Care Home: Insight

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What the care home does well Brusons has provided successful support to some people with very challenging behaviour, where other services have failed. The home undertakes detailed and individual assessments of people who wish to move to the service so that the staff team have a good knowledge of how to respond to the person when they enter the home.The service is proactive in developing its own training in minimising and responding to behaviours that challenge and is seeking accreditation by the British Institute for Learning Disabilities for its own training programme The focus of the service is on the individual client. There is a clear aim in the home of setting goals for each individual client and monitoring that they are met. People who live at the home have opportunities to try out new experiences. For example, swimming and participating in a boot fair. The home employs a behavioural therapist. Psychology support is purchased externally as it is not available through the local learning disability team. The home has a good understanding of Mental Capacity Act and has used it to promote the best interests of two clients in relation to their physical health. The home has got the balance right between making the environment safe, but also homely. What has improved since the last inspection? The service has highlighted two main areas where improvement was needed and has taken action to address this. They have employed a person centred coordinator full time, whose responsibility is to make sure that each client has clear goals that they are aiming for, and that these goals are met. They have employed a full time human resources officer to ensure that staff receive all the necessary training for them to perform their roles. This person is also responsible for making sure the correct procedures are followed when a new member of staff is employed. Taking these tasks away from the registered manager has freed her time to more effectively undertake her other responsibilities. What the care home could do better: The staff team is not up to date with all areas of training. They could have been quicker to respond to this shortfall. However, they have now employed a human resources officer to book this training and ensure that the staff team are full trained. Only 30% of the staff team is qualified to NVQ 2 or above. The National Minimum Standards state that this percentage should be 50%. The home have put plans in place to address this shortfall. CARE HOME ADULTS 18-65 Insight Brusons 5 London Road Teynham Sittingbourne Kent ME9 9QW Lead Inspector Nicki Dawson Unannounced Inspection 27th February 2009 09:45 Insight DS0000023966.V373907.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 Insight DS0000023966.V373907.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. Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Insight Address 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) Brusons 5 London Road Teynham Sittingbourne Kent ME9 9QW 01795 520290 lyndainsight@aol.com Mrs Lynda Jane Cashford Mrs Jayqueline Frances Hales Mrs Lynda Jane Cashford Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 11. Date of last inspection 29th March 2007 Brief Description of the Service: Insight Brusons is a care home providing care for up to 11 adults who have a learning disability and present challenging behaviours. It is one of a group of three homes owned by Mrs J Hales and Mrs L Cashford. The home is located in a village, close to shops and other local amenities. Accommodation is provided in 2 separate buildings. The main house is a large detached building that offers spacious communal accommodation and has 7 single bedrooms. A further 4 single bedrooms are provided in a detached bungalow situated immediately behind the main house. There is a large attractive garden to the rear of the property and ample parking facilities are provided. The current fee levels range from £1280.75 to £3592.86 per week. Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means people who use this service experience excellent quality outcomes. The inspection was unannounced, which means that the service users and staff did not know that the inspector was calling at the home. The inspection started at 9.45am and took 8 hours. Discussion took place with clients, a visiting relative and members of the care and management team to gain their views and knowledge of the level of care, provided by the service. The inspector was invited to observe a care plan review for one client. The shared areas of the home and most clients bedrooms were entered. Time was also spent looking at records to do with clients care and safety. Prior to the inspection an annual quality assurance assessment (AQAA) was sent to the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The AQAA gave clear and detailed information about how the service strives to meet and improve the service for the benefit of the people who use it. Survey questionnaires (Have Your Say About..) were sent by the CSCI to the home before the inspection visit. There was a good response from people who live in the home. Comments received were positive about the level of care provided by the service. For example, My bedroom is nice. Nice staff. I like the people I live with; I like the food; Its a nice place and I like living here. The staff are OK too; I am very happy here and I have a lovely life….I am happy to go home, but I am also happy to go back to Brussons. In addition, one survey was completed and returned from a social care professional. This person commented that the service, Works with individuals with challenging behaviour with a very can do approach. Very person centred service. What the service does well: Brusons has provided successful support to some people with very challenging behaviour, where other services have failed. The home undertakes detailed and individual assessments of people who wish to move to the service so that the staff team have a good knowledge of how to respond to the person when they enter the home. Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 6 The service is proactive in developing its own training in minimising and responding to behaviours that challenge and is seeking accreditation by the British Institute for Learning Disabilities for its own training programme The focus of the service is on the individual client. There is a clear aim in the home of setting goals for each individual client and monitoring that they are met. People who live at the home have opportunities to try out new experiences. For example, swimming and participating in a boot fair. The home employs a behavioural therapist. Psychology support is purchased externally as it is not available through the local learning disability team. The home has a good understanding of Mental Capacity Act and has used it to promote the best interests of two clients in relation to their physical health. The home has got the balance right between making the environment safe, but also homely. What has improved since the last inspection? What they could do better: The staff team is not up to date with all areas of training. They could have been quicker to respond to this shortfall. However, they have now employed a human resources officer to book this training and ensure that the staff team are full trained. Only 30 of the staff team is qualified to NVQ 2 or above. The National Minimum Standards state that this percentage should be 50 . The home have put plans in place to address this shortfall. Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 7 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. Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who live or may want to live at Brusons have all the information that they need to help them decide if this is the right place for them to live. Prospective clients can be confident that their needs and aspirations will be fully assessed and met. EVIDENCE: The aims and objectives of the home are clearly set out in the homes Statement of Purpose. The Service User Guide sets out the services and facilities for people that live or plan to live in the home. It has been developed into a pictorial guide so that the document is accessible to those people for whom the service is intended. Although an excellent document, the team leader said that the service has recognised that for more able clients, the current format of the guide may not be appropriate. He said that in future the Service User Guide will be made individual to the specific needs of the client. Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 10 Before a prospective client is admitted to the home a very detailed assessment report is made of the clients needs. The assessment of one client was viewed. It was very professionally written and contained a lot of well thought out information. For example, not only did the assessment contain information about the persons diagnoses, but also information about how the clients current environment differs to that at Brussons and how this may affect the person concerned. In addition to assessing need, the report also identifies strategies to be put in place to meet these assessed needs such as redirecting behaviours that may challenge. The service specialises in supporting people who have severe challenging behaviours in addition to a learning disability. The home has a number of strategies in place to ensure that they meet this aim. They employ a behavioural therapist. They have good links with local health professionals. A number of staff is currently undertaking training at the Tizard Centre, which offers specialist courses in adults with learning disabilities. All staff attend external courses in challenging behaviour. The home has designed its own training workshop proactive and responsive support to challenging behaviours which it is seeking accreditation by the leading organisation in this area, the British Institute for Learning Disabilities. Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6-9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Clients can be confident that their individual needs and personal goals are contained in their care plans and that clear instructions are in place for staff to follow to ensure that they are met. Clients are supported to make decisions and choices, and are consulted on all aspects of life in the home. EVIDENCE: The care plans for two clients were looked at. Each plan contains a pen picture of the client which gives the reader a good description of the person’s individual personality. Care plans contain the assessed health, care and social needs of clients, together with the staff support that is needed to meet these needs. Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 12 In addition to care plans, clients have person centred plans completed with input from family members. One such plan was viewed and contained pictures and important information about the clients life, including their likes and dislikes, and communication needs. Detailed but clear risk assessments are in place for clients. Where a client has a number of risk assessments in place a summary is given which gives an overview of the clients individual needs. Some clients at the home have limitations on choices. The reasons for these are fully documented. The home manages risk, whilst at the same time ensuring that clients are supported to lead as normal a life as possible. Clients changing needs are observed and recorded on a daily basis. The behavioural therapist reviews all the information regarding clients challenging needs, communication and behaviour. Their findings are then fed back into individual care plans, risk assessments and behaviour guidelines. This information is presented to clients and their representatives at any care reviews that take place. There is an important emphasis in the home on setting and meeting clients individual goals. Clients have a monthly meeting with their key worker and the person centred planning coordinator to ensure that progress is being made towards setting and meeting their goals. Formal reviews are held six monthly with all interested parties. These review meetings are both informative and positive experiences. Clients have a regular opportunity to make their needs know at client forum meetings. These meetings are made up from clients from the three homes in the company and give those who want to and are able to, a real say in day to day decision making. These meetings are facilitated by an individual who is not employed by the company. This is an excellent piece of work. The team leader said at the inspection that the home does not have responsibility for managing any clients monies. However, he has since clarified that the registered manager is appointee for a number of people that live at the home. The team leader states that all clients moneys are checked by an independent person. This makes sure that moneys are spent according to the needs and wishes of the people who live at Brussons. Insight DS0000023966.V373907.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): 11 - 17 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Clients are supported to live fulfilling lives. EVIDENCE: The aims of the home, as set out in its Statement of Purpose, are for people with learning disabilities and severe challenging behaviours to live in an ordinary home in the community, to grow and develop and to become more independent. There is evidence that clients have the opportunity for personal development, since their wishes, aspirations and goals are identified in their care plan and these goals and progress towards them is regularly monitored. One client Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 14 said, The home has helped me be more independent and with making friends. I have lots of choices. Clients that were spoken with said that they had lots of opportunities to be involved with life in the community and in home life. All clients who completed surveys said that they can choose what they want to do during the day, evening and weekend. One client said that they go to college and a personal development group; another said that they are going out on a special trip for their birthday. During the inspection clients were observed taking part in domestic tasks and playing games in the garden. A relative said about a client that lives in the home, He goes out a lot. Life in the home was very calm and organised on the day of the inspection and it is sometimes easy for a visitor to forget that this is a home for adults with challenging behaviours. The home supports clients to have new experiences. One clients wish to go swimming has been met by privately hiring a swimming pool. One client wanted to get a job in the market and now regularly organises boot fairs. Holidays for clients are encouraged, based on a thorough assessment of an individuals behaviours over a set period of time. Clients are encouraged and supported to maintain links with their friends and family. It was clear during discussion that the home plays a key role in supporting these positive relationships. A visiting relative said that she is able to visit the home at any time and that she is always made to fell welcome. Clients are involved in choosing what is on the daily menu. The inspector joined some clients for lunch. Mealtimes are social occasions. Staff always eat meals with clients and use this as an opportunity for role modelling and a time to sit down and talk with each other. Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 15 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 - 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Clients personal and healthcare needs are fully met. Clients benefit from their healthcare needs being promoted in their best interests. EVIDENCE: There are written records of clients support needs and personal preferences for personal care. All tasks that are carried out are clearly recorded and tracked in daily care notes. Clients health care needs are detailed in a separate health care record. This record is a detailed document of historical and ongoing health or medical concerns, and provides information and guidance regarding specific health needs. Any visits by or to healthcare professionals are recorded in the daily notes, and the detail of the visit is recorded in the health care plan. As part of Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 16 the initial assessment, the home undertakes a ‘health check’ on all new clients. This adds to and complements the health care record, and includes a summary for further action. Clients benefit from specialist support. A behavioural therapist provides behavioural support and psychology support is purchased externally. Many community resources for mental health, epilepsy and speech and language are accessed on behalf of the people who live in the home. One member of staff has the additional role of health and social care coordinator. It is their responsibility to make sure that all clinical and health appointments are booked and that there is sufficient staffing levels for clients to attend. The home has championed the health care needs of two clients recently by organising two best interest meetings under the Mental Capacity Act. This has ensured that clients health care needs have been met. At the last inspection it was found that clients medication was stored and signed for correctly and that specific guidance is in place on how the individual prefers to take their medication. At this inspection, staff demonstrated that they were competent in administering medication and knew what to do if an error occurred. Evidence was found that there are good systems in place to audit medication records so that it can be assured that medication is given safely and that clients receive it as prescribed by their GP. Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 17 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 excellent. This judgement has been made using available evidence including a visit to this service. Clients can be assured their views are listened to and acted upon, and that they will be protected from harm. EVIDENCE: Neither the home nor the commission have received any complaints about the service since the last inspection. Clients and relatives who were spoken with said that they could talk to anyone if they have any worries or concerns. All clients who completed surveys stated that they know who to speak to if they were not happy. Each client has a copy of the complaints procedure in their Service User Guide. It is also recommended that the complaints procedure is displayed prominently in the home so that anyone living in or visiting the home is aware of it. The home provides in house training for staff and for people living in the home about abuse, neglect and self-harm. Staff who were spoken with described the appropriate action they would take if they suspected abuse having taken place. They said that they felt confident to speak out if they observed any potentially abusive behaviour and that they had done so. One relative said, It is peace of mind that X is living in this home. As stated earlier in this report, the service specialises in supporting people who have severe challenging behaviours in addition to a learning disability. Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 18 Physical intervention is seen as the last resort by the home, and guidelines inspected evidenced a professional and measured approach to responding to aggressive incidents. All staff attend external and internal courses in how to manage challenging behaviour. Staff demonstrated that they have a good understanding of the individual programmes in place for people that live in the home. The home is seeking accreditation by the British Institute for Learning Disabilities for its own training programme in minimising and responding to challenging behaviours. One client said, staff have taught me to walk away when I am angry….. like a Jedi knight. Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 19 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 - 28 and 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Clients benefit from living in a home that is comfortable, safe, clean and well maintained home. EVIDENCE: The home is a converted private house, situated close to the village of Teynham. The home is typical of houses in the surrounding area and there is nothing to determine this is anything other than a family home. The service is split into two buildings. The main house provides accommodation for seven people. These clients are provided with two communal lounges, a dining room and kitchen. The bungalow which is situated immediately behind the main house provides accommodation for three people. People that live in this part of the home have use of a lounge and kitchen dinner. It was noted during the inspection that people who live in the bungalow also have access to the communal areas of the main home, with Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 20 staff support. In addition, clients benefit from large gardens to the front and rear of the property. Clients were making good use of these facilities on the day of the inspection. A number of client bedrooms were entered and contain a varying degree of personal belonging depending on the individuals choice and safety. It is not obvious from first entering the home that the service is intended for people who present behaviours that challenge. The service has informed us that in order to reduce the impact of challenging behaviours on the environment, a high level of maintenance is required. This strategy has paid off, as it was evident on the day of the inspection that the home is pleasant and comfortable and kept in a good decorative state both internally and externally. The home have got the balance right between making the environment safe, but also homely. One of the toilets in the main house has been removed as it is not working properly. However, clients still benefit from sufficient numbers of toilets. At present the laundry room is situated in an outbuilding. The home has plans in place to improve the bathroom and laundry facilities available to people who live in the home. An additional bathroom and laundry room are to be provided by an extension to the main house. The team leader said that building plans for this project have been submitted to the local council. The home presented as clean and hygienic on the day of the inspection. Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clients benefit from a well supported staff team. The home is working towards ensuring that all staff are trained in the areas necessary for them to perform their roles safely. EVIDENCE: The staff rota indicates that there are between eight and ten care staff on duty during the day. High staffing levels reflect the assessed needs of the clients in the home, with the majority requiring one to one staff support. The shift leader is responsible for allocating a member of staff to an individual client for that shift. At the next shift a staff member is allocated to a different client. The service understands the delicate balance of ensuring continuity of care, without making one client dependent on a particular member of staff. At night time there are three members of staff with a mixture of waking and sleeping duties. To ensure the individual needs of clients are met, there is always one male member of staff on duty. Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 22 Both clients and relatives were complimentary about the support that care staff offer at the home. A relative said, The staff team is cohesive and there is good communication, with few staff changes. They (the staff) really care about one another and the people that live in the home. One client said, staff are magnificent……. I love em. The majority of clients who completed surveys said that staff, always treat them well, with one client responding that they were sometimes treated well. Information sent to us in the AQAA before the inspection was contradictory about the number of staff trained to NVQ level 2 or above. The registered manager states that the home employs a high percentage of staff trained to NVQ 2 or 3. However, later in the document she states that only 8 out of the 26 staff employed at the home have achieved NVQ 2 or above. This is 30 of the staff team. The NVQ award is useful because it helps staff develop good care practices and their skills in working with people who live in a residential care home. The team leader said that ten people have signed up to work towards an NVQ. When these people have achieved this qualification, the home will exceed the National Minimum Standard that 50 of care staff should be qualified to NVQ 2 or above. Two staff files were viewed and contained all the relevant checks and documentation showing that the recruitment process followed protects the people that live at Brussons. The registered manager is responsible for making sure that care staff have the skills they need to support the clients who live in the home. The registered manager stated in the AQAA that all new care staff receive the appropriate introductory training, which gives them the basic competencies they need to be able to work without direct supervision. The company have acknowledged that they are finding it difficult to ensure that staff are kept up to date with training essential for their roles. They have recently employed a full time human resource manager to meet this need. The staff training matrix shows that there are a number of gaps in staff training in areas such as first aid, moving and handling and food hygiene. Evidence was seen that the human resource manager has begun to book additional courses for staff to fill these shortfalls. She is currently booking staff on health and safety training which staff have not completed for some time. Staff said that that regular staff meetings and formal supervisions take place so they have the opportunity to discuss care practice and to identify any areas of development that are needed. Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 23 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 and 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Clients benefit from living in a home that has clear, effective, and innovative management. EVIDENCE: The registered manager and the team leader have both obtained the qualifications that are recognised by the commission, as being useful in helping people who manage residential care services to have the competencies that are necessary to do so. The registered manager is also one of the home owners. The home owners have been developing specialist behavioural services for adults with a learning disability and additional behaviours that challenge since 1991. The home owners both have a sustained track record for delivering services that are both innovative and visionary. Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 24 Everyone was very complimentary about the management style of the home. Leadership of the staff team is clear and it is evident that staff, clients and relatives are valued. A client said, My life has got better since living here. A relative said, This is the best place that X has lived in all this time. A member of staff said, I get a lot of support from Linda, Adam and Paul (The registered manager and members of the management team). In their AQAA, the service has told us that they ensure that it is run in the best interests of the people for whom it is intended by conducting annual quality audits. The team leader said that staff are given goals that they must achieve each month and these targets are part of the audit system. Questionnaires are sent out yearly to clients and their families and the results are fed back into the services quality assurance report. Feedback from clients is also regularly sought in client forums, key worker meetings and client reviews. The registered manager made a declaration in the AQAA that all items of equipment in use in the home remain in good working order and has given dates on which all equipment has been serviced. As stated earlier in the report, some staff training is in need of updating and the human resources manager is working towards this for the whole staff team. Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 25 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 4 2 4 3 4 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 4 25 4 26 4 27 3 28 4 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 4 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 4 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 4 4 4 X X 3 X Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 26 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 Insight DS0000023966.V373907.R01.S.doc Version 5.2 Page 27 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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