Care Home: 8 Chestnut Road

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What the care home does well Generally the visit was satisfactory; we found the home to be clean, tidy, warm, well lit and free from unpleasant odour. The individuals met were found relaxed and were accessing all parts of the home without restrictions. Staff were interacting with service users in a sensitive and respectful manner. The home told us in their Annual Quality Assurance Assessment that the home has a well mix of staff with relevant training in National Vocational Qualification (NVQ) at level 3 and another staff member working towards NVQ 4 in management. The home ensures that service users, families and or representatives and other health professionals are involved in the decision-making processes to ensure that individual needs are met holistically. Each individual living in the home has Essential Living Plan, which identifies their choice of how they want to live and provide staff with the idea of how the individuals want to be supported. What has improved since the last inspection? The home told us in the Annual Quality Assurance Assessment that it had secured extra funding for one of the individuals to enable the person to have more support in local community based activities. The home had purchased sensory equipment for an individual to maximise their sensory stimulation. The home has supported and enabled two individuals to take risks to become more independence to go out on their own. What the care home could do better: Individuals living in the home would enjoy a better and more homely environment and would be protected from ill health if the damp in the identified rooms were satisfactorily treated. Furthermore in order to protect the people living in the home, staff and visitors, the radiators identified with rust on the covers and sides must be replaced. Whilst the home is waiting for decision in term of refurbishing the kitchen risk assessment must be reviewed to include all areas with sharp edges that are potentially hazardous to the service users and staff. The expert by experience who accompanied us in this visit was concerned about the condition of the road in particular the ramp in front of the building and the potholes in the road The expert felt that the area is not service user friendly and should be addressed to provide easy access to service users staff and visitors to and from the home. It is recommended that this work is carried out as soon as possible. To enable the individuals living in the home and or their representatives to contact the Commission if their were not satisfied with the outcome of their complaint, details of the Commission for Social Care Inspection must be updated in the Service Users Guide. The acting manager stated that this would be remedied as soon as possible. All complaints to the home must be recorded including action taken in relation to the complaint and the outcome to the complainant.To ensure that the home meets the statutory requirement in relation to protection of people living in the home staff training on the Protection of Vulnerable Adults from Abuse must be updated. People living in the home would be adequately protected if all hand written medication on the Medicine Administration Record Sheets (MARS) are signed and dated. CARE HOME ADULTS 18-65 8 Chestnut Road Downend South Glos BS16 5UN Lead Inspector Grace Agu Unannounced Inspection 28th November 2007 09:15 8 Chestnut Road DS0000020300.V351812.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 8 Chestnut Road DS0000020300.V351812.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. 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 8 Chestnut Road Address Downend South Glos BS16 5UN 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) 0117 9572687 0117 9709301 admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Miss Claire Maine Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate up to 5 persons aged 18 - 35 years with Learning Disabilities May accommodate one named person aged 16 - 18 years with Learning Disabilities May accommodate one named person aged 18-35 years with Mental Health needs 31st October 2006 Date of last inspection Brief Description of the Service: 8 Chestnut Road is a care home operated by Aspects and Milestones Trust. The home previously provided nursing care for a mixed Service User group of up to five adults with learning disabilities. The home closed in it’s previous capacity on 31 March 2005 and reopened in July 2005 following refurbishment and redecoration and variation in the category of Service Users and type of service provided. The home is currently registered to provide personal care only for five people aged between 16 and 32 with learning disabilities. The home is set in a residential location in the middle of Downend, and is within close walking distance of local shops and amenities. The home is a converted bungalow, which has been extended and provides accommodation all on one floor. Bedroom accommodation is provided in five single rooms. Whilst there is no en-suite provision, all rooms have a wash hand basin. There is an open plan lounge and a dining room, which is fully utilised. Bathrooms and toilets have been fitted with adaptations to meet the care needs of service users within the home. There is appropriate provision of equipment to assist staff and clients. The home is set within its own grounds, and there is level access to the gardens. The home supports residents to use public transport, access day care and social activities. Car parking is available. Fees range from £900 per week. 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit which was undertaken as apart of key inspection over eight hours to review the requirements made at the last inspection and also to review the care practice to ensure that it is in line with the legislation and that best practice is followed at the home. The inspection was also undertaken to monitor strategies agreed by a multidisciplinary agency and the home to protect an individual living at the home from an alleged mistreatment from another service user. As a part of this inspection the Commission for Social Inspection invited an individual (expert by experience) of a similar background and with knowledge of how to communicate with people with learning disability to help us to us to find out how the people access the facilities in terms of activity and education. The person’s report can be found in the body of the report. We met with the acting manager Katherine Britton and a recently assigned manager from a sister home who assisted with providing information for the inspection process. Whilst touring the building, we observed a number of residents; spoke to three service users three support staff and a number of records were viewed. What the service does well: Generally the visit was satisfactory; we found the home to be clean, tidy, warm, well lit and free from unpleasant odour. The individuals met were found relaxed and were accessing all parts of the home without restrictions. Staff were interacting with service users in a sensitive and respectful manner. The home told us in their Annual Quality Assurance Assessment that the home has a well mix of staff with relevant training in National Vocational Qualification (NVQ) at level 3 and another staff member working towards NVQ 4 in management. The home ensures that service users, families and or representatives and other health professionals are involved in the decision-making processes to ensure that individual needs are met holistically. Each individual living in the home has Essential Living Plan, which identifies their choice of how they want to live and provide staff with the idea of how the individuals want to be supported. 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Individuals living in the home would enjoy a better and more homely environment and would be protected from ill health if the damp in the identified rooms were satisfactorily treated. Furthermore in order to protect the people living in the home, staff and visitors, the radiators identified with rust on the covers and sides must be replaced. Whilst the home is waiting for decision in term of refurbishing the kitchen risk assessment must be reviewed to include all areas with sharp edges that are potentially hazardous to the service users and staff. The expert by experience who accompanied us in this visit was concerned about the condition of the road in particular the ramp in front of the building and the potholes in the road The expert felt that the area is not service user friendly and should be addressed to provide easy access to service users staff and visitors to and from the home. It is recommended that this work is carried out as soon as possible. To enable the individuals living in the home and or their representatives to contact the Commission if their were not satisfied with the outcome of their complaint, details of the Commission for Social Care Inspection must be updated in the Service Users Guide. The acting manager stated that this would be remedied as soon as possible. All complaints to the home must be recorded including action taken in relation to the complaint and the outcome to the complainant. 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 7 To ensure that the home meets the statutory requirement in relation to protection of people living in the home staff training on the Protection of Vulnerable Adults from Abuse must be updated. People living in the home would be adequately protected if all hand written medication on the Medicine Administration Record Sheets (MARS) are signed and dated. 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. 8 Chestnut Road DS0000020300.V351812.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 8 Chestnut Road DS0000020300.V351812.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): 1,2,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a detailed and well-planned admission process to enable prospective residents to make an informed choice about moving into the home with the assurance that their needs would be met. However it fails to update information in the Service Users Guide. EVIDENCE: There has been no addition to the residents’ numbers since the last inspection. From discussion with the acting manager, two individuals would be leaving the home for different reasons and that the home would admit new service users using the Trust admission procedure. The admission would be well planned and individuals living in the home would be fully involved to ensure that they are happy for the new person to live in their house. The Statement of Terms and Condition was noted in the residents’ care files. This document is written in picture format and explained to the residents by staff. In one of the care files the individual signed the document. 8 Chestnut Road DS0000020300.V351812.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): 6,7,9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are supported with individualised care plan and are supported to participate in running the home. Risk assessments are in place to enable them to live independent lives. Information about them is kept confidential. EVIDENCE: Evidence from the two care files viewed showed that both individuals have individualised care plans. The care plans are person centred and contained a range of information to include likes and dislikes, choices they make, how they communicate, family and friends. These care plans were regularly reviewed. The service users met in the home, looked well looked after and were noted accessing most areas of the home without restrictions 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 11 One individual confirmed that staff assist and support them to participate in the running of the home. The individual told the inspector that she makes her bed and cleans the room with staff support. It is particularly commendable to note that one individual is currently being supported by the home in her choice to live independently in the community. The acting manager stated that the individual has made significant progress in terms of self- esteem and confidence and is now ready to take the step into independent living with support from people she knows and can trust. The individual told us that it is positive move and that she is looking forward to moving into her own flat after Christmas. All the tasks noted in the care files were supported with risk assessments to ensure that the people were well protected. Staff spoken with on the day-demonstrated knowledge of the residents’ needs and understanding of their roles and responsibilities in relation to confidential information about the residents. Individuals care files and other records were securely locked away. 8 Chestnut Road DS0000020300.V351812.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): 12,13,14,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents have opportunities for personal development and are supported to maintain links with family, friends and the community. Their individual rights are protected, whilst providing them with healthy diets at chosen times. EVIDENCE: As mentioned earlier the expert by experience accompanied us on this visit to help us find out how the people living in the home are supported to make choices on how to live their lives particularly regarding activities. The experts name is Kerry Ford. She was supported by Leslie Doherty to write the report below. When I visited the staff were warm and friendly. It was busy with everyone going out and about but staff were interacting with residents in a respectful and fun way. 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 13 The resident I spoke to was happy to be living there. This resident is going to move on. This resident also said that she goes to college and is also getting help with her move. She made us a drink in the kitchen. She said she is supported to cook sometimes and she eats when she wants. “When I’m hungry I eat something”. One resident was still in bed, they can choose when they get up. Other residents have support to do different activities during the day. They go on different holidays. Two residents are going to Euro Disney next week. They go to pubs and out shopping on weekends and evenings. There are games like bingo in the house and residents can sit in the living room or go to their rooms and listen to music or watch DVDs. One resident said, “Normally in my room, listen to music”. There is no home transport as residents are encouraged and supported to use public transport. Families and friends are encouraged to visit when they want and stay for meals and overnight. “We can use the phone when we want” to contact our friends and family. There is a staff rota with pictures of staff. All the residents have communication books with pictures. And there is a picture book so that they can choose food and different activities they want to do. Staff support the residents’ meetings. They talk about problems. I think it would be good if residents had some contact with local advocacy organisations. Those between 16–25 go to YIPIN project. The manager said the People First phone number is on the notice board. I had one concern about the outside access to the house. The road is very rocky and uneven and I fell on my way out. I don’t think it is safe for the people living there. A requirement has been issued to ensure that the uneven area in front of the home is remedied ensure safety of the individuals living in the home. In addition to the observation made by the expert, the inspector noted that one individual is supported to develop personal relationship with a person of her choice. The individual told the inspector that she was expecting her ‘boy friend’ on the day and that he normally visits and has tea with them. This is commendable. 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 14 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): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive support for health and personal care including wishes in the event of death. Medicine administration practices are safe and offer protection to residents. EVIDENCE: Staff met on the day were able to demonstrate a good understanding of the needs of the people living at the home. Individuals living at the home have different levels of needs and are dependent on staff for all aspects of their care One staff member spoken with explained how the complex needs of two individuals were being met. The care file viewed showed evidence of the level of support the individual needed and how staff are to meet those needs. Care plans viewed included how to meet the needs in relation to personal hygiene, food and drink, making and maintaining relationships and communication. On the care file there was evidence of G.P visits, Consultant medication reviews and other health checks. The resident stated, “ I go to the surgery with staff I need to see the doctor.” 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 15 Two individuals in the home currently manager their own medication with risk assessment consent and agreement to support them. Medication was held securely in a metal cabinet attached to the wall. Medication administration records were in place and were found to be accurate and reflected the current medication held within the home. However the inspector noted that on this inspection that medication dispensed on 24/11/07 was not signed for and two hand-written medication on the Medication Administration Record Sheet (MARS) were not signed and dated to ensure that the service users are protected. A requirement was made for these to be corrected. The requirement was met before the inspection was concluded. Upon discussion with the acting manager and also examination of staff training records it was evident that staff have undergone medication competency training at the home. There has been no recent death in the home. Staff spoken with on the day demonstrated knowledge of death and dying and the location of the home’s policy and procedure in relation to death and dying should it occur. 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. The Residents are supported and encouraged to complain with the confidence that their views would be listened to and acted upon. Appropriate systems are in place to protect residents from harm and abuse. However staff training on the Protection of Vulnerable Adults from Abuse has not been updated. EVIDENCE: It was noted when reviewing the care files that all the residents have complaints procedure, which was in picture format due to their Learning Disability. Information about the Commission for Social Care Inspection was included in the document to enable residents and their representatives to contact the Commission if they were not satisfied with the services provided at the home. The organisational complaints procedure was also noted displayed at the home. It was agreed that the current details of the Commission must be updated in the Service Users Guide to provide correct information to all concerned. The Commission for Social care inspection received anonymous complaint in regards to staff frequent use of bank staff and potential harm that may be 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 17 caused to the service users if bank staff are left to work on their own with service users with profound learning disabilities and complex needs. This complaint was not recorded in the complaints book. However, action plan sent to the Commission in relation to the complaint was satisfactory. Aspects and Milestones policy on the Protection of Vulnerable Adults from Abuse policy was viewed and was found to contain appropriate in formation to enable staff to report incidents of abuse in the home. The South Gloucestershire Guidance on abuse was also noted at the home. The Commission for Social Care Inspection received a notification from the home in relation to maltreatment experienced by a service used by another individual living at the home. Whilst this was reported to the Commission and the Social services under the guidance, the incident happened on three separate occasions before the Commission and Social services were informed. The acting manager stated at a discussion that the home has learnt from the incident and would ensure that the correct procedure is followed in future. A safeguarding adult meeting was carried out and the inspector was led to believe that comprehensive action plan has been put in place to protect the individual. Both individuals were seen interacting well on the day of the visit. Another strategy meeting took place on 10/12/07 following a repeat of similar incidents involving same individuals The outcome of the meeting was positive and would seem likely to prevent further incidents. The inspector also noted that staff training on the protection of vulnerable adult from abuse was last undertaken in 2005. It was agreed that the manager must ensure that all staff undertake this very important training update to ensure that staff are familiar with the protocol if the incident reoccur. 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 18 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): 24,26, 28,30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The residents are provided with a good comfortable environment with suitable specialist equipment where they feel safe to live, however the home fails to provide safe environment in some parts of the home. EVIDENCE: The hone is a converted bungalow that provided care and accommodation to five service users with a range of Learning and physical disabilities. The home is situated in a residential location next to the local allotment and has been well accepted in the community. Access to the home is through the private lane. The condition of the road surface remains has deteriorated resulting in pot holes which makes it difficult people for people walking to and from home as identified by the expert by experience on the day. The home is required to carry out a review of the road surface in order to facilitate safe access for every one with mobility. 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 19 The bedrooms viewed were found to be reflective of each individual’s personality and choice, hobbies and interests. The rooms were found spacious and homely. In individual rooms there were photographs, televisions and music centres. All rooms have furnishings of a good standard. The Inspector had a tour of the building and noted that the radiators in the shower room and the kitchen had rusts and rough edges. This is hazardous to the health and safety of the individuals living in the home, staff and visitors. Furthermore, it was noted whilst touring the rooms that three bedrooms had damp areas covered with mould. The acting manager stated that the Landlord had attended the damp, however the treatment had been unsuccessful. It is required the more effective maintenance must be carried out to protect the health of the individuals and also to provide them with a more comfortable environment. All other areas were found clean tidy and odour free. The laundry was noted to have good flooring to ensure residents safety, there were two washing machines and one dryer and this was sufficient to meet the residents’ needs. A poster with guidelines on Control of Substances Hazardous to Health was also noted in the laundry to provide residents and staff with information dealing with chemical emergencies. 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 20 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): 32,34,35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents enjoy good warm relationships with competent staff and are protected by the home through staff supervision. EVIDENCE: Records reviewed showed that staff have undertaken training to include Manual Handling, First Aid, supervision skills. The acting manager stated that the psychologist was visiting the home the next day to talk to staff about the work he had done around needs of three individuals living in the home. One staff member spoken with stated that she has attended manual handling training, food hygiene and also fire lecture. All staff are aware of their roles and responsibilities in relation to the care of residents. Whilst staff have undertaken the above training it was agreed that staff must attend Protection of Vulnerable Adults from Abuse training update to ensure that individuals living in the home are adequately protected. This was previously discussed. 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 21 Supervision records seen demonstrated that one to one supervision is being carried out on a regular basis and covers topics like care plans. Review of staff duty rotas evidenced that the home is adequately staffed, for example, on the day of visit, two staff members and the acting manager were met on duty between 8am and 16 30. There was also one additional staff from 12 noon to support one individual following several incidents involving two individuals living in the home. There was also one additional staff provided for one individual with complex needs. One staff member was able to describe a typical day with one of the service users; the staff member was able to give a clear description of the likes and dislikes of the individual and how staff managed their behaviours. This staff member demonstrated a clear understanding of her roles and responsibility toward the residents and how the residents are supported, physically, emotionally and psychologically. However the Commission for Social care for inspection received an anonymous complaint about the use of agency staff and the possible implications on the service users with complex needs. A satisfactory explanation was received from the Trust regarding the use of agency staff on the occasions identified. The recently employed staff member had a job description in his or her file two satisfactory references and evidence of Criminal Record Bureau check before commencement of employment in accordance with the Trust policy. The individual had a comprehensive five day induction programme to include, Risk assessment workshop, Basic First Aid, Food Handling and hygiene, vulnerable Adult awareness Alerter training and Moving and Handling. 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 22 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): 37,39,42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home lack leadership, guidance and direction to staff to ensure service users receive consistent quality care. This results in some practices that do not promote and safeguard the health and safety of the people using the service. EVIDENCE: The current registered manager is on long-term leave due to personal circumstance and will not be returning to work until May 2008. Katharine Britton was acting manager for several months and had put in an application for registration to the Commission for Social Care Inspection. However Katharine withdrew her application for personal reasons. 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 23 Katharine Britton is a Senior Support Worker and has been in the home since it opened. She has clear understanding of the role she has within the home. The inspector met Katharine on the day of the visit and she was able demonstrate an understanding of the needs of the individuals living in the home. However Katharine felt that she was not supported by the management following recent incidents involving two service users. Staff spoken with told us that Katharine is approachable, open and would listen to suggestions about approaches that would promote the wellbeing of individual service users. “She is always willing to come in to deal with any problems no matter what time”. The Trust recently assigned Cherrie Ba an experienced registered manager from another Aspects and Milestones home to work at Chestnut Road 30 hours a week to support Katharine and staff in meeting the needs of the service users before the registered manager returns. The individual was met on the day of the visit and she stated that she was visiting the home to familiarise herself with the service users and staff before starting officially on Monday 3 December. The person was noted interacting with the service users in a sensitive and dignified way. Whilst the relatives/ representatives made positive comments about the home and staff team in the survey sent to them before the visit for example one relative states: “I consider the care at Chestnut Road is of a very high standard. Residents appear to have individual attention with permanent staff showing lots of interest to all. Chestnut Road has achieved a home from home feel, with privacy for each resident”. It appeared that lack of leadership and direction led to the recent anonymous complaint and various incidents that led to strategy meetings to protect an individual living in the home. One staff member told us that the recent incidents ‘knocked our confidence, staff need to have updates on abuse to ensure that we are aware of steps to take in case it happens again’. It is expected that the additional support from Cherrie would strengthen the leadership of the home in terms of direction and give staff confidence to provide quality care to the service users. Accident book was reviewed and it was noted that accidents are satisfactorily recorded and followed up and the risk assessment were reviewed as necessary to minimise incidents of falls. 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 24 There is a generic risk assessment to cover various areas in the home however the risk assessment for the kitchen had not been updated to include cupboards noted with sharp edges in order to protect the service users. A representative of the Trust undertakes the monthly visits to the home and reports are sent to the Commission for Social Care Inspection in line with regulation 26. Information regarding recent protection of vulnerable adult from abuse issue was included in the report. Maintenance records were found to contain the appropriate maintenance records and details of work done were seen. Fire records seen demonstrated that appropriate checks are carried out and that and staff have attended fire lectures and fire drills. The home’s Liability insurance certificate was prominently displayed in the entrance. The home has policies and procedures on Whistle Blowing, Protection of Vulnerable Adults, Complaints, Health and Safety and Medication. These policies are readily accessible to all staff working at the home. The quality assurance tool used to monitor the quality of service provided at No 8 Chestnut Road was discussed with the acting manager these include, residents’, relatives, staff and professionals questionnaires and all the information gathered is used to drawn up an action plan to deal with any issues identified. Other tools used include auditing the weekly activities plan; monthly Health and Safety Checks and business plan 6 monthly reviews. Regular feed back from families, visitors and service users. 8 Chestnut Road DS0000020300.V351812.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 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 X 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 X 3 3 3 X 2 3 8 Chestnut Road DS0000020300.V351812.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 YA22 Regulation 22(6) Requirement Include full details of the Commission for Social care Inspection in the Complaints procedure in the Service Users Guide. Ensure that identified bedrooms are free from damp in order to protect the health of the individuals and provide them with a comfortable environment. Ensure that the risk assessment for the kitchen is reviewed to include the cupboards noted with sharp edges. Repair or replace the radiators in the shower room and kitchen noted with rusts and sharp edges to protect the service users, staff and visitors. All complaints must be recorded in the complaints book including action taken in regard s to the complaint. Provide staff with training update on the Protection of Vulnerable Adults from Abuse to enable them to perform their duties effectively. All hand written medication must DS0000020300.V351812.R01.S.doc Timescale for action 30/01/08 2 YA24 23 30/01/08 3 YA42 13 30/01/08 4 YA24 23 27/02/08 5 YA23 22 30/01/08 6 YA35 18 27/02/08 7 YA20 13 22/12/07 Page 27 8 Chestnut Road Version 5.2 be signed and dated to protect the service users. 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 YA27 Good Practice Recommendations Carry out a review of the road surface to the bungalow and make good the potholes to facilitate easy and access for service users and their visitors. 8 Chestnut Road DS0000020300.V351812.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Regional Office 4th Floor, 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 8 Chestnut Road DS0000020300.V351812.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. 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