Care Home: Flat D 12 Hyde Close

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What the care home does well There is good information about the service in easy to understand language and peoples` needs are continually assessed to make sure that their needs are still being met. Although the majority of the residents are non-verbal, the staff have a good understanding of their needs and communicate well with them. Care plans are written in a way that involves the resident and they have a special carer, called a key worker, who takes particular responsibility for their care and support. The home provides good opportunities for people who live in the home to enjoy a stimulating and fulfilling lifestyle by making use of everyday opportunities in the home and the community. Each person living in the home has an individual care plan and appropriate risk assessments are carried out to ensure that a full range of activities in the home and the community can safely take place. There are good systems in place to ensure that the people who live in the home have access to professional healthcare, and medication is safely administered.The staff show a good knowledge and awareness about how to protect the residents from being abused. The staff team has been together for a long time, which enables them to have an in-depth knowledge and understanding of the residents and how to support them in their preferred manner. Staff recruitment procedures are thorough so that residents` best interests are safeguarded and staff are well trained. The manager provides clear leadership to the staff and provides a good model for best practice. Senior managers from Sense regularly monitor the service to ensure good practice and to protect the health and safety of the residents and the staff. Sense carries out an audit each year of the people who use their services to find out their views. Based on the outcome, targets and timescales are set to meet objectives to improve the service. What has improved since the last inspection? The wardrobe door in a resident`s room has been repaired to ensure their safety. The lounge carpet has been replaced, and the lounge/dining area has been redecorated. New lounge furniture has also been provided. The communal garden has been significantly improved to provide a valuable sensory area for the people who live in the home. CARE HOME ADULTS 18-65 Hyde Close 12D High Barnet Hertfordshire EN5 5TJ Lead Inspector Tom McKervey Key Unannounced Inspection 31st July 2008 10:00 Hyde Close 12D DS0000069374.V364601.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 Hyde Close 12D DS0000069374.V364601.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. Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hyde Close 12D Address High Barnet Hertfordshire EN5 5TJ 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) 020 8364 8083 www.sense.org.uk Sense, The National Deafblind and Rubella Association Anne Dennison Care Home 5 Category(ies) of Learning disability (5), Physical disability (5) registration, with number of places Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD 2. Physical disability - Code PD The maximum number of service users who can be accommodated is: 5 Date of last inspection 17th July 2007 Brief Description of the Service: 12 Hyde Close D is managed by an organisation called Sense. It is a service for five adults, male and female who have sensory impairments, mobility problems and severe or complex learning disabilities. The home was purpose built and is shared by four independent flats with five residents in each flat. In March 2007, each flat and manager were independently registered by the Commission for Social Care Inspection, and Flat D was registered as a new service. Each flat has its own kitchen and lounge area, two bathrooms and a toilet. All the residents have a single bedroom with a wash-hand basin. There is large communal sensory garden to which the residents from all the flats have access. There is a shared laundry room, where each flat has its own equipment. Flat D has its own team of staff, led by a manager. At night, there is a waking member of staff. There are sleeping staff on duty who cover all four flats. Opposite the home, there is a specialised day service, which is separately managed. The residents have access to these facilities as well as other local community resources. The home has its own minibus, which accommodates wheelchairs. The home is situated in High Barnet in a pleasant residential area, and is a short walk away from shops, restaurants, pubs, and other local amenities. The Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 5 area is well serviced by public transport. The stated aims of the service are to provide support in which the residents are supported to achieve their optimum potential in areas of social, emotional, developmental and educational activities, and in this way, enjoy a good quality of life. Following Inspecting for Better Lives, the provider must make information about the service, including inspection reports, available to service users and other stakeholders. The fees for the service are £1736 per week, which are paid by various local authorities. Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Stars. This means the people who use this service experience good quality outcomes. This inspection was unannounced and was completed in a period of four hours. All the residents were in the home during the inspection, apart from periods when some people went out on various activities. The inspection included visiting all areas of the home, meeting and observing the residents and the staff. Residents’ and staffs’ records and other documents relating to the running of the service were examined. We sent surveys out to the staff before the inspection, seven of which were returned with comments. These comments are referred to in this report. Most of the people who live here are not able to converse but they can make their needs known in other ways for example by singing and gestures. Prior to the inspection, the manager sent valuable information to the Commission in a document called an Annual Quality Assurance Audit, (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. This information was discussed with the manager for clarification and where the information could be improved, this was pointed out. There are references to the AQAA in appropriate sections of this report. What the service does well: There is good information about the service in easy to understand language and peoples’ needs are continually assessed to make sure that their needs are still being met. Although the majority of the residents are non-verbal, the staff have a good understanding of their needs and communicate well with them. Care plans are written in a way that involves the resident and they have a special carer, called a key worker, who takes particular responsibility for their care and support. The home provides good opportunities for people who live in the home to enjoy a stimulating and fulfilling lifestyle by making use of everyday opportunities in the home and the community. Each person living in the home has an individual care plan and appropriate risk assessments are carried out to ensure that a full range of activities in the home and the community can safely take place. There are good systems in place to ensure that the people who live in the home have access to professional healthcare, and medication is safely administered. Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 7 The staff show a good knowledge and awareness about how to protect the residents from being abused. The staff team has been together for a long time, which enables them to have an in-depth knowledge and understanding of the residents and how to support them in their preferred manner. Staff recruitment procedures are thorough so that residents’ best interests are safeguarded and staff are well trained. The manager provides clear leadership to the staff and provides a good model for best practice. Senior managers from Sense regularly monitor the service to ensure good practice and to protect the health and safety of the residents and the staff. Sense carries out an audit each year of the people who use their services to find out their views. Based on the outcome, targets and timescales are set to meet objectives to improve the service. What has improved since the last inspection? What they could do better: Two requirements have been made in this report to improve the service for the residents. More details must be documented in the home’s complaints log and details of complaints investigations should be kept in the relevant person’s file. This will make it easier to audit complaints and show that complaints have been thoroughly investigated. The bathroom floor must be repaired or replaced to protect the health and safety of the people who live in the home. In addition, it is recommended that senior managers from Sense discuss with staff, their concerns as outlined in this report. This includes their expressed wishes to be trained in British Sign Language to improve their communication skills with the residents. All policies and procedures should be reviewed and updated to ensure that they still reflect current guidance and best practice. Please contact the provider for advice of actions taken in response to this Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 8 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. Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3 & 5 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides good information about its service so that people can decide whether it is appropriate to meet their needs. The structure and layout of the building, enable the residents to have easy access to all areas of the home. No-one is admitted to the home until their needs are fully assessed and the residents have a Licence Agreement that sets out in detail what is included in the fee. EVIDENCE: The home has a Statement of Purpose and Service User Guide, which describe what services the home provides. Each resident also has an individual tenancy agreement from the landlord, which is in pictorial format to make it more understandable for them. The home was purpose built and is shared by three other independent flats with five residents in each flat. Each flat has its own kitchen and lounge area, two bathrooms and a toilet. All the residents have a single bedroom with a wash-hand basin. Flat D is on the first floor of the building which can be accessed by a passenger lift. Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 11 Since the last inspection, the large communal garden area has been extensively renovated as a sensory area and is now a very attractive feature. The people who live in the home are able to access all areas of the home. No new people have been admitted in the past few years, but the residents’ case files include needs assessments that were completed prior to admission. Care reviews are being carried out every year by care mangers from the placing authorities to ensure that the home continues to meet the residents’ needs. The residents’ relatives are invited to attend these reviews. Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including looking at residents’ care plans. Each person living in the home has an up to date care plan that supports them to achieve their potential and a better quality of life. This involves managing possible risks and health and safety issues that might otherwise curtail their activities. The staff are skilled at understanding the residents’ wishes and how to support them in the manner of their choosing. EVIDENCE: Three of the residents’ care plans were sampled at random. The staff have implemented plans that are person-centred and are written in the first person. For example; “I am unsteady on my feet. I can walk unaided round my home using a trailing technique. Outside, I like to be guided by linking arms with you, but I often pull back on you, so hold on to me tightly”. Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 13 There are clear guidelines for staff about how best to support people, including how to communicate with residents who are non-verbal. It was evident in the care plans that each resident has a key worker who sits down with them regularly to review their care plan. We observed the staff interacting with the residents. The staff group has been together for a considerable time, which enables them to have a very good relationship with them. The staff were obviously able to understand the residents’ wishes and how to support them in decision-making. Most staff have had training in Makaton, some of which was being used when offering choices to residents. However, in our surveys that we sent to staff, many of them stated that they could provide better communication if they were trained in British Sign Language. The manager said there was a problem about funding this training. A recommendation from the last inspection is restated that Sense considers providing this training. Assessments of potential risks to residents where identified, both in the home and in the community; for example, when bathing or when travelling in the home’s vehicle. Some restrictions are in place in the residents’ interests. For example, in the “Service Guide” in each person’s file, there is a statement; “Your room is locked to keep your belongings safe”. There was ample evidence in the case files of people who live in the home being supported to exercise choice, ranging for example, from preferring to have a bath rather than a shower, to being accompanied to Ikea to choose bedroom furniture and deciding where to go on holiday. Hyde Close 12D DS0000069374.V364601.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): All these standards were assessed. People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including observation and examining residents’ records. People who live in the home are well supported to enjoy a full and stimulating lifestyle. This staff team, which has been together for a long time, enables them to develop good relationships with the residents. This supports them to achieve their goals. The residents can be confident they will be supported to maintain important personal and family relationships, and staff ensure that their meals are nutritious and appropriate for their cultural and dietary needs. EVIDENCE: All the residents were present in the home during this inspection, but at various times they went out, accompanied by staff on various activities. It was evident that the staff rota is adjusted to ensure that staff are available at appropriate times to support residents on their various activities. Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 15 The home has access to the nearby Anne Wall Centre, which is used by many people with learning disabilities in the community. The centre provides swimming, Jacuzzi, a trampoline and there is also a canteen. An activity programme is drawn up for each resident and is included in a “shift planner”. This identifies the staff who are allocated to support each resident’s activity. This is then recorded in their daily log. Staff are encouraged to take a camera to record some activities. We saw many photographs of these in the case files. Residents are also supported in household tasks such as doing their laundry preparing meals, cleaning and shopping for food. One person is supported to recycle materials from the home. This includes going to the Council recycling facility. During the inspection, a resident was observed using a computer that has a software package of symbols to enable someone with learning disabilities to use it. The home also has an electric massage chair, which is very well used by the residents. All the residents spend considerable periods of time in the community. A resident went out horse riding on the day of the inspection and another went out to a café and did some shopping. Other activities include, bowling and going to pubs and the cinema. Each person has a holiday every year, which in some cases, is taken abroad. Residents’ records showed that some people visit their families and spend weekends at home with them. The staff have regular contact by phone with relatives who live some distance from the home. In the AQAA, the manager states that they have introduced drama therapy sessions for some residents and the home is looking at developing more challenging activities to optimise each resident’s quality of life. It was noted during the inspection that there was a very relaxed atmosphere in the home and there was constant communication between staff and residents. The residents were fully engaged and appeared very happy. Staff were observed knocking on residents’ doors before entering and when supporting the residents with personal care. This was done discreetly to protect their privacy and dignity. The manager told me that she has made approaches to the Barnet Advocacy Scheme to provide a service for the residents. This is documented as an objective in Sense’s “Audit action plan” for Flat D. Menus are decided on a day-to-day basis and food shopping is done each day by residents and staff for that days meals. Residents’ files contained details of their individual food preferences. Only one resident can independently choose their meals. Staff use pictures of meals to help the other residents to decide what they want to eat. Once a week, staff and residents choose a “cultural meal”, for example, Indian, Chinese etc. The menu indicated that meals are varied and wholesome. One resident is Jewish, and while their relatives have stated that they are nonobservant, there was evidence that this person is supported to have Kosher meals regularly. This included using recipes provided by the family. Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 16 Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All these standards were assessed. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including checking health records. The residents and their representatives can be confident that the staff ensure they are seen by healthcare professionals if they become unwell and there are good procedures to ensure that they receive their medication as prescribed so that their health is maintained. Relatives can be assured that their wishes in regard to residents’ funeral arrangements will be respected. EVIDENCE: There was a “health action plan” for each person in their case file. This document contained a medical history and any allergies. All visits to the GP and hospital appointments were clearly recorded. Everyone had been assessed by a speech and language therapist with regard to swallowing reflex to assess the risk of choking. Guidelines for staff were in place where individuals were deemed to be at risk. There was evidence that people who live in the home were seen regularly by the consultant psychiatrist, and where appropriate, a psychologist from the Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 18 Community Learning Disability Team was consulted about how to meet the needs of someone with challenging behaviour. A chart is used to monitor this behaviour, which the manager said helps to identify key triggers. It was evident that in one such person’s case, significant improvement had been made in the past year, with few incidents occurring. All the residents were weighed monthly, and any concerns arising were referred to the dietician. At the time of this inspection, all the residents were in good health and they looked well cared for, happy and well dressed. The medication standards and records were checked. The company requires two staff to administer and check the medication. There is a system for monitoring compliance with this. No errors were found in the administration records and the medication was safely stored and accounted for. The relatives of the people who live in the home have informed the staff about their wishes in relation to funeral arrangements in the event of the resident’s death. These are clearly recorded in the case files. Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including looking at complaints records. Residents and their representatives can be confident that concerns are taken seriously and responded to. The staff have an in-depth knowledge of the residents that enables them to understand and support them if they are distressed. The staff understand the procedures for Safeguarding Adults and how to report concerns so that residents’ best interests are safeguarded. EVIDENCE: The home has an appropriate complaints procedure. Each resident has a copy of the procedure in pictorial format in their Service User Guide. One complaint was made in the past year. This was from a relative and was thoroughly investigated and responded to by a senior manager from Sense. A record of the complaint and the response were sent to the Commission. However, there was no copy of this in the resident’s file and there were insufficient details in the home’s complaints log; for example, the outcome, and whether the complaint was substantiated. A requirement is made about this matter. There is a copy of Barnet local authority’s Protection of Vulnerable Adults procedure in the home. The staff have attended training in the subject of protecting service users from abuse. It was evident in discussion with the staff that they were fully aware of their responsibilities in this regard and knew how to report any concerns. Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 20 It was also evident from observation, that the staff had a good relationship with the residents and were able to understand their state of well being. They described to the inspector how residents communicate if they are feeling anxious or happy. Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All these standards were assessed. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including visiting all areas of the home. Residents can be confident that they live in a home that is clean, safe and comfortable so that their specific needs are met. They are also supported to personalise their rooms. Toilets and bathrooms for the use of people using the service are appropriately located within the home and are easily accessible. EVIDENCE: We undertook a tour of the premises, including communal areas and residents’ bedrooms. The building is owned and maintained by Stonham Housing Association, which is responsible for major repairs and maintenance. Flat D is located on the first floor. There is a lift to the flat from the ground floor, which accommodates wheelchairs. All areas of the flat are easily accessible to all the people who live in the home. Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 22 The kitchen, lounge and dining areas are open-plan, and there is an adjoining large room that is called the “resources room”. This contains some furniture and a computer and electric massage chair, both of which are for residents’ use. Bedrooms and bathrooms are located along a wide corridor. The manager’s office is outside the main area of the home in another corridor. There is a small balcony outside the resources room, with a spiral staircase leading to the ground. Access to the stairs is protected by a safety gate. The lounge/dining area has been improved by recent redecoration and the provision of new carpets and curtains. These improvements have contributed to a homely feeling. The bedrooms were individually decorated with furniture that was appropriate to peoples’ needs. They were personalised with residents’ photographs and other possessions. We were informed that the bedrooms are scheduled for redecoration this year and residents will be asked to choose their preferred colour schemes. The bathrooms and toilets had doors that could be locked to protect residents’ dignity. However, the floor covering in one bathroom was torn and a requirement is made to replace this. There were appropriate aids and adaptations in the toilets and bathrooms for people with mobility problems. The manager stated in the AQAA, that she intends to make the bathrooms more specialist and person-centred by having scented candles etc to enhance the residents’ bath time experience. Since the last inspection, the communal garden has been refurbished and is now a very attractive feature. Great effort has been made to make the garden a sensory experience and we were informed that many residents had been involved in the improvement works. There is a policy in place regarding control of infection and the home was clean and tidy and smelled fresh at the time of the inspection. Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All these standards were assessed. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including speaking to staff and examining their records. Residents can be confident that staff rotas are arranged to ensure that they are available to support them in their planned activities. The staff are well trained, supervised, and properly recruited so that residents’ best interests are protected and they receive appropriate care. EVIDENCE: Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 24 The staff rotas correctly identified the staff who were on duty during the inspection. It was explained that the rota is designed so that staff are available at the busiest times of the day when the residents need most support. This includes supporting the residents on their planned activities outside the home. Generally, there are four staff in the morning and three in the afternoon/evening. There is one member of staff awake at night on Flat D and two other staff provide support for all of the flats on a sleep-in basis. Staff records contained job descriptions and contracts of terms and conditions. In discussion with them, the staff demonstrated an in-depth knowledge of the residents and their responsibilities in supporting them. Through observation, it was evident that they were very competent and caring. The AQAA states that six staff had attained National Vocational Qualifications, some at level 2, and some at Level 3. and three staff were currently working towards NVQs. The AQAA also provides information about other training courses, for example; epilepsy, sexuality and relationships, crisis intervention and care planning, challenging behaviour and protection of vulnerable adults. Staff have to complete a training workbook during their first twelve weeks. This is then signed off by a senior manager to confirm they are safe practitioners. Staff were very positive about the training and supervision they received. This is an example of the written comments they sent us; “I am helped to understand and meet individual resident’s needs through team briefing, conferences and regular support and supervision with my line manager”. As stated elsewhere in this report, several staff commented that they needed training in BSL to help them to communicate with residents better. There was one new member of staff since the last inspection. This person’s records showed that they had undergone a written induction, which included training in mandatory health and safety subjects. Appropriate checks had been carried out, including a Criminal Records Bureau screening and references. There were records to show that all staff receive regular, formal supervision and have an annual performance appraisal. The staff who were spoken to, said that supervision was helpful in providing an opportunity to discuss their work with their line manager and identify their specific training needs. Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 & 42 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including discussion with the manager and examining various records. People who live in the home can be confident that the manager is competent to run the home well and that staff take good care of their personal finances. The service is committed to enable people to develop their skills to achieve their potential. The residents’ health and safety is protected by regular checks in the home and by frequent monitoring by senior management. EVIDENCE: The manager is registered with the Commission for Social Care Inspection. She has attained the Registered Manager Award and is a NVQ assessor. She has Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 26 managed the home for four years and has long experience of working with people with physical and learning disabilities. There was a homely and relaxed atmosphere in the home during the inspection. Residents and staff were fully occupied with household tasks and external activities. The staff appeared to have a warm relationship with the residents and with each other. Seven staff returned written comments to us in the surveys we sent prior to the inspection. The staff said that there was a good team spirit and that the manager set high standards for the care of the residents. One person stated; “I find my manager very supportive and inspirational, easy to approach and she encourages me to realise my potential”. As a result of Sense’s quality assurance audit, an “Audit action plan” was developed for the home. A copy of this document was seen at the inspection. The plan outlines areas for development; for example, person-centred planning, diversity and culture and improving communication. Timescales were set for achieving these objectives. Senior managers carry out unannounced monitoring visits and complete a report on their findings and any actions required to address shortfalls, for example, health and safety issues. However, in our surveys, some staff were critical of “senior management”; for example, “They should learn more about the service users before giving instructions on how to support them. They get it wrong most of the time”. “Senior management often don’t listen to staff regarding service users. We know them better as we work day-to day with them. Some objectives are sometimes not appropriate to service users’ understanding and behaviour”. Staff meetings are held each month and a record is kept of the content of the meetings. It is recommended that senior managers from Sense attend staff meetings to discuss these concerns with them. None of the residents are able to manage their finances. A senior manager from Sense acts as their appointee. The residents’ case files contained information about their personal finances, including their entitlement to benefits. We examined a resident’s cash box at random and found that the records were reconciled with the amount of money in the box. The manger stated in the AQAA that the gas, electric, water and fire systems had been serviced in the past year. The hoists, lift and electric portable appliances were also serviced. There are records of monthly health and safety audits of all areas of the home. Accidents and incidents were recorded and appropriate actions were taken to minimise these. The fire alarms were tested weekly and drills were regularly carried out. The employers liability insurance is up to date. The AQAA showed that the home has all the policies and procedures required by the National Minimum Standards, however, some of these had not been reviewed for some time. It is recommended that these are reviewed and, if necessary updated to ensure that they still reflect current guidance and best practice. Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 27 Hyde Close 12D DS0000069374.V364601.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 3 2 3 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 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 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 X 3 3 X Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 29 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA22 Regulation 17(2) Sch 4.11 Requirement Timescale for action 31/08/08 2. YA27 23(2) All complaints must be fully recorded in the complaints book giving the response to the complaint and the outcome. A copy of the investigation must be kept in the relevant resident’s file. The flooring in the bathroom 30/09/08 must be replaced for the safety and comfort of the residents. 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 YA8 Good Practice Recommendations Sense should consider training for staff in British Sign Language to enhance their communication skills with the people who live in the home. Senior managers from Sense should attend staff meetings to discuss the concerns raised in staff surveys. All policies and procedures should be reviewed and, if DS0000069374.V364601.R01.S.doc Version 5.2 Page 30 2. 3. YA38 YA40 Hyde Close 12D necessary updated to ensure that they still reflect current guidance and best practice. Hyde Close 12D DS0000069374.V364601.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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