Care Home: Ellsworth House

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What the care home does well Survey comments were received from people at the home, staff and health and social care professionals. Additional comments from the people at the home included ` It is a busy and noisy house and I like to do thinks on my own,` `I like going to the local pub` and ` I am very happy here and I have told my family I want to stay here.` An advocate said that the person they support has good use of the community and is well supported by the staff. Since the person`s accommodation at the home, this person has become calmer and more settled. Members of staff through surveys said that empowering, choice and meaningful occupation and activities is what the service does well. Comments were also made about people given every opportunity to express concerns and opinions. Health and social care professionals` comments indicate that people are given choices and have opportunities to experience varied activities. Other comments included `They have a fresh approach to supporting people that have learning disabilities.` What has improved since the last inspection? This is the first key inspection for this home. What the care home could do better: There are five requirements and two recommendations arising from this inspection. Requirements are based on reviewing information provided during admission and improving care planning systems, the environment and policies and procedures. Support action plans must describe how the identified needs are to be met and must incorporate the likes and preferred routine of the person. This person centred approach will ensure people have consistent and individualised care where they can have a say about the way their care is to be delivered. For people that challenge the service, support plans must define the warning signs, triggers and actions that staff must take to diffuse or divert behavioursEllsworth HouseDS0000072639.V374833.R01.S.doc Version 5.2 exhibited. The person will then benefit from a consistent approach from the staff. The Service User Guide must be updated to include the rules and expectations of the home. This will ensure that people have full information about the home before making decisions about moving there. The Safeguarding Adults procedure must be updated to follow `No Secrets` guidelines. This will ensure that people at the home are safeguarded from abuse. The manager must provide an action plan on the way the environment will be adapted to ensure the annex is fit for the person currently living there. The two recommendations relate to complaints and staffing to ensure that people at the home are reassured that they can express concerns and their needs will be met. The manager should ensure that people at the home know what a complaint is and the actions that will be taken to resolve their concerns. A review of the staffing level in particular at night should be undertaken to ensure that the needs of the people are met. Key inspection report CARE HOME ADULTS 18-65 Ellsworth House Fosseway Midsomer Norton Bath & N E Somerset BA3 4AU Lead Inspector Sandra Jones Unannounced Inspection 3 & 4th March 2009 10:00 rd Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ellsworth House Address Fosseway Midsomer Norton Bath & N E Somerset BA3 4AU 01761 404550 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.concensusupport.com Consensus Support Services Ltd To be appointed Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Ellsworth House DS0000072639.V374833.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 only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 7. Date of last inspection Brief Description of the Service: Ellsworth House blends well with its local environment, it is close to local shops and on bus routes. The property has a main house for six people and a selfcontained annex for one person. In the main house the accommodation is arranged over three floors, with communal space on the ground floor and bedrooms on all floors. On the ground floor there is a lounge, quite area and dining room for the people accommodated in the main house and bedrooms are all single, lockable and en-suite. There is a self-contained flat on the third floor that has a kitchen and sitting room, the annex offers single accommodation for one person and contains one en-suite bedroom, with a lounge and kitchen. The aim of the home is to provide holistic care and support to eight adults with learning disabilities who also exhibit behaviours that challenge the service. The range of fees charged at the home range from £1,937.00 - £5,000.00 per week. Ellsworth House DS0000072639.V374833.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 two star. This means the people who use this service experience good quality outcomes. This key inspection was conducted unannounced over two days in March 2009 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from individuals and staff. Prior to the visit some time was spent examining documentation accumulated since the home was opened and this information was used to plan the inspection visit. This included the Annual Quality Assurance Assessment (AQAA) and notifications from the home. ‘Have your say’ surveys were used to seek feedback about the service from people living at the home, staff and health and social care professionals that visit the home. ‘Your say’ advocacy was used to support people to complete the surveys and five were received at CQC from five people at the home. The use of advocates is seen as good practice because the home ensures that people can express their opinions freely. Five members of staff and five health and social care staff completed and returned the survey to the Commission. There were five people living at Ellsworth and these individuals were case tracked. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The homes policies and procedures were also used to confirm the findings. Face to face discussion occurred with the manager, one person and members of staff. Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There are five requirements and two recommendations arising from this inspection. Requirements are based on reviewing information provided during admission and improving care planning systems, the environment and policies and procedures. Support action plans must describe how the identified needs are to be met and must incorporate the likes and preferred routine of the person. This person centred approach will ensure people have consistent and individualised care where they can have a say about the way their care is to be delivered. For people that challenge the service, support plans must define the warning signs, triggers and actions that staff must take to diffuse or divert behaviours Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 7 exhibited. The person will then benefit from a consistent approach from the staff. The Service User Guide must be updated to include the rules and expectations of the home. This will ensure that people have full information about the home before making decisions about moving there. The Safeguarding Adults procedure must be updated to follow ‘No Secrets’ guidelines. This will ensure that people at the home are safeguarded from abuse. The manager must provide an action plan on the way the environment will be adapted to ensure the annex is fit for the person currently living there. The two recommendations relate to complaints and staffing to ensure that people at the home are reassured that they can express concerns and their needs will be met. The manager should ensure that people at the home know what a complaint is and the actions that will be taken to resolve their concerns. A review of the staffing level in particular at night should be undertaken to ensure that the needs of the people are met. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Ellsworth House DS0000072639.V374833.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 Ellsworth House DS0000072639.V374833.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (1) & (2) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information available about the home and the admission process ensure that accommodation is only offered to people whose needs can be met. EVIDENCE: The manager told us that the Statement of Purpose is currently in draft because there will be an increase in the registration numbers and change of manager. It clear from the documentation that the organisational aim is assist individuals where possible to develop their independence and enhance their daily living skills. The Statement of Purpose viewed confirmed the comments made by the manager regarding the admission process. Referrals are generally from the commissioning team who will provide an assessment of need. This assessment will be used to determine that the home can meet the individual’s Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 10 needs. Once it has been established that the person is compatible, introductory visits will take place and trial periods offered to ensure the staff have the skills to meet the needs identified. The case file of the most recent person to move into the home was examined to assess the admission process followed at the home. It contains the social workers needs assessments and in-house initial assessment conducted by the manager. The manager explained that the standard assessment of need checklist currently used is to be reviewed to provide a more in-depth checklist. One individual at the home agreed to give feedback on the admission process. It was stated that the introductory visits took place and information about the home was provided. This ensures that people have full information to make decisions about moving to the home. The four people responding through the survey about the admission process said they were asked if they wanted to move into the home. Two people said that they received enough information about the home before moving in and two said they did not. Their comments included ‘ Looked at the home in the internet’ and ‘came to tea before moving in.’ Ellsworth House DS0000072639.V374833.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (6), (7) & (9) People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. For people to benefit from individualised and consistent care, support plans must be more person centred and risk assessments must ensure that people are not prevented from taking risk in a safe way. EVIDENCE: The manager explained the care planning process followed at the home. We were told that the person, with the staff draws their pen portrait and life history, which forms part of their support plan. The assessment package will be developed from initial assessments conducted by the home and social workers assessments. Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 12 Support plans viewed during the inspection are not fully person centred and the intention is to develop them. The manager explained that Bath and North East Somerset council (BANES) have specified the format to be used by the people that are funded by them. However, support plans are not detailed and are open to interpretation by the staff. Action plans must describe how the needs are to be met and include the individual’s likes, dislikes and preferred routines. The home currently meets the needs of people that challenge the service this includes inappropriate, violent and aggressive behaviours. The manager told us that diversion and distraction, with early understanding of triggers is the approach used at the home. Additionally, the organisation commits to increasing staff insight into behaviours that challenge which includes the needs of people with autism and asperger’s. Members of staff must attend PRT training during induction to provide them with the skills and techniques needed to manage potentially aggressive and violent behaviours. We were told that behaviours that challenge are seen as a means of communication and the aim is to understand the behaviours to reduce the aggressions and violence exhibited by the person. Support plans for people that challenge must include warning signs, triggers and actions to be taken by the staff to diffuse and divert behaviours. We were told that there are no restrictions regarding Deprivation of Liberty, although assistive technology is used to minimise the risks of someone leaving the property without support from staff. The Mental Capacity Act (MCA) has impact on one person in particular Deprivation of Liberty and the manager is aware that the person will need support from an IMCA to make ‘best interest’. The manager said that two people have good verbal skills; another is going to college to increase communication skills, the fourth uses Makaton and the fifth person uses gestures. For the person that uses gestures to communicate, there is a detailed plan informing the staff about the meaning of the gestures used. While it acknowledged that assessment packages contain pictures, support plan must be in a format that can be followed by the person for whom it’s intended. Risk assessments are in place for activities that may involve an element of risk and must show that people are enabled to take risk safely and not prevented from taking risks. There is a handover file where staff write daily reports about the activities undertaken, their observation the person and outcome of visits. One individual at the home was consulted about the care planning process. We were told care reviews are convened and are based on the support needed from the staff. This person confirmed that they are able to make decisions and Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 13 said that there are occasions when they become angry. This person said that these times are usually because of others living at the home and the staff will speak to the person concerned. To diffuse the situation, staff with then ask the individuals involved to ‘chill’ out in their rooms. Feedback through surveys was sought from the staff about care planning. The five staff that responded said that they receive up to date information about the needs of the people they support. Additional comments were made by two staff, which included ‘ keyworkers compile care plans and all service users have full assessments.’ Ellsworth House DS0000072639.V374833.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): This is what people staying in this care home experience: (12), (13), (15), (16) & (17) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home maintain appropriate and fulfilling lifestyles in and out the home. For people to make informed decisions about moving into the home, the Statement of Purpose must explain the expectation with household chores and the rules of the home. Support plans that include the individuals personal development will ensure that they address their aspirations for occupation and education. EVIDENCE: The manager told us that at the point of admission people are asked about their aspirations with education and occupation. Referrals are made to Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 15 Connections day support, operated by Bath and North East Somerset Council (BANES) so that their wishes and needs can be matched to assist the person in achieving their goal. People at the home currently attend colleges; day care centres and are in voluntary and paid employment. There is an expectation that people undertake independent living skills on the days that they are home and are not participating in any structured activities. On the other days people undertake 1:1 activities with their keyworker or community based group activities. People at the home have access to a home’s vehicle, which is used to take people to their day care placements, community activities and places of interest. In terms of people becoming part of the community, the manager said that local shops, pubs and amenities such as local swimming pool are used to ensure people are recognised within the community. The arrangements for visiting are included within the Statement of Purpose and we were told that four people have regular contact with family and friends. There is an expectation that people participate in household chores. However, these expectations along with the rules that exist for smoking are not detailed in the Statement of Purpose or Service User Guide. The Statement of Purpose must be updated to include the expectations regarding participation in household chores and rules to ensure they are able to make decisions about moving into the home. Assessment packages include the individuals daily living skills needs and their ability to undertake the task and community activity involvement. Support plans that include the action plan to meet the identified need must be developed and monitored to ensure the actions from the staff meet the identified need. Feedback from the manager was sought about the way people are respected as individuals at the home. The manager said that a community type spirit exists, where people make daily decisions about the task to be undertaken. All rooms are single and lockable and staffing levels allow for 1:1, with sufficient areas for people to have private space. Two health care professional responding through surveys about the lifestyles of people at the home said the service respect individuals privacy and dignity and one said it was usual. It was also stated through the survey that the home supports individuals to live the life they choose. One individual at the home was asked to comment on their ability to maintain appropriate and fulfilling lifestyles in and outside the home. This individual told us that activities with their keyworker occur, they are part of the local Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 16 community and are in paid employment. This individual confirmed that there is an expectation that household chores are undertaken. Comments from three people through surveys were received about the activities available at the home. One person said that they always make decisions about what to do each day and two said that they sometimes made these decisions. Three people said that they could do what the want during the day. Comments from these individuals included ‘ I attend activities during the week and go to my parents at weekends’ and ‘I enjoy the activities I do especially football, I enjoy weekends as I go home to my family.’ There is a standard five week rolling menu in place which shows that people at the home are served with is continental style breakfast, with a light lunch and cooked meal for tea. However, a record of food served is not currently kept. A record of choices and alternatives not included within the menu should be maintained to demonstrate that people can choose their preferred meals. From the observations of provisions held that include fresh, frozen and tinned foods; the people at the home have a varied and healthy diet. Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (18), (19) & (20) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate personal and health care support is provided. Medication systems are safe. EVIDENCE: The person’s ability to meet their health and personal care needs is described in their assessment package People at the home are registered with a GP and with the exception of one that the GP visits, people visit their GP with staff support. Where a GP’s visit has taken place, a separate record is maintained about the outcome of the visit. The manager told us that referrals were made through Bath and North East Somerset Council (BANES) for Health Action plans to be completed for the people at the home. Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 18 Documentation in place shows that through the Community Learning Disability Team (CLDT) people have access to psychiatrists; community nurses and care managers’. It was also stated that the organisation employs behaviour and autism specialists that advise care homes on best practice. Three people are supported by their family on regular routine dental checks and two people have no input from NHS facilities. Care notes explain how people with complex needs show that they are in pain. Comments from health and social care professionals were sought through surveys about the standards of care at the home. Social workers and Learning Disabilities team said that the home seeks advice and acts upon it to manager and improve the individual’s health care needs. Two professional said that the staff meets the individual’s health care needs. Four people have regular prescribed medication, which is administered by the staff through a monitored dosage system. Records of medication are signed by the staff following administration and the use codes to record the reasons for not administering the medications. A record of medications not required at the home is maintained and the pharmacist’s signature evidences receipt of the medication for disposal. Individual medication profiles that list the prescribed medication, its purpose and side effects are not currently in place. Individual profiles must be developed to provide staff that administer medication with information about medications they administer. One person at the home told us that visits to the GP are arranged when necessary, the staff administer medication and no assistance is needed with personal care. Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (22) & (23) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home know who to approach with complaints and feel safe at the home. For people to be empowered to express their views, the complaints procedure must be available to them. Safeguarding Adults procedures must show the organisations commitment to protecting people from abuse, procedures must therefore follow ‘no Secrets’ guidance. EVIDENCE: The Complaints procedure is included in the Statement of Purpose and Service User Guide. There is a symbolised format that includes pictures and words. However, the procedure is not on display in the home and people are not provided with copies of the procedure. The manager must ensure that people know that there are steps that can be taken to resolve their concerns and complaints. Neighbours made three complaints and these were resolved satisfactorily. Safeguarding and WhistleBlowing procedures show an organisational commitment towards protecting people from abuse. The organisations Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 20 procedures do not currently follow good practice as it instructs staff to gather statements, which contradicts Local Authority’s ‘No Secrets’ procedures. While the WhistleBlowing procedures reassure staff that they will be protected from reprisals, the principle purpose of the procedure is not included. The Whistleblowing procedure must inform staff that its their duty to report poor practice and staff may be subject to disciplinary procedures for not reporting poor practice that they have witnessed. Five staff responding through surveys said that they know what to do if a person, their relative or advocate has concerns about the home. A person at the home was asked about making complaints and Safeguarding Adults. This person told us that they would approach the manager with complaints and felt safe at the home. Three people responded through surveys about the way their concerns are resolved. Individuals said that they know who to speak with, if they are not happy. Their comments included ‘ I would speak to the staff, tell my mum and dad,’ ‘ I would tell the manager’ and ‘ speak to one of the staff or whoever is on duty.’ Regarding making complaints two people said they did not know what was a complaint. The manager must ensure that people are helped to understand what a complaint is and who to approach with concerns and complaints. Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (24), (26)& (28) People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is well maintained and is suitable for the people living in the main house. The annex currently restricts the preferred activities of the person living there. EVIDENCE: Ellsworth House blends well with its local environment, it is close to shops and on bus routes. The property has a main house for six people and a selfcontained annex for one person. The accommodation in the main house is arranged over three floors, on the ground floor there is a lounge, quite area and dining room for the people accommodated in the main house. Bedrooms are single and on all floors, there is a self-contained flat on the third floor that Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 22 has a kitchen, sitting room and en-suite bedroom. The annex offers single accommodation for one person and contains one en-suite bedroom, with a lounge and kitchen. Communal space comprises of a quiet area and leads into the lounge that has a television and sufficient space for people to sit in a group or for private use. Bedrooms are en-suite and lockable by a door entry system and staff can assist people to use the system which respects their rights. As well as meeting NMS, double beds, plasma televisions, CD & DVD with private phone lines are provided as standard. Communal space is on the ground floor and bedrooms on all levels, there is also self-contained flat on the third floor. Arrangements are in place to ensure staff safety in self-contained annexe. Additional safety measures need to be put in place to make sure service user access to the kitchen is not unduly restricted. The detail of this is not discussed in this report to protect confidentiality. However the issue was addressed in detail with staff during the inspection. As good practice assistive technology is used in the annex to ensure rights are respected and to maintain levels of independence with personal care. At night sensors are used to alert the night staff that they are needed. However, the waking staff are stationed in the main house and must go outside to enter the annexe. We had some concerns about this and have asked the manager to provide an action plan showing us how care can be provided safely at night and how staff can address people’s preferred activities in safety (as above). The three people responding through surveys said that they home were sometimes fresh and clean. Additional comments made include ‘ Sometimes it stinks and ‘ we take turns to help clean.’ Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (34), (35) & (36) People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment process must be robust to ensure that the staff employed are suitable to work with vulnerable adults. Staffing levels must be reviewed to ensure people are well supported at night. Members of staff’s performance is monitored and training ensures they are able to meet the individuals needs. EVIDENCE: Fourteen support workers are employed at the home, with two senior support workers, a deputy and manager maintaining a management presence at the home. The manager is supernumerary and we were told that rotas are needs led which means that the staff are rostered to meet the needs of the people at the home. For this reasons there are three staff are rostered throughout the day. Rotas are arranged so that there are enough staff to meet individual Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 24 needs and staff are identified to work with individual people where necessary. However, the deployment of staff at night is unclear in terms of the responsibilities to the people in the main house by waking staff. The manager must devise a staffing risk assessment to ensure that people at the home have sufficient staff at night when assistance is needed in the annexe. Staff at the home have combined roles of cooking, caring and cleaning. Support staff undertake sleeping-in and the regional manager provides on-call service. Comments were made from staff through surveys about the staffing levels available to meet the individual needs. Four staff said that usually there are enough staff to meet the needs of the people at the home and one member of staff said that this was always so. The manager explained the recruitment process followed at the home. We were told that vacant posts are advertised and candidates are short listed for interviews on their application form. The manager and deputy will then interview applicants and subject to satisfactory Criminal Records Bureau (CRB) and references the successful candidate is appointed. The personnel files of seven staff employed were checked to confirm the recruitment process followed. Completed application forms that request employment history; the names of two referees one of which must be the last employer, with disclosures of criminal history are in place. Cleared CRB checks were found in place and for some staff there were two written references. The manager explained that before the manager’s appointment, recruitment was conducted at the organisation’s office and this is where the references are currently kept. It was noted that where an organisational reference request form is used, the referee is not asked to validate the reference. The manager must ensure that all staff have two written references and references are authenticated to support a robust recruitment process. Comments from the five staff that responded through surveys indicate that Criminal Records Bureau (CRB) and references were sought before starting work. The manager said that the organisation has a training matrix and staff must attend Food Hygiene, Safeguarding Adults, and First Aid with specific courses on medication, Infection Control and Mental Health care needs. Courses provided by the Community Learning Disabilities Team (CLDT) include diabetes and epilepsy. Staff newly employed must complete a three-week induction that leads into the Learning Disability Qualification (LDQ) for support staff. Staff must complete PRT training and update their knowledge 6 monthly to ensure they Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 25 use correct techniques to manage situations where people exhibit aggressive and violent behaviours. Comments from five staff were received through surveys about induction and training. Four staff said that the induction covered everything they needed to know to do the job and one person said it mostly covered what they needed to know. One member of staff said ‘ Thee is a three week induction programme at the start, specific ongoing training that leads into vocational qualification’ and ‘I am currently undertaking the induction and the knowledge has been very helpful with experienced trainers.’ The five staff also indicated that training is ongoing. Individual supervision is provided by the line manager and occurs 6-8 weekly. The minutes of the last meeting were viewed and discussions were based on people at the home, performance and personal development, with action plans for implementation. The person at the home giving feedback about the staff told us that the staff know how to meet their specific needs and they are ‘ok’. Surveys were also used to seek feedback from people at the home about the staff’s attitude. The three people that responded said that the staff sometimes treat them well and they sometimes listen and act on what they say. Comments made by these individuals include ‘ The staff always hep me and are cheerful, they talk about what is happening each day.’ Three surveys were received from health care professionals and two surveys say that staff have the skills to meet the individuals needs while the other said it was usual. Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (37), (39) & (42) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals benefit from a well managed home which is subject to ongoing monitoring. EVIDENCE: The manager was consulted about the leadership style used to ensure standards of care are maintained at the home. The manager told us that a Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 27 ‘hands on’ style is used and, this approach allows for the monitoring of tasks, observation and interaction between staff and people at the home. Developing staff through training and induction also ensures standards of care are maintained. Regarding the quality of care, the manager told us that it is achieved through such systems as individual supervision, appraisals and audits from senior manager. The external manager visits monthly to conduct an intensive audit of the home. During the visit, all areas of the home are reviewed including records and from the visit an action plan is developed. Surveys sought feedback from staff about the supervision and handovers. The five staff that responded said that the manager meets with staff to give support and discuss how they are working. One member of staff said that the manager is approachable and easy to talk to but other senior staff are not as positive as the manager. Regarding passing information between shifts about the people at the home three staff said this always occurred, one said it was usual and another said it was sometimes. Their comments included ‘ There is not always time for staff to pass information or discuss information’ and another said ‘there is a communication book and handovers with handover sheets.’ Each person has a safe in their bedroom for the safekeeping of their cash and valuables. This provides the person with opportunities to develop budgeting skills with keys to the safe and records of cash held kept in the office. This is seen as good practice as it enables the person to be independent with budgeting as well as respecting the person as an individual. Fire risk assessments are the means used to identify the potential of an outbreak of fire, the source of ignition and the steps to be taken to reduce the level of risk. Fire risk assessments in place identify the risk of fire at the home, the preventative measures that are reviewed. While the systems in place for the detection of fire, the means of evacuation and training, the frequency of checks and practices are not included. Fire risk assessments must include the frequency that practices and checks will be conducted. The manager ensures compliance with other legislation to ensure that people live and work in a safe environment. Contractors check the gas boiler system and portable electrical equipment to ensure they operate safely. Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 2 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Version 5.2 Page 29 Ellsworth House DS0000072639.V374833.R01.S.doc N/A 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 YA6 Regulation 12 Requirement Support action plans must describe how the identified needs are to be met and must incorporate the likes and preferred routine of the person. This person centred approach will ensure people have consistent and individualised care where they can have a say about the way their care is to be delivered. Support plans for people that challenge the service must define the warning signs, triggers and actions that staff must take to diffuse or divert behaviours exhibited. The person will then benefit from a consistent approach from the staff. The Service User Guide must be updated to include the rules and expectations of the home. This will ensure that people have full information about the home before making decisions about moving there. The Safeguarding Adults procedure must be updated to follow No Secrets guidelines. DS0000072639.V374833.R01.S.doc Timescale for action 30/08/09 2. YA6 13 30/08/09 3. YA1 6 30/05/09 4. YA23 13 30/05/09 Ellsworth House Version 5.2 Page 30 5. YA24 23 This will ensure that people at the home are safeguarded from abuse. The manager must provide an action plan on the way the environment will be adapted to ensure the annex is fit for the person currently living there. Do you think this should say whats in the text? ie The manager must provide an action plan showing us how care can be provided safely at night and how staff can address people’s preferred activities in safety 30/04/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA22 YA33 Good Practice Recommendations The manager should ensure that people at the home know what a complaint is and the actions that will be taken to resolve their concerns. A review of the staffing levels in particular at night should be undertaken to ensure that the needs of the people are met. Ellsworth House DS0000072639.V374833.R01.S.doc Version 5.2 Page 31 Care Quality Commission South West Region PO Box 1251 Newcastle upon Tyne NE99 5AN National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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