Care Home: Cintre Community

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What the care home does well "Its brilliant, its alright and there is lots to do," was the comment made by one individual through the survey. During consultation one person made the following comment about the standards of care, "Cintre is a good place to be"Comments made by the manager through the AQAA about what the service does well included, "Offering freedom of choice, a safe and clean environment and access to a wide selection of therapies, with a stable staff team". Health care professional made the following direct comments about the home. "Reflects and acts on the individuals needs, seeks advice appropriately and acts on the advise," "Seeing people as individuals and attempting to offer support appropriately" and " Prepared to manage risk to support people, open to discussion." The following comments were made by relatives through surveys, " Supports clients towards independence", " When problems arise they support us and our relative at the home" and " They offer opportunities to live in a comfortable environment and undertake activities." What has improved since the last inspection? Since the last inspection, the home has been successful in reducing the use of physical restraint. The home has not used any physical restraint for behaviours that challenge since the last inspection and members of staff are clear that this intervention is the last possible resort. Repairs and redecoration continue to be made so that individuals can benefit from a homely environment. Staff have access to vocational qualifications and training that ensures they have the skills and resources to meet the changing needs of the people at the home. There is a clear person centred approach to meeting needs. People at the home are more empowered to make decisions. Accessible formats are available to support people with communication needs to make decisions. The expectation that people at the home have all their meals together was relaxed. People are more able to eat their meals at their preferred times and with whom they choose to eat with. What the care home could do better: There is one requirement arising from this inspection. The manager must ensure that references are validated to ensure that only staff suitable to work with vulnerable adults are employed. CARE HOME ADULTS 18-65 Cintre Community Cintre Community 54 St Johns Road Clifton Bristol BS8 2HG Lead Inspector Sandra Jones Unannounced Inspection 5 & 6 August 2008 3:30 th th Cintre Community DS0000026532.V365335.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 Cintre Community DS0000026532.V365335.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. Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cintre Community Address Cintre Community 54 St Johns Road Clifton Bristol BS8 2HG 0117 9738546 0117 9467842 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) Cintre Community Management Co Mr Gordon Charles MacDonnell Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 7 persons, aged 18 - 45 years. Date of last inspection 3rd August 2007 Brief Description of the Service: The Cintre Community is registered with the Commission for Social Care Inspection to provide care for 7 adults who have a learning disability. The property is a large detached house in a residential location within walking distance of local amenities. There are 7 single bedrooms set over three floors. One of these rooms consists of an independent living flat. There is a large lounge divided into a homely seating area. The Statement of Purpose informs people wishing to live at the home, their relatives and funding agencies about the fees. It is stated that fees start from £1500 per week Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection was conducted unannounced in August 2008 over two days and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from individuals and staff. Prior to the visit some time was spent examining documentation accumulated since the previous inspection. A completed Annual Quality Assurance was received from the home and this information was used to plan the inspection visit. “Have your say” surveys were sent to people living at the home, their relatives and health care professionals. Seven people living at the home returned, four relatives and four health care professionals returned completed surveys to CSCI. There are seven individuals living at the home and four were case tracked during the inspection. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The home’s policies and procedures were also used to confirm the findings. The views of the people living at the home and staff were gathered through face-to-face discussions. There were four people at the home during the inspection and three refused to give feedback. What the service does well: “Its brilliant, its alright and there is lots to do,” was the comment made by one individual through the survey. During consultation one person made the following comment about the standards of care, “Cintre is a good place to be” Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 6 Comments made by the manager through the AQAA about what the service does well included, “Offering freedom of choice, a safe and clean environment and access to a wide selection of therapies, with a stable staff team”. Health care professional made the following direct comments about the home. “Reflects and acts on the individuals needs, seeks advice appropriately and acts on the advise,” “Seeing people as individuals and attempting to offer support appropriately” and “ Prepared to manage risk to support people, open to discussion.” The following comments were made by relatives through surveys, “ Supports clients towards independence”, “ When problems arise they support us and our relative at the home” and “ They offer opportunities to live in a comfortable environment and undertake activities.” What has improved since the last inspection? Since the last inspection, the home has been successful in reducing the use of physical restraint. The home has not used any physical restraint for behaviours that challenge since the last inspection and members of staff are clear that this intervention is the last possible resort. Repairs and redecoration continue to be made so that individuals can benefit from a homely environment. Staff have access to vocational qualifications and training that ensures they have the skills and resources to meet the changing needs of the people at the home. There is a clear person centred approach to meeting needs. People at the home are more empowered to make decisions. Accessible formats are available to support people with communication needs to make decisions. The expectation that people at the home have all their meals together was relaxed. People are more able to eat their meals at their preferred times and with whom they choose to eat with. Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 7 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. Cintre Community DS0000026532.V365335.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 Cintre Community DS0000026532.V365335.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 an effective admissions procedure in place, which enables people wishing to live at the home to make informed choices about moving there. They can be reassured that the home will have the skills and resources to meet their assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is an up to date Statement of purpose and Service User Guide that is symbolised with pictures and words, available at the home. It states that the aim is to assist people living at the home in taking individual steps to manage their own lives. The primary focus is then to provide a therapeutic and structured environment for the people living there. It is made clear through the Statement of Purpose that the home provides accommodation to people 16-45 years with learning disabilities and behaviours that challenge. Information about the way challenging behaviour is managed at the home with a description of the training provided to the staff and the techniques used are clearly specified, enabling individuals, their relatives and placing agencies to make decisions about moving into the home. Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 10 The admission procedure in place stated that introductory visits are encouraged before admission. It confirms that assessments are conducted and trial periods are offered to determine the individual’s suitability to live at the home assessments are conducted. The referral criteria for admission is explicit about the home being provided with a social workers needs assessments and agreements must be discussed in advance of admission to the home. The admission process followed establishes whether the staff have the skills and resources to meet the needs of the people wishing to live at the home. The case record of the most recent admission was examined and social workers’ needs assessment, pen portraits, home’s care plans and associated risk assessments are held on file. Also included are signed copies of the complaints procedure and Service User Guide with the home’s rules and expectations. The person most recently admitted to the home was consulted about their experience of the process. It was stated that looked around Cintre and other homes before making a decision to move into residential care. Members of staff arranged other introductory visits to look around the home and during these visits a Service User Guide was provided and the rules of the home were explained. “ Have your say” surveys were sent to people living at the home and their relatives. Their comments indicate that the home provides enough information to make decisions about moving into the home. Two people said that they had not received any information and one qualified the statement by saying “I can’t remember it was a long time ago.” Cintre Community DS0000026532.V365335.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). There are effective care planning systems in place so that individuals at the home benefit from receiving an individualised and consistent service. They can expect to be involved in making decisions about all aspects of their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a medical and pen profile for each person at the home, which lists contact details, professionals involved and medications prescribed. Pen profiles describe the person, the way behaviour that challenge is presented, the designated keyworker and relationships. There is also a historical overview, which provides the person’s background history, their abilities, medical diagnosis and how this is manifested. Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 12 The manager was consulted about the care planning process in place. It was stated that care plans are built on what the person says, what is written in the social workers’ needs assessment and staff’s observations which can take up to three months to complete. Home’s care plans are sectioned by the assessed need, with clear input from the person and depending on the person, the participation can be detailed or one word comment. For example, “I can clean my teeth” or “ I don’t need prompting with personal care.” Within each section, the individual’s comments about their ability, the support from the staff to meet the need is specified. The observation segment is completed by the staff, which clarifies the comments made by the person and includes a description of the person’s needs and the way the need is met. Care plans are signed by the person further evidencing their input and, where appropriate, they are symbolised with pictures and words to ensure the person can understand their care plan. A person centred approach to meeting needs is evident and guide the staff to meet the need in individualised and consistent manner. Care plans are reviewed six monthly to assess the success of the action plan and to update them so that the individuals changing needs can continue to be met. Home’s care plans were checked against the social workers needs assessment and they corresponded with each other. The manager was consulted about the way care plans are monitored and it explained that assessments programmes and checklists are used to monitor consistency. This ensures that action plans are followed and, weekly supervisions with the person and keywoker are also used to check the progress. The manager explained that the purpose of the weekly supervisions is to provide uninterrupted time to discuss care needs, an opportunity for the keyworker to discuss issues with the person and provide guidance. One person living at the home was consulted about the care planning process in place. This individual was aware that there is a care plan in place and its purpose, which is to assist with independence through life. Examples about the needs identified through the care plan were explained including the assistance provided by the staff to meet the action plan. The care plan was signed because this person agrees with the action plan. Keyworking was also discussed with this person and explained that the manager allocates a keyworker and explained their role. Individuals at the home can expect keyworker to support with problems, discuss the progress of the care plan and spend 1:1 time. Members of staff on duty were consulted about their responsibilities towards care planning. It was stated that care plans are very person centred and are devised by the keyworker, the manager will then check contents and the prepared documents are then taken to staff meetings for discussion. This member of staff said that the main aim of the keyworker was to look after the Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 13 best interest specific individuals living at the home. Working with relatives and health care professionals to improve behaviours is also part of the role. Comments received from relatives through “Have your say” surveys indicate that the home generally meet the needs of their relative living at the home. Risk assessments in place are detailed and include strategies for managing behaviours that challenge. The level of aggression and violence that the person can at times exhibit is defined and include the staff observation and causes that contribute to the behaviours, for example, autistic characteristics or fragile x which have a positive approach. Triggers that precede or cause violent and aggressive behaviours are specified and linked to each trigger, guidance for staff to consistently manage the behaviour exhibited. In terms of physical restraints, strategies are detailed about the type of restraint, the level to be used and makes it clear that it’s the home’s policy is to diffuse, divert or use breakaway techniques for behaviours that challenge. There were no incidents of physical restraint since the last key inspection. One individual was consulted about the way behaviours that challenge are managed at the home. This individual explained that staff generally ask people that exhibit aggressive and violent behaviours to go to their room. The manager said that one person has communication needs, one has speech impairments and another will agree with what staff say. In line with the Mental Capacity Act, psychologist reports were sought for two people to establish their ability to make choices. This is the first step towards their moving towards independence. The case records of these three individuals were examined to confirm the way individuals are supported to make decisions over all aspects of their lives. For the person with speech impairments, care plans guide the staff about the way this person communicates and for the others symbolised formats (words and pictures) are used. One person was asked about making decisions at the home and how they are supported. This individual said because they are an adult they are able to make decisions and gave the following example. It was stated that where risk are identified with undertaking an activity, members of staff will explain the risks so that they are able to make informed choices. Members of staff on duty were consulted about the way individuals at the home are supported to make decisions about all aspects of their lives. It was stated that some individuals are very clear about making decisions and others find it more difficult to express their feelings. Individuals are asked in specific ways and given options so that they can make decisions. A day book is used by the staff to record tasks completed, appointments, outcome of visits and information to be passed on from shift to shift. A diary is also used for appointments; 1:1’s with individuals and local events. Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 14 Memos are used to pass information about individuals changing needs and policy changes and staff sign the memo to indicate their awareness of the changes. Cintre Community DS0000026532.V365335.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) & (17) Quality in this outcome area is (good). Individuals benefit from good support systems in place for people to lead active and interesting lifestyles and to be valued members of the community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Education and occupation form part of the care plan review and from the care plans separate portfolios that include action plans to meet the goal are developed. Within the action plan, the steps needed to achieve the goal, the date for achieving it and the progress made are included. Activity timetables, which include in-house and outside activities, are in place and show that people at the home are employed, participate in activities outside the home and attend college courses. Daily reports and diary’s confirmed that people at the home participate in education, occupation and Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 16 leisure activities. There is also free time and they attend local events, for example, the Balloon fiesta. Three people stated through the survey that the always make decisions about what they do each day and three said it was only sometimes. The manager said that two people are supported by staff outside the home while the others are independent in the community. People are encouraged to use local shops and pubs so that they can be recognised as part of the community. One person was consulted about their participation in the local community. This individual said that they visit local coffee shops and pubs. A member of staff on duty confirmed that part of the care plan is to integrate individuals and to support people to engage in the local community The home has a visitor’s policy and its included in the Statement of Purpose and Service User Guide. This policy recognises the importance of maintaining links with family and friends, for this reason visiting is open and bedrooms can be used for additional privacy. Comments from relatives through surveys indicate that people at the home are supported to maintain contact with friends and family. Feedback from the manager about the way individuals are respected as individuals was sought. The manager said that by enabling people to make choices, allowing people to do things for themselves and using a person centred approach, people are treated as individuals. There is also Privacy and Dignity policy in place that underpins the approach, which is that staff are trained to respect people’s rights including confidentiality. Home’s agreements include house rules and they are based on group living, household chores, visitors and leaving the building. It was understood from the manager that there is reward system for undertaking household chores. Each person has an additional £5.00 voucher, with their personal allowance, for doing household chores, which can then be used for leisure activities. When individuals refuse to undertake their designated chores, the voucher may be withdrawn. One person’s feedback was sought about the way staff respect people at the home and about the rules of the home. It was stated that staff treat individuals like adults and, they knock before entering bedrooms and use the correct form of address. Regarding the rules of the home it was stated that rules about drugs, alcohol, smoking, nighttime routines and household chores exist. It was stated that there is an expectation that people living in the home undertake household chores and for this a £5.00 voucher is given, which can be used for activities. A daily record of the food served is kept and shows that a continental style breakfast is provided, lunch is generally hot with a salad and the main meal at Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 17 teatime. A support worker on duty said that the decision about the meal to be served is daily, with the person participating in cooking. Additionally, the member of staff stated that the evening meal is the main meal and generally a lighter meal is prepared at lunchtime. The range of fresh, frozen, dried and tinned foods confirmed that a varied and nutritious diet is served. Since the last inspection a snack bar was installed in the dining room for people refreshments to make refreshments, snacks and to help themselves to fruit. One person was consulted about the meals served at the home and it was stated that the food served and portions are good. This person also said that a healthy diet is served, they are able to make snacks and refreshments without asking staff. At a recent visit from the Environment Agency, the home was awarded four stars for their standards in the kitchen. Cintre Community DS0000026532.V365335.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) & (20) Quality in this outcome area is (good). People at the home can expect sensitive and prompt support for their personal and health care needs from a skilled staff team. Medication systems are safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal care also form part of the care plan and individuals mainly need prompting to undertake personal hygiene. Individuals make decisions about the times to rise, retire Times to rise, retire, dressings and staff follow their preferred routines. Feedback was sought from one individual about the assistance that staff provide with personal care. It was stated that staff prompt with personal care Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 19 otherwise this task will not be undertaken. It was also stated “Sometimes I get grumpy because they want me to do my room”. Each person has a medical profile that lists the names of health care professional involved in the care of the person. Within the profile the individuals medical history is included with their diagnosis any recurring health care needs. Documentation held within case records illustrates that people access NHS facilities, there are regular check arranged to the optician, dentist and chiropodists. Separate records are used to record health care visit which confirm that people at the home have input from the Community Learning Disability Team (CLDT) dentist, optician and included are the date and reasons for the visit. Staff meeting minutes show that consideration is being given to introducing Health Care Action plan, which is seen as good practice. The manager said that support from staff on GP’s visit, depends on their level of ability and these visits are arranged when needed. It was also stated that individuals were given an opportunity to change their health care service so that they can visit the Health Centre independently. Members of staff were consulted about the way health care is managed at the home. A member of staff said that some people are supported on GP’s visits and communications books and handovers are used to ensure the staff consistently follows medical advice. Comments made by relatives through surveys indicate that they are kept informed about important issues affecting their relative at the home. Four “Have your say” surveys were received at CSCI from health care professional. Their comments indicate that the health care needs of the individuals at the home are always met. Comments made include “From my experience staff can meet the needs of the people at the home” and “ The current management structure and approach is working very well with meeting the health care needs of the people at the home.” Medications are administered from a monitored dosage system and records were checked for gaps and correct use of codes. There were no gaps found in the recording, indicating that staff sign the records immediately after administration. Correct use of codes shows that staff record the reasons for not administering the medications. Records checked corresponded with medications kept within the system. A record of medications no longer required is maintained which the pharmacist stamp’s to indicate receipt of the medication for disposal. Risk assessments that establishes the individuals competency to selfadminister medications are in place for those individuals that administer their Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 20 own medications. The steps to lower the level of risk are included so that the person can continue to self-administer their medications. Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 21 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). Individuals at the home can expect their concerns to be listened to and to be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Complaints procedure is included within the home’s Statement of Purpose and Service User Guide, which is symbolised (pictures and words). It is confirmed through the procedure that complaints are an opportunity to improve practice, agrees to investigate complaints and to resolve them to a satisfactory level. It is also specified that individuals will be informed about the actions to be taken and may seek further action if they are not satisfied of the outcome. One person was asked about the way complaints are handled at the home. It was stated that the know how to complain because the procedure is on display in bedrooms. This person would approach the manager with complaints. A member of staff on duty confirmed when people at the home make complaints, the complaints procedure is followed to ensure they are resolve to a satisfactory outcome. People at the home and their relatives made comments through the surveys about making complaints. People at the home and their relatives know how to Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 22 make a complaint. Their relative also stated that they home always responds appropriately to their complaints. There is a home’s Whistle Blowing policy and Abuse policy, which shows a commitment towards safeguarding people from abuse. The Whistle Blowing policy makes it clear that staff should raise concern or suspicions of abuse with their line manager. The Abuse policy clarifies the factors of abuse and the actions to be taken by the staff where there is alleged abuse. One person was asked about the way the home safeguards people from abuse. This person said, “I feel safe here, it’s a good place to be.” A member of staff giving feedback said that Safeguarding Adults training is provided and the manager would be informed about alleged abuse. The manager made one Safeguarding Adults referral involving two people living at the home, for alleged physical abuse. Policies and procedures regarding behaviours, support and management including the use of physical restraint are in place and detailed. Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 23 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 (good). The home is adequately maintained so that individuals benefit from living in a comfortable and clean environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Cintre is a large detached period property, which has the appearance of a domestic dwelling and blends well with its residential location. It is within walking distance of shops, amenities and bus routes. The accommodation is arranged over three floors with bedrooms on two floors and shared space on the ground floor. On the ground floor there is a lounge, dining room, kitchen and downstairs toilet. There is a large lounge divided into a television lounge and arts and crafts area. The lounge area has two large comfortable sofas, individual chairs and window seat for the people at the Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 24 home. In the dining room there is a large table for staff and individuals to sit and have meals together, there is also refreshment making facilities and easy chairs for people to use outside of meal times. The kitchen is large with seating and is used as social space for individuals. There are 7 single bedrooms set over two floors and accessible by stairs. On the first floor there are four bedrooms and two bathrooms and on the second floor there are three bedrooms, one of these is an independent living flat. Bedrooms are single, lockable and furnished with a combination of the home’s furniture and personal belongings, which reflects the person’s lifestyle and interests. Since the last inspection the bathrooms were redecorated and central heating system was replaced. While it is noted that there is a maintenance programme in place, areas of the property are in need of minor repair and redecoration. The laundry room is set away from the kitchen and, it has a tiled floor and painted walls for easy cleaning. There is a domestic size washing machine and tumble dryer, with sluicing and hand basin. Comments from people living at the home indicate that the home is always fresh and clean. Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 25 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): (34) & (35) Quality in this outcome area is (good). People are supported by a competent, qualified and skilled staff team who are well supervised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The recruitment process was examined to establish that the home has a robust recruitment process. This will ensure that the staff are suitable to work with vulnerable with adults. The home’s application from requires that candidates provide the names of two referees and disclose any criminal background. Personnel records of the most recently employed staff were examined and completed application forms, two written references and Disclosure of Criminal Background (CRB) obtained. However, referees are not currently requested to validate the home’s standard reference request forms. Referees must be asked to validate the reference to reinforce that only staff suitable to work for vulnerable adults are employed. Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 26 A recently appointed member of staff was consulted about the recruitment process. This member of staff said that they had to complete an application form, provide the names of two referees and disclose any criminal background and attend an interview. They were provided with an induction pack, which the manager discusses with all new staff and they had three supernumerary shifts before they were included in the staff rota. New employees must complete an in-house induction programme, which follows the Skills for Care Common Induction programme. This is recommended to enable staff to give high quality care and support, provide recognition for their work, and prepare them for entry onto NVQ health and social care programmes. The manager said that where new employees have no vocational qualifications they are registered onto NVQ training following from the induction programme. Also new staff have a three days supernumerary to experience the different shifts. The manager has developed a training programme that must be completed by all staff which includes statutory training (Food Hygiene, First Aid and Fire training) and other courses such as Management of Aggression and Mental Capacity Act training. This ensures that staff have the skills necessary to meet the needs of the people at the home and to fulfil the aims and objectives of the home. Feedback from one individual was sought about the skills of the staff. It was stated that people at the home are treated well by the staff, they attend training and know how to meet their needs. A member of staff on duty was consulted about training. It was stated that training is always available to the staff. It was stated that statutory, refresher and courses that ensure the changing needs of the people at the home are met. Comments were received through surveys about staffing from people at the home, their relatives and health care professional that visit the home. People at the home said that staff treat them well, listen and act upon what they say. Relatives said that staff have the skills to meet the needs of the people at the home. One relative stated, “ the staff are skilled, knowledgeable and experienced.” Two healthcare professional said that the staff always had the skills to meet the needs of the people at the home and two said this was usual. One health care professional said, “ The staff are high quality.” Cintre Community DS0000026532.V365335.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) & (42) Quality in this outcome area is (good). Individuals benefit from a well managed home. They can expect to live in a safe environment and can be assured that standards will be the subject of ongoing monitoring, including input from their own views. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was consulted about the management style used at the home and it was stated that an “independent thinking” style is used. It was explained that the ethos behind it is that rules are there to guide and help but not inhibit their development. This system is based on freedom of choice, Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 28 teaching people to be aware of others and avoiding physical intervention where possible. One individual agreed to make comments about the manager. It was stated that the manager maintains good relationships with people at the home and if problems arise, he can be approached. Members of staff at the home were consulted about the style of management used. It was stated that managers are approachable, conscientious and address issues. Handover when shift changes occur, supervision and staff meeting ensure that consistency of care is maintained. Three staff are rostered throughout the day and generally the manager is office based and at night two people sleep in the premises, with an on call duty manager. At weekends two staff are rostered in the morning and three in the afternoon. The manager confirmed that where trips are arranged or the needs of the people increase, staffing levels would increase. Facilities for the safekeeping of cash and valuables exist at the home and to check the system sample check cash held was conducted. The records examined were accurate and corresponded with the cash held in safekeeping. Receipts held evidence the purchases made on behalf of the person. Fire risk assessments are in place and look at the hazards and list the preventative measures to be taken to prevent fire. The checks of fire alarm system and training of staff will ensure that the risk of fire at the home is reduced. The manager ensures that the home meets associated Health & Safety legislation to ensure that people at the home are safe. This includes annual servicing of the gas safety and checks of portable electrical equipment. The manager has developed an action plan from the completions of the Annual Quality Assessment required by CSCI. The action plan focuses on the improvements, how it will be achieved with target dates. Further discussions took place with the manager about the way individuals at the home give feedback about the standards of care in place at the home. Surveys are used to obtain feedback from individuals which the manager analysis. From the analysis the manager will devise an action plan and the names people that agree with the plan are included. Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 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 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 30 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation 19 (C) Requirement The manager must not employ staff unless he/she is satisfied of the authenticity of the reference Timescale for action 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. Refer to Standard Good Practice Recommendations Cintre Community DS0000026532.V365335.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. Extracts may not be used or reproduced without the express permission of CSCI Cintre Community DS0000026532.V365335.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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