Care Home: Church View

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What the care home does well The home provides good information for prospective people considering using the service. Before any new admission the manager undertakes an assessment of need and accesses information from community professionals, funding authorities, families and other persons involved. A visit to the home and a short stay is encouraged to help the person make an informed choice of care home place. The inspectors saw good evidence of the support and attention given to help someone settle in this was at their own pace and tailored as their confidence grew. Each person at the home has a detailed care plan formulated with their involvement and stating how their preferences are supported and how care needs are met. Identified risks are assessed and plans are put into place give the support required. An example was seen where one to one attention was identified as required for community visits. All records are maintained confidentially. People in residence had access to their care plans and other relevant records such as the duty rota. There is an open and inclusive management culture. The home supports each person in his or her development through activity and meaningful occupation. People at the home have routines, which they have agreed and enjoy. Meals at the home are a social event with people using the service participating in choice, preparation and clearing away. People are supported with their healthcare needs by having the access to appropriate healthcare professionals. The homes environment is very well presented and bedrooms are decorated to each person`s tastes and personalised with their own belongings. There is sufficient communal space for people to live together comfortably, there is a choice of two lounges, one has a television. Staffing levels at the home are adequate to meet the needs of the current client group. The inspectors heard that extra staff are available as required. There is some flexibility between the care homes and people in residence were familiar with the staff from the other homes.Staff training is in place to support the needs of people using the service. Recruitment is robust to ensure the protection of people living at the home. The management of the home appears to support both the people using the service and staff. Health and Safety measures are in place to promote protection; policies and procedures are in place to ensure good practice. What has improved since the last inspection? At the last random inspection requirements were made and action was taken immediately to rectify the deficits highlighted at that inspection. CARE HOME ADULTS 18-65 Church View Chapel Hill Odcombe Yeovil Somerset BA22 8UH Lead Inspector Barbara Ludlow Unannounced Inspection 20th August 2008 09:30 Church View DS0000016251.V372356.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 Church View DS0000016251.V372356.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. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Church View Address Chapel Hill Odcombe Yeovil Somerset BA22 8UH 01935 863973 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) Mrs Amanda Jane Webb Mrs Amanda Jane Webb Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th April 2007 Brief Description of the Service: Mrs Webb is the Proprietor and manager of Church View, a five-bed home situated in the pretty village of Odcombe on the outskirts of Yeovil. It provides a service to people with a learning disability, some of whom have been assessed as having behaviour which can be challenging to manage, and would benefit from small living environment. Church View has twenty-four hour staffing and Mrs Webb and her husband and family live nearby. People who live at the home have individual daily programmes and are supported to attend a wide range of work, educational and leisure activities. Mrs Webb also owns two other cottages in the village called Poppy Cottage, and Wisteria Cottage. Mrs Webb has also just opened a new supported living service called Daisy Cottage. The current fee range is between £595.00 and £1200.00. People using the service purchase from their own finances confectionary, music CD’s and magazines. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for people who use the service and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This was an unannounced inspection, which took place over two days (seven hours) on the 20th August and the 10th September 2008 by Regulation Inspectors Barbara Ludlow and Gail Richardson. The first day of inspection was only partially completed, records were inspected on day two by Gail Richardson, in conjunction with the inspection of a sister home, Wisteria Cottage. A tour of the premises was made with the permission of the people in residence on the day. A sample of the bedrooms and all communal areas were seen. There were three people at the home at the time of the visit on day one. One person was a resident of Wisteria Cottage, which was closed for two weeks due to holidays. The person seen was in residence with the permission of the person in whose room they were staying. One ex resident was visiting with their carer from the new supported living home owned by Village Homes, called Daisy Cottage. The inspector spoke with the three people present and three members of care staff and the maintenance worker. The Registered Manager was not available but there was telephone contact and help in ensuring that all records and information needed was made available at Wisteria Cottage on the 10th September. Some records were delivered to CSCI Taunton office for completion of the inspection process. The home had provided CSCI with a completed AQAA (Annual Quality Assurance Assessment), which was completed by the Manager and gives details of all aspects of the home. This includes service improvements over the past twelve months and proposals for development during the coming year. As part of the inspection process the inspector surveyed the opinions of people using the service. Three responses were received from people using the service, four from their representatives and five staff members responded in writing. Information and comment received from the surveys and following discussion with people using the service are included in this report. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 6 The inspectors spent time talking to people within the home and the staff on duty. Records relating to care were sampled and reviewed. Duty rotas were examined and staff recruitment files were sampled. The inspectors would like to thank the people in residence, their representatives, staff and management for their help and contributions to the inspection process. What the service does well: The home provides good information for prospective people considering using the service. Before any new admission the manager undertakes an assessment of need and accesses information from community professionals, funding authorities, families and other persons involved. A visit to the home and a short stay is encouraged to help the person make an informed choice of care home place. The inspectors saw good evidence of the support and attention given to help someone settle in this was at their own pace and tailored as their confidence grew. Each person at the home has a detailed care plan formulated with their involvement and stating how their preferences are supported and how care needs are met. Identified risks are assessed and plans are put into place give the support required. An example was seen where one to one attention was identified as required for community visits. All records are maintained confidentially. People in residence had access to their care plans and other relevant records such as the duty rota. There is an open and inclusive management culture. The home supports each person in his or her development through activity and meaningful occupation. People at the home have routines, which they have agreed and enjoy. Meals at the home are a social event with people using the service participating in choice, preparation and clearing away. People are supported with their healthcare needs by having the access to appropriate healthcare professionals. The homes environment is very well presented and bedrooms are decorated to each person’s tastes and personalised with their own belongings. There is sufficient communal space for people to live together comfortably, there is a choice of two lounges, one has a television. Staffing levels at the home are adequate to meet the needs of the current client group. The inspectors heard that extra staff are available as required. There is some flexibility between the care homes and people in residence were familiar with the staff from the other homes. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 7 Staff training is in place to support the needs of people using the service. Recruitment is robust to ensure the protection of people living at the home. The management of the home appears to support both the people using the service and staff. Health and Safety measures are in place to promote protection; policies and procedures are in place to ensure good practice. 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. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. There is good information available about the service and thorough assessment procedures for individuals who are looking to take up residence at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a statement of purpose and service user guide for prospective residents. The AQAA indicated that these contain photographs and that there is also a CD Rom to take out to prospective residents who are making their choice of care home. The registered manager / proprietor, Mrs Webb will visit to assess people before they come along to the home for a visit or trial period. One new person was case tracked at this visit and they had visited the home prior to making their decision to come and stay. The staff team were informed that a visit was to be made by so they were aware and any preparation could be undertaken. The homes daily logbook had details of one admission and who had accompanied them, there was detail about the support given during the early days after admission to help them settle in and feel comfortable and more confident. The evidence seen supported individualised and thoughtful care at this time of change and of settling into a new environment. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 10 In the AQAA Mrs Webb indicated that assessments for care are evidence of the service providing ‘value for money’ as the ‘fair pricing tool’ is used and the process is ‘well planned and discussed with all parties’. Each person has a contract which outlines and details the terms and conditions of residency, this includes current fee scales. Comment card responses were positive and were made by the three people who live at the home, they confirmed people being ‘asked’ if they wanted to live at this home. The people and four relatives all commented that they had enough information to make an informed decision about choosing this home. All four relatives responded that their relative’s needs are ‘always’ met at the home. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good People using the service are consulted about their needs and supported by staff in making decisions and developing independent life skills. Appropriate risk taking is promoted. Risk assessments were regularly reviewed and updated but need to be easily accessible at all times. All records are stored securely. People using the service have access to their care records. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans were sampled at the random inspection and were satisfactory. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 12 Each person using the service has a detailed plan of care, the plans outline any specific care needs. The care plans also contain risk assessments and any care plan resulting from that risk. Areas that are risk assessed include: the management of challenging behaviour, helping around the house, personal care and assistance required when bathing. They were sampled for people in residence at the time of the visit, this included people from Wisteria Cottage who were staying at Church View during the holiday. One person did not have their risk assessments with them only their daily log / records. It was suggested that the whole care plan should be available at Church View for staff to refer to and especially all risk assessments. Care plans demonstrated that input from community health care specialists is accessed appropriately such as the diabetes specialist nurse and the chiropodist. People are supported to go out and to take advantage of the local countryside and facilities. Two people were taken out on a walk for fresh air and exercise during inspection day one, they said enjoyed the outing. Staff said they paced walks to suit the people and their varied levels of fitness. There is a Home Day Rota and encouragement is given to individuals to take part in household duties such as cooking and on a home day to clean their bedroom and manage their own laundry with supervision. The home has a people carrier vehicle and trips out socially and for shopping on a home day is arranged. One person said they planned to go for a walk and then shopping in Crewkerne, a small town nine miles away. Comment cards indicated that people felt they ‘sometimes’ make decisions about what they do each day. All said they can do what they choose each day, each evening and at weekends. One person said that ‘decisions on entertainment are normally by majority vote’. Since the random inspection in June 2008, two people have moved on to more independent living in a cottage that is also part of ‘Village Homes’. One of these people was seen and spoken with at Church View. It was pleasing to note the progress and development they had achieved in the time between CSCI visits. The support being given during the transition to a more independent living was well planned, individualised care. Mrs Webb states in the AQAA that the progress and achievement of the residents in the development of their independent living skills is the best indicator of good value and high service delivery. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 13 Individuals may need assistance to manage their personal finances. Appropriate records are kept of staff involvement. Care managers are involved in checking finances at formal reviews. Financial records with receipts were seen on day two. All transactions are audited monthly and any money being stored is securely held and locked into individual tins. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,15,16,17 Quality in this outcome area is excellent People are encouraged to take part in age appropriate activities, leisure pursuits and occupation. Relationships and contact with family and friends is supported. Individual rights are respected and responsibilities in daily life at the home encourage personal development. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the random visit people were seen as they returned home together from their weekday activities. The second visit was during the summer holiday period. The people living at Church View have looked happy and relaxed at each CSCI visit. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 15 At the key inspection visit only three people were in residence. Two people from Church View were on holiday with their families. Wisteria Cottage was closed for two weeks due to holidays and the one remaining person had come to stay at Church View. All arrangements about this had been agreed with the incoming person and their family and the person whose room was being temporarily used; their family had given their consent and agreement to the arrangement. Family contact is supported, people living at the home confirmed that their visitors are welcomed and can come to see them anytime. The comment cards indicated that parents experience good communication with the home. The people attend activities they enjoy and the manager has developed the farm activities available to people. All people in residence go to the farm on Tuesday and four people were described as working there each Friday, this work is unpaid. People are encouraged to take up employment, one person was seen who is hoping to start working in a coffee shop. People were asked about going to the farm; we heard that there are ducks and chickens to be attended to. One person said they had enjoyed going to the farm and spoke of the fun they enjoyed. Lunch is taken at the manager’s farmhouse. People said they enjoy going swimming. The record book where trips to town to visit the bank are recorded was seen. People draw £20.00 to spend each week. Trips to the cinema are paid for by the individual, some people have carer cards, which allow free entry for their supporting carers. A sample of individual’s logbooks were shared with the inspectors, these highlighted preferences, described trips out, the individuals participation and enjoyment of the trips. Help with household tasks and chores are recorded. Feedback from people living at the home was received on comment cards at CSCI. People responded that they are treated well by staff and are listened to by staff. One person commented that ‘staff try and explain a situation and advise the best way to resolve it’. Four relatives responded very positively about the lifestyle at the home comment included that ‘we are extremely pleased with the level of support in helping with learning life and social skills’. Feedback from relatives also indicated that there are ‘good group discussions and plans that enable all residents to enjoy their lives to the full’. The menu for the day was tuna pasta salad and tea was cottage pie and vegetables. Staff were seen preparing the evening meal, this smelled delicious and looked appetising. People in residence are involved in food preparation and undertake basic food hygiene including hand washing. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 16 The people in residence said they enjoy the food and were asked about breakfast, we heard that cereal and fruit is offered each day and a cooked breakfast is offered at the weekend. Menu preferences are taken into account and special diets were confirmed where people had dietary restrictions. Meals are taken together around the dining table. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good People are well cared for physically and emotionally. Personal and health care needs met in accordance with their agreed care plan. Medication is generally safely managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people living at the home had care plans. These were seen with the consent and agreement of the people case tracked at the key inspection visit. The inspectors saw a good level of family information for contacts and more personal reminders. There was detailed information about college attendance. Hospital letters are held for information about appointments for consultant care and screening relevant to the individual. Other appointments such as the hairdresser and chiropodist were recorded. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 18 Risk assessments were seen to corresponded to the care plan. For one person their risk assessments had not been brought to the home. A recommendation is made for risk assessments to be available at the place of residence. Another person had a care plan devised elsewhere but this was very detailed and relevant providing a detailed individual support plan. Detailed entries seen in a daily log showed that a good level of emotional support and encouragement was given to help one person settle into life at Church View. People asked said they were are well cared for and happy. People knew they could knock on the bedroom door of the sleeping night staff if they became unwell in the night. Health promoting care is undertaken and people are encouraged to attend their doctor for relevant screening and health assessments. Chiropody visits are three monthly for those requiring this service. Most people have a regular hair appointment, every six weeks. One of the people living at the home confirmed attending Boot’s the chemist each month to be weighed and have a printout of their weight, height and BMI index. People pay for this themselves each month but said they enjoy doing this activity, it was described as a fun event. Care plans are signed by people to confirm their agreement with the plan written and prepared on their behalf. Medication Administration Records (MAR) were examined. There was evidence of good management of diabetes. An eating plan was seen, there was regular blood sugar monitoring by staff who confirmed their technique and practice, which was appropriate and safe. Staff said Mrs Webb who is a Registered Nurse trained them to undertake capillary blood sugar monitoring. Insulin was stored in an unlocked fridge and was not in a lockable box. The fridge temperature is recorded daily, however a daily log of minimum / maximum temperature monitoring is recommended. Quantities of prescribed medications received were not all signed in on the MAR charts; this is recommended as good practice and to provide a complete audit trail. People who live at the home responding in writing to CSCI said they are ‘happy in the home’. One relative said the care home do ‘extremely well, they understand and look after and cater for all needs in a professional and caring way’. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good There is an accessible complaints policy and procedure. Good recruitment practice and staff training protects people from the risk of harm from unsuitable people working at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints policy and procedure in the policy manual for staff. Complaints and concerns are taken seriously and are acted upon. No complaints have been recorded at the home since the last inspection. CSCI received an anonymous concern about this service; a random inspection visit was made. The concerns raised were not validated as poor practice but highlighted practice that was not clearly documented. This has been addressed. The home has a complaints procedure, a whistle blowing policy and an abuse policy. Staff receive training in abuse awareness as part of the induction process and early delivery of a regular update was planned as good practice in response to the concern raised with CSCI. The whistle blowing policy needs to be updated with CSCI contact details, it should also be reviewed and dated accordingly. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 20 Surveys received from three people using the service indicated that two people they knew how to make a complaint, one said no. Four relatives surveyed confirmed that would all know how to make a complaint. Staff surveys confirmed that Criminal Record Bureau checks had been carried out at recruitment and that staff understood what to do if a concern was raised. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is excellent. Church View provides a homely, comfortable and safe environment. It is decorated and maintained to a high standard. The home was found to be clean and hygiene was well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Church View is a well-maintained cottage that is comfortably furnished and well decorated. People living at the home said they liked their home and were pleased to show the inspectors around the communal areas and their own bedrooms. Bedrooms were personalised and are respected as the personal space of the individual occupant. The home days are used as a day to encourage cleaning of bedrooms and personal laundry management. These tasks are part of the personal Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 22 development to encourage responsibility in preparation for more independent living. High cleaning is undertaken by dedicated cleaning staff. The home has a bathroom with a shower and a separate shower room; these were seen to be clean and tidy. There is a staff bedroom on the first floor and staff toilet on the ground floor. There is sufficient storage for outdoor clothing and shoes. A notice on the dining room wall indicates that there is a restriction in place regarding drinks being taken into either of the two lounges. People living at the home were comfortable with this and were happy to take their food and drink in the dining room. The dining room opens onto the patio area at the back of the house and is adjacent to the small kitchen. The dining room has a large farmhouse style pine table and chairs; this room is a central meeting point in the house, is comfortable and is well used. Action has been taken to restrict widely opening first floor windows to a safe limit since the random inspection, this was a precautionary health and safety measure. The home is very clean and hygienic. There are good accessible staff hand washing facilities. Staff have food hygiene training and health and safety training to promote safe practice at the home. There is no smoking in the house. Feedback from parents indicated they are happy with the standard of the accommodation and cleanliness of the home. One relative felt it could be more relaxed about things being ‘so tidy’. All people living at the home said that the home is clean and fresh. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good The staff at the home are carefully recruited, trained and supported in their roles. People living at the home are supported by a competent staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff at the home demonstrated caring and respectful relationships with the people in residence. There is an age mix of staff providing the balanced care and support needed by the young people in residence at Church View. The people in residence spoke highly and affectionately of the staff and managers of the home. Staff are required to be multi skilled in delivery of this service and they succeed, providing a family style caring home. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 24 Staff numbers were confirmed to be at least two when the home has five people in residence. There are staff available to cover from within the ‘Village Home’ staff team if more staff are required or if needed to cover staff absences. The inspectors heard that term times can be ‘hectic’. No concerns were heard at this inspection visit about staffing numbers being less than required. Staff spoken with worked a mix of shifts, early shifts from 07:30am until 2pm or 3:30pm, and late shift from 2pm until 10pm. The night duty is a sleeping night from 10pm, staff are easily accessible should the need arise. One staff survey included “ staff and management do their best to always cover shifts”. Staff and relatives commented on turnover in the staff team and felt this could be unsettling at times for the people living at the service. Staff also commented that ‘one person can be left on their own for a while’ with five people. The inspectors understand that a ratio of one to five is assessed as safe and extra help can be sought via the on call member of staff that can attend the home in an emergency or to support activities that need extra staff. At the time of the inspection due to the holiday period there were sufficient staff available to work on each shift and provide one to one as required. The manager was interviewing new staff on inspection day two, this recruitment was in hand to bring the staffing number back to sufficient number for the homes at full capacity. Staff also commented that they always do their best to provide cover in times of sickness and absence. Recruitment was examined on day two of the inspection. Recruitment procedures were found to be robust and all staff had CRB (Criminal Record Bureau) and POVA (Protection of Vulnerable Adults) checks prior to commencing employment. The manager is recommended to ensure that all recruitment files contain a recent photograph of that staff member. Staff receive an induction to the post and are supported through regular supervision. Staff spoken with confirmed having appropriate training and regular management support. When surveyed five staff responded that they meet with their manager for support and to discuss how they were working: three said regularly and two said often. People living at the home responded positively that staff treat them well. One person said that they ‘like the staff’ at the home. Staff confirmed having training and in response to ‘What does the service do well?’ we heard that the home is ‘helping the service users to be as independent as they can be’, is promoting ‘healthy eating’ and one person said ‘this is one of the best homes I have worked in’. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is excellent The home is well run with clear management and leadership. People who live at the home are involved in all aspects of daily living at the home. The home is well maintained; attention is paid to the health, safety and the welfare of people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 26 Mrs Webb has over twenty years experience as a carer and manager. She has worked with people with a learning disability for sixteen years. She has a Higher National Diploma in Care Management and is a registered nurse. Mrs Webb was part of the senior management team at a specialist college for people with a learning disability for a number of years. Since the last inspection, changes in the management structure to support Mrs Webb are being made, the AQAA indicated that a ‘care manager’ had been introduced to more regular ‘care shifts’ ‘to monitor the quality of service delivery and report to senior managers any potential issues for addressing’. Mrs Webb also indicated in the AQAA under improvement over the past twelve months, that there has been attendance at an external conference on current topics such as the Mental Capacity Act. There has also been more training made available to staff working at the home. At the random inspection the laundry was unlocked and a requirement was made to secure the chemicals stored in this room in line with Chemicals Hazardous to Health (COSHH) guidance. Mrs Webb responded positively and lockable storage had been provided in the utility room and under sink cupboard in the kitchen, these were seen to be locked. At this Key inspection the laundry door was open and a number of chemicals on the shelves were accessible. This was discussed with the maintenance person at the visit, they said the door was normally closed and locked. The door was then locked for supervised access only. Staff on duty confirmed that they normally keep the laundry locked. The Data sheets for chemicals on the premises were available and were accessible to staff for reference should the need arise. The home is well maintained and records seen were up to date. The home has a fire risk assessment in place. All fire alarm tests and fire safety equipment testing was up to date. Fire extinguishers had been serviced in May 2008. Staff have fire training with a fire officer, this was held at the farm (Mrs Webb’s home) in February 2008. People and staff that were asked were familiar with the routine for evacuation in the event of the fire alarm sounding. Staff training had also been given in manual handling, health and safety and food hygiene. The inspectors heard that a meeting is held each Friday for staff, and people living at the home and staff meet each month. Every month there is quality review of care delivery on a one to one basis, this ensures the people are receiving personal care and are happy. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 27 Staff meeting notes were seen and these indicated good communication and discussion of relevant issues. Planned outings are discussed, the next will be a trip to see High School Musical in Plymouth. The homes CSCI Certificate of Registration and Employers Liability Insurance were prominently displayed. Policies and procedures are in place but it was noted that the policy for resident’s property and money was generic in style and not specific to the service, it did not indicate what is paid for within the fees. The whistle blowing policy requires a review date and signature. The AQAA dataset did not indicate policy review dates. Good practice is an annual review of the homes policies and procedures to confirm their continued relevance, in line with any changes to legislation. There is ongoing quality monitoring. Regular feedback from stakeholders is taken up each year and the key worker role includes assessment of quality of care for each person each month. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 4 25 3 26 3 27 X 28 4 29 X 30 4 STAFFING Standard No Score 31 X 32 3 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 X 12 4 13 3 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 4 X 4 X X 2 X Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA42 Regulation 13 4 c Requirement All chemicals must be stored safely in line with the COSHH (chemicals and substances hazardous to health) guidance. This refers to the open shelved storage of chemicals in the unlocked laundry. Medication stored in the fridge must be in a lockable container. Timescale for action 30/10/08 2. YA20 13 2 30/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA34 YA20 Good Practice Recommendations The manager should ensure that all recruitment files contain a recent photograph of that staff member. The fridge temperature is recorded, a daily log of minimum / maximum should be recorded where temperature sensitive medication is stored. Quantities of prescribed medications received should be signed in on the MAR charts to ensure there is an audit Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 30 3. YA9 trail of medications at the home. Risk assessments must be accompany people who have moved into the care home from another ‘Village Home’ and be easily accessible to staff caring for the individual at Church View. Church View DS0000016251.V372356.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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