Care Home: 28-30 Woolston Road

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What the care home does well What has improved since the last inspection? The home was last inspected in July 2006 but no requirements were made as a result of that visit. The home then closed for major refurbishment. This work was scheduled for completion by June 2007, but delays resulted in the home opening later and the first admission of a service user was in November 2007. The home was previously registered to admit people with physical disability but this category has since been removed and the home can only accommodate people whose primary need is learning disabilities. The homes has also reduced its numbers from accommodating eight to six service users. The refurbishment of the home has been completed to a high standard and offers spacious accommodation and high quality furnishing and equipment. What the care home could do better: The home could do better to ensure health action plans are completed in full and are regularly reviewed and updated to reflect the changing needs of the service users. This includes care plans that are specific to service users` health care needs such as the management and treatment of epilepsy.The home supports people with limited or no verbal communication skills and therefore is advised to consider how it can support them to raise and express their concerns. The home is required to ensure all staff is recruited using a robust recruitment procedure, this is to safeguard service users from potential risk of abuse. Inconsistencies in obtaining specific information such as criminal record bureau checks (CRB) and references was observed at the time of the visit. CARE HOME ADULTS 18-65 28-30 Woolston Road Butlocks Heath Netley Abbey Southampton Hampshire SO31 5FQ Lead Inspector Christine Walsh Unannounced Inspection 31st March 2008 10:30 28-30 Woolston Road DS0000055425.V359107.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 28-30 Woolston Road DS0000055425.V359107.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. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 28-30 Woolston Road Address Butlocks Heath Netley Abbey Southampton Hampshire SO31 5FQ 023 8045 3396 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) Robinia Care Ltd Miss Amy Jane Sanger Care Home 6 Category(ies) of Learning disability (3), Physical disability (3) registration, with number of places 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning |Disability - (LD) The maximum number of service users to be accommodated is 6. 2. Date of last inspection 4th July 2006 Brief Description of the Service: 28-30 Woolston Road is a care home providing personal care and accommodation for six younger adults with learning disabilities. The home is owned and operated by Robinia Care Limited, an organisation that has been a registered care provider since 1995. All residents are accommodated in single rooms. Four of the rooms are situated on the first floor and have en-suite facilities. The two rooms on the ground floor share an assisted bathroom. The home has a large lounge with an alternative room, used as a quiet area. There is a large enclosed garden to the rear of the property, which is situated in a quiet residential area of Netley Abbey, close to local amenities. Fees vary between individuals from £2.266.0 - £2.558. 0 per week. In addition service users pay for their haircuts, personal requisites, homeopathic remedies (Variable), Chiropody, annual holiday above £500.00 and a contribution towards lunch out. 28-30 Woolston Road DS0000055425.V359107.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. This site visit formed part of the key inspection process and was carried out over one day by Mrs C Walsh, regulatory inspector and the acting manager assisted with the inspection visit. The registered manager who has since left the service completed an Annual Quality Assurance Assessment (AQAA) document, which was returned to the Commission for Social Care Inspection prior to the visit to the service. In respect of equality and diversity the AQAA informed us that the service ensures staff receive training and are provided with appropriate polices and procedures. It was evident through the course of the visit by talking with staff and service users that staff have an understanding of equality and diversity, using a person centred approach and respecting the service users individuality and wishes. The information obtained to inform this report was based on viewing the records of the people who use and work for the service, of which two service user records were looked at in depth. The day-to-day management of the home was observed, and discussions with residents and staff took place. Comment cards were received and also assisted in informing this report. Prior to carrying out this key unannounced visit the Commission for Social Care Inspection received information raising concerns that the service was not meeting the care needs of the service users. The outcome of this visit shows us that the service has taken seriously the concerns of the care managers and improved these areas of documentation and care practices. The people who use this service are referred to as service users. What the service does well: 28 – 30 Woolston Road does well to ensure it provides prospective service users and their representatives with information about the home, it assesses if it can meet their needs and supports them to become familiar with their new surroundings and others living in the home by supporting regular visits prior to moving in. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 6 The home does well to support the residents using a person centred approach, respecting their wishes, decisions and aspirations. It encourages the service users to develop and maintain their independence, integrate into their local community and maintain contact with family and friends. The staff do well to ensure the physical and psychological needs of the service users are being met, providing them with support to access health care professionals such as GP’s, dentists, speech and language therapist and psychologists and supports them with their medication. The home listens to the service users needs and wishes and shows us that it will act promptly to deal with any concerns or complaints the service user or their representatives may have. Staff are trained to protect the service users and to inform someone immediately if they are concerned that they are at risk of harm. 28 – 30 Woolston Road offers a homely, safe and welcoming environment, which is spacious, tastefully decorated and furnished and offers individual bedrooms that are personalised and decorated to the service users liking. The acting manager and the staff are provided with the skills and the training to meet the needs of the service users. They go through an interview and induction process followed by mandatory training, such as moving and handling, and fire safety and specific training such as abuse awareness, communication and managing challenging behaviour. What has improved since the last inspection? What they could do better: The home could do better to ensure health action plans are completed in full and are regularly reviewed and updated to reflect the changing needs of the service users. This includes care plans that are specific to service users’ health care needs such as the management and treatment of epilepsy. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 7 The home supports people with limited or no verbal communication skills and therefore is advised to consider how it can support them to raise and express their concerns. The home is required to ensure all staff is recruited using a robust recruitment procedure, this is to safeguard service users from potential risk of abuse. Inconsistencies in obtaining specific information such as criminal record bureau checks (CRB) and references was observed at the time of the visit. 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. 28-30 Woolston Road DS0000055425.V359107.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 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures the people who wish to move into the home have their needs assessed prior to admission to make sure they can meet their needs. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that the home does well to provide a full assessment of service users’ needs to ensure that their needs can be met. The AQAA also informed us it provides all interested parties with a service user guide and statement of purpose, which can be obtained in an accessible format to meet services users communication needs. This was tested by viewing the Service User Guide, assessment documents for two service users, accompanying documents and speaking with the acting manager. The service user guide has recently been updated and provides information about the facilities the home provides, but in its current format it does not meet the cognitive and sensory disabilities of all the service users. The acting manager stated that the service has plans to adapt the Service User Guide and will in future consider the communication needs of people referred to the home and will add in the views of the service users. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 10 Both service users currently living in the home have moved internally from other Robina Care Ltd services. The home can evidence that it undertakes a thorough assessment and moving in process when considering if it can meet the needs of the prospective service users. The assessment includes the services user strengths, area of support required, likes, dislikes, hobbies and interests and cultural beliefs. The assessment documents show us that where required other professionals will be involved in the assessment process such as occupational therapists and GP’s. In addition information is obtained from relatives and social workers where appropriate. Other documents showed us that the home had taken care during the moving in process, ensuring the services users had a named carer and had visited the home on a number of occasions before moving in. Staff from the service users previous home met with new staff and exchanged information. Outcomes of each contact and visit were recorded. A comment card received from a care manager confirmed that a thorough three-day assessment was undertaken before her client moved into the home. She went onto say: “During the transition process the staff at Woolston Road provided respect and enabled dignity”. The home does not provide respite care but currently a service user is being supported in the home with a designated staff team and a separate area of the home whilst their own home is being refurbished. 28-30 Woolston Road DS0000055425.V359107.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. This judgement has been made using available evidence including a visit to this service. The home does well to ensure the people who use the service have their needs met using a person centred approach and have a say about how they wish to receive their care and support and make decisions about their everyday lives. The risk to health and welfare is minimised by using a risk management approach. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that the home does well to adopt a person centred approach when developing plans and supports them to make informed decisions about their lives. The AQAA also states that risk assessments are developed to enable and not restrict activities that could pose a potential risk. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 12 This was tested by viewing the personal plans of the service users and accompanying documentation, speaking with a service user, observing care practices and speaking with staff. On the cover of the personal file of one service user it asks that the reader seek permission from the service user before reading the information. Information was sought from the service user who agreed that their personal plan could be looked at. Each personal plan has been written as if the service user has written it themselves (First person) and includes care plans covering personal care, providing a safe environment, communication and behaviours. All plans identify the need, the outcome and the actions to be taken by staff. These were written clearly and enable the reader to support the service user using a consistency of care and a person centred approach. There is evidence to show us that the plans are reviewed, involve the service user and are read and signed by staff, although there was evidence that some staff hadn’t signed to say they had read certain plans. The acting manager said he would ensure this was addressed. A record of the service users day is completed for each care plan and describes what action staff and the response from the service users took. A service user said she was aware of her personal plan and is involved in developing her own plans. She also went onto say that the information in the plans are a true reflection of what she can and cannot do. Throughout the course of the day and by viewing personal plans it was clear that the home supports service users to make decisions about what they would like to do, eat and wear, and is in the process of developing life plans which looks at the service users wishes, goals and aspirations. The home supports a service user with communication difficulties. The acting manager said the staff have developed an understanding of the service user’s gestures and behaviours and said the home is working with a speech and language therapist to develop a communication passport. Currently the home has developed a picture menu, a daily activity picture board and uses yes and no cards when encouraging the service user to make choices. Personal plans include risk assessments and these are linked to care plans, identifying the risk associated with the activity such as moving and handling. The risks associated to cooking, making drinks, going to the hairdressers, using the bathroom and accessing the garden have been assessed. The risk assessment identifies the specific hazard, the current control measures and the likelihood of the risk occurring. These have been written in plain English and clearly describe what the staff must do to minimise the risk/s. Risk assessments recorded that staff have signed to say they have read the 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 13 information. This shows us that the service takes seriously the need to ensure all staff are fully aware of what they must do to safely support the service users. A care manager commented: “The service does well to pay attention to detail and providing an individual care package”. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 14 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. This judgement has been made using available evidence including a visit to this service. The home ensures that the people who use the service are supported to participate and engage in activites of their choice, maintain contact with family and friends and provides them with meals that meets their dietary needs and preferences. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that the home provides a range of activites and opportunities for the people they support to engage in valued and fulfilling activites of their choice, which includes leisure, education, accessing the community whilst promoting the service users independence with personal and domestic tasks, and maintaining relationships with family and friends. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 15 This was tested by viewing the service users personal activity plans and associated documentation, speaking with the service users, observing activity on the day and speaking with a member of staff and acting manager. The home can evidence that it supports the service users to take part in everyday life activites with the emphasis on encouraging independence, choice and community participation. Both service users have a weekly activity record in their personal plans, which showed us that they are involved in a number of activities such as bowling, trampolining, and arts and crafts. Photographs were also seen that showed service users enjoying activities. Other activities include swimming, cooking, shopping, going to the local pub for lunch and foot massages. Daily notes record the activity the service user has been involved in and how the activity went for the service user. Currently the service users are accessing a day service that they used when living in their previous home. As this quite a distance to travel several days a week, the acting manager stated that this arrangement was being looked into whilst the service users wishes will be taken into account. A member of staff said: “I like this part of my job, it’s rewarding to see the service users enjoying themselves whilst developing new skills”. A service user said: “I like to go shopping, it makes me feel good when I buy something nice. The staff help me to do this” Evidence in one service user’s plan showed us that the home has “circle of support” information, (this is a document that informs the service user and reader of who is involved in their lives and to what extent). It told us that for this service user there is regular contact with family and friends, and the home supports the service user to visit family and friends and to speak on the phone. A record of these visits is kept and the acting manager said that the relatives are very much involved in the services user’s health and welfare. Prompts in the service users’ care plans and the induction programme carried out by staff, informs and reminds them of the rights of the service users and how the staff can support them in various activites whilst recognising the services users have a right to choose, make decisions and to do things for themselves within safe parameters. A member of staff was aware of the importance of this and said she feels it is important for services users to be 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 16 supported to do as much as they can for themselves to improve independence and self-esteem. The homes staff are responsible for preparing the meals, which are planned in advance. Fresh produce is used although not all meals are prepared from scratch. The home is in the process of developing a picture menu to assist service users who are unable to verbally communicate. Objects of reference are also used to support the service user to make choices. In a service users personal plan a specific care plan has been devised for mealtimes and includes the identified need, the expected outcome, identified risks and support required. Further evidence showed us that the home has involved health care professionals such as a speech and language therapist and a dietician. A concern which was identified in respect of a service user not having their dietary needs and health care needs monitored as required, has been resolved by the interventions of the health care professionals, and the staff taking more care to monitor and record outcomes for the service user. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 17 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. This judgement has been made using available evidence including a visit to this service. The home does well to ensure the people who use the service receive the appropriate support with their personal care, health care and medication in the way in which they require and prefer. However the home must ensure that health action plans are completed in full, regularly reviewed and updated. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that the home does well to ensure the services users attend regular health care appointments, to ensure that good levels of health and wellbeing is maintained. An annual medical review takes place by a general practitioner employed by Robina Care Ltd in a person centred and respectful manner. The AQAA went onto say that the service users are supported to the best of their ability to chose their clothes and hairstyles and are supported to take their medication by staff who have received training. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 18 This was tested by viewing the service users health action plans and associated documentation, observing care practices including the administration of medication and speaking with service users and staff. Service users’ personal plans provide staff with information on how the service users wish to spend their day, written as if the service user has written it themselves. For one person it tells the staff when the service user likes to get up, support needed with personal hygiene at that time, that the service user likes a cup of tea and to watch TV until day staff come on duty when breakfast will be chosen. The information reminds staff of the importance of promoting the service users dignity and privacy, and promoting independence when supporting the service user with personal care. Daily records tell us how the service users have spent their day and what they have chosen to do. Each service user has a health action plan, which provides information on medical history, current general health, people who are important to the service user including family and health care professionals and a health diary. It was noted that the health action plans require reviewing, completing in full and updating where changes have occurred in respect of the service users health and wellbeing. It was noted that not all health care plans had been updated as required by specific health care professionals. This included a care plan for the care of a service user with a specific health condition information on the care plan differed from a recent report from a neurologist. There was evidence that staff had received training in the use of a life saving devise and oxygen. The acting manager confirmed that the service user was attending an appointment for soon and he would ask that the care plan be altered to reflect current care and treatment practices. The home has systems in place for the administration of medication. The home uses a monitored dosage system which is supplied by a well-known high street pharmacy and who also provide training for staff if required. Medications are received, stored, recorded and disposed of using systems as recommended in the Royal Pharmaceutical Guidelines. Observation of the administration of medication showed us that the home has adopted safe procedures for the administration of medication including shaking liquid medications and signing following administration. Staff are provided with training by the organisation, which includes understanding the use of the medication, potential side affects and following correct policy and procedures as recommended by The Royal Pharmaceutical Guidelines. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 19 The service users have care plans in place for staff to follow in respect of “as required medication”, such as medications used in the management of inappropriate behaviours and epilepsy. These were observed to be clear and provide step-by-step guidance for staff including initial triggers leading to behaviours, and at what point the medication needs to be administered. “As required medications are only given with the consent of the person on call who is a senior person acting on behalf of the organisation. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home does well to listen to and act upon the concerns raised by the people who use the service and ensures as far as feasibly possible that they are safeguarded from potential risk of harm. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that the home has a complaints file where complaints are logged, and what action has been taken. Monthly service users meetings are held and one to one time with the services user with a keyworker allows them to express any concerns they may have. The AQAA went onto say that staff receive training in adult abuse and have access to policies and procedures. This was tested by viewing the complaints procedure, log book, and speaking with service users and staff. Records held in service user files and the complaints procedure provides evidence that the service listens to the services users’ concerns and views. A complaints procedure is held within the service user guide, but the service must consider if the current complaints procedure in its current format meets all the services users’ cognitive and sensory needs. A member of staff said that she is aware when a service user is unhappy by how they express themselves through their behaviours. Evidence of this is recorded in the service users care plans. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 21 The staff member went onto say that if a service user expressed that they had a concern or a complaint they would listen record in detail in the service users daily notes and the complaints log book and report it to her manager. A service user said that there were no complaints, and the staff very good, helpful and listened. The service user went onto say that the staff and the manager are approachable and if there was a concern it would be listened to. On the day of the visit five staff were attending abuse awareness training, which was being provided by the organisation. This was identified as an area of improvement in the AQAA and was in the process of being achieved. The staff spoken with at the time of the visit said they were aware of the different types of abuse and was able state clearly what she would do if they suspected abuse was taking place. Policies and procedures are in place in the home that link with the local authorities safeguarding procedures and the governments white paper “No Secrets”. The home supports service users who have the potential to challenge and exhibit inappropriate behaviours. There are clear care plans in place that provide staff with step by step guidance including the triggers, recognising the first stages of the behaviour and what steps to take to prevent the behaviours escalating, and guidance to the use of “As required medications”. Although this states that this is considered as a last resort and can only be administered following authorisation from the senior manager on call. This action limits the risk of using these medications inappropriately. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home does well to ensure the people who use the service live in a welcoming, comfortable and clean environment. A major refurbishment has made significant improvements to the home and now provides a more homely and pleasant environment to live in. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that the home is clean and tidy throughout, all areas downstairs are on one level and accessible to all service users and the garden is well maintained. The AQAA also tells us that the home has infection control policies and procedures in place. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 23 This was tested by taking a tour of the building, viewing bedrooms currently not in use, speaking with the service users about their home and personal space viewing maintenance records. The home has recently reopened following a total refurbishment of the environment, its décor and furnishings. These alterations have been completed to a high standard and appear to meet the needs of the service users. There are three communal rooms one of which is in the process of being transformed into a quiet and sensory room and a separate dining room. The home has a fully equipped kitchen and bathrooms that have been designed to meet the physical needs of the service users. The home can support up to six service users. The empty bedrooms were viewed and have been completed to a high standard with en suite bathing facilities. The acting manager stated that wall colours and soft furnishings can be changed to meet the preference of the service users, which is established when a prospective service user is planning to move in. The home has an enclosed garden that has a disable access for those with limited mobility. A service user said that they would use the garden more when the better weather comes but is happy that from where they sit during the day she can see into the garden. The same service user said that they had been involved in choosing how they would like their bedroom decorated and furnished and is happy with how it looks. The ground floor is level throughout and the service users can access all parts of downstairs in a wheelchair if required. Moving and handling equipment is available to assist service users in and out of bed and the bath if required. The acting manager said that staff have received training in moving and handling. The staff are responsible for maintaining the homes cleanliness. The home was observed to be tidy, clean and free from offensive odours at the time of the visit. The acting manager said that the service users are encouraged to help with the domestic tasks in the home including keeping their own rooms clean and tidy. The home has policies and procedures in respect of infection control and Control of Substances Hazardous to Health (COSHH). Equipment is in place to minimise the risk of cross infection such as disposable gloves, hand gels and clinical waste bags and specific instruction on how to work with people who have communicable diseases. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does well to ensure that the people who use the service are supported by adequate numbers of skilled staff, but a more robust recruitment system must be put in place to safeguard the people from potential risk of harm. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that the home does well to ensure all its staff are trained in areas such as epilepsy, first aid, equal opportunities/values, to ensure the people they support are treated with dignity and respect. The staff are supported to do a national vocational qualification (NVQ). The AQAA did not tell us how it recruits its staff a key standard that is viewed at every inspection visit. At the time of the visit the home was not fully occupied. The acting manager said that currently they were in the process of assessing other service users who were thinking of moving in. A member of staff and the acting manager were on duty at the time of the visit, covering a long day shift, as other staff 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 25 who had recently started working in the home were on an abuse awareness course. Both members of staff were observed to go about their roles and responsibilities calmly and were observed spending time with the service users. Despite the staff having to carry out domestic tasks and prepare meals the home was clean and the service users received regular snacks, drinks and meals throughout the day. At the time of the visit it was established that only two of the 10 staff had a National Vocational Qualification (NVQ). The home has been open less then six months and the majority of staff are new to the service. The acting manager is advised that the National Care Standards advises that 50 of its staff have a NVQ. The AQAA told us that it could do better and plans to enrol new staff on NVQ courses with support from the organisation in the next twelve months. This shows us that the service recognises that staff are advised to achieve this qualification. The recruitment records for six staff were viewed some who are newly appointed. Although there was evidence that staff had completed an application form, attended an interview, provided identification and names of two referees there were inconsistencies in the information held in staff personal files. Not all staff had evidence of having a criminal record bureau (CRB) and protection of vulnerable adult (POVA) check in place before commencing in the home. One did not have evidence that references had been taken up, and another did not have a contract or information to state when they commenced working in the home. The acting manager and a registered manager of another home who joined us said that all recruitment information is held at head office, and as there was evidence that three of the six staff had all their documents in place that this must be a slip up with the administration of these particular records. The managers were advised that all specified documents must be in place as required for the purpose of safeguarding the service users and inspection. The managers agreed to check the whereabouts of the missing information. The home has a comprehensive training programme and at the time of the visit five of the 10 staff were attending abuse awareness training. Staff receive training as required by law such as moving and handling, first aid, fire safety and food hygiene and training that is specific to the needs of the service users and the aims of the organisation. These include managing-challenging behaviour, which includes passive responses and restraint. The home currently does not use restraint and staff are aware they cannot assist in restraining someone unless they have received training. Staff also receive training in values and standards, personal care, supporting people with a learning disability, Learning Disability Qualification (LDQ) and care of medication. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 26 The AQQA informed us that their plan for the next twelve months is to develop a specific in house induction programme. A member of staff said she had attended a number of training sessions and felt these have provided her with the right skills to meet the needs of the service users. A social care professional answered in a comment card that she felt the staff had the right skills and experience to support her clients individual social and health care needs. The acting manager undertakes support and supervision sessions with the staff. A calendar on the office wall informs staff when their next planned supervision is and informs us that the staff have received regular supervision. Records viewed, and discussion with the acting manager, provided evidence that staff are asked about what they think they do well or need help with, what their training needs are, their keyworker role and how this is working for them and the service user, and if they have any concerns. Staff are set objectives, which are reviewed during the next supervision. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The appointment of an acting manager and the skilled staff has ensured the home is running affectively and in the best interests of the people who use it. The home provides a safe place for the people who use the service to live. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that the registered manager who completed the AQAA has 10 years experience working with people with learning disabilities and appropriate qualification such as the registered managers award (RMA) and Diploma in social work (DIPSW). The AQAA goes on to tell us that the home is regularly visited by senior managers to audit quality and equipment is regularly serviced. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 28 This was tested in part by viewing quality audits and health and safety documents including fire records and spending time with the acting manager. Since completing the AQAA the registered manager has left the service. In acting manager has been appointed with the support of a registered manager from another home. At the time of the visit it was announced that an appointment for a new manager had been made and it was hoped that he would be ready to start in the next couple of weeks. The majority of the visit was supported by the acting manager who was able to answer questions and queries clearly and confidentiality and went about his day-to-day business calmly and professionally. Towards the end of the visit the acting manager was joined by two registered managers from other organisation other services and a telephone call was received from the service manager, this was to establish if everything was going okay. Records held in respect of monitoring the quality of the service such as regulation 26 visits, monthly reviews, monthly meetings and support and supervisions provided evidence that the service users and staff views are sought on a regular basis. The service is advised to consider how it can involve services users who have limited verbal communication in this process. Following a number of concerns in other Robina Care Ltd services the organisation has undertaken unannounced safeguarding audits, which recommended that the staff in 28 – 30 Woolston Road receive training in abuse awareness in a specific timescale. That timescale had been met. Health and safety and service certificates were viewed and showed us that checks are undertaken as specified by the law, but a recent audit of fire safety equipment identified a number of faults. Maintenance records provided evidence that repairs are to take place within the next couple of weeks following the visit, these included emergency exits and escape routes. The acting manager stated that measures had been put in place to use alternative routes and each service user has a risk assessment in the event of a fire. Other fire records provided evidence that alarms, extinguishers and emergency lighting are checked as required by fire safety legislation and staff have received fire safety training and drills on fire evacuation. The home must however seek advice to adjust the closure mechanism on the fire doors, as they repeatedly bang and snap shut causing a potential risk to the service users and staff. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 3 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 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 2 3 X 3 X 3 X X 2 X 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 30 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 YA19 Regulation Requirement Timescale for action 31/05/08 15(2)(b)(c) The home must ensure that “health action plans” are completed in full, reflect the service users health care needs and are regularly reviewed and updated. 2 YA19 15(2)(b)(c) The home must ensure that care 31/05/08 plans developed in respect of treatment for specific health care treatments are regularly reviewed and updated to reflect what health care professionals require. 19(1) Persons must not be employed to work in the care home unless the specified information and documents have been obtained in respect of that person. This is to ensure that the people who use the service are safeguarded from people who are not fit to work in a care home. 31/05/08 3 YA34 4 YA42 13(4)(a)(c) The people who use the service must be protected from the risk of fire, which includes regularly servicing and maintaining checking their effectiveness. DS0000055425.V359107.R01.S.doc 31/05/08 28-30 Woolston Road Version 5.2 Page 31 This includes ensuring fire The fire doors that have been identified in the body of the report are adjusted to prevent banging and snapping shut. 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 YA22 Good Practice Recommendations It is good practice to develop systems to enable people who use the service, who limited or no verbal communication skills, to convey their wishes and raise any concerns. 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU 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 28-30 Woolston Road DS0000055425.V359107.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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