Care Home: Forest Grange

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What the care home does well Information is available about what the service provides, so that people can decide if it is right for them. People have written agreements, so that everyone is clear about what the service should provide. Residents` needs are properly assessed and their care plans are very detailed. This means that staff are clear about how people like to be supported, and how to keep them safe. There are enough staff working at the home to make sure that people can get the support they need to do the things they want and go to places they like. People are well looked after, so that they get the support they need to stay well, safe and healthy. They can be confident that their concerns are listened to and taken seriously. The house is well maintained so that residents can feel safe and comfortable in their home. The staff team is well trained and qualified, so that people working in the home have the knowledge and skills they need to meet residents` care needs properly. The home is well run for the benefit of the people who use the service. What has improved since the last inspection? The Manager and staff team have carried on working hard to make sure that residents continue to be well cared for. There are no outstanding requirements from the last inspection. The home has achieved the "Investors in People" award, showing that the service provided is of a very high standard. New furniture has been bought and new flooring put down in the communal areas. Work continues to refurbish and redecorate the house, so that the residents enjoy living in a comfortable and homely place. The service continues to achieve the highest quality rating. What the care home could do better: In discussions with the management team it was suggested that the staff training plan could be developed, so that it is easier to monitor and plan future training. CARE HOME ADULTS 18-65 Forest Grange 15 Forest Road Moseley Birmingham West Midlands B13 9DL Lead Inspector Gerard Hammond Key Unannounced Inspection 18th March 2008 09:15 Forest Grange DS0000039321.V361274.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 Forest Grange DS0000039321.V361274.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. Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forest Grange Address 15 Forest Road Moseley Birmingham West Midlands B13 9DL 0121 449 2040 0121 449 4704 i.batool@btinternet.com 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) Ms Itrat Batool Mrs Mandy Josephine Callaghan Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That the 2nd floor bedroom may only be occupied by a designated service user, agreed with the NCSC, currently Mr PG At such time he vacates this room, the agreement of the NCSC must be obtained prior to it being occupied by another person. That all residents must be aged under 65 years Date of last inspection 7th February 2007 Brief Description of the Service: Forest Grange is a three - storey property situated in the Moseley area of Birmingham. The home provides care and accommodation to up to seven adults with a learning disability some of who have complex needs. Some bedrooms have en suite facilities and there are bathroom and toilets on each floor. Communal space consists of a large lounge, which leads onto a dining room, and a separate smaller lounge. There is a spacious rear garden, which has ramped access. The home is within close proximity to local amenities. The current service user group are all male. The home should be contacted for information about the current fees chargeable. Items not covered by these include chiropody, barbers, toiletries, magazines/papers, transport and holidays. The CSCI inspection report is available in the home for those who wish to read it. Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. This was the home’s key inspection for the current year 2007-8. Information was gathered from a range of sources to inform the judgements made in this report. The Manager completed an Annual Quality Assurance Assessment and sent it to us. Previous inspection reports and notifications that the service has sent us during the year were reviewed. We visited the home and met with the residents. Unfortunately their learning disabilities and communication support needs meant that it was not possible to seek their views directly. We also spoke with the Manager, members of staff and the Owner of the home, and met the relatives of two of the residents. We were able to directly observe staff supporting the people in their care. We looked at records including personal files, care plans, staff files, safety records and other documents. A tour of the building was also completed. Thanks are due to the all the people who live at Forest Grange, the Owner, Manager and staff, for their co-operation and support throughout the inspection process. What the service does well: Information is available about what the service provides, so that people can decide if it is right for them. People have written agreements, so that everyone is clear about what the service should provide. Residents’ needs are properly assessed and their care plans are very detailed. This means that staff are clear about how people like to be supported, and how to keep them safe. There are enough staff working at the home to make sure that people can get the support they need to do the things they want and go to places they like. People are well looked after, so that they get the support they need to stay well, safe and healthy. They can be confident that their concerns are listened to and taken seriously. The house is well maintained so that residents can feel safe and comfortable in their home. The staff team is well trained and qualified, so that people working in the home have the knowledge and skills they need to meet residents’ care needs properly. The home is well run for the benefit of the people who use the service. Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 7 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 Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 8 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, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have the information they need to see if the service is right for them. Their support needs are assessed, so that their care can be properly planned. People have written agreements, so that it is clear what the service provides and what they have to pay for. EVIDENCE: There have been no admissions to the home since the last key inspection. Six out of the seven current residents have lived at Forest Grange since it opened. As previously reported, the last person to move in came in 2005. This was after a lengthy period of assessment and introduction, to make sure that the placement was right for him. Sampling of records showed that assessments are in place as required, and that these are reviewed regularly and kept up to date. An appropriate Statement of Purpose and Service Users’ Guide are available, providing clear information about what the service provides. Taking account of the communication needs of people using the service, information is supported with pictures to make it easier to understand. Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 9 Sampled records included individual licence agreements. These give details of fees and terms and conditions about living at the home. They show what the home provides and what people have to pay for. Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Detailed care plans and risk assessments are in place and are kept up to date, so that staff have the information they need. This means they can support people in the ways that suit them and keep them safe. EVIDENCE: Two people’s records were sampled. Both contained care plans that were detailed and comprehensive. People who live in this home have complex and high-level support needs. It is important that their care and support is structured and consistent. This is especially significant for people with Autistic Spectrum Disorders. There is clear evidence of the use of “person-centred” approaches: for example, plans include clear indications of “what works” and “what doesn’t work” for each individual. Plans include explicit guidance about people’s routines and rituals, so that staff understand clearly how individuals like to be supported. Information includes morning routines, supporting people with their personal care and hygiene, preparation of food and drink and Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 11 managing mealtimes, daily living skills, healthcare information, financial matters, and cultural and spiritual needs. Plans also contained reactive strategies to promote effective behaviour management, particularly through helping people to develop skills to cope with situations they find difficult. It was good to note that detailed communication guidelines are also in place. How people communicate underpins everything that they are able to do. Guidelines covered individuals’ verbal skills, and use of alternative means of communication such as objects of reference, pictures, signs and gestures, and so on. Conversations with the Manager showed that she is well aware of the potential for enhancing people’s opportunities by developing their ability to communicate more effectively. She demonstrated a positive attitude towards taking this forward, recognising the need to continue building on current good practice. Care plans are kept under monthly review, when goals set the previous month are evaluated, and new ones set as appropriate. Designated key staff do these with individual residents. This is so they can be consulted appropriately about things they enjoy doing, and supported to make choices about things that are important to them. During the inspection visit staff were seen encouraging people to make choices about what they wanted to eat and drink, what activities they wanted to do, and if they would allow their rooms to be looked at. People are encouraged to do as much for themselves as they can, so as to maintain or enhance their personal independence. This is built into their daily activity programmes. The Manager advised that information gained from monthly reviews is collated from all staff. This is then used to inform an annual review. These full reviews normally take place around the month of May each year. In addition to involving people directly in their care planning, the service has recognised the need for people to get specialised support in making decisions about important things affecting their lives. For one individual this has involved engaging the support of an Independent Mental Capacity Advocate (IMCA), to help ensure that decisions made about his future are made in his best interest. Care plans are well presented and organised so that important information can be found quickly and easily. There are clear links between plans and risk assessments, which are similarly comprehensive. Sampled files showed risk assessments for individuals’ rooms. These covered potential hazards associated with appliances, windows, using en-suite facilities, and positioning of furniture. There were risk assessments in place relating to specific behavioural support needs at mealtimes. All community-based activities were assessed in detail, including suitability of specific venues, use of transport, safe seating in vehicles, and so on. Information gained from the risk assessment process was “imported” into care plans, to make sure that staff have good guidance about keeping people as safe as possible. Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 12 Personal records are securely stored in the home’s office, and there are appropriate policies in place covering access to files and confidentiality / disclosure of information. Conversations with staff showed that they have a good understanding of their responsibilities to keep confidences and when to share information appropriately. Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are well supported to do a wide range of activities, so that they regularly get to do things that they value and enjoy. Where possible, they get help keep in contact with families and friends, so that they can stay in touch with the people who are important to them. Residents have a varied and balanced diet, so that they can enjoy their food and eat healthily. EVIDENCE: Each resident has an individual activity programme. Programmes are planned with the direct involvement of the person concerned. Each person has a copy of his programme, which is drawn up as a picture timetable, to help make it easier to read and understand. The complex nature of people’s support needs (and autism in particular) make it extremely important that activities are undertaken in a structured and reliable way. A lot of work goes into organising and risk assessing venues for their suitability and safety. Staff have clear guidance about transport arrangements and specific issues they need to Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 14 consider (for example the importance of beginning activities on time and making sure that people have any clothing or equipment they need to do the activity) ensuring that people can get the most out of doing the things they like to do. This demonstrates good understanding of the needs of people with learning disability and autism and represents good “person-centred” practice. The service provides two vehicles to enable people to access local facilities and amenities in the community. People also use local public transport and taxis for this purpose, according to their needs. They are able to get out each day and do the things they want because there are enough staff available to support them. People go to colleges and local centres to do training, education and leisure activities. Courses include woodwork, photography, music, drama, arts and crafts, pottery, and living and independence skills. People also go to the cinema, bowling, and to leisure centres for swimming and fitness training. They go out for walks, shopping, to the park and out for meals and to the pub. Staff support them to do as much for themselves as they can, cleaning their bedrooms, doing their laundry and preparing / cooking food, so as to promote and develop their independence. If someone does not want to do his scheduled activity, he can be supported to go and do something else of his choosing, either in the community or at home, according to personal choice. Records of activities were appropriately detailed, and included information on people’s responses to what they did, their behaviour and mood and so on. It is important to have this recorded, so that future planning can be appropriately informed. People are supported to keep in touch with their families, where this is possible. Sadly, some issues about managing contact appropriately have lead to difficulties in arranging this for one of the residents. This matter was unresolved at the time of the inspection. However, relatives for two of the residents were seen at the home during the inspection visit. One man’s parents said that they are able to drop in and visit when they like, and they see their son regularly. Another person’s relative said she came to visit when she could, and staff always made her welcome. Particular efforts have been made to re-establish contact with the local Jewish community, recognising the cultural and religious background of another of the residents. People’s cultural and religious backgrounds are also catered for in providing for their dietary needs. Food is bought from a local kosher supplier, and the resident has his own separate utensils so that food can be prepared and cooked according to the relevant traditions and practice. Others diets are similarly sensitive to individuals’ backgrounds and cultures. Records showed that people enjoy a wide range of choices, and that their diets are balanced and nutritious. Food stocks were examined: these were plentiful and included good quantities of fresh fruit and vegetables. The Owner explained that nonperishable items were purchased on-line and delivered by the supermarket, but that residents and staff went out and bought fresh produce locally as they Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 15 need it. People were directly observed having their evening meal after they had been out for the day. Staff were assisting those needing support appropriately. People were able to enjoy their food in a relaxed and pleasant environment. Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are well looked after in ways that suit them individually, so that they are cared for properly and supported to stay healthy and well. EVIDENCE: Direct observations of people’s clothing and grooming provided evidence that they had been appropriately supported with their personal care. People were well dressed: their choices of clothing reflected their individual tastes and choices, their ages, gender, culture, the weather and what they were going to be doing during the day. As reported above, people’s care plans are very detailed and comprehensive, so that staff have good guidance about how to support people in the ways that suit them and make them feel comfortable. Importantly, plans include specific guidelines about the ways in which people communicate. This is always important, but of particular significance when supporting people with autism. Visual cues (e.g. “objects of reference”, signing or pictures) help people know when activities are to begin. Using cues inconsistently or inaccurately may disorient people, leading to anxiety and subsequent challenging behaviour. For one person, putting his coat on means Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 17 that he is going out straight away. If staff delay after he puts his coat on, this may lead to problems, as he is likely to become confused and anxious. The “fine detail” included in people’s care plans is the result of several years hard work, learning about what suits people and what does not. This makes the plan very “person-centred”, that is very personal, specific and individual to each resident. Direct observations of interactions between residents and staff showed support being given with friendliness, warmth and respect. Both were relaxed and appeared comfortable in each other’s company. Staff were actively engaged in supporting people rather than sitting around talking to each other. Feedback from relatives that were spoken to on the day of the inspection visit was very positive. One person’s parents said, “We are very happy with the support our son gets”. Another man’s relative said, “I know that he is very well looked after here”. Sampled files included detailed personal medical histories and showed that advice and support is sought from other health professionals as required. Records showed that this included the GP, Practice Nurse, Consultant Psychiatrist, Optician, Dentist, Community Nurse, and Occupational Therapist. Treatment and medication are regularly reviewed. Information provided in the Annual Quality Assurance Assessment (AQAA) also showed that the Dental Hygienist did a workshop with some of the residents to explain proper brushing methods, and the Practice Nurse did one for staff in supporting one person with his asthma. Previous reports show that the District Nurse has trained staff to administer insulin and monitor blood sugar levels for the resident who is diabetic. Files also contained evidence of regular monitoring of people’s weight. Residents are dependent on staff’s vigilance, and records show that support and treatment are sought as soon as any problems are identified. Medication is securely stored in a locked cabinet in the medication room, which is also secure. The medication store was clean and tidy. A local Pharmacist supplies residents’ medicines in individual sealed “blister packs” each week. The Medication Administration Record (MAR) was examined and had been completed appropriately. The record included a copy of the medication policy and sample signatures of staff that administer medicines. Written protocols are also in place for PRN (“as required”) medication, homely remedies and insulin. These give staff clear guidance about the circumstances in which medication can be given, and take account of individuals’ regularly prescribed medicines. Insulin is stored in a fridge located in the Manager’s office. This room is also secure. The Manager carries out regular audits, and there was also a record of an audit carried out by the Pharmacist in January 2008, showing that no problems had been identified. Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are properly recorded, acknowledged and looked into, so that people can be confident their concerns are listened to and taken seriously. Residents are protected from abuse, neglect and self-harm so as to keep them safe and well. EVIDENCE: Appropriate policies are in place for complaints, safeguarding and the prevention of abuse, and using physical intervention and restraint. Information provided in the Annual Quality Assurance assessment shows that these have been reviewed recently. The complaints procedure has also been produced in an “easy read” format to try and make it easier to understand. Each resident has a copy of this. It has to be acknowledged that formal procedures of this nature may be of limited relevance to the people living in this house, due to their levels of learning disability and communication support needs. People are dependent on the vigilance of members of the staff team to notice changes in behaviour, “body language” or demeanour as indicators that something may be amiss. The complaints record was examined. One complaint has been received from the family of one of the residents regarding contact arrangements. This has been responded to appropriately and referred to the Local Authority. As reported above, the support of an Independent Mental Capacity Advocate has been engaged, to ensure that the rights and best interests of the person involved Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 19 can be protected. At the time of the inspection this matter had been referred for mediation but remained unresolved. We have not received any other complaints in respect of this service. Records show that staff have received training in the protection of vulnerable adults from abuse. Staff interviewed demonstrated their understanding of relevant issues, including knowledge of the different forms of abuse, what indicators they need to be aware of, and the action they should take in the event of witnessing or suspecting abuse. Records show that each resident has his individual bank account and receives the interest accrued. Activities they pursue are paid for by the service as part of their agreed package of care, funded from the fees received. Their money is held individually and separately in the office safe, with records to support expenditure on personal items, including receipts. These are audited regularly by the Manager, and also by the service’s accountant. Two residents’ records were sampled. Cash held tallied with the amounts shown on the record, and receipts were available for items purchased. Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The house is generally well maintained, clean and tidy, so that residents needs are met and they can feel at home in safe and comfortable surroundings. EVIDENCE: A tour of the building was completed. On the ground floor there is the main lounge and a second “quiet room”. Three residents’ rooms are also on this floor, as well as the kitchen, dining room, laundry, shower room and WC. On the first floor there are three more bedrooms, a bathroom and small office. On the second floor is the Manager’s office, a separate staff room with lockers, and an “overspill” walk-in cupboard used for storing tins and packets of nonperishable food. There is another bathroom on this floor, and one more resident’s bedroom. The property also has a large cellar. This is kept locked: it is used for storing cleaning materials and the access is via a steep staircase. Some rooms also have en-suite facilities, so there are ample bathrooms and toilets for residents’ use. People’s bedrooms are all very individual in style and Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 21 personal to the occupant. Personal possessions and effects were very much in evidence, including pictures and family photographs. At the rear of the property is a large enclosed garden area. This can be accessed via a ramp. The area is mainly block paved – this was done with safety in mind, as one of the residents would eat plants or shrubs. The Owner said that the garden is well used when the weather permits. Things people are said to enjoy include sitting out or playing football. The house is generally well maintained and decorated, and comfortably furnished. It has to be acknowledged that the support needs of this particular group of residents means that wear and tear on the fixtures, fittings and fabric of the home is heavy at best, and sometimes excessive. The Owner and Manager were able to show evidence of a rolling programme of maintenance and refurbishment work, either in progress or scheduled for completion. Some jobs have to be left until the residents are away on holiday, in order to minimise disruption and ensure safety. Some of the bedrooms need redecorating, and these will be done in the near future. New flooring has been laid in most of the communal areas since the time of the last inspection. Damaged or worn furniture has been replaced. The Owner, Manager and staff team are to be commended on succeeding in striking a good balance between creating and maintaining an environment that is suitably robust, while keeping it homely, welcoming, comfortable and safe. The home was clean and tidy, with a very good standard of hygiene maintained throughout. Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that proper checks have been carried out on staff before they come to work at the home. This is to make sure they are fit for the job and to ensure people’s safety. Staff are well trained and supervised, to make sure they have the knowledge, skills and support they need to do their jobs well. EVIDENCE: Information provided in the Annual Quality Assurance Assessment shows that 65 of the current staff team hold qualifications at NVQ level 2 or above. The rest of the staff team are working towards this. Sampling of staff records showed that completed application forms were in place, together with two written references and evidence of checks with the Criminal Records Bureau (CRB). Records also included notes of recruitment interviews, declarations of fitness for the job, written job descriptions and contracts, signed receipts for staff handbooks and codes of conduct. There was also evidence of structured induction training, including manual handling, safe handling of medication, food hygiene, safeguarding, challenging behaviour, first aid and enrolment on NVQ training. Induction included a two-week period of supervised practice and Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 23 job shadowing. The Manager advised that retention of staff in the home is good. The service received the “Investors In People Award” in November 2007. The home is well staffed and there are currently no vacancies. Staff spoken to said that they felt they were part of a good team that works well together. Residents receive 1:1 support to enable them to enjoy an individualised package of care to meet their assessed needs. The Manager advised that each resident has three staff with specific “key worker” responsibilities. She also said that additional staff resources are made available to meet needs if required. Staff records provided evidence of regular training. It was recommended that the staff training and development plan be presented in a spreadsheet or chart format. This should show (for each member of staff) qualifications gained and training completed, and highlight any gaps (including “refreshers”), showing dates when outstanding training is to be delivered. Doing this should provide the Manager with an “instant overview” of the position with regard to training, and be a useful tool in planning future provision. It should be stressed that the Manager was able to provide this information, and the recommendation is made merely as a suggestion for practice development. The staff team meets regularly, and copies of minutes were made available. Staff spoken to confirmed that they are able to contribute items to the meetings’ agenda, and said that they felt their opinions were recognised and valued. Records also showed that staff receive regular, formal supervision, with minutes kept of each meeting. They have also received an annual appraisal of their performance and development needs. One staff member said, “I’m really happy working here, and so are the service users”. Relatives seen on the day of the inspection visit said that they felt comfortable asking staff about anything and were very happy with the responses and support that they received. Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41 & 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well managed and run. People can be confident that the service is developed with the best interests of the residents in mind. Maintenance and checks of important equipment are carried out regularly, to ensure that people living and working in the home can stay safe. EVIDENCE: The Registered Manager is appropriately qualified and has several years experience working with and managing services for people with learning disabilities and autism. She holds the Registered Manager’s Award, NVQ level 5 (Management), and has just completed a foundation degree in business and administration. Her management style is open and inclusive, and staff confirmed that they felt comfortable going to her about anything that Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 25 concerned them. As reported above, they said that they felt that their opinions are listened to and valued. The Owner is also actively involved in the home’s management, and both she and the Manager clearly have a good working relationship. Staff said, “This is the best management I’ve ever had. They are always there to listen to you and to help”. Other feedback included “ Both (Owner and Manager) are very approachable” and “The Manager is very understanding, you can go to her with any problems”. The Owner is a frequent visitor to the home and completes reports required under Regulation 26 (Care Homes Regulations 2001) each month. Residents’ meetings are held regularly, and copies of the minutes taken were seen. A discussion was held with the Owner and Manager about developing the systems for quality assurance and monitoring of the service. The desired outcome for this standard (National Minimum Standards for Care Homes for Adults [18 – 65] no.39) is “Service users are confident that their views underpin all self-monitoring, review and development by the home”. It has to be acknowledged that this is a significant challenge when working with people with complex and communication support needs. The management team demonstrate their commitment to a continuous development of the service for the benefit of the people who use it. As previously reported, there is ongoing compliance with regulations and standards, and (as before) there are no outstanding requirements. It may be that consideration could be given to engaging an independent external body to work with the home on the development of quality assurance processes, including canvassing the views of other interested parties. The service has a comprehensive range of policies and procedures to support the operational management of the home. These are subject to review and updating as appropriate. The standard of record keeping is very good - in particular residents’ care plans and supporting risk assessments. Records are well presented and maintained, and stored securely. Safety records were sampled. The local Fire Officer completed an audit in June 2007 and reported that fire precautions were satisfactory. Fire fighting equipment and the alarm and emergency lighting systems have been serviced and checked regularly. Certificates for the electrical wiring, central heating service and checks on the water storage systems were in place and in date. The Landlord’s Gas Safety Certificate and schedule of Portable Appliance Testing (of electrical equipment) were also available and up to date. A current valid certificate of insurance (employer’s liability) was also displayed. Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 4 27 3 28 4 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 4 34 3 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 x 4 4 3 3 3 3 X Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 YA35 YA39 Good Practice Recommendations Present the staff training and development plan in a spreadsheet format, to provide a better tool for planning and managing training. Develop quality assurance and monitoring systems to demonstrate clearly how residents’ views underpin service review and development. Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Forest Grange DS0000039321.V361274.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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