Care Home: Adult Care Home - Newberry and Gilley`s

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What the care home does well Dame Hannah Rogers Trust has for many years provided care and support to young people with a Physical disability. In addition to the new adult care service the trust provides a non-maintained school for up to 50 children aged between 5-19 years. Newbury and Gilley are two adult care homes providing accommodation for young people who have previously attended the school but now attend a post 19 college facility. Each young person has had their needs assessed during their time in the school and the home and college staff work closely together to support each individual to pursue their goals and develop their skills for the future. Staff in the homes have a good understanding of each individuals daily care needs and records provide good detail to ensure that support is delivered consistently and in a manner that the individual prefers and chooses. Staff have a good understanding of how each individual communicates and are supported by the Trusts Speech and Language Department to enable residents to use specialist communication tools and develop their independence wherever possible. The residents are encouraged and supported to partake in a range of activities relevant to their age and personal interests. Staff support residents to maintain regular contact with family and friends. People who use the service have access to a 24 hour nursing service as well as specialist support from the Occupational therapy, Physiotherapy and Speech and Language service based within the school. Staff are trained and competent in healthcare matters particularly in the care of people who remain immobile for long periods of time. The living environment is appropriate to the needs and lifestyle of people using the service and allows individuals where possible to develop their skills in preparation for moving on when the college course has been completed. The staff working within the care home demonstrate an understanding of peoples rights and are keen to empower people to make choices and have control over their lifestyle. What has improved since the last inspection? This is the first Key Inspection since the home Registered in July 2007. What the care home could do better: The Registered Provider must ensure that people who move into the home are provided with information that is relevant to the setting and the services they will receive. Any arrangements for managing episodes of difficult behaviour must be agreed only as part of a full multi-disciplinary process. These arrangements must be documented and reviewed as part of the care plan process. Now that people using the service have moved from the school into an adult care home consideration must be given to reviewing all policies and procedures to ensure that are relevant to the setting and services provided. All people using the service should be supported to make choices and have control wherever possible about their lifestyle and the care they receive. Consideration should be given to reviewing the policies relating to peoples finances and healthcare to ensure that people are able to develop their skills and make choices about how they are supported to manage this area of their life. The home should explore the use of advocacy services to assist them with this process. The practice of using wedges, to keep doors in an open position, must cease and the Registered Provider should seek advice to ensure that people are able to live in a safe environment at all times. CARE HOME ADULTS 18-65 Adult Care Home - Newberry and Gilley`s Dame Hannah Rogers Trust Woodland Road Ivybridge Devon PL21 9HQ Lead Inspector Wendy Baines Unannounced Inspection 27 /28th November 2007 10:00 th Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.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 Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.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. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Adult Care Home - Newberry and Gilley`s Address Dame Hannah Rogers Trust Woodland Road Ivybridge Devon PL21 9HQ 01752 892461 01752 898101 mail@damehannah.com 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) Dame Hannah Rogers Trust Mrs Joanne Eaton Care Home 7 Category(ies) of Physical disability (7) registration, with number of places Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Physical disability (Code PD) The maximum number of service users who can be accommodated is 7. Date of last inspection First. Brief Description of the Service: The Registered Provider for the home is Dame Hannah Rogers Trust; a Registered charity providing services for children and young adults who have physical disabilities and associated sensory, communication and learning difficulties. The Trust provides a non-maintained residential school for up to 50 children and young people aged between 5 and 19 years. In addition the school has also set up a post 19 further education department and have Registered two bungalows- ‘Newbury’ and ‘Gilley’- to accommodate the students who attend this college facility. The college course would normally run for two or three years, for young adults between the ages of 19 and 25. Some of the students who live in the bungalows during this time may still go home at weekends and holidays. Newbury and Gilley are two self-contained bungalows situated next door to each other within 9 acres of private grounds in the small town of Ivybridge in the South Hams. Both bungalows have a team of staff who provide a high level of support to meet each individual’s personal, social, physical and healthcare needs. The service has also been registered as a nursing home and qualified nursing staff are available throughout the day and night. Young people on the post 19 course who live within one of the registered bungalows also have access to the full range of Trust facilities including; Occupational Therapy, Physiotherapy and Speech and language services. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 5 Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.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 the service experience good quality outcomes. This report is a summary of a cycle of Inspection activity since the service registered two bungalows; Newbury and Gilley as adult care homes in July 2007. For the purpose of this report the term service user will be used to describe the people who use the service. To help CSCI make decisions about the home the Provider gave us information in writing about how the homes are run; any documents submitted to the Commission since they opened were examined and a two day site visit totaling 12 hours was carried out with no prior notice being given to the homes as to the date and timing; discussions were held with management and staff on duty; various records were sampled, such as care plans and risk assessments, and a tour was made of each bungalow; time was spent with the people who use the service and we were able to talk with, and observe the staff on duty. A sample group of residents were selected and their experience of care was tracked through records and discussions with staff and management from the early days of their admission to the current date, looking at how well the home understands their needs and the opportunities and lifestyles they experience. Where possible time was then spent with these residents, and feedback was sought from their care managers and other specialist services. Questionnaires were sent to residents, relatives, staff and other agencies. A sample of the feedback within these questionnaires will be included in this report. This inspection approach hopes to gather as much information about what the experience of living at the home is really like, and to make sure that the residents view of the home forms the basis of this report. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 8 This is the first Key Inspection since the home Registered in July 2007. 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. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.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 Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.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): Quality in this outcome area is good. 1,2,3,4,5. This judgement has been made using available evidence including a visit to this service. There is good multi-disciplinary working between the college and care home staff to ensure that people’s needs are assessed regularly and that their needs are sufficiently met in both settings. The young people living in the adult care homes are provided with information about the home and the services provided. However, some of this information still relates to children’s services and may be misleading and inappropriate to an adult wishing to consider moving into the home. EVIDENCE: All of the young adults currently living within the two bungalows Newbury and Gilley attend a post 19 education course, which is part of the facilities located within the grounds of Dame Hannah Rogers school. Information provided by the trust stated that the post 19 educational course would normally run for 2-3 years, for young people between the ages of 19 and 25. During this time students would be offered the opportunity to live within one of the adult care homes with the intention of developing their skills and opportunities in all areas of their life. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 11 It is expected that at the end of the course students will move on from the bungalows into an alternative setting, which will meet their long term care needs. Students on the post 19 course have previously attended Dame Hannah Rogers school as children and have had their needs assessed as part of this process. Care records confirmed that the staff within the adult care homes work closely with the school to ensure that these assessments are regularly reviewed and that each individuals needs continue to be adequately met. A statement of purpose is available, which details the aims and objectives of the home and also describes the facilities and services available. People who live in the home are also provided with copies of this information, although this still needs to be updated to ensure that it relates to the adult care home and is separate to the information provided by the school. The Director of Education for the Trust said that consideration is being given to extending the Adult care services in the future. The home would need to ensure that all new people are admitted only on the basis of a full assessment including visits to the home to ensure that that the placement is appropriate and that needs can be met. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.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): Quality in this outcome area is adequate. 6,7,8,9,10. This judgement has been made using available evidence including a visit to this service. Staff are provided with the information they need to support people with their daily care needs. The staff recognise the rights of individuals to take control of their lives and to make their own decisions and choices. However, this may not always happen in practice as some of the current policies and procedures could restrict staff when supporting people to develop their skills and to make choices about their care and lifestyle. EVIDENCE: The two adult care homes are situated next door to each other. Newbury currently provides residential accommodation for three young male students and Gilley provides the same type of support for four young female students. A sample of care plans; risk assessments and other daily records were inspected within each home during the visit. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 13 Care plans were linked with the college course and detailed individual targets that had been agreed between the people who use, college and the care home. One person was being supported to use their communication aid when shopping and to assist them to explore new opportunities within the local community. Information was documented about how staff should support people to achieve their identified target and a timescale agreed for when the target and outcome should be reviewed. Care plans and individual learning targets had been reviewed on a regular basis between the college and care setting. However, it was not evident that reviews are completed specific to the care home or if any independent advocacy support is accessed as part of this process. Most of the people living within Newbury and Gilley have profound communication difficulties. Care plans contained detailed information about the communication methods of each young person and any specialist equipment used to support them. Throughout the inspection staff demonstrated a good awareness of each individuals communication methods and were able to use this knowledge and understanding to promote choice and independence where possible. All staff are able to attend a weekly training session provided by the schools speech and language department. Discussion with staff confirmed that much emphasis is placed on encouraging people to make choices and have more control over their lifestyle and the care and support they receive. Some of the staff spoken to expressed concern that choice is at times limited as many of the policies and procedures within the adult care home still relate to the school and children’s services. Most people receive regular support and input from a range of specialist staff within the school and college. The home should amend their policies and procedures to ensure that rights, privacy and dignity of all the people who use the service is considered outside of the college setting. Any arrangements for support within the persons own home must be documented and agreed with the individual as part of the persons care plan. This should include any arrangements for visits by the school and nursing staff during the evenings and weekends. There were some arrangements and guidelines in place to manage the behaviour of particular individuals that live in the home. Some of these guidelines could restrict the person from moving freely around the home and although the guidelines were documented they had not been agreed as part of a full multi-disciplinary process. Staff said that some of the behaviour occurred during the college day and staff within the care home had not needed to follow the guidelines. The home must ensure that they undertake their own review of an individuals needs and care plan to ensure that any guidelines are up to date and appropriate. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 14 The staff said that all the residents require support to manage their personal finances and this is also supported by families outside of term time and when people go home for the weekend. Care plans did not include information about any skills and needs the person may have regarding their money and the arrangements agreed to support them. Each individual’s personal money and daily expenditure is currently managed within the main office of the school. People request money with the assistance of the care staff and this is then passed to the care home. Discussion took place with the Director of Education for the trust regarding the need to review these current policies and procedures to ensure that people are able to access their money at all times and are supported to make real choices and develop their skills and independence wherever possible. Risk assessments had been completed for inside and outside the home and were found to be well documented and up to date. Staff spoken to were aware of the need to ensure that information about people who use the service is handled appropriately at all times. Staff said that that due to the communication limitations of some people it is at times appropriate and important to pass some information between the care home and college. The care home needs to review their policy relating to confidentiality to ensure that staff are clear when and why information needs to be passed to people outside of the care home and to ensure that the individual service user or their advocate is involved in this process. All agreements must be documented and reviewed as part of the care plan process. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. 11,12,13,14,15,16,17. This judgement has been made using available evidence including a visit to this service. The home understands the importance of enabling younger adults to achieve their goals and follow their interests. Links with the local community are good and support and enrich residents’ social and educational opportunities. The meals in the home are good offering both choice and variety and catering for special dietary needs. EVIDENCE: The atmosphere in both homes throughout the inspection was warm and welcoming. Staff were observed interacting positively with residents creating a homely and fun environment, whilst meeting each individuals care needs in a respectful and unobtrusive manner. The post 19 Educational course has a particular focus on life skills, communication and choice making. Staff within the care home work closely Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 16 with the college staff to ensure that any new skills are transferred and encouraged in the home setting. Guidelines were available to support one service user to use the kettle safely as part of their care plan to develop skills and enhance their independence. Residents are able to access facilities within the school such as a sensory room, hydrotherapy pool and activities hall. Inclusion within the local community is encouraged, and people make regular use of the local shops, churches and leisure facilities. The residents were very excited about plans for the Christmas celebrations and several were keen to tell us about their trip to the local superstore to spend money on recent DVD’s. Individual bedrooms and communal areas contained a range of music, computer and sensory equipment. Staff said that they often bring in information about local events and inform each service user about opportunities in a way that they can understand. Communication passports are completed, which residents carry with them to inform people of their needs and to enable them to make choices when accessing facilities in the community. Some of the residents and staff said that due to the high care needs of people living in the home and number of staff required to go out it is sometimes difficult for people to go out individually. It was thought that this could at times limit the choice available to partake in some activities. People who currently live in the care homes go home to family outside of the collage term and some also go home at weekends. Due to this arrangement most of the residents families are still very involved in issues relating to their care and maintain regular contact. Family and friends are able to visit at any time and a range of communication aids including specially adapted speaker phones are available for residents to use during the week. The feedback received from one family member stated that ‘ The staff make regular contact with me, and keep me informed of any important issues’ We were invited to join some of the residents for lunch and was able to observe the support provided during this time. All of the residents require a high level of staff support with eating and most have specific dietary needs. This information is documented and staff are provided with step-by-step guidelines for each individual and the need for any specialist utensils. Staff spoken to said that this information is crucial to ensure that the support provided during mealtimes is consistent and meets individual needs. The food provided was of good quality and the staff supported residents to enjoy their meal in a relaxed and unrushed environment. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 17 Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are trained and competent in health care matters particularly in the care of individuals who remain immobile for long periods of time. Some of the current policies and procedures relate to the school and may not always ensure that people are offered a choice in the services they receive or the way that they are delivered. EVIDENCE: Service user records included information regarding personal and healthcare needs. The information was detailed and included people’s daily routines and personal preferences about they want to be supported. Staff recognised the importance of consistency particularly for people with complex care needs and communication difficulties. Throughout the inspection staff were observed supporting people in a respectful and sensitive manner. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 19 Daily charts, communication tools, handover meetings and a key-worker system are used to ensure that health is monitored and any changes addressed as soon as possible. Most people who use the service have increasingly complex medical conditions, and require regular support from healthcare services. The Trust has a nursing department situated within the main school/college and nursing staff are available for support during the day and night. The nursing staff work closely with the care staff regarding administration of medication and other specific healthcare needs. Physiotherapy and Occupational therapy support is also provided by the trust and care staff receive training and guidance regarding care plans and the use of equipment. Residents are registered with a local GP and receive regular visits from the Primary care Trust Optician, dentist and dietician. Examples were given of when staff had liaised with health professionals outside of the trust when it was felt they might not have the skills and knowledge to meet an individuals needs. All medication and records are kept within the nursing department attached to the school and senior, trained care staff within the home receive and administer medication on a daily basis. Through discussion with staff it was evident that the arrangements to support people with their healthcare needs have been in place since they attended the school as children. Records confirmed that these arrangements are reviewed on a regular basis but it was not evident whether or not residents had been offered any options to how their needs are met now that they have moved into an adult care home. Consideration should be given to reviewing the homes current policies and procedures in relation to medication and health needs to ensure that they are relevant to the adult care home and allow people to make choices and have control over the care and support they receive. Feedback from one relative stated ‘ The medical care is outstanding, carers and health staff keep me informed of ant concerns and offered the family constant support when our relative was admitted to hospital’ Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. 22,23. This judgement has been made using available evidence including a visit to this service. People who use the service are supported to express their concerns and have access to a robust and effective complaints procedure. EVIDENCE: The Trust has a written procedure for handling complaints and concerns. This is reviewed and publicised regularly. There are also policy statements regarding Adult Protection and Whistle-blowing. There is a young peoples’ Complaints book available, which contains symbols and pictures of staff and other people and services that may be contacted. The complaints procedure available in the homes referred to ‘children’ and the school and had not been updated for the Adult Care home services. Staff have a good understanding of the communication methods of each young person and those spoken to said that they use this knowledge and understanding to monitor each individuals well being. In addition to general observation the home has a range of systems including, daily records, health charts, key-workers and hand over meetings to ensure that any concerns or changes to an individuals care needs is recognised and dealt with promptly. Senior staff had received training relating to the protection of vulnerable adults and staff spoken to had a good understanding of issues relating to abuse. The Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 21 acting manager said that all staff would have the opportunity to attend this formal training. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is good. 24,25,26,27,28,29,30. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables people to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: Newbury and Gilley are two bungalows situated next to each other within the grounds of Dame Hannah Rogers School and college. Each bungalow has four bedrooms and separate communal areas. Bedrooms do not have en-suite facilities although wash hand basins are available in each room and bathrooms/ toilets are located close by. Two of the bedrooms in each house do not meet the National Minimum standards for their size, however as residents are likely to move on following completion of their college course the space was considered sufficient for people who do not require the use of a wheelchair. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 23 A sample of bedrooms were seen during the visit and these were found to be pleasantly decorated with a range of personal items to reflect the individuals, age, interest and personality. Bathrooms and bedrooms contained a range of specialist equipment including, and records confirmed that these are checked and serviced on a regular basis. Each bungalow has level access into the communal hallway, which leads into a large dining and sitting room area. Sliding patio doors lead into a flat, enclosed garden, which is used by residents during the summer months. The kitchen has low surface work- tops to enable residents to partake in cooking and other activities within this part of the home. Throughout both bungalows there were a range of modern and specialised equipment to support residents to partake in in-house activities and keep in touch with family and friends. Systems were in place to allow individual communication aids to be linked to the TV, telephone, computer and music systems. Staff spoken to said that this equipment is really important to the young people they support and enable them to live a more independent and fulfilled lifestyle. Feedback received regarding the environment was generally positive although some people did say that the general décor within one of the bungalows would benefit from being updated. Both homes were found to be clean and hygienic throughout. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is good. 31,32,33,34,35,36. This judgement has been made using available evidence including a visit to this service. The staff have a good understanding of the support needs of people who live in the home. This is evident from the positive relationships, which have been formed between the staff and the residents. Staff in the home are trained, skilled and sufficient in number to support the people who use the service. The staff team support each other and share skills and knowledge with colleagues. EVIDENCE: Staff demonstrated a good awareness of peoples needs and when spoken to were very familiar with care plans and specific guidelines for providing support. Throughout the inspection staff were observed interacting with residents on a one to one basis and in groups. There was a good rapport between residents and staff and the atmosphere in the home was happy and relaxed. Staff spoken to were very passionate about supporting residents to make choices and have control over their lifestyle. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 25 A sample of staff files were seen including the recruitment records of any new staff. All the required recruitment records were available and sufficient checks had been completed prior to appointment. The most recently appointed staff member described their induction process, which included a period of working alongside other staff, reading records, policies and procedures and the completion of mandatory training such as Health and Safety, food hygiene and Fire awareness. Staffing levels are high due to the complex care needs of the people who use the service, and reviewed on a regular basis to ensure that needs are being sufficiently met. The care staff work closely with the staff from the college to ensure that service user skills and goals are transferred and developed into their home environment. Staff spoken to said that this continuity of care is important to help equip people with the skills for the future. The trust provides regular training to all the care staff. Specialist training sessions are organised by the Physiotherapy, Speech and Language, Occupational and nursing staff. Care staff are supported at all times by senior staff and a planned 24hr on-call system. Staff spoken to said they felt well supported by other team members and management. Key-worker and team meetings take place on a regular basis, and the rota allows for a shift handover to discuss daily events. Records confirmed that formal supervision takes place every 6-8 weeks and this information is documented. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 26 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): Quality in this outcome area is good. 37,38,40,41,42. This judgement has been made using available evidence including a visit to this service. Senior staff within the Trust have a good understanding of the areas in which the home needs to develop and improve. EVIDENCE: The Registered Provider for Newbury and Gilley is Dame Hannah Rogers Trust. At the time of the Inspection the homes did not have a Registered Manager and the Trust had advised the Commission that they were in the process of appointing a new member of staff to this post. In the interim a senior member of staff was overseeing the day-to-day management of the home with support from the Director of Education for the Trust. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 27 In addition to the care staff Dame Hannah Rogers Trust also recruits a large number of full time and part time multi-disciplinary staff who are available to support the needs of people living within the care homes. The young people living within the two care homes have only recently moved from the school and children’s services. Some of the homes policies and procedures still relate to these services, however staff spoken to were keen to consider the changes that need to occur to support people to move on and develop their skills as adults. An induction process is in place for all new staff and training included Health and Safety, Manual handling and Fire safety. Risk assessments had been completed for safe working practices. A number of door wedges were being used to hold open fire doors and the acting manager was advised that this practice must cease. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 28 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 3 4 3 5 3 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 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 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 2 3 3 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 3 X 2 3 3 X Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 29 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 YA1 Regulation 6 Requirement The Registered Provider must ensure that the Service user guide and any information provided prior to admission is appropriate and relevant to an Adult Care setting. The Registered provider must undertake a review of the behaviour management guidelines as discussed during the inspection. Any practices, which may restrict a service user must only be agreed as part of a full multidisciplinary process and must be documented and reviewed on a regular basis. These arrangements must be made in the persons best interests, be consistent with the purpose of the service and the homes duties and responsibilities under law. The Registered Provider must ensure that Policies and Procedures are relevant to the setting and appropriate to the needs of people living within an adult care home. Timescale for action 15/04/08 2 YA7 13(7) 15/03/08 3 YA40 Appendix 3 15/04/08 Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 30 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 YA6 Good Practice Recommendations The home should have a process for reviewing an individuals care plan specific to an individuals’ home environment and separate to the review undertaken by the college. The home should consider the use of advocacy services to support this process. People using the service should be supported and encouraged to make real choices about their lifestyle and the services they receive. • Current policies and procedures should be reviewed to ensure they do not prevent people from making choices about their care and lifestyle. • Any support provided by the school and college should be agreed as part of the individuals care plan. The individual should be involved in this process with the assistance of advocacy where possible. • The current arrangements for managing peoples finances should be reviewed to ensure that people are able to develop their skills, make choices and have control over their money wherever possible. The home should undertake a review of the policies and procedures relating to residents information and confidentiality. All staff must be aware of matters relating to peoples rights, privacy and confidentiality when sharing information between the home, college and other people involved in the individuals care. People who use the service should be able to partake in activities of their choice and as agreed within their service user plan. Group trips should be planned and chosen by people who share the same interests. People using the service should be supported to make choices about the support required to meet their healthcare needs. These arrangements should be agreed and documented as part of the individuals care plan. The complaints procedure should be updated to ensure DS0000070306.V352100.R01.S.doc Version 5.2 Page 31 2 YA7 3 YA10 4 YA14 5 YA19 6 YA22 Adult Care Home - Newberry and Gilley`s that it is appropriate to an adult care setting. Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Adult Care Home - Newberry and Gilley`s DS0000070306.V352100.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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