Care Home: Byron Terrace (Respite Care)

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What the care home does well The manager has co-operated fully with inspection process and has dealt with all but two of the 23 requirements made at the previous inspection.People using the service and their relatives are able to make choices about their lives and supported, and they are able to maintain their ordinary routines if they want to. Staff have access to training that influences and improves the way they work. Staff enjoy their work and have a good rapport with the people using the service. The manager and staff have effective relationships with other professionals involved with people using the service. This means that communication is established which, in turn, promotes continuity in the support provided. The service is highly thought of by relatives and staff. This comment summarises the opinion of staff: `There are good systems in place for logging documenting concerns. Also, verbal communication is of good standard; good staffing ratios; caring and compassionate staff group; high staffing levels mean we are able to meet peoples needs and offer quality experiences; professional - clinical experience in relation to disability/complex needs/medication; liaise with other professionals who may be involved with service user; able to access people/ professionals who can help deliver a care package to people and excellent relations/communication with carers.` Relatives generally felt that: `They are all lovely with each one who goes in that wonderful place.` What has improved since the last inspection? Since the last inspection when some risks have been identified, risk assessments have been completed and this has included moving and handling. Since the last inspection the majority of staff have completed protection of vulnerable adult training and the complaints procedure has been developed into a picture and symbol format to make it more accessible. Since the last inspection there is documentary evidence that staff have received the training they need to do their jobs safely. Since the last inspection the manager has arranged a contract that ensures that hoists and other equipment are serviced every six month or in keeping with the manufacturer`s instructions. Since the last inspection the manager has ensured that a copy of the accident and incident reports are kept in the home. Since the last inspection the staff sign and date when care plans have been looked at. Since the last inspection the manager has updated the assessment document to include questions about specific cultural needs. Since the last inspection staff are now instructed to provide keys and, when this is not in the best interest of the person, it is recorded. Since the last inspection a two-weekly menu has been introduced and meals sent to the home are presented in individual portions so that people are able choose what they want to eat. Since the previous inspection `consent to treatment` forms have been introduced in respect of medication administration. Since the previous inspection a new waste disposal system has been installed. Since the last inspection a shower curtain has been fitted in the shower room. Since the previous inspection the manager has ensured that the majority of current staff are on target to achieve National Vocational Qualification (NVQ) level 2 health and social care in 2008. Since the last inspection a quality assurance system has been introduced. What the care home could do better: The manager ensures that comprehensive risk assessments are developed and used by staff, however, it would be beneficial if all risk assessments relating to individuals were available their care file. The manager should make sure that information recorded in relation to any injury sustained by people using the service, is as detailed as possible and possibly to include pictures or illustration. The manager should also consider highlighting in peoples records, at all times, any additional investigations and actions that has been taken to reduce the chance recurrence. The manager should be able to provide evidence that staff recruitment has been robust and that the vetting process includes taking up two references and completing Criminal Record Bureau and Protection of Vulnerable Adult checks. CARE HOME ADULTS 18-65 Byron Terrace (Respite Care) 11 - 21 Grandidge Street Rochdale Lancashire OL11 3SA Lead Inspector Michelle Haller Key Inspection 22nd April 2008 09:15 Byron Terrace (Respite Care) DS0000067356.V362701.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 Byron Terrace (Respite Care) DS0000067356.V362701.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. Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Byron Terrace (Respite Care) Address 11 - 21 Grandidge Street Rochdale Lancashire OL11 3SA 01706 702180 01706 702181 byron.terrace@nhspeople.net 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) Heywood, Middleton and Rochdale PCT Miss Gillian Patricia Golden Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 4 service users, both male and female to include: up to 4 service users in the Category of LD (Learning Disabilities) The service should employ a suitable qualified and experienced manager who is registered with the Commission for Social Care Inspection. 24th April 2007 Date of last inspection Brief Description of the Service: Byron Terrace, which is run by the Heywood, Middleton & Rochdale Primary Care Trust (PCT), offers short-term accommodation for up to four service users under the age of 65 years, with a learning disability. The service’s aim is to provide respite to parents/carers of people who are cared for in their own home, to enable them to maintain their role as carers. The home is adapted to meet the needs of physically disabled individuals. Four single bedrooms are provided, one of which is on the ground floor level. There is a lift to the first floor. Lengths of stay vairy, dependent upon need and this is determined jointly with the Local Authority. The home is situated less than a mile from the Rochdale town centre and is close to local shops, pub and public transport. The weekly fees are dependent upon the assessed needs of the individual with benefits being taken into account. Additional charges are made for activities/ outings and toiletries. The manager makes information about the service available in the form of a Respite Service Handbook, a copy of which is kept in each bedroom. Byron Terrace (Respite Care) DS0000067356.V362701.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 3 star. This means the people who use this service experience excellent quality outcomes. This was a key inspection that included an unannounced visit to the service. This means the manager did not know in advance that we were coming to do an inspection. During the visits we looked around the building, spent time with residents and staff, including the deputy manager and administrator. We observed the interactions between people receiving respite support at Byron Terrace and examined care plans, files and other records concerned with the care and support provided to people while at the facility. We also looked at all the information that we have received or asked for since the last inspection. This included: The annual quality assurance assessment (AQAA) that was returned to us by the manager. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Information we have about how Byron Terrace has managed any complaints and any adult protection issues that may have arisen. What the manager has told us about things that have happened in the home through ‘notifications.’ We also received seven Commission for Social Care Inspection (CSCI) surveys that were returned to us by people using the service and from other people with an interest in the service, such as staff and relatives. We are not aware of any complaints or safeguarding referrals in respect of this service. What the service does well: The manager has co-operated fully with inspection process and has dealt with all but two of the 23 requirements made at the previous inspection. Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 6 People using the service and their relatives are able to make choices about their lives and supported, and they are able to maintain their ordinary routines if they want to. Staff have access to training that influences and improves the way they work. Staff enjoy their work and have a good rapport with the people using the service. The manager and staff have effective relationships with other professionals involved with people using the service. This means that communication is established which, in turn, promotes continuity in the support provided. The service is highly thought of by relatives and staff. This comment summarises the opinion of staff: ‘There are good systems in place for logging documenting concerns. Also, verbal communication is of good standard; good staffing ratios; caring and compassionate staff group; high staffing levels mean we are able to meet peoples needs and offer quality experiences; professional - clinical experience in relation to disability/complex needs/medication; liaise with other professionals who may be involved with service user; able to access people/ professionals who can help deliver a care package to people and excellent relations/communication with carers.’ Relatives generally felt that: ‘They are all lovely with each one who goes in that wonderful place.’ What has improved since the last inspection? Since the last inspection when some risks have been identified, risk assessments have been completed and this has included moving and handling. Since the last inspection the majority of staff have completed protection of vulnerable adult training and the complaints procedure has been developed into a picture and symbol format to make it more accessible. Since the last inspection there is documentary evidence that staff have received the training they need to do their jobs safely. Since the last inspection the manager has arranged a contract that ensures that hoists and other equipment are serviced every six month or in keeping with the manufacturer’s instructions. Since the last inspection the manager has ensured that a copy of the accident and incident reports are kept in the home. Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 7 Since the last inspection the staff sign and date when care plans have been looked at. Since the last inspection the manager has updated the assessment document to include questions about specific cultural needs. Since the last inspection staff are now instructed to provide keys and, when this is not in the best interest of the person, it is recorded. Since the last inspection a two-weekly menu has been introduced and meals sent to the home are presented in individual portions so that people are able choose what they want to eat. Since the previous inspection ‘consent to treatment’ forms have been introduced in respect of medication administration. Since the previous inspection a new waste disposal system has been installed. Since the last inspection a shower curtain has been fitted in the shower room. Since the previous inspection the manager has ensured that the majority of current staff are on target to achieve National Vocational Qualification (NVQ) level 2 health and social care in 2008. Since the last inspection a quality assurance system has been introduced. What they could do better: The manager ensures that comprehensive risk assessments are developed and used by staff, however, it would be beneficial if all risk assessments relating to individuals were available their care file. The manager should make sure that information recorded in relation to any injury sustained by people using the service, is as detailed as possible and possibly to include pictures or illustration. The manager should also consider highlighting in peoples records, at all times, any additional investigations and actions that has been taken to reduce the chance recurrence. The manager should be able to provide evidence that staff recruitment has been robust and that the vetting process includes taking up two references and completing Criminal Record Bureau and Protection of Vulnerable Adult checks. Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 8 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. Byron Terrace (Respite Care) DS0000067356.V362701.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 Byron Terrace (Respite Care) DS0000067356.V362701.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The manager makes sure that people’s needs are assessed so that they are offered support that will best meet their needs. EVIDENCE: The care files for the people using the service at the time of inspection were examined plus the information available for other people using the service, including a person recently introduced to the service. There was diary evidence that people were able to spend time at Byron Terrace for periods at different times of day, including meals times, overnight and weekends, as a part of the assessment process. This also helps the person to become accustomed to staff and the facilities. The manager stated that some people preferred to commence with overnight stays while others needed a period of time to be introduced. The way in which people are introduced is dependant on their preference. All the files examined contained information about people’s education and work activities, family contact, physical and mental health and the families point of view, communication, likes and dislikes. Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 11 The manager is in the process of updating the assessment document so that it provides more information in relation to cultural needs. The manager described a comprehensive information she returned and stated that: assessment process in the ‘A joint assessment is conducted, generally with the Care Manager and Respite Manager. (Should no Care Manager be identified, this may be another professional who has referred, i.e., Community Nurse). The assessment is conducted at the individual’s home or at the Respite Unit. Information is also obtained from other professionals involved or other services involved in their package of care, including the individual as appropriate themselves.’ Staff who returned surveys stated that there was always enough information about people to help them meet assessed needs. They said ‘every service user has a care plan, this is kept up to date and is accessible to support workers and kept in the office, the care plan is read by me when I come on duty in case there has been any changes made’ and ‘care plans are updated every visit.’ Relatives also confirmed that they received enough information to help them make decisions about the service and stated: ‘If there is something I don’t know or want to know, I know I can contact Gill (the registered manager) and get an answer.’ An improvement in this area would be for assessments to reflect, more fully, the self-help and independence skills of people using the service. This would make sure that people’s independence would be promoted in keeping with their full abilities. Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The manager ensures that people are encouraged to be as independent as possible within individual capabilities, enabling them to lead fulfilling lives. EVIDENCE: Four care plans and other information about the support people received were examined. We found that care plans had been complied for each person. The care plans were individualised and included instructions in relation to specialist medical needs, such as epilepsy care, skin care and general health concerns that required attention during any period of respite. Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 13 The plans that were looked at had been signed as updated in April 2008, however, through cross-referencing the assessments with daily records and care plans, we found that they did not always reflect the actual support required and offered. At times, new information and changes were not used to update the assessment or care plan. For some people, changes, for example, in communication or behaviours, could only be identified through the diary updates. It is important that care plans and assessments provide comprehensive, clear and accurate information because this will promote safe and effective interactions between people and staff. All the assessments looked at had been signed either by the person using the service or their representative, this confirmed that they had been involved in developing the care plan and also agreed with the content. The manager confirmed that comprehensive risk assessments had been completed, however, these had not been placed in all the care files that were examined on the day of inspection. In relation to risks and monitoring, at the time inspection, staff did not complete a ‘body chart’ to illustrate the position and type of injury when reporting and dealing with marks, bruises, cuts, abrasions or pressure areas. This was discussed with the manager who stated that she had been told not to use diagrams or ‘body maps’ as this was ‘impersonal’ and not in keeping with the philosophy of the service. We request that the manager clarify this further because she must be able to show that an effective and accurate process is in place to monitor, assess and treat people who have injuries caused by accident, self harm or other event or incident. This issue was looked at again in relation to complaints and adult protection. Admission updates dated April 2008 were seen on each file, and signatures and dates confirmed that care plans were read through and updated on each visit. Likes and dislikes were also identified and cultural preferences and requirements concerning diet or the need for same sex carers were clearly identified. The manager has introduced a system so that consent forms have been signed by people agreeing to have their medication administered. People also had a calendar showing where they would attend each day, the time they preferred to get up and how they would like to spend their evening or weekend at the facility. There were no limitations to the choices made by people accessing Byron Terrace on the day of inspection. As previously stated, preferences were identified and daily records confirmed that people lived the lifestyle they wanted, such as going to bed. Records also showed that staff would try lots of strategies to try and communicate with a person and meet their needs. Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 14 Observations of the interactions between staff and people using the service on the day of inspection showed that people were confident with staff. Staff listened to what people said, giving them time to respond and make their own choices. People looked relaxed, and smiled and joked with staff. Daily records confirmed, however, that if people wanted to be on their own, this was respected. Two people using services returned CSCI surveys; one felt that they were ‘sometimes’ able to make day-to-day decisions and the other person felt they were ‘always’ able to make day-to-day decisions. Both felt that staff ‘always’ treated them well. The manager continues to make sure that any money spent on behalf of people is accounted for through receipts that are retained for audit purposes. Relatives were content with the service and one person identified that staff did work towards promoting and maintaining people’s independence: ‘They encourage her to do different activities and to go out and about but going out uphill is a struggle. They also follow her care plan and help her where appropriate.’ Byron Terrace (Respite Care) DS0000067356.V362701.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): 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 manager and staff provide opportunities for people to pursue leisure and social activities, reflecting their diversity and social, intellectual and physical capacities within the financial limits of the individual while they access the service short term. EVIDENCE: Peoples daytime activities were assessed prior to them using the service. The manager ensures that people continued with their normal activities of attending a day centre or going to college during their respite period. On the day of inspection, three of the four people receiving support attended a day activity. Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 16 People’s interests were recorded in their assessments. Daily records confirmed that activities organised by staff included walks to the town centre, trips to local beauty spots, and meals at different fast food places. Feedback from the manager and staff continue to relate that activities are sometimes limited due to the amount of money sent in by some carers. This means that activities that cost money, such as going to the cinema, theatre or other places of interest, were restricted. The diary entries confirmed that people could attend a Gateway Club on the Fridays that they received respite if they wanted to go. The manager also felt that during the week most people who had gone to the day centre were tired and ready to relax at the end of the day. On the day of the inspection the person who remained at the Byron Terrace, had their nails manicured, helped to make a trifle and then went out with staff. After returning from the day service, people were able to watch television or participate in another activity, such as drawing, while tea was been prepared. People who returned CSCI surveys felt that they could do what they wanted both during the week and at the weekend. Byron Terrace was well staffed, as for most of the inspection period, people received one to one support. Staff interaction was friendly and respectful. The service is a respite facility and most people attend a day centre. In order to widen the activities enjoyed by people, especially at weekends, the manager should have discussion with service users, their relatives and other representatives, such as care managers, about what could be offered if people were given more of their own money when receiving respite. Relatives who returned CSCI surveys confirmed that they were kept in touch with people as much as they wanted during any period of respite. They said ‘I like us to have a break from one another and it helps her from being unsettled. But if she wanted to ring me, they would do this for her’ and ‘I always ring about my daughter when she goes in Byron and they always answer me and put my mind as rest when I ask how … is.’ Records demonstrated when people had been offered keys to their bedrooms and a risk assessment was in place for one person who had a tendency to lock his room only when someone else had entered it. Meals continue to be delivered frozen from a local hospital. The portions sent have been reduced to single or double portions. This means that now lots of different dishes can be ordered and people can each choose what they want each day. Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 17 Staff are also able to order and purchase fresh items, such as salads, fresh fruit, meat and particular items enjoyed by specific people. On the day of inspection people were offered a choice of cottage pie, curry, chicken and dumpling casserole. The person chose cottage pie. This looked fine and it was all eaten. Staff eat their meals at the same time as people using the service, and they chose a salad. For their evening meals people could choose from fish cakes, curry and pasta bake. Staff who were interviewed felt that the meals were adequate and quite enjoyed them. They did feel, however, that these would be improved if the service were given it’s own budget for food. Staff were pleased, however, that single portions were now sent, as this meant more choice for service users and far less waste. The home’s menu choices have been expanded to more than three choices and the menu is rotated every two weeks. This means that people who receive two weeks’ respite will not have a repeat of meals. People’s dietary intake was recorded depending on their needs, such as weight management or other special diet, such as Halal. Staff said that they usually cooked breakfast and Sunday roast. People receiving respite care usually brought in their own snacks, such as biscuits and crisps. Transport is aided through the provision of a bus. It is unfortunate that people who are wheelchair users have limited access to this vehicle. The manager could consider requesting access to the mobility cars or mobility allowance that may have been allocated to people through the Disability Benefits system. Peoples comments confirmed that those using the service were treated individually and included: (Staff are).. ‘very helpful they see they are all happy.’ And service users who returned surveys all said ‘yes’ they could do what they wanted at the weekend. Byron Terrace (Respite Care) DS0000067356.V362701.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): 18, 19 and 20 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. The manager makes sure that effective health care needs of people using the respite unit are assessed and met. EVIDENCE: Diary records, letters and other correspondence confirmed that staff at Byron Terrace made sure that people using the service received all necessary health care. Records clearly showed that monitoring and treatment in respect of epilepsy care, skin care and the effects of long-standing conditions, some associated with the cause of a person’s learning disability, was provided. Records also made it clear that care was provided to reduce the effect and treat illnesses that developed while on respite. This included colds, coughs and people feeling generally unwell. Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 19 The manager stated, and records confirmed, that the registered nursing staff promoted continuity of care while people received respite support at Byron Terrace. This was achieved through getting to know individuals away from the respite unit, developing a positive and professional relationship with the person’s carer or relative. Daily diary entries showed that staff have a ready access to care managers from social service, the community learning disability nurses, speech and language therapists, general practitioners, psychologists and other specialists as required. The manager also stated that nursing staff attend review and planning meetings. The medication record sheets were looked at for people using the service on the day of inspection. Medication that had been given was signed for and two people had checked the medication into the unit. The manager needs to make sure that when a person receives their daytime medication from day service that this is also recorded. This will show that an alternative arrangement had been made. Training and medication supervision records confirmed that the competency of staff to administer medication is assessed twice a year. This includes their knowledge in relation to administering rectal Valium. Medication is safely stored in a locked cabinet. Relatives felt that people’s health care needs are met. One person commented that: ‘They got … in hospital very quickly (when ill) and was very good and never left during (the hospital) stay - I will never forget how good they were.’ And another felt that what the service did well for people was ‘‘… care for their physical needs and emotional needs.’’ Byron Terrace (Respite Care) DS0000067356.V362701.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): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The policies, guidelines and conduct of the manager and staff makes sure that people are listened to and safeguards against abuse are in place. EVIDENCE: The complaints record was read through; issues mostly concerned the laundry and missing clothes. The records included the date of the complaint, the investigation and the date when the outcome was discussed or made known to the complainant. The complaints procedure was looked at and an easy read picture and symbol format has been produced. This was clear and provided information about who to speak to and what would happen when a complaint was received. The manager also stated that a copy of the complaints procedure was sent through to all new referrals as a part of the admission process. People who returned CSCI surveys confirmed that they knew how to complain and that their complaints and concerns were listened to. Comments included: ‘yes I am aware of the procedure’ and ‘Any concerns I have had or have voiced have been dealt with speedily and to my satisfaction.’ Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 21 Comments from staff included: ‘I would document the concern - endeavour to resolve dependant upon level of concern. Inform the line manager or whoever may be involved - follow appropriate guidelines/protocol again, according to the concern.’ The manager stated that no Protection of Vulnerable Adult investigations had taken place in the service since the last inspection. Certificates confirmed that 11 out of 14 staff had received protection of vulnerable adults training in the past year. This training was a one-day course led by trainers from the RMBC training partnership. Staff who were interviewed were clear about the steps they must take to safeguard people against abuse and what they would do if this was suspected. One member of staff said: ‘I learnt a lot about the rights of individuals, enabling people and making sure that what happens is their choice.’ Byron Terrace (Respite Care) DS0000067356.V362701.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): 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 manager has made sure that Byron Terrace is clean, homely and accessible to the people who use the facilities. EVIDENCE: The frontage to Byron Terrace is in keeping with other houses on the street. Byron Terrace is within walking distance of the local town centre and there is easy access to public transport. We had a tour of the building. All areas were clean. The manager stated that the building was due to have some areas redecorated. The lounge was clean and furnished with easy chairs and sofas that were clean. The dining room was also clean and bright and overlooked a large landscaped garden. Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 23 The manager stated in the information she returned that: ‘Bathrooms and shower rooms, including furnishings, have been adapted to cater for all mobility needs.’ Observation confirmed that this was the case. Toilet and bathing facilities include one low bath in a bathroom with toilet, with two separate toilets downstairs and one fully adapted rise and fall bath, a shower room, plus three separate toilets upstairs. The furniture and decoration is homely and domestic. The manager stated in the information returned that fire equipment had been checked in January 2008. People who returned surveys confirmed that the home was ‘always’ clean. Byron Terrace (Respite Care) DS0000067356.V362701.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): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Staff have received training and have access to training that will provide them with the skills and knowledge to carry out their jobs. EVIDENCE: Recruitment and selection of staff were discussed with the manager. There is a very stable staff team. Most staff have worked in the service for longer than five years and the most recent recruit has been employed since 2006. We identified at the last inspection that the organisation (the PCT) which operates the service must demonstrate through information held on site that it employs staff only when the necessary checks have been made and it is satisfied that the people who are suitable are employed to work at the service. This information is still not on site. We are therefore unable to say with confidence that the necessary checks have been made, although the manager assured us they had been, and staff we spoke to confirmed that they had a police check and references in place before they were employed. Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 25 The manager was able to produce the Heywood, Middleton and Rochdale PCT’s policy and procedures concerning the handling and disposal of CRB’s and references. Staff who returned CSCI surveys all confirmed that they had been vetted prior to working in the home. The person commented that: ‘I couldn’t begin work until my CRB was returned’. A member of staff who had been recruited within the last three years said that they had received a copy of their CRB check. The manager provided information stating that: ‘All staff have attended induction courses or more recently, the LDAF. In addition, 90 of the care team will have completed NVQ level 2 award by May 2008.’ The Learning Disabilities Award Framework (LDAF) is a specialist course for those working with people who have learning disabilities. Certificates and other training records also confirmed that, since the last inspection, staff had attended a variety of courses relevant to their job, including fire lectures; physical intervention; food hygiene; moving and handling, and staff are due to complete infection control by 14 May 2008. By the end of 2008 the manager said they would be able to demonstrate that 90 of staff held NVQ level 2 in health and social care; a member of staff has also been funded to complete a Reiki course which is a type of alternative therapy. First aid and basic life support is be will have achieve National Vocational Qualifications in care level 2. Two people have completed first aid training and copies of their certificates were seen in confirmation. In addition, basic first aid is included in the LDAF training that has been completed by five members of staff. People who returned CSCI surveys assessed that staff had sufficient training and expertise to be able to carry out their jobs to a good standard. Staff also feel that they are given good information so that they support people appropriately in relation to equality and diversity issues. Comments from staff included: ‘‘Our knowledge and skills are continuously updated. We attend courses on a regular basis - epilepsy; cultural awareness; vulnerable adults; moving and handling; food hygiene and first aid.’ ‘Yes we do. We have very good support from our manager. I have experience and knowledge gained from … years as a support worker, this is backed up with regular courses I attend’ and ‘In terms of people whom we care for I feel we are given relevant training such as dementia/Alzheimer’s or break-away techniques/vulnerable adults.’ Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 26 All staff felt that there were nearly always sufficient staff to meet people’s needs. When regular staff are unavailable, the manager has access to a bank of staff. On the day of inspection the manager was heard directing potential bank staff through the recruitment process. Comments concerning staff numbers included ‘We have two bank staff to assist when staff are on leave or off sick so that shifts are always fully covered and the ratio of staff to clients is properly met.’ Relatives who responded felt that the staff ‘usually’ had the correct skills to fully meet people’s needs. Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 27 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. Byron Terrace is well run on a day-to-day basis and provides a service that is highly regarded by those who receive and provide support. EVIDENCE: The registered manager is a registered nurse and has worked in the health care sector for a substantial number of years, she stated that she completed her registered manager’s award in January 2008 and has developed a continual development portfolio as a means of maintaining her nursing registration. Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 28 The manager returned a very detailed annual quality assurance assessment; she clearly identified for improvement and what the organisation did well and what could be improved. The majority of statutory requirements and recommendations relating to good practice from the previous inspection had been addressed. People who commented felt that the day-to-day running of Byron Terrace was effective. Relatives who responded through the CSCI surveys were very satisfied with the service provided at Byron Terrace. One person commented that what the service did well included: ‘provides a home from home environment; tries to accommodate dates for respite as far as possible; there is not a big turnover of staff so they know individuals well; they try to put compatible individuals together if possible and they try to make their stay productive and enjoyable.’ Staff felt well supported and able to influence what happens in the home. They said: ‘I work with my manager on a daily basis and I am free to speak with her at any time. We also have regular staff meetings where we are all given a chance to air out views and put ideas forward’; ‘The staff team are very good, the management is good – fair - and so I work harder for her’ and ‘‘I feel that the staff at Byron Terrace, under the full guidance and support of the manager, give an excellent quality of care to the clients who stay here on respite. If a client has a particular diet or likes to do a certain activity, this is all catered for, the staff check in advance to see who is coming in and will make sure those clients needs are catered for during their stay. The manager always makes sure that the relevant staff are on duty, e.g., if a client has an appointment and a driver is needed to support to the appointment.’’ A quality assurance system is in place and includes a questionnaire to people who use the service and their relatives. A number of these questionnaires had been returned. The manager now needs to analyse the replies provided and compile a report in response. This could include a description of action that may be taken. The report could then be distributed to people who use the service and their relatives. This will demonstrate that there was a purpose to the quality assurance exercise. The training record confirmed that staff had received moving and handling and fire safety training. Staff said and certificates confirmed that they had completed some first aid training. Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 29 The information provided by the manager confirmed that all electrical checks, gas safety checks and other maintenance checks to utilities and services had been conducted in keeping with the appropriate regulators and best practice advice. Records seen onsite also confirmed that the fire-extinguishers were checked on 7th October 2007; emergency lighting was serviced on 3rd April 2008 and the last fire risk assessment was completed on 5th December 2006. The manager produced a contract taken out on 17th May 2007 with the ‘Arjo service and inspection department’ that specifies that hoists and other moving and handling equipment will be serviced six- monthly. A report dated 30th January 2008 confirmed that checks had been done. The accident record confirmed that accidents were now logged and this information is analysed by the Middleton, Heywood and Rochdale PCT. Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 30 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 4 33 x 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 x 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 4 4 3 x 3 x 3 x x 3 x Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation 19 Requirement The registered person must provide evidence that Criminal Record Bureau checks have been undertaken for all staff so that anyone inspecting the records can be sure that the service is employing people who can be trusted to work with vulnerable people. (Requirement should have been met 25/05/07). Timescale for action 01/08/08 Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 32 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 registered person should make sure that assessments are revised to reflect changing needs so that there is a clear record that staff know what action to take promote their wellbeing by meeting their needs. The registered person should request that people who use the facilities bring enough personal funds for them to carry out the all the activities they would like. The registered person should finalise quality assurance system that has commenced in the service. 2 3 YA14 YA39 Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Manchester Local Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Byron Terrace (Respite Care) DS0000067356.V362701.R01.S.doc Version 5.2 Page 34 - 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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