Care Home: 4 Homeground

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What the care home does well People living at the home, benefit from having a couple of staff that have known and supported them for many years. This enables them to share their knowledge and offer guidance to the newer members of staff. The people using the service are treated respectfully and are included in the day-to-day running of the home, where possible. Staff members include the people living at the home in their conversations and ensure that they are informed of what is taking place. Staff are recruited from a variety of ethnic groups to reflect the local population. The home is clean and hygienic, and provides a homely atmosphere. The people living there are encouraged to make decisions regarding the decoration of the home, including communal areas. What has improved since the last inspection? The home report that they now have 45% of the staff team, qualified or working towards their National Vocational Qualification (NVQ) in Health and Social Care level 2 or above. The home has two members of staff trained in Infection Control. Any gaps in employment history are explored and recorded. What the care home could do better: Care plans should include detailed information and guidance on specific conditions, such as diabetes and epilepsy. There should be greater clarity on who is responsible for carrying out checks, such as the monitoring of blood sugar levels and tests. Any healthcare input must be recorded. Risk assessments for specific conditions must be in place. Care plans need to detail circumstances or events, which may cause anxiety to people living in the home. They need to provide the reader with possible triggers and distraction techniques, which may be used. Individual risk assessments need to be reviewed. The recording of activities and social interactions requires greater clarity, to ensure that an evaluation of the activity can take place. The evaluation should not be based purely on the accompanying staff member`s perception of the success of the activity.The cultural needs of the people using the service could be further developed. Care must be taken to ensure that the medication cabinet is locked at all times, to safeguard the people living at the home. To comply with Regulation 37 of the Care Standards Act 2000, the Commission must be notified of any event, which may affect the well being of the person using the service. The home needs to appoint a suitably experienced, qualified and competent person to manage the home. This will ensure that the home is run in the best interests of the people who use this service. CARE HOME ADULTS 18-65 4 Homeground 4 Home Ground Wootton Bassett Swindon SN4 8NB Lead Inspector Pauline Lintern Key Unannounced Inspection 2nd September 2008 9:30 4 Homeground DS0000028669.V370333.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 4 Homeground DS0000028669.V370333.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. 4 Homeground DS0000028669.V370333.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 4 Homeground Address 4 Home Ground Wootton Bassett Swindon SN4 8NB 01793 849495 01793 849495 homegroundmanager@whct.co.uk 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) White Horse Care Trust Joanna Whyman Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 4 Homeground DS0000028669.V370333.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either category whose primary care needs on admisssion to the home are within the following category: 2. Learning disability- Code LD The maximum number of service users who can be accommodated is 3. Date of last inspection 5th September 2006 Brief Description of the Service: 4 Homeground is registered to the White Horse Care Trust. It offers accommodation and personal care to three people with a learning disability. The home itself is a detached house in a residential estate on the outskirts of Wootton Bassett, near Swindon. Each service user has a single room on the first floor. There is a lounge, dining room and a garden to the rear of the property. The bathroom is on the first floor and there is a toilet on each floor. People using the service receive personal care and support throughout the day from a permanent staff team. There are two members of staff on duty during the day. There is one staff member in the evening and one member provides sleeping in provision at night. The philosophy of care emphasises the importance of an ordinary, domestic type home environment and the involvement of people with a learning disability within the wider community. Each service user is offered a range of daytime and leisure activities. The fee ranges per week from £1,043.00 to £1,138.06. 4 Homeground DS0000028669.V370333.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. The unannounced key inspection took place over six hours, on September 2nd 2008. One person living at the home, accompanied by one member of staff greeted us at the front door when we arrived. We were informed that the other two people using the service were at their day services, accompanied by another member of staff, who would be returning to the home later. The home does not currently have a registered manager in post. However, the Trust is recruiting to fill the position. In the meantime, a deputy manager from another Trust service has been seconded to Homeground, three days a week, to support the recently appointed, deputy manager at the home. Prior to our visit we sent survey forms to the home to be distributed to the people using the service and healthcare professionals. We only received one response from a healthcare professional. The deputy manager explained that when staff distributed our surveys to the people living at the home, they were unable to express their views or fully understand the purpose of the surveys. The surveys could not therefore be completed. We were able to observe interactions between staff members and people living at the home during the day. We also met with two staff members to obtain their views on the service being provided. As part of the inspection process, we sent the home an Annual Quality Assurance Assessment (AQAA) to complete. The AQAA provided us with the information we required. The deputy manager and care staff spoken with throughout the inspection were helpful and co-operative. We examined care records of two people in full, along with health and safety records, the complaints log, social opportunities and quality assurance. We also sampled staff recruitment, induction and training records. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. 4 Homeground DS0000028669.V370333.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Care plans should include detailed information and guidance on specific conditions, such as diabetes and epilepsy. There should be greater clarity on who is responsible for carrying out checks, such as the monitoring of blood sugar levels and tests. Any healthcare input must be recorded. Risk assessments for specific conditions must be in place. Care plans need to detail circumstances or events, which may cause anxiety to people living in the home. They need to provide the reader with possible triggers and distraction techniques, which may be used. Individual risk assessments need to be reviewed. The recording of activities and social interactions requires greater clarity, to ensure that an evaluation of the activity can take place. The evaluation should not be based purely on the accompanying staff member’s perception of the success of the activity. 4 Homeground DS0000028669.V370333.R01.S.doc Version 5.2 Page 7 The cultural needs of the people using the service could be further developed. Care must be taken to ensure that the medication cabinet is locked at all times, to safeguard the people living at the home. To comply with Regulation 37 of the Care Standards Act 2000, the Commission must be notified of any event, which may affect the well being of the person using the service. The home needs to appoint a suitably experienced, qualified and competent person to manage the home. This will ensure that the home is run in the best interests of the people who use this service. 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. 4 Homeground DS0000028669.V370333.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 4 Homeground DS0000028669.V370333.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): NMS 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective new people to the service have their needs fully assessed prior to being offered a place. EVIDENCE: Service users have lived at the home for many years. Due to this, the key standard, which relates to the assessment process, could not be addressed in practice. At the previous inspection, there were no concerns relating to this outcome group. Within the AQAA it states that all new admissions are fully assessed and risk assessments are completed. It confirms that the Statement of Purpose is regularly updated and reviewed. 4 Homeground DS0000028669.V370333.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): NMS 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home may not have their needs fully met, due to a lack of information within their care plans. People using the service are empowered to make decisions, where possible. Risk assessments need to be kept under review and be completed for specific health care conditions. EVIDENCE: As part of the inspection process, we looked in detail at the case files of two people who are receiving a service. Although generally, care plans reflect the assessment and for the most part, provide information on how the person’s needs would be met, they fall short in certain areas. One person’s care plan states that they are diabetic. The plan provides a limited amount of information to the reader. There is a record of blood sugar level checks, which are taken daily. However, it was noted that the levels had not been recorded for the 1st and 2nd of September 2008. There was no evidence of the parameters of the person’s blood sugar level, to ensure 4 Homeground DS0000028669.V370333.R01.S.doc Version 5.2 Page 11 wellbeing. The deputy confirmed that new staff are provided with an advice sheet on diabetes. However, this did not relate solely to the individual person. There were no guidelines for the procedure of testing the blood sugar level or who was responsible. Training records showed that some staff had received training in diabetes. This training is offered regularly. People living at the home, who have epilepsy, should have clear information of the management of the condition, documented in their care plan. They should also have a risk assessment completed and this must be kept under review. The deputy reported that arrangements have been made for a healthcare professional to visit the home and update all epilepsy management plans. While many of the staff team have a sound underpinning knowledge of what may be a trigger to anxiety for some of the people they support, this is not recorded within care plans. Staff need to ensure that their experiences and knowledge of the people they support, is shared within the person’s plan. For example, during our visit to the home, staff explained that one person was becoming anxious due to the fact that many files were open on the table and being looked at. This information was not recorded within the person’s care plan as a possible trigger to anxiety. During our site visit, staff members were observed offering choices to the people using the service. For example, one member of staff took in the jar of coffee and a tea bag, asking the person they support to choose, which they would prefer. Care plans state how people are able to make choices and their preferred mode of communication. One staff member showed us a file, which contained pictures of various foods, meals and drinks. They reported that the file is used on a Sunday, when the people using the service choose the menu for the following week. One staff member was observed asking the person they support, if they wished to help hang out the washing. The person followed them into the kitchen and then changed their mind and returned to the lounge area. Records show that some people using the service, are able to make choices by pointing, using body language and facial expressions. Care plans state whether the person living at the home is able to understand the principles of giving their consent or not. Within the AQAA, it states that the home has provided training to staff members on Person Centred Planning and approaches. The people using the service also have the opportunity to attend. Staff told us that they are planning to develop individual communication passports for each person they support. 4 Homeground DS0000028669.V370333.R01.S.doc Version 5.2 Page 12 Following review meetings, realistic goals are set. Documentation details how these are to be achieved, who by and the progress made. One case file stated ‘to arrange for a holiday to take place’. Although this had been planned, no one had recorded this on the progress sheet. The sheets, when completed, provide a clear audit trail of desired outcomes for the people living at the home. Individual risk assessments are in place and dated, as having been completed in July 2007. These assessments are now in need of being reviewed. The deputy confirmed that she is planning to do them as soon as possible. 4 Homeground DS0000028669.V370333.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): NMS 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Opportunities are available for people using the service, to participate in appropriate activities, if they wish to do so. Relationships with family and friends are encouraged by the home. People living at the home have their rights respected. Meals are well planned and varied. EVIDENCE: The majority of the people using the service attend day services during the week. One person prefers to remain at the home and chooses not to attend the day centre. Staff members reported that this person likes to listen to music and play ball at home, although they do enjoy a ride in the car. One person chooses to take a packed lunch to their day service, whereas the other person prefers to have a meal there. 4 Homeground DS0000028669.V370333.R01.S.doc Version 5.2 Page 14 Daily records show that other activities that take place are, walks in the park, trips to the pub, cinema, cafes, restaurants and visits to places of interest, such as railway museums. Staff report that one person is being supported on a holiday of their choice to Kent. Another person has chosen a holiday in Cornwall. Staff explained that leaflets of various options had been brought to enable people to choose the venue themselves. Within care plans, people’s spiritual needs have been identified. One person sometimes attends the Christian Fellowship meetings. We discussed the cultural needs of people living at the home. Although the relatives bring in ethnic food for the people using the service, it is an area, which could be further developed by the home. One person’s care plan states, there will be an option of Polish food on the menu at least once a week. There was no evidence to indicate that this is happening. We suggested accessing the Internet to obtain information on food/meals, and to ask the person’s family if they have any ideas of recipes or preferences. The deputy began looking for recipes during our visit. Links with families and friends are encouraged by the home. Daily diaries demonstrate that trips to visit family and friends are arranged. Regular telephone calls also take place. One staff member explained that one person they support enjoys going to another Trust home to visit a friend there. As mentioned earlier in this report, people living at the home have the opportunity to contribute to the menu planning for the week. Menus were sampled and were found to be varied and healthy. Consideration is given to ensuring there are low sugar options available. One person’s care plan states that they should be supervised at all times when eating. A risk assessment is in place to support this. Staff were observed monitoring the size of the food being consumed to ensure it was small enough to prevent choking. 4 Homeground DS0000028669.V370333.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): NMS 18, 19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People using the service have their personal care delivered in a way that they prefer. Healthcare professionals support the staff team to ensure that people have their physical and emotional needs met. Generally medication is managed well, however care must be taken to ensure that the medication is securely locked away at all times. EVIDENCE: Care plans provide information on daily routines and how these should be delivered. They identify the amount of support required for bathing, showering and dressing. One plan sampled explained that the person relies on staff to offer them appropriate clothing for the weather and to suit their age and gender. One care plan reminds staff that if they accompany one person living at the home on an appointment, it is important that they explain to them where they are going, using pictures and photographs before they leave the home. 4 Homeground DS0000028669.V370333.R01.S.doc Version 5.2 Page 16 Each person using the service has an annual ‘OK’ health check completed. Records show that people living at the home have access to various health care professionals, when needed. One person attends the diabetic clinic annually for check ups. The deputy reported that the Chiropodist, now visits the people they support at the home. One care plan sampled states that one person has been feeling tired and is currently undergoing tests. The deputy confirmed that this had taken place. However, there was no record of the results of the tests or the recommendations made as a result. As mentioned earlier in this report, greater care needs to be taken to ensure that there is a clear audit trail of any medical interventions taking place. The home keeps a record of when the people they support experience epileptic seizures and the duration. The record also asks if the medication, Midasolam has been administered. It was noted that as these forms are generic and not individual to the person. They could lead the reader to believe that someone should be considered for this medication even though it has not been prescribed to them. This was explained to the deputy who immediately temporarily amended the record to clearly show that the person has not been prescribed the medication and therefore it should not be considered. Within our surveys, one healthcare professional confirmed that they are a ‘very caring home who treat their people with respect’. We asked; does the care service support individuals to administer their own medication or manage it correctly where this is not possible? They replied ‘always’. They added that the care home ‘always’ seeks advice and acts upon it to manage and improve individuals’ health care needs. We looked at the arrangements for managing medication and found them to be correct. Administration records are well maintained with no gaps apparent. All ‘as required’ medication is recorded separately on yellow sheets, so that they are easily identified. Madazolam is stored securely and separate records are maintained, with two staff signing, when it has been administered. Regular medication stock checks take place. It was noted that on our arrival to the home the medication cabinet was found to be unlocked. This was discussed with the deputy during feedback. Care must be taken to ensure that that medication cabinet is locked at all times. 4 Homeground DS0000028669.V370333.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): NMS 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service have the opportunity to raise concerns and feel confident that they will be acted upon. Policies and procedures are in place to safeguard the people living at the home. EVIDENCE: The Trust has an established procedure in place, to enable the people using the service to raise any concerns or complaints. Addressed post cards are available to be posted directly to the Chief Executive of the Trust. Each service user guide includes a copy of the complaints procedure, which is in a pictorial format. The home also has a complaints video, which can be shown to the people using the service at regular times, to remind them of the procedure to follow. The home has a complaints log, which details any complaint raised, timescales and outcomes. The last complaint logged was from a relative of one of the people receiving a service. The matter appeared to have been dealt with appropriately by the manager at the time. The last entry in the log was a compliment made by a relative of one person using the service. 4 Homeground DS0000028669.V370333.R01.S.doc Version 5.2 Page 18 The AQAA states that there has not been any safeguarding referrals made in the last twelve months. There has also not been any staff referred to the Protection of Vulnerable Adults list (POVA), within the last twelve months. All staff receives training in safeguarding procedures. One recently recruited staff told us that they had yet to attend this training. Other training records sampled indicated that this training is available to staff members throughout the year. The home holds some personal spending money for the people using the service. Two individual’s expenditure records were checked against the cash held. Both cash and records balanced. It was noted that the deputy took the time to ensure that the money of one individual was counted and checked in front of them. 4 Homeground DS0000028669.V370333.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): NMS 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to live in an environment, which is homely, comfortable and clean. EVIDENCE: As part of the inspection process, we toured the premises. Bedrooms are decorated to suit the individual needs of the people living there. Staff told us that one person had chosen to have their bedroom pink, with matching bedding and curtains. Another person had chosen to have a double bed in their room. Personal possessions and ornaments are on display in individual bedrooms. Communal areas are comfortable and homely. The lounge has a large television and a music system for people to use. There is a personal computer in the dining room. 4 Homeground DS0000028669.V370333.R01.S.doc Version 5.2 Page 20 Bathrooms and toilets were found to be clean and hygienic with supplies of anti bacterial soap available at hand washing facilities. The deputy explained that if any maintenance work is needed, this has to be highlighted to the Trust’s Home Co-ordinator in the first instance. The lounge had been decorated since our last visit to the home. Staff reported that the colour scheme had been chosen by one of the people living at the home. The home was found to be in good decorative order throughout. The home has a small, enclosed garden to its rear. There is a garden table and chairs for those people wishing to sit outside, when the weather allows. The Trust employ a person to maintain the upkeep of the garden. The domestic washing machine and tumble drier are situated in the kitchen area. The Trust delegate individual staff members to take responsibility for all aspects of Health and Safety within the home. A requirement was set at the last inspection for the home to ensure staff receive training in Infection Control. One staff member on duty at the time of our visit confirmed that they were the person responsible for Infection Control within the home. They confirmed that they had attended training on the subject. The AQAA states that there are two staff members who have received Infection Control training. Records demonstrate that regular audits are completed for infection control and testing water for Legionella. The last check for Legionella took place on 24/08/08. 4 Homeground DS0000028669.V370333.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): NMS 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Competent and qualified staff support the people using the service. Records demonstrate that staff are recruited, inducted and trained properly. Staff members tell us that they are able to meet people’s individual and needs by working flexibly. EVIDENCE: As part of the inspection process we met with two members of staff in private. One was a newly recruited person and the other was a long-standing staff member, who had a vast knowledge of the needs of the people they support. The newer staff member confirmed that they had received an induction, which involved reading policies, procedures and care plans, getting to know the people living at the home and shadowing more experienced staff members. They added that as part of their induction they spent time at the Trust Head Office training. They confirmed that they are hoping to be able to undertake an NVQ, following completion of their Learning Disability Qualification and foundation units. 4 Homeground DS0000028669.V370333.R01.S.doc Version 5.2 Page 22 A positive feature of this service is that staff are recruited from a variety of ethnic groups to reflect the local population. The AQAA states that the home is good at promoting Equal Opportunities, which has led to a diverse mix of ethnic backgrounds in the staff team. The deputy reported that generally there are sufficient staff on duty to meet the needs of the people living there. She confirmed that the home use bank staff to provide extra support, if it is needed for activities and trips out. She added that some of the bank staff also work at the local day service, so they are familiar with the people they support. The deputy told us that she would be looking to see if the rota could become more flexible. Records indicate that new staff are being properly recruited, inducted, trained and supervised. Gaps in employment history are now being explored and recorded. We sampled the personnel records of four staff, including the most recently appointed. Records showed that POVA first checks had been received, prior to the person commencing their employment. Records indicated that the full check with the Criminal Records Bureau has not been received. The deputy has requested clarification on this from the Trust head Office, which will be forwarded to the Commission. This was received on the 5th September 2008. Newly recruited people are asked to provide proof of identity and obtain two satisfactory references. Files contain a statement of particulars and a job description. The home has a copy of the Trust’s training programme for 2008. Training dates planned, include training in first aid, manual handling, basic food hygiene, abuse awareness, infection control, health and safety, risk assessment, COSHH, the ageing process, Downs syndrome, O’Brien’s principles, the role of the key worker, person centred planning, drug competency, Epilepsy, equality and diversity, bereavement, palliative care, physical intervention, fire marshal training and sign along. Each staff member has an individual training record, which also holds any certificates they have been awarded. 4 Homeground DS0000028669.V370333.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): NMS 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home need to appoint a suitably qualified and competent person to manage the home and register with the Commission. The home must ensure that the Commission are notified of any event, which may affect the well being of people living at the home. Failure to submit a notification is a breach of Regulation 37. Mechanisms are in place to ensure the views of people are listened to. The health and safety of the people living at the home and the staff is promoted. EVIDENCE: The home has been without a permanent manager for over three months. At the time of our visit to the home, a deputy manager had recently been appointed. The Trust have also seconded a deputy manager from another 4 Homeground DS0000028669.V370333.R01.S.doc Version 5.2 Page 24 service, to support her for three days a week. The Trust is currently recruiting to fill the managers position. The deputy told us that one person had recently been taken to hospital as a result of a seizure. When asked if a notification form had been submitted to the Commission, they confirmed that this had not happened. It is a requirement that the home familiarise themselves with events that need to be reported to the Commission under Regulation 37 to safeguard the people using the service and comply with the regulation. Managers within the Trust have a Training Programme, which includes supervision, disciplinary, NVQ assessor support meetings, recruitment, continuing personal development, the Mental Capacity Act, Health and Safety for managers and mental health awareness. The Trust has well-established mechanisms in place for monitoring quality assurance. Regular audits are completed, which cover health and safety, finance and management. Once a month a Trust member visits the service to talk to the people living at the home and staff members. As part of the Trusts audit for 2008/9 questionnaires were sent out to 58 relatives and friends of people using the Trust’s services. All relevant health and safety checks are completed, such as checking and recording hot water temperatures, fridge freezer temperatures and the probing of hot food. The Trust has a health and safety committee who meet regularly. Health and safety representatives are located in each service. All accidents and incidents are recorded properly and audited by the Trust. Fire safety procedures are in place. Staff receives regular fire instruction and attend fire drills. The fire risk assessment was last reviewed on 7/5/08. One staff member has attended the Fire Marshal course. 4 Homeground DS0000028669.V370333.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 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 3 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 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 3 X 4 Homeground DS0000028669.V370333.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 YA6 Regulation 15 Requirement The management of diabetes must be clearly detailed within the person’s care plan. This must include the safe parameters of the person’s blood sugar levels, the procedure to follow if the level is outside of the parameters and the procedure, frequency and responsibility of taking the blood sugar levels. A risk assessment detailing the processes must be in place. Care plans must demonstrate the management of health care conditions, such as Epilepsy and how individual needs will be met and monitored. Individual risk assessments must be kept under review. The medication cabinet must be securely locked when not in use. A competent and qualified person must be appointed to ensure that the home is run in the best interests of the people living there. Timescale for action 02/10/08 2. YA6 15 02/10/08 3. 4. 5. YA9 YA20 YA37 13 (4) b 13 (2) 8 (1) a 02/10/08 02/09/08 02/11/08 4 Homeground DS0000028669.V370333.R01.S.doc Version 5.2 Page 27 6. YA37 37 (1) In accordance with Regulation a,b,c,d,e,f,g 37 notification of any (2) occurrence must be given to the Commission without delay. 02/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA13 YA12 YA6 Good Practice Recommendations Further consideration should be given to further developing the cultural needs of the people using the service. A clear evaluation of all social activity provision should be undertaken. Care plans should set out how possible triggers to anxiety can be avoided through positive interventions. 4 Homeground DS0000028669.V370333.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 4 Homeground DS0000028669.V370333.R01.S.doc Version 5.2 Page 29 - 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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