Care Home: Broadview

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What the care home does well There was detailed written information about the needs of the people that lived there that enabled the staff to provide the help and support that each individual required. The home promoted equality and diversity and its routines were flexible. Individuals were encouraged and supported to make choices for themselves and use the amenities in the local community. The building was comfortable, well furnished and decorated. The home`s managements systems and procedures were effective including staff recruitment, health and safety, medication and quality monitoring. These ensured that among other things the safety and welfare of people living and working in the home were promoted and that they were able to influence the way the service was provided by the home. What has improved since the last inspection? There were no matters of concern identified as a result of the last key inspection of the home. What the care home could do better: Implement a plan that ensures that at least 50% of the home`s staff will obtain a formal and relevant competency based qualification indicating that they have the skills and knowledge to meet the needs of the people living in the home. CARE HOME ADULTS 18-65 Broadview 22 Kiln Road Fareham Hampshire PO16 7UB Lead Inspector Tim Inkson Unannounced Inspection 27 February 2008 09:30 th Broadview DS0000063312.V359187.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 Broadview DS0000063312.V359187.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. Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broadview Address 22 Kiln Road Fareham Hampshire PO16 7UB 01329 829177 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) www.milburycare.com Milbury Care Services Ltd Mr. Russell Weeks Care Home 6 Category(ies) of Learning disability (5) registration, with number of places Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th August 2006 Brief Description of the Service: Broadview provides care for up to six young adults with learning disabilities and associated behaviour support needs. Milbury Care Services Limited a national organisation manages the home. It is located on the outskirts of Fareham with easy access to local shops, other amenities. The building is a two-storey domestic detached house, and the accommodation for people living there comprises 4 single bedrooms with en-suite facilities and 2 self-contained flats. There is a large area at the front of the building where vehicles can park and an enclosed rear garden with a large pond, summerhouse and areas of decking with railings. The communal/shared space includes a large lounge, and separate dining room, laundry and kitchen. The self-contained flats have their own front doors as well as access to the main home. Information about the service provided at the home is made available to people wishing to live there by providing them with a copy of the home’s Service Users Guide in a format that is easy to understand. A copy of a report of the most recent inspection of the home carried out by the Commission for Social Care Inspection (“the Commission”) is available in the home. At the time of this site visit the home’s fees ranged from £1500 to £2500 per week depending on the degree of support and help a person needed. This fee included a contribution towards the cost of a holidays but not the cost of hairdressing, toiletries, podiatry/chiropody and travel/transport. Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This site visit was part of the process of a key inspection of the home. It was unannounced and took place on 28th February 2008, starting at 09:05 and finishing at 16:20 hours. During the visit accommodation was viewed including bedrooms, communal/shared areas and the home’s kitchen and laundry. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. People living in the home and staff were spoken to in order to obtain their perceptions of the service that the home provided. At the time of the inspection the home was accommodating 6 people, 4 males and 2 female and their ages ranged from 24 to 59 years and none was from a minority ethnic group. The home’s registered manager was present during the visit and was available to provide assistance and information when required. Social care professionals involved with people living in the home were telephoned for their views about the home following the site visit and their comments have been taken into consideration when producing this report. Other matters that influenced this report included: Responses in questionnaires returned by people living in the home, their relatives and also telephone discussions with relatives. An Annual Quality Assurance Assessment completed by the registered manager in which he set out how he believed the home met and planned to exceed the National Minimum Standards (NMS) for Care Homes for Adults (18 –65) and evidence to support this. A “dataset” containing information about the home’s staff team, and some of its managements systems and procedures. Information that “the Commission” had received such as statutory notices about incidents/accidents that had occurred. What the service does well: There was detailed written information about the needs of the people that lived there that enabled the staff to provide the help and support that each individual required. The home promoted equality and diversity and its routines were flexible. Individuals were encouraged and supported to make choices for themselves and use the amenities in the local community. The building was comfortable, well furnished and decorated. The home’s managements systems and procedures were effective including staff recruitment, health and safety, medication and quality monitoring. These ensured that among other things the safety and welfare of people living and Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 6 working in the home were promoted and that they were able to influence the way the service was provided by the home. What has improved since the last inspection? 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. Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 7 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 Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 8 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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had systems and procedure in place to identify the help people needed before they moved in, in order to ensure that the home could properly provide it. EVIDENCE: Everyone that moved into the home was referred to it by and the arrangements made in partnership with the adults services department of a local authority and/or a primary health care trust. Most of the group of people living in the home had been there for some considerable time. One individual had however moved into the home two weeks prior to the site visit. The admission process of this individual was looked into and the documentation concerning it examined in detail. Before the person had moved into the home the help and support that they required was identified by a range of heath and social care professionals employed by a National Health Service Partnership Trust. The company that owned the home employed a behavioural therapist/psychologist and staff that knew the person concerned completed a profile about them that was assessed by the therapist who then indicated that the home was suitable and able to meet that individuals’ needs. Staff from the home also visited the individual where they had been accommodated previously and also the person visited the home before they moved in. Staff Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 9 supporting the person where they had been accommodated previously had also visited the home to talk to the staff there about the how the person’s behaviour was managed and any specific needs. Staff from the home also completed their own assessment of the individual’s needs. It was apparent from discussion with staff, the individual concerned and documents examined that the “transition” process, was carefully planned and prepared and everyone concerned obtained as much information as possible about what and how the help and support a person needed when living in the home would be arranged and provided. This included matters such as individual decision making in accordance with the Mental Capacity Act 2005; health; communication skills; behavioural and emotional support; risk factors; life skills; leisure interests; and access to the community. A social care professional involved with the move of the individual concerned into the home said: • “The home was very accommodating and considerate of his needs and supportive of his move …”. Broadview DS0000063312.V359187.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had systems and procedures in place for planning the care and support that people received. People were helped to exercise choices about day-to-day life. The potential of harm to individuals was identified and plans were put in place to promote responsible risk taking. EVIDENCE: Documents examined during the site visit included comprehensive plans setting out details of the support that each person living in the home needed and how it was to be provided. The plans were focussed on the choices and wishes of the individual, demonstrating that “person centred planning” was the principle upon which they were based. The format for the documents used in the home was being changed and they were being produced in the first person and it was apparent from discussion with people living in the home able to have a meaningful conversation that they were involved in the development of the plans. The existing plans were very detailed and set out how and what action staff had to take to provide the support each person needed. They were based on the Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 11 assessed needs and included short and long-term goals for the individuals concerned. This is illustrated by a short terms goal for one person being supported and encouraged to maintain a good level of personal hygiene. While the long term goal was to support the person to improve and maintain a positive level of self -esteem and self-confidence. This was to be achieved by supporting the person to have a shower and give him “space” and time to do so but to check his hair and “let him know that he had done a good job” as well as encourage him to take care of his laundry. The intention with the new format was that each person with the support of staff would complete a personal planning book with pictures and symbols setting out important things in the individual’s life e.g. relationships, goals/aspirations and details of likes and dislikes. Any restrictions that were considered necessary and agreed with the person were included e.g. “I like my food very much and try to eat fatty/sugary food in moderation as part of a balanced diet. I am encouraged not to spend too much of my money on unhealthy foods. I like a drink of beer and up until recently I was drinking 2 cans a day which I have reduced to 1 can a day. I have also given up smoking due to my ill health”. The home used pictures and symbols to assist some people to make choices e.g. menus and also to convey information about who was on duty. The ability of individuals living in the home to exercise choice and control about their day-to-day life was clearly illustrated by the comments arising from discussions with one of the people living in the home. • “I have a phone and my mother phones me … I have been to Gracelands 3 times … I pay the rent out of my post office … I get up in my own time, I like to go to bed at 9 o’clock but sometimes I sit up late with C …”. “I went to see my parents today, I see them every week … I got up early today but sometimes I stay in bed, it depends how I feel, I normally go to bed at 11 or 12 o’clock … I know about my care plan and I agree with it ... I am going to Butlins with D , I went last year and I like it there, I chose to go there and I will probably get drunk ….There are not many rules here …” “I can mix with people if I want … I go to bed at about 10 o’clock and IO get up when I am ready coming to live here was my choice … “. • • Daily notes supplemented the plans of care and support and there was evidence from documents and discussion that care plans were reviewed regularly with the individuals concerned and that some people depending on their abilities were fully aware of the contents of their plans. Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 12 A range of assessments of potential harm to each person had been completed and informed the plans of care that included strategies about how these risks would be managed. The risks identified included the following: Behaviour; relationships; physical health; social skills allegations; activities/holidays; communication; decision making; finances; living skills; medication; smoking; abuse; visiting friends; and cooking and making drinks. The plans did include where necessary clear instructions about how staff were to manage behaviour of particular individuals that was difficult or challenging. Any restrictions agreed with all interested parties as necessary to promote an individual’s health and welfare were documented (see above). The responses in the one questionnaire received from a relative of a person living in the home indicated that they believed that the home gave the support to the person living in the home that they expected or agreed. One relative spoken to said: • “I have nothing but praise for them. D can be very difficult sometimes and he was on a lot of medication when he first went there but he is on a lot less now ... He comes home most weekends and he can’t wait to get back there on a Sunday night …”. Social care professionals spoken to were very positive about the support provided to the people whose admission to the home they had arranged. Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home promoted the right of people living in the home to live ordinary and meaningful lives. They were supported to take part in social and recreational activities and to develop life skills. The food provided by the home was varied, nutritious and according to individuals’ needs and choices. EVIDENCE: It was apparent from discussion with people living in the home and records examined that individuals were able to pursue their own particular interests and these were noted in plans of care and support. Daily notes and individual weekly activity plans indicated that people were also supported to develop life skills, use amenities in the local community such as shops, colleges and banks and went out regularly for meals and to venues such as pubs and social clubs. People living in the had or were attending college courses but on occasions they declined or chose not to adhere to their planned activity programmes. On the day of the site visit one person had decided not to attend the course about Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 14 “promoting independence” that he was attending at a local college 3 days a week. The course programme included the following subjects: Literacy; numeracy; ICT; sport; music; creative arts/drama; and safety awareness. An individuals’ activity programme could include the following: Living skills e.g. cleaning room/laundry; board games; bowling; eating out; club; video of choice; etc. During the site visit individuals were participating in a range of individual interests and activities these included visiting relatives, shopping, watching a video, and playing board games. One of the home’s management team said that the individuals living in the home rarely did things as a large group, although a number of them did enjoy visiting an outdoor activities centre in a local country park together where they participated in things such as canoeing, stream walking and using a zip slide. Discussion with some individuals confirmed that this was the case. There was a range of board games available for the use of people living in the home and a number of videos and DVDs in the home’s lounge where there was also a television set for communal use. Individuals had televisions and other equipment in their rooms so they could enjoy their personal tastes in music or viewing in the privacy or their bedrooms Regular contact was maintained between people living in the home and their relatives and friends. Comments from people living in the home about this included: • • “I went to see my parents today and I see them every week”. “I go out with S my girlfriend on Fridays for a pub lunch and then I go and see my mother. I see her every week”. Answers in the one questionnaire received from a relative indicated that they believed that the home helped their relative keep in touch with them. Individuals living in the home had their own single rooms promoting their right to privacy and staff were clearly expected to knock on bedroom doors and seek permission to enter them. They were offered a key to enable them to lock their own rooms if they wished to do so and some exercised that right. A person’s preferred form of address was noted in their plan of care, as was their choice about the gender of staff that provided them with help and support with matters such as access to the community or physical care/personal hygiene. Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 15 People living in the home were involved in planning the meals that they ate and were invited to make suggestions for menus. Healthy eating was promoted by the home and there was advice about this on display in the kitchen in a format that was easy to understand. Individuals were supported to take part in meal preparation and details were kept by the home of the food provided. The record of food provided indicated that on occasions there would be as many as 3 different main meals of the day eaten because of individuals’ personal preferences. Comments from people living in the home about the food provided included: • • • “The food is alright, but I am not keen on spicey stuff. We have a menu and it is what we sorted out with the staff”. “The food is alright, but I shall soon be doing things for myself and they will learn me how to cook”. “I like it”. Staff spoken to said that people living in the home could make for themselves or have snacks and drinks at any time. Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 16 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. The health and personal care that people received was based on their individual needs and their medication was managed safely. EVIDENCE: The home’s staff team was relatively stable and numbered 20 and included both males and females. Male staff were not involved in assisting any of the women living in the home with any intimate physical care needs. Records examined concerning the people living in the home indicated that they made visits to healthcare professionals or received them when necessary and these included among others; general practitioners; community psychiatric nurses; and a specialist nurses in epilepsy. One person spoken to said: • “I am going to see the doctor next week about my finger”. The company that owned the home employed a behavioural therapist/psychologist who provided support and helped to agree plans with individuals and staff to assist individuals with specific behavioural problems. Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 17 The home had detailed written policies and procedures about the management of medication. Medicines were kept in suitable locked metal cabinets and the home used a monitored dosage system with most prescribed medicines put into blister packs for a period of 28 days by a pharmacist. The exception being those items that would deteriorate when removed from their containers or liquids. Records that were kept of the receipt into the home, administration (giving out) and disposal of unwanted medicines were accurate and up to date. There were clear instructions for the use of medications that were prescribed for use on occasions only when it was required (i.e. PRN). Controlled medication was stored appropriately and an audit carried out at the time of the site visit confirmed the accuracy of the records being kept. Staff working in the home also carried out regular audits of the medication system to ensure that as far as possible errors would be avoided but if they were to occur would be quickly identified. People living in the home were supported to manage their medication safely based on the individual’s abilities and their understanding of the risks involved. At the time of the site visit no individual kept/looked after all of their own medication. All staff who were responsible for giving out medicine had received comprehensive training in the safe management of medication and received an assessment to ensure that were competent to do so. The home’s system required that 2 staff were involved in giving out medication, one to give it out and the other to witness the procedure. Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home had access to a complaints procedure that would enable the home to address their concerns and independent advocacy services could be used to represent the concerns of people if necessary. There was a system in place in the home to protect vulnerable adults from harm. EVIDENCE: A copy of the home’s complaints procedure was readily available in the home’s dining room it was in a format that was simple and easy to understand. A copy was also included in the home’s service users guide that was in the room of every person living in the home. People spoken to who were living in the home and responses in a questionnaire returned by a relative and one returned by a person living in the home indicated that all were aware of whom they could raise any concerns with and how to do it. The home had a system for recording complaints and how they were dealt with and it had received one in the previous 12 months and it was apparent that it had been resolved satisfactorily. “The Commission” had received no complaints about the home during the same period. The home’s registered manager said that the home supported people living there to access and use independent advocacy services. There were written procedures readily available in the home for the guidance of staff, about safeguarding vulnerable adults. These included a copy of the local authority’s adult protection procedures. Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 19 All staff spoken to had received training in the subject of adult protection and knew what to do if they suspected or knew that it had occurred. In accordance with required procedures the home had proactively referred a matter of concern following an incident that occurred between 2 of the people living in the home to the local authority, which is the lead statutory agency with the responsibility for “safeguarding vulnerable adults”. It was apparent from discussion with staff, examining policies and procedures and staff training records, that everyone working in the home received regular training from an organisation with appropriate accreditation in the subject of physical intervention (non violent crisis intervention (NCVI)). All new staff received such training within a short time of starting work at the home. The home’s registered manager said that such intervention was rare and there had been no incidents for some time. Records were kept when such intervention had been used. People living in the home were supported by staff to manage their financial affairs and individual savings accounts had been arranged for them in building societies and banks. Their benefits were paid into their accounts and where necessary staff helped them withdraw cash when it was required. The home kept some money on behalf of some individuals living there and accurate records were kept of all incomings and outgoings. A representative of the company that owns the home regularly audited these records. Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s environment was comfortable safe, and well-maintained for the benefit of the people living and working in it. EVIDENCE: The home’s registered manager said that approval had been given by the company for some redecoration of the building and that people living there would be consulted about colour schemes in communal area s and able to choose that of their own bedrooms. At the time of the site visit the premises, its décor, fixtures, fittings and furnishings were well maintained and generally in good repair. Some areas of the interior were in need of touching up because of scratches and marks and some floor coverings were marked/stained. Signage based on symbols and pictures was used effectively to enable people living in the home to easily identify the location of stored items or the purpose/use of a room. Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 21 People spoken to were pleased with their bedroom accommodation, which was spacious and provided with en-suite facilities comprising WC and either a shower or bath. The home had infection control policies and procedures and staff had received training in the subject. Good practice noted during the site visit included the provision of liquid soap and paper hand towels in the communal WC. There was a well-equipped and suitably sited laundry room in the building and the home’s procedures included a system for safely and effectively managing soiled items if that was necessary. A social care professional spoken to said: • “Maintenance problems are actioned quickly which is good for service users health and safety” Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment, deployment level and mix of staff ensured the needs of people living in the home were being met and their safety was promoted. Staff training could be improved to ensure that an appropriate number of the staff team have obtained a qualification that indicates clearly that they have the competence to provide the support and meet the complex needs of people living in the home. EVIDENCE: At the time of the site visit the home’s permanent staff team comprised the manager and 19 others and of these 2 (i.e.10 ) had obtained a relevant qualification that indicated that they were competent i.e. National Vocational Qualification (NVQ) to at least level 2 in care. The home has been operating for some3 years and the proportion of staff with a relevant competency based qualification was still well below the expected level of 50 according to the National Minimum Standards for Care Homes for Adults (18 – 65). The failure to achieve this consequently affects the overall quality rating of this group of standards. The majority of the staff team had completed the Learning Disability Awards Framework (LDAF) induction and foundation training that included many elements that would contribute towards a relevant NVQ. Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 23 There was evidence from examining staff records, discussion with staff on duty and the training programme that there was strong commitment to staff training and development and also to ensuring that all staff received regular training and updates in subjects that were regarded as core or essential as well as those that were about the specific needs of people living in the home i.e. • Autism awareness • Mental health • Makaton (i.e. a special method of communicating) • Epilepsy As a result of advice provided at a previous site visit the home’s registered had produced a matrix that enabled the training needs of the staff team to identified at a glance as it set out the dates when training had been completed and when updates were due. The matrix for example indicated that 90 of the staff team had received training in safeguarding vulnerable adults and 95 in non-violent crisis intervention. The home’s registered manager said that the company that owned the home had a training department but until recently staff often had to travel to some distance to attend many of the training sessions but now there was a local venue. The company had also invested in an interactive software training programme that was on a laptop computer that staff had access to. It included modules about health and safety, food hygiene, protection of vulnerable adults and medication management. Comments from staff about the training that they received included the following: “I have been here 14 months and I have completed LDAF and it included fire safety, food hygiene, firsts aid, and I have done autism. Communication was included in my induction and I have done NVCI and that was a 2-day course. I want to get on an NVQ because the induction was too quick you had to learn too much in a short time. I like working her but my main concern is getting a qualification”. • “I have been here 2 years and have done LDAF and NVCI, food hygiene, first aid, epilepsy, health and safety, fire safety, we have regular fire safety training and drills. We have drills every month”. “I have done NVCI and LDAF, POVA (protection of vulnerable adults), food hygiene, first aid. I did a course about mental health and learning disability and medication training … I was told at interview that I would go on NVQ as soon as possible but no one has said anything, I am convinced that the company will put off NVQ training for as long as possible …”. • Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 24 • “We have a lot of training, we are going for a second lot of Makaton … we have supervision about once a month … I have done a course about supervision and appraisal because I am a senior and supervise others …”. A quarter of the home’s staff team completed and returned questionnaires before the site visit took place. All respondents indicated that they received training that was relevant to their role, helped them understand the needs of people living in the home and kept them up to date with new ways of working. Comments with the questionnaires included the following: • • “I am still waiting to do NVQ2 as well as other staff after being here for 2 years which is appalling”. “I would like to see all staff go on NVQ2/3 after completing their induction period of 6 months”. It was apparent from discussion with staff and comments received that there was a group of staff that were enthusiastic but frustrated because opportunities to obtain formal qualifications were limited. The records were examined of 3 staff that had started work in the home within the previous 12 months. It was apparent that the home had robust employment procedures in place that precluded someone from working in the home until all the necessary checks into the suitability of that individual to work with vulnerable adults had been completed. The registered manager said that people living in the home were involved informally in the appointment of new staff. They met with people when they came to the home for interviews and the staff sought their views of them. He also said that he wanted to implement a more formal system in future. Staff spoken to indicated that staffing levels were adequate and one who had worked ion other similar care services said • “We have 4 on duty and 5 with Russell (the registered manager) we are quite highly staffed compared to other services”. The number of staff on duty at any time was set out in the basic minimum rota 7 days a week and was as follows: 07:30 to 14:30 4/6 14:30 to 21:30 5/6 21:30 to 07:30 1 wakeful and 1 sleeping The home’s registered manager and deputy manager both worked 09:30 to 16:30 and could and did help out with many of the everyday tasks in the home Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 25 Comments about the qualities and approach of the staff team from social care professionals, people living in the home and relatives included the following: • • • “The staff look after me alright” (person living in the home). “ I get on alright with them, we has a laugh” (person living in the home). “The care is very good. They look after J well and do the best they can to ensure that she is happy and safe, She is happy ther and we have seen a great improvement as she is more confident in herself and goes out more” (relative) “I can’t praise them highly enough …” (relative). “They seem to be very friendly and messages always get passed appropriately” (social care professional). • • Discussion with people during the site visit and observation indicated that relationships between those living and working in the home were informal and open. A lot of friendly banter was witnessed and staff clearly demonstrated respect for the people that they were supporting and were noted providing individuals with information that would help them make decisions for themselves and promote their independence. Broadview DS0000063312.V359187.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): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s registered manager provided effective leadership There were systems and procedures in place for monitoring and maintaining the quality of the service provided and also for promoting the safety and welfare of everyone living and working in the home. EVIDENCE: The home’s registered manager had been responsible for its day-to-day operation for some 3 years. He had worked with adults with learning disabilities and autistic spectrum disorder for 14years and had been employed previously as the registered manager of another care home for 3 years. He was due to start a management development programme organised by the company that owned the home, which would provide evidence towards a recognised and relevant management qualification i.e. the registered managers award. He was also working towards completing NVQ level 4 in care. Observation, discussion with the home’s registered manager, the home’s staff, people living there, relatives and social care professionals indicated that he Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 27 was; highly motivated; enthusiastic; knowledgeable and sensitive to the needs of both the home’s staff team and the individuals accommodated there. Comments about his qualities as well as those of the home’s management team included: • “Russell is supportive, flexible, he has helped me with my NVQ. He is a hands on manager and is happy to support people out and about” (member of staff). “He is OK. He is good to work with and good with both service users and the staff” (member of staff). “The managers are good if you have a problem you can go to Russell and T and they sort it out” (member of staff). “Russell always keeps me informed about things he is very good” (relative). “He is very proactive and all I have seen of his work is appropriate” (social care professional) “He is very approachable, he does hands on work and service users relate well to him. I have no doubt that he is professional” (social care professional). • • • • • All staff spoke positively about working in the home and all without exception described their relationships with their colleagues as being one of the good things about it. There was an open management style in the home and regular meetings for people both living and working in the home were held at which individuals could readily voice their opinions. Topics noted from the minutes of recent meetings of the home’s staff group included the promotion of the independence of people living in the home. The home used questionnaires to obtain the views of people living in the home, relatives and other interested parties that informed an “annual service review” the outcomes and a development plan based on the responses in the questionnaires was available in the home. Reviews were also held with individuals their relatives and the social care professionals from the authority funding their placement at which people could express their views about the service provided by the home. A representative from the company that owned the home visited the home every month to check on the home’s management systems and also to obtain the views of people living in the home. Copies of reports of these visits were made available to the home’s registered manager and were seen during the site visit. Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 28 The home had a range of written policies and procedures and other information available and readily accessible to staff who said that they informed their working practice. There was evidence that they were reviewed and updated as necessary. Records seen and discussion with staff indicated that safe working practices were promoted in the home. Up to date certificates were on file indicating that fire safety and other systems and equipment in the home were checked and monitored e.g. hot water outlets; Legionella; chemicals/substances hazardous to health. It was also apparent from records examined and discussion with staff and people living in the home that they had received fire and other health and safety training. The home had equipment in place for alerting staff at night to the movement of an individual prone to epileptic episodes. Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 30 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 YA32 Regulation 18 Requirement The registered person must produce a plan indicating how and when the proportion of staff with a formal relevant competency based qualification will be increased to at least 50 . This is to ensure that there will always be sufficient staff on duty at all times with the necessary skills and knowledge to meet the complex needs of the people living in the home. Timescale for action 31/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Broadview DS0000063312.V359187.R01.S.doc Version 5.2 Page 32 - 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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