EVIDENCE: The Statement of Purpose and Service User Guide gave up to date information about the home. The information in the Service User Guide was in large print and contained pictorial symbols to better communicate the information. There were plans in place to further improve the guide to provide it in other formats. All of the 8 gentlemen have lived at the home for a number of years now. Each had received an assessment of their needs initially and regular reviews are undertaken and recorded of their current needs and how these are to be met. The manager said that the organisation had recently piloted new initial assessment documentation. She also talked through the process that would be followed for any prospective resident should there become a vacancy in the home. This would include all good practice requirements including a number of visits, seeking the prospective residents views and those of current residents, and a trial stay before a permanent admission was made. 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 10 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 11 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): Standards 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are involved in decisions about their lives, and play an active role in planning the care and support they receive. EVIDENCE: The care plans were personalised to show the individual support required by each individual and how these needs would be met. In each case there was evidence that the plan had been developed with the resident and there was evidence of recent review. The plans gave good information about how each person’s individual needs would be met and there was clear reference to individual strengths and personal preferences. In addition to written information documented for staff, each person had an individual Personal Planning Book, the content of which is discussed with the resident on a regular basis by their personal carer, to confirm their current 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 12 wishes and their plans for the future. The plans also had a range of risk assessments and a Health Action Plan. There was evidence that each person had been involved in discussions about risk, with creative ways to overcome any limitations agreed within a risk management framework. There was evidence that such risk assessments are regularly reviewed. Each resident also had a Life Book setting out their history and achievements, and a memory box to stimulate discussion about past activities. There were plans in place to further develop the planning books in a more individual format using other communication tools such as photographs that the manager considered that the residents at the home could more readily understand. There had been some moves to this already with one gentleman having a DVD ‘My life in pictures’ developed with him. This further development is recommended as good practice. There was evidence of an advocate being involved in discussions with 2 residents and of them making their own decisions to cease this involvement when they felt ready. The service works in a multi-disciplinary way to address residents’ needs. There was evidence of psychological services and the social work team being called upon to help meet individual needs. Residents have regular meetings with their key workers. House meetings are also held to remind the residents of important issues such as fire safety and their right to complain, and also to allow some discussion about how the home should be run. Residents have some involvement in staff selection by the chosen worker visiting the home and the staff team assessing residents’ reactions to them. 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 13 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): Standards 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use services are able to make choices about their lifestyle, and are supported to develop their life skills. EVIDENCE: Residents are encouraged to undertake activities linked to their individual interests. On the morning of the visit 2 residents were out at a college course on horticulture; on their return one of them had lunch and then went out to do his paid job with Choices, where he assists the handyman. Another resident was out at day services. There was evidence in each file seen that the residents are supported to join in activities of their choosing, such as going to a country and western club, swimming sessions, attendance at a social club, visits to the theatre. There was good involvement in the local community with regular food shopping trips and visits to the local shop for everyday items, as well as visits to the pub and for meals out. 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 14 The daily routines of the home are flexible to meet the individual needs and wishes of the residents. Each had a comprehensive 24 hour support plan that evidenced choice in time of getting up, going to bed etc. This was witnessed at the inspection. Responsibilities for housekeeping tasks were seen as part of the promotion of independent living skills and were appropriately recorded in the person centred plans. Residents talked about their interests and said that they did the things that they enjoy. ‘I go to the country and western club with x. Its good.’ ‘I’ve been to my gardening class this morning. We learned about seeds and how much they cost. I like going there. I went to cookery classes before and liked that as well.’ In returned survey forms relatives also spoke enthusiastically about how the home supports people to access a range of meaningful activities. ‘x now does a lot more things in the house than he used to, i.e. going to his room to listen to music, and helping to clean his room. He attends armchair aerobics and rambling and enjoys doing all of the things that the home has offered him.’ ‘They help and support X to meet his full potential.’ ‘It was beyond my hope that we would find a place for x that suits him so perfectly. He is very happy and content and holds the carers in high regard. He has also progressed well becoming more independent and assertive, and gets on well with his ‘housemates.’ Residents who choose have keys to their front door and bedroom doors. They are supported to open their own mail. They keep their own diary detailing their activities and when they have appointments for structured activities. There was evidence to show the involvement of relatives and there was good support provided by the home to enable residents to visit the family home. Records also showed how visits to other friends were supported and encouraged. A dietician visits the home on annual basis to provide advice. Within this framework the residents are involved in meal planning on a monthly basis and decide at house meetings on their chosen main meals for the coming period. Residents choose their own breakfast and choice of snack meals at lunchtime. Throughout the visit residents were seen either making or assisting to make regular drinks. Lunch was a relaxed affair with residents helping to prepare their meal and sitting with staff and chatting about what they had done that morning or what they had plans to do later. 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 15 Menu plans were seen and they provided a balanced diet with a range of choices. 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 16 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): Standards 18, 19 and 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The gentlemen all had very comprehensive individual plans indicating how they wished to be supported. The plans promoted independence throughout. Residents were all dressed very individually according to their own tastes. Residents said that they please themselves when they get up and go to bed, and a variety of times were recorded in the daily record sheets. There were appropriate aids and equipment in place for those who need some support with mobility. There is an assisted bath. 1 resident has a wheelchair, a walking stick and a perching chair. These have been supplied with the involvement of the appropriate professionals and reflect the changing needs of the resident. 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 17 There are 8 gentlemen living in the home but there are only 2 male staff. Residents who were able to express a view did not mind having a predominantly female staff team, although this is possibly an area for development of the service. All the men have a personal carer who spends time with them and discusses their person centred plan and their aspirations. Working records and partnerships with advocates in some instances, and with relatives ensure consistency and continuity of support for each person. The needs of some of the residents were discussed with a staff member. She had a good understanding of each person’s needs and was able to describe in detail how their diverse needs would be met. Observation during the inspection evidenced discreet support being provided and the privacy and dignity of residents being promoted. Each gentleman has an ‘OK Health Check’ that is completed annually with them, that provides opportunity to assess their holistic health needs. All have their own health action plan that is set out in an easy to follow style. Personal carers discuss the health action plan with the resident on a regular basis. There was clear evidence that all health appointments are kept in a timely way. There was also good evidence of professional advice being sought for areas of individual concern, and the advice given being followed through by the staff. All of the men annually attend a well man clinic. One resident has been supported to attend a health run ‘expert patient’ programme in relation to his individual health needs. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. None of the residents currently self medicate. Medication records are fully completed, contain required entries, and are signed by appropriate staff. All aspects of medication from storage through to administration were satisfactory. Regular management checks are recorded and these monitor compliance. All staff had received external training in medication and there was evidence of more recent in-house training in medication. Staff competency is checked every 6 months and they also complete a written questionnaire on a 6 monthly basis. The manager said that the organisation now requires all relevant staff to do a module in medication as part of their NVQ (National Vocational Qualification). 2 Cowley Way, DS0000008213.V358264.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): Standards 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. EVIDENCE: Residents responded either yes or always to the question ‘Do you know how to make a complaint?’ In response to surveys they all said that they knew who to speak to if they were not happy. I resident said in a survey: ‘I have a pictorial complaints procedure. I have made a complaint.’ Another said ‘I would speak to the manager if I wasn’t happy.’ All relatives who responded to surveys said that they knew how to make a complaint, and also that the service had responded appropriately if they had raised any concerns. Residents and relatives are satisfied with the service: ‘Very caring and understanding. No concerns about x when we go away as I know he is well cared for, and x is very happy in the care home.’ 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 19 During the visit residents were asked about their satisfaction with the service and all responded positively. Residents were able to point out the complaints procedure that is displayed in the entrance hall in the home. This is in pictorial format. The manager also confirmed that discussions about how to make a complaint are held with the residents during their monthly house meetings. The manager is reminded that the current procedure needs updating with the commission’s revised contact details. There have been 6 complaints made within the last 12 months, all concerning disagreements between the gentlemen, and each had been handled appropriately. There have been no complains made to the commission about the service. The manager discussed that the organisation has revised policies and procedures linked to safeguarding that are being incorporated into the training for staff. Staff that were questioned answered confidently and appropriately to the scenarios about abusive practice that were set. The policy about whistleblowing was understood. Staff considered that the organisation would be very supportive if the issue ever arose where a concern needed to be raised. The training records showed that all of the staff had received training about abuse. This was confirmed by staff. There is an issue at the home where psychological and emotional abuse is been perpetrated by 1 resident to another. Professional support and advocates for both gentlemen have been in place and a social worker is now involved, but the evidence suggests that the situation should have been resolved in a more timely way. The service is asked to consider this comment in relation to any future issues. The situation needs resolution with some urgency. All staff at the home receive training in the management of potential and actual violence and aggression. Sample records were checked for incidents of restraint plus other records where less restrictive de-escalation techniques had been used. The records sampled were detailed and there were appropriate responses to the associated incidents. There were detailed pro-active and reactive intervention plans in place for each resident where appropriate, that showed good practice. The residents had been involved in the drawing up of these plans and the care manager of the local authority was also aware. A discussion was held with the manager about the Mental Capacity Act. All managers and deputies are to receive training within the month on the Act. 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 20 2 Cowley Way, DS0000008213.V358264.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): Standards 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well maintained and comfortable environment, which encourages independence. EVIDENCE: Cowley Way is a very pleasant home situated on a housing estate and not distinguishable as a care home from the other neighbouring properties. It is well situated with ready access to a local supermarket and on a bus route. Externally there is a small car park at the side of the property. At the rear is a garden area with a more recent addition of a patio. A tour of the home was made and all areas were appropriate to the needs of the residents living there, including assisted bathing facilities for those 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 22 residents who require some support with mobility. There are handrails fitted throughout the downstairs corridors. The home is divided into 2 self contained units, each with 4 single bedrooms. The upstairs unit is only accessible by stairs and this is therefore reserved for those residents who are totally mobile The toilet and bathrooms have privacy locks. There is a large open plan lounge/dining area on each floor, with the kitchen leading off this. Individual bedrooms seen were personalised to reflect individual tastes. They are not en–suite but each has hand washing facilities. They are each of a good size. It was noted in a bedroom for a resident who is hard of hearing that a RNID (Royal National Institute for the Deaf) smoke alarm was in place. There were no obvious hazards anywhere in the home, and it was bright, cheery and well maintained. Residents said that they like their home. The building meets the requirements of the fire service. There are also procedures within the organisation for the planned maintenance and renewal of the premises and the linked budget setting procedures, and for repairs reporting procedures. Within the last 12 months there have been new carpets fitted to 2 residents’ bedrooms, the first floor lounge, stairs and landing, and new floors have been fitted to both kitchens and the shower room. The home presented as very clean at the inspection. The downstairs laundry is well sited away from the kitchen area with appropriate wall and floor finishes. Protective clothing was seen in use. The home has cleaning standards in place that are monitored regularly. All staff are trained in food hygiene and infection control. Good practice was observed of staff dealing with laundry. 2 Cowley Way, DS0000008213.V358264.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): Standards 32, 33, 34 and 35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, and to support the smooth running of the service. EVIDENCE: Staff attitudes to residents were observed throughout the visit. They were at all times communicating with residents in a respectful way. They were interested in what residents had to say, and in discussion were motivated and committed. Staff had the skills and experience to undertake their work. There are low levels of staff turnover and low sickness levels. Discussion with a member of staff evidenced a good understanding of the residents needs. All new employees undertake the Learning Disability Qualification (LDQ), before moving on to National Vocational Qualifications (NVQ). The opportunity to undertake the LDQ is being extended to include longer standing employees. 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 24 75 of support workers currently have NVQ level 2 or above. A further 12.5 are due to commence this training. The staffing rotas identified that there are always at least 2 staff on duty until 9pm, when there is 1 staff on duty who does a ‘sleep in.’ The rota also evidenced that additional staff are on duty linked to the activities that residents are taking part in. This was reflected in staffing levels on the day of the inspection. Staff responses were 3 (always) and 7 (usually) to the question: ‘Are there enough staff to meet people’s individual needs?’ The home is asked to keep evening staffing levels under regular review, particularly as a 9pm shift changeover is rather early. There was evidence of regular staff meetings being held when the needs of all of the residents are discussed. Relatives were very satisfied with the support being provided by the staff team. ‘X is very well cared for. He loves Cowley Way and always wants to go back after a visit. They are very kind and caring.’ ‘Very caring and understanding. No concerns about x when we go away as I know he is well cared for, and x is very happy in the care home.’ ‘We could not ask for better care and support. x is very happy there.’ ‘There is good insight into x’s needs.’ ‘They help and support X to meet his full potential.’ Recruitment records showed all the appropriate information in place, with CRB (Criminal Records Bureau) checks and 2 references being obtained before the staff commenced working in the home. There have been no new staff since the last inspection. Staff surveys evidenced a full recruitment procedure in place, in line with equal opportunities and employment legislation. A discussion was held with the manager about the involvment of residents in the interview process. She said that although residents still do not take part in the formal interview process, a prospective employee now has a second interview at the home so that residents can pass their opinion about them. The further development of the engagement of residents in the recruitment process would be a good practice development. Choices organisation has a history of excellent staff training. They have Investors in People award. 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 25 There is a 6 month induction programme for all new staff, with ongoing reviews and end of period assessment. The AQAA also states that there are high standards of mandatory training for all staff including First Aid, Food Hygiene, Fire Safety, Personal Safety, Lone Working, MAPA, Origins of Behaviour and Behaviour Management, Moving and Handling, Safeguarding Adults. All staff are trained to the above level by the end of the 6 month induction period. Good practice training is in place including Sexuality, Values and Attitudes, What is a Learning Disability, origins of behaviour and behaviour management, record keeping, continence workshop. The training matrix for the forthcoming year was looked at during the inspection. This showed that all of the above courses, where due for staff, had been organised. The staff files inspected contained a full record of mandatory and other training. The Deputy Manager has completed NVQ 4 in care. Staff surveys showed satisfaction with the level of training on offer. In response to ‘‘What does the service do well?’ comments were: ‘Care for clients. Train staff.’ ‘I feel Choices provide good training.’ ‘Care for clients well. Staff are well trained.’ ‘Training to support service users needs. Regular support meetings for staff.’ ‘Provides excellent training. Uses in-house trainers therefore familiar with the clients and settings.’ There were no negative comments. 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 26 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): Standards 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect. The service is led by a qualified, competent manager. EVIDENCE: The manager has been in charge of the home for some 10 years. She is a qualified nurse in learning disabilities and has in recent years also completed her Diploma in Nursing. She has kept up to date with all aspects of training to enable her to lead the service. She is a trainer in moving and handling and in the management of actual and potential aggression. In the next 12 months she is to undertake a management and leadership programme that is being provided by Choices organisation. Training about the Mental Capacity Act has 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 27 not yet been undertaken, but the manager said that this is scheduled within weeks. This training is essential for the manager of the service and is considered a little late in being provided. The manager runs the home in an effective way. She focusses on meeting the diverse needs of the residents and strives to provide care in a person centred way. All of the records held in the home are in good order with evidence of regular monitoring to ensure that the health, safety and wefare of the residents is ensured. Reference is made earlier in the report about the need to involve other professionals at an earlier stage where difficult issues present, and this should be borne in mind for future reference. The manager ensures that all staff are trained in all mandatory areas and encourages staff to undertake further good practice training. Regular meetings are held with staff to discuss the further development of the service. Staff say that the manager is supportive and leads by example. The AQAA was completed in a timely way. The manager identified how the service had progressed in the last 12 months and recognised where improvements could be made, with plans in place to address these areas. The data set was accuratley completed. The manager is aware of the need to develop an annual improvement plan for the home. The home is supported by a strong organisation with knowledgeable line management. A senior manager visits the service on a regular, unannounced basis to assess the progress of the service. There is an overarching business plan for the organisation and the manager feeds into this the plans for the service for the next 12 months. There are also bi-monthly meetings of home managers and senior management when issues that impact on service delivery are discussed and resolved. The service was developed following the closure of the local long stay hospital for people with learning disabilities. The cost of the service for each resident was set at this time, with inflation updates only since then. Choices is a registered charity and provides good value for money. The manager and staff consult with the residents about the service via individual reviews. Each has a personal carer who spends time with them to get regular feedback about their individual support. There are regular house meetings where issues that impact on care is discussed. There was evidence that there has been some contact with relatives via an annual survey. All responses were positive. Another annual survey is now due. This could be extended to a survey for residents to gather more formalised evidence about their satisfaction with the service. Other stakeholders who have 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 28 interaction with the home and the residents could also be asked to give their views about the service. The organisation overall is an Investor in People. All the working practices in the home are safe, evidenced by good monitoring and record keeping systems. The home has a comprehensive range of policies and procedures to promote and protect residents’ and employees’ health and safety. Staff are trained, understand, and consistently follow these. There is full and clearly written recording of all safety checks, and there are limited accidents. The commission is appropriately notified of any untoward incidents. All staff are trained in health and safety, evidenced in training records. 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 29 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 3 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 4 33 3 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 3 X 3 X X 3 X 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 30 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations Further develop the individual resident’s person centred plans in other formats, such as the inclusion of photographs, to enable them to be more readily understood by the individual. Find ways of involving residents more in the recruitment and selection of staff, to support them in gaining greater control over their lives. Keep the staffing levels under regular review, to ensure that there are always sufficient staff on duty to enable residents to undertake activities of their choice at the appropriate time. (In this instance this refers to evening activities) YA34 2 3 YA33 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 77 Paradise Circus Queensway Birmingham B1 2DT 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 2 Cowley Way, DS0000008213.V358264.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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