Care Home: 8 The Villas

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What the care home does well The service provides information about it`s aims and facilities for prospective service users and a user friendly Service User Guide for people who live at the home. Assessments of prospective service users are undertaken in co-operation with other relevant agencies and anyone referred to the service has the opportunity to visit it and meet staff and the people who live there before deciding if it is suitable to meet their needs. Care plans are in place to meet the assessed needs of people who live at the service, these are subject to regular review and the allocated key workers discuss care needs with each individual. People who use the service are supported to access recreational, occupational and social opportunities. They are involved in the day-to-day decision-making in the home and have access to all areas of it. People who use the service say they are happy it at the home, "it`s lovely here," "this is my home and I am happy living here." And know what to do if they are unhappy or have concerns. The environment is comfortable and presents as homely. The service has a well-established staff team who have been provided with access to relevant training including National Vocational Qualifications (NVQ). Recruitment procedures are robust and staff receive opportunities to discuss their practice at regular 1:1 supervision sessions and staff meetings. The provider and the manager are actively involved in the day-to-day running and management of the home. They are both registered and approved by us, (CSCI, Commission for Social Care Inspection). Systems and arrangements for the safety and well being of people who use the service are in place, this means that equipment is well maintained, serviced regularly and complies with expected standards. What has improved since the last inspection? The provider has carried out a number of environmental improvements since the last visit to the service, these include, refurbishment and decoration of the ground floor shower room, redecoration of the lounge and some bedrooms, and has an on going programme of redecoration. During this site visit, one of the double bedrooms was being redecorated. The manager said that routines in the home have become less rigid and people who use the service are supported to be independent and involved with the day-to-day decision making in the home. Greater choices are provided.The frequency of staff supervision has improved and key workers meet regularly with people who use the service to discuss their goals and aims. Relationships have been formed with other agencies in an effort to improve self-advocacy among the people who use the service. Staff has received greater opportunities to access relevant training courses, the number of staff trained to a NVQ level 2 and above exceeds the recommended minimum standards. CARE HOME ADULTS 18-65 8 The Villas 8 The Villas West End Stoke-on-Trent Staffordshire ST4 5AH Lead Inspector Wendy Jones Key Unannounced Inspection 18th and 22 September 2008 18:00p nd 8 The Villas DS0000065377.V372033.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 The Villas DS0000065377.V372033.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 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 8 The Villas Address 8 The Villas West End Stoke-on-Trent Staffordshire ST4 5AH 01782 847947 01782 412492 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 Ronald Mark Snijders Ms Allison Bernard Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (8) of places 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of care only: Care Home only To service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD) 8 Learning Disabilities over 65 years of age (LD)(E) 8 The maximum number of service users to be accommodated 8. 2. Date of last inspection 10th October 2006 Brief Description of the Service: Number 8,The Villas, provides personal care and accommodation for eight service users with a learning disability, the minimum age for who is 30 years. The home, was opened in 1988, and is located in a residential area known as The West End, near the centre of the town of Stoke. Whilst quietly situated, it is very conveniently placed for access to all of the facilities of Stoke town. It is near to shops and pubs and is on a good public transport route. The home is provided in a large detached house that is intentionally preserved as being indistinguishable from other properties in the small un-adopted road. The accommodation consists of four single bedrooms and two shared bedrooms. None of the bedrooms have en-suite facilities. There are bathrooms on both floors, and separate W.C’s conveniently situated around the home. There is ample communal and private space for the service users to enjoy, with a good standard of furniture, furnishings and fittings throughout. In addition to the spacious internal accommodation, the home has large and attractive rear gardens, with a smaller formal garden at the front. There is provision of outdoor seating in good quality high-grade garden furniture. The garden contains several fruit trees, a vegetable plot and a large greenhouse. The stated aims of the home are to provide a home for life for the service users 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 5 based upon good management of care that promotes choice and normal lifestyles with strong community presence. The service has as service user guide, but it does not contain the fee range or additional costs of the service. Prospective service users and their supporters should contact the provider for this information. 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 6 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 was a key inspection site visit of this service undertaken on 18th and 22nd September 2008. In total the visit took approximately 07:00 hours. The purpose of this visit was to assess the services performance and to establish if it provides positive outcomes for the people who live there. The visit included checking that any requirements and recommendations of the previous inspection visit of 10 October 2006 have been acted upon; looking at information the service provides for prospective residents, their carers and any professionals; looking at information that the service provides to people who use the service to ensure that they understand the terms and conditions under which they have agreed to live at the home and the fees they should pay. Other information checked included assessments and care records, health and medication records; activity and records relating to the menu’s, finances, staff training and recruitment, complaints and compliments, fire safety and health and safety checks. The provider, manager, staff and people who use the service were spoken to during the site visit and a brief tour of the building was undertaken. Before the visit began, the service provided it’s own assessment of its performance, in the form of an Annual Quality Assurance Assessment (AQAA). Surveys were sent out to people who use the service, staff, and relatives and any professional that has involvement in the service. We have received 5 surveys from people who use the service and 4 from staff; the main points are included in this report. The service has confirmed that the 2 requirements made at the last inspection have been complied with. And we have confirmation from the fire safety officer that he is satisfied with the fire safety arrangements at this service. Since the last key inspection site visit we have carried out an annual service review, at that time and based upon the evidence we had, we concluded that the service continues to provide good quality outcomes for service users. As a result of this inspection visit we have made 9 recommendations. What the service does well: 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 7 The service provides information about it’s aims and facilities for prospective service users and a user friendly Service User Guide for people who live at the home. Assessments of prospective service users are undertaken in co-operation with other relevant agencies and anyone referred to the service has the opportunity to visit it and meet staff and the people who live there before deciding if it is suitable to meet their needs. Care plans are in place to meet the assessed needs of people who live at the service, these are subject to regular review and the allocated key workers discuss care needs with each individual. People who use the service are supported to access recreational, occupational and social opportunities. They are involved in the day-to-day decision-making in the home and have access to all areas of it. People who use the service say they are happy it at the home, “it’s lovely here,” “this is my home and I am happy living here.” And know what to do if they are unhappy or have concerns. The environment is comfortable and presents as homely. The service has a well-established staff team who have been provided with access to relevant training including National Vocational Qualifications (NVQ). Recruitment procedures are robust and staff receive opportunities to discuss their practice at regular 1:1 supervision sessions and staff meetings. The provider and the manager are actively involved in the day-to-day running and management of the home. They are both registered and approved by us, (CSCI, Commission for Social Care Inspection). Systems and arrangements for the safety and well being of people who use the service are in place, this means that equipment is well maintained, serviced regularly and complies with expected standards. What has improved since the last inspection? The provider has carried out a number of environmental improvements since the last visit to the service, these include, refurbishment and decoration of the ground floor shower room, redecoration of the lounge and some bedrooms, and has an on going programme of redecoration. During this site visit, one of the double bedrooms was being redecorated. The manager said that routines in the home have become less rigid and people who use the service are supported to be independent and involved with the day-to-day decision making in the home. Greater choices are provided. 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 8 The frequency of staff supervision has improved and key workers meet regularly with people who use the service to discuss their goals and aims. Relationships have been formed with other agencies in an effort to improve self-advocacy among the people who use the service. Staff has received greater opportunities to access relevant training courses, the number of staff trained to a NVQ level 2 and above exceeds the recommended minimum standards. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 9 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 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 10 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 and 3. Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. People who use the service can be confidant that they will receive an assessment of their care needs to ensure that the service is suitable for them. They must also be sure that they have up to date copies of the service user guide with the fees and costs of the service. EVIDENCE: The service has a statement of purpose and service user guide. The manager should ensure that they are reviewed regularly to ensure that the information is up to date. We are told that people who use the service have their own copies, but when asked about them they could not sure they did. We looked at the records of two people; one had been admitted to the service since the last key inspection visit, the documentation we saw is of a very good quality. There is evidence of good assessment information and involvement of the person in decision-making. Regular reviews of the placement have been carried out, and the records show that the placing authority has been satisfied with the service provided. One person said in the surveys we sent out that, “Ron and Allison came to visit me and told me about the Villas, then invited me to tea and a look around.” The service has one vacancy at the moment and the provider is concerned about the lack of suitable referrals he has received. He is also concerned that 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 11 the majority of people, who have been at the home for many years do not routinely receive a review of their care from their placing authority. 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 12 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, 8 and 9 Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that their needs are known and support plans are in place to ensure that the staff knows how to meet their needs. Plans and risk assessments are reviewed regularly. But the service should continue to develop the person centred approaches they know will improve the quality of service delivered. EVIDENCE: The service told us in the AQAA, “that we view all people who use the service as individuals and provide choices in most areas of living.” People who use the service said, “ We can choose what we want to do during the morning, afternoon and evening.” “I know who my key worker is, she talks to me about what I want to do, I really like her.” Staff said, “People who use the service are treated as individuals, but we need to support them to be more independent.” 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 13 The service has adopted a person centred model of care planning but this needs to be further developed to ensure that people who use the service are involved and lead their care planning and goal setting. The manager and the provider are conscious that this work is needed. We looked at a sample of two care files. One had very comprehensive support plans and risk assessments with evidence of very regular review. The other care plans we saw are fairly basic and need to be developed. The 24-hour plan of care titled an “ordinary day” details the person’s known and preferred routine. Support/care plans are then in place to address needs. In the sample, we saw risk assessments and management strategies have been agreed where risks and challenges are known. One person is subject to Care Programme Approach, (CPA) meetings, this means the individual meets with people involved with their care, including health and social care professionals to ensure that their needs continue to be met. People who use the service know who their key worker is and confirmed that they talk to them about the things they need regularly. A member of staff gave a good account of the principles of person centred thinking when discussing the needs of the person she is key worker to. 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, and 17. Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that they will be supported to access recreational and social opportunities if they are planned, but should be able to make spontaneous choices and be supported with these. They should also be supported to access more integrated activities in the community. EVIDENCE: The service told us in the AQAA that, “Staff support people who use the service find fulfilling activities and support them doing these, and we actively support relationships. We offer exceptional quality food and choice of menu.” People who use the service said, “ I go to the Grocott centre, I enjoy going there.” “I like going to the football, my key worker sorts it out for me, I can go every week if I want to.” “I like baking, dear; the food is very good.” People who use the service have a range of activities that they enjoy these include college and other placements, but the service needs to consider how 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 15 they can be better integrated in the community. The manager stated that neighbourhood relationships are good, and people who use the service are invited to local events such as bonfire night celebration and garden parties. They also invite neighbours to these. Staffing levels may limit the opportunity that people who use the service have to go out of the home in the evening, unless it is pre planned. And therefore should be kept under review. A number of people go to the Grocott centre, which provides a day service for people who may not find it easy to socialise or integrate into mainstream facilities. People who use the service have free access to the kitchen and we saw that they are encouraged to make their own drinks. We are told that they are involved in preparation and cooking meals. One person confirmed that she liked to be involved in baking cakes. The menus are pre planned based upon people’s known preferences and special dietary needs, the manager said that she is keen to offer as much choice as possible; this was evident from the information available. There is a good range of breakfast and evening meal choices and 2 alternatives of the main meal of the day at lunchtime. Additional options are also recorded. Some people require special diets because of health issues, we were told how this was managed and have been impressed with the sensitivity staff and the management team show to ensure that the people who require this additional support do not feel marginalised because of it. People who use the service said, “The food is good,” “ I like it dear,” “ It couldn’t be better.” Leading from the main dining room the service has a large patio area where people who use the service can have their meals when the weather is good; the provider confirmed that barbecues are sometimes arranged as well. People who use the service confirmed that they went on holiday and had days out, records show that some have been to Butlins at Skegness and some are going to Blackpool in October. Not everyone enjoys holidays so alternatives are arranged. One person loves to go to the theatre and has had the opportunity to do this; another likes to go to the cinema on a regular basis and to local football matches. From discussion with people who use the service, staff and management it was clear that support is given to ensure that relationships with families and friends are maintained as much as possible. 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 16 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. People who use the service can be sure that their personal, health care and medication needs will be met by a staff team who have the skills to this. This means they can be confident that their needs will be properly addressed. EVIDENCE: The service told us in the AQAA that, “ We provide individual, respectful support, flexible assistance and access to health services. Staff are well trained and the management of medication is safe.” We saw positive staff interactions throughout this visit and it is clear that relationships between people and staff are based upon trust and mutual respect. People are supported to be independent within the home as much as possible and are sensitively supported in areas they need assistance with. There is an absence of rigid routines, which means that people who use the service feel that they have some control over their lives and decision-making. The staff team is familiar with the aims of the service and understand the importance of a supportive rather than a doing for approach. 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 18 The health needs of people who use the service are well documented and it is evident to us that they receive the care and support they need. Health professionals are involved and the staff and management gave examples of where health advice has been sought for at least 3 of the people who live at the home. Records show that people who use the service are supported to access appointments with their GP, dentist, chiropodist and optician. Access to occupational therapy for those who require it namely those with mobility difficulties and eating difficulties; speech therapy services have been sought where relevant. Since the last key visit one person has suffered a fracture as a result of a fall, the service has taken extraordinary steps to ensure that they can accommodate his needs during a period of convalescence, liaising regularly with occupational health services. But we haven’t been informed of this accident, the provider needs to do this formally. Medication management is appropriate, in that the records are properly maintained, there is information available about the medication that is prescribed, what it is for and any side effects. None of the people who use the service currently self medicate, assessments should be undertaken about this when the service properly introduces person centred plans. In addition consent to medication should be discussed and recorded. The service uses a monitored dosage system (MDS) this means that the medication is dispensed pre packed from the chemist. Matters arising from this visit include the need to replace the current medication storage facility in line with new guidance relating to care services. Where medication is given occasionally or when required, there should be clear guidance for staff about when and under what circumstances the medication can be given, these protocols should be retained in the medication file and copied to he individual care files. We are told that staff has received accredited/certificated medication training, we confirmed this when talking to a member of staff. 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. People who use the service are confidant that they can complain and that they will be listened to and protected. But need to be sure that staff is up to date with the most recent safe guarding reporting procedures agreed locally. EVIDENCE: The service has told us in the AQAA that, “ We listen to people who use the service, and work proactively to manage challenges and protect them from abuse.” The service has also said, “we plan to introduce more advocates and attempt to get allocated social workers for all the people who use our service.” We have not received any complaints about the service and are not aware of any safeguarding referrals. The manager confirmed that the complaints procedure is available to people who use the service, we saw that is displayed in the home. People we spoke to said, “ I like living here, I don’t have any problems,” “ I have no complaints, it’s alright here.” Staff said in the surveys that they knew what to do if they receive a complaint from a person using the service or their relative. We talked to staff about safeguarding and have been assured that they know what to do should they suspect someone is being abused or harmed. They said 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 20 they hadn’t received training in this area recently, but if they where unsure what to do they would discuss it with the manager or provider. The service doesn’t have a copy of the most recent procedures agreed in Stoke-on-Trent and Staffordshire, these provide up to date information about how suspected abuse should be reported and who to, including whose responsibility it is to look into these matters. It is recommended that staff should receive up to date safeguarding training to ensure that they know how to recognise and report suspected abuse. And the service should contact the local authority for the most recent version of the safeguarding procedures. Recruitment records show that pre employment checks for staff, including Criminal Records Bureau checks (CRB) are carried out. We have not received any notification of accidents or incident in the home, but know that one person has suffered a fracture as result of a fall. The provider has said that we have been informed but our records don’t show this. A copy of the report of this accident should be forwarded to us and the provider should confirm that the accident has been reported to environmental health services of the local council under RIDDOR. 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 21 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, 25, 28 and 30. Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. People who use the service can be sure that the home in which they live is clean, comfortable and well maintained and that they are involved in decision making about any improvements that are needed and their thoughts are respected. EVIDENCE: The service told us in the AQAA that, “We provide a well maintained, warm, homely environment with lots of communal space, large well maintained gardens and conform to minimum standards in relation to the number of bathrooms and toilets provided. We have invested in maintenance of the home, installed new double glazing, improved décor and improved health and safety.” The service is in a lovely residential area of Stoke on Trent called The Villas and is a detached and impressive property. The gardens are beautifully maintained and provide people who use the service with a fantastic 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 22 outside space. The building it self requires a lot of maintenance, the manager reported that there have been a number of problems that have had to be put right since the provider took over the service. There is evidence that further work is needed, but the provider knows this and is working hard to ensure that the environment is up to a good standard. During this visit a double bedroom was being redecorated, the occupant had moved into other rooms in the home on a temporary basis while this took place. We have been told that this has been agreed with them. The service has two double bedrooms and the provider discussed proposals to extend the service to provide single bedrooms, these plans are in the very early stages, but would improve the service for the benefit of the people who live there. We saw a sample of bedrooms with the kind permission of the people who live at the home. It is evident that they are supported to personalise their bedrooms and own their space. One person is currently living in a ground floor room that had previously been used as a study because of his health problems and need to convalesce following an accident. This temporary arrangement is not ideal but the room is of sufficient size to accommodate him, the provider should contact the fire officer to ensure that the change of use is known about and fire safety risk assessments should be revised to reflect the individuals changed needs. One of the people who live at the service gave a guided tour of the home. The main lounge is spacious and well maintained. The dining room is functional and provides sufficient space for all people to dine comfortably. There are patio doors leading into the rear garden that also has table and chairs, records show that people can have had their meals out in the garden area when the weather allows. The ground floor shower room has been refurbished since the last key visit and redecoration of some areas of the home has been completed. 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 23 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, 33, 34, 35, 36. Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that staff will have the training opportunities they need to be able to deliver a good and relevant service, and will be supported to develop individually and as a team. But staffing levels should be kept under review. EVIDENCE: The service told us in the AQAA that, “We have a good induction programme and provide regular supervision and appraisal of staff. We don’t use agency staff ever. Our records show that we are committed to staff training and development. Since the last inspection we have provided additional training and hugely improved the management structure by appointing a deputy manager.” Staffing levels are usually two staff through out the waking day and one at night. The evidence from the records shows that this is usually the case but occasionally there are more staff provided particularly if there is an activity planned. One person using the service is contracted to receive 29 hours per 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 24 week 1:1 support, we saw that the records show where the staffing hours have been allocated. We interviewed one member of staff and spoke to the provider and the manager. Staff said in the surveys we sent that, “Relevant training is always given and we receive the support and supervision we need.” “ We take good care of the people who use the service, but could do with more staff sometimes.” “We provide a good and supportive environment, but could improve by providing more staff in order to meet peoples social needs, have more meetings with regards to the needs of people who live at The Villas and ensure that staff are working consistently.” The member of staff confirmed that she had achieved NVQ level 2 and has received all mandatory training except safeguarding training, although this had been included in the NVQ training. Other confirmed mandatory training includes infection control which was a lengthy course and all attendees were assessed, first aid, basic food hygiene, manual handling and medication. The manager said, that fire training has been provided; some staff have attended a course on Dementia care. Additional training related to the individual needs of people who use the service is also sourced an example of this is where a key worker has received training in sign language to support a person who does not communicate verbally. The service is also planning training in equality and diversity and a management and leadership course for the care manager. Numbers of staff trained to NVQ level 2 and above are very good, exceeding the current minimum recommended levels of 50 of the workforce. We looked at the recruitment records of two staff, they included all pre employment checks we would expect to find, including CRB, Protection of Vulnerable Adults (POVA) checks; references, application forms and evidence of supervisions. New staff are routinely enrolled on an induction programme that is relevant to the people they support. 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 25 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 (good) This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that the service takes all action necessary to ensure their welfare and safety, but need to be sure that the service is actively and regularly assessing the quality of service provided and acting to continually improve the service it delivers. EVIDENCE: The service has told us in the AQAA that, “ the manager is being trained to NVQ 4 and the Registered Managers Award (RMA). Policies and procedures are in place reviewed, regularly and available to staff.” The current manager has been appointed since the last key inspection visits and is registered and approved by us as a fit person. She has undertaken relevant training and will provide evidence of completion to us when she receives her certificate. She has some years experience in this service and 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 26 demonstrated an awareness of the need to develop the service in line with current care principles. The service has created a deputy managers post, which is reported to be valued and has strengthened the management team. The provider plays an active part in the day-to-day running of the home is a supportive presence for the manager. Administration tasks have been allocated to the manager for a period of time and are shared with the provider, but we understand there are some supernumerary hours allocated for this. We looked at a sample of financial records and with the help of the provider were able to evidence that the information in them accurately reflects the actual balances in service users accounts. Information in the AQAA tells us that the equipment in the home has been serviced regularly and is up to date. Policies and procedures are kept under review. People who use the service have said to us that they are happy at the home and have said that Alison (the manager) is approachable and ensures they have what they need, staff have confirmed this. Matters arising and for further attention include, the need to keep us informed of any significant incidents within the home including accidents that result in serious injury; contacting the fire safety office to advise of the temporary change of use of a ground floor room and to revise the fire safety risk assessment for a person currently living in that room. The manager confirmed that a fire evacuation procedure and emergency contingency plan has been agreed with fire safety officers. We recommended that this information if more readily accessible to staff in the event of a fire. The service should demonstrate that it actively seeks the views of people who use the service and their supporters about the service provided and use this information, and any other audits of the quality of the service, to produce an annual development/improvement plan. 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 27 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 3 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 x 27 x 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 4 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 X 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 x 3 x 2 x x 3 x 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The service user guide should contain the range of fees and any additional costs. To ensure that people who use the service know what they can expect to pay. The PCP model of care planning should be further developed to ensure that people who use the service can be confident that they take the lead role in decision making that affects their life. People who use the service should be supported to access more integrated community services, and engage in socially valued activities. The current medication cupboard should be replaced with a fixed lockable metal cabinet that complies with current guidance. To ensure that medication is safely stored 2 YA6 3 YA13 4 YA20 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 29 5 YA20 Where people who use the service are prescribed “as required” medication, the service should agree the circumstances under which this medication is to be administered. This information including the specific dose should be recorded for each person. The service should contact the local authority to access the most recent guidance regarding Safe Guarding and ensure that the staff team is familiar with the current procedures. The provider should keep staffing levels under review to ensure that service user can exercise real freedom of choice in their social lives. The provider should ensure that fire safety officers have been informed of the temporary change of use of a ground floor bedroom. The provider should ensure that the fire safety risk assessment reflects the current circumstances of people who use the service and is easily available to staff. 6 YA23 7 YA33 8 YA42 9 YA42 8 The Villas DS0000065377.V372033.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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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