Care Home: 76 Bodmin Road

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What the care home does well The home helps people find out about the home, and finds out about people`s needs, before they are offered a place. This helps people make a good choice about where to live. People benefit from a home that is run with regard for their views and their best interests, with improvements made to promote their welfare (see section below, especially). They are given the support they need and want. They are enabled to have appropriate and fulfilling lives, with their preferences and wishes respected, and new experiences to promote their personal development. They are helped to make personal choices and be as independent as possible. People benefit from homely and clean accommodation. What has improved since the last inspection? The manager has a system for reviewing and improving the quality of care at the care home, to promote peoples` quality of life. There was evidence of financial viability and current insurance, so people can have confidence in the business management of the home. People who cannot manage their own money now have their own appointee, so their financial affairs are handled independently of the home. Care records are kept securely, protecting peoples` rights to confidentiality. Their individual preferences and choices are included in their plan of care. Their nutritional needs are better managed, with records kept of what people eat, and food prepared by people who have an understanding of food safety. Medication systems have been improved, protecting everyone at the home through safer practices. People have had a surprise holiday, and are now involved in planning the next one for the coming summer. What the care home could do better: Information provided by the home could be in more suitable forms for some people whom the home is intended to look after, so they get information they need - to make a choice about where to live, how to make a complaint, etc. More of peoples` individual needs (especially their health needs) and potential risks to their wellbeing should be recorded in their care plans, to ensure all their needs will be met and met safely, in the longer term. Fuller assessment of the safety of their environment would also protect their wellbeing. Training on local safeguarding procedures would further help the manager to ensure peoples` welfare. Record-keeping has greatly improved since our last inspection, but availability and retention of such records must be bettered, to ensure there is information about peoples` care for future reference. CARE HOME ADULTS 18-65 76 Bodmin Road 76 Bodmin Road St Austell Cornwall PL25 5AG Lead Inspector Ms Rachel Fleet Announced Inspection 3 March 2008 10.15 76 Bodmin Road DS0000008978.V347653.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 76 Bodmin Road DS0000008978.V347653.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. 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 76 Bodmin Road Address 76 Bodmin Road St Austell Cornwall PL25 5AG 01726 74629 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) Mr David Roseveare Mrs Janet Roseveare Miss Lisa-Marie Shaw Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th March 2007 Brief Description of the Service: ‘76 Bodmin Road’ – also called ‘Bos Y’n Dre’ – is a three-storey house, which was a school in the 1800’s. It is in walking distance of the centre of St Austell. The Registered Manager and her partner (with their young family) live at the home, caring for four adults who have a Learning Disability, in a family style home. Currently, people who live at the home go to day centres regularly. The Registered Providers used to run the home and are still very involved, acting as relief carers/support staff for the manager. No other staff are employed. Nursing care is not provided other than that which local community nurses can provide if necessary. Bedrooms, bathroom and toilet facilities for people living at the home are on the first floor, accessed by stairs. The bathroom has a shower and a corner bath. One bedroom has an en suite, with a shower. Bedrooms are for single occupancy. They are heated by freestanding heaters with time switches. The ground floor has a large kitchen, a lounge and dining room/conservatory for people to use. Two other rooms are mostly used by the family, although people living at the home join them when they wish to. There is a car parking area and garden to the rear of the home, with plans for decking in the garden by this summer, to make it easier to use. There is also a paved area outside the conservatory, used for barbeques in better weather. Access to the rear of the home is by a very poorly surfaced lane, and steep steps. There is easier access at the front of the home, although parking is limited here. Weekly fees at the time of our visit were £330. The fees do not include the cost of all activities. Reports about the home by the Commission for Social Care Inspection (CSCI) are available from the manager. If a personal copy is needed, people are directed to our website. 76 Bodmin Road DS0000008978.V347653.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 took place as part of our usual inspection programme. The ‘announced’ visit to the home lasted almost five hours. We pre-arranged the date with the manager Lisa Shaw, to ensure someone was at the home, since she and the people who live there often go out. Four people were living at the home on the day of our visit, although three were out, at day centres, so we did not meet them. No staff are employed at the home; the manager assisted us throughout our visit. A CSCI questionnaire on the home (the Annual Quality Assurance Assessment, or AQAA) had been returned prior to our visit, completed by the manager. This included current information about the service, staff and people living at the home, some assessment of what they do well, and any plans to improve the service. Surveys were sent to the home for the people living at the home and their next-of-kin. None were returned to us before our visit to the home, but when we visited we were given completed surveys from the four people living there and one relative. We also sent surveys to four community-based care professionals, who all returned them, and we spoke with two others. Our time at the home included ‘case-tracking’ of three people – a sample that included people with greater needs, men and women, and people we wished to follow up as a result of information from the AQAA, surveys, or in relation to the last inspection to see if certain issues had been addressed. We looked into these peoples’ care in more detail, meeting with them if possible, checking their care records and other documentation relating to them (medication sheets, etc.), talking with the manager, and observing the care or support they received. We spoke with one person who lived at the home, although they were not able to answer our questions in detail because of communication difficulties. We looked around the home, and checked medication systems as well as looking at information relating to health and safety, and quality assurance. We ended the visit by discussing our findings with Lisa Shaw. Information gained from all these sources and from communication about the home since the last full inspection (detailed in our report dated 26 March 2007) is included in this report. 76 Bodmin Road DS0000008978.V347653.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: 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 7 Information provided by the home could be in more suitable forms for some people whom the home is intended to look after, so they get information they need - to make a choice about where to live, how to make a complaint, etc. More of peoples’ individual needs (especially their health needs) and potential risks to their wellbeing should be recorded in their care plans, to ensure all their needs will be met and met safely, in the longer term. Fuller assessment of the safety of their environment would also protect their wellbeing. Training on local safeguarding procedures would further help the manager to ensure peoples’ welfare. Record-keeping has greatly improved since our last inspection, but availability and retention of such records must be bettered, to ensure there is information about peoples’ care for future reference. 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. 76 Bodmin Road DS0000008978.V347653.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 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2. Quality in this outcome area is good. The home helps people find out about the home, and finds out about people’s needs, before they are offered a place - to ensure the home is a good choice for anyone that moves in. However, some information is not accessible to people with more diverse needs, so some people may not be able to make an informed choice about where to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose/Service User Guide we saw had current information about the home. Besides explaining how the home was run and giving views of people who live at the home, it had been updated to include training that the manager had just had, and our new contact details. She agreed to forward us a copy, as required when changes are made to such this document. She had obtained pictures to include in an alternative format she hopes to produce, which will be more suited to the needs of some people. There have been no admissions to the home since our last inspection, since there have not been any vacancies. We saw the Statement of Purpose said the home does not take emergency admissions. 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 10 The manager said this was because she would expect prospective residents to get to know the home before anyone moved in, through visits of increasing length (including overnight stays if possible). She said this also gave her an opportunity to more fully assess their needs and wishes. The manager did not have a specific form for recording her assessment of prospective residents’ needs, but she was aware of the guidance in the National Minimum Standards as to what should be included and knew the assessment must be recorded. She said the views of people already living at the home would be listened to, once they had met the prospective resident, prior to making any decision about admission. She also confirmed she would get an assessment of the person’s needs from their care manager, and would write to people to confirm that the home can meet their assessed needs if they choose to live there. 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is good. Individuals’ identified needs are met, with promotion of their preferences and independence. However, since some needs or associated risks are not identified in their care plans, they may not get all the care that they need or some needs may not be met safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw much information about each person’s preferences and routines, what they were able to do for themselves, and what support they needed, written in a very person-centred way. This is an improvement since our last inspection, when we recommended that peoples’ choices be recorded. Conversation with the manager showed she thought each person living at the home very much as individuals with strengths and positive qualities, as well as needs. The information had been reviewed recently, to make sure their care plan was correct. The manager said she had discussed them with each individual, and we saw two had signed their plan. 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 12 However, we saw care plans did not include people’s health needs, arrangements for enabling them to have general or specific health checks (such as by a dentist or optician), etc. Professionals’ surveys showed they were concerned about a health problem someone at the home had; the manager told us the person had seen their GP about it, and their medication had been changed subsequently. Although this was reflected in medication records we saw, care records provided did not include the problem or action taken. The manager said she would get advice from individuals’ GPs about relevant health checks for each person, for future care planning. Risks to individuals were recorded in their care plan, with what should be done to reduce these risks to keep the person as safe as possible. This was planned in a way that enabled them to still enjoy as full or independent a life as possible. Support when in an area with traffic, for example, helping in the kitchen, or assistance to prepare for a bath before leaving the person to bathe in privacy. Some risks were not fully considered and/or recorded, however, although the manager had identified them and described measures she took to minimise potential harm to the individuals concerned. For example, when people are left alone at the house for short periods because they choose not to go out with the manager. Or their possible vulnerability when in the community, though the manager clearly knew each person’s abilities well, describing any support each needed (with money, for example). All surveys from people living at the home said they could make decisions about what they did each day. During our visit, we heard people were consulted and offered choices about what they wanted to do, when, and what they wanted to eat, etc. This was reflected in their care notes, where ways of encouraging people to express their choices were given, along with a daily record that included their choices. She said she has not been able to get any information on advocacy services for people living at the home, although day centre staff are very supportive and helped people complete our survey. The manager said three peoples’ relatives now act as their appointees, rather than the registered persons for the home, and the fourth person manages their own money. This change was arranged following a recommendation we made at our last inspection. Each person keeps their personal monies. The manager told us she ensures they get receipts for shopping they do, and these are sent to their appointee. 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 – 17. Quality in this outcome area is good. People living at the home are enabled to have appropriate and fulfilling lives in and outside the home, with personal preferences respected, and new experiences promoting their personal development. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During our visit, one person spent time doing activities that their care plan said they enjoyed, such as listening to music and learning to write; daily notes showed they did these things regularly. Other people were out for the day at a day centre, which they attended regularly. Surveys completed by them showed they felt able to spend their time as they wished. We saw a range of opportunities for leisure activities within the home - quizzes, music, satellite television, jigsaws, scrabble and literacy games. 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 14 Care records showed people walked to the town centre either independently or with the manager, some go out in the evenings to local clubs, and that one person has active links with a local church. Professionals were positive about the home’s support for people to do activities, with costs never a problem; one said the manager had been to the day centre to watch one person performing in a play. The manager said one person had undertaken short college courses through the day centre staff, who had also invited her to accompany someone on a canoeing course. One person told us they had enjoyed a recent holiday. The manager said this was a surprise holiday, paid for by the home - everyone living at the home went away with the manager and her partner for 5 days. People living at the home are now being involved in planning a summer holiday, which will also be paid for by the home. People help at mealtimes, with food preparation, clearing dishes, etc. The manager said one person helped in a particular way with dusting in their bedroom. We suggested that this detail was included in their care plan, to ensure they continued to receive enabling, person-centred support in the long term. A relative’s survey said the home always kept them up-to-date about important issues affecting their relative at the home and helped them keep in touch.The manager told us that people can invite visitors to the home, and that they are able to see their visitors in private in their rooms, or use the conservatory off the lounge. The conservatory area has been made into a dining area, giving people a dedicated, more spacious and pleasant place to eat. They used to eat at a dining table, in the lounge, which is now used for board games and other social activities. The manager said meals are made according to individuals’ requests, with everyone involved in the grocery shopping. We saw individuals’ preferences included in their care plans, and during our visit someone was offered a choice of light meals at lunchtime which reflected this information. A record was kept of what meals each person had eaten each day, a requirement made at our last inspection. It was clear from our conversations that the manager tries to ensure people get the food they like, but fruit, vegetables and exercise are encouraged to promote their general health. Day centre staff communicate about meals people have there, to help with menu planning. 76 Bodmin Road DS0000008978.V347653.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 – 20. Quality in this outcome area is good. People are given the support they need and want, although a lack of detail in some care records means some peoples’ personal and health needs may not be met in the long term. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The person we met during our visit looked content and well, keen to speak to us, and responding to the manager when she spoke with them. We saw they were given support depending on their needs, wishes or choices; this was reflected in all the surveys from people living at the home. Daily care notes showed people went to bed at flexible times, and spent their time in different ways to each other. Surveys from professionals said people living at the home seemed happy, and had not shown any adverse reactions to changes at the care home as the manager’s family commitments have increased. One said, “The staff I have met are very knowledgeable and certainly support the service users well.” 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 16 Peoples’ care plans included their preferred personal care routines in some detail, although we discussed that more detail should be included. For example, the manager told us how people liked to be supported in very individualised ways – preferring particular people for help with shaving, etc. but this level of detail was not always in the written care plans. A professional said staff respect for peoples’ privacy “appears to be first class.” The manager told us that people living at the home are offered an annual health check, due later in the year. Professionals’ surveys indicated that the home sought advice from health care professionals, and that people living at the home had regular appointments with dentists and opticians. One felt people might benefit from an extra day at home when they had had ‘common ailments’, before returning to day centres, etc. The manager told us people were very keen to return as soon as possible, however. She confirmed no-one currently needed specialist equipment, with care records reflecting that people living at the home were relatively able and independent, physically. One survey said some people living at the home had lost weight, although didn’t know if the individuals had chosen to do so. The manager confirmed some people had been overweight, but through increased exercise (walking to the shops, etc.) and a more balanced diet they had lost weight. Two peoples’ care plan indicated they were losing weight to achieve a more healthy weight, but care records did not show how such health needs were identified, monitored, or met in some cases (see earlier section on ‘Individual needs and choices’). The manager agreed to seek advice from GPs on health matters relevant to individuals, to inform care planning. Only one person living at the home takes prescribed medication, which the manager said they declined to look after themselves so the home dealt with it. We saw it was stored in a secure facility. Medication from the supplying pharmacy is in blister packs - a new system since our last inspection, when we made a requirement that systems must be improved. The manager confirmed she has had training from the pharmacist, explaining appropriately how it is to be managed (how refused medication or other ‘returns’ would be dealt with, etc.). She told us that she is to give this training to the registered providers, who occasionally give out medication. Pre-printed administration record sheets had been signed appropriately, with medication received into the home recorded here. We discussed that pharmacist or GP advice should be sought about one medication prescribed at lunchtime but often given at teatime because the person was out in the day, to ensure the safest arrangements were used. The AQAA said the Policy for Safe Handling of Medicines was reviewed in March 2007. It still needed some additional information, to address all aspect of National Minimum Standard (NMS) 20 – including the latest guidance from The Royal Pharmaceutical Society of Great Britain (2007). 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 17 For example, it indicated that people may self-medicate, but did not include that a risk assessment would be carried out to ensure they are able to do this safely, identifying any support they may need, etc. 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. People are listened to, so as to improve the service the home gives. Training on local safeguarding procedures would further help the manager to promote peoples’ welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Surveys from people living at the home said they were treated well and knew who to speak to if they were not happy or wanted to make a complaint. Professionals said that the home always or usually responded appropriately to any concerns they had raised – one adding, “Most definitely,” another writing, “Not always.” One said concerns would be discussed at any care reviews. No record is kept of any concerns or low-level complaints, and this was discussed again with the manager with regard to monitoring them as part of quality assurance processes. The manager said there are regular informal opportunities where views and feedback are gathered from people living at the home. The Commission have not received any complaints about this home since the last inspection, and the manager confirmed the home has not received any. 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 19 The complaints procedure can be given in larger print, but no other format has been used yet by the home to make the procedure more available to people with learning disabilities. The manager said people currently at the home relied on explanation of the procedure, or could read it themselves. The registered manager undertook a self-directed Internet course on safeguarding (in February 2008), whilst waiting to attend relevant training provided by Cornwall County Council as recommended at our last inspection. She showed awareness of what is considered abusive practice, and knew she should report any concerns to Social Services rather than try to investigate her concerns further. She agreed to contact the relevant Council staff to enquire again about training. 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. Quality in this outcome area is adequate. People have a homely and clean place to live, but safety of the environment has not been properly addressed, so peoples’ welfare may be at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The environment looked homely, with well-kept décor and furnishings. One person we asked said they liked their bedroom. At our last inspection, we recommended they be offered a wardrobe rather than just a hanging rail. The manager said this had been done, but the person preferred the rail. We suggested that this should be recorded in their care records. Peoples’ rooms were personalised with their possessions, pictures, etc., reflecting their personalities and interests. One person had a lockable facility they used. The manager said one bedroom was due to be redecorated and recarpeted with a new sink vanity unit to be provided, the occupant having been involved in choosing colour schemes. 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 21 On the day of the inspection bedrooms felt cold. Some had freestanding heaters seen for which risk assessments have been completed. These include use of timer switches, which the manager said was so that the heaters were not on when people were in their rooms, to remove a potential risk of burns. The manager said people currently only use their bedrooms to sleep in, using rooms downstairs in the day usually. However, this arrangement must be continually monitored to ensure peoples’ use of their bedroom - and in effect their freedom of movement - is not affected by environmental problems such as insufficient heating. The windows in a first floor bedroom were not restricted, although we saw one had been obtained. Access from the home to the garden is to be made safer for people to use independently by decking an area, but there is steep access to the home’s back door. Written environmental risk assessments have not been completed – a requirement was made about this at our last inspection. These matters are also addressed later in this report under Standard 42 in ‘Conduct and Management of the home’. The home looked clean and it was free from malodours. The manager said she advises people living at the home to use cleansing hand rub each time they come in, to reduce the risk of current community infections affecting the home. We heard her encourage someone to wash their hands before lunch. The laundry facilities are domestic in nature, with the washing machine in the kitchen. The manager confirmed washing is not done when food is being dealt with, to minimise cross-infection risks. Dirty laundry is carried in a covered container. 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Not applicable – no staff are employed. The manager said she would ensure she addressed our regulatory requirements should staff be employed in future. EVIDENCE: 76 Bodmin Road DS0000008978.V347653.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, 41 & 42. Quality in this outcome area is good. People benefit from a home that is run with regard for their views and best interests, with improvements made that promote their welfare, although further improvements are needed to ensure their continued welfare and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager obtained an National Vocational Qualification (NVQ) Level 4 in Care in 2007, and is undertaking the Registered Manager Award. She had certificates for food hygiene and fire safety courses undertaken in February 2008, and was booked on a first aid course the day after our visit. She said the registered provider had taken first aid and food hygiene in February 2008. 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 24 A rota had been drawn up since our last inspection, to show when the registered providers will be at the home so that the manager can have time off regularly. The manager had surveys she said had been completed by people living at the home, completed with help from community-based professionals, in November 2007. She intends to provide them 6-monthly. They were also sent to relatives and professionals at day centres who supported people at the home, although none had been returned. We discussed that a report of findings should be produced and shared with those to whom surveys were given or sent, as part of quality assurance processes. This is to help ensure ongoing improvement of the service and encourage people to respond in future. Information and records were generally available and well kept. The insurance certificate displayed (as required at the last inspection) was valid until November 2008. However, we could not find care records for one person relating to one week in January 2008. The manager said she must have thrown the record away. We reminded her that regulations require that records must be kept for three years from the date of the last entry. The last entry in the accident book we were shown was dated 2004. We saw current safety certificates for portable electrical equipment and gas appliances. We found one bedroom window was unrestricted. The manager said a restrictor would be fitted promptly, and has since confirmed all bedroom windows are now restricted where there is a risk of falling from them. No risk assessment had been carried out regarding Legionella. The manager said she would seek advice on this from environmental health staff. See also the earlier section on ‘Environment’ where a lack of environmental risk assessments is noted (an unmet requirement from our last inspection). We suggested the manager should take a Health and Safety course, which would help her with her risk assessment responsibilities. She had sought advice whilst on recent fire safety training for writing the home’s fire risk assessment she showed us. Care records showed people living at the home had been involved in fire drills, with their care plans including individual fire safety-related risk assessments. 76 Bodmin Road DS0000008978.V347653.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 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 N/A 32 N/A 33 N/A 34 N/A 35 N/A 36 N/A 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 2 3 X 3 X 3 X 2 2 X 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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(1) Requirement You must, after consulting each person or their representative, include in each person’s care plan how the person’s health needs are to be met – So that each person knows their care plan shows their current or changing health needs and how they are to be met. You must ensure that unnecessary risks to the health or safety of individuals living at the home are identified and so far as possible eliminated, and any activities they do are similarly free from hazards – So that they each enjoy a fulfilling life without undue risk to their individual wellbeing. Previous timescale of 01/06/07 not fully met. You must make proper provision for peoples’ health, ensuring their healthcare needs are assessed and recognised, with procedures in place to address them – DS0000008978.V347653.R01.S.doc Timescale for action 31/03/08 2. YA9 13(4) 31/03/08 3. YA19 12(1) 30/04/08 76 Bodmin Road Version 5.2 Page 27 4. YA41 17 & Schedule 3 So their physical and emotional needs are met. You must ensure records required by regulation (including all care-related records) are up to date, accurate and available for inspection To safeguard the best interests and rights of people who live at the home. You must ensure that unnecessary risks to peoples’ health or safety are identified and so far as possible eliminated And that all parts of the home (internally and externally) are as free from hazards to peoples’ safety as possible. This includes recording assessment of potential risks from Legionella, falling from any upper window, etc., and how any risk subsequently identified is to be managed So people live in a homely but safe environment. Previous timescale of 01/06/07 not fully met. 31/03/08 5. YA42 13(4) 30/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations For the service users’ guide (which includes the complaints procedure) and other information about the home to be available in formats that are suitable for the people for whom the home is intended i.e. appropriate languages, pictures, video etc. – 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 28 So they get information they need despite their diverse needs. 2. YA23 For the Registered Manager to attend the local authority’s training on safeguarding – To ensure people living at the home will be safeguarded from abuse or harm as much as possible. 3. YA42 For the Registered Manager to attend accredited training (such as an accredited Health & Safety course) that will further enable her to promote safe working practices and carry out risk assessments – To ensure the health and safety of everyone at the home. 76 Bodmin Road DS0000008978.V347653.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection CSCI, 4th Floor 33 Colston Avenue, Colston 33 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. 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