Care Home: 26 Ladyfield Road

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What the care home does well What has improved since the last inspection? It was reported in the AQAA that developments during the last year have mainly involved the extension of the home, and the increase in numbers to six places. We were told that this would be beneficial for the people who already live at the home, by providing them with additional communal space and areas for different activities. Some parts of the original accommodation were redecorated as part of the home`s development, which has improved its general appearance. The garden has had some further work on it, and provides people at the home with a large recreational space and an area for growing vegetables. People at the home have had some changes in their day activities, and the home is looking at new opportunities for people. One person talked to us about a centre that they attended, which they enjoyed as they could meet people and take part in activities such as art and cooking. We had concerns at the last inspection about how the home had managed people`s medication and recorded this. Since the last inspection there has been a change in the way medication is recorded. The records we saw were up to date and included the relevant details. Written information about the home has been amended, so that it is up to date and gives better information about the services and facilities that are available. What the care home could do better: People`s main care needs and goals were included in their individual plans and records. However the way in which the plans were reviewed and recorded meant that they were not as informative about people`s current needs as they should be. Mrs Wright-Palmer confirmed that the plans would be rewritten, and produced in a format which would ensure that the information is sufficiently detailed, clearly presented and reviewed according to the required frequency. The home`s stated aim was to promote people`s independence. This was reflected in general terms in people`s individual plans and goals, although more information could be recorded about the steps that people need to take and how success will be measured. This will help to ensure that people make the progress that they are capable of and that the goals continue to be relevant. We have recommended that the services of a dietician are obtained. This is so that they can provide advice about how well the meals being prepared are meeting people`s nutritional needs. We have also recommended that a staff training plan is developed. This will help ensure that staff training needs are met in the future and are matched to the individual needs of the people who live at the home. There are records that need to be improved, in order to give better information and to present this in a clearer format. CARE HOME ADULTS 18-65 Ladyfield Road (26) 26 Ladyfield Road Chippenham Wiltshire SN14 0AL Lead Inspector Malcolm Kippax Unannounced Inspection 4th September 2008 5:00 Ladyfield Road (26) DS0000053430.V368320.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 Ladyfield Road (26) DS0000053430.V368320.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. Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ladyfield Road (26) Address 26 Ladyfield Road Chippenham Wiltshire SN14 0AL 01249 654451 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) Tranquillity Care Ltd Mrs Sharon Wright-Palmer Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning Disability (Code LD) The maximum number of service users that can be accommodated is 6. Date of last inspection 10th September 2007 Brief Description of the Service: 26 Ladyfield Road is in a residential area of Chippenham. The home was originally a semi-detached property with places for three people with learning disabilities. During the last year the home has increased in size, and now has six places. This involved extending the property to include the house next door at number 28 Ladyfield Road. The new accommodation was not being used at the time of this inspection and there were three people living at the home. The directors of Tranquillity Care, Mrs S. Wright-Palmer and Mr E. Palmer, are both involved in the day to day running of the home. Mrs Wright-Palmer is registered as the home’s manager. Each person who lives at the home has their own bedroom. There is a communal room in the original part of the accommodation, which is used as a lounge and a dining area. The extension of the home has provided other rooms that can also be used for communal activities. The range of fees at the time of the inspection was between £675.00 and £1,105.00 per week. Information about the service provided is available in the home’s ‘Statement of Purpose’. Copies of inspection reports are available from Tranquillity Care. They are also available through the Commission’s website at: www.csci.org.uk Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. Initially we asked the home to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how they were performing. It also gave us some information about what has happened during the last year, and about their plans. We sent out surveys to the people who live at the home, and to staff. We had one survey back from a person at the home and we also spoke to a person’s relative. We looked at all the information that we have received about the home since the last inspection. This helped us to decide what we should focus on during an unannounced visit to the home, which took place on 4th September 2008. The visit was made in the early evening so that we could meet with the people who live at the home after they returned from their day activities. We looked at some of the accommodation and talked to a staff member. We made a second visit to the home in order to conclude the inspection with the manager, Mrs Wright-Palmer. We looked at some records and gave feedback about what we had found. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. What the service does well: 26 Ladyfield Road is in a well established residential area, which is not far from the town centre. People who live at the home are involved in the local community. The home is close to places that they go to regularly, either socially or for occupation. One person has family living nearby, who they are able to visit frequently. People can participate in the daily routines and make decisions about what they want to do when at home. During our visit, one person was helping out in the kitchen; another person was watching the evening’s ‘soaps’ on their own television. People who live at the home have individual plans, which describe how they spend their time during the day and on different days of the week. This information helps to ensure that people receive the support that they need and that there is a consistent approach from staff. There is written guidance for staff, which highlights the personal support that people require in order to be safe. Personal Planning books are being used, which helps to ensure that people’s needs are looked at in a person centred way. Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 6 People looked well supported with their personal appearance. The relative that we spoke to told us that they felt people received the support that they needed, and that issues could be discussed with the manager if the need arose. People who live at the home are supported with doing things that they enjoy and find interesting. Meetings are held when people’s needs are reviewed and they can talk about things that they would like to do in the future, such as visiting new places and going to different day centres. Risks are being assessed, which helps people to be safe when taking part in activities and when using certain items of equipment in the home. Procedures have been produced so that staff have information about how to protect people in the home. Checks are undertaken on prospective staff members, which helps to ensure that they are suitable to work with the people who they will be supporting. People who live at the home receive support with decorating their own rooms. We saw bedrooms that reflected people’s interests and their choice of décor. Staff members provide support, so that the accommodation is kept clean and tidy. The home produces a Service Review report, which help to ensure that improvements are identified and implemented for the benefit of the people who live at the home. What has improved since the last inspection? It was reported in the AQAA that developments during the last year have mainly involved the extension of the home, and the increase in numbers to six places. We were told that this would be beneficial for the people who already live at the home, by providing them with additional communal space and areas for different activities. Some parts of the original accommodation were redecorated as part of the home’s development, which has improved its general appearance. The garden has had some further work on it, and provides people at the home with a large recreational space and an area for growing vegetables. People at the home have had some changes in their day activities, and the home is looking at new opportunities for people. One person talked to us about a centre that they attended, which they enjoyed as they could meet people and take part in activities such as art and cooking. We had concerns at the last inspection about how the home had managed people’s medication and recorded this. Since the last inspection there has been a change in the way medication is recorded. The records we saw were up to date and included the relevant details. Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 7 Written information about the home has been amended, so that it is up to date and gives better information about the services and facilities that are available. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ladyfield Road (26) DS0000053430.V368320.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 Ladyfield Road (26) DS0000053430.V368320.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 good. People have the information that they need in order to make an informed decision about living at the home. Standard 2 did not apply at the time of this inspection. Nobody had moved into the home during the last year. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a Statement of Purpose for 26 Ladyfield Road, which had been amended when the home increased in size. A Service User’s guide had been produced for the people who live at the home. We reported at the last inspection that the guide needed to include details of the arrangements for charging, and for paying for services that are not covered by the fees. We saw that information had been added to the guide, so that people knew what the fees did not cover, and what would have to be paid for out of their own money. Mrs Wright-Palmer told us that the new accommodation was unoccupied. There were three people living at 26 Ladyfield Road when we visited, and nobody had moved into the home since it increased in size. The three people had lived together for a number of years, with the most recent admission being in May 2005. We were told in the AQAA that there was a policy and procedure for new referrals and admissions to the home. Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. People’s main needs and goals are reflected in their individual plans. However the way in which the plans are reviewed and recorded means that they are not as informative as they should be, to ensure all people’s needs are met. People are assisted to make decisions about what they want to do and receive support to reduce the risk of being harmed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person who was living at the home had an individual file, which contained a range of care plan forms. The forms described people’s routines, and the support that they needed throughout the day and on different days of the week. Some of the forms concerned specific needs, such as mobility, bathing and people’s physical health and well-being. We saw care plan forms that had originally been written in 2004 and 2005, when people had moved into the home. Some of the forms had been signed at the time by the person living at Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 11 the home, or by a social worker. We read in the Statement of Purpose that there would be a full review of the plan every six months. However, we saw from the care plan records that this was not happening in practice. Some comments such as ‘Reviewed July 2008’ had been written on the individual forms, although these had not been recorded on a six-monthly basis. There was no review section on the forms. Some of the original details had been added to or changed over time, but the information lacked clarity because the most recent information was not clearly identified. Mrs Wright-Palmer confirmed that the plans would be rewritten, and produced in a format which would ensure that the information was sufficiently detailed, clearly presented and reviewed according to the required frequency. A timescale for this was agreed. People’s individual records also included Personal Planning books. These books were designed to contain information that was more ‘person centred’ than the individual plans. There was information about what people liked doing best and how their days were spent. The content varied in detail. They included useful information about people’s likes and dislikes, and the important people in their lives. Some sections would benefit from further detail. For example, in response to the section titled ‘What would you do when you got up?, the response was ‘visit the toilet’. The Personal Planning books included an Action Plan section, where personal goals had been recorded. One person had some recently set goals, which included for example wanting to visit one of the nearby towns. Other goals were more general in nature, covering such things as participating in more activities, and communicating better with other people. There was a section for recording how it would be known that the goal had been achieved. However the responses lacked detail about what the person would have done and the actual tasks or activities involved. We thought that more information could be recorded about how the goals were to be measured and about the progress that people were making towards achieving their goals. We saw records of review meetings that had been held to discuss people’s placements at the home. The meetings were a time when people at the home could talk about their routines and activities, and whether changes needed to be made. People’s files included records of risk assessments. These showed that hazards relating to certain activities and use of equipment were being discussed and decisions made about people’s personal safety. During our visit we saw examples of how people who live at the home made decisions and choices in their daily lives. People were occupied in different ways when they returned from their activities. One person was helping with the evening meal, another person was mainly spending time in their own room, and somebody else was occupying themselves in the lounge. Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. People’s lifestyles include involvement in the local community and in the home’s daily routines. Some new opportunities and developments are being identified for the benefit of the people who live at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We met with people at the home after they had returned from their different day activities. Each person had occupation during the week, which included a mix of regular planned activities outside the home, and other activities that were arranged at home on the day. On the day we visited, one person had been working at a charity shop in the town. Other people had been to local resource and day centres. One of the people living at the home talked to us about the centre they attended. They said that they liked meeting people there, and doing activities such as art and cooking. We read a report from the centre, dated May 2008, which had been prepared for a review meeting. This Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 13 stated that there had been a ‘remarkable difference’ in the person over the last few months, and there was a comment about how much they enjoyed going to the centre. Somebody else at the home also liked art and they had a folder of their art work that we were able to look at. We were told in the AQAA that some changes in activities had been made as a result of a reduction in the service offered at a local resource centre. These included involving people in more community based activities, such as visiting the library, and working in a shop. There were plans to find further opportunities for people. The home’s stated aim was to promote people’s independence. This was reflected in general terms in people’s individual goals, although as reported in the ‘Individual Needs and Choices’ section, there was a lack of detail about the steps that would need to be taken to achieve this. People said that they went to the local Gateway Club each week. Individual diaries were used for recording the activities and social events that people attended. We read that weekend activities included going to a nearby church and some trips into town. The home was well placed for people to access a range of town shops and local facilities. One person had family living nearby, who they visited frequently. We were told about the contact that people at the home had with their relatives. The details of family contacts were recorded in people’s personal records. We were told at the last inspection that additional facilities, such as a recreation room, were expected to be available as part of the plan to enlarge the home. The additional communal areas were now available and Mrs WrightPalmer said that it was the intention to use these areas for new activities in the future. There was a large garden, which provided areas for recreation, vegetable growing and for hanging out washing. During our visit, people were helping out in the kitchen, watching ‘soaps’ on their own television and looking at books. Two people showed us their bedrooms, which had been individually decorated and showed their interests, such as local history. One person had an electronic keyboard in their room. They said that they liked to play it when it ‘when the evenings get darker’. The person who completed a survey confirmed that they can do what they want at different times of day. People who live at the home helped to choose and prepare the meals. The staff member said that the choice of meal was usually made on the day, depending on what food was in stock. We looked at records of the meals that are served. Some meals, such as sausages, mince, and meatballs were prepared regularly. We read in the meeting minutes that staff had been reminded of the importance of providing a balanced diet. We suggested to Mrs Wright-Palmer that it would be useful to get the views of a dietician, so that they could advise about how well the meals being prepared were meeting people’s nutritional needs. Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 14 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 overall. People receive the support that they require with their health and personal care. People are protected by the home’s procedures for dealing with medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People had individual care plans, which included details of the personal support that they needed. This covered a range of areas such as shaving, foot care, bathing, teeth and hairdressing. As previously reported, there were some shortcomings in the review process and the presentation of the information, but the plans were dated to show that they had been reviewed in recent months. We read that support was often in the form of prompting, rather than ‘hands on’ care. For example, it was recorded that one person at the home needed prompting to help them to finish their meals within a reasonable time. When we visited, we heard the staff member encouraging the person from time to time with their meal. Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 15 Guidelines had been written for particular areas, such as the support that people needed with aspects of their behaviour. Risk assessments had been undertaken, including one for moving and handling. Some of the written guidance was not dated and had not been cross-referenced to people’s individual plans. We thought that the recording system could be developed, so that all the information and guidance that had been produced about a particular area of support could be readily identified. People looked well supported with their personal appearance. The relative that we spoke to told us that they felt people received the support that they needed and that any issues could be discussed with the manager. They also thought that their relative in the home was seeing their GP when the need arose. The staff team included male and female support workers. A policy had been produced about gender and the provision of personal care. Records were maintained of appointments with healthcare professionals. Details of health related matters and appointments were recorded in people’s personal diaries. Various day to day events were also recorded in the diaries and the health related information was not highlighted. We thought that separate forms would provide a better record of people’s healthcare. The support we observed when we visited was by way of verbal prompting and encouragement. One person said that they had a shower each morning, and we were told that other people prefer to have baths during the evening. There were sections in people’s plans, which showed the support that they needed at different times of day. The staff member we met said that there were no concerns at the time about the health of the people who live at the home. The people who live at the home did not manage their own medication. Staff provided support with its safekeeping and administration. There was a written policy and procedure for dealing with medication in the home. As with some of the other polices, staff members had signed to confirm that they had read the information. Mrs Wright-Palmer, who is a registered nurse, had devised a checklist for assessing the competency of staff. This was done after a period of supervision and in house training. There were suitable storage facilities for the small amount of medication that two people at the home had been prescribed. No medication was being prescribed on a PRN (‘as required’) basis. A record was being kept of medication received into the home, and of its administration. We had concerns at the last inspection about the standard of record keeping, as there were gaps in the medication administration records. Since the last inspection there has been a change in the way medication is recorded. We saw that the administration of medication was now being recorded in the back of people’s personal diaries. The records were up to date and included the relevant details. We thought that this recording format was adequate for the current arrangements, but we advised Mrs Wright-Palmer to keep it under review. Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 16 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. People have the opportunity to express their views. There are procedures which help to ensure that people are protected and that any concerns are followed up. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Tranquillity Care Ltd. had produced a complaints procedure and a version of this was included in the Service User’s guide. The person who completed a survey confirmed that they knew how to make a complaint, and who they could speak to if not happy. We were told in the AQAA that the home had received no complaints during the last 12 months. The Commission has not received any complaints about the home during that period. Mrs Wright-Palmer had attended a course in adult protection and used the notes from this to devise a policy and procedure for the home. This included an enlarged copy of the flowchart for making a safeguarding adults alert. We saw that the home also had a copy of Swindon and Wiltshire’s procedures for safeguarding vulnerable adults. The staff member we met said that they were aware of the home’s policy on whistle blowing. They also said that they, and all the staff, had been given a Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 17 copy of the ‘No Secrets’ booklet, which summarises Swindon and Wiltshire’s procedures. We have recommended at previous inspections that a policy and procedure are produced about the safe handling of people’s finances. We saw that a policy has now been written, which confirms the need for people’s money to be properly documented and for appropriate receipts to be obtained. We looked at examples of the records that were being maintained and saw that receipts were being kept. It was agreed with Mrs Wright-Palmer that a column would be added to the recording form, to show when a receipt had been obtained for a particular purchase. Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 18 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. The accommodation is meeting people’s needs and is kept clean and tidy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 26 Ladyfield Road is in a well established residential area, not far from Chippenham town centre. It did not stand out as being a care home and the appearance was in keeping with the neighbouring properties. The home was close to places that people went to regularly, either socially or for occupation. It was reported in the AQAA that developments during the last year have mainly involved the extension of the home, which has increased in size to six places. We were told that this would be beneficial for the people who already live at the home, by providing them with additional communal space and areas for different activities. Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 19 There was an enclosed garden at the rear of the property. The original garden at 26 Ladyfield Road was enlarged following the acquisition of the adjacent property, and was providing people at the home with a large recreational space. There were also areas of the garden for growing vegetables and for hanging out washing. Some parts of the original accommodation were redecorated as part of the home’s development, which has improved its general appearance. When we visited, people at the home were using the communal room in the original part of the property. This was the main lounge and dining area. One person had their bedroom on the ground floor, and two people had rooms on the first floor. The doors to the first floor bedrooms had latch type locks, which had been adapted so that they could not be deadlocked. This meant that people, who did not have keys, had to get assistance to unlock their door if it was not kept open. We recommended at the last inspection that a type of lock is fitted which will enable people to use the doors independently. When we visited on 4th September 2008 we saw that the locks had not been changed and we discussed this again with Mrs Wright-Palmer. Mrs WrightPalmer said that the current arrangements were not presenting any difficulties, but confirmed that she would discuss this further with people at home and give people the opportunity to have their own bedroom keys. The accommodation was generally homely in character and people had personalised their own rooms. There was a domestic type kitchen with a separate laundry area. The Environmental Health Officer had last looked at the kitchen during a visit to the home in November 2005. It was reported at the time that it was very clean and there were good standards. The person who completed a survey told us that the home was always fresh and clean. The home looked clean and tidy when we visited. There were no unpleasant odours. We saw some notices around the home and on doors to remind people of the cleaning jobs that needed to be done regularly. These had some practical use, but tended to detract from the homely type environment. Guidance about infection control was available to staff. Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 20 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 and 35 Quality in this outcome area is good overall. People at the home are supported by competent staff. The staff training programme could be developed further, to ensure that this fully reflects the needs and diversity of the people they support. Procedures are in place for the safe recruitment of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a staff team of four support workers, in addition to Mrs WrightPalmer and Mr Palmer who both covered shifts in the home on a regular basis. There had been changes in the staff team during the last year, which had resulted in the recruitment of two new staff members. We were told in the AQAA that following the increase in the number of places it was the intention to recruit more staff. This had not yet happened and the number of people who lived at the home had remained at three. We saw from the records that the current staff held a variety of qualifications and had attended courses that were relevant to their work. The staff member Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 21 we met during the visit on 4th September 2008 had a Certificate in Social Care and a background in working with young people. They had attended a range of courses, which included first aid, medication, manual handling and food safety. One of the two new staff members had achieved a National Vocational Qualification (NVQ) at Level 3. Both of the new staff members had experience in other care settings, and had attended a range of care related courses in their previous employment. Mrs Wright-Palmer said that one staff member had been offered the opportunity to undertake an NVQ at level 4, but had decided that they were not yet ready for this. The new staff members had signed an induction checklist to show that the home’s polices and procedures had been gone through with them. The checklists were not dated to show when this had happened. Some ‘Performance Assessment’ checklists had also been completed. It was seen during the visits that the home had an induction standard manual and workbook that had been produced by a national organisation that provides services to people with learning disabilities. This had not been completed with the new staff members, although we thought that it would have been a relevant induction for them. Some training resources were available in the home for use with staff, in areas such as fire safety, medication and abuse awareness. There was a Service Review Report for 2007–2008, which confirmed the need for staff to attend courses in certain ‘core’ subjects. We had recommended at the last inspection that a training plan is produced which sets out the intention for training and how this is to be prioritised and provided. A plan was not available when we visited and we discussed this further with Mrs WrightPalmer. The two new staff members had been recruited using a recruitment company, which specialised in finding staff for the health and care sectors. The company undertook some of the required checks, including references and proof of identity, and they reported on any ‘fitness’ and work permit issues. Mrs Wright-Palmer said that she maintained responsibility for the completion of Criminal Record Bureau disclosures on new staff, and for checks of the Protection of Vulnerable Adults (POVA) list. We saw evidence of these checks on the staff members’ files. There was no employment checklist being kept. We thought that this would be a useful development, which would give an overview of the recruitment process, and the relevant dates, on a single form. Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 22 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, 41 and 42 Quality in this outcome area is good overall. The manager is qualified and has experience to run the home. Policies and practices protect people and are meeting their current needs. Further developments in management and recording systems will help ensure that people can be confident about improvements and good standards being maintained in the future. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mrs Wright-Palmer is a registered nurse who has managed 26 Ladyfield Road since the home opened in 2004. Mr Palmer, a director of Tranquillity Care and its ‘responsible person’, also worked in the home and was involved in its day to day running. Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 23 Mrs Wright-Palmer and Mr Palmer have both undertaken the Registered Managers Award. Certificates dated April 2008 were issued after there had been some delay in the verification of the awards. Mrs Wright-Palmer had completed training courses that staff members were expected to attend, as well as some other ‘one-off’ events. These have included a Dignity and Respect conference in June 2008. It was stated in a policy on quality assurance that questionnaires had been sent out to social services, day centres, staff, relatives and service users. The information was assessed, and a plan of action put into place. There was a Service Review Report for 2007–2008 in the home, which set out a number of recommendations for improvements and commented on how these could be achieved. They had been worked through during the last year. Mrs WrightPalmer said that surveys were due to be sent out again and a new report produced. The 2007–2008 report did not directly show the results of the feedback that had been received and we thought that more details could be included about the outcome for the people who live at the home. The responses that we received in the AQAA also lacked detail and we confirmed with Mrs WrightPalmer the level of information and evidence that was expected. The standard of record keeping had improved in some areas during the last year. However, some records and procedures that we saw were not consistently dated. We also thought that the format of some records, for example people’s individual plans, made it difficult to see when the information had been updated. Health and safety records were kept on file. There was a landlords gas safety certificate dated 1st October 2007. We saw a fire risk assessment that was dated 22nd May 2008. Other risk assessments had been undertaken in respect of some environmental hazards and there was information about the safekeeping of hazardous materials. A range of checklists was being completed in connection with health and safety. A general health and safety check of the home was being carried out each month. During our visit we saw that fridge and freezer temperatures were being checked regularly. A handrail had been fitted in the bathroom. A person who lived at the home told us that this helped them to get into the bath safely. Radiators were covered to reduce the risk of burning. Records were kept of checks of the fire precaution systems and discussions about fire safety were recorded in the staff meeting minutes. Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 24 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 N/A 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X 3 3 X 3 X 2 3 X Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Timescale for action Individual care and support plans 31/12/08 must be reviewed every six months. They must be produced in a format which will ensure that the information is sufficiently detailed and clearly presented. Requirement 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 That people’s personal goals and their progress with achieving these are more fully reflected in their individual plans. This is so that it will be easier to assess the progress that residents are making and there will be better guidance for staff about the support that they need to provide. This recommendation is outstanding from last inspection. Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 26 2. YA17 That the services of a dietician are obtained, so that they can provide advice about how well the meals being prepared are meeting people’s nutritional needs. That a system of cross-reference is used between the support plans, support guidelines, and risk assessments. This is so that all the information and guidance that has been produced about a particular area of support can be readily identified. 3. YA18 4. YA19 That the details of healthcare matters are recorded on separate forms. This is so that the information can be readily identified, and a clearer record of people’s healthcare is maintained. 5. YA34 That a staff employment checklist is kept. This would give an overview of the recruitment process, and the relevant dates, on a single form. 6. YA35 That a training plan is produced which sets out the intentions for training and how this is to be prioritised and provided. (Initially, a training needs assessment should be undertaken to ensure that the training provided is matched to people’s individual needs and statutory requirements). This recommendation is outstanding from last inspection 7. YA41 That the arrangements for record keeping are reviewed, to ensure that records are consistently dated and clearly presented. Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ladyfield Road (26) DS0000053430.V368320.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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