Care Home: 346b Newton Road

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What the care home does well The staff team has remained stable for some time with very few changes. Staff have got to know the people living at the home very well and have built up warm relationships. The atmosphere is happy and relaxed. Good information is available about the people living at the home; meaning that staff are aware of their different needs and wishes. Key workers regularly review care plans and risk management plans, with any changes being acted upon. Staff help the people living at the home to stay healthy and keep good records of any hospital or GP visits.The new bathroom has been designed and furnished to meet the needs of the three people living at the home. There is plenty of space in this room, which is helpful for the people living at the home and for the staff. What has improved since the last inspection? Since the last inspection more staff have gained a qualification. Now half of the staff team are qualified at level 2 NVQ (National Vocational Qualification). Staff have also taken part in fire safety training, as well as attending refresher training in other health and safety topics. What the care home could do better: Some of the people living at the home spend a lot of their time at home. Staff need to look at ways of increasing links with the community and finding meaningful and fulfilling things for people to do. A new dining table, suitable for all those living at the home, must be provided as at present not everyone can use the existing table. The arrangements for food purchasing should be reviewed, with the need for social interaction and choice being taken into account. The building could be made more homely by the removal of staff notices, which have been placed in the hallway and kitchen. Items such as these could be kept in the office. Work needs to be carried out to the garden areas and entrances to the home, as some areas are not easily accessible to the people living there. Internally, some parts of the home, such as bedrooms, need decorating. The induction of new staff needs strengthening, with a solid induction programme put in place. A permanent manager must be appointed and apply for registration with the CSCI. CARE HOME ADULTS 18-65 346b Newton Road 346b Newton Road Lowton Nr Warrington Cheshire WA3 1HF Lead Inspector Lesley Plant Unannounced Inspection 26th March 2008 09:25 346b Newton Road DS0000005752.V349260.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 346b Newton Road DS0000005752.V349260.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. 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 346b Newton Road Address 346b Newton Road Lowton Nr Warrington Cheshire WA3 1HF 01942 676555 01942 676555 tominaroden@nugentcare.org 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) Nugent Care vacant post Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (1), Physical disability (4) of places 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home is registered for a maximum of 4 service users to include:up to 4 service users in the category of LD (Learning Disability) up to 4 service users in the category of PD (Physical Disability) The service should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. One named service user (DC) may be admitted in the category of LD(E) Learning Disability over 65 years of age). The Home`s categories of registration must revert back if DC is no longer accommodated at the home. 18th July 2006 Date of last inspection Brief Description of the Service: 346B Newton Road is a care home located on the grounds of Lime House care home on the outskirts of Lowton, and is managed by the Nugent Care Society. The property is a bungalow with three single bedrooms, a lounge, conservatory/dining room, kitchen, bathroom and WC. There is a reasonable level of public transport in the area, however, residents use taxis or wheelchair accessible transport. The home provides twenty-four hour care and accommodation for up to three residents with a learning disability and a physical disability. 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection which the service did not know was going took place during the morning and afternoon. All the key national minimum standards were assessed. At the time of the inspection there were three people living at the home. The inspector spoke to the acting manager, a senior support worker, a support worker and the three people living at the home. One person living at the home has specific communication needs and therefore discussion with this individual was limited. Records and documentation were viewed and a tour of the building took place. Staff and those living at the home were observed engaging in their daily activities. CSCI questionnaires inviting feedback about the home were distributed at the end of 2007, with six being received from staff and one from a GP with links to the home. Two people living at the home were supported to complete their questionnaires. Information was also gained from the Annual Quality Assurance Assessment completed by the manager in September 2007. The manager has since left her post and one of the senior support workers is acting as temporary manager of the home. The inspector was informed that Nugent Care lease the building from Wigan Council and that this arrangement was now being reviewed and a tendering process had commenced. It is anticipated that the outcome of this tendering process would soon be finalised. What the service does well: The staff team has remained stable for some time with very few changes. Staff have got to know the people living at the home very well and have built up warm relationships. The atmosphere is happy and relaxed. Good information is available about the people living at the home; meaning that staff are aware of their different needs and wishes. Key workers regularly review care plans and risk management plans, with any changes being acted upon. Staff help the people living at the home to stay healthy and keep good records of any hospital or GP visits. 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 6 The new bathroom has been designed and furnished to meet the needs of the three people living at the home. There is plenty of space in this room, which is helpful for the people living at the home and for the staff. What has improved since the last inspection? 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. 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 7 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 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 8 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): 2 Quality in this outcome area is good. Thorough assessments take place prior to any admission to the home. This helps to ensure that the person’s needs could be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no new admissions to the home since the last inspection. The three people living at the home have all been resident for many years. Information seen on the two files viewed, showed that thorough assessments took place before each person moved into the home. Social work re-assessments had taken place in February 2007 for both these individuals. The acting manager explained how any new admission would be managed, stating that introductory visits would take place and compatibility would be considered. This process had been applied when the last person moved into the home in 1998, with a series of visits, including overnight stays, before a final decision was made. The two people living at the home who completed CSCI feedback questionnaires confirmed that they were asked about moving into the home and that they received enough information in order to make the decision to move in. 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 9 The Statement of Purpose was reviewed in June 2007 and good information is available for prospective residents or other interested parties. 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. Care plans and risk assessments are in place and reviewed regularly, meaning that any changes can be responded to. Individuals are supported to make decisions about their day-to-day lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care planning information for two people living at the home was viewed. The organisation uses the ‘essential lifestyles’ method of care planning. Each person has a ‘my life’ document, giving good information including; people who are important to the individual, likes and dislikes, feelings, and past events. Staff have supported individuals to build up past history booklets, containing family and childhood photographs. Photographs and symbols are used to make the information meaningful and accessible to the person concerned. This information is used to inform the care plan, which has an internal review each 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 11 month and a fuller review, involving other people with links to the individual, every six months. Each person has a key worker allocated, who reviews the care plan each month and compiles a short report addressing areas such as health, social and emotional well being and aims for the future. Comments from the individual are also included. This review process allows for any changes to be identified and responded to. It was noted that for one person the care plan had changed, as he now required staff support to clean his teeth. Full reviews take place every 6 months, with other interested parties such as relatives being invited. Individuals are supported to make decisions as part of day-to-day interaction with staff. New bedding and curtains had been ordered, with the three people living at the home choosing their preferred colours and styles. People are asked regarding meal choices as was observed during this visit. Minutes of residents meetings show that individuals are encouraged to voice their opinions and make suggestions and that these are responded to. New slings had been purchased and certain foods provided, as a result of discussions at previous residents meetings. Risk assessments and risk management guidance is in place and address areas such as bathing, dressing, smoking and using a powered wheelchair. One person spends time outside the home, without direct staff support. This has been risk assessed and a risk reduction plan put in place, which includes the individual taking his mobile phone with him and wearing a ‘talisman’, giving information about his disability. All the risk assessments viewed were being reviewed on a monthly basis. 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. Meaningful day activities are limited, so that individuals do not have many opportunities to develop skills or interests, and make links in the local community. The lack of a suitable dining table means that there are restrictions regarding where people can eat their meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The three people living at the home have different interests. At present no one attends college or organised day services. One person explained how he enjoyed being at home, doing his jigsaw puzzles and knitting, which he did on the day of this visit. Another individual is able to spend time away from the home without staff support and so has opportunities for community links and participation. The third person used to attend a day service. The ‘my life’ care planning information for this person states ‘ I am happy when I go to the day 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 13 centre.’ Staff explained that this service was not now available for individuals who are funded for 24-hour care. It is important that opportunities for personal development and social inclusion continue to be explored. The inspector was informed that a drop in centre was due to open in the summer and that this resource may be of interest to those living at the home. Staff informed the inspector that not all of the team can drive the mini bus and that this can limit the activities provided. The temporary manager is looking into how this can be resolved. In addition, two people living at the home have been assessed as requiring the support of two staff when out. It is advised that this be reviewed and risk assessed to look at the feasibility of just one member of staff supporting one resident when out in the close vicinity of the home. There is a pub nearby and also one person does like to look at passing traffic, which he could do more often, if taken for short walks around the neighbourhood. The need for two staff for all outside activities appears to be restricting what is offered. The provision of meaningful day activities needs to be further explored. A weekly plan for each person could then be developed and act as a guide for each day’s activities. This weekly plan could include certain domestic tasks such as accompanying staff food shopping. Staff complete daily records for each person, detailing how they have spent their time and any activity that has taken place. A record of joint activities was also being maintained. The inspector advised that this duplicate record was not necessary, and that all records should be kept individually. The people living at the home have enjoyed holidays in Blackpool and plan to go again this year. Each summer day trips on a canal boat take place, which are enjoyed by all. One person enjoyed showing the inspector photographs of past holidays and trips out. Another individual has a love of buses, trains and trams and each year is supported to visit the Tram fair at Fleetwood. The three people living at the home all have relatives who maintain contact with them. One individual has a relative who visits the home each week. Relatives are invited to the six monthly care plan review. One person is able to spend time away from the home without staff support. This individual has links with the local community, often has lunch out and attends church regularly. Files contain details of peoples’ preferred routines and how they like to spend their time. On one record it explains how the person likes to spend a little time to ‘come round’ in the morning before being supported to get up. Daily routines are flexible, as observed during this visit. Breakfast was staggered over the course of the morning, in order to fit in with individual preferences regarding the time of getting up. Each person was then offered a choice of breakfast cereals. The relationships between staff and those living at the home 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 14 appeared warm and friendly, with staff spending listening and talking to each person. Arrangements regarding meals and meal times are flexible. Meal options are discussed on a daily basis, with each person choosing what they would like to eat. A record is kept of what each person has eaten. One person requires a more specialised diet. The speech therapist and dietician have been involved and provided guidance for staff regarding foods to be avoided. This persons’ diet is now provided with small meals and certain food textures being taken into account, as advised by the other professionals involved. The arrangements for food shopping have recently changed, with food now being ordered using a central purchasing ordering process advocated by the provider organisation. This limits opportunities for social interaction and choice as the people living at the home used to accompany staff when food was purchased from local shops. The home still has a small budget with which to purchase some food locally but the main shopping is bought in bulk. The staff spoken to stated that there are also storage problems with this new system as well as it impacting upon social interaction opportunities for the three people living at the home. It is recommended that this system be reviewed, with the need for social interaction and choice being taken into account. There are problems regarding the dining table. One person, since having a new mould fitted in his wheelchair, cannot sit at the dining table to eat his meals. Another person can only sit at a certain place at the table, as his chair will not fit underneath. The temporary manager stated that a new dining table had been requested, but that this purchase had been put on hold, until the outcome of the tendering process was confirmed. A new dining table, suitable for all those living at the home, must be provided. 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. Good practice and well organised record keeping, help to ensure that personal care and health care needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans and records give good details of the personal care needs of each person and include preferences regarding how the support should be provided. Moving and handling equipment is in place. The bathroom has overhead tracking and a specialised bath suitable for people with physical disabilities. The temporary manager explained that they were aiming to have overhead tracking installed in the bedrooms. Records are kept of personal care, such as bathing. Each person has a key worker, who completes a monthly update, which feeds into the programme of six monthly care plan reviews. It was evident that 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 16 specialist advice is sought when necessary, such as the input from a dietician and speech therapist, with regard to one person at the home. Staff keep good records of healthcare appointments and interventions. One person, with particular health problems needs to have his weight monitored and these records were viewed. The good systems for recording mean that any health issue or intervention can be monitored and that information is easy to find. A GP, with links to the home, who completed a CSCI questionnaire confirmed that staff seek advice when necessary and commented; “They work well and with compassion and empathy.” There is a whiteboard in the hall, which is used to remind staff of certain events such as appointments. On the day of this visit, personal information regarding a health check was written on the board, this is unnecessary (as the same information is also in the diary) and means that potentially sensitive information is on display. This was discussed with staff during the visit, who agreed that the board would not be used for this purpose. Medication is safely stored in a cupboard, which is kept locked. Staff who administer medication have undertaken specific training in this area. The pharmacist, who undertakes periodic checks of the medication handling at the home, dispenses medication in blister packs. The medication administration records for two people were viewed and these were being completed appropriately. Two members of the staff team take a lead responsibility regarding ordering medication and they also do monthly checks and the records for these were viewed. This auditing of medication procedures is good practice and means that standards can be monitored and good practice maintained. It is recommended that any medication not supplied in blister packs such as liquids, be dated when it is opened. 346b Newton Road DS0000005752.V349260.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): 22 and 23 Quality in this outcome area is good. Arrangements for dealing with complaints are in place and the people living at the home have opportunities to raise concerns. Staff training, policies and good practice help to promote the protection of those living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure for the home was viewed. This information is also provided using symbols, to make it more meaningful to those living at the home. An audio taped version has also been created demonstrating that the service is trying very hard to ensure that this important information is accessible to people with disabilities. No complaints have been received by the home or the CSCI since the last inspection. People living at the home have opportunity to raise any concerns as part of daily interaction with staff. The regular residents meetings provide further opportunities for views to be shared and relatives are invited to the six monthly reviews, when they are asked for their views of the service being provided. 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 18 Feedback from the two people who completed the CSCI questionnaires confirmed that they know who to speak to if they are unhappy and that they know how to make a complaint if necessary. The temporary manager explained that relatives had been invited to a meeting, with the relatives of one person attending and providing feedback that they were happy with the current support being provided. The whistle blowing policy for Nugent Care is given to all new staff and a copy is available in the office. The home has an emergency procedure file, containing information regarding emergency evacuation of the home, such as following a fire, and guidance to follow should any allegation of abuse be made. This directs staff to ensure the immediate safety of all concerned, inform senior managers and inform the local social services department. This guidance follows locally agree procedures. Training records show that all but two of the staff team have attended training regarding vulnerability and protection. Dates have been set for these staff to attend the next programme. This area is also covered within NVQ (National Vocational Qualification) training programmes. Recruitment procedures include obtaining a satisfactory CRB (criminal records bureau) disclosure and checking of the POVA (protection of vulnerable adults) list. Any incident of verbal aggression is recorded and files contain guidance for staff to follow in such circumstances. Arrangements are in place for the safekeeping of monies held on behalf of those living at the home. A record is kept of income and expenditure, with these records being viewed. Long term savings for those living at the home are managed at the organisations head office. 346b Newton Road DS0000005752.V349260.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): 24 and 30 Quality in this outcome area is adequate. Access problems put restrictions on the people living at the home. The homeliness of the building would be improved by some redecoration and consideration regarding where staff information is displayed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is situated in a residential area of Lowton a few miles from Leigh town centre. All rooms are on one level and each person has their own bedroom. Bedrooms have a washbasin and there is a large specially adapted bathroom plus a separate toilet, which is accessible to people using a wheelchair. A laundry room and office are also provided. Bedrooms have been personalised, with pictures and personal belongings, however these rooms are in need of re decoration. This has been raised during residents meetings but has not yet been attended to. The outcome of the forthcoming tendering process appears to have put improvements such as this 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 20 and the request for overhead tracking in the bedrooms, on hold. The last inspection highlighted problems regarding access. These problems remain. People living at the home are not able to use the front entrance, as the ramp surface needs repairing. At present the conservatory/dining room is used as the main entrance to the home. The paving outside the conservatory is slightly ramped but cannot be accessed independently by those living at the home. There are safety issues regarding this entrance and also regarding the entrance via one of the bedrooms. Access around the garden areas is also difficult for people who use a wheelchair and this too needs attending to. The pathways need widening and levelling, so that the people living at the home can enjoy the outside space in safety. All areas of the home must be kept in a reasonable state of repair/decoration and the access problems must be addressed. The temporary manager explained that maintenance jobs are recorded, with small jobs being attended to by a maintenance worker employed by Nugent Care. Bigger jobs would be referred to head office and outside contractors used. The importance of creating a homely environment was discussed with staff, as at present there are a large number of notices and staff information papers on the walls of the home. The hallway contains a notice board and a whiteboard. The notice board displays details of forthcoming staff training and the whiteboard is used to remind staff of certain events or tasks. A large staff annual leave chart is also displayed on the hall wall and health and safety notices are in abundance throughout the home. All of these give the home an institutionalised appearance. This was discussed with the temporary manager and it was agreed that much of this information could be sited elsewhere or was not needed. Staff information should be kept in the office and checks need to be made regarding what has to be on display for health and safety or fire safety purposes and this information kept to a minimum. The support staff at the home have responsibility for domestic tasks, including cleaning and the cleaning schedule was viewed. Staff work hard to maintain a good standard of cleanliness in the home. Night staff also carry out cleaning duties. Aprons and gloves are available for staff to use when carrying out personal care tasks and there are plans in place for staff to undertake infection control training. 346b Newton Road DS0000005752.V349260.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): 32, 34 and 35 Quality in this outcome area is good. Well established recruitment procedures and the arrangements for staff training, including qualification training, help to ensure that the people living at the home are supported by a competent team of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this unannounced inspection there were three staff on duty, including the temporary manager of the home. Rotas show that these staffing levels are regularly maintained and that there are two staff on duty each evening, with a night staff then working through the night. A senior member of staff is also available on call, should any emergency arise. The team consists of 12 staff, six having achieved an NVQ (National Vocational Qualification) award at level 2 or above. A number of these are now working towards gaining the level 3 award. Two staff are soon to commence the level 2 programme. The temporary manager is a qualified NVQ assessor and acts as assessor to staff at the home. This arrangement appears to be working well, with half of the team now holding a relevant qualification. 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 22 The staff team has remained stable for some time, with just one new employee commencing since the last inspection. Records show that appropriate recruitment checks take place. This includes gaining; two references’ a CRB (Criminal Records Bureau) disclosure and checking the POVA (Protection of Vulnerable Adults) list. The training programme includes; moving and handling, food hygiene, first aid, fire safety, health and safety, medication, care planning, report writing, risk assessment and training regarding abuse and protection. Dates of these courses are set each year, meaning that staff get opportunity to attend refresher training and so update their knowledge. Training records were viewed and show that the majority of staff have attended all of the core training courses and that any gaps are being addressed. Surveys completed by staff confirm satisfaction with the training provided by Nugent Care. One person stated; “The training is excellent” and also added, “I feel that all the staff here work well together as a team, and the service users are very happy with the care we provide.” Newly appointed staff work alongside an experienced staff member during the induction period, however there does not appear to be a structured induction programme in place. The current induction arrangements for new staff should be mapped against the nationally agreed Skills for Care induction standards, to ensure that all elements are being covered. 346b Newton Road DS0000005752.V349260.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): 37, 39 and 42 Quality in this outcome area is good. Management and quality assurance systems are in place, which help to ensure that a good standard of service is provided. Staff training and good practice help to promote the health and safety of those living and working at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector was informed that Nugent Care lease the building from Wigan Council and that this arrangement was now being reviewed and a tendering process had commenced. It is anticipated that the outcome of this tendering process would soon be finalised. 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 24 The manager of the home, who was registered with the CSCI, left her post in October 2007. One of the senior support workers has been acting as temporary manager since that time. The temporary manager has worked at the home for 15 years, has gained the NVQ level 2 award, is a qualified NVQ assessor and is currently undertaking the Register Manager Award. The inspector was informed that these temporary management arrangements would remain in place until the tender process was completed. Staff appeared to be organised in their work and confirmed that supervisions and team meetings are taking place. The temporary manager has maintained the management procedures, which had become established at the home and appears to be carrying out her management duties well. However there needs to be permanent management arrangements in place. The registered provider, Nugent Care, must make arrangements to appoint a permanent manager, who is then registered with the CSCI There are some quality monitoring and quality assurance procedures in place. The temporary manager compiles a quarterly report which is sent Nugent Care head office. This covers certain aspects of service provision, including staffing and health and safety. A senior manager within the provider organisation carries out monthly visits to the home, reporting on developments and any areas to be addressed. Copies of these regulation 26 reports were viewed. Internally, medication audits take place, and there are regular staff meetings and residents meetings, where issues can be raised and minutes of these were viewed. It was confirmed that certain requests raised during residents meetings had been acted upon. These included menu changes and the purchasing of new slings. This shows that the views of those living at the home are responded to. Certain other requests, such as the decoration of bedrooms have been put on hold, until the outcome of the tendering process has been confirmed. Relatives are invited to review meetings, giving opportunity to provide feedback about the service provided at the home. Relatives had been invited to a meeting, with the relatives of one person living at the home attending and confirming their general satisfaction with the support provided to their relative. Meetings such as these should continue and the temporary manager should also look at distributing feedback questionnaires to interested parties such as relatives, which did take place a few years previously. The Statement of Purpose, describing the service to be provided at the home, was reviewed in June 2007. There are systems and practices in place, which promote health and safety at the home. Records of fire drills, and fire equipment checks were viewed. The Fire and Rescue service visited the home in June 2007 and issued a 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 25 satisfactory report. The majority of staff attended fire safety training in October 2007. Staff carry out regular checks regarding the assisted bath, water temperatures and fridge and freezer temperatures. Water hygiene monitoring also takes place. Accidents are recorded and these records were viewed. The temporary manager confirmed that there have been no accidents regarding those living at the home, since the last inspection. Nugent Care arrange a rolling programme of staff training addressing health and safety, first aid, moving and handling, and food hygiene. There are plans in place for staff to attend training regarding infection control. 346b Newton Road DS0000005752.V349260.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 X 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 27 YES 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. 2. Standard YA17 YA24 Regulation 16 Requirement Timescale for action 30/05/08 30/06/08 3. 4. YA24 YA37 A new dining table, suitable for all those living at the home, must be provided. 23 Suitable ramps must be installed, in order to improve access at the home. Previous timescale of 30/09/06 not met. 23 All parts of the home must be reasonably decorated. Section 11 A suitably qualified and Care experienced manager must be Standards appointed and apply for Act 2000 registration with the CSCI. 30/06/08 30/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA12 YA13 YA17 Good Practice Recommendations Further opportunities for taking part in meaningful activities and making links within the community should be explored. The arrangements for food purchasing should be reviewed, with the need for social interaction and choice being taken DS0000005752.V349260.R01.S.doc Version 5.2 Page 28 346b Newton Road 3. 4. 5. YA20 YA24 YA24 6. YA35 7. YA37 into account. Medication not supplied in blister packs should be dated when opened. Access in the garden areas should be improved and made more suitable for people who use wheelchairs. Staff information should be kept in the office and checks need to be made regarding what has to be on display for health and safety or fire safety purposes and this information kept to a minimum. The current induction arrangements for new staff should be mapped against the nationally agreed Skills for Care induction standards, to ensure that all elements are being covered. Quality monitoring and quality assurance practices should include sending feedback questionnaires to relatives. 346b Newton Road DS0000005752.V349260.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 346b Newton Road DS0000005752.V349260.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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