Care Home: 24 Bowens Field

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What the care home does well People who live at Bowens Field told us that they enjoy living at the home and that they like the staff. Discussions with them evidence that they lead active lifestyles and are involved in the day-to-day running of their home.People are very much part of their community and are encouraged to engage in local voluntary groups, churches, clubs and have developed good networking and positive relations with others. People living at Bowens Field have confidence in the people who support them. The staff team are well established and have developed good working relationships with the people living at Bowens Field, their relatives and other agencies. People are supported to develop their independence and partake in daily living skills such as maintaining a clean home, cooking, shopping and providing opportunities for work experience. Their home is spotlessly clean and homely and finished to a high standard. Staff have effectively managed and adapted well to the significant changes in the senior management team, the change in paperwork and new procedures. The AQAA states `we have embraced the new systems and implemented them in a way that has not caused disruption to service users`. What has improved since the last inspection? The requirements made following the previous inspection are considered met. People now have an allocated food budget, which has provided people with greater opportunities to develop their links with local shops and businesses and plan their meals according to personal choice. A new Quality Audit tool has been developed and implemented as required by the previous inspection. This is used on a monthly basis to audit the homes performance covering a number of areas to include the environment, records, health and safety, finance, medication and complaints. This helps monitor how the home is performing, its strengths and areas for improvement. What the care home could do better: Two people jointly manage the home. One manager is currently seconded to another home and the other manager is also the registered manager of another service, in addition to developing a new adult day service at Loppington House. Management arrangements should be reviewed to ensure the manager currently responsible for Bowens Field is allocated sufficient time to effectively fulfil the role and responsibilities required of a registered manager. New support plans have been developed but the format is better suited to older peoples needs and is not relevant to the current needs of the individuals living at Bowens Field. Support plans should be person centred and focus more on the individual`s strengths, personal preferences and their goals and aspirations and include evidence that the service values improving outcomesfor people. This will help staff to provide support in such a way as to ensure people`s individual needs and aspirations are met. Staff would benefit from greater opportunities for training to ensure they have the necessary skills and knowledge to equip them to do their work. Staff require refresher training in physical intervention and food hygiene in addition to training in moving and handling, person centred planning, mental capacity act, autism and deprivation of liberties. They should also receive formal supervision at the required frequency, which is dedicated time set aside for them to receive support regarding their work. A staff-training matrix specific to the service and individual training and development assessments would help in identifying staff training needs, actual training undertaken and assist with future planning. The manager acknowledged the need to improve the homes record keeping systems to ensure records are more easily accessible and better presented. The AQAA acknowledges the need to develop information in formats appropriate to the needs of the people living at the home to ensure information is more easily accessible. CARE HOME ADULTS 18-65 24 Bowens Field Wem Shrewsbury Shropshire SY4 5AP Lead Inspector Rebecca Harrison Announced Inspection 11th November 2008 09:10 24 Bowens Field DS0000020736.V373082.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 24 Bowens Field DS0000020736.V373082.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. 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 24 Bowens Field Address Wem Shrewsbury Shropshire SY4 5AP 01939 236517 NONE 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) www.loppingtonhouse.co.ukE mail office@loppingtonhouse.co.uk Loppington House Ltd Hilary Evans Andrea Minton Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th November 2006 Brief Description of the Service: 24 Bowens Field is registered with the Commission of Social Care Inspection (CSCI) to provide accommodation and care for three people with a learning disability. Active Care Partnerhips (Holdings) Limited, a subsidiary of Southern Cross Health Care purchased the entire share capital of Loppington House Limited on 25 October 2007, which incorporate 24 Bowens Field. They advised CSCI that it is not their intention to re-register the homes. Hilary Evans and Andrea Minton are the joint Registered Managers of Bowens Field and Loppington House. Bowens Field is a semi-detached property located in a well-established residential area of Wem, convenient to all local amenities and is in keeping with the local community. Accommodation is provided over two floors comprising single bedrooms one with en-suite facility. Communal areas include a lounge, dining room and a kitchen. A small-enclosed garden is provided to the rear of the property. People who use the service and their representatives are able to gain information about this service from the Statement of Purpose and Service User Guide, however these documents need updating. Inspection reports produced by CSCI can be obtained direct from the provider or are available on our website at www.csci.org.uk The fees charged were not available in the Service User Guide as required; therefore the reader may wish to obtain this information direct from the service provider. 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. One inspector carried out the inspection over five hours. Given people lead busy lifestyles and the nature of the service, the provider was given very short notice of this inspection to ensure a member of staff was available to assist with the inspection and that the inspector was able to meet all three people living at the home. A range of evidence was used to make judgements about this service to include discussions with all three people who live at the home and one of the managers, a tour of the home, sampling a number of records to include care records, complaints and protection, staff training, recruitment, quality assurance and health and safety records. We also reviewed the information provided in the Annual Quality Assurance Assessment (AQAA) which is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for them to share with us areas that they believe they are doing well. Two people who live at Bowens Field were ‘case tracked’ this involves establishing individuals experience of using this service by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. We reviewed all ‘key standards’ for care homes for younger adults and information to produce this report was gathered from the findings on the day and also by review of information received by CSCI prior to the inspection date. We completed an Annual Service Review on 19th November 2007 and a copy of the report can be obtained from the provider. This did not involve a visit to the service but is a summary of new information given to us, or collected by us, since we did our last key inspection undertaken on 24th November 2006. What the service does well: People who live at Bowens Field told us that they enjoy living at the home and that they like the staff. Discussions with them evidence that they lead active lifestyles and are involved in the day-to-day running of their home. 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 6 People are very much part of their community and are encouraged to engage in local voluntary groups, churches, clubs and have developed good networking and positive relations with others. People living at Bowens Field have confidence in the people who support them. The staff team are well established and have developed good working relationships with the people living at Bowens Field, their relatives and other agencies. People are supported to develop their independence and partake in daily living skills such as maintaining a clean home, cooking, shopping and providing opportunities for work experience. Their home is spotlessly clean and homely and finished to a high standard. Staff have effectively managed and adapted well to the significant changes in the senior management team, the change in paperwork and new procedures. The AQAA states ‘we have embraced the new systems and implemented them in a way that has not caused disruption to service users’. What has improved since the last inspection? What they could do better: Two people jointly manage the home. One manager is currently seconded to another home and the other manager is also the registered manager of another service, in addition to developing a new adult day service at Loppington House. Management arrangements should be reviewed to ensure the manager currently responsible for Bowens Field is allocated sufficient time to effectively fulfil the role and responsibilities required of a registered manager. New support plans have been developed but the format is better suited to older peoples needs and is not relevant to the current needs of the individuals living at Bowens Field. Support plans should be person centred and focus more on the individual’s strengths, personal preferences and their goals and aspirations and include evidence that the service values improving outcomes 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 7 for people. This will help staff to provide support in such a way as to ensure people’s individual needs and aspirations are met. Staff would benefit from greater opportunities for training to ensure they have the necessary skills and knowledge to equip them to do their work. Staff require refresher training in physical intervention and food hygiene in addition to training in moving and handling, person centred planning, mental capacity act, autism and deprivation of liberties. They should also receive formal supervision at the required frequency, which is dedicated time set aside for them to receive support regarding their work. A staff-training matrix specific to the service and individual training and development assessments would help in identifying staff training needs, actual training undertaken and assist with future planning. The manager acknowledged the need to improve the homes record keeping systems to ensure records are more easily accessible and better presented. The AQAA acknowledges the need to develop information in formats appropriate to the needs of the people living at the home to ensure information is more easily accessible. 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. 24 Bowens Field DS0000020736.V373082.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 24 Bowens Field DS0000020736.V373082.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 and 2 Quality in this outcome area is adequate The home currently has no vacancies however information about the service is available but requires updating to ensure people looking for a service in the future can make an informed choice about whether the home is appropriate to their needs. The service has assessment and admission processes in place and individuals would only be admitted following an assessment of need to ensure the service is appropriate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about the service is available in the form of a Statement of Purpose and Service User Guide. The manager present at the inspection committed to update the documents to reflect the change in the new organisational structure and staff qualifications and to ensure that fees charged are included in the guide, as required. There have been no admissions to Bowens Field since 2000, when the home first opened. The three people living at 24 Bowens Field previously lived at Loppington House and were chosen carefully for their compatibility. They were 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 10 fully involved in the resettlement process, choosing decoration, furniture and fittings prior to a gradual transition to their new home. The AQAA states ‘Active Care policies and procedures are comprehensive and show clear processes to follow in the event of an admission’. Discussions held with the manager demonstrated she has a good understanding of the procedure in the event that the home has a vacancy in the future. 24 Bowens Field DS0000020736.V373082.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 and 9 Quality in this outcome area is good People living at Bowens Field have a support plan in place however these could be further developed to include their personal goals and aspirations to deliver a more person centred service. Individuals are able to make decisions, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to remain independent. This is because the staff have appropriate information on which to base decisions. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at Bowens Field have been involved in the development of their new support plans as required by the previous inspection. However the new format adopted is more suited to the needs of older people and not the needs of the individuals living at Bowens Field. Support plans should be person 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 12 centred and focus more on the individual’s strengths, personal preferences and their goals and aspirations and include evidence that the service values improving outcomes for people rather than adopting a tick list format and areas that are not relevant to the people living at Bowens Field. The AQAA identifies the need to develop person centred planning and discussions held with the manager indicate she hopes to commence these shortly. Reviews are held at the required frequency and the people we spoke with said they attend their meetings. Discussions held with two people living at Bowens Field clearly evidence that they take an active role in decision making in areas to include activities, routines, choice of meals, purchasing food and the day to day running of the home. People have access to an external advocate to represent their best interests. The advocate supported one person with obtaining his own vehicle through the Motorbility scheme. Risks are handled positively and are assessed, which enables the people living at the home to lead the life they want and to develop their daily living skills. For example people assist with food preparation, cooking, cleaning, gardening and regularly access the community. Dependency assessments are in place for pressure sores, continence, falls, moving and handling. Again the manager fully acknowledged that these are not relevant to the current needs of the people living at Bowen’s Field. 24 Bowens Field DS0000020736.V373082.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): 11,12,13,14,15,16 and 17 Quality in this outcome area is good People who live at Bowens Field are enabled to keep in contact with family and friends and are provided with greater opportunities to develop and maintain their social and recreational interests so that they can lead their life in a chosen way. People receive a healthy, varied diet according to their assessed requirements and choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People lead active lifestyles and are very much part of their local community. They are supported to attend local events for example they attended a recent bonfire and firework night at the local social club, access local churches, car boot sales and the annual carnival held in Wem. 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 14 Two people told us about the activities that they do during the week, which helps to develop and maintain their social, emotional, communication and independent living skills. For example people continue to access a local workshop and retail outlet where they gain work experience and are supported to develop their life-skills in the home. The introduction of allocated 1:1 time has provided greater opportunity for individuals to pursue an activity on their own with a staff member, which is proving very successful. One person reported that they use this time to go horse riding and also enjoyed a horse riding holiday this year arranged with a riding for the disabled group. Another person told us about his holiday in Wales, the various day trips he has attended and the Gardening group where he grew fresh vegetables for the home. He is also involved in a country conservation project leading to an accredited volunteer award. People living at Bowens Field are supported to maintain contact with their family and friends and all contact is recorded, as evidenced on the files examined for the two people we case tracked. The home are making arrangements to enable one person to visit relatives that live a distance away from the home. One person said, “My mum and dad phone me and come and take me out”. A satisfaction survey completed by a relative since our last inspection states “The home always welcomes us, it’s a lovely home and we couldn’t wish for a better home”. Preferences in relation to choices, routines, likes and dislikes were documented on the support plans examined and discussions held and observations made evidence that people are being provided with greater opportunities to develop their daily living skills for example they are now allocated their own food budget which enables people to purchase food from local shops, develop their budgeting skills and they continue to assist with household tasks to develop and maintain their independence. The two people we spoke with told us that they can choose what meals like want to eat and that they enjoy the food. Individual dietary likes and dislikes are clearly recorded and the menu seen appeared healthy and well balanced. On our arrival at the home people were sat together enjoying breakfast with a member of staff, which appeared a social and enjoyable experience. One person said, “I like the food here, I like pies and making my own pastry. I help cook and make my own sandwiches”. 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good People receive personal support based on their assessed needs and in the way they prefer and want. People living at Bowens Field are safeguarded by the home’s systems for handling, storing and administering medication, supporting their continued good health. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The two people that we ‘case tracked’ attend to their own personal care needs with minimal assistance as seen recorded in their support plans. People were well groomed and said that they are happy with the support that they receive. The system for recording health appointments has improved, as required by the previous inspection. This helps the home to monitor health screening provided. One person said, “I go to the dentist and opticians and someone comes to the home to do my feet”. The team obtained an NHS pictorial guide for people with a learning disability and successfully supported one individual with a health screening appointment and helped to alleviate their anxieties. 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 16 People also receive annual health checks and health action plans are in place. People in receipt of medication can be confident that they are protected by the homes procedures in place for the management of their medication. The manager demonstrated a clear understanding of how people are supported with the management of their medication and improvements have been implemented following our last inspection. Medication procedures appeared satisfactory at the time of the inspection and the home has a policy and procedure for the receipt, storage and administration of medication. Guidance has been sought and received from the GP in respect of the administration of homely remedies. Staff responsible for the administration of medication have received training in the safe handling of medicines and undertake assessments to assess their ongoing competency. An audit of medication has recently been undertaken as part of the homes quality assurance checks. There have been no medication errors since our last inspection and the manager reported she has ‘no concerns’ regarding the management of medication. 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good If people have concerns with their care, they or people close to them, know how to complain. Their concern would be looked into and action taken to put things right. The service safeguards people from abuse by ensuring staff are trained in adult protection and action taken to follow up any allegations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who use the service and their representatives have access to a complaints procedure, which is readily available and developed in a format appropriate to their needs. The people we spoke with had a clear understanding of what to do if they were not happy with the service they receive. We have not received any concerns or complaints about the service since our last inspection in 2006. The home has received two complaints and records seen evidence these were dealt with appropriately. The service has a copy of the local Multi-Agency Adult Protection Policy. Since our last inspection one person was referred under safeguarding adult procedures and an investigation held and the case substantiated. The provider has actioned the recommendations and there have been no further incidents. The manager demonstrated a clear understanding of local safeguarding procedures and confirmed all staff have received training in adult protection. It was reported that staff have received training in physical intervention but require refresher training; this should be given priority to support their lone 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 18 working. Both managers have attended training on the Mental Capacity Act to ensure they are familiar with the new legislation. People told us that they have their own bank account and are supported with the management of their finances. A written policy and procedure is in place and records of all transactions are appropriately maintained, checked regularly and signed. The manager was advised to provide two signatures for transactions where possible and that the balance of monies held are checked on a more regular basis to provide greater protection for both parties. 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good People live in a comfortable, spotlessly clean and well-maintained home, which is appropriate to their needs and promotes their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at Bowens Field take much pride in their home and very much benefit from the location of the home and the nearby facilities offered in the town. People are provided with single bedrooms and the female resident has her own en-suite facility and is now able to lock her own bedroom door, offering greater privacy and dignity. People were happy to provide us with a tour of their home and show us their bedrooms, which were very personalised and furnished appropriately in accordance with their needs. Communal areas include a lounge, dining room and domestic style kitchen and provide a pleasant and homely environment for people to live. The small garden to the rear of the home is enclosed and well maintained by the people who live at the home. One person has had their 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 20 room redecorated and was involved in choosing the colour schemes and soft furnishings. It was reported new floor covering for the kitchen has been ordered and due to be fitted shortly. People would also benefit from a replacement bath panel as the current one is damaged. People living at Bowens Field help maintain a clean environment to live and are supported to use cleaning products safely. Assessments to support the use of products are now available. Most staff have received training on infection control procedures and personal protective equipment is readily available. A risk assessment has been developed to support people carrying soiled laundry through the kitchen, however the risk of cross contamination is considered low. 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36 Quality in this outcome area is adequate People living at Bowens Field are supported by a dedicated team of staff but greater opportunities for training would better equip the staff with the skills and knowledge to meet their individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People we spoke with told us that they like the staff that support them. One person said, “I like the staff here, they’re really nice”. The manager who assisted with the inspection demonstrated a good understanding of the needs of the people living at Bowens Field and it is evident that she has developed positive working relationships with all three individuals. Only one member of staff has gained a recognised care award known as a National Vocational Qualification, which falls short of the national targets for staff working in care homes. This was fully acknowledged by the manager who is keen to address this when new staff are recruited very shortly. The staffing ratio is one member of staff supporting up to three people at any one time, which is considered appropriate to meet the current individual needs of the people living at the home. People are now provided with some 1:1 time 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 22 on a Wednesday and this is taken on a rota basis. This arrangement allows flexibility and enables individuals to pursue their own interests as recommended at the previous inspection. Agency staff are not used to cover vacancies, it was reported bank staff from Loppington House are utilised, as they are familiar with the needs of the people at Bowens Field, which is crucial given staff lone work. No new staff have been recruited since the last inspection however the manager confirmed that the organisation has robust procedures in place to safeguard people who live at Bowens Field. The home currently has two vacancies and interviews were scheduled for the day after the inspection. Two people told us they were helping with interviews and will help choose their new staff. A training matrix is available however this is not service specific as it also covers the organisations other establishments and therefore information about staff employed at Bowens Field was not easily accessible. The manager agreed to review this in addition to developing individual staff training records and an overall team-training plan. This will help managers identify any gaps in training and establish individual and team training needs to assist with future planning. The last inspection identified some significant omissions in mandatory training such as health and safety, infection control, fire etc and records evidence that staff have since received training in most of these areas but would benefit from receiving refresher training in physical intervention and food hygiene in addition to training in moving and handling, person centred planning, mental capacity act, autism and deprivation of liberties. New staff will commence a qualification in learning disability (LDQ) followed by NVQ level 2. There is evidence that staff receive formal supervision, however this is not at the required frequency, which was fully acknowledged by the manager. This is currently being addressed and should improve following training. However good systems continue to be in place for management support during and out of office hours, which was evidenced at the inspection. Given staff are lone workers the frequency of staff meetings should be reviewed. 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good People living at Bowens Field benefit from being supported by an effective and open management team. Quality assurance processes enable the home to identify people’s thoughts on the service provided and make changes to improve outcomes for people using the service. Effective health and safety checks mean that the people living at Bowens Field live in a safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has two registered managers in place in addition to a team leader who is responsible for day-to-day operational issues of the home. One of the 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 24 registered managers is currently seconded to manage another of the organisations care homes until further notice. The other manager, who was present at the inspection, is also developing an adult day service at Loppington House. Both registered managers have considerable experience in working with people who have a learning disability and now have the necessary management and care qualifications required of their role. Since our last inspection they have attended numerous training courses to include Mental Capacity Act, Equality and Diversity, Health Facilitation, Challenging Behaviour and First Aid and also attend conferences arranged via Shropshire Partners in Care. Given one manager is currently seconded and the other manager is also the registered manager of another service and currently involved in the development of an adult day service, it is crucial that these arrangements do not detract from the management of Bowens Field. The manager present at the inspection acknowledged that she requires more time to effectively fulfil the role and responsibilities required of a registered manager. Records seen evidence that both registered managers now receive formal supervision and attend regular briefings held at Loppington House. The manager stated, “I feel I have lots of opportunities for support and have just had my appraisal”. The views of people who use the service are taken into account through feedback gained in satisfaction surveys that were very recently distributed. People living at the home are involved in all decisions about the running of their home and attend meetings and annual reviews. The manager reported that surveys to relatives and stakeholders would be distributed and agreed to compile a report based on the overall findings and develop an annual development plan based on outcomes for the people living at the home. This will help assess how the service is currently performing, evaluate outcomes for people and aid future planning. There is evidence that Regulation 26 visits are undertaken but not at the required frequency, which was addressed with a senior manager at the time of the inspection. A new quality audit tool has been implemented as required by the previous inspection. The tool covers numerous areas to include catering, accidents, complaints, medication, finances, supervision health and safety, privacy and dignity, activities etc and is undertaken on a monthly basis by the registered manager and verified by a senior manager. The Annual Quality Assurance Assessment (AQAA) forwarded to CSCI reflects both the strengths and areas of improvement for the service. Desired improvements include recruiting staff who have achieved NVQ 2 care where possible, transferring relevant policies and procedures into an accessible format for people who use the service and the possible installation of Internet access to enable wider choices and use as a communication tool. Health and safety and maintenance checks are undertaken to ensure that the equipment is safe and in full working order. Service certificates were readily available in addition to risk assessments and other safety records required. It was reported that neither the Environmental Health nor Fire Departments have visited the service since our last inspection and that there are no outstanding 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 25 requirements. Records evidence that staff are in receipt of training in safe working practices but not at the required frequency, which the manager committed to address. The requirements previously made in relation to health and safety are considered met. 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 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 4 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 27 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 Support plans should be developed adopting a person centred approach and in a format appropriate to the people living at Bowens Field. This will support staff to provide support in such a way as to ensure all the individual needs of people are met and identify goals and aspirations for people using the service. Staff should be provided with training appropriate to the work for example autism, person centred planning, mental capacity act, physical intervention so they are better equipped to effectively meet peoples individual needs and aware of their responsibilities under legislation. 2 YA35 24 Bowens Field DS0000020736.V373082.R01.S.doc Version 5.2 Page 28 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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