Care Home: Country Bungalow

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What the care home does well Country Bungalow is a relaxed, friendly and comfortable home which is managed well so that the people who live here have a good life. The relative/advocate who returned our survey wrote "I have always found the staff very helpful and caring". Staff who returned our survey were very positive about the home. They wrote: "We have a fantastic manager"; "I really enjoy working at Country Bungalow"; "Provides an excellent service for the service users"; "Service users are treated individually and all have different needs which are catered for"; "Everyone is treated with respect"; and "Provides opportunities each day for different activities". One person wrote to the manager following consultation about the change of provider, and said "I hope that (name) continues to have the opportunities that you and the rest of the staff team have worked so hard to give him. I do feel you do such a good job in providing a caring family home for (name) and all the other residents". There is good information about the home available and thorough assessments of people`s needs are carried out. Support plans are detailed, person-centred and give staff good guidelines about how each person wants to be supported. People are able to make decisions about every part of their lives, and they are supported in the way they prefer. People`s health needs are recognised and met.People have choices about every aspect of their lives. Each person does as much or as little as they want to do. Activities are available both inside and outside the house, and the people who live at Country Bungalow choose the meals they want to eat. People know their complaints will be listened to, and they will be kept safe. Staff are recruited well, and offered a lot of training opportunities, as well as regular supervision and staff meetings. Health and safety is taken seriously, and the home is run in the way the people who live here want it to be. What has improved since the last inspection? 11 of the 13 requirements we made after our last inspection have been met, which means that the service has improved in almost all areas. In the AQAA the manager showed she is aware of areas the home can continue to get better, and we have confidence that it will continue to improve. What the care home could do better: There are only two requirements from our last inspection which had not been fully met, so these have been carried forward. One of these is about ensuring there are enough staff on duty so that people`s needs are fully met. In their responses to our survey, staff all commented that more staff are needed. The other requirement is that if charts are needed to record, for example, what someone eats and drinks, the charts must be completed properly otherwise the record is of no use. We have made one recommendation: that all staff should be involved in a fire drill at least once a year. CARE HOME ADULTS 18-65 Country Bungalow 21 Potton Road Everton Bedfordshire SG19 2LD Lead Inspector Nicky Hone Unannounced Inspection 30th October 2008 09:10 Country Bungalow DS0000071794.V371636.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 Country Bungalow DS0000071794.V371636.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. Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Country Bungalow Address 21 Potton Road Everton Bedfordshire SG19 2LD 01767 692001 01767 692759 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.choicesupport.org.uk Choice Support Mrs Sandra Parkin Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning Disability - Code LD The maximum number of service users who can be accommodated is: 6 This is the first inspection of Country Bungalow since it transferred to Choice Support. The last key inspection was on 24/05/07. 2. Date of last inspection Brief Description of the Service: Country Bungalow is a residential home for up to six adults with learning disabilities. Management of the home passed from the Bedfordshire and Luton Mental Health and Social Care Partnership Trust (BLPT) to Choice Support in March 2008. The bungalow is owned by the Bedfordshire Pilgrims Housing Association (BPHA), which is responsible for the maintenance and upkeep of the building. The home is situated on the main road in the village of Everton, Bedfordshire and is close to local village facilities including shops, pubs and a church. The building is a single storey bungalow, and provides six single bedrooms. Shared areas of the home include a large lounge/dining room, kitchen, bathrooms, toilets, and laundry. There is a large, pleasantly landscaped back garden. There is parking for several cars at the front of the property. Fees for the service were not available at the time of the inspection. A copy of the last CSCI report is kept in the dining area. Country Bungalow DS0000071794.V371636.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. Choice Support took over as provider of the service at Country Bungalow from the Bedfordshire and Luton Partnership Trust (BLPT) on 1st March 2008. The building is owned and maintained by the Bedfordshire Pilgrims Housing Association (BPHA). The manager and staff team continued to work at the home. At the time of this inspection there were six people living at Country Bungalow. About two years before the transfer to Choice Support, Country Bungalow was re-registered by the Commission for Social Care Inspection (CSCI) as a home for older people, as the majority of people who lived here were over 65 years of age. However, everyone who lives at the home is here because they have a learning disability. When the home was registered to Choice Support, it reverted to being registered as a home for adults with learning disabilities. People of any age can be admitted to the home, provided they have a learning disability, the home can meet their needs, and they fall within the home’s aims as stated in its Statement of Purpose. For this inspection we looked at all the information that we have received, or asked for, since the last key inspection of Country Bungalow. This included: • The AQAA (Annual Quality Assurance Assessment) that the manager completed and sent to us in May 2008. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living at the home. It gives the manager the opportunity to say what the home is doing to meet the standards and regulations, and how the home can improve to make life even better for the people who live here. The AQAA also gives us some numerical information about the service; Surveys which we sent to the home to give to people who live at Country Bungalow, to their relatives/carers, and to staff. We received 8 replies: 4 from people who live at Country Bungalow; 1 from a relative/advocate; and 3 from staff. What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement; Any safeguarding issues that have arisen; and • • • Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 6 • Information we asked the home to send us following our visit. This inspection of Country Bungalow included a visit to the home on 30/10/08. No-one knew we were going to visit on this day. When we arrived, we learnt that all the staff were on a training day, and the manager was on annual leave. In spite of this the home was staffed well. The person in charge was someone who had retired after working at the home for many years, but still does occasional shifts. He was assisted by two agency staff who had both worked previous shifts at Country Bungalow and who knew the people who live there. The manager decided to come in and spend the day assisting us with the inspection. We spent time talking to the manager and some of the staff, and talking to and observing the people who live at the home. We also looked at some of the paperwork the home has to keep including care plans, risk assessments, medication charts, and records such as staff personnel files, staff rotas, menus and fire alarm test records. What the service does well: Country Bungalow is a relaxed, friendly and comfortable home which is managed well so that the people who live here have a good life. The relative/advocate who returned our survey wrote “I have always found the staff very helpful and caring”. Staff who returned our survey were very positive about the home. They wrote: “We have a fantastic manager”; “I really enjoy working at Country Bungalow”; “Provides an excellent service for the service users”; “Service users are treated individually and all have different needs which are catered for”; “Everyone is treated with respect”; and “Provides opportunities each day for different activities”. One person wrote to the manager following consultation about the change of provider, and said “I hope that (name) continues to have the opportunities that you and the rest of the staff team have worked so hard to give him. I do feel you do such a good job in providing a caring family home for (name) and all the other residents”. There is good information about the home available and thorough assessments of people’s needs are carried out. Support plans are detailed, person-centred and give staff good guidelines about how each person wants to be supported. People are able to make decisions about every part of their lives, and they are supported in the way they prefer. People’s health needs are recognised and met. Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 7 People have choices about every aspect of their lives. Each person does as much or as little as they want to do. Activities are available both inside and outside the house, and the people who live at Country Bungalow choose the meals they want to eat. People know their complaints will be listened to, and they will be kept safe. Staff are recruited well, and offered a lot of training opportunities, as well as regular supervision and staff meetings. Health and safety is taken seriously, and the home is run in the way the people who live here want it to be. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Country Bungalow DS0000071794.V371636.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 Country Bungalow DS0000071794.V371636.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): 1, 2, 5 People who use this service experience good quality outcomes in this area. Information is available about the service for people thinking about moving here, and assessments are carried out so that people know the home can meet their needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has produced a Statement of Purpose (SOP) and a Service User Guide (SUG), which were both up to date. We saw a copy of the SUG in each person’s room. This has been produced in an easy-to-read way, using pictures and plain language, but still contains good information for people about what they can expect from the home. The manager sent a full copy of the SOP to CSCI in September 2008 when it was revised. All of the people living at Country Bungalow have lived here for some years, so we were not able to check whether good assessments had been carried out before they moved in. However, on the files we looked at we found detailed assessments of people’s abilities and needs which were done in 2007 in preparation for the change of provider. One person’s file also contained a Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 10 recent assessment (August 2008) as this person’s needs are changing as she gets older. A Support Service Agreement has been drawn up which explains to people the service they are paying for, and what they can expect from the service. This uses pictures and very clear language. People also sign a licence agreement with the Housing Association. Country Bungalow DS0000071794.V371636.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, 8, 9, 10 People who use this service experience good quality outcomes in this area. Support plans are clear and detailed, and give staff good guidance on the way each person wants to be supported. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We saw that each person has a care plan. We looked in detail at one person’s care plan. This contained detailed guidelines for staff on the way the person wants to be supported in every aspect of her daily life. The guidelines had been reviewed regularly, and had been updated to include specific information about dementia. The plan also included risk assessments and good risk management plans, giving staff step-by-step guidelines on all movements, for example transferring from the bed to the wheelchair, using the bath and so on. Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 12 The manager had taken the detailed guidelines for personal care and reduced the information to a single page of bullet points for agency staff and new staff to take with them to the person’s room. In this way, personal care tasks are carried out consistently. Staff also complete a checklist about the personal care tasks they have supported the person with each day. Each person has a ‘My File’ in their room. This contains a lot of information, including photographs, and the person’s care plan in pictures. It also includes details of ‘What I want to happen to me when I die’. Daily support notes are written by staff and give a good picture of how each person has spent their day. We saw that food and fluid intake charts are filled in for some people, but staff have not completed these very well, so the information is not accurate enough for the chart to be of any use. If these are needed, they must be completed properly. Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 People who use this service experience good quality outcomes in this area. People are offered a range of opportunities to lead full, satisfying and interesting lives. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: As part of their ‘My File’ each person has a folder full of photographs of activities, outings, holidays and so on, and certificates from any college courses they have completed. All the people who live at Country Bungalow are ‘older’, with the youngest being in their late sixties, and the oldest nearly 93. The manager explained that although they each do some activities and outings which they enjoy, they choose not to be out and about and as busy as some younger people might want to be. Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 14 One person has almost no hearing or sight, and uses a wheelchair. Staff communicate with him by touch, and use the facial expressions and sounds he makes to work out what he enjoys. They know he enjoys swimming, and have worked hard to find a suitable pool: regular swimming sessions were being organised at the time of the inspection. He enjoys using the spa bath. The person whose records we looked at has a calendar in her room which staff, especially her keyworker, use to plan future activities. This person enjoys going shopping, for walks in the village, and likes to sit at home and do her knitting. She also watches DVDs on the computer which is in the dining area for people to use. An ‘activities record’ is in place for each person, but this has not been completed very well, so is not an accurate record. The manager told us that the documents used to record how people have spent their daily lives are going to be changed, because currently there are too many different places to write things down, so things get missed. Although the staffing situation on the day we visited was not ‘normal’, staff still took people out for a walk if they wanted to go. One person prefers not to see the television, and sits in a corner of the lounge where he can listen to his CD player. Another person likes to sit in his bedroom listening to his music. He told us that most of the time he does not want to go out. Discussions, and our observations, led us to conclude that the activities people can do is somewhat limited by the space available. As there is only one shared living area (the large dining room/lounge), it is difficult for individuals to pursue their preferred activities. For example, on the day we visited, the person who likes to listen to CDs was in one corner of the lounge, but the music made it difficult for anyone wanting to watch the television; any activities that are started at the table have to be cleared away for meals; anyone wanting a ‘noisy’ activity, such as playing a musical instrument, would disturb other people. Activities are also sometimes limited by the number of staff on duty (see Staffing section of this report). Menus are being developed, with each person choosing what they would like to eat for one day a week. Pictures of meals have been collected so that people can make choices. In the AQAA the manager explained that people are still asked daily if they want what is on the menu, or if they would prefer something different. During our visit, staff supported people to make homemade pizzas for lunch, which were very tasty. Menus showed that a balanced diet is provided. Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 15 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 People who use this service experience good quality outcomes in this area. People are supported in their personal care in the way they prefer, their health needs are met and staff administer medicines correctly and safely. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Staff know the people who live at Country Bungalow very well and know how each person prefers to be supported with their personal care. On the morning we visited one person was in the lounge in her nightclothes, as she prefers o eat her breakfast before having a bath. When she was ready she collected everything she needed from her bedroom and staff supported her to have her bath. The guidelines in her records reflected this. On the file we looked at, we saw that a Health Action Plan has been completed by the person and her keyworker, and her health is looked after. Monthly recordings of this person’s weight showed gradual weight loss, so a dietician was contacted for advice and a nutrition plan completed. The plan included Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 16 the person’s likes and dislikes, and ways of increasing the calories in the food that she enjoys. Another person had a treatment plan for their teeth, and the records showed both people had attended the ophthalmology clinic. We also saw letters showing that people are referred to other professionals when needed. Some staff have had specialist training for particular health needs or conditions, for example dementia. The manager has also gathered together some very useful information about dementia so that staff can learn how this illness might affect someone. None of the people who live at Country Bungalow want to look after their own medicines, so these are kept in a cupboard in the office and administered by staff. Each person has their own medication folder. One we looked at included an explanation of each of the medicines the person takes, and why; a body map clearly showing which of several different creams prescribed for this person is applied to which part of the body; clear guidelines for ‘when necessary’ medication; and evidence that the doctor regularly reviews the person’s medication. Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 17 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 People who use this service experience good quality outcomes in this area. People know that their concerns will be listened to and acted on, and that staff are trained to keep them safe from harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a complaints policy and procedure, with a simplified version which is in easy language and pictures, and is part of the Service User Guide. A complaints and compliments log is kept: there have been some compliments, but no complaints. A SOVA (Safeguarding of Vulnerable Adults) file is kept in the office for all staff to refer to, and contains clear guidelines. It includes Choice Support’s policies and procedures, as well as the Bedfordshire ones, and forms and contact numbers for reporting any incidents. Information about how to report incidents is also in the information file that is given to all agency staff when they start their shift at the home. All except two new staff have had SOVA training. The manager said that SOVA was covered in the new staff’s induction, and they will attend a course as soon as one is available. Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 18 A small amount of cash is kept in the home’s safe for each person. Transaction records are kept: staff count the money at each handover to make sure no mistakes are made, and the manager audits the records. The manager told us that each person is currently being supported to open their own bank or building society account so that they can earn interest on any savings. Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 19 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 People who use this service experience excellent quality outcomes in this area. Country Bungalow offers a comfortable, homely, clean and well-maintained home for the people who live here. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A lot of work has been done in the home since our last inspection. About a year ago, all the people who live at Country Bungalow went on a week’s holiday while the builders refurbished the whole bungalow. Among other things they took down a wall in the lounge, removed a huge stone fireplace, decorated throughout and replaced all the flooring. There is now non-slip, wood-style flooring throughout the bungalow, which makes it much easier for people to move around safely. Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 20 The bungalow is pleasantly decorated in colours chosen by the people who live here, and staff have worked hard to make it homely and comfortable. Each of the people who live here has chosen how they want their room to be decorated. They chose the paint colours, curtains and matching bedding, and have been supported by staff to buy things that they want in their room. So each room is personal and very different to the others. The kitchen was not replaced during the refurbishment but is in reasonably good condition and is large enough for several people to help with food preparation. There are some lowered work surfaces so that people in wheelchairs are able to work in the kitchen, helping to prepare meals. The manager told us that BPHA visit the house regularly and have recently agree to come in to touch up the scuffed paintwork on skirting boards, door frames and so on. They will also re-paint the wall in one of the bedrooms where a grab-rail was fitted then had to be moved. The lounge/dining room is very spacious, with two large dining tables and plenty of space for everyone to have a comfortable seat in the lounge area. There is a computer in one corner of the dining area, cupboards for storage, and a large TV in the lounge, and still plenty of room for people, including people using wheelchairs, to move around. However, this large room also has some disadvantages (see Lifestyle section of this report), and staff and the people who live here would welcome another room where people could go if they did not want to be in this lounge. One of the bathrooms has a special bath which has spa jets which the people who live here enjoy, and there are shower facilities and plenty of suitable toilets. A door from the dining area leads to a paved area of garden, with patio furniture and raised flowerbeds so that people can easily do some gardening if they want to. On the day we visited, all areas of the home were clean and tidy, and the bungalow smelled fresh throughout. Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 21 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 People who use this service experience good quality outcomes in this area. The people who live at Country Bungalow benefit from staff that are recruited well, and who have sufficient training so that they can do their jobs properly. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: In their responses to our survey, staff made it clear that they enjoy working at Country Bungalow (see Summary of this report). The person on duty on the day we visited who has retired, said he really likes coming back to do occasional shifts at the home. At the time of the inspection there were fifteen permanent members of the staff team (some work part time), and four vacancies. Any gaps are covered by bank or agency staff. There is always a minimum of three staff on duty in the morning, three in the afternoon/evening, and two at night. Although this number of staff can meet the basic care needs of the six people who live at Country Bungalow, three staff cannot do much in the way of activity, and are not able to take people out, other than for a walk to the village. Staff told us Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 22 that three staff is not enough for them to have time to enable people to maintain or improve their independence skills. Two of the people who live here need two staff for any personal care or transfers. In their responses to our survey staff wrote, “We try our best but more staff are always necessary”; “We are short staffed but thankfully have some really good agency staff that come regularly”; and “Provide us with more staff”. As part of their recruitment procedure, homes must gather information about new staff, before they start work, to show that the staff member is ‘fit’ to work with vulnerable people. This information includes a Criminal Records Bureau (CRB) disclosure, proof of identity and two written references. All the required information was in one of the files we looked at. The manager had details relating to two other staff, showing that the information had been received, and the manager had made sure she had a copy of the CRB disclosure for a student nurse who is doing a work placement at the home. For the fourth staff member, there was only an application form available. When we spoke to a member of Choice Support’s Human Resources team, he told us that Choice Support have an agreement with CSCI that staff information is held at their head office. Following the inspection he confirmed that all the required information about this person is available. He also said that since the inspection the manager has made sure that there is a pro-forma in place for all staff, giving full details about the information that is on their file. Staff at Country Bungalow Have good opportunities for training. Choice Support produce a ‘training and development prospectus’ detailing which courses are being arranged, where and when, so that staff can request a place. The home has developed its own induction pack for new staff which is very detailed. The manager keeps a clear record showing the training staff have received. This record, and our discussion with the manager, showed that the majority of staff have received all the required training, plus have been able to do training in additional topics. All staff were up to date with moving and handling, fire safety, health and safety (including infection control), first aid and food hygiene. All staff have done training so that they can administer medicines safely, although some people did this training a while ago and the manager is arranging some refresher training. Most staff have done a range of other courses including person centred planning, epilepsy, dementia and so on. Records showed that all staff have received regular supervision and will have a minimum of six sessions in twelve months. Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 23 The manager said that seven of the staff have been awarded a National Vocational Qualification (NVQ) in care, at level 2 or 3, and two staff are currently working towards this qualification. Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 24 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, 38, 39, 41, 42 People who use this service experience good quality outcomes in this area. Country Bungalow is managed well so that the people who live here have a good quality of life. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: One of the staff who returned our survey wrote, “We have a fantastic manager, always very supportive, service user orientated and caring”. The manager, Sandra Parkin, managed Country Bungalow for BLPT and transferred to Choice Support in March 2008. She is currently undertaking the Registered Manager Award (RMA). Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 25 The fact that we have only made two requirements and one recommendation following this inspection shows that the home is run well, and in the best interests of the people who live here. The manager is clearly part of the staff team. She knows the people who live at the home well, and is passionate about her job. She sent us detailed information in the AQAA, and showed that she recognises that there are areas in which the home can still improve. The manager showed us her ‘Quality folder’. It contained documents showing a number of different ways in which the quality of the service is monitored. These included: the results of questionnaires sent to families (which had very positive feedback); the reports of monthly visits done by the provider and any action plans arising from the visits; and in-house audits and monitoring on every aspect of the service. The manager completes a monthly report for Choice. To make sure that what the home is doing is what people want, and that it is doing it right, a number of meetings are held, and a record kept. For example, monthly meetings involving each person and their key and link worker; monthly meetings for all six people together if they want to attend, plus the ‘house advocate’; weekly activity planning meetings; and annual care reviews by social services. The manager said that since joining Choice Support, ‘Reach’ standards are starting to be used, which will include an audit by a Quality Checker. Quality Checkers are recruited from people who use Choice Support’s services and who visit services in other areas to check that the service provided is what the people living at the home want. The fire log showed that a fire risk assessment was completed in January 2008. The records showed that weekly checks have been done on the fire alarms (except for a couple missed in September) and tests of the emergency lights have been done monthly. We recommended that the acting manager makes sure all staff are involved in a fire drill at least yearly. The manager told us that a thorough health and safety audit is carried out by an external organisation. Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 26 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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 4 26 X 27 3 28 2 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X 3 3 X Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA19 Regulation 12(1) Requirement If the assessment of a person’s needs indicates that charts, for example food and fluid intake or bowel movement charts, are needed, these must be completed fully so that a picture of any further needs can be seen, and the person’s health is maintained. This was a requirement following the previous inspection and was not fully met. 2 YA33 18(1)(a) There should be enough staff on duty so that people’s needs are met including doing the activities they want to do. This was a requirement following the previous inspection and was not fully met. 30/11/08 Timescale for action 30/10/08 Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 28 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 YA42 Good Practice Recommendations All staff should be involved in a fire drill at least once a year, so that they all know what to do if a fire breaks out. Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Country Bungalow DS0000071794.V371636.R01.S.doc Version 5.2 Page 30 - 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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