Care Home: Granary The

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What the care home does well Relatives of the people living in the home said that they are made to feel welcome by the people working in the home and that they can visit when they please.The home has an enthusiastic team of people working within the service, who like doing their jobs and learning more about how to do it well. The people working in the home want to make sure that the people who live in the home receive good care. People being cared for have good access to professional medical staff and are able to access external services such as dentists, opticians, physiotherapists, chiropody and dieticians, so their health is looked after and they are kept well. The people spoken to are positive about the home and like living there. People living in the home expressed their satisfaction during this visit regarding the care given and the service received. Staff are hard working and do their best to meet the needs of those people living in the home. What has improved since the last inspection? Repairs and redecoration of the home have improved the living environment for people using the service, so they now have a safe and comfortable place in which to live. Staff training has got better and includes a good range of subjects that relate to looking after people with learning disabilities, so staff have the skills and knowledge to meet the needs of people living in the home. Evidence from this visit shows that the manager and staff have worked extremely hard to improve the service and meet the requirements and recommendations from the last two reports (November 2007 and April 2008). This has provided people who live in the home with a better service. What the care home could do better: The person who owns the home must make sure there are enough staff on duty throughout the day, who can work flexibly to meet the needs of people using the service, and ensure that individuals are supported to take part in activities outside of the home, including at weekends and evenings. This will improve the quality of life for those people living in the home. We would like to thank everyone who completed a survey or spoke to us during this visit. Your comments are very important to us and ensure this report includes the views of people who use the service or work within it. CARE HOME ADULTS 18-65 Granary The Church Lane Brandesburton Driffield East Yorkshire YO25 8QZ Lead Inspector Eileen Engelmann Key Unannounced Inspection 20th October 2008 10:00 Granary The DS0000019742.V372809.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 Granary The DS0000019742.V372809.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. Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Granary The Address Church Lane Brandesburton Driffield East Yorkshire YO25 8QZ 01964 543332 01964 543332 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) londonroad@tiscali.co.uk Milbury Care Services Ltd Jacinta Murray Care Home 15 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (4) of places Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC; To service users of the following gender: Either; Whose primary care needs on admisson to the home are within the following categories: Learning disability - Code LD and LD(E) The maximum number of service users who can be accommodated is: 12 Category LD(E) relates only to named service users identified to the Commission for Social Care Inspection on 18.9.2006. 22nd April 2008 2. 3. Date of last inspection Brief Description of the Service: The Granary is a care home providing accommodation and care for up to 12 adults with learning disabilities. It is located in the village of Brandesburton. It is a short walk into the village and allows access to hairdressers, shops, post office, pubs and a fish and chip shop. The main road through the village allows access to public transport. There are 12 single bedrooms, two of which have en-suite facilities. All bedrooms are for single occupancy. The home has a well-maintained front garden and is surrounded on two sides by fields. Garden furniture is available for service users to sit outside. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home. Information given by the manager on 21 October 2008 indicates the home charges fees from £761.59 to £980.91 per week. The level of fee is dependent on the specific needs of the individual. People will pay additional costs for optional extras such as use of the minibus, hairdressing, private chiropody treatment, art classes, toiletries and newspapers/magazines. Information on the specific charges for these is available from the manager and in the service user guide. Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. Information has been gathered from a number of different sources over the past 11 months since the service had its last key visit from the Commission for Social Care Inspection, this has been analysed and used with information from this visit to reach the outcomes of this report. This unannounced visit was carried out over two days as the manager was not available on the first day, so the inspector came back to discuss the outcomes and clarify some information with the manager on day two. This unannounced visit took place with the deputy manager, staff and people using the service. The visit included a tour of the premises, examination of staff and people’s files, and records relating to the service. Informal chats with staff and people living in the home took place during this visit; their comments have been included in this report. Questionnaires were sent out to a selection of relatives, people living in the home and staff. Their written response to these was good. We received 4 from staff (80 ), 7 from relatives (70 ) and 6 from people using the service (60 ). The manager completed an Annual Quality Assurance Assessment and returned this to us within the given timescale. There was an additional unannounced visit in April 2008 when we looked at issues raised in the last report (November 2007). It was found at this visit that the home was making progress to address the requirements and recommendations from the key visit in November 2007. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: Relatives of the people living in the home said that they are made to feel welcome by the people working in the home and that they can visit when they please. Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 6 The home has an enthusiastic team of people working within the service, who like doing their jobs and learning more about how to do it well. The people working in the home want to make sure that the people who live in the home receive good care. People being cared for have good access to professional medical staff and are able to access external services such as dentists, opticians, physiotherapists, chiropody and dieticians, so their health is looked after and they are kept well. The people spoken to are positive about the home and like living there. People living in the home expressed their satisfaction during this visit regarding the care given and the service received. Staff are hard working and do their best to meet the needs of those people living in the home. 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. Granary The DS0000019742.V372809.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 Granary The DS0000019742.V372809.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): Standard 2, 3 and 5 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. EVIDENCE: Three people’s care and records were looked at as part of this visit, they each have been provided with a statement of terms and conditions/contract on admission and these are signed by the person or their representative. These documents give clear information about fees and extra charges, which are reviewed and kept up to date. In each of the three care plans looked at during this visit there was a copy of the community care assessment and Local Authority care plan. The home also completes their assessment of need and from these a detailed and descriptive care plan is developed. Input from other professionals and/or family is also recorded and each plan is individualised to the person using the service. Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 9 Discussion with the manager, at our visit in April 2008, indicated that the home would no longer be accepting emergency placements. All people coming into the home will have a planned admission, which ensures the assessment of need; local authority care plan and information about the person are available before a decision to accept the person is made. One person whose file we looked at has recently been admitted, they were able to visit the home on several occasions to meet the staff and other people using the service, before making the decision to come in permanently. Discussion with the manager indicated she goes out to assess individuals who have expressed an interest in coming into the home, and each person is given information about the service and life in the home. Information from the Annual Quality Assurance Assessment and discussion with the manager and people living in the home indicates that the majority of the people using the service are of White/British nationality. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of the care given on a daily basis. Information from the people’s surveys showed that they were satisfied with the care they receive and have a good relationship with the staff. Two relatives said ‘staff go to great lengths to meet people’s individual needs and give people as much fun and enjoyment in life as possible’ and ‘the service is first class and the staff are marvellous’. Information from the training files and training matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, and have access to a range of more specialised subjects that link to the needs of people using the service. Some individuals in the home have limited or no verbal communication skills but alternative methods, such as the use of Makaton and basic sign language, are used to good effect. Granary The DS0000019742.V372809.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): Standards 6, 7 and 9 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to be independent within their daily lives using a risk assessment approach to care. EVIDENCE: Information from the surveys indicates that the majority of people who responded are satisfied that the staff give appropriate support and care to those living in the home. People said they are able to make their own decisions about their daily lives most of the time; that staff treat them well and listen and act on what they say. Comments from the relatives surveys said ‘ I am very happy with the care in the home, my relative is well looked after. They definitely feel at home and are settled in their daily life’ and ‘staff are always friendly and helpful, it is a pleasant environment and a well run home’. Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 11 Since the visit in April 2008 the manager and staff have worked extremely hard to improve the quality of the care plans for the people using the service, using a corporate format. Each individual now has a detailed, descriptive and person centred plan, which identifies their individual needs and abilities, choice and decisions and likes and dislikes. In addition to this information there are risk assessments to cover daily activities of life, behaviour management plans where a risk to the person or others has been identified, and clear information about health and input from professionals and the outcomes for people. Staff are monitoring and reviewing the care plans on a regular basis and work is progressing to ensure each plan is explained to the person concerned and that their signature/or their representatives signature is obtained to show they agree with the content. Reviews of care with the families, person living in the home and care coordinator from the local authority are taking place and minutes of these meetings are in the plans. The in-depth care plan for the person newly admitted into the home is being created. Discussion with the manager indicated this process could take up to six weeks to complete due to the complexity of the information gathered. New staff in the home told us that the care plans were made available to them at all times, but it took some time to read and understand all the information within them. The manager recognises that the corporate care plan is not an appropriate format for people using the service, in that some individuals would not be able to read or understand the information within it. Instead the people in the home have been involved in developing their own personal care plan, using photographs and pictures about their lives and easy to read information about their needs and abilities. With help from their key worker they have created simple but meaningful care plans that reflect their feelings and understanding of their care. Staff enable people to take responsible risks in their every day lives and information within the care plans includes a number of risk assessments covering activities of daily living. Talking to the people living in the home and watching them go about their daily business showed that some individuals find it relatively easy to maintain their independence and are able to make their choices and decisions known without a lot of input from the staff. Others require a lot more from the staff because of communication difficulties, physical support and assistance and this is managed well on a day-to-day basis. Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 12 The more able bodied of the people living the home are able to live fairly independent lifestyles, two people we spoke to have their own lounge, kitchen and bedrooms in the annex (Brandes Lodge). They kindly showed us around their living accommodation and talked about going out into the local village and taking part in the community. One person enjoys being part of the local darts team and showed us their certificates from the matches played. Granary The DS0000019742.V372809.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): Standards 12, 13, 15, 16 and 17 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities within the home and community means that people that live in the home have the opportunity to maintain and develop their skills and participate in stimulating and motivating activities that meet their individual needs, wants and aspirations. This would be further improved by additional staffing. EVIDENCE: At the time of this visit (October 2008) there was no-one using the service who was attending any educational courses, however if anyone expressed an interest in doing so this would be facilitated as it has in the past. Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 14 Improvements to the recording of activities, in the care plans, means that there is clear information about who enjoys what hobbies and interests and how these are accessed within the home and community. Information from the care plans and talking to staff and people using the service indicates that three individuals attend ‘the Green Project’ which is on a farm in Hatfield; where they enjoy vegetable planting and general gardening sessions. Most attend twice a week and the two people that we spoke to during this visit said they enjoyed going. One person goes twice a week to Sowerby Hall and helps out in the green houses and gardens. Two people showed us around their accommodation and introduced us to their dog, usually there are two animals but one stays with the manager overnight. They said they like going out for walks with their animals and clearly enjoyed the interaction with their pets. People using the service have access to a range of social activities inside and outside of the home. At the moment outside events are limited to when there are sufficient staff on duty to act as escorts and drivers for the mini-bus and car. The staff are very motivated about their work and often come in their own time to ensure people get out and about in the community. There is no activity co-ordinator for the home so staff are responsible for organising and carrying out social activities. Each person using the service has their own activity plan in their care file, showing what their interests are and what they want to do each week. For those who are fairly independent these plans are very detailed and show they get out every day, for those more dependant the activities provided still reflect their choices and decisions but are more limited. People we spoke to told us that the staff ‘ cook nice meals’, ‘we go out on day trips’, and ‘they look after us well’. Some individuals told us that they would like to have film nights in the home or go to the pub more regularly. There is a weekly art class that people enjoy attending and pictures they have created are hung on walls around the home. One relative said ‘it would be nice if more music and theatre activities could be introduced’. At the moment there are no church services in-house, but people can access the local church in Brandesburton. Two people attend regularly and one other person attends when staff numbers are sufficient enough to take them. People living in the home are encouraged to celebrate Christian festivals such as Christmas, Easter and Harvest Festival; birthdays are celebrated in different ways depending on the individual’s wishes. Staff have accessed equality and diversity training through their NVQ’s and the L-Box training facility, they are aware of peoples rights and can offer individual support in the community and at the home. Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 15 Evidence in the care plans indicates the people in the home are registered to vote should they wish to do so; and although the local advocacy services cannot offer a service to the home, there are best interest meetings held with outside professionals when individuals cannot give consent themselves to medical treatment due to mental incapacity. Considerable importance is attached by the manager for people to have contact with members of their family. Where a person may not have had good contact on admission with their family, the manager and staff have made considerable efforts on the person’s behalf to establish contact. A newsletter has been developed to share information of events going on in the home with relatives who cannot visit regularly. One relative told us that ‘I am always made welcome when I visit the home, any questions I may have are answered fully and my relative is happy in the home’. The people living in the home relate well to each other and the staff. It was observed that people are aware of those who cannot communicate verbally. Individuals were seen to use sign language/makaton to communicate to another who has no verbal communication skills. The conversations between the people using the service and the staff were natural and spontaneous, and it was evident that the people living in the home have a good sense of humour and enjoy a laugh and a joke with others. We were made welcome in the home and it was clear throughout our visit that people were interested in what we were doing and went out of their way to let us into their daily lives. Observation of the midday meal showed it was a relaxed occasion and people could choose to eat in the main house dining room or take a tray back to their accommodation. Individuals can select their favourite meals to appear on the monthly menus, through discussion at the regular resident meetings. From discussions with the staff and an examination of the records, it was evident that a reasonable balance has been achieved between healthy eating and the meals preferred by the people using the service. People were offered a choice of sandwiches, sausage rolls, salad, fresh fruit and biscuits at lunchtime. Every one in the home eats a normal diet, with some people needing assistance/prompts to ensure they ate their meal appropriately. Granary The DS0000019742.V372809.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): Standards 18, 19 and 20 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s personal and healthcare needs are met through good inter-agency working and by the staff having a sound knowledge of each individual’s needs. EVIDENCE: It was apparent from discussions with the staff and observation of the people using the service that people require primarily support and encouragement to do as much as possible for themselves. Whilst some individuals require some assistance with personal care such as bathing and washing, this is relatively low key and in the main consists of staff supervision and guidance. The staff are fully aware of the need to maintain people’s dignity and efforts are ongoing to achieve this whilst carrying out care tasks. The care plans are very detailed about individual wishes and routines so that people’s independence is supported and individuality is not lost. The home is able to offer people a choice of staff gender for carrying out personal tasks, as the home employs three male care staff who do day duties. Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 17 Discussion with the people living in the home indicates that they have no difficulties communicating with the staff and that they can express their preferences of staff gender for individuals giving their personal care. In general there was a very flexible approach to the people’s routines although they are expected to attend their work experience placements and some individuals have small housekeeping duties to perform. A plan of the housekeeping tasks for people to do is on display in the home and individuals have signed it to say they agree with its content. People said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from the people and relatives indicate they are satisfied with the level of medical support given to the people living at the home. Information in the care plans show where best interest meetings have been held with multi-disciplinary teams, to decide the appropriate treatments and medical decisions, where individuals are unable to give their consent to this due to mental incapacity. Checks of the systems showed that medication is secured in a dedicated drugs cabinet. The staff who are responsible for administration of medication have received appropriate training. The bulk of the medication is administered from a nomad system. Other medication including creams, ointments and liquids is administered directly from their original containers. An appropriate medication administration policy and procedure is in place. From a description of the process provided by a member of staff, it was apparent that it was safe and efficient. The medication records are complete and up to date. There were no controlled medications being used in the home at the time of this visit (October 2008). One person’s medication had been hand written (transcribed) onto the medication sheets, as they had come in after the pharmacist had printed the records. We recommend that where staff are writing in the details, there should be two staff signing the entry to indicate they have both witnessed that the information on the sheet (name of medication, strength and administration methods) is correct. Granary The DS0000019742.V372809.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): Standards 22 and 23 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that people’s views are listened to and acted upon. EVIDENCE: The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home. An easy read version is available in the back of people’s service user guides and for those with communication difficulties the staff explain it using makaton. The complaints process is also discussed during the monthly resident meetings. People’s survey responses showed individuals have a clear understanding about how to make their views and opinions heard and those people spoken to said ‘we can always talk to the staff or the manager’. Checks of the records show that there have been no formal complaints made about the home or its service since the last key visit in November 2007. There is a complaints/concerns book in the entrance hall of the home, and whilst the format is satisfactory we recommended that the home consider using individual forms instead of a bound book, in order to protect confidentiality. Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 19 The staff demonstrated a good awareness of the process to safeguard the people in the home. They had all received training on the subject that included the types and indications of abuse. No referrals have been made under the Protection of Vulnerable Adults procedure. Appropriate policies and procedures are in place in relation to the protection of the people using the service. Discussion with the people using the service indicates that they feel safe within the home and are confident that staff would help them if they had any concerns or problems. Granary The DS0000019742.V372809.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): Standards 24 and 30 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment provides people with safe, comfortable and homely surroundings in which to live, that meet their individual needs and lifestyles, EVIDENCE: The home presented as a normal domestic environment. There is no external indication that it is a care home thereby minimising any possible stigmatisation of the people using the service. The furnishings and fittings of the communal or shared areas, such as the lounge, dining room and kitchen, continue the theme of domesticity. They are furnished and decorated to a good standard and are appropriate for the needs of the people living in the home. At our last visit in April 2008 a requirement was made that Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 21 ‘The registered person must ensure there is a written maintenance programme for the premises with given timescales for completion. Outstanding issues must be given priority for action to ensure people’s health and safety is protected and maintained’. Checks at this visit show this has been met. Discussion with the manager, observation of the environment and information supplied to us during this visit indicates that there is a maintenance programme in place for the home. The windows to Brandes lodge have been replaced and redecoration within the home is ongoing. People showed us that their living accommodation, bedrooms and kitchens have been re-painted, and the ceiling below bedroom 12 has just been re-skimmed due to a water leak. Since our last visit in April 2008 the windows and doors to the laundry area have been replaced, the front garden wall has been rebuilt and a ramp to the side of this, for access by people using wheelchairs or motorised scooters, is now in place. The manager, staff and people using the service have enjoyed gardening at the home during the warmer summer months and the outside areas were looking good during this visit. People have been provided with new garden furniture of solid benches, tables and parasols. Discussion with the manager and staff indicated that in the past they have been responsible for the painting and decorating of people’s bedrooms. The processes within the home show that the manager has access to a maintenance person on request, but this does not address the day to day needs of the home around repairs and the registered person should strongly consider providing the service with its own handyman to carry out the small jobs that occur daily. People using the service have access to one large lounge in the main house, this is provided with a large screen television, DVD and CD player and a pool table. All bedrooms in the home are single rooms and there are 2 en-suite shower and toilet facilities. Communal facilities include 4 bathrooms and 1 shower room. Two people living in the annex have their own lounge and kitchen as well as individual bedrooms. There is no nurse call system in the home, but night staff are supplied with hand held walkie-talkies, one person also has this facility in their room as they require more assistance at night and they also have a personal tag alarm. Other communication devices include intercom devices to monitor individual rooms and door alarms to alert staff if people are moving around at night. Discussions during this visit indicate that people using the service are satisfied with the laundry service provided by the home. Infection control policies and procedures are in place, and staff have access to good supplies of aprons and gloves for use in personal care. The staffing Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 22 matrix supplied to us on 20 October 2008 indicates that infection control training took place throughout 2007 and is valid for three years. Granary The DS0000019742.V372809.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): Standards 32, 33, 34 and 35 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The contingency plans for cover of staff vacancies and sickness are not robust or imaginative, and rely on the good will of existing staff to provide that cover. Staffing levels are insufficient to provide a flexible service to fit around the lifestyles of individuals. EVIDENCE: At our last visit in April 2008 a requirement was made that ‘The registered person must ensure that staff receive specialised training in meeting the complex needs of people with a learning disability so the health and welfare of the people using the service is promoted and protected’. Checks at this visit show that the manager is making progress towards introducing a wider range of specialist subjects linked to learning disabilities. This requirement is now met. The staffing training matrix supplied to us during this visit shows that staff are attending mandatory training and some specialised subjects including autism, Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 24 equality and diversity, report writing, basic sign language, person centred plan awareness, safe handling of medication, non-crisis intervention techniques and safeguarding of vulnerable adults. 39 of care staff have completed their NVQ 2 in care and all staff undergo LADF training after 12 weeks with the company. New starters complete an induction and attend reviews of their progress throughout their probationary period. One member of staff is responsible for keeping the staff training records up to date and said that the staff access to E-Learning has improved the uptake of training across the board. Each staff member has their own training file and knows what training they must attend each year. The employment records show that the manager is using a selective approach to recruitment; ensuring new staff have the right skills and attitude to meet the needs of people in the home. Checks of the staffing rotas and observation of the service showed that the home employs male and female care staff and a number of staff are from different countries and cultures. At our last visit in April 2008 a requirement was made that ‘The registered person must ensure that the home has an effective staff team with sufficient numbers and skills to support people’s assessed needs at all times. Staffing levels must be regularly reviewed to reflect peoples changing needs’. Checks at this visit show this has not been addressed despite repeated requests for more staffing resources by the manager. The requirement will remain on this report and if not addressed within the given timescales could lead to enforcement action being taken. Discussion with the manager and checks of the staffing rotas show that although the existing staff team are very good at covering shifts when others are on sick leave or holiday, they are also inputting a lot of their own time to ensure the people using the service have a good quality of life. Evidence from this visit shows that the manager and staff have worked extremely hard to improve the service and meet the requirements and recommendations from the last two reports (November 2007 and April 2008). However there is a risk that the improvements seen at this visit could be undermined by a lack of staff support. Our evidence gathered during this visit shows that low staffing levels are impacting on people’s activities and staffs’ ability to engage with people on a 1-1 basis. Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 25 Comments from the surveys back up our observations in that people said ‘mornings are difficult (if staff are limited) due to care tasks such as bathing. People are left sitting in the dining room until staff are free to start breakfasts’ and ‘cleaning and taking people to appointments means staff do not have much time to spend with people’. Information from the staffing rotas shows that at present there are 507 staffing hours being provided for the service, this figure includes the managers hours, care hours, laundry, cleaning and cooking hours. At the time of this visit in October 2008 there were 12 people living in the home and the staffing levels were as follows Morning Afternoon Night - 4 staff on duty (including the manager) - 3 staff on duty - 2 staff on duty Using information about dependency levels provided by the manager at the this visit, checks against the Residential staffing forum guidelines for a learning disability home shows that staffing hours should be 544. Given that the latter figure is for pure care hours and that staff in the home actually do domestic, laundry and kitchen duties, the registered person must ensure there are sufficient staff on duty to provide the appropriate care hours in addition to the ancillary tasks. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of three staff files showed that police (CRB) checks, written references (kept at head office), health checks and past work history are all obtained and satisfactory before the person starts work. Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. EVIDENCE: The registered manager is Jacinta Murray and she has been in post for the past two and a half years. She has previous work experience with younger adults with challenging behaviours. Evidence was seen at this visit that the manager has completed her registered managers award, this was a recommendation in the last report (April 2008). Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 27 Throughout this visit the manager demonstrated a good understanding of what constitutes good care and provided numerous examples on how that could be achieved. From discussions with the people using the service and the staff, it was apparent that the manager possessed good leadership skills. The manager has a democratic style that involves the people living in the home and the staff in the decision making processes. The home does not have a formal quality assurance process in place, but does have a range of quality monitoring systems in use. Policies and procedures within the home have been reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The responsible individual does spot checks and completes the regulation 26 visits. Feedback is sought from the people living in the home and relatives through regular satisfaction questionnaires, and the manager has produced a development report as part of this process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. An annual service review is held with all stakeholders on a yearly basis when individuals are invited to comment on the service and discuss its progress. Meetings for people using the service are held on a regular basis and minutes are available for those expressing an interest. Staff have meetings with the manager and everyone is encouraged to join in with discussions and voice their opinions. People and staff agreed that they are able to express ideas; criticisms and concerns without prejudice and the management team will take action where necessary to bring about positive change. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling and daily activities of living. Granary The DS0000019742.V372809.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 x 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 2 14 x 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 29 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 YA33 Regulation 18 Requirement The registered person must ensure that the home has an effective staff team with sufficient numbers and skills to support people’s assessed needs at all times. Staffing levels must be regularly reviewed to reflect peoples changing needs. (Timescales of 31/08/07, 28/02/08 and 1/10/08 were not met) Timescale for action 01/04/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA13 YA20 Good Practice Recommendations The registered person should ensure that staff time with, and support for, people outside of the home is flexibly provided, including weekends and evenings. The manager should check the medication records to ensure that where staff are hand writing medication onto the sheets (transcribing), there are two staff signing the entry to indicate they have both witnessed that the information on the sheet (name of medication, strength DS0000019742.V372809.R01.S.doc Version 5.2 Page 30 Granary The 3. 4. 5. YA22 YA24 YA32 and administration methods) is correct. The registered person should consider altering the complaints book so forms are detachable and not kept in a bound book. This will protect people’s confidentiality. The registered person should consider employing a handy man specifically for the home, who could carry out the day to day maintenance tasks in a timely manner. The registered person should ensure that at least 50 of staff are qualified to NVQ level 2 by the end of April 2009. Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Granary The DS0000019742.V372809.R01.S.doc Version 5.2 Page 32 - 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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