Care Home: Larkins

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What the care home does well Residents` needs are fully assessed before an offer is made for treatment at the home. Residents are given full information about the home and what treatment entails. They are also invited to spend a day at the home, where possible, to ensure that their needs can be met. Health and social care needs and how these are to be met are detailed within care plans with residents being fully involved in their development. Residents set goals within the confines of the rules and expectations of the treatment programme for their treatment. There were very positive comments made about the way staff work with and support residents through their treatment. The home is well managed and run in the interests of the residents. What has improved since the last inspection? Staff have all received training in adult protection. CARE HOME ADULTS 18-65 Larkins 14 Campbell Road Boscombe Bournemouth Dorset BH1 4EP Lead Inspector Martin Bayne Unannounced Inspection 8th September 2008 10:00 Larkins DS0000003953.V372201.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 Larkins DS0000003953.V372201.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. Larkins DS0000003953.V372201.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Larkins Address 14 Campbell Road Boscombe Bournemouth Dorset BH1 4EP 01202 392241 01202 300338 arlenequinton@aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Miss Lorraine Pamela Parry Mrs Arlene Edna Rodgers Care Home 13 Category(ies) of Past or present alcohol dependence (13), Past or registration, with number present drug dependence (13) of places Larkins DS0000003953.V372201.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th July 2006 Brief Description of the Service: Larkins and Seastrole are two Registered Care Homes that form part of the Quentin House project. They are adjacent properties located in Boscombe, Bournemouth and much of the treatment programme is shared between the two houses. Larkins offers residential support to 13 men and women recovering from addiction and has five single rooms and four double rooms, one of which is ensuite. At the back of the home there is a garden with a patio and two relaxation/ counselling rooms. The Quentin House project has two blocks of ‘move on’ flats and one house able to accommodate four people. People who have completed their treatment can be referred to this accommodation as part of follow-up after-care. Larkins promotes a non-discriminating and non-stigmatising treatment programme for alcohol and drug dependence. The treatment model is an eclectic evidence-based bio/psycho/social approach focusing on the 12-steps abstinence model. Treatment can also include therapeutic approaches such as grief work, psychosexual therapy, family therapy, treatment for eating disorders, life skills training, lectures and workshops, one to one counselling, anger management and relapse prevention and cognitive behavioural therapy. The length of stay at the home is generally between twelve weeks and six months, depending upon funding and the needs of the individual person in treatment. A criterion of admission is that prospective residents sign up to the rules and expectations of the home. These are clearly spelt out within the home’s brochure/statement of purpose and terms and conditions of residence. The weekly fee for the home is £475, which includes toiletries, laundry, heating, board and lodging as well the full treatment package. Should a person have family therapy sessions, the first two sessions are free with subsequent sessions charged at £30 per session. Aftercare support is available with the first three sessions being free and thereafter the charge is £30 per session. Larkins DS0000003953.V372201.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 the people who use this service experience good quality outcomes. We, the Commission, carried out a key inspection of the home, the aim of which was to evaluate the home against the key National Minimum Standards for younger adults and to follow up on the three recommendations made at the last key inspection in July 2006. We were accompanied by an ‘expert by experience’. This is a person who, because of their shared experience of using services, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Information received from the ‘expert by experience’ has been included in this report. Mrs Rodgers, the Registered Manager, assisted us throughout the day by providing us with records that the home is required to keep by Regulation and explaining how the home operates. The expert by experience also gathered information when talking to residents of the home. We also carried out a tour of the premises. What the service does well: Residents’ needs are fully assessed before an offer is made for treatment at the home. Residents are given full information about the home and what treatment entails. They are also invited to spend a day at the home, where possible, to ensure that their needs can be met. Health and social care needs and how these are to be met are detailed within care plans with residents being fully involved in their development. Residents set goals within the confines of the rules and expectations of the treatment programme for their treatment. There were very positive comments made about the way staff work with and support residents through their treatment. The home is well managed and run in the interests of the residents. Larkins DS0000003953.V372201.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. Larkins DS0000003953.V372201.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 Larkins DS0000003953.V372201.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. Residents benefit from an assessment of their needs being carried prior to being offered a place at the home and being given full information about the treatment programme. EVIDENCE: We were told that residents are generally admitted from outside the area through spot purchase agreements with local councils but occasionally through privately funded arrangements. A pre-admission assessment of a person’s needs is always carried out before a person is offered a place at the home. We looked at a sample of two residents personal files and saw that a full and detailed pre-admission assessment of their needs had been carried out and recorded. Generally people are invited to visit the home up for a day and take part in all the activities throughout the day. This forms part of the full assessment and also allows for the person referred being confident that the home is the right environment for their treatment needs. In cases where people cannot attend the home for a day, such as the case of a person being in prison, a telephone assessment is carried out with the person. Larkins DS0000003953.V372201.R01.S.doc Version 5.2 Page 9 The expert by experience found that: ‘Four of the residents I spoke with were invited to visit Larkin’s for a day and they all gave good comments about their visits. They felt there was enough information given prior to and during the visit. One resident stated ‘my visit was excellent; I enjoyed having the whole day to see how the rehab works and how it would benefit me’. Another resident stated ‘I did like my visit and the assessment was very particular and precise’. There was one resident that felt he didn’t have enough information before entering Larkin’s and didn’t like the fact that the assessment was done over a lengthy phone call due to the fact they were in custody at the time. They felt it would have been better if a member of staff came to the prison to do the assessment’. Mrs Rodgers told us that this was not possible and that the telephone assessment was the most pragmatic way of carrying out the pre-admission assessment. At the time of the person visiting the home, they are given a copy of the Service User Guide, which provides full information about the home, its philosophy and the treatment programme. The person is also taken through the expectations and house rules, so that they are fully informed of what would be expected if they chose Larkins to carry out their treatment. Where a person is in prison their probation officer or worker in prison gives this information to them. There is an expectation that people on entering the home must have been free from drugs or alcohol use for a period of seven days prior to admission. Many of the residents therefore have primary detoxification treatment before moving to the home. Larkins DS0000003953.V372201.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): 679 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from being fully involved in developing their treatment plan, taking control over their lives within the boundaries of the homes rules and expectations of treatment. EVIDENCE: We saw that within the two personal files that we looked at, a detailed care plan had been developed with the resident concerned. The plans are divided into separate goals such as a person’s psychological, physical family and social needs, spiritual and cultural needs, vocational, resettlement and after care needs. There was evidence of care plans being continually evaluated as people progressed through treatment with their signing up to agreed goals. The expert by experience found that, ‘All service users said they have a care plan Larkins DS0000003953.V372201.R01.S.doc Version 5.2 Page 11 and they all have an input in developing and reviewing their care plans at specific points in the treatment’. We also saw that residents sign up to the treatment expectations, which include: • Total abstinence from drugs or alcohol • • • • • • • Not to enter licenced premises. Not to go from the home unaccompanied, (initially being accompanied by two peers and after three weeks accompanied by one peer). Taking part in all house activities. Attending mealtimes. Not to form a special relationships or friendships whilst in treatment. Verbal or physical abuse will not be tolerated. Restricted use of mobile phones. Within the structure of the rules of the home, residents are encouraged to take responsibility for their lives and for the welfare of the other residents. Taking part in all house activities also includes taking part in the domestic running of the home and carrying out daily domestic chores, such as cleaning and assisting in the cooking of meals. Larkins DS0000003953.V372201.R01.S.doc Version 5.2 Page 12 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 benefit from having opportunities for personal development, from taking part in appropriate activities and from their rights being respected. Improvements could be made by consulting with residents on how to meet dietary needs, at the same time providing more cooking skills with residents. EVIDENCE: Larkins provides a structured treatment programme throughout the daytime, however at weekends and in the evenings residents are able to watch TV, DVDs, read or play board games within the home, if they are not out of the home attending fellowship meetings, (alcoholics, cocaine or narcotics anonymous). Larkins DS0000003953.V372201.R01.S.doc Version 5.2 Page 13 The expert by experience found that, ‘The residents informed me that having the structure in place is very good as they get to plan their week for meetings, groups, cooking, activities etc. All the residents I spoke to said that having to adapt to the structure was difficult but now they all benefit from it. One resident said that having structure had really helped him to take responsibility for his life. The majority of residents said they benefited from attending the groups and workshops. Concerning attendance at fellowship meetings, ‘The majority of residents said that they enjoy attending meetings, however one resident did point out that he didn’t feel any benefit from attending NA meetings as it is always the same faces from the wider community and they all talk about the same thing and everyone just talked about war stories. He feels that having one to one time or an assignment to do would be more relevant and beneficial to him’. During the daytime on Wednesdays residents can take part in communitybased activities. Larkins has links with a local drama organisation, access to a local gym, and access to an organisation that assesses and supports residents in voluntary work. The expert by experience found that, ‘Residents like the fact that they have a day off on Wednesdays to carry out activities such as college, voluntary work or go to the library and all residents said that all of the staff encouraged this’. Occasional group activities are also arranged that encourage people to develop new interests and hobbies enhancing a balanced and healthy lifestyle. Examples given included, a local boat trip, a visit to ‘Funderworld’, the Bournemouth air show, firework displays and barbecues. Each week Larkins has a resident’s community meeting, overseen by a counsellor, at which residents can discuss menus and any other issues affecting them. Every day two residents are assigned, as part of their therapeutic duties, to assist in cooking the main meal of the day. The aim is to develop people’s ability to cook and to eat healthily. Mrs Rodgers told us that staff oversee and assist in meal preparation. The expert by experience found that, ‘Residents had some quite strong opinions on the quality and quantity of food that is available to them at Larkin’s. All residents are provided with three meals per day, breakfast is done on a ‘help yourself’ basis with cereals, toast, fruit or yoghurts, lunch is usually a light meal and dinner is the main cooked meal. Snacks are available throughout the day. Residents are involved in the shopping and preparation of all meals, but not all residents are happy with that involvement, as they feel they are taken shopping just to push the trolley and carry the bags. Residents feel the shopping could be used as a lesson for budgeting skills as some of them have never been shopping and feel it would be beneficial to learn those skills. Staff informed me that all religious, cultural and vegetarian needs are met within the menu. All residents are required to take part in cooking, this works on a rota basis and is a peer led activity with two residents preparing lunch and cooking the main meal each evening. Some of the residents are not happy about the way this is worked out as not everyone in the house can cook. A rota is worked out so that there is one resident that can cook and another resident that can’t. The majority of Larkins DS0000003953.V372201.R01.S.doc Version 5.2 Page 14 residents feel this could be worked better with proper cooking lessons for all residents, as most days the cooked meals are not very good. Residents did inform me that if there is a special meal they would like to cook they can do so and this is planned through the community meetings. In terms of quality of the food residents are generally unhappy as they feel the food is cheap and there is a lack of fresh vegetables in their diet, all residents agreed that the majority of the food provided is frozen and they would prefer some of it to be fresh. Residents did say that they are allowed to have snacks between meals which they enjoy’. These findings were discussed with the manager who told us that concerning shopping, usually one resident goes out with a member of staff each Monday morning to do the shopping and in addition residents are asked to do incidental shopping for items such as bread, milk, fruit and vegetables on a daily basis. Budgeting assistance is offered to residents whilst they are in treatment. Some residents who want assistance with budgeting are given assignments of having to go out with a shopping list or menu and have to investigate costs. Community meetings are held each Friday during which residents are encouraged to make suggestions regarding menus and these are then discussed between the person compiling the menus and the manager and if possible put into practice. It was agreed that the home would continue to raise the issue of budgeting and food with residents to ensure that their concerns and suggestions are listened to and action taken accordingly. At the time of our visit there was one resident requiring a Halal diet. We were told that the person concerned takes responsibility for supervising their particular diet. Larkins DS0000003953.V372201.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 19 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from their health needs being met and social needs assessed and supported as part of the treatment programme. Medication is administered safely within the home. Residents had fears and concerns about aftercare and there may be areas where residents could be supported more and be more involved in planning earlier in the programme. EVIDENCE: The treatment programme provides both group and individual counselling to support residents. Residents also elect one person to be house leader for a two-week period and this person’s role is to take some responsibility for the welfare of the other residents. When a person newly enters the home they are allocated a buddy whose role is to help the person settle into the house. There is an expectation that for the first three weeks of treatment residents do not receive visitors, as this can be disruptive in settling into the treatment Larkins DS0000003953.V372201.R01.S.doc Version 5.2 Page 16 programme. After the initial three-week period visits from families or significant others can be arranged, subject to their homes visiting policy. In the event of a person breaching house rules or wanting to leave treatment the home has a policy of aiming to keep the person safe by making an emergency plan together with the person’s care manager. Aftercare is also planned with residents. The expert by experience found that residents had strong views on aftercare. ‘I did go into this topic with some of the residents and only one resident gave me information about aftercare and he stated ‘there is the opportunity for aftercare and ex peer involvement which is ok at times but it just reinforces the difficulties we will all have to face when we leave Larkin’s’. The majority of residents had concerns for when they leave Larkins around support and housing. Support was the main topic of discussion and some had fears that they won’t have the support they need in place to continue the progress they have already made. Residents feel their treatment needs and issues are addressed through groups, one to ones, counselling sessions and care plan reviews but they don’t feel aftercare needs are addressed before they leave. Some did say that it happens in the last two weeks but they don’t feel that is enough time to have everything in place before they actually leave. ‘All residents I spoke with asked me to highlight this matter as they are concerned they are going to leave treatment and have nothing to go to and the fact that they will have little or no structure is quite important to them. Aftercare is the final hurdle on a long journey and if this is not put into place, for many individuals, there is little point in attending residential treatment to begin with, especially if they have to go back to their home towns, which makes it even more difficult to prepare if you do not do it as early as possible’. These findings were discussed with the manager who told us that the issue of aftercare is acknowledged as being important and is usually addressed after about 6 weeks into treatment not two weeks before leaving the home. The extent to which the home can assist residents with aftercare is dependent on whether the person chooses to remain in Bournemouth or to return to their home area. If residents choose to return to their home area, they are encouraged to contact their care manager to assist in what support can be put in place. It was agreed that the issue of aftercare would continue to be highlighted in consultation with residents to help alleviate their concerns and ensure that residents receive as much support as possible in making plans for their aftercare. Each resident is registered with a GP, usually from a local GP surgery that is well acquainted with the home and the needs of the residents. Should a person need specialist healthcare services these are arranged. We were given examples of where one person was referred for community psychiatric nursing support and an example of psychology services being arranged. We were told that residents are supported with dental care, as often residents in the past Larkins DS0000003953.V372201.R01.S.doc Version 5.2 Page 17 have neglected their dental needs. The home has input and links to a charity that specialises in education concerning blood-borne viruses. We looked at how all medication is administered within the home. An initial risk assessment is carried out to establish if a person can manage their medication safely. Some residents have their medication administered by the staff, which is kept in a locked safe in one of the offices. One member of staff has accountability to the key to the safe. The home has the facility of a small fridge for medicines requiring refrigeration, and this has a maximum and minimum thermometer to ensure medication is stored at the correct temperature. We saw the medication administration records for all the residents and found that there were no gaps within the recording. We recommend that where hand entries are made to the medication administration records, one member of staff records the medication to be administered and a second person checks and signs that the entries have been made correctly. Unused medication is returned to the pharmacist who stamps the record to validate that the medication has been returned. The home has a system that allows very full audit of any medication entering the home. Larkins DS0000003953.V372201.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. Residents benefit from a well-publicised complaints procedure and through the staff being trained in adult protection. EVIDENCE: Since the last key inspection of the in July 2006 there have been no complaints made to the management of the home and none have been brought to the attention of the Commission. Residents have the facility of community meetings in which to air grumbles so that complaints are dealt with at an early stage without recourse to a formal complaint. The home maintains a complaint’s log for recording complaints. The complaints procedure is detailed within the Service User Guide and each resident has given a copy of this document. The procedure is also detailed within the policies and procedures manual, a full set of these are kept in the residents’ lounge for them to reference if they choose. All staff receive training in adult protection. The home has abuse policies including a whistle blowing procedures. Larkins DS0000003953.V372201.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 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Larkins provides a safe, ‘homely’ and comfortable environment for a treatment unit that is kept clean. EVIDENCE: The home is conveniently located in terms of its proximity to local shops and amenities. Larkins itself provides a homely and comfortable environment. On the day of our visit the home was found to be clean and in reasonable decorative order. The home provides five single rooms and four double rooms and the home has a policy of allocating single rooms. Generally people are expected to share a room when they first entered the home. We saw that screens are provided in Larkins DS0000003953.V372201.R01.S.doc Version 5.2 Page 20 shared bedrooms to provide some privacy. We also saw that the rooms were adequately furnished and that residents are able to personalise their room with photos and other possessions. One of the expectations of residents is that they keep their room tidy as part of maintaining a structure to their lives. The expert by experience found that, ‘On arrival to Larkin’s most of the residents said they had to share a room for the first couple of weeks, some residents didn’t agree with this but they did say it was good for making friends. One of the residents said he liked sharing a room, as he felt isolated so that helped him get over that. After two weeks residents have the opportunity of moving into a single room (depending on bed spaces) and all reported that Larkins provided a good standard and was comfortable. There is also access for disabled residents and a room on the ground floor has been adapted to meet these needs. All residents said that the rooms are well used especially in the evenings. Residents have access to a large garden which has a designated smoking area, tables and chairs and two small sheds where they can go for quiet time or one to ones which is available at anytime of the day or night’. A maintenance person is employed at the home vast ensuring that faults and redecoration is kept in order. We saw that within communal bathrooms liquid soap and paper towels are provided in the interests of infection control. The home has a laundry room that can be accessed without going through food preparation areas. Residents are allocated to times to access the laundry room and there is an expectation that they will do their own washing once a week. Laundry facilities are adequate to the laundry needs of the home. The expert by experience found that, ‘Each resident has access to a washing machine which is managed by a rota which can be negotiated if need be. One resident stated ‘Larkin’s is a really good environment to live in’’. Larkins DS0000003953.V372201.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): 32 34 35 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 well qualified and competent staff team. EVIDENCE: The home provides staff in between 9 a.m. and 10 p.m. Mrs Parry, the Registered Provider and Mrs Rodgers live within separate properties within the boundaries of the registered premises. Both are available to deal with any emergencies that occur outside of the hours when the home is staffed. There is a panic button within the home should residents need to raise Mrs Parry or Mrs Rogers. During the daytime a manager is on duty together with three counsellors and one or two support workers. We were told that Mrs Parry is present at the home an average of 25 hours per week. All of the councillors who have been trained to NVQ level 3, with the exception of one who is currently studying for NVQ level 3. During the inspection we spoke with one member of staff who confirmed that there was continual learning and good training opportunities provided. Three of the senior staff are Larkins DS0000003953.V372201.R01.S.doc Version 5.2 Page 22 trained as ‘train the trainers’. We were told there is a lot of in-house training provided in areas such as, dealing with anger, case management, role playing, facilitating groups and training in presenting workshops. In addition to this training, staff receive core training in health and safety, fire training, food hygiene, first aid, drug overdose and adult protection. Since the last inspection there has been one new member of staff appointed at the home. We looked at their recruitment records and found that all the necessary checks required under Schedule 2 of the Regulations had been complied with. We recommend however that the application form be changed to request a full employment history from applicants with gaps in employment history accounted for, and also that where appropriate one reference is sought from the person’s last place of employment of not less than three months duration when working with vulnerable adults or children. The expert by experience found that, ‘All residents said the staff also integrate well with all residents’. We also spoke with two members of staff and found that they were highly motivated and committed to providing a good quality service to residents. Larkins DS0000003953.V372201.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 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is well managed with views of residents underpinning development of the home. Residents also benefit from the health and safety being promoted. EVIDENCE: Mrs Rogers, the registered manager who has completed the NVQ level 4 qualification in management and care. She has also worked at the home for over seven years has registered manager. Larkins DS0000003953.V372201.R01.S.doc Version 5.2 Page 24 Quality assurance systems are in place to ensure that there is self monitoring and review of the home. Residents provided ongoing feedback/community meetings and also when they leave the home they are asked to complete an exit survey. We found that this inspection that the home was well run in the interests of the residents. We saw that the home had a current employer’s liability insurance certificate. We looked at the fire logbook and saw that tests and inspections of the fire safety system were taking place to the required timescales. We also saw the portable electrical equipment wiring was tested as required. There were no hazards identified during the inspection. Larkins DS0000003953.V372201.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 X 2 3 3 X 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 X 27 X 28 X 29 x 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 X 3 X X 3 x Larkins DS0000003953.V372201.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. 1. Refer to Standard YA20 Good Practice Recommendations We recommend that where hand entries are made to the medication administration records, one member of staff records the medication to be administered and a second person checks and signs that the entries have been made correctly. We recommend however that the application form be changed to request a full employment history from applicants with gaps in employment history accounted for, and also that where appropriate one reference is sought from the person’s last place of employment of not less than three months duration when working with vulnerable adults or children. 2. YA34 Larkins DS0000003953.V372201.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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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