Care Home: Fountain View

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What the care home does well Several processes are in place to consult the people living in the home about the service that they receive and new processes are being introduced. Care needs are comprehensively assessed and up to date guidance is in place for staff providing support to people and these take risks and any restrictions into account. The approach to residents is person centred and staff encourage decision-making on a day-to-day basis and for the future. Good relationships exist between the staff and the people living in the home and good staffing ratios are in place. Residents are encouraged to be independent and make choices. They are encourage to take part in meetings, household tasks and recreational activities. Support is available to obtain services from health professionals. Residents say that they can express their views and feel listened to and those relying on more non verbal communication are also assisted by increasing use of pictorial images. The staff members are provided with good support for induction, followed by a college induction course, supervision, further training, staff meetings and opportunities to be assessed for National Vocational Qualifications (NVQ). Currently nine out of twelve staff have been assessed to NVQ level 2 or above. The manager, through experience and training, provides strong, well-organised leadership and makes improvements to the service based on audits including consultation with residents, staff and relatives. Health and safety is routinely addressed for the safety of residents. What has improved since the last inspection? Three requirements were made following the last report in respect of the environment. The manager was required to: redecorate and make good the downstairs hallway and entrance area, redecorate and replace fittings to the en suite ground floor bathroom, and improve the accessibility and exit of the main entrances to the home to ensure the safety of residents and staff. Good progress had been made in respect of these areas and the replacement of the floor in the hallway is planned. Through audits and consultation there are further plans to make ongoing improvements to the service on a regular basis. What the care home could do better: No requirements were made as a result of this inspection. Among other improvements in the home`s improvement plan, the manager is working towards improvements to the environment at a faster rate. CARE HOME ADULTS 18-65 Fountain View Upham Street Upham Hampshire SO32 1JD Lead Inspector Sue Kinch Key Unannounced Inspection 15th January 2008 11:30 Fountain View DS0000055841.V355948.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 Fountain View DS0000055841.V355948.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. Fountain View DS0000055841.V355948.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fountain View Address Upham Street Upham Hampshire SO32 1JD 01489 860112 01489 860965 fountainview@truecare.co.uk 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) Truecare Group Ltd Ms Sandra Corton Care Home 6 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (6) of places Fountain View DS0000055841.V355948.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users in the categories MD and LD may be admitted between 18-55 years. Service users may only be accommodated in category MD if they are also accommodated by reason of LD. 26th March 2007 Date of last inspection Brief Description of the Service: Fountain View is a care home providing personal care and support for up to 6 male residents who have complex learning disabilities and mental health needs. The home is located in the village of Upham, close to local amenities. The house is a two storey detached property with car parking for several vehicles and stands in a one acre garden. Residents are provided with single bedroom accommodation, one of which has en- suite facilities. Fountain view is part of the Truecare Group centrally managed by C.H.O. I.C.E. Ltd. Fees range from £1316 - £2382 but are negotiated based on the individual needs of residents. Fountain View DS0000055841.V355948.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 star. This means the people who use this service experience excellent quality outcomes. The inspection consisted of a review of the file held at The Commission for Social Care Inspection (the Commission) office and of an Annual Quality Assurance Assessment (AQAA) document completed and sent in by the manager before the inspection visit. The visit took 5.5 hours. All residents were met and spoken with at varying lengths. Three staff and the manager were also spoken with during the visit and the operations manager at the end. Parts of the physical environment were assessed and some records and documentation were examined. Surveys were sent to a sample of staff residents, relatives and care professionals involved in the home. Five completed survey forms were returned from residents who were assisted by staff. Five were also returned from staff, and three from relatives. What the service does well: Several processes are in place to consult the people living in the home about the service that they receive and new processes are being introduced. Care needs are comprehensively assessed and up to date guidance is in place for staff providing support to people and these take risks and any restrictions into account. The approach to residents is person centred and staff encourage decision-making on a day-to-day basis and for the future. Good relationships exist between the staff and the people living in the home and good staffing ratios are in place. Residents are encouraged to be independent and make choices. They are encourage to take part in meetings, household tasks and recreational activities. Support is available to obtain services from health professionals. Residents say that they can express their views and feel listened to and those relying on more non verbal communication are also assisted by increasing use of pictorial images. The staff members are provided with good support for induction, followed by a college induction course, supervision, further training, staff meetings and opportunities to be assessed for National Vocational Qualifications (NVQ). Currently nine out of twelve staff have been assessed to NVQ level 2 or above. The manager, through experience and training, provides strong, well-organised leadership and makes improvements to the service based on audits including consultation with residents, staff and relatives. Health and safety is routinely addressed for the safety of residents. Fountain View DS0000055841.V355948.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. Fountain View DS0000055841.V355948.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 Fountain View DS0000055841.V355948.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough assessment process is available for prospective residents and plans are in place to take account of the wishes of the existing resident group. EVIDENCE: This area was assessed in March 2007 when it was found that the residents had favourable views about their admissions to the home. There have been no further admissions since then although there is currently one vacancy. Policies and procedures are in place and were discussed with the manager at the last inspection. In the AQAA the manager described the admission process and said that it includes a full assessment from care managers and other another information is requested from relevant parties before admission. Also in the AQAA the manager described how she intends to ensure that residents living in the home are consulted about any further admission. The manager said that there had been a recent referral and visits by professionals but it was decided by mutual agreement between that manager and the referrers that the needs of the person may not be able to be met. The manager said diversity issues are considered at admission but that the home did only admit male residents due to the specific issues in the current Fountain View DS0000055841.V355948.R01.S.doc Version 5.2 Page 9 resident group. The home had been adapted to ensure that the needs of one resident who uses a wheelchair could use the facilities. In the AQAA the manager gave more information in the ways that the home are addressing equality and diversity in reference to staff training and meeting religious needs. Fountain View DS0000055841.V355948.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): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People at this service are supported by staff that encourage independence and decision-making and they are consistently assisted in areas identified in the up to date care plans including issues of risk. EVIDENCE: Much information is gathered about people living in the home. Care plans are stored separately from other information and staff member said this made it easy to find. Care plans for two service users were sampled and these were up to date with evidence of regular reviews within the service. They are detailed and set up in a way, which a member of staff said, is easy to find specific details. The risk assessments are recorded on the reverse side of the care plans, which the staff member said made cross-referencing easy. The care plans cover a range of issues and are individualised based on the diverse needs of the residents living in the home. There are some goals for individuals and challenging behaviours have been assessed with guidance provided for staff. Fountain View DS0000055841.V355948.R01.S.doc Version 5.2 Page 11 Two residents were spoken with about the care received and the care plans which they knew about and they described activities which they are supported with. This was recorded in the care plans checked in relation to this. The manager said that there are plans to have weekly discussions about how people living in the home feel about their service using a pictorial format. There are some restrictions placed on some people depending on their individual needs and these were, in part, discussed with staff and residents. A restriction was discussed with one resident who agreed with it. For another person these were recorded where sampled and action plans in place. Restrictions were reported at the last inspection to have been put in place following reviews with care managers. Interventions, including de-escalation and physical interventions, are recorded. These are reviewed within the home. For one person there was evidence of a recent review including care management and this had included risk assessments but the manager said that other reviews had been delayed by the difficulty of obtaining care management attendance. Some reviews are overdue. Two are planned for February 2008. The operations manager, at the end of the inspection said that a system was to be put in place to ensure that reviews were held annually. As at the last inspection it was noted that the standards relating to care plans and others are recorded in the care plans for guidance and plans themselves are detailed but not in a format accessible to people using the service. The manager is planning to use a pictorial health action plan to discuss with residents and on recording more communication details. In the AQAA the manager said that they are ‘working towards improving its communication systems to assist residents who have limited communication and comprehension skills to make decisions and choices.’ At the inspection staff were aware of the varying communication needs of less verbal people and were, for example, observing non-verbal behaviour to assess their responses. During the inspection there were several occasions when conversations between staff and residents were observed and situations where staff assisted the residents to answer questions, give examples, or make choices. In all of these situations staff were demonstrating that they were assisting resident to make decisions and were friendly in their approaches. One person living in the home said that he was supported to do the things he wanted to do and that were on the activity plan. Another spoke about the weekly one-one support available for each resident to do what they wish to do in the community. Examples were noted to support the view that residents are able to make choices about routines in the home and their participation, about shopping, food and activities. A resident confirmed previous involvement in staff recruitment. Fountain View DS0000055841.V355948.R01.S.doc Version 5.2 Page 12 In resident surveys they reported to feel treated well. In staff surveys comments received referred to good relationships between staff and residents although one comment was received that staff could sometimes be more positive role models using less bad language. This was not witnessed during the inspection visit. Fountain View DS0000055841.V355948.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): 12,13,15,16,17, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to varying degrees with recreational and domestic activities in the home and in the local community. Work is taking place to improve the range of activities for some of the less independent residents. EVIDENCE: A newly revised activity plan has been written based on the activities that the residents like and include a range of activities in and out of the home. External activities, arranged mainly on an individual basis, for developing personal interests and for personal development, include football, college courses such as computers and cooking, going for drives, and visiting stables. One person goes to a private day service once a week. These activities were discussed with one of the residents who confirmed that they were happening. In house activities include domestic jobs which people living in the home are encouraged to take responsibility for or take part in and, other activities, such as car cleaning and arts and crafts. Fountain View DS0000055841.V355948.R01.S.doc Version 5.2 Page 14 There are a lot of gaps for some people on the timetable and although other personal interests are persued in the house, the manager said that steps were being taken to develop a room for arts and crafts. She spoke of the spare room next to the office in the grounds of the home being developed to offer more space for activities. This is a proposed development that she felt could benefit the older residents who have less stimulation currently and who can be distracted from activities in the main house in the more limited shared areas of the home. It will include an IT suite and will be accessible to all. Access to a hydrotherapy pool was also being assessed. Information from seven staff was received for this inspection and one commented on the need for more activities and another on the need for resources being spread more evenly. One relative said that their relative was involved in activities but that sometimes the television could be turned off and more activities provided. A outdoor swimming pool is available for residents in the warmer months and this is enjoyed a lot according to a staff and manager. They said that it increases the range of activities for everyone in the summer. The manager said that its use in the future depends on the provision of lifeguard training. One person living at the home said that he was ‘quite happy’ at the home ‘its okay’ and prefers it to the last place he was living at. Another said ‘ no problems here it’s like a hotel’. A resident was watching a favourite DVD late in the afternoon of the inspection visit. The resident said he likes the things he does, shopping (and had been that morning) and going in car. He wants a record player and staff and he were talking about getting one. When asked if would he like to do anything he said likes to go to London and that staff had taken him. He also went to museum and submarine museum last summer. In the AQAA the manager referred to a ‘good relationship with the local community and ‘we are actively involved in village life’. Taking part in summer fetes, the Xmas fayre and local hog roast were given as examples. Staff said that the home has two cars that they can use for going out. Another said that activity plans ensure that each person living at the home is given an opportunity each week to do something unplanned, out of the home, on a one to one basis with a member of staff. Relationships are also supported and one person spoke about liking to write letters and having support to do this. The same person also talked about being supported to travel some distance to visit his mother. Two out of three relatives felt that they were kept up to date with important issues. Another said that staff drive a resident to visit his relative sometimes. Food was discussed with two residents. One said he doesn’t like some food but the staff help and has was quite happy. The pictorial menus were discussed with another who agreed that they were used and that the shopping was done at weekends and that he was involved. He also said that the residents choose Fountain View DS0000055841.V355948.R01.S.doc Version 5.2 Page 15 the menus and alternatives were provided. A staff member talked about most people living in the home being encouraged to be involved in the cooking and that this was applied flexibly with varying levels of involvement. In the AQAA the manager spoke of a plan to promote healthy eating options at lunchtime by introducing a healthy eating daily lunch diary for each person. Fountain View DS0000055841.V355948.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 good. This judgement has been made using available evidence including a visit to this service. Personal, health and emotional needs are met through consultation with the residents and other health professionals as necessary. The home has safe systems in place to support residents with their medication. EVIDENCE: In the two files viewed personal plans are to date and clearly explain how residents wish to be supported with their personal, health care and psychological needs. The plans are written clearly allowing staff to know how to address the residents and support them with their daily needs. One staff member said that decisions about personal care are made through personal choice, and skill use is encouraged. The staff member continued to say that staff also considers clothing for the weather, shopping needs for personal care and risks and confirmed that information is in the care plan In a discussion with another staff member about the personal care needs of a resident they were able to give details of the support and staff level needed, the likes and dislikes of the resident, the adaptations needed, the emotional Fountain View DS0000055841.V355948.R01.S.doc Version 5.2 Page 17 issues and the privacy issues around bathing. This matched some of the information read in care plans. Aspects of sexuality and privacy were addressed in care plans. Health appointments were recorded and showed that health needs are monitored and specialist health professionals used. For example records showed that a medication review had take place for one person in relation to epilepsy. A staff member confirmed to have received training in epilepsy. Another said that the doctor called as necessary and appointments planned in the diary. From other conversation with staff and a resident during the inspection there was evidence that support was being given on a day-to-day basis with emotional and health needs. One resident said he had help with his aggression and gave an example of when he went out and got aggressive and he said that the staff helped him calm down and they know how to help him. Another said that staff were there to talk to if he needed it. From conversations with a resident and observation of a sample of records there was evidence that there is support in the home with medication reviews and changes to medication. One resident spoke of being very pleased with the results. We found the medication practices to be well managed at the last inspection. At this inspection it was stored securely. Elements of the process and were discussed with a staff member who said that team leaders dealt with medication and that clear procedures were in place for ‘as required’ medication. Fountain View DS0000055841.V355948.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. Systems are in place for listening to residents and these are being improved upon by planning to consult them more often. Systems are also on place to promote adult protection and they are used. EVIDENCE: In the AQAA the manager said that they provide an inclusive environment in which people living in the home can raise concerns. Staff are expected to understand the varied communication styles and to respond to them individually. The two residents spoken with at the inspection visit said that the staff listened to them. One said that he got on with the staff, and another, that ‘there are no problems here’. Staff were responding to residents with fewer verbal skills by observing and assessing needs. Lots of pictorial aids are available through out the home and the manager said that assessing communication was going to be extended. Staff assisted all residents to complete surveys and in all they said that they knew what to do if they were unhappy and how to make a complaint. Some would need assistance with this. We noted that the complaints procedure was not in an accessible format for all at the last inspection, especially for those with cognitive and sensory disabilities. In the AQAA the manager said that the procedure is now provided using symbols as well as words. She also said that more opportunities would be available for concerns to be raised in one-one weekly individual discussions planned for residents. Fountain View DS0000055841.V355948.R01.S.doc Version 5.2 Page 19 The three relatives who returned survey forms said that they know how to make a complaint. They said that the home always or usually meets the needs of their relative. One said they had ‘nothing but praise for all of them’. In the AQAA the manager stated that there had been no complaints from families in the last twelve months The manager said that the home has access to all appropriate policies and procedures on protection of vulnerable adults and provides training for staff. Training in abuse commences at the time of induction and includes the principles and core values of care. This is further covered when staff undertake a national vocational qualification (NVQ). Evidence of adult protection training was noted in the staff training records viewed. The manager said that all staff except the newest have completed the accredited training in prevention and management of violence and the newest member of staff is not involved in physical interventions until the training had been completed. All staff are planned to receive this training from a different organisation in February and March 2008 and all of the interventions for challenging behaviour will be reviewed. Evidence of staff training so far and individual interventions was noted in training records. The manager is reporting incidents, affecting the well being of residents, to the Commission. Reports received most recently were discussed and the manager said that she had made a referral under the adult protection procedures in relation to one of the incidents in accordance with locally agreed procedures. The manager, in the AQAA stated that plans for improvement included developing in one of the resident’s guidelines to improve management of increased aggression in order to protect others and to ensure a consistent approach from all staff. Systems are in place in the home for the management of residents’ personal monies where support is given. Elements of this were discussed with a member of staff and a sample made of the records held in the home. These were accurate. There is also an additional recording procedure for staff when taking money for shopping. Fountain View DS0000055841.V355948.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): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a comfortable, clean, environment in which shared and private rooms are provided and upkeep is mostly addressed within reasonable timescales. EVIDENCE: At the last inspection some areas in need of attention were identified and requirements were made about the physical environment. These related to: redecoration and repairs to the front hallway, redecorating and replacing fittings to the en suite ground floor bathroom, and improving the accessibility and exit of the main entrances to the home to ensure the safety of residents and staff. At this inspection aspects of these were discussed with the manager and a member of staff and the areas were observed. The work had been completed with further plans to replace the stained front hall flooring. The manager said in the AQAA that the lounge/dining room had also been repainted in the last twelve months with new carpets and furniture in the Fountain View DS0000055841.V355948.R01.S.doc Version 5.2 Page 21 lounge and new laminated flooring in the dining room area. This was viewed and throws had been put over some older seating so that the colours matched the general decor, which staff said they are improving. The manager also said that bedrooms and the stairwell had been re-decorated in the last twelve months. The three bedrooms and the stairwell viewed looked freshly painted. The manager reported an intention to improve contact with the maintenance department to get things repaired more quickly. There is a reporting book in the house, which was viewed with a staff member and spoken about with a resident. Events had been recorded and ticked when completed. Mixed views were received about how quickly things were fixed and improvements made. A resident spoke of a leaking tap in his room that had been reported and fixed but also of drawers missing from under his bed for some time. However the manager said that a new bed was ordered. The manager, staff and residents spoke about the recent disruption in the hot water supply but that the boiler had just been fixed and it had improved. The manager said that the home had managed during this period without major disruption. Part of the panelling of one fence in the rear garden had blown over and the manager had reported this. The manager has identified that recreational needs could be better served by increasing the communal space available and using one of the buildings in the grounds. She said this had been agreed but work had not yet started. Staff and residents are involved in the cleaning and routines are on the rota. A staff member said that if residents decide not to be involved on certain days then staff need to complete the work. Areas of the home viewed were clean. The home has procedures for infection control and at the last inspection it was noted that staff received training. When viewing bathrooms and water closets it was noted that there were no paper towels in any of the areas viewed for residents to use before leaving the bathroom. A staff member said that there were usually. In discussion with another member of staff there was evidence that staff consider infection control on a day-to-day basis and the member of staff spoke about a resident’s needs in this area. Fountain View DS0000055841.V355948.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): 32,34,35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents are supported by competent staff who receive well organised regular, updated and specific training to meet their individual needs. The home supports and protects residents by using robust recruitment policies and procedures. EVIDENCE: A resident spoke about having been involved in the recruitment and selection process in which he felt listened to. The manager said she plans for there to be more a more structured involvement in future recruitment. Recruitment records are held with the company’s human resource department, the Commission has agreed this and the manager holds records to demonstrate checks have been made for her staff. At this inspection records were discussed and a sample viewed for one person. The manager had all the records requested to be viewed by us regarding pre-employment checks. These had been completed before employment. All staff said, in surveys, that criminal records bureau and reference checks were carried out before their recruitment. Fountain View DS0000055841.V355948.R01.S.doc Version 5.2 Page 23 In the AQAA the manager provided a lot of details about the training and support of staff in the home. She spoke of the induction for all staff in the first six weeks and the subsequent Learning Disabilities Qualification (LDQ) induction provided to new starters on a one day a week course at a local college. Evidence was in place to show this had happened for the newest member of staff and discussions had been helped with senior staff. The induction for people working with adults with learning disabilities was planned and would include first aid food hygiene, communication, adult protection and moving and handling. Then supervision would begin. The manager said that the staff member was not involved in administering medication or physical interventions until relevant training had been received. There was evidence from the staff spoken with and the surveys, that formal staff supervision is mostly regular and carried out by team-leaders and the management. A chart of supervision is planned for 2008 indicating an intention to provide monthly supervision. Staff spoken with said this usually occurred every two months. The manager said that supervision records are made. There was a chart for supervision in 2007 but no clear record of dates when supervision was provided. The manager agreed that records could be improved. In the staff surveys four out of the five respondents said that they were given the training that is relevant to their role and all said that it helps them to understand and meet the diverse individual needs of residents and keeps them up to date with new ways of working. At the inspection two staff spoke about handovers, opportunities to read records and a communications book. In one survey a staff member said that the manager is available for discussion and any work issues. Another said that training is good and updates are planned before previous training expires. Records of training for two staff were sampled and there was evidence that both had received several days training in 2007 including a four-day course in prevention and management of violence. Other courses included health and safety fire safety, rectal diazepam and adult protection. The manager said that the business plan focussed on training. Written evidence of this was viewed and she said that manual handling training, prevention and management of violence was planned. Mental Capacity training is planned for team leaders. She also said that nine staff are assessed to National Vocational Qualification (NVQ) level 2 or above. All certificates were for this not viewed as all were held in separate files but a certificate was found in the file sampled. The manager said that she maintained a rota of four staff a shift and was able to continue with this when staff are training. The rotas sampled and staff spoken with supported this. Fountain View DS0000055841.V355948.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): 37,39,42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from a competent manager who provides good leadership, ongoing improvements to the service, regular consultation and good management of health and safety. EVIDENCE: The manager has several years of experience in this management and gave examples of how she keeps herself up to date with care practices. There are also records of her training demonstrating that she attends courses regularly In the last year courses have included adult protection, mental capacity prevention and management of violence, medication management, first aid, health and safety and food safety. Positive comments have been received from, staff and relatives. These include ‘any issues that I cannot address I will report to the manager and will be able to find a solution in everyone’s best Fountain View DS0000055841.V355948.R01.S.doc Version 5.2 Page 25 interest’, and ’ the manager is supportive’ and of the manager and staff ‘are totally and realistically and caring supportive’. Systems are well organised and information was easy to obtain during the inspection visit. Staff commented on the home being well organised and with regular updates. Staff meetings are regular. It was noted at the last inspection that the home had developed some communication aids to assist quality auditing for obtaining residents views about the service and residents. All staff had completed a quality questionnaire. In the AQAA the manager said that a further audit had taken place in 2007 and this had included service users views. From this development plans were produced and three for 2007 were viewed. The manager said the survey included relatives things achieved in response to consulting them. It included improved communication with relatives and between residents and relatives. The Manager also said that as a result of the audits she was focussing on staff seeing residents in a holistic way in team meetings and encouraging person centred care. A business plan was also viewed at the inspection visit. It matched the manager’s view that between 2007 and 2008 there has been a focus on staff training and motivation, and staff had training in specific areas like epilepsy. The manager also said that the regulation visits by the organisation’s representatives were made regularly and that these included aspects of health and safety. Records of these visits were not viewed on this occasion. A sample of records in relation to health and safety were viewed during the site visit and those asked for in relation to fire risk assessment, in house fire checks, fire training, and water temperatures showed that systems were in place and in use regularly. Oils checks are routinely made. The manager and staff said that boilers had just been serviced. The manager says improvements were made in accident reporting, and has plans to update fire risk assessments following training in January 2008. Evidence of staff receiving training in health and safety matters is recorded in the staffing section. After the last inspection a requirement was made that the home must improve the accessibility and exit of the main entrances to the home to ensure the safety of residents and staff. At this inspection the manager showed that an additional mobile ramp had been obtained to aid wheelchair access. It was noted at the last inspection that the training manager of the home had completed a quality audit and one area of concern identified at the time of the Fountain View DS0000055841.V355948.R01.S.doc Version 5.2 Page 26 visit was the maintenance of the swimming pool and the new legislation in place that requires training for staff including life saving. The outdoor pool is not in use at the moment due to the time of year and the manager said that further use of it would depend on the company’s decision about staff training. Fountain View DS0000055841.V355948.R01.S.doc Version 5.2 Page 27 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 x 2 x 3 3 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 3 ENVIRONMENT Standard No Score 24 3 25 x 26 3 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 4 33 x 34 3 35 4 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 4 x 4 x x 3 x Fountain View DS0000055841.V355948.R01.S.doc Version 5.2 Page 28 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. 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. Refer to Standard Good Practice Recommendations Fountain View DS0000055841.V355948.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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