Care Home: 330a Guildford Road

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What the care home does well 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. 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. 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.` 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` medications in order to minimise the risk of errors occurring. Over the previous twelve months a sixmonthly medication audit, carried out by a pharmacist, had been introduced to confirm safe medication procedures to protect the service users. A recent change in the process for ordering goods such as furniture promoted service user involvement and new sofas and a wide screen television had been purchased for the lounge since the previous site visit. Three service users had chosen new furniture for their bedrooms, new flooring had been laid in the hall and lounge, the kitchen units had been repaired and two service users` bedrooms had been redecorated. All these improvements had enhanced the environment for the comfort and pleasure of the service users. An independent provider had carried out a comprehensive fire risk assessment and the service user who had insisted on leaving a chair in the doorway of his bedroom during the day had chosen new furniture. Consequently his bedroom had been reorganised and the habit of propping the door open had ceased, the manager stated. 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. The manager wrote in the Annual Quality Assurance Assessment, `We will continue to work with service users in developing their communication skills and confidence to express any concerns they may have,` and `we intend to purchase a symbol programme for the home computer in order to produce more user friendly information to assist service users in decision making.` Staff who work consistently at the home should be provided with suitable contracts including terms and conditions binding both the employer and the employee to ensure continuity and consistency for the service users. Suitable well-maintained facilities should be provided for the manager and the staff to carry out administrative work, conduct private meetings and meet with visiting professionals and relatives and representatives of service users. 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. CARE HOME ADULTS 18-65 330a Guildford Road Bisley Woking Surrey GU24 9AD Lead Inspector Christine Bowman Key Unannounced Inspection 28th January 2008 11:00 330a Guildford Road DS0000013490.V357283.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 330a Guildford Road DS0000013490.V357283.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. 330a Guildford Road DS0000013490.V357283.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 330a 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.330aguildfordroad@careuk.com manager.burroughs@careuk.com Care UK Community Partnerships Ltd Ms Samantha Jayne Moth Care Home 5 Category(ies) of Learning disability (0) registration, with number of places 330a Guildford Road DS0000013490.V357283.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 5. Date of last inspection 28th June 2006 Brief Description of the Service: 330a 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 5 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 five single rooms, four of which have a hand washbasin and one having a large 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 fees charged range from £1200 to £1800 per week inclusive of all facilities and services provided. 330a Guildford Road DS0000013490.V357283.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, Ms Samantha Moth, was present all 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 next door (330 Guildford Road) in addition to this home. Throughout the day service users and staff were spoken with and observed as they carried out their daily routines. The Annual Quality Assurance Assessment (AQAA) had been completed by the manager and sent to the Commission for Social Care Inspection (CSCI) 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 Annual Quality Assurance Assessment (AQAA) recorded that, ‘all of the service users at the home had severe communication difficulties which made expressing themselves verbally very difficult and the staff learn to interpret gestures, moods and behaviour as they become familiar with each individual’. Observations confirmed that the staff understood the service users’ needs very well and two service users had been assisted to complete pictorial surveys to give their views of the service. Two staff members 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 the welfare and safety of the service users was promoted. 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 330a Guildford Road for their assistance and hospitality during the visit and to the service users and the staff members for completing surveys. What the service does well: 330a Guildford Road DS0000013490.V357283.R01.S.doc Version 5.2 Page 6 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. 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. 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.’ 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’ medications in order to minimise the risk of errors occurring. Over the previous twelve months a sixmonthly medication audit, carried out by a pharmacist, had been introduced to confirm safe medication procedures to protect the service users. A recent change in the process for ordering goods such as furniture promoted service user involvement and new sofas and a wide screen television had been purchased for the lounge since the previous site visit. Three service users had chosen new furniture for their bedrooms, new flooring had been laid in the hall and lounge, the kitchen units had been repaired and two service users’ bedrooms had been redecorated. All these improvements had enhanced the environment for the comfort and pleasure of the service users. An independent provider had carried out a comprehensive fire risk assessment and the service user who had insisted on leaving a chair in the doorway of his bedroom during the day had chosen new furniture. Consequently his bedroom had been reorganised and the habit of propping the door open had ceased, the manager stated. 330a Guildford Road DS0000013490.V357283.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 330a Guildford Road DS0000013490.V357283.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 330a Guildford Road DS0000013490.V357283.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): 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 330a Guildford Road DS0000013490.V357283.R01.S.doc Version 5.2 Page 10 issues with regard to the paying of fees to inform prospective service users, their representatives and commissioners. There had been no new admissions to the home for almost three years, but a comprehensive assessment procedure and documentation were available to support this process 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. Two service users who completed surveys with support from staff stated they had not been asked if they wanted to move into this home and nor had they received sufficient information about this home before they moved in to decide if it was the right place for them, however, they had lived at the home for a number of years. The manager wrote in the Annual Quality Assurance Assessment that, ‘when admitting a new service user detailed information is gathered about the individual to ascertain if we can meet their needs and if they would be compatible with the existing service users.’ Assessment documentation viewed on service users’ files included personal details including ethnic origin, religious and cultural needs, communication needs, health and personal care needs and the likes, dislikes and preferences of the service user from which a person-centred plan of care had been drawn up. 330a Guildford Road DS0000013490.V357283.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): 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 330a Guildford Road DS0000013490.V357283.R01.S.doc Version 5.2 Page 12 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. The manager gave an example in the Annual Quality Assurance Assessment of a service user whose need was identified as a result of his behaviour, which demonstrated that he desired company and occupation at night after the sleep over staff had gone to bed. He could not make a verbal request but the way he behaved demonstrated what he wanted and the service had secured extra funding to cover staff costs to provide waking night staff at the home. The staff received values training through the Common Induction Standards and the Learning Disability Award Framework, which helped them to identify appropriate ways to support learning disabled adults whilst emphasising the need to ensure that they obtain the same rights as non disabled individuals. There were many good examples of service users participation in choosing new items for the home and colours for the redecoration of rooms. The two service users who completed surveys with support confirmed they made decisions about what they wanted to do during the day and at the weekends and one that they decided what to do in the evenings, but the other service user did not answer. 330a Guildford Road DS0000013490.V357283.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): 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, who attended college, took part in life skills, cookery, fitness, woodwork and Tai Chi and attended a ‘Get Together Club’ one evening each week, enjoyed swimming at the local leisure centre two evenings each week and played football at the weekends. Another service user liked to take short walks, play records, listen to the radio, watch television programmes, look at picture books and play simple games when they were not attending college or day centres. The manager wrote in the Annual Quality Assurance Assessment, ‘the service is designed to promote 330a Guildford Road DS0000013490.V357283.R01.S.doc Version 5.2 Page 14 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’. All the service users required support to enable them to do this and the home had a car for transportation, but service users 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. They were supported to keep in touch with important people in their lives and, where relatives/friends had difficulty with transport to the home, arrangements had been made to take the service users to visit them. Service users participated with varying levels of support in the running of their home, planning their meals with pictorial aids, shopping, sharing the cooking and assisting with domestic chores. On the day of the site visit the service users were either attending college, day centres, shopping with the staff for food or having a haircut and lunch out. Only one service user was at home until early afternoon and he prepared lunch with support from the staff. The home had a four-weekly menu and a pictorial menu, which was changed daily, and informed the service users what they had chosen for each meal. The dining room was pleasant, comfortable and the furnishings domestic. 330a Guildford Road DS0000013490.V357283.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): 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. The manager demonstrated her awareness and knowledge of the cultural and religious needs of the diverse community in which the home was located and gave examples of the care she had provided previously to a disabled service user of the Muslim faith. She stated that service users preferences with respect to the gender of the staff providing their personal care or supporting them on appointments with healthcare professionals was always taken into consideration and that service users chose their key workers to provide them with consistency and continuity of support. Service users were supported to select and buy their own clothes and in deciding what they wanted to wear each day. The manager wrote in the Annual Quality Assurance Assessment that, ‘the house routines are flexible 330a Guildford Road DS0000013490.V357283.R01.S.doc Version 5.2 Page 16 and change dependent upon the needs and wishes of service users. There are no set times for getting up or going to bed, visiting, meals, baths etc. The day flows according to the wishes of the individuals, and they are supported to meet the commitments they have chosen to make’. One service user whose file was sampled had a section in their care plan entitled ‘About my health’. This chart contained symbols and recorded the service user’s social worker, General Practitioner, behaviourist psychiatrist, optician, dentist and chiropodist. Records confirmed that chiropodist appointments were 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, who attended on the day of the site visit and conducted a session with a service user at the home. The manager stated that, ‘the home has excellent links with local healthcare services and service users are supported to access them when required’. A music therapist had given support for a period of time following the death of a service user. ‘The current service users are unable to identify their own health needs so require intensive support in this area’, the manager stated. 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.’ 330a Guildford Road DS0000013490.V357283.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 completed surveys either did not know who to speak to if they were not happy or did not answer and did not know how to make a complaint or did not answer. The two staff members who completed surveys confirmed they knew what to do if a service user /relative/advocate or friend had concerns about the home. The home had a clear complaints procedure and a pictorial version for the service users showing them what they could do if they were not happy and the manager stated, ‘the service continues to work with service users in developing their communication skills and confidence to express any concerns they may have.’ The complaints policy welcomed comments and manager wrote in the Annual Quality Assurance Assessment that, ‘an open culture exists at the home whereby staff feel comfortable to raise concerns they may have’. 330a Guildford Road DS0000013490.V357283.R01.S.doc Version 5.2 Page 18 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 no safeguarding referrals had been made. 330a Guildford Road DS0000013490.V357283.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 leather sofas and a wide screen television, DVD and video player and a selection of games. The sitting room led through into the dining room via an archway and was also pleasant and comfortably furnished. Displayed in the communal living areas were pictures and pottery artefacts created by the service users on Adult Education courses. The pictures were tastefully framed valuing the service users’ creative endeavours and promoting their self-esteem and confidence. The kitchen was accessed from the dining room and provided sufficient space and facilities to enable the service users to be involved in the preparation of their meals. The living areas were homely, comfortable and reflected the fact that it was an exclusively male environment. French windows led from the dining 330a Guildford Road DS0000013490.V357283.R01.S.doc Version 5.2 Page 20 room and from the hall between the kitchen and the laundry room into the garden, which was situated to the rear of the home and was equipped with garden furniture for use in the summer months. ‘Bar-be-cues were popular when the weather permitted’, the manager stated, ‘some of the service users enjoy playing football in the garden, two service users like to mow the lawn and one enjoys doing some weeding’. To the front of the home was a large car parking area, which was prone to flooding. The manager recorded in the Annual Quality Assurance Assessment that the planned improvements to address the drainage problem had not taken place due to weather conditions. ‘Our maintenance department has contacted the environment agency for advice about the drainage and we are currently awaiting a response’, the manager stated. Other planned changes with respect to the conversion of the garage next door at 330 Guildford Road (also operated by Care UK Ltd) into a large training room with an office above had not taken place. This office was intended to be for the manager who is managing both services, leaving the existing offices in each house free for use by the deputies and other members of staff. The existing office was very small and in need of complete refurbishment. 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 and a wide screen television had been purchased since the previous site visit and three service users had chosen new furniture for their bedrooms’. New flooring had been laid in the hall and lounge, the kitchen units had been repaired and two service users’ bedrooms had been redecorated. The service user’s bedroom, which was sampled, was appropriately furnished, personalised with pictures, photographs and other items, which reflected their taste and interests. The home had an infection control policy and staff training logs confirmed they had received training in the prevention and management of infection. The laundry room was clean, had an impermeable floor covering and hand washing facilities were provided to promote good hygiene practices. The position of the laundry facilities ensured that soiled linen would not pass through areas where food was stored or prepared. The home was clean and fresh and a service user who completed a survey thought it was always so. 330a Guildford Road DS0000013490.V357283.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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: The AQAA confirmed that 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 the service and one thought there usually were. Both confirmed they always had the right support, experience and knowledge to meet the different needs of the service users with respect to equality and diversity. One of the two service users who completed surveys thought the staff always treated them well and always listened and acted on what they say and the other service user thought they sometimes did. 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’. 330a Guildford Road DS0000013490.V357283.R01.S.doc Version 5.2 Page 22 Four part-time staff had left the employment of the home over the previous twelve months, the AQAA recorded. One staff member, who was interviewed had left the employment of the home some time ago but had returned, was very positive about the management style of the home and stated they felt involved and valued. The personnel files of two staff employed since the previous site visit were sampled, confirming robust recruitment checks had been completed prior to their employment to safeguard the service users. Two staff, who completed surveys, confirmed the employer had carried out checks, such as Criminal Record Bureau and references, 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’. Some staff who worked at the home consistently were provided with ‘bank staff’ contracts which required no obligation on behalf of the employee to accept work offered and no obligation on behalf of the employer to provide work. 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. Two staff, who completed surveys, thought the induction covered everything they needed to know about the job before they started very well and that they were given training which was relevant to their role. One thought they were given training which helped them to understand the individual needs of the service users with respect to equality and diversity issues and that the training 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, Sexuality and Personal Relationships, Risk Assessment, Maketon, Bereavement, 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 330a Guildford Road DS0000013490.V357283.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. She was also in the process of completing the Registered Managers Award, which had been delayed due to statutory leave. Her application to manage 330 (the home next door which is also owned by Care UK Ltd) had not been completed also as a result of statutory leave and she was in the process of re-submitting it. The manager stated in the AQAA that she tries to create an open culture within the home where staff and service users feel valued and able to be involved of the running of the service. 330a Guildford Road DS0000013490.V357283.R01.S.doc Version 5.2 Page 24 A member of staff who was interviewed confirmed this was the case and stated that, ‘the manager was approachable, open and empowering and that they enjoyed working as part of the team’. 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 review policies and procedures 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. A requirement, which had been made at the previous site visit, was that the manager must ensure that the risk assessment carried out regarding the provision of door safety devices is signed by, the fire officer completing that assessment. A full fire risk assessment had been carried out by an independent company in the meantime and the situation referred to had changed in that the service user who had insisted on using a chair to keep his bedroom door open had chosen new furniture and no longer habitually blocked open his bedroom door, the manager stated. 330a Guildford Road DS0000013490.V357283.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 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 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X 330a Guildford Road DS0000013490.V357283.R01.S.doc Version 5.2 Page 26 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. Staff who work consistently at the home should be provided with suitable contracts including terms and conditions binding both the employer and the employee to ensure continuity for the service users. Suitable well-maintained facilities should be provided for DS0000013490.V357283.R01.S.doc Version 5.2 Page 27 2. YA34 3. YA37 330a Guildford Road 4. YA40 the manager and the staff to carry out administrative work, conduct private meetings and meet with visiting professionals and relatives and representatives of service users. 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. 330a Guildford Road DS0000013490.V357283.R01.S.doc Version 5.2 Page 28 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. 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