Care Home: 330 Guildford Road

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What the care home does well The assessment process is sensitively carried out and designed to suit the individual prospective service user. Great care is taken to develop a good understanding of their needs prior to admission, to ensure compatibility with the service users already living at the home and to introduce them slowly and with familiar support to the new home environment. Care plans included full details of all the activities of daily living with instructions to carers of `how we care`. Explanations of how service users make their wishes known were described and each individual had their own communication profile and their preferences, likes and dislikes had all been fully explored and recorded to inform those supporting the individual. One relative commented, `The staff are friendly, extremely patient and understanding and the support and care is of a very high standard.` Each service user had a `Whole life risk assessment`, which assessed the levels of risk in the home environment and all those associated with the activities of daily living showing actions to eliminate or reduce risks to the lowest factor whilst promoting independence. The home was comfortable and the furnishings domestic. Plants, decorative items and pictures were displayed and some of the artwork had resulted from service users` adult education sessions. The valuing of the service users` creative endeavours promoted self-esteem and confidence and confirmed the manager`s commitment to ensuring that the staff respect their workplace primarily as the service users` home. The home was very much the clients` home. Observations confirmed they were relaxed, as they made themselves comfortable on the large sofas. The manager recorded in the AQAA that, `the home`s recruitment procedures supported the Equality and Diversity Legislation and resulted in a staff team made up of people from a rich and diverse cross section of the local community. Their different backgrounds and life experiences enrich the home environment by exposing both service users and staff to different cultures.` A service user commented, `Yes, I am happy`, and a relative wrote, `the home ensures the service users are happy and occupied. The home is always clean and so are the service users. They are well fed and their privacy is respected.` A healthcare professional commented on what the home did well, `It provides a happy, caring and homely environment to support service users and encourages the maximum degree of independence. 330 does a great job, good team, happy environment for service users.` What has improved since the last inspection? Protocols had been put into place giving instruction to staff on when and how often to administer `as required` or `as directed` medication for the protection of the service users. A recent change in the process for ordering goods such as furniture promoted service user involvement and new sofas had been purchased since the previous site visit. New wood-effect flooring had been laid in the lounge, kitchen, and dining room. This had promoted the cleanliness and tidiness of those communal areas in that, where people were prone to spill things, the environment was not spoilt but remained attractive. Three service users had received new bedroom furniture, new flooring had been laid in four of the six bedrooms and two bedrooms had been repainted since the previous site visit. Paper hand towels had been provided in all communal toilets, bathrooms and the kitchen in order to promote good hygiene practices and prevent cross infection. Locks on the doors of the communal toilets and bathrooms had been repaired or replaced in order to protect the privacy and dignity of service users. What the care home could do better: The Statement of Purpose and the Service User Guide would benefit from a review to update the contact details for the Commission for Social Care Inspection to inform service users, their relatives/representatives/ friends and enable them to contact us should they wish to do so. Amendments to Regulation 5 had not yet been included in the Service User Guide to clarify issues with regard to the paying of fees to inform prospective service users, their representatives and commissioners. Policies and procedures should include a Code of Conduct, a Procedure for dealing with Emergencies and Crises and a policy reflecting the home`s access for staff to the `Common Induction Standards` to inform the staff and it is good practice to ensure policies and procedures are reviewed annually to ensure they are kept up to date with current practice. A relative commented, `I can`t think of anything that needs improving. The standard of care in the home is excellent. The staff are caring, pleasant and helpful.` Another relative wrote, `It is a difficult job and more training would help everybody. There is a lot of sitting around doing nothing,` and a third relative commented, `I don`t know of anything the home could do better, I am satisfied with the care my relative receives.` CARE HOME ADULTS 18-65 330 Guildford Road Bisley Woking Surrey GU24 9AD Lead Inspector Christine Bowman Key Unannounced Inspection 18th January 2008 11:00 330 Guildford Road DS0000013489.V357282.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 330 Guildford Road DS0000013489.V357282.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. 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 330 Guildford Road Address Bisley Woking Surrey GU24 9AD 01483 489208 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) manager.330guildfordroad@careuk.com manager.burroughs@careuk.com Care UK Community Partnerships Ltd Care Home 6 Category(ies) of Learning disability (0) registration, with number of places 330 Guildford Road DS0000013489.V357282.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: 2. Learning disability (LD). The maximum number of service users to be accommodated is 6. Date of last inspection 22nd June 2006 Brief Description of the Service: 330 Guildford Road is a large detached property, located off a main road and approximately 1 mile from the village of Bisley. The property is registered to accommodate up to 6 people with learning disabilities, and is owned and operated by Care UK Community Partnerships Ltd. The accommodation is arranged over two floors and comprises of a living room, dining room and a large, separate kitchen. There is a bathroom with toilet and another toilet on the ground floor and a bathroom with toilet plus another toilet on the first floor. There are six single rooms, five of which have a hand washbasin and one having an en-suite bathroom. The first floor of the building is reached by single staircase and there is no passenger lift or chairlift. There are pleasant, well kept gardens to the rear of the property and parking for several cars to the front. The home also has transport available for Service Users. The fee charged is £1,299 per week inclusive of all facilities and services provided. 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit was conducted as part of a key inspection using the Commission’s ‘Inspecting for Better Lives’ (IBL) process. The site visit took place over six hours and was undertaken by Ms Christine Bowman, regulation inspector. The manager, who is also the registered manager of 330a Guildford Road, which is situated adjacent to 330 Guildford Road, was present for most of the day to assist with the inspection process. She had recently returned from statutory leave and was in the process of applying to be registered as manager for the home. The deputy manager was also present and throughout the day service users and staff were observed as they carried out their daily routines. The Annual Quality Assurance Assessment (AQAA) recorded that, ‘all of the service users at the home had severe communication difficulties, which often made expressing themselves verbally very difficult. The staff learned to interpret gestures, moods and behaviour as they became familiar with each individual’. Observations confirmed that the staff understood the service users’ needs very well and two service users were assisted to complete pictorial surveys to give their views of the service. Four relatives/friends/representatives of service users, one healthcare professional and a member of staff also completed surveys and comments from these sources have been included in the report. A partial tour of the premises was conducted and a service user allowed their bedroom to be viewed. Outcomes for service users in respect of the key inspection standards for Care Homes for Younger Adults were assessed and records were sampled including service users’ care plans, staff personnel files, medication administration records, maintenance certificates and accident/ incident and complaints/compliments files to confirm that regulations were being adhered to. An Annual Quality Assurance Assessment (AQAA) had been completed by the manager and sent to the Commission for Social Care Inspection to show how the service had improved over the previous year and how the service users’ views were incorporated into all aspects of the running of the home including plans for the future. Other information recorded on the inspection record since the previous site visit was also taken into consideration. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. Thanks are offered to the management and staff of 330 Guildford Road for their assistance and hospitality during the visit and to the service users, their 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 6 relatives/friends/representatives, the staff member and the health care professionals for completing surveys. What the service does well: The assessment process is sensitively carried out and designed to suit the individual prospective service user. Great care is taken to develop a good understanding of their needs prior to admission, to ensure compatibility with the service users already living at the home and to introduce them slowly and with familiar support to the new home environment. Care plans included full details of all the activities of daily living with instructions to carers of ‘how we care’. Explanations of how service users make their wishes known were described and each individual had their own communication profile and their preferences, likes and dislikes had all been fully explored and recorded to inform those supporting the individual. One relative commented, ‘The staff are friendly, extremely patient and understanding and the support and care is of a very high standard.’ Each service user had a ‘Whole life risk assessment’, which assessed the levels of risk in the home environment and all those associated with the activities of daily living showing actions to eliminate or reduce risks to the lowest factor whilst promoting independence. The home was comfortable and the furnishings domestic. Plants, decorative items and pictures were displayed and some of the artwork had resulted from service users’ adult education sessions. The valuing of the service users’ creative endeavours promoted self-esteem and confidence and confirmed the manager’s commitment to ensuring that the staff respect their workplace primarily as the service users’ home. The home was very much the clients’ home. Observations confirmed they were relaxed, as they made themselves comfortable on the large sofas. The manager recorded in the AQAA that, ‘the home’s recruitment procedures supported the Equality and Diversity Legislation and resulted in a staff team made up of people from a rich and diverse cross section of the local community. Their different backgrounds and life experiences enrich the home environment by exposing both service users and staff to different cultures.’ A service user commented, ‘Yes, I am happy’, and a relative wrote, ‘the home ensures the service users are happy and occupied. The home is always clean and so are the service users. They are well fed and their privacy is respected.’ A healthcare professional commented on what the home did well, ‘It provides a happy, caring and homely environment to support service users and encourages the maximum degree of independence. 330 does a great job, good team, happy environment for service users.’ 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The Statement of Purpose and the Service User Guide would benefit from a review to update the contact details for the Commission for Social Care Inspection to inform service users, their relatives/representatives/ friends and enable them to contact us should they wish to do so. Amendments to Regulation 5 had not yet been included in the Service User Guide to clarify issues with regard to the paying of fees to inform prospective service users, their representatives and commissioners. Policies and procedures should include a Code of Conduct, a Procedure for dealing with Emergencies and Crises and a policy reflecting the home’s access for staff to the ‘Common Induction Standards’ to inform the staff and it is good practice to ensure policies and procedures are reviewed annually to ensure they are kept up to date with current practice. A relative commented, ‘I can’t think of anything that needs improving. The standard of care in the home is excellent. The staff are caring, pleasant and helpful.’ Another relative wrote, ‘It is a difficult job and more training would help everybody. There is a lot of sitting around doing nothing,’ and a third relative commented, ‘I don’t know of anything the home could do better, I am satisfied with the care my relative receives.’ 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 8 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. 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 9 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 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 10 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): Standards 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 provides sufficient information in suitable formats to enable prospective clients, their relatives/friends/representatives to decide if the home will meet their needs and a thorough assessment is carried out to ensure the home is able to meet those needs. EVIDENCE: The Statement of Purpose and the Service User Guide provided sufficient information for service users, their relatives and representatives to make a decision about the ability of the service to meet their needs. Information for service users with learning disabilities was provided in pictorial format with symbols, large print and short sentences to promote their understanding. This information was also available in audio form to enable access for those with profound learning disabilities and those with visual impairment. The manager wrote in the Annual Quality Assurance Assessment that there were plans in place to purchase a symbol programme for the home computer to be able to produce more user-friendly information. Both documents would benefit from a review to update the contact details for the Commission for Social Care Inspection to inform service users, their relatives/representatives/ friends and enable them to contact us should they wish to do so. Amendments to Regulation 5 had not yet been included in the Service User Guide to clarify 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 11 issues with regard to the paying of fees to inform prospective service users, their representatives and commissioners. The majority of the service users had lived at the home for several years, but there had been one admission since the previous site visit. Great care had been taken to ensure the service user, who had lived for many years in a long-term hospital environment, was well prepared and thoroughly assessed prior to a placement at the home being offered. The manager and deputy manager described the process in which the whole team were involved. The deputy manager, who carried out the assessment, was invited to a staff meeting at the hospital. Other staff visited and the prospective new service user was observed taking part in activities as verbal interaction was not possible. ‘It was important to ensure compatibility with the service users already living at the home’, the manager stated. A transition book was given to the service user with photographs of the home, the staff and the bedroom, which would be theirs. Visits were made to the home, initially and then overnight stays accompanied by familiar staff and then without familiar staff and a visit to Brooklands Museum was arranged with another service user. Assessment documentation to support this process was comprehensive covering all aspects of the service user’s health, social and personal care needs. Information with respect to equality and diversity was collected to enable an individual approach to the service user’s care needs. The two service users, who completed surveys confirmed they had been asked if they wanted to move into the home and confirmed that they had enough information about the home before they moved in to decide if it was the right place for them. 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 12 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): Standards 6,7,9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Person-centred planning promotes the involvement of service users in decision-making about their lives with appropriate support and independence is promoted through the balancing of the risk factors involved. EVIDENCE: The care plans of two service users were sampled. Individual care plans developed from care needs assessments were comprehensive covering all aspects of personal, social and healthcare needs. Personal details recorded included ethnicity, disability and cultural and spiritual needs for consideration to be given to these diversity issues for each individual. The involvement of significant others in the service users’ lives including relatives, advocates and health and social care professionals was recorded. Care plans included full details of all the activities of daily living with instructions to carers of ‘how we care’. Explanations of how service users make their wishes known were described and each individual had their own communication profile and their 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 13 preferences, likes and dislikes had all been fully explored and recorded to inform those supporting the individual. The Annual Quality Assurance Assessment recorded, ‘All service users within the home have severe communication difficulties and their abilities to make their needs or preferences known are compromised. Therefore comprehensive care plans have been developed which reflect observations and assessments, which have been made over previous years indicating the preferences of the service users’. Service users had a support needs profile covering areas such as domestic, life skills, leisure, employment and education and a ‘Whole life risk assessment’ assessed the levels of risk in the home environment and all those associated with the activities of daily living showing actions to eliminate or reduce risks to the lowest factor whilst promoting independence. Key workers had been allocated to service users to provide consistency and continuity and records confirmed that care plans had been reviewed and up-dated on a monthly basis. The manager stated that the service users did not yet have a copy of their person-centred plan in a format suited to their communication needs, but these were due to be completed over the next twelve months. Creative ideas had been utilised in supporting service users to make their own decisions and choices. One service user, who had not made decisions for themselves, previously could not cope with more than two choices at the same time. There were many good examples of service users participation in choosing new items for the home and colours for the redecoration of rooms. Three of the four relative/friend/representatives of service users, who completed surveys thought the home always meets the needs of their relative/friend and always met the different needs of the service users with respect to equality and diversity and one thought it usually did. 330 Guildford Road DS0000013489.V357282.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): Standards 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users take part in appropriate activities that take account of their needs and preferences, they are supported to maintain their relationships and to be part of the local community. Service users rights are recognised and they are offered a healthy diet that reflects their individual tastes and dietary needs. EVIDENCE: Individual timetables of activities were included in the service user’s files showing planned weekly events. One service user was attending a day centre, which they enjoyed five days of the week taking part in music, computer sessions, life skills, textiles and art. This service user had retained friends from a previous placement and liked to socialise with them attending social clubs three evenings per week, the manager stated. Another service user attended the Woking Leisure Centre in the afternoon to play football. Other sports such as bowling and badminton were also accessed, the manager 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 15 stated. Good use was made of resources in the local community and the service users all participated in shopping trips and were well known in the village. The home had a car for transporting the service users, but they were also supported to use public transport, the manager stated. Birthdays were celebrated either at the home or with meals out and service users enjoyed trips out, visits to local pubs and annual holidays. One of the two service users who completed surveys stated they always made decisions about what they do each day and the other that they sometimes did. Both confirmed they could do what they wanted during the day, in the evening and at weekends. The manager wrote in the Annual Quality Assurance Assessment, ‘the service is designed to promote inclusion which is often a very difficult area for severely learning disabled adults. The staff team work hard to assist service users to access mainstream community facilities and become part of their local community’. Two of the four relative/representatives of service users who completed surveys confirmed the care home always helped their relative to keep in touch with them and two that it usually did. One relative commented, ‘When I am unable to visit my sister, the home arranges to bring her to visit me,’ and another wrote, ‘they help my relative to write to the family and to telephone them.’ Two relatives thought that the home always supported the service users to live the life they choose and two that they usually did. A relative stated, ‘my sister is very happy where she is. She goes out quite often, which she enjoys and is looked after so well,’ and another commented, ‘the home ensures the service users are happy and occupied. One service user was observed preparing their lunch with support from a member of staff and the Annual Quality Assurance Assessment recorded that, ‘The service users are actively encouraged to participate in the household routine and share in the cooking and domestic chores within the home.’ A pictorial menu was completed showing the meal choices service users had made with the aid of pictures. The dining room provided a pleasant environment for the taking of meals. Records showed that a dietician had been consulted when a service user had experienced weight loss and that this had been thoroughly investigated. A relative commented, ‘the service users are well fed and their privacy is respected.’ 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ personal, health, physical and emotional needs are met according to their preferences and wishes and safe procedures promote their access to medication. EVIDENCE: Personal support preferences were recorded in the service users’ care plans with clear instructions for the staff, who were observed throughout the day showing sensitivity in their interactions with service users as they supported them to carry out their daily routines. Three of the four relatives who completed surveys thought the home always gave the support and care to their relative/friend that they expected/agreed, and one thought they usually did. One relative commented, ‘The staff are friendly, extremely patient and understanding and the support and care is of a very high standard.’ Flexibility was observed in daily routines and one service user, who did not have engagements on the morning of the site visit and had had a strenuous day previously was having a lie in and accessed breakfast at their leisure. 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 17 Service users were all registered with a local General Practitioner (GP) and specialist health professionals such as a consultant psychiatrist and a dietician had been accessed through the GP practice. Records confirmed that chiropodist appointments are made every four to eight weeks, optician annually and dentist every six months. Care UK employed an aroma-therapist for all the homes in the area and sessions could be booked. The four relatives/representatives who completed surveys confirmed the home always kept them up-to-date with important issues affecting their relative/friend’, and one commented, ‘They are very prompt in informing me of any changes.’ A health care professional wrote, ‘the individuals’ health care needs are always met by the service.’ Medication administration records for two service users were sampled, neither of which were able to self-medicate. Both had a clear photograph of the service user for identification, information was clearly recorded, a sample of staff signatures kept and also records of medication received and returned to the pharmacy. Most of the medication was supplied in blister packs from the local chemist and protocols had been put into place giving instruction to staff on when and how often to administer ‘as required’ or ‘as directed’ medication to prevent errors to safeguard the service users. Staff personnel records confirmed that the staff responsible for the administration of medication had accessed medication training. Medication audits were carried out three times each day and the results were recorded to confirm procedures were being followed correctly. The Annual Quality Assurance Assessment completed by the manager recorded, ‘Six monthly audits are undertaken by an independent pharmacist who reviews all documentation, storage and systems in place.’ A health care professional who completed a survey commented, ‘The care service always seeks advice and acts upon it to manage and improve service user’s health care needs,’ and ‘the staff appear to be doing an excellent job of supporting individuals with their social and health care needs.’ 330 Guildford Road DS0000013489.V357282.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): Standards 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home endeavours to ensure that the communication needs of the service users are met to enable them to make their feelings, wishes and views know so they may be acted upon. Complaints are welcomed and systems are in place to protect the service users from the possibility of abuse, neglect and self-harm. EVIDENCE: Since the previous site visit no complaints had been recorded by the home and the Commission for Social Care Inspection had received no complaints on behalf of this home. The two service users who had been assisted to complete pictorial surveys, confirmed they knew who to speak to if they were not happy and knew how to make a complaint. Three of the four relatives/representatives of service users who completed surveys stated they knew how to make a complaint about the care provided by the home if they needed to and one stated they didn’t but had never needed to complain. A healthcare professional who completed a survey commented that, ‘The care service has always responded appropriately if the person using the service has raised concerns about their care.’ A clear complaints procedure was included in the Statement of Purpose and a pictorial version was included in the Service User Guide for the service users to follow should they need to do so and the key worker system allowed for time to be spent with individuals to support their communication needs. The complaints policy welcomed comments and the manager stated in the Annual Quality Assurance Assessment that, an open culture exists whereby staff feel comfortable to 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 19 raise concerns they may have,’ and ‘the service continues to work with service users in developing their communication skills and confidence to express any concerns they may have.’ The home held a copy of the local authority Safeguarding Adults Policy and Procedure and the manager stated that she had attended training in ‘Managing Safety in Adult Protection’ provided by the local authority and that all the staff attended the Protection of Vulnerable Adults training annually. Certificates held on staff personnel files verified this. Risk assessments had been carried out to identify the service users’ vulnerability to abuse and a safeguard was that all the staff go through rigorous recruitment checks including Criminal record Bureau and the Protection of Vulnerable Adults list check prior to the offer of employment. Over the previous twelve months two safeguarding referrals had been made and two investigations had been carried out. One of these had led to a member of staff being referred to the Protection of Vulnerable Adults List (POVA). 330 Guildford Road DS0000013489.V357282.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): Standards 24,25,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable, homely and safe environment, which is clean and hygienic. EVIDENCE: A partial tour of the premises revealed that the shared accommodation consisted of a sitting room equipped with comfortable sofas and a wide screen television, DVD and video player, a kitchen with sufficient space and facilities to enable the service users to be involved in the preparation of meals, a comfortable, pleasant dining room and bathrooms on the ground and first floors. The furnishings were domestic and the result was a homely environment. The manager was determined that the home should not be encumbered by anything institutional and had liaised with the fire service with respect to being exempt, as a small home, to providing fire signage. The manager stated in the AQAA that, ‘a recent change in the process for ordering goods such as furniture promoted service user involvement and that new sofas 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 21 had been purchased since the previous site visit. New wood-effect flooring had been laid in the lounge, kitchen, and dining room. This had promoted the cleanliness and tidiness of those communal areas in that, where people were prone to spill things, the environment was not spoilt but remained attractive’. There were plants, decorative items and pictures displayed and some of the artwork had resulted from service users’ adult education sessions. The valuing of the service users’ creative endeavours promoted self-esteem and confidence and confirmed the manager’s commitment to ensuring that the staff respect their workplace primarily as the service users’ home. The home had a large garden, which the manager stated, ‘ the service users use as they choose and when the weather is fine much time is spent enjoying the garden having barbecues or relaxing and service users are involved in its maintenance’. A service user allowed their bedroom to be viewed. The room was well furnished and pleasantly decorated and there were personal items including photographs displayed. The service user had a comprehensive collection of videos and compact discs reflecting their taste and they nodded their head to confirm they were happy with their room. The manager wrote in the AQAA that three service users had received new bedroom furniture, new flooring had been laid in four of the six bedrooms and that two bedrooms had been repainted since the previous site visit. Locks on the doors of the communal toilets and bathrooms had been repaired or replaced in order to protect the privacy and dignity of service users and paper hand towels had been provided in all communal toilets, bathrooms and the kitchen in order to promote good hygiene practices and prevent cross infection. Infection control was included in the mandatory training for staff and the two service users who completed surveys thought the home was always clean and fresh. A relative commented, ‘the home is always clean and so are the service users’. 330 Guildford Road DS0000013489.V357282.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): Standards 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Safe recruitment practices, appropriate induction and mandatory and specialist training prepare the staff for the supportive role and to meet the service users’ individual needs. EVIDENCE: Staff training records confirmed the home had a core group of loyal and committed staff working at the home to maintain the health and welfare of the service users. The manager stated that, ‘whilst the home had a structured shift system, the pattern was flexible according to the needs of the service users.’ The two service users who completed surveys confirmed the staff always listened to them and acted on what they say and that they thought the staff always treated them well. The AQAA recorded that, ‘all of the service users at the home had severe communication difficulties, which often made expressing themselves verbally very difficult. The staff learned to interpret gestures, moods and behaviour as they became familiar with each individual’. The AQAA also confirmed 50 of the staff team had either achieved a National Vocational Training Qualification at Level 2 or above or were working towards one. A staff member who completed a survey thought there were always enough staff to meet the individual needs of all the people who use 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 23 the service and that they always had the right support, experience and knowledge to meet their different needs. Staff recruitment was sampled and three new staff had been employed since the previous site visit. Two staff personnel files were viewed confirming robust recruitment checks had been completed prior to the employment of the new staff to safeguard the service users. One staff member who completed a staff survey and two carers who were interviewed confirmed that the employer carried out checks; such as Criminal Record Bureau checks, that references had been returned before they started work and that their recruitment had been carried out fairly. Interview notes were retained on files to support this. The manager recorded in the AQAA that, ‘the home’s recruitment procedures supported the Equality and Diversity Legislation and resulted in a staff team made up of people from a rich and diverse cross section of the local community. Their different backgrounds and life experiences enrich the home environment by exposing both service users and staff to different cultures.’ A relative commented, ‘when the staff are new to the work there are always experienced staff nearby to help.’ The staff induction programme was based on the Common Induction Standards and The Learning Disability Award Framework and completed over seven working days to prepare them for working in this specialist area of care provision. Three carers confirmed the induction covered the things they needed to know to do the job when they started and that the training given was relevant to their role, helped them to understand the individual needs of the service users and kept them up-to-date with new ways of working. There was no evidence of specific training with respect to Equality and diversity but there were plans in place to resource this training in the future. Staff Individual training profiles were sampled and up-to-date certificates were viewed for mandatory training. Additional certificates included, Epilepsy, Autism, Risk Assessment, Challenging Behaviour, Assessment workshop for Medication handling, Leadership Skills, National Vocational Qualification at level 3, Team Building and Aging and Learning Disability. The staff training matrix had not been kept up-to-date to show when training updates were due so that bookings could be made. Three of the four relative/representatives of service users who completed surveys thought the carers always had the right skills and experience to look after the service users properly and one thought they usually did. One relative commented, ‘I can’t think of anything that needs improving. The standard of care in the home is excellent and the staff are caring, pleasant and helpful.’ Another relative wrote, ‘It is a difficult job and more training would help everybody. There is a lot of sitting around doing nothing,’ and another stated, ‘I don’t know of anything the home could do better, I am satisfied with the care my relative receives.’ 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 24 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): Standards 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a well managed home which is run in their best interests. Their health, safety and welfare is promoted and protected. EVIDENCE: The manager had many years of experience of working with adults with learning disabilities and was well qualified, holding a degree in Sociology and a Diploma in Social work. Due to recent statutory leave, the home manager’s application to manage this home in addition to 330a Guildford Road, (the home next door, which is also owned by Care UK), had not been completed and she was in the process of re-submitting it. She was also in the process of completing the Registered Managers Award. A member of staff who was interviewed stated that, ‘the manager was approachable, open and empowering and that they enjoyed working as part of the team’. 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 25 The manager stated that the homes’ annual quality assurance surveys had been returned but had since been sent on to the organisation’s Clinical Governance Department to be collated and would be published to service users and their families. The Annual Quality Assurance Assessment (AQAA) completed by the manager and sent to the Commission for Social Care Inspection recorded that equipment had been serviced or tested as recommended by the manufacturer or other regulatory body, that the Control of Substances Hazardous to Health had been appropriately risk assessed and that policies and procedures and codes of practice in relation to Health and Safety had all been reviewed in 2006. Policies and procedures listed did not include a Code of Conduct, a Procedure for dealing with Emergencies and Crises or a policy reflecting the home’s access for staff to the ‘Common Induction Standards’ to inform the staff and it is good practice to ensure policies and procedures are reviewed annually to ensure they are kept up to date with current practice. Maintenance certificates sampled were up-to-date and staff training logs confirmed that training in health and safety, infection control, moving and handling, first aid, fire safety and food hygiene training had been regularly updated to inform the staff. Records were kept of accidents and other serious incidences and the home kept the Commission for Social Care Inspection appropriately informed of such events. There was an ongoing programme of maintenance and repair. 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 4 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 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 27 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation Requirement Timescale for action 14/03/08 5 Amendments to Regulation 5 (1)(bb)(bd) should be included in the Service User Guide to clarify issues with regard to the paying of fees to inform prospective service users, their representatives and commissioners. 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 YA1 Good Practice Recommendations The Statement of Purpose and the Service User Guide would benefit from a review to update the contact details for the Commission for Social Care Inspection to inform service users, their relatives/representatives/ friends and enable them to contact us should they wish to do so. Policies and procedures should include a Code of Conduct, a Procedure for dealing with Emergencies and Crises and a policy reflecting the home’s access for staff to the ‘Common Induction Standards’ to inform the staff and it is good practice to ensure policies and procedures are DS0000013489.V357282.R01.S.doc Version 5.2 Page 28 2. YA40 330 Guildford Road reviewed annually to ensure they are kept up to date with current practice. 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 29 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 330 Guildford Road DS0000013489.V357282.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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