Care Home: Condover College

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What the care home does well Condover College meets people`s needs well and there is a high level of customer satisfaction with few concerns. Systems are in place to ensure that peoples individual care needs are known and acted upon. For example people`s health and personal care needs are met including those that are complex. Staff and Managers appreciate the positive relationships they have with local health professionals who they report, support people living within the home well. It was positive to see that individual spiritual and cultural needs are known and understood. People who want to for example go to church and time had been taken to locate an out of area Caribbean hairdresser who was able to provide specialist hair care services to meet the specific wishes of a service user. Again a strength of the home is ensuring that people`s individual social and leisure interests are known and that they are supported to enjoy them. All this supports the well being of people living there and it was rewarding to see people flourishing following admission. The service is reaping rewards from building partnerships with an independent advocacy group. This partnership is helping Condover House to develop proactively with person centred care as its focus. One illustration is how service users are being encouraged to be an active part of recruiting care staff. Recently following a joint decision who to appoint, a service user rang the applicant to offer the position and was supported to be ready early the next morning as she had expressed the wish to greet her when she returned to complete the necessary employment check documents. Condover is listening to residents and has taken steps to purchase more vehicles following feedback. What has improved since the last inspection? Some communal areas of the home have been decorated providing in part, a cleaner and fresher living environment for service users. The new colours also help to create a more relaxing, domestic feel in the large main building. Training records have improved as they are now computerised so it is easier to monitor and plan individual and group staff training required. Most significantly however, are improvements made to medication systems, which have been radically overhauled. Condover managers have worked with a pharmacist to review their medication policies, procedures and practices to ensure better accountability and safer practice to minimise risk to service users. What the care home could do better: Outcomes are excellent for service users. Minor improvements to demonstrate compliance with good practice would be as follows: Although the Manager feels well supported by daily contact with the Chief Executive, she should receive regular formal, recorded supervision in addition. Omissions in formalised supervision have not impacted adversely on service users. Information available to potential service users, relatives and other partner agencies should explicitly state ranges in fees charged for services. Action to address handover periods, which staff still describe as being rushed. To complete redecoration of areas that require it to improve the feel of the main building (especially remaining corridor and hallway areas). To demonstrate on rosters how staffing levels are meeting residents needs. For example to record the numbers of residents being cared for when staffing is reduced and staff are lone working. Training records were made available to us after the inspection day as the administrator was not at work and the manager could not access the new computerised system. It would help the Manager on a day-to-day basis to learn to access these and would ensure that all records are available for inspection as required. Condover House is an old building that was not built to accommodate people with physical disabilities and in spite of best efforts the main building will always have limitations. The corridors will never be wide enough to comfortably accommodate an electric wheelchair but the provision of powered doors for the service user whose care was looked at in detail would facilitate her greater independence. This was the most significant need identified at thisinspection. Accommodation provided in the bungalows on site however offers good accommodation. CARE HOME ADULTS 18-65 Condover College Condover House Condover Shropshire SY5 7AA Lead Inspector Deborah Sharman Key Unannounced Inspection 12th February 2008 09:30 Condover College DS0000061651.V350659.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 Condover College DS0000061651.V350659.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. Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Condover College Address Condover House Condover Shropshire SY5 7AA 01743 872250 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) stephen.mcgill2@btinternet.com Condover College Vicki Pryce Care Home 21 Category(ies) of Learning disability (21) registration, with number of places Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care (excluding nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 21 The maximum number of service users to be accommodated is 21. 2. Date of last inspection 16th January 2007. Brief Description of the Service: Condover College is a Care Home, registered with the Commission for Social Care Inspection to provide accommodation, personal care and education for up to twenty-one young adults with Profound Learning Disabilities and Visual Impairment. Service users currently living at Condover College are aged 18 - 27 years but the service does offer ‘life long’ care to the age of 65. Service users are offered a transition between education and adult life. Condover College Ltd operates the home. Ms Vikki Pryce, the current manager, is responsible for the homes day-to-day management. The College is located in the village of Condover some three miles from Shrewsbury town. The main building is a three-storey house standing in its own spacious grounds. Three dormer bungalows situated in close proximity and accessed through a walkway from the main garden complement the main house. The Home seeks to provide a positive homely environment for service users affording the appropriate levels of support required to meet their needs and aspirations. An ‘Information Guide’ states that fees are assessed individually according to the needs of the Student. This further explains who helps with funding and how. The ranges of fees are not outlined in the written information about the Service and therefore this information was not available to us. Specific information about fees charged should be sought from Condover College. Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means that the people who use this service experience excellent quality outcomes. One Inspector carried out this unannounced key inspection between 9.30 am and 6.30 pm. As the inspection visits were unannounced this means that no one associated with the home received prior notification and were therefore unable to prepare. As it was a key inspection the plan was to assess all National Minimum Standards defined by the Commission for Social Care Inspection as ‘key’. These are the National Standards, which significantly affect the experiences of care for people living at the home. Information about the performance of the home was sought and collated in a number of ways. Prior to inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to the Commission within a given timescale. The registered manager completed this document and returned it to us. Comments from the AQAA helped us to formulate a plan for the inspection. Additionally prior to inspection, the Commission for Social Care Inspection sought the views of people living at the home and those of their relatives and other independent professionals associated with the home. Written responses were received from 2 relatives and one health professional. Nine people who live at Condover College returned questionnaires that they had completed with the help of an independent advocate. All this information was analysed prior to inspection and helped to formulate a plan for the inspection and has helped in determining a judgement about the quality of care the home provides. During the course of the inspection we used a variety of methods to make a judgement about how service users are cared for. An Expert by Experience (in this report known as ‘the Expert’) assisted us. This was someone with personal experience of using learning disability services who had been trained to accompany inspectors during a visit to a service. Experts by Experience observe what happens in the home and talk to service users to get their view of the home. This Expert talked in detail with two people living at Condover College (everybody else had gone home to family or out for the day as it was half term). He also toured the care home, visiting all Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 6 four units of accommodation, the main house known as Condover House and numbers 25, 32 and 34. The Expert has provided a report of his findings, parts of which have been included in this report. The homes registered manager, senior and other staff, supported the inspection day. The Inspector interviewed four staff members and also chatted briefly with people living at the home about their experiences during a tour of the environment. We also looked in detail at care provided to two service users. One service user whose care had been looked at in this way was happy to show the Inspector her bedroom and during this time was able to talk about her experience of living at Condover College. We sampled a variety of other documentation related to the management of the care home such as training, recruitment, staff supervision, maintenance of the premises, accidents and complaints. What the service does well: Condover College meets people’s needs well and there is a high level of customer satisfaction with few concerns. Systems are in place to ensure that peoples individual care needs are known and acted upon. For example people’s health and personal care needs are met including those that are complex. Staff and Managers appreciate the positive relationships they have with local health professionals who they report, support people living within the home well. It was positive to see that individual spiritual and cultural needs are known and understood. People who want to for example go to church and time had been taken to locate an out of area Caribbean hairdresser who was able to provide specialist hair care services to meet the specific wishes of a service user. Again a strength of the home is ensuring that people’s individual social and leisure interests are known and that they are supported to enjoy them. All this supports the well being of people living there and it was rewarding to see people flourishing following admission. The service is reaping rewards from building partnerships with an independent advocacy group. This partnership is helping Condover House to develop proactively with person centred care as its focus. One illustration is how service users are being encouraged to be an active part of recruiting care staff. Recently following a joint decision who to appoint, a service user rang the applicant to offer the position and was supported to be ready early the next morning as she had expressed the wish to greet her when she returned to complete the necessary employment check documents. Condover is listening to residents and has taken steps to purchase more vehicles following feedback. Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Outcomes are excellent for service users. Minor improvements to demonstrate compliance with good practice would be as follows: Although the Manager feels well supported by daily contact with the Chief Executive, she should receive regular formal, recorded supervision in addition. Omissions in formalised supervision have not impacted adversely on service users. Information available to potential service users, relatives and other partner agencies should explicitly state ranges in fees charged for services. Action to address handover periods, which staff still describe as being rushed. To complete redecoration of areas that require it to improve the feel of the main building (especially remaining corridor and hallway areas). To demonstrate on rosters how staffing levels are meeting residents needs. For example to record the numbers of residents being cared for when staffing is reduced and staff are lone working. Training records were made available to us after the inspection day as the administrator was not at work and the manager could not access the new computerised system. It would help the Manager on a day-to-day basis to learn to access these and would ensure that all records are available for inspection as required. Condover House is an old building that was not built to accommodate people with physical disabilities and in spite of best efforts the main building will always have limitations. The corridors will never be wide enough to comfortably accommodate an electric wheelchair but the provision of powered doors for the service user whose care was looked at in detail would facilitate her greater independence. This was the most significant need identified at this Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 8 inspection. Accommodation provided in the bungalows on site however offers good accommodation. 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. Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4. Quality in this outcome area is excellent. Admissions procedures are thorough and are adhered to. A full range of staff and other professionals contribute to pre admission assessments. This assures service users that their needs will be very well assessed and known. People are only admitted to the home if Managers are confident that their needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked in detail at the admission of two new service users admitted to Condover House since the last inspection. Information available tells us that admissions continue to be managed well. Appropriate literature in accessible formats is available to help applicants and their representatives learn about the services on offer but fee information needs to be more explicit within it. A range of information about applicants is gathered from a variety of sources. This contributes to helping Managers decide whether they can meet the needs of the people referred to them for a place at Condover. It was positive to see, on record copies of letters sent to applicants and their families confirming that following assessment, Condover believes that they can meet the applicant’s assessed needs. Applicants continue to have the option to visit and to stay for a few days prior to making a decision and this period of time is well Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 11 documented and contributes to the pre admission decision-making process. It is testimony to the time taken pre admission, that new service users settle so well and quickly come to regard Condover as home. New service users confirmed that shortly after moving in, they attended a review of their care with people significant to them. Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is excellent. Care plan and risk management systems provide excellent guidance to staff as to how to meet service users needs. There is also clear guidance about how service users make their own choices. There is very strong evidence that staff provide care and facilitate choices in accordance with service users preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked in detail at care plan guidance available to staff for two service users. Care plans are very well written and are person centred. They are clear and describe all the little foibles that differentiate people from each other. These help staff to know about the important little things that help people to maintain and create their individual identities. Accessible formats are available. Significantly, when we tested these care plans, we found that staff are familiar with what they say and ensure that they are implemented. For example, people are supported with appropriate skin care, nail care, hair Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 13 care, hobbies and of significance to the young people who live there, to top up personal pay–as-you-go mobile phones etc. In one case, we advised the Manager to ensure that time limits in a care plan are clear for one service user whose dietary health is complex. Guidance tells staff what is important to service users, wearing jewellery for instance. This promotes peoples’ wellbeing and personhood. A letter we saw on file from a Consultant psychiatrist confirmed our judgement. Similarly risk assessments consider preferences and how to minimise risks and are exceptionally well written. Moving and handling risk assessments are amongst the best examples the Inspector has seen and again staff and service users confirmed that they are followed. Records of care provided are detailed and well written. They give a clear picture of how care has been provided in accordance with the plan of care and service users wishes. It is positive to see how staff describe in these records how service users are able to make choices in their day to day lives ranging from the times they go to bed, whether they got up early or decided to have a lie in, personal care and activities requested and provided. For example ‘we went across to the club as X asked to go’. On the day of inspection, two people asked if they could go for a meal together followed by a trip to the cinema and we saw staff supporting this that day. We could also see from records that staff understand that behaviours can be a way of communicating a concern or choice and that staff work to resolve the problem, rather than engage in a battle about the behaviour. In feedback to us a relative wrote about Condover: ‘ it encourages our daughter to make her own decisions, to develop her independence skills, to become integrated within the local community. It gives her a wide range of social skills’. Care is reviewed and care plans and risk assessments are updated to reflect any changes. The Expert said: ‘I asked the lady if she was involved in her reviews. She said she had a review recently in college where her aunt, granddad and Nan came along. The lady said in her review she asked for a new mobile phone, due to the current one not working in this area, and also for some support to makes new friends. The lady said she has a new mobile phone and now goes to lots of clubs. I felt that this lady was truly involved in her review and fully understood what happenedgood practice. The other person said he had a review where his parents came and it was at this home. In the review the person asked for a Welsh flag for his bedroom and the staff are helping him to find one.’ Condover College DS0000061651.V350659.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): 12, 13, 15, 16, 17. Quality in this outcome area is excellent. Full opportunities are available. Service users are supported to develop their social, communication, and emotional skills at Condover House and in the community. They are supported to have regular contact with family and friends. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Perusal of records tells us that service users have frequent contact with families, often by phone as many live at a distance. Staff also communicate with families well to inform them of any significant issues. Records also tell us that service users are supported to take part in their preferred activities on a regular basis and that they are provided with their favourite meals and snacks. Documentation showed a service user whose care we looked at in detail to be partial to bagels and jam and also fish. Records show that she has bagels for breakfast about twice per week and that she had enjoyed fish for dinner on several occasions. Dietary needs are known and referrals have been made to Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 15 the dietician when necessary. Records told us that the dietician had been pleased with the weight loss a service user had achieved since moving to Condover. We verified the information in records by talking to service users and staff and also by observing at teatime how service users who require it are supported to eat. We found them to suitably supported on a one to one basis and at an appropriate pace. From talking to service users the Expert gained a lot of information about service users experiences and his report tells us a lot about what it is like to live at Condover College: ‘As it was half term week during our inspection lots of people were visiting family and others were out for the day. 2 people chose to stay home to speak with me. My first thoughts were, I was pleased so many people were out on such a beautiful day and the 2 people that were in, were only in as they chose to speak to me.’ I first asked if they like living in this home and one lady said she did because she lives with her friends. The other person said he likes it here as he goes to see trains and likes to go out for meals. I asked what else she likes doing with her time and she, with support, got out her Dream Book. This Book contained lots of photographs of the type of things she like to do. This involved swimming, clothes shopping, going to theatre shows and discos. The other person said he went on holiday last year to Wales where he saw lots of trains that he really liked. Lots of people in the home also go to a club called Reflex in the local town, which they hire out for the evening and lots of friends are invited to come along and the lady said it’s great fun. She likes to invite people from the home, college and the sharks swimming club, she is involved in. I’m really happy this lady has such a big group of friends and is supported to see them regularly.’ I noticed people who live here; some have come from far away in the country. I was disappointed to hear people having to travel so far away from their home and family to access this service. I did ask when family does come for people’s reviews are they able to stay over. Staff said they have a Travel lodge nearby that family use and also have plenty of B&Bs and a self-catering cottage that parents like to use. I asked about holidays in the home. One lady had not been here that long but was due to have a holiday this year. Staff said people currently have a leaflet to fill in with their key worker to say where and what type of things people would like to do on holiday. Last year the home was involved in 4 holidays to make sure everyone’s needs and wants are catered for. The lady said she wanted to go somewhere lively. I’m really pleased to hear people are given the choice about where to go, what they’d like to do and also they can say who from the home they would like to go away with. This is great not everyone has Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 16 to go in one big group! At Birthday times, people can choose what they would like to do and with who. The lady has not yet had a Birthday in the home but said she was looking forward to it. I asked what the ladies hobbies were and she said she loves shopping, bowling, disco, and the beauty therapist coming to the home to paint her nails. I was disappointed to hear the beauty therapist was coming into the home and the lady was not accessing the services in the community. I got confused about who opens the post for people as the lady, at first, said the staff opens it, but a staff member then said people open it with their key-worker. The lady then agreed with the staff member that post is opened with staff. The other person said he goes to a youth club every Friday evening, he said he was looking forward to going to the cinema tonight as he had chosen what film he wanted to watch. He also said he wanted to eat out this evening and staff said that was fine. This person also said he enjoys going to church on a Sunday. He also said he likes staying in his bungalow and gets involved with the cooking and likes to dance around the kitchen. This person said he is supported every day to prepare his own sandwiches to take to college and tidies his own bedroom. The gentleman said he likes the noises of lorries and train brakes and staff support him to visit different places to hear these things. They go to fire stations, airports and hospitals. I asked if people have anytime for themselves and the gentleman said he likes his private time in his bedroom. He likes to listen to his Abba music and watch TV. My next question related to what people do during the day. The lady attends college where she said she’s involved in cooking and computers. The other person attends college some days to use the computers but also has day opportunities. One of the day opportunities he said was he loved doing is horse driving. Staff said people are supported every year to make up their own timetable and choose what they would like to do. I asked the lady what type of things does she like to do in the evenings. As she mentioned before she likes the disco, going out with new friends, staying in with her friends, baking cakes. The other person said he likes the local social club where he plays snooker, uses the jukebox and likes to order his own drinks at the bar. The 2 people then said they like to spend time together and were making valentines card for each other. The lady said she would like the opportunity to spend more time with this person, maybe to the park or bowling with him. Staff said now they know about it they can support it to happen. I then asked about meal times and what happens if people don’t like what’s on the menu. The lady said she would just choose something else. She said she has plenty to eat and choice at the home. When they go out to eat she says she pays for her own meal and staff said when people choose to have a Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 17 takeaway the home pays for the meal. The staff were very clear in saying whatever food people have in the home is paid for by the home. Condover College DS0000061651.V350659.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 excellent. People receive personal support in the way that they prefer and require. Changing and complex health needs are identified and responded to well. Service users benefit from a positive working relationship between staff and health professionals. Medication systems have significantly improved which promotes the health of service users whilst simultaneously reducing risk due to greater accountability. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Peoples on going and changing health needs are known, are understood and in partnership with health professionals are met. Good systems are in place to maintain appointments and detailed record keeping supports consistency and follow up by staff. We know of no concerns. Service users told our Expert that they visit their local Doctors and when the District Nurse visits she sees people in their rooms. Managers and staff told us they are well supported by their local surgery who often give them same day appointments. Records show us that staff listen to health concerns raised by service users who can vocalise and enable medical advice to be sought. Detailed records enable medical Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 19 changes of those who are not vocal to be monitored and acted upon too. A staff member described how working in partnership with an independent advocacy group put them in touch with a learning disability nurse contact at the local hospital. This ensured a resident benefited from provision of a side room upon admission as the nurse coordinator arranged this to ensure positive action was taken to help someone with a learning disability address their health needs more easily. People are supported with personal care in a manner that accords with personal preference and safety. We could see that a service user that prefers a shower rather than a bath is supported to shower at times when she requests this. For another person there is good photographic guidance available as to how to ensure that splints are fitted safely and comfortably. Staff have a developed sense of how they promote service users privacy and dignity during the provision of personal care when their support is required. Assessments of medication records showed that service users whose care was looked at in detail are receiving their medication as prescribed. This was additionally confirmed by auditing a short course of medication prescribed mid medication cycle. We could see that 28 tablets had been prescribed and 28 had been administered to the service user, enabling health to be maximised. We agreed however with the Manager, the need to review with the GP medical direction for one service user, where a pain killer is prescribed to be given regularly but is being administered ‘as required’. The homes annual return has told us in detail how they have improved medication systems and practice. It says ‘An external audit has been carried out to ensure good practice is occuring when dealing with medication. also that practice reflects the policy and procedure in place’ and also we ‘Carry out weekly quality assusrance monitoring on medication.’ By talking to senior staff we confirmed the additional checks now in place. By talking to staff we learned that staff are aware of the risks when administering medication and are ‘being more careful now. The number of reportable incidents about medication errors is no longer presenting a concern. Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. No complaints have been made to the home but a complaint made to us about the service, received a robust and timely response by Managers. Management action has been swift in situations where allegations have been made and has demonstrated that service user protection is prioritised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A staff member who coordinates working with a local independent advocacy group explained how this partnership has helped Condover to provide a more accessible complaints ‘kit’ to service users that they keep in their room. In the annual return, the Manager told us that they have not received any complaints. Sight of the complaints records confirmed this. A relative wrote to us and told us that ‘‘ I have never had any concerns to raise’ and ‘It would appear to me that the care home does everything well. I certainly have not got any complaints’. Since the last inspection, an anonymous complaint has been made to us about the management of the home. This was passed to Condover to investigate and the Senior Board have been made aware of its content. We received a comprehensive and timely response to the concerns we had been made aware of. The provider did not uphold the issues at the time. We have explored some of the anonymous concerns about senior management as part of this inspection and can find nothing that corroborates them. Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 21 Since the last inspection two staff have been dismissed following investigated allegations about practice. There was a short time delay (overnight) whilst the staff member considered the options open to her before raising the alarm but upon learning of the matter/s management action was swift and uncompromising. The Expert asked service users if they feel safe at Condover House. The person he spoke to said she feels really safe and she ‘can tell her key worker anything as she has a really caring way’. This person also said she talks to staff if she is upset. She described how angry she had become when her wheelchair broke but she verified records we had seen that said she had been supported the same day to contact the mobility shop to get it repaired. The Expert is ‘really pleased the home is supporting people to do things for themselves’. This is pleasing for another reason. The effective management and diffusion of behaviours safeguards service users from themselves and others and promotes their emotional wellbeing. Systems to account for service users finances are robust and are counterchecked by senior staff. Staff feel that service users monies are safeguarded. Retaining receipts of expenditure supports documented accounts. The Manager explained that they are exploring alternative ways of safe holding service users monies to enable individuals to have greater control over their own money. On one occasion we found (as the staff member had recorded it) that a staff member had used her personal credit card to make a purchase on a service users behalf and for this reason had retained the receipt herself so it was not held on the service users finance file. This is not good practice on a number of counts. It blurs professional boundaries, disempowers the service user in the long term as well as failing to fully account for the expenditure making both the service user and staff member vulnerable. The Manager agreed. Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is adequate. The main house is an old building, which is not designed for people with disabilities. Although there is more to do, managers work hard to reduce the impact of the barriers imposed by such an old building and provide a clean and comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The bungalows on site provide good quality accommodation but at this inspection we identified limitations in respect of the main building. Steps are taken to minimise the barriers to homely living and independence imposed by the main old building, Condover House. Some repainting has been done in communal hallways and corridors and the effect of the modern colours used is softer. Redecoration is an ongoing task however and large areas are waiting to be done. These areas in comparison are more institutional in effect and reminiscent of an old school house. Corridors are narrow and a service user manages but finds it difficult to manoeuvre her electric wheelchair inside the Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 23 premises and so usually doesn’t, deferring to her manual chair. We followed her to her bedroom where she led the way in her electric wheelchair. Although she got stuck on a few occasions due to restricted space, she managed independently and arrived at her bedroom. Restricted space combined with a ninety-degree angle and the weight of her bedroom door meant that although determined she was unable to open her door and negotiate the turn required to enter her bedroom. A powered door would assist her independence. The Manager is also reviewing her bed, as she is aware that it does not fully meet the service user’s moving and handling needs. The Manager is aware that any alternative must also assure the safety of staff whilst moving and handling and these conflicts are under consideration. All other equipment required has been provided following occupational therapy assessment. On entering her bedroom, it felt cool. The Service user said she sometimes gets cold. Immediately her key worker adjusted the radiator and agreed to keep the temperature of her room under review. The premises are clean and odour free with no evident hazards. The Expert fully toured the premises and these are his thoughts: ‘I first was given a tour around the home as they have one big main house for 8 people and then 3 smaller bungalows. I didn’t really like the feel of the main house as it was too big and I felt quite lost in it, it didn’t feel like a home. I did like the bungalows, as they were smaller. More personal and I was pleased they were not all next door to each other. The lady told us she was going to have her bedroom painted, as it had not been done since she moved in last year. She said she has asked for the room to be painted red and it will be done while she is on holiday. I’m not sure when the holiday will be as its not booked yet, but I feel this ladies room should have been decorated when she moved in last year.’ Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is excellent. Staff who are well supported are safely recruited in partnership with service users. Staff are confident and competent in their job roles. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Other than a few complaints about a new rota pattern, staff morale seems high. Staff feel well-supported and new staff particularly so. Supervision and induction records confirm this. It is a considerable achievement that the frequency of supervision for staff exceeds the national minimum standards. Staff reported good communication between themselves and managers, enhanced by weekly staff meetings. Staff reported having good training opportunities and a new staff member who has previously worked in the care profession appreciated the level of training she was given during her induction at Condover. Staff continue to report little time for an effective handover and the annual return acknowledges that consistency in handovers could improve. New computerised training records show there is a rolling programme of expected basic training and additional training to help staff to understand Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 25 service users needs e.g. epilepsy, makaton, PEG feeding, bowel management and visual impairment awareness training. Records show there are high rates of training provided in moving and handling, first aid and adult protection. Little MAPA training has been provided and fire training now needs to be prioritised as records show many staff have not received it for two full years. The Expert and Inspector agree that staff know people who live there very well. We observed staff giving people time to answer questions without being tempted to answer for them. The Expert said ‘I thought the atmosphere within the home with people and the staff was great. The staff were very respectful towards people and made me feel very welcome’. We assessed recruitment documentation in respect of two people; one new current staff member and a staff member who had been dismissed. There were no errors or omissions in pre employment checks and references which provides assurance that vulnerable people are protected as far as is possible from people who are newly recruited to work with them. Staff confirmed that the employment processes are robust and that service users are beginning to be involved in the recruitment and selection of staff. The Experts report summarises our findings: ‘The lady said she had recently been involved in interviewing for a new staff member to work at the home. When the group decided on whom to offer the job to, this lady said she phoned the person to offer her the job and arranged to meet her the next morning to start the CRB check process. This lady seemed really happy to be part of the process and I hope this happens to all new staff that are recruited to the home.’ From discussion and the annual return staff and Managers are satisfied with staffing levels. The rosters are clear and well managed and from them we identified a number of occasions when staff are lone working in houses 25, 32 and 34 at peak times especially first thing in the morning. Managers say that lone working policies and risk assessments reduce any associated risks (we didn’t ask to see these on this occasion). Staff spoken to say they are comfortable with this and they along with managers said that lone working only happens when service user numbers are reduced for any reason. On reflection, it would better account for how staffing levels are meeting service users needs if rosters reflected the rationale for staffing level decisions (ie service user numbers could be written on rotas daily). We believe it to be important that this is implemented as a relative told us ‘’Condover often has a number of staff on duty whom we have never met. Perhaps some way could be found to give parents their names so that we could know to whom we are talking and perhaps put names to faces’. Moreover in written feedback to us a service user said ‘‘the staff cant always help me as they are busy with other people’. Service users feedback to the Organisation in surveys referred to earlier state: ‘needs physical support: not always Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 26 available at 1 to 1 level’ and ‘not enough transport or staff to go out’. This was not evidenced for those whose care we looked at but will be kept under review. Condover College DS0000061651.V350659.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 excellent. The home is being proactively managed in the interests of individual service users and the service user group as a whole. Service users can be confident that their views underpin all selfmonitoring, review and development by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Expert wrote ‘the people I spoke with seemed very happy here and really active in their lives. My only big concern was the layout of the main home, it didn’t feel like a home and was too big. The results of questionnaires sent by Condover to people living at Condover have been analysed and more transport purchased as a result. Most people did not express concern about the physical environment of the home but one or two person expressed a wish for a bigger Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 28 room. Overall the results show a high level of satisfaction. Ongoing work with a local advocacy group is ensuring that the service does not stand still and a number of creative initiatives for the benefit of service users have emerged from this project and have been referred to earlier in this report. In addition, the Organisation has recently registered a new service locally as a ‘sister’ care home. This has enabled 8 people to move on from Condover, to develop their potential and create opportunities for others. A wide range of service maintenance and safety records were sampled and all were up to date providing assurance that equipment, fire systems, gas, electric, water temperatures, hazardous chemicals and bedrails are all safely managed with risk reduced as far as practicable. Risk assessments are well structured and moving and handling risk assessments are amongst the best the Inspector has seen. The Manager feels supported on a day-to-day basis and in turn supports staff well who speak highly of the way in which Condover College is managed. The Manager reported that she does not feel the need for formal supervision, as she has daily contact and support from the Chief Executive and has confidence in the governing Board. It is however her right to receive this and the National Minimum Standards dictate that she should be in receipt of this. The Manager has refreshed her moving and handling training and is now able to teach moving and handling to others. She is qualified to national standards for her role as manager but is looking she said to exceed this, as she has plans to undertake an NVQ level 5 qualification. Condover College DS0000061651.V350659.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 4 2 4 3 3 4 3 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 4 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 4 X 4 X X 3 X Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 30 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA42 Timescale for action 23(4)(d)(e) Arrangements must be made for 30/04/08 persons at the care home to receive suitable training in fire prevention and are aware of the procedure to be followed in the event of fire. Regulation Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations Pre admission written information should include the range of fees charged so all parties are aware prior to applying for a place what the charges are. Recommendation arising from this inspection February 2008. Receipts accounting for expenditure by staff on service users behalf should always be available. Steps should be taken to discourage staff from using their personal finances to meet service user expenditure. Recommendation arising from this inspection February 2008. Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 31 2 YA23 3 YA24 With regard to the number and needs of service users suitable adaptations should be made for service users who are physically disabled to help them to access the building as independently as possible. Recommendation arising from this inspection February 2008. Steps should be taken to evidence how staff are available in sufficient numbers to meet the needs of service users at all times in all houses. Recommendation arising from this inspection February 2008. The Registered Manager should review current handover arrangements to ensure that staff are provided with the information they need to carry out their jobs. Recommendation arising from inspection January 2007. 4 YA33 5 YA36 6 YA36 The manager should receive formalised recorded supervision, a minimum of six times per year. Recommendation arising from this inspection February 2008. Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Condover College DS0000061651.V350659.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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