Care Home: 20 Oulton Road

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What the care home does well Observation of staff attitudes and positive relationships with people who used the service was observed. Staff continue to strive for high standards within the home and have supported people who use the service in a sensitive and supportive way. Staff receive a thorough induction to the home which is "Skills for Care" based. This involves the completion of a workbook by both the staff member and a senior member of staff. Each person using the service has a plan of care, which they have helped to develop. Some people living in the home need support to communicate with others. People are involved in a variety of leisure and work activities. Staff support people to identify what activities they want to be involved in on a daily basis. People are able to develop life skills, to complete domestic chores in the home, and take responsibility for shopping and cooking. Staff said they are committed to supporting people to achieve identified goals. People are supported to go out for meals, or to the pub, and food is prepared and cooked with the support of staff members. Staff enable and support people to keep in touch with their family and friends, either by arranging visits, and or by phone or letter. What has improved since the last inspection? What the care home could do better: The home has a rolling programme of repair and maintenance. However it is a recommendation of this report that the exterior paintwork and woodwork to the front bay windows and rear kitchen door frame is renewed and or replaced. Night staff sleep on an inflatable mattress, which is sited within the home`s lounge area. Consideration should be given in regard to people who use theservice, their use of the lounge later on in the evening, and in relation to the time that staff need to retire to bed. The conservatory, which is cold in winter, and can get very hot in summer, would benefit from some blinds, some heating, and an extractor fan. CARE HOME ADULTS 18-65 20 Oulton Road Stone Staffordshire ST15 8DZ Lead Inspector Pam Grace Key Unannounced Inspection 30th April 2008 10:30 20 Oulton Road DS0000005095.V352459.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 20 Oulton Road DS0000005095.V352459.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. 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 20 Oulton Road Address Stone Staffordshire ST15 8DZ 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) 01785 615486 RMP Care Mrs Dorothy Tarpey Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th February 2007 Brief Description of the Service: The home is a double fronted town house set in a residential street within walking distance of the town centre and it’s amenities. It is in keeping with similar properties and does not present itself as a care home. It provides care for five younger adults with a learning disability, on two floors. There is a communal lounge, dining room, and domestic kitchen, two single bedrooms, and a toilet and shower room, plus conservatory on the ground floor. The conservatory is also available in the daytime as quiet/private space for residents, or residents and their visitors. On the first floor, there is a bathroom and three single bedrooms, one having an en suite toilet. There is a courtyard area to the rear, which has access to another home owned and managed by the same providers, and to Old Road. The stated aims and objectives of the home are to provide a small comfortable home, which is staffed to meet individual service users needs, and enable development and integration into the local community. The fee chargeable for the service at 20 Oulton Road, is from £498.00 £898.00 per week. The fee information included in this report applied at the time of inspection the reader may wish to obtain more up to date information from the care service. 20 Oulton Road DS0000005095.V352459.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 stars. This means the people who use the service experience excellent quality outcomes. This visit was an unannounced key inspection and therefore covered the core standards. The inspection took place over approximately 8 hours by one inspector who used the National Minimum Standards for Younger Adults as the basis for the inspection. Prior to the inspection, the care manager completed an Annual Quality Assurance Audit (AQAA) for us. There were also questionnaires sent to people who use the service, and staff. Discussion took place with a visiting Community Psychiatric Nurse at the home. A tour of the home was undertaken. On the day of the inspection, the home was accommodating 5 people. We, the commission examined records, carried out indirect observation of people who used the service, and two staff on duty. Three care plans and three staff records were examined and observation of daily events took place. We joined the people who used the service for lunch. Medication procedures were inspected. There were no Requirements, and 5 Recommendations made as a result of this unannounced inspection. What the service does well: 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 6 Observation of staff attitudes and positive relationships with people who used the service was observed. Staff continue to strive for high standards within the home and have supported people who use the service in a sensitive and supportive way. Staff receive a thorough induction to the home which is “Skills for Care” based. This involves the completion of a workbook by both the staff member and a senior member of staff. Each person using the service has a plan of care, which they have helped to develop. Some people living in the home need support to communicate with others. People are involved in a variety of leisure and work activities. Staff support people to identify what activities they want to be involved in on a daily basis. People are able to develop life skills, to complete domestic chores in the home, and take responsibility for shopping and cooking. Staff said they are committed to supporting people to achieve identified goals. People are supported to go out for meals, or to the pub, and food is prepared and cooked with the support of staff members. Staff enable and support people to keep in touch with their family and friends, either by arranging visits, and or by phone or letter. What has improved since the last inspection? What they could do better: The home has a rolling programme of repair and maintenance. However it is a recommendation of this report that the exterior paintwork and woodwork to the front bay windows and rear kitchen door frame is renewed and or replaced. Night staff sleep on an inflatable mattress, which is sited within the home’s lounge area. Consideration should be given in regard to people who use the 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 7 service, their use of the lounge later on in the evening, and in relation to the time that staff need to retire to bed. The conservatory, which is cold in winter, and can get very hot in summer, would benefit from some blinds, some heating, and an extractor fan. 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. 20 Oulton Road DS0000005095.V352459.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 20 Oulton Road DS0000005095.V352459.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): 1, 2 and 5 - 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: People had a copy of the Statement of Purpose and Service user Guide, which is used across the organisation. These documents had been explained to people who use the service with the use of pictorial support. The Guide included details of the terms and conditions of occupancy and fee level. Both documents had recently been reviewed. However, it is a recommendation of this report that information should include the costs for individual holidays and transport. This was highlighted and discussed at the time with the manager. The manager and staff confirmed that pre-admission assessments had originally been undertaken by social services and or the specialist community learning disabilities service. However, because people who use the service had been living at the home for a number of years, records had since been archived. We were unable to view the original documentation in relation to people’s pre-admission assessments. This was highlighted and discussed with the manager at the time. The Annual Quality Assurance Assessment document (AQAA), which is completed by the care manager, confirmed the following: 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 10 “People who enquire about our accommodation and services are provided with an information pack. They may then apply directly for a place in one of the homes. All applications must be accompanied by a comprehensive assessment of need, which states the reasons for the referral or application and the specific services sought, e.g. short or long term care, respite care etc. Assessments are usually multi-disciplinary and submitted by a local authority social services care manager, specialist community learning disabilities, mental health social work team or nominated keyworker of a multi-disciplinary team. They will include a financial assessment, which will determine any local authority or health service funding to which the applicant may be entitled. Each application is given careful consideration. Where there is a match between application and need assessment, and the availability of a suitable vacancy or potential vacancy, a final decision is taken at an admissions meeting to which everyone involved in the application including the service user, carers and representatives are invited to attend. If agreement is reached to admit the service user an initial action plan is then drawn up to decide the next steps in the process”. People who provided feedback from our surveys, and people spoken with, said that they “were able to choose the colour scheme and furniture for their bedroom”. 1 person using the service said that they did not have a contract, and 2 people said that they did. All 3 people said that they had enough information about the service prior to moving in. We looked at 3 care plans and saw 3 contracts, the fees were in the process of being reviewed, and the revised fees had not been added to the documentation. This was highlighted and discussed with the manager at the time. The manager confirmed that this would be done straight away. 20 Oulton Road DS0000005095.V352459.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): 6,7,8 and 9 - Quality in this outcome area is excellent 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: We looked at 3 care plans. All of which contained a client profile, with person centred information. Evidence of health services input was also seen. Each plan was individualised, and recognised the personality and needs of the person. The plans were reviewed on a regular basis; any changes to the skills achieved were recorded. Two people using the service choose to write their own daily records, one of those people confirmed this during discussion with us, saying “I sometimes get help from staff when I’m writing my daily diary”. People who use the service said that they were consulted and encouraged to be involved in their care plan. This consultation was confirmed when we spoke with people during the 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 12 inspection. One person said that they were “able to come and go as they please”. Another person said that they “had been shopping for some new clothes”, and had “chosen the furniture for their room”. Daily activities and life continued as normal during our visit. Staff explained the inspection process to people using the service, during the inspection visit. People were asked if they wanted drinks, food and snacks were made available throughout the day, with a choice of options for hot or cold food and or drinks. During a tour of the building two people when asked, showed us their room, and said that they “chose their own colour schemes and furniture,” “chose their own books, music and films to watch”. People spoken with said that “they can choose holidays each year”, Surveys received from people who use the service said, “I am always given choices so that I can decide for myself what I want to do”. “I go to swimming, keep fit and discos”. Evidence contained within care plans seen pointed to there being six monthly reviews held for each person. Care plans contained out of date paperwork, which should be archived on a regular basis. Instructions for staff should be on headed paper, which would be more easily recognised. Directives from management should be signed and dated by management. These were highlighted and discussed with the manager at the time. The Annual Quality Assurance Assessment (AQAA) document, provided by the care manager, confirmed the following: “Tailor care plans to individual needs maintaining flexibility. Work well with other agencies to provide support that takes in to account other fields of working. Advice is (sought) from health staff and other healthcare professionals. Speak to people who may help people make choices such as people first and Assist advocacy. “All service users will have a key worker allocated to them from the staff. Service users will have some choice in the allocation. Staff will provide sensitive and flexible personal support and nursing care to maximise service users privacy, dignity, independence and control over their own lives”. 20 Oulton Road DS0000005095.V352459.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): 11,12,13,15,16 and 17 - Quality in this outcome area is excellent 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: Information regarding triggers to any known behaviour, for example what may upset a person, or known fears was included within the care plan. Detailed information was recorded in regard to how the person communicated. Assessments covered all aspects of daily living for example traffic awareness, cooking skills, travelling in vehicles. Information relating to the person’s culture and religious needs was included in the plan, and how these were to be met. People at the home are able to express their own sexuality with appropriate support. 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 14 For example one person talked about staff supporting her with her relationship with her boyfriend, and said she was “visiting him that evening, to watch television and listen to music”. Personal risk assessments recorded identified risk, level of risk and how to support the person. However, we found that they were not complete, in that they did not have contingency plans identified and in place. It is recommended that risk assessments should include contingency plans, which minimise the risk to the individual. This was highlighted and discussed at the time with the manager. The Annual Quality Assurance Assessment document (AQAA), completed by the care manager, confirmed the following: “Local colleges are used and one lady accesses this independently on public transport, other people use different colleges and use taxis to get there. Independently and with support. Holidays are chosen by residents and documented by staff so that choices can be listened to. Residents are supported to maintain family contact where appropriate and requested. Care plans include plans for cleaning bedrooms and developing household skills. One gentleman actually works with the local oak tree farm acorn garden services of which he is a valued employee and part of the community. Menus show that meals this week consist of cottage pie and veg fish homemade chips and veg, sausages and mash veg, chicken Jacket potatoe and veg. Chinese takeaway. Menus are chosen by the clients themselves with asistance about healthy eating to give an informed choice when making decisions. Lifestyle choices are supported with access to all local facilities i.e gym westbridge park local shops and library and local services such as hairdressers. Other activities have been promoted with one lady accessing a stafford nightclub to celebrate a friends birthday. Residents are fully supported and their independence is promoted in all aspects of their home lives”. Discussion took place with people who use the service throughout the visit, this covered daily programmes, activities, visits to the local day service and to Oak Farm - which is a working farm. One person explained his work at the farm, and how that work helps him in developing the garden and communal area to the rear of the building. People spoken with said that they “help with the cooking and the cleaning”, that they “enjoy their food very much”. “We go to the pub sometimes”. Surveys received from people who use the service - 3 people said that “there are always activities that they can take part in”. 2 people said that they “always like the food”, 1 person said that they “usually” like the food. Feedback received indicated that the outcomes for people who use the service is excellent. 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 15 20 Oulton Road DS0000005095.V352459.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): 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: 3 people said that they “always get the care & support they need, including medical support”. Plans of care recorded health care needs and how people were to be supported. For example if a person had epilepsy, a record would be kept of any seizures, and actions taken. Each person was registered with a local General Practitioner (GP). There were good relationships fostered between the home, the learning disabilities service, the GP and the local pharmacist. Other specialists maintain further contact and support. For example these include the Speech and Language Therapist, and where necessary, district nurses were approached for advice, information and any equipment necessary. 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 17 During the visit we spoke with a visiting Registered Mental Nurse (RMN) from the learning disabilities service, currently supporting a person at the home. She explained her role, which is to support and advise staff in regard to learning disability, including behavioural management techniques and ways of monitoring and recording. She confirmed that the home’s staff are always happy to assist her, they are always co-operative, and good at contacting her for advice when needed. We discussed the care of a named person at the home. Staff had sought and received advice, with regard to the ongoing care of that person. People using the service attend surgery and or clinics as appropriate to their health needs. The evidence to support this was contained within daily records, and care plans seen. People spoken with during the inspection visit told us that “they were feeling well”, and they “could tell a member of staff if they felt unwell, and something would be done about it”. Discussion with staff revealed that they had an indepth knowledge of how to support each individual, their attention to detail, including personal space, communication and interaction. Staff were seen to be sensitive to individual’s needs. This resulted in an excellent outcome for people who use the service. Medication records showed that there were one or two gaps in the signatures on the Medication Administration Sheets (MAR). This was thought to be an oversight, and was discussed with the manager at the time. It is a recommendation of this report that all medication is signed for. The storage of medication was within a locked cupboard within the kitchen. Staff should continue to monitor the temperature of the kitchen in respect of certain medication that may be prescribed, as there is no medication fridge. This was highlighted and discussed at the time with the general manager, and was not thought to be a problem, as the service can access a medication fridge on loan if required. The Annual Quality Assurance Assessment (AQAA) document, completed by the care manager, confirmed the following: “All new staff should be encouraged to read the policy on personal support as part of their induction process. Existing staff will be offered training to National Training Organisation standards covering basic information about personal care of service users. Access to a personal hygienist is facilitated for one lady. Access to mental health services including a psychiatrist provided for three residents. Evidence in individual tailored health care monitoring files based on individuals medical and mental health care requirments. Regular dental, optician, and chiropidist check ups and services detailed as necessary. 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 18 A high degree of specialist input is assisted. One lady is facilitated in accessing a trichologist, Psychiatrist, Epilepsy specialist nurse. High level of information is documented in to homely remedies held by the home and there is information and research about these in care plans. These are checked by the GP and are being incorporated in to the Boots MDS system with the approval of the pharmacist for administration, recording and stock control. Individual residents upon admission are provided with detailed comprehensive information in an appropriate format about the facts of death and their choices after dying. These choices are upheld and respected by the company. Personal care is supported for three residents. One resident requires a specific routine to enable her to get up in the morning, this is involves running a bath and assisting her in bathing”. 20 Oulton Road DS0000005095.V352459.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 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 and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. EVIDENCE: The manager and the complaints log confirmed that the service had received no complaints since the previous inspection. Complaints are documented and recorded. There is also a “Grumbles book”, which is used on a daily basis for minor grumbles. The manager said that they encourage relatives to approach them if they have a problem. It would be discussed and addressed where appropriate at a time convenient to the family. People who use the service confirmed that they were very aware of whom to tell if they had a complaint. One person said “ I would speak to a member of staff if I wasn’t happy with something”, “or if something was bothering me”. There had been no complaints and no Adult Protection/Safeguarding issues reported to the Commission for Social Care Inspection. The complaints procedure had been printed into a pictorial and clear format to enable people using the service to understand it. This information was on view in the home, and easily accessible to people. 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 20 3 Staff recruitment records evidenced that staff are recruited following robust procedures, which included Criminal Records Bureau and Protection of Vulnerable Adults checks prior to commencement of employment. Staff spoken with at the time of the inspection confirmed this. The home’s training matrix also confirmed the training that staff had undertaken. Staff spoken with were very aware of the need to Protect Vulnerable Adults, and said that they had received training in respect of this. The Annual Quality Assurance Assessment document, which was completed by the care manager, confirmed the following: “All oral complaints, no matter how seemingly unimportant, should be taken seriously. There is nothing to be gained by staff adopting a defensive or aggressive attitude. Front line care staff who receive an oral complaint should seek to solve the problem immediately if possible. If staff cannot solve the problem immediately they should offer to get the home manager to deal with the problem. All contact with the complainant should be polite, courteous and sympathetic. At all times staff should remain calm and respectful. The outcomes of the investigation and the meeting should be recorded in the complaints book and any shortcomings in the homes procedures should be identified and acted upon. The home should discuss complaints and their outcome at a formal business meeting and the homes complaints procedure should be audited by the home manager every six months.” Surveys received by us showed that 1 person using the service said that they would not know how to complain, but stated “my mother is fully aware & would do so on my behalf”. 2 people said they would know how to complain. All 3 people said that they always knew who to speak to if they were unhappy. 6 Staff surveys received by us, said that they would know what to do if a person who uses the service has concerns about the home. 20 Oulton Road DS0000005095.V352459.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 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 people who use the service to live in a safe, and comfortable environment, which encourages independence. However, the exterior paintwork and woodwork needs refurbishing and or replacing. EVIDENCE: A tour of the building confirmed that all areas internally had been well maintained. The kitchen was domestic in nature, and had been recently refurbished to a good standard. The first floor bathroom had also been recently refurbished. The lounge/diner is a large room, which is big enough to accommodate the people who use the service. The dining area is well used for mealtimes, and for activities. There are modern and comfortable type furnishings in place, which people using the service had helped to choose. There is also a small conservatory which is not used very often, and which leads to the outside rear 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 22 of the building. The outside rear has a paved area, which leads into the area for the sister home. Staff spoken with confirmed that the conservatory is now being used as a quiet lounge. As the conservatory can be hot in the summer, and cold in the winter, it is a recommendation of this report that blinds are fitted, heating is installed, and an extractor fan is fitted. Permission was given to us, by two of the people who use the service, to view their bedrooms. Each bedroom had been personalised, and had been decorated to their individual choice. Bedrooms seen were of a high standard in furnishings and fittings. People who use the service told us that they “were very pleased with their bedrooms, and with their choice of furniture, fittings and colour schemes”. The bathroom on the first floor had been totally refurbished, and included a shower. One resident on the ground floor had the use of his own en-suite shower facility. Throughout the home exceptional standards of hygiene was observed, this was a credit to the staff and residents. The exterior of the building – particularly the woodwork to the two bay windows at the front, and the doorway into the rear garden from the kitchen are looking tired and poorly maintained, they need either painting, and or replacing. This was highlighted and discussed with the manager at the time, she confirmed that the provider is aware of the need to do this. There are also plans to have those windows replaced. There is an ongoing programme of redecoration and refurbishment for the service. Surveys received by us, from people who use the service said “ I help to keep the house tidy and treat it as my home”. When asked if the home is always fresh and clean, one person using the service said, “I know it because I clean it”. They also said, “It’s comfy”. The Annual Quality Assurance Assessment (AQAA) document completed by the care manager commented on the following: “Bedrooms are decorated with personal effects and colour schemes chosen by the residents and families themselves. One service user has a quilt hanging on the wall, which has family photographs embroidered on and handprints. In all bedrooms service users have photographs of family and people who are special to them. One service user had an en-suite installed after family requested they would like their daughter to have one. The communal areas have personalised pictures of friends and family also and has ornaments that service users have made themselves at day services. 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 23 The house has been adapted for a service user who recently moved in hand rails have been fitted in the shower and at the front door upon recommendation of the Occupational Therapist after requesting an assessment. Also a toilet seat raiser placed in the toilet for one lady whose assessed needs require one. One lady uses a walking frame and wheelchair and these have been suitably assessed by Occupational Therapy department. The home recognises that the use of rugs or any un fixed floor materials are a hazard to the lady with the walking frame and no rugs are used around the home. The home is cleaned with the help of staff through service users individual plans to maximise independence. All service users are involved in the cleaning of the home to the best of their abilities. Cleaning jobs are shared appropriately and completed daily. Staff maintain a high level of cleanliness. Maintenance is carried out by suitably qualified technicians.” The AQAA document also confirmed that appropriate safety checks had been undertaken. Since the previous inspection, the lounge/dining area had been painted, a new fire door had been fitted to the kitchen, and to a bedroom, and plans are in place to replace and update old furnishings in bedrooms and communal areas. 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 24 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): 32,34,35 and 36 - Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. EVIDENCE: From our discussions with staff, the manager, and the examination of staff recruitment and training records. We were assured that the recruitment and training provided, promoted an effective staff team. 3 staff records were examined, there had been no new staff recruited, and the manager confirmed that the service was fully staffed. Staff spoken with confirmed that the provider gives loyalty incentives to employees, including flowers on their birthday, and meals out. One member of staff said, “they really look after us”. The provider’s ability to retain their staff has resulted in existing staff having worked at the home for many years. This has had a very positive outcome on the consistency of support and care that people who use the service have received. 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 25 Records examined were therefore the longer existing staff members. Those records evidenced that appropriate police and security checks had been made prior to their employment. 5 of the 6 staff completing a Commission for Social Care Inspection (CSCI) survey said that the employer had carried out Criminal Records Bureau checks and received references before they started work, 1 said they had not. 1 staff member said the induction covered all they needed to know very well, 4 said it mostly did, and 1 said partly. All 6 said they received training relevant to their role, which helps them to meet the needs of the people using the service and keeps them up to date with new ways of working. 3 said that they met with their manager for supervision regularly, 2 said often, and 1 said sometimes. 1 staff member said that there are always enough staff to meet the needs of the people using the service, 3 said there usually are, and one said sometimes. 2 staff said that they always have the right support, experience & knowledge to meet the needs of the people using the service, 3 said they usually do, and 1 said sometimes. Staff spoken with confirmed that staffing levels were flexible to meet the needs of the people who use the service, and their commitment to daily activities, for example attendance at college, transport to an appointment, or a shopping trip. A member of the staff team and or the manager would be available at the home during the day. The staff rota confirmed that 1 staff member was on duty from 5pm, with a sleep in duty over night. An additional staff member would be on duty from 5pm until 10.00 pm, this was to accommodate and support people who were going out for the evening, and or needed support during that time. The staff rota also evidenced that staffing levels had been maintained. We saw the service’s training matrix for 2008, which covered the whole of the organisation. Staff spoken with, and records seen confirmed that their mandatory and update training was current, and that they received regular supervision via their line manager. Staff surveys received by us contained the following comments: “Senior carer meets every member of staff every 2 months to check on progress and feedback”. “Staff communication can lack”. “Sometimes when a member of staff rings in sick & there are 2 houses joined the member of staff on duty covers both houses”. “Some of the houses only provide air beds for staff to sleep on in living areas”. “We try to adhere to the needs of all the clients as much as possible, (extra staffing would make this more possible)”. 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 26 “They should provide staff bedrooms in all of the houses”. “An occasional staff meeting would be useful”. The above comments were discussed during the inspection visit with the manager. It was not possible to establish when the member of staff was on duty covering both houses. Staff communication was seen during our visit to be generally good, diaries are kept, and handovers by staff are given for each incoming shift. Staff on night duty, do have to use air-beds, and sleep in living areas, in some homes. However, staff are made aware of this, prior to employment. Staff meetings are held wherever possible on a 3 monthly basis. Staff meeting minutes were available for us to view. The Annual Quality Assurance Assessment document (AQAA), which is completed by the care manager, confirmed the following: “Staff employed at the home are a team of staff available to all homes within the Rmp Care group. This allows for great flexibility whilst people visit friends at other houses and allows someone familiar to cover holidays for those staff who are more permanent at this home. Rmp Care try not to use Agency staff and have only done so when this will not impact on the service users when for instance a lady whose needs altered and werent being met at rmp was waiting to go elsewhere to receive specialist health treatment waking night staff was required. We used Agency staff just for the waking night. We have a good team who will provide cover for other members of the team and provide continuity of care for the residents.” The AQAA also confirmed the current training courses being undertaken by staff and the numbers of staff qualified to NVQ standard. These were seen to be satisfactory. New members of staff would receive a “Skills for Care” induction package, which includes a workbook that is signed off by a senior member of staff. 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 - Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. EVIDENCE: People who use the service are well supported by the sensitivity, training, and experience of the staff employed by the company. Meetings for people who use the service, and for staff are held on a regular basis. People are encouraged and supported to speak out at meetings. There is evidence that the service has a robust recruitment procedure in place, this is from the staff spoken with, and the records sampled. The ethos of the home was reflected in the policies and procedures, the records, attitude and 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 28 competence of the staff, and comments received from the people who use the service. People’s citizenship and their rights, are protected by the staff and the training that they undertake. There is a suggestions pro forma for everyone to put forward ideas, these are listened to and acted upon by the manager in a timely way. For example a new television was requested for the lounge, this was undertaken fairly quickly and put into place. Records including the Annual Quality Assurance Assessment (AQAA) confirmed that the practice and procedure for weekly fire alarm testing and fire drills were current. The home had a fire risk assessment, people who have special needs in relation to fire evacuation, had been risk assessed. The risk assessment had been included in their care planning process, and staff spoken with during the inspection were aware of those special needs in the event of a fire. Staff surveys received by the Commission for Social Care Inspection (CSCI), confirmed that “the ways that information is passed between management and staff always works well”, 3 said it “usually does”, and 1 said “sometimes”. Other comments received included: “The care manager is available 24 hrs”. “RMP Care works to it’s philosophy and ethos and promotes equal rights”. “Everyone who is part of the organisation has a value” “the ambiance within all the homes is relaxed, comfortable & homely”. The Annual Quality Assurance Assessment (AQAA) document, completed by the care manager, contained too much information in relation to policy and procedures, and did not contain enough information in regard to the outcome groups. This was highlighted and discussed with the general manager during our visit. The AQAA document confirmed the following: “New training structure and personnel files. New fire risk assessment folders with comprehensive training and evacuation procedures. RMP Care is fully committed to staff learning and development. All staff receive training, using the Learning Disability Award Framework. Care Managers are working towards the Registered Care Manager Award and support staff towards NVQ Level 3. The aim is to have existing staff trained in NVQs in line with National Minimum Standards and after that the policy will be to recruit only already qualified permanent staff if at all possible.” “The function of this home is to provide continuing care for people who have experience of learning disabilities. The home is intended to provide a home for 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 29 life for its residents if they wish for this, and will help those who wish for more independent living through support and assistance designed to maximise their skills to live in their chosen setting”. 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 30 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 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 4 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 2 X 3 X 3 X X 3 X 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 31 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. 2. 3. 4. Refer to Standard YA1 YA10 YA11 YA14 Good Practice Recommendations The statement of purpose and service user guide should clearly state that additional charges are made for individual holidays, and transport. Out of date paperwork should be appropriately archived, and directives from management should be signed and dated. Risk assessments should also include contingency plans to minimise the risk to people using the service. Consideration should be given to night staff sleeping on an air-mattress in the main lounge. In regard to people who use the lounge later in the evening, and the time that staff need to retire to bed. All medication administered via the Medication Administration Record should be signed for. A system for daily monitoring should be introduced. 5. YA20 20 Oulton Road DS0000005095.V352459.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 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. 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