Care Home: 305 Cressex Road

What the care home does well The home deals with a number of diverse care needs offering a personalised service to meet the needs of those using the service. There is a very real commitment to ensure that all users of the service, however diverse their needs may be, receive a person-centred package of care, which meets their needs appropriately. What has improved since the last inspection? A new care plan format is in use which has allowed for a more person centred package of support and care, all of which evidence service users involvement in the care planning and review process. Healthcare plans have been developed which clearly show healthcare needs and evidence is available of appointments that have been made to meet those needs. They enable staff to monitor peoples` health and address any health issues promptly. Improved records of service users individual planned activities and activities they have attended are now documented appropriately. The service has developed generic and specific guidelines, policies and procedures to protect the people who use the service from cross infection. Moving and handling assessments are now undertaken and held in the service users files detailing any actions to minimize any risks. What the care home could do better: Ensure that the heating be maintained and in good working order to ensure comfort for those living in the home. Ensure that all newly recruited staff understand their roles and responsibilities and are provided with an appropriate induction into their role in a timely manner. When individuals choose not to attend NHS services for check ups with the dentist, optician and audiology services, it should be documented in the service users files to evidence that their choice and a risk assessment be put in place where the refusal may be detrimental to their health and well being. A tissue viability assessment should be undertaken for the service user identified in this report and a support plan be put in place in the event of any possible pressure area care.It is strongly recommended that the registered person explore the gaps in employment for the staff member identified within this report and documents the explained gaps in the staff members file and any references received addressed to whom it may concern, be retrospectively verified with evidence of such verification being held on the said persons personnel file. It is recommended that all staff receive an annual appraisal of their work to review performance and agree career development plans CARE HOME ADULTS 18-65 305 Cressex Road High Wycombe Buckinghamshire HP12 4QG Lead Inspector Jane Handscombe Unannounced Inspection 7th August 2008 10:30 305 Cressex Road DS0000069096.V368921.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 305 Cressex Road DS0000069096.V368921.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. 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 305 Cressex Road Address High Wycombe Buckinghamshire HP12 4QG 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) 01494 445239 kim.chew@turnstone.org.uk Turnstone Support Mr Kim Lai Chew Care Home 7 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th August 2007 Brief Description of the Service: The home provides twenty-four hour care for seven people of both sexes with learning and associated physical disabilities. The house is owned by McIntyre Housing Association and the care is provided by Turnstone Support. The service has been in existence for many years but was registered in March 2007 when it was transferred from the Health Authority to Turnstone Support, a private provider who offer care to people with diverse special needs. The house is two domestic dwellings that have been adapted into accommodation for seven people, there are three bedrooms on the ground floor and four bedrooms on the first floor. The first floor is accessed by steep staircases and is not accessible to those with physical disabilities or frailties. Communal accommodation is limited, including a small kitchen. There is a sizeable rear garden, which is not easily accessible to those with physical difficulties. There are adequate bathing and toileting facilities. The home is approximately two miles from the town centre and there are local facilities within walking distance. The home has its own vehicle and residents are able to access public transport. The fees are approximately £1,348.41 to £1,356.39 per week for care and housing services. 305 Cressex Road DS0000069096.V368921.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 the people who use this service experience good quality outcomes. This was an unannounced key inspection, which took place over 1 day and carried out by one inspector; Jane Handscombe. The visit took place on the 7th August 2008. The purpose of the visit was to see how the home is meeting the National Minimum Standards. Results of this inspection report are derived from feedback gained from the service users, discussions with staff during the visit, viewing client’s records held within the service, viewing policies and procedures, staff personnel files, general observation throughout the day, along with information provided to us within the AQAA, a *****and any other information that CSCI has received about the service in order to gain an understanding of how the service meet the service users’ needs, and impact upon their lives. A tour of the home was undertaken, care plans were examined and meeting the residents to see if the care plans gave a true reflection of their care needs and how these were being met followed this up. The inspector met with residents, staff, visiting professionals, relatives and friends to find out their views on how well the service is doing. Records required by regulations were examined, including staff files and the home’s policies and procedures We looked at how well the home was meeting the key standards set by the government and have in this report made judgements about the standard of the service. What the service does well: The home deals with a number of diverse care needs offering a personalised service to meet the needs of those using the service. There is a very real commitment to ensure that all users of the service, however diverse their needs may be, receive a person-centred package of care, which meets their needs appropriately. 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Ensure that the heating be maintained and in good working order to ensure comfort for those living in the home. Ensure that all newly recruited staff understand their roles and responsibilities and are provided with an appropriate induction into their role in a timely manner. When individuals choose not to attend NHS services for check ups with the dentist, optician and audiology services, it should be documented in the service users files to evidence that their choice and a risk assessment be put in place where the refusal may be detrimental to their health and well being. A tissue viability assessment should be undertaken for the service user identified in this report and a support plan be put in place in the event of any possible pressure area care. 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 7 It is strongly recommended that the registered person explore the gaps in employment for the staff member identified within this report and documents the explained gaps in the staff members file and any references received addressed to whom it may concern, be retrospectively verified with evidence of such verification being held on the said persons personnel file. It is recommended that all staff receive an annual appraisal of their work to review performance and agree career development plans 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. 305 Cressex Road DS0000069096.V368921.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 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 Quality in this outcome area is good The home provides good clear information, which is used by prospective residents to help them choose a home that is right for them. All residents have their care needs assessed before moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no new admissions to the home since the last inspection. However, the organisation have policies and procedures in place which provide comprehensive guidance to ensure that a thorough assessment of needs is undertaken prior to a place being offered to a new service user to ensure their assessed needs can be met in full. All current and prospective users of the service are provided with information about the service and the services it offers in the form of a service users’ guide. However, whilst viewing service users files it was noted that the service had not provided them with an individual written contract or statement of terms and conditions, detailing the costs and how much they are to pay towards it. The registered manager assured us that this would be addressed 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 10 and the contact details for the Commission for Social Care Inspection would also be amended to reflect their new address and telephone number. At the time of writing this report we have received correspondence from the provider; a draft of the terms of conditions was forwarded to us detailing the charges and we are assured that each service user will be supplied with an individual statement when the individual statements have been approved. 305 Cressex Road DS0000069096.V368921.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. Clear and consistent care planning systems are in place that provides staff with adequate information that they need to satisfactorily meet service users needs. These contain risk assessments which outline individual vulnerabilities and contain control measures that enable service users to live their lives as independently as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection the inspector viewed a sample of care plans and found them to be individualised and contain appropriate detailed information on the users individual needs and preferences and how these needs are to be addressed. 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 12 Care plans are drawn up and reviewed regularly with the involvement of service users together with family/representatives and other relevant health and social care professionals. People using the service are actively encouraged to be involved in their own care planning and reviews of care with support, this involves them being supported in the organising, the planning, inviting relevant parties and chairing their own review. A local independent advocacy service is provided regularly to those using the service both in group discussions and on a one to one basis when required. During our visit, the independent advocate was in the home visiting people on an individual basis and informed us that he has recently been invited, by a service user to support them and attend their review of care. Risk assessments are contained within the care and support plans detailing any risks present and how these risks are to be minimised whilst promoting users choices and independence. Where high risks are identified the service ensures to review the risk assessment on a quarterly basis, medium risk are reviewed every six months and low risks reviewed on an annual basis. The risk assessments covered areas including, personal care, emotional support, moving and handling, finances, travelling and in the event of a fire. However, it was noted that one of the service users who could be prone to pressure sores, did not have a risk assessment in place for pressure area care/tissue viability and it is strongly recommended that one is put in place. Likewise moving and handling risk assessments did not contain the due service date for equipment in use or the contact details, however we were assured that this would be dealt with accordingly. Service users are encouraged and supported to make decisions about their lives. Regular meetings are held to gain service users views on different aspects of their lives, both within and outside of the home, all of which are minuted. 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. Service users live a full and varied lifestyle according to their wishes and preferences and are encouraged to maintain contact with their families, friends, representatives and the local community as they wish with support being given as required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service ensures that meaningful opportunities are encouraged, supported and promoted. During this visit it was evident from documentation held in service users files and from entries in their dairies that Service users are involved in a range of different activities and pastimes, which include swimming, horse riding, shopping, visits to the theatre and cinema and all have the opportunity to 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 14 attend day service placements within the county, although two service users choose not to attend and direct their own activities. Two of the service users have chosen to attend the local RSPCA where they undertake voluntary work, one walking the dogs whilst another helps with the cats, which they both enjoy. Two service users have taken a recent holiday to Blackpool and the manager tells us that holiday plans are being discussed and arranged for the remaining service users; that he is awaiting confirmation that staff are available to go with them to provide the care and support and if this is not possible, other sources will be accessed to ensure they have the opportunity take a holiday. From viewing documentation within service users files and from discussions with service users, there was evidence of service users leading busy social lives and having regular contact with the community. Arrangements to see family and friends are flexible and service users can choose to receive them in private if required. People using the service are involved in the domestic aspects of the home, with varying degrees of supervision according to their needs, such as involvement in the choosing of and preparation of meals, the laundry and hovering. Individuals spoken to on the day of the inspection confirmed this. All individuals are provided with their own key to their personal bedrooms and to the home, within a risk management process and staff were observed to respect their privacy, knocking on their doors before entering their rooms and addressing them courteously. Service users are provided with healthy nutritious meals, which are freshly cooked on the premises and which they are involved in the choosing of; staff ask what they would like to eat and pictorial guides are provided to enable them to make a choice. Those who have the ability are encouraged to be involved in the preparation and cooking of the meals with support from staff, although if they prefer and choose not to be involved but instead to observe, their wishes are respected. Meals are taken in the communal area of the home, although people can choose to take their meals in the privacy of their own room if required. People are enabled to make snacks and drinks for themselves and for their visitors if required, as was the case during this visit in which a user of the service provided the inspector with a hot drink. 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. Each service user has an individualised plan of care detailing their individual needs, preferences and goals and how these needs are to be met. Medication is securely stored at the home and all required policies and procedures are in place to ensure the health and well being of those using the service This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection undertaken in August 2008, the home is using a new care plan format, which has resulted in service users care plans being more person centred. Each service user has an individualised plan of care detailing their individual needs, preferences and goals and how these needs are to be met. Each person has an allocated key worker who works with him or her on a one to one basis. The home respects individuals’ personal wishes when providing or assisting in personal care and offers same gender personal care whenever possible, they also have a cross gender care policy, which discusses the 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 16 privacy and dignity of individuals. Information provided to us prior to the inspection informs us that the service have acknowledged that improvements need to be made and that they plan to ensure that personal care guidelines are in place for each service user. Service users records viewed during the inspection evidenced that their views, preferences and needs are taken into account when providing care and support. Service users have the necessary disability equipment they require to enable them to maintain their independence and robust risk assessments are in place detailing how the care is to be delivered in a safe manner whilst maintaining and promoting the users independence. A recommendation has been made elsewhere within this report to ensure that tissue viability assessments be undertaken for those who may be at risk at risk of pressure sores. (see section headed Individual needs and choices) Of those service users being case tracked during the inspection it was evident that the carers spoken to were aware of their individual needs and had a good understanding of how to address their needs whilst promoting their independence. People using the service are supported and facilitated to take control of and manage their own healthcare including accessing NHS healthcare facilities in the community such as dentists, opticians, audiologists, chiropody etc and any medical appointments that service users have attended are documented in their individual files. However there was no documentation in one of the two service users files to evidence that the service is ensuring to support the said person to access appropriate services for dental check ups, hearing tests, eye tests and an annual influenza inoculation. Upon discussion with the registered manager, we were informed that the said service user had chosen not to access such services and refused to attend such check ups. It is strongly recommended that such choices be documented in service users files to evidence that they have chosen not to access such appointments and a risk assessment be put in place where the refusal may be detrimental to their health. The service has good working relationships with health and social care professionals and accesses them where appropriate. Medication is securely stored at the home and all required policies and procedures are in place. No individual self medicates at present although there are policies and procedures in place to enable people to do so if they have the ability, within a risk management process. Of those files viewed, each contained a medication agreement form agreeing to staff administering their medication and signed by the said service users. 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 17 All staff are provided with medication training and are assessed on annual basis in both the theory and practical side of administering medication to ensure they are competent to undertake such a task. The home uses the Boots Monitored Dosage System and two staff administers medication wherever possible. The registered manager undertakes an audit of the medication on a monthly basis to ensure that policies and procedures are being adhered to. The pharmacist does not visit the home but is always available on the telephone should the need arise. It was noted that one of the service users files viewed contained a document entitled ‘Medication I take’ , this was not filled in and was blank, however each service user has a medication administration record detailing the medication they are prescribed and have been administered. It is recommended that the registered manager ensures that any relevant documentation held in service users files is completed in full. 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. There is a robust complaints procedure in place, which is produced, in a userfriendly format to meet the needs of those using the service. People using the service feel safe and are protected from harm through the homes policies and procedures and the provision of suitable training for staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a robust complaints procedure, which has also been produced in a user-friendly format and is accessible to both those using the service and their family members/representatives. In addition, each service user is provided with a concerns/complaints/compliments card in their individual service users guide file with a freepost envelope for them to use should the need arise and their link worker discusses the complaints procedure with them to ensure that they know what to do if they have any concerns or complaints. There have been three complaints received during the last 12 months, all of which were dealt with appropriately and resolved within a timely manner. Feedback from surveys sent out to people using the service and feedback on the day of the inspection tells us that they know how to make a complaint, and who they would go to if they had any concerns and that staff listen and sort 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 19 out any problems they have. The organisation’s service manager deals with all complaints and logs of such complaints are held centrally where they record any actions taken and the resultant outcomes. Service users are protected form abuse, neglect and self harm and have all been provided with guidance and support in understanding vulnerable adults issues. All staff are provided with relevant training both in their induction training and regularly thereafter, enabling them to recognise the signs of abuse and how to respond if an allegation or incident is brought to their attention and are encouraged to use the whistle-blowing policy where need arises. There have been three safeguarding allegations made to the service during the last 12 months, all of which were dealt with appropriately. One of these allegations, following an investigation resulted in a referral to the POVA list (Protection of Vulnerable Adults). No further incidences have been brought to the attention of the Commission for Social Care Inspection or to the service itself. Since the last inspection undertaken in August 2007, the home has addressed the shortcomings that were evident around service users monies and finances. Policies and procedures are in place to address the safeguarding of service users monies, individual risk assessments are undertaken and documented within each service users file, expenditure forms are completed by both the service user and member of staff and receipts of all transactions are kept. The registered manager undertakes a monthly audit of the individual service users expenditure forms and receipts to ensure they are in good order and correct. Each service user has been provided with a copy of their individual budget plan and are provided with lockable storage facilities in their rooms to store any personal items and their money safely. 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 and 30 Quality in this outcome area is good. The home provides a safe and comfortable environment for those living there and presents as clean and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection, the inspection toured the home and in one area of the home it was found to be uncomfortably warm. One service user commented upon the heat to the inspector and informed us that the radiators were on continuously during the warmer weather. Upon discussion with the registered manager, it was ascertained that there are problems with turning the heating off in one area of the home, that people had been provided with fans where required and he assured us that he will contact the Housing Association to rectify the problem. A requirement has been made within this report to address the issue. 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 21 The home was generally clean and tidy. Clients said that they liked their bedrooms, which were personalised, clean and well presented. Since the last inspection improvements to the environment include providing service users with lockable storage facilities in their bedrooms, New carpets, curtains and furniture have been purchased to add to the comfort of the home and a ramp has been provided to allow access to the outdoor garden area for those in wheelchairs. The home was free from offensive odours and and washing procedures were in place to prevent the spread of cross infection. 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34,35 and 36 Quality in this outcome area is good. The home has an effective staff team who are well trained and have the skills and competence to keep the residents safe and meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The policies and procedures around the recruitment and selection of staff are robust and serve to protect service users health and welfare. Face-to-face interviews are undertaken and two references are sought. Prior to starting work, all prospective staff are checked against the Protection Of Vulnerable Adults list and a Criminal Records Bureau disclosure is sought to ensure that they are suitable to work with vulnerable adults. People who use the service are encouraged and supported to be involved in the recruitment procedure if they wish. Two users of the service have been very involved in the recruitment procedure and underwent training to enable them to take part in asking questions, that were relevant to them and their fellow service users. However, they have chosen not to be involved in this first 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 23 interview stage anymore but remain involved with all the other service users at the second interview stage. During the inspection we chose to view three staff personnel files to check that robust recruitment process is undertaken, that staff receive regular supervision and that they have received appropriate training to enable them to undertake their roles competently. The three files viewed were of one long standing member of staff and two recently employed members of staff, one who had been in post since May 2008 and the other who had been in post for three and a half weeks. Whilst viewing these files it was evident that there were some shortcomings. Documentation within one of the said files highlighted that there were gaps in the employment record, with no evidence of checking these gaps up and the same file contained a reference addressed to whom it may concern. It is strongly recommended that the registered person explore the gaps in employment record and documents the explained gaps in the staff members file and any references received addressed to whom it may concern, be retrospectively verified with evidence of such verification being held on the said persons personnel file. There was no personnel file for the second staff member who was recently recruited and whose employment began three and a half weeks prior to this inspection; the registered manager explained that said file had not yet been received from the organisations HR department but that it would arrive in due course, we were therefore unable to check that all the appropriate checks had been undertaken prior to them being offered employment. However previous inspections have not highlighted this as an area of concern and acknowledge that there are robust recruitment procedures in place. Discussions with the registered manager informed us that each newly recruited member of staff is provided with a structured induction to enable them to undertake their role competently and to provide them with the knowledge and skills to undertake their roles competently. They shadow an experienced care and support worker until they are confident and deemed competent to work alone. Of the two newer members of staffs files viewed, one file contained an induction checklist and each section had been signed off to evidence that they had been provided with an induction and each section had been signed to evidence that they had the necessary knowledge and understanding. However, the newest member of staffs induction checklist had not been completed appropriately. Areas that are generally covered by the end of the first week had not been fully covered. There was no evidence to suggest that important aspects of their role had been explained to them. The manager assured us that the said person was not working alone and was being shadowed by experienced care and support staff and that he would be working alongside the carer the weekend following this visit and would ensure to 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 24 address this issue. We received confirmation following the visit that this shortfall has now been addressed. We chose to view a fourth file in place of the newly recruited member of staff highlighted above and found that the provider offers a comprehensive training programme, which includes all mandatory health and safety courses and the updating of training is undertaken appropriately. The training programme also includes Protection of Vulnerable Adults, medication, value- based practice, working within professional boundaries and epilepsy. All staff have an individual training profile, set against the home’s training needs analysis. It is an expectation that staff will undergo the National Vocational Qualification (NVQ) in care and of the eight permanent staff four have attained the relevant NVQ at level 2 or above. Staff are provided with regular formal supervision sessions on a one to one basis which is documented within their personnel files and their practices in delivering care and support are observed on an annual basis. There was no evidence of annual appraisals being undertaken for which a requirement has been made within this report. 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 25 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. The home is well managed in the best interests of those using the service. The home ensures that Health and Safety procedures are followed so that service users are as safe as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for several years and was registered with the Commission for Social Care Inspection in March 2007; he is a trained nurse, has 28 years experience in the care sector and has recently gained the Registered Managers Award. 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 26 The registered manager sent us their annual quality assurance assessment (AQAA) when we asked for it. It was clear and gave us all the information we asked for. The AQAA contains clear, relevant information that is supported by a wide range of evidence and informed us of where improvements need to be made and how they are going to attend to these. The Quality assurance system includes regular regulation 26 visits, a report of the visit is kept in the home. Service user meetings are held regularly and minutes of the meetings are held in the home; action plans from the meetings are completed, annual questionnaires are sent to residents, their families and staff. Data is collated from the annual questionnaires and other quality assurance processes and an action plan is developed, details of which are added to the homes continuous improvement plan. The home has a health and safety file and all maintenance checks are recorded. Fire alarm testing is undertaken weekly and fire drills are carried out with the full involvement of the service users. Progress has been made in attending to requirements made during the last inspection undertaken in August 2007. 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 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 3 x 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation 23 Requirement Ensure that the heating be maintained and in good working order to ensure comfort for those living in the home. Ensure that all newly recruited staff understand their roles and responsibilities and are provided with an appropriate induction into their role in a timely manner. Timescale for action 31/10/08 2 YA32 18 30/09/08 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 YA19 Good Practice Recommendations It is strongly recommended that when individuals choose not to attend NHS services for check ups with the dentist, optician and audiology services, it be documented in the service users files to evidence that their choice and a risk assessment be put in place where the refusal may be detrimental to their health and well being. It is strongly recommended that a tissue Version 5.2 2 YA9 viability Page 29 305 Cressex Road DS0000069096.V368921.R01.S.doc 3 YA34 assessment is undertaken for the service user identified in this report and a support plan be put in place in the event of any possible pressure area care. It is strongly recommended that the registered person explore the gaps in employment for the staff member identified within this report and documents the explained gaps in the staff members file and any references received addressed to whom it may concern, be retrospectively verified with evidence of such verification being held on the said persons personnel file. It is recommended that all staff receive an annual appraisal of their work to review performance and agree career development plans 4 YA36 305 Cressex Road DS0000069096.V368921.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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