Care Home: Leigh Bank

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• Turning Point (Hoole Road)

What the care home does well As part of the programme provided at the home, residents are expected to participate in a range of individual and group activities, including: one-to-one support; relapse prevention; stress/anxiety management and relaxation. The aim is to support residents in addressing their lifestyles and aid their rehabilitation. A group of residents were spoken with including 2 people who now live within the supported housing project. All expressed that the home had given them an opportunity to `improve the quality of their lives`. Some residents expressed that they were `supported` and felt `safe`. One of the ex-residents said `you won`t get any complaints from me` and `I wouldn`t be where I am now if it wasn`t for their help`. Another resident said that he now `wanted some meaning to life` and `wanted to give something back` was exploring areas, which may provide career opportunities. The acting service manager also spoke highly about the staff team and their level of commitment and enthusiasm to the work. What has improved since the last inspection? Work was being carried out with a new kitchen and appliances being fitted. Further work is also planned. This will improve the appearance of the home. A further team leader has now been appointed to the post and is to make application to the CSCI for registration. New staff have been recruited to cover vacancy providing a stable team to support residents. New risk assessment documents have been introduced, which allow for clearer information to be recorded. Further staff development has been identified with regards to them used effectively. What the care home could do better: Application for the position of registered manager should be forwarded to CSCI without delay. This has been outstanding for some time due to changes in managers. Training in the use of the new risk assessment needs to be provided so that the information provides staff with clear direction on how to effectively minimise areas of risk. A number of areas within the environment require attention to bring the accommodation up to a good standard. The team leader is asked to provide the CSCI with a programme of improvements and timescales for completion. The team leader must ensure the adequate staffing levels are available at all times to ensure that residents receive the appropriate level of support agreed. That consideration is given in relation to feedback received from residents about the structure and support offered at the home. This could be explored within residents meetings allowing for information and ideas to be shared. Work required in relation to the gas and electric safety certificates needs to be addressed. Certificates need to be placed on file and any action identified must be carried out ensuring the home is safe for those living there. Once reviewed copies of the homes statement of purpose and service user guide should be forwarded to the CSCI. CARE HOME ADULTS 18-65 Leigh Bank Leigh Bank 4 Glebelands Road Prestwich Manchester M25 1NE Lead Inspector Lucy Burgess Unannounced Inspection 2 August 2007 09:30 nd Leigh Bank DS0000008455.V339979.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 Leigh Bank DS0000008455.V339979.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. Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Leigh Bank Address Leigh Bank 4 Glebelands Road Prestwich Manchester M25 1NE 0161 773 1523 0161 773 0125 chris.wynne-jones@turning-point.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Turning Point ** Post Vacant *** Care Home 11 Category(ies) of Past or present alcohol dependence (11), Past or registration, with number present drug dependence (11) of places Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the maximum registered numbers there can be up to 11 people with past or present alcohol dependence and up to 11 people with past or present drug dependence. The service should employ a suitably qualified and experienced Manager who is registered by the Commission for Social Care Inspection. 11th August 2006 2. Date of last inspection Brief Description of the Service: Leigh Bank is an 11-bedded residential care home for younger adults, between the age of 18 to 65 years, with problems associated to drug and alcohol misuse. The service, which is run by the national charity, Turning Point, aims to provide an environment where residents are supported in achieving change in their lives. Referrals are considered from across the country. At the time of the inspection there were no vacancies. Fees are charged at £377.00 per week. The property is situated in Prestwich, Manchester and is close to the M60 motorway network. It is convenient to local shops, leisure facilities and the metro tram network. The accommodation is an old Victorian style semi detached house in keeping The accommodation comprises of 7 with other properties within the area. single bedrooms and two double rooms. All services such as heating, lighting, food, accommodation, staffing costs and laundry facilities are included as part of the fees. A large well maintained garden is available to the rear of the property. Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector had visited the home 2 days prior however had been unable to carry out the inspection as residents and staff had planned a day away from the home due to work being carried out. A further visit was arranged for later in the week. The inspection was carried out over 1 day for a period of 7 hours. The inspector spent some time looking round the home, viewing records as well as talking with residents and staff. Discussion and feedback was also held with the Acting Service Manager. The home is registered to provide accommodation for 11 people. At the time of the visit there were no vacancies. The home is staffed during the week between 9:00am and 10:00pm and at week ends 9:00am until 5:00pm. An on-call system operates out of these hours. As part of the inspection process the Provider was asked to complete an Annual Quality Assurance Assessment (AQAA), which was then forwarded to CSCI. Information provided looked at both the strengths and weaknesses of the home and what plans had been made to develop and improve the service further. Information was requested about residents and other stakeholders so that feedback surveys could be sent out however this was not provided. All the key standards were looked at during this inspection visits. What the service does well: As part of the programme provided at the home, residents are expected to participate in a range of individual and group activities, including: one-to-one support; relapse prevention; stress/anxiety management and relaxation. The aim is to support residents in addressing their lifestyles and aid their rehabilitation. A group of residents were spoken with including 2 people who now live within the supported housing project. All expressed that the home had given them an opportunity to ‘improve the quality of their lives’. Some residents expressed that they were ‘supported’ and felt ‘safe’. One of the ex-residents said ‘you won’t get any complaints from me’ and ‘I wouldn’t be where I am now if it wasn’t for their help’. Another resident said that he now ‘wanted some meaning to life’ and ‘wanted to give something back’ was exploring areas, which may provide career opportunities. The acting service manager also spoke highly about the staff team and their level of commitment and enthusiasm to the work. Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Application for the position of registered manager should be forwarded to CSCI without delay. This has been outstanding for some time due to changes in managers. Training in the use of the new risk assessment needs to be provided so that the information provides staff with clear direction on how to effectively minimise areas of risk. A number of areas within the environment require attention to bring the accommodation up to a good standard. The team leader is asked to provide the CSCI with a programme of improvements and timescales for completion. The team leader must ensure the adequate staffing levels are available at all times to ensure that residents receive the appropriate level of support agreed. That consideration is given in relation to feedback received from residents about the structure and support offered at the home. This could be explored within residents meetings allowing for information and ideas to be shared. Work required in relation to the gas and electric safety certificates needs to be addressed. Certificates need to be placed on file and any action identified must be carried out ensuring the home is safe for those living there. Once reviewed copies of the homes statement of purpose and service user guide should be forwarded to the CSCI. Leigh Bank DS0000008455.V339979.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. Leigh Bank DS0000008455.V339979.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 Leigh Bank DS0000008455.V339979.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 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Opportunity is made available for prospective residents to visit the home as part of the assessment process. This enables an informed decision to be made regarding the suitability of placement. EVIDENCE: Information is available with regards to the nature of the service and what individuals should expect. Due to changes within the staff and management team, documents now need to be reviewed and updated. A further review will also be required once work has been completed to the environment providing family friendly and disabled facilities. Due to the nature of the service, regular changes in the group of people living at the home takes place. The length of placements varies depending on initial agreements and progress made. Some individual may choose to move to the supported living project linked to the home, return to family or move to more independent accommodation. Individuals are referred to the home via different agencies. Some come direct from detox, other through the probation service or community referrals. The relevant funding authority or service provides assessment information. Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 10 Turning Point also has a comprehensive assessment document, which is generally completed at the home prior to individuals moving in. This explores individual needs, their additional history, personal, health and emotional support needs as well as areas of risk, particularly around relapse. Residents spoken with confirmed that they had been involved in the decision making process and had made visits to the home prior to their admission. Leigh Bank DS0000008455.V339979.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, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments are updated and reviewed on a regular basis with the involvement of residents however information needs to be expanded upon to ensure that areas of risk fully reflect the support required ensuring their safety. EVIDENCE: Detailed information is held in relation to each of the residents. Files include the initial assessment, care plan, risk assessments, correspondences, 1-2-1 notes, financial information, licence agreement as well as policies, procedures or other information about the resident. Files were examined for 3 residents, all of which were new to the home. Information was detailed and orderly. In order to develop the care plan, time is spent with the resident and their key worker exploring what support needs they have and areas of risk, which may result in relapse or be a consequence of relapse. Strategies are then explored to minimise the risks. Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 12 On examining the care plan some of the information was found to be generic and applied to each of the residents as part of their placement agreement at the home however other details were more personal to each individual. Some of the documents had not been read through and checked as they made reference to another home within Turning Point. Plans should be reviewed fully ensuring that the information is relevant to each person. Risk assessments are also in place. Staff and residents complete a clinical risk assessment and management plan. Whilst assessments explore relapse and the consequence of relapse information appeared quite limited. This was discussed with the acting service manager who expressed that further training was being offered to staff with regards to the completion of the documents, ensuring information clearly outlines the support required, intervention strategies and personnel involved. Due to placements being on a relatively short-term basis, for example 3, 6 or 9 months, the plans are generally reviewed on a monthly basis to ensure that information is up to date and accurate. An up to date copy is then forwarded to the funding authority with regards to the residents’ progress. Documents had been signed by the residents to evidence their agreement. The completion of other documents such as, consent to information being shared, behavioural policy/agreement, self-medication, and confidentiality and licence agreement continues to be held on file. Information is held securely within the staff office and is easily accessible to staff. Additional records are completed in relation to daily reports. These outline what residents have done throughout the day as well as notes from the 1-2-1 sessions therefore providing information, which could be used for monitoring purposes. As the project is relatively small, informal day-to-day contact is made between residents and staff, which continues to enable the views and opinions of both parties to be easily aired. This method is used as well as formal meetings and discussions. Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst residents are encouraged to develop new skills as well as maintain some level of independence, improvements could be made in providing further opportunities for development within the local and wider community, which may continue once residents move away from rehab. EVIDENCE: As part of the programme within the home residents are expected to attend the group work sessions. Sessions include stress and anger management, personal and social development and relationships and boundaries. In addition to this residents are encouraged to explore other opportunities and learn/regain skills as part of their rehabilitation. This may include accessing local colleges, voluntary work or leisure activities. Some of the individuals spoken with are involved with a variety of organisations such as, Stash, Merc, Mace, and ADS Bridging the Gap, who Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 14 provide opportunities to get involved with art groups, computers, football, outings etc. However some residents expressed that these were not accessible to all as it was dependant on funding/placement agreements and that at times they were ‘bored’. One resident suggested that staff should put together an information file with details of all services, which are accessible throughout the area, particularly Bury, so that residents are aware of places/people to contact. This should be explored. In relation to leisure time, this is at the discretion of each person. Some of the activities undertaken include, visiting the gym, bike rides, visiting the local park and boating lake and go carting. Residents also have access to 2 computers, which were being used during the visit. One resident said that it ‘kept him occupied’ whilst other said ‘they were old and outdated and did not give them access to the Internet’. Another resident spoken with regularly attends alcoholics and narcotics anonymous groups within the local community to support his recovery spending the weekend on a camping trip and attending a conference. A further resident was involved in voluntary work and felt this was opening up opportunities following rehab. Residents also spoke about being able to travel independently. Whilst they accept they are provided with some money for travel this does not cover the cost if they are accessing the local and wider community each day. The acting service manager also acknowledged that the current arrangement was not adequate and that alternative arrangements were being considered. Contact with family and friends are also maintained. This is based on the wishes of each individual with contact allowed following the initial settling in period. As part of the refurbishment of the home, one of the bedrooms is being made into an en-suite room providing facilities and space for residents to have relatives/children stay overnight. This would be included within the risk assessment process. As work was being carried out to the kitchen, residents had not been able to cook their own meals. Arrangements had been made for the first week for an outside caterer to provide hot meals during this time. Residents were also having take away meals. This was being paid for by the home. At present the home does not support anyone with specific dietary needs. However some staff have received training in cultural and religious needs which includes diet. Previous arrangements have been made for the provision and storage of special diets such as halal. Once the kitchen has been completed, the residents will hold responsibility for the preparing and cooking of the evening meal. Each agree the menu and who is responsible for cooking each day, they also take turns is doing the shopping. Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 15 Residents make their own arrangements for breakfast and lunch, as this is dependent on individual routines. A group of residents were spoken with including 2 people who now live within the supported housing project. All expressed that the home had given them an opportunity to ‘improve the quality of their lives’. Some residents expressed that they were ‘supported’ and felt ‘safe’. One of the ex-residents said ‘you won’t get any complaints from me’ and ‘I wouldn’t be where I am now if it wasn’t for their help’. Another resident said that he now ‘wanted some meaning to life’ and ‘wanted to give something back’ was exploring areas, which may provide career opportunities. Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by staff and relevant health care professionals to ensure that their emotional, physical and personal care needs are met. EVIDENCE: Information in relation to specific health and personal care needs are gathered at the assessment process. This enables the team to make appropriate referrals and access support at the earliest opportunity. It has previously been identified that residents living at the home also have additional needs such as a mental health diagnosis. Psychiatric services would be accessed to offer further support and advice. One of the support workers now working at the home has previous experience of working with individuals with mental health needs therefore is able to share their skills with other members of the team Residents living at the home are not always from the local or surrounding area, therefore need to be registered with the local GP. Should additional health care support be required arrangements would be made to relevant health care professionals. This may include the optician, chiropody or dentist etc. Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 17 The programme within the home remains unchanged and provides residents with support around their emotional needs and managing addiction. This is done through the group work sessions as well as 1-2-1 discussions with key workers. This enables residents to explore issues or concerns within a safe and supportive environment. Whilst sessions have continued some of the feedback from residents however was that the formal therapeutic sessions had not been taking place more recently due to changes within the team. The acting service manager acknowledged this however felt that the new team leader would address this area. Generally each of the residents living at the home are able to manage their own personal care needs however where prompts and encouragement are needed to enable residents to increase their independence this too is provided. Bathing facilities are available on each floor, therefore easily accessible. With the programme of refurbishment one of the ground floor rooms is to be converted into a bedroom with en-suite facilities providing facilities for people who are disabled or have difficulties with their mobility. Arrangements regarding medication were discussed with the acting service manager. In the main residents take responsibility for their own medication including ordering, collection and administration. Individual risk assessments have been completed, which explore the residents’ awareness of managing their medication as well as safe storage. Where risks have been identified or as part of specific agreements with residents, arrangements are made for staff to offer support. At the previous inspection it was noted that a system of monitoring medication has been implemented however this had not been continued. The acting service manager and team leader should explore this ensuring medication is being administered as prescribed by individuals GP’s. New secure cabinets have been fitted in each of the bedrooms and residents hold their own key. Staff continue to monitor residents with regards to abstaining from any alcohol or drug use. Residents are advised at assessment and on admission that they are expected to follow the rules of the home and that periodic testing is carried out to ensure that rules are not being breached and that the well being of all residents is not compromised whilst working through the rehab programme. Leigh Bank DS0000008455.V339979.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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements are in place in relation to the protection of service users as well as responding to their concerns. EVIDENCE: A copy of the home’s complaints procedure is provided to each of the residents either on assessment or admission as it is contained within the information about the home. Individual leaflets are also available with a ‘tear off’ sheet, which can be used for recording any issues that may need to be brought to the homes attention. A resident had raised one minor issue. This had been responded to promptly and resolved. No further issues had been raised with either CSCI or the home. Comments made by those spoken to confirmed that they were aware of whom to speak to should they need to. The acting service manager advised the inspector that staff had completed adult protection training, however there was no evidence seen on staff files. Information about the course completed and certificates of attendance should be held on file. Further procedures are in place to ensure the protection of residents. As part of the placement agreement residents agree to abstain from the use of drugs and alcohol, any breaches would result in a 28-day monitoring notice being served. This would involve restrictions being placed such as a curfew and periodic testing. Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 19 Should concerns continue action would be taken with a further 28-day notice to quit or where necessary sooner to ensure that other residents are not compromised and placed at risk. Practice in relation to the management of residents’ finances remains the same. Staff will collect rent money each week with any remaining money being held and managed by individual residents. Some residents also have their own bank accounts. Money would only be held where a risk has been identified and would be part of the agreement. Turning Point have in place comprehensive policies and procedures with regards to ensuring the safety and protection of individuals residing at each of the projects. Copies of the documents were available at the home. Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. On-going redecoration and refurbishment is needed to ensure that the environment is of a good standard for those living at the home. EVIDENCE: It was noted during the last visit that on-going redecoration and refurbishment of the home needed to be addressed. This has been explored by Turning Point and funding has been made available along with the approval of a grant, to support and develop the improvements required within the service. At present work is being carried out in the kitchen, which has been stripped with new cupboards and equipment being fitted. Following this the inspector was informed that the heating system is also being replaced with a new boiler and radiators throughout. Further work has also been identified, including the refurbishment of the 3 bathrooms and the adaptation of two rooms to create a ground floor bedroom with bathroom facilities allowing for disabled access and an en-suite ‘family Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 21 friendly room’ providing accommodation and children/relatives to have overnight stays and visits. space for residents’ To the side of the property plans have also been made to build a separate area where the structured group work sessions and activities can take place leaving the communal areas within the home places where residents and visitors can relax. The team leader is asked to provide the CSCI with a copy of the programme of work planned and timescales for completion. Each of the residents continue to be encouraged in taking responsibility for domestic tasks. Tasks are allocated and checks are carried out to make sure that things are being done properly. Residents spoken with said that this generally worked well, however some individuals did not always take responsibility for their own tasks leaving it for others to do. Additional health and safety checks are also carried out throughout the home, these included water temperatures etc. The acting service manager also completes a periodic safety compliance form, which monitors health and safety procedures within the home, hazards, training etc. Work has been identified further within the report with regards to the gas and electric certificates. Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are competent at carrying out their roles and responsibility however improvements are needed with regards to staff recruitment and levels to ensure that residents are protected and adequately supported. EVIDENCE: On the visit made prior to the inspection it was noted that there was only 1 support worker on duty with 11 residents. However during the inspection additional staff were available. The team comprises of the acting service manager, team leader (due to take up post August), full-time support worker, evening support worker and a weekend support worker (currently on maternity leave). Feedback from residents was mixed. Whilst individual were very positive about the staff and the commitment given it was felt that changes within the service had impacted on staffing levels and opportunities for more individualised support and less formal therapeutic group work sessions. It was also stated that due to the changes in staff availability and lack of cover, no staff had been available at weekends. Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 23 Through discussion with the acting service manager it was acknowledged that the home had experienced some difficulties however steps had been taken to rectify the matter. The support worker on duty had recently been taken on a full-time basis and a new team leader was taking up post the week following the inspection. A regular evening support worker was also in post having transferred from another Turning Point service. However arrangements still need to be made however with regards to weekend cover as the regular worker is now on maternity leave. Generally staff cover is provided weekdays between 9am and 10pm and weekends 9am and 5pm. On call support is also available. Information in relation to staff files was requested as previous issues had been identified at the last inspection. Information for the newest member of the team, who had transferred from another service, had not been gathered and was therefore not available for inspection. Another file for a long-standing member of the team had all relevant information. The manager must ensure that prior to commencing new staff have all relevant information and checks required which must be held on file and satisfy the standard required. Since the last inspection training has been undertaken by some of the staff. These have included courses in equality and diversity (human rights and disability discrimination act), cultural and religious awareness, fire safety, medication and mandatory courses. As identified earlier in the report training staff have also completed training in adult protection however no evidence was seen on file. This should be provided. Training in NVQ is also provided. The evening worker has previously completed level 2 and recently done level 3. Another member of staff has done the GNVQ level 2 and is to complete the NVQ level 3. Arrangements have also been planned for the new team leader to complete training relevant to his role. The newest member of the team did not complete a full induction as they have worked for Turning Point for some time however on transferring to the home did undertake a period of shadowing and had a service specific induction, which explored all areas of support within the home. The home holds information in relation to the Skills for Care Induction and DANOS standards. The acting service manager was advised of the Bury Training Partnership Group, which provides a number of quality training courses in line with Skills for Care for services across the Borough. This may be an area the new team leader wishes to explore so that quality training can be sourced for staff as well as networking with other Registered Managers in the area. Support is offered to staff and supervisions have recommenced. At present the acting service manager is completing the annual appraisals (PDPO) with Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 24 each member of the team. The acting service manager spoke highly about the staff team and their level of commitment and enthusiasm to the work. Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 25 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, 29 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home needs a period of stability with regards to the staff and management team to ensure that residents receive a good quality service. EVIDENCE: Since the last inspection a further change has taken place with regards to the management of the home. This has meant that the home has been without a registered manager for some length of time. Discussion was held with the acting service manager with regards to how this matter can be addressed and resolved. The newly appointed team leader has worked for Turning Point for approximately 3 years in a management capacity. He is due to take up post the week following the inspection and will be supported by the acting service manager. Funding has been agreed for the relevant management training to Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 26 be undertaken. Arrangements are currently being made for the team leader to make application to the CSCI for registration. The acting service manager has years of experience in this field and has worked for Turning Point for the last 10 years, with the last four as a registered manager for another home. She holds the level 4 NVQ and Registered Managers Award and the A1 Assessors Award. And is completing further study undertaking a Leadership Development Programme. Discussion was held with the acting service manager with regards to their understanding of the Inspection process under Inspecting for Better Lives including KLORA’s and the expectation for services to evidence how they monitor and continuously develop their service. Information is being documented with regards to the Providers monthly visits as required under Regulation 26. Copies have been provided and further copies have been requested whilst the service is going through a period of transition. Further monitoring and auditing of the service takes place, including periodic spot checks and health and safety monitoring. It was suggested that the spot checks are recorded to evidence the monitoring taking place. Staff meetings have recently commenced again as have supervisions providing staff with the opportunity to share information and ideas. Meetings for residents are also to be set up again as these too have not taken place for a while and residents spoken with said that they had found them useful and enabled them to make some decisions. The home has yet to complete the National Minimum Data Set for Skills for Care, which is supported by CSCI. In relation to health and safety periodic checks are carried out. These included fire equipment and alarm, emergency lighting, electric certificate and small applicances. Servicing in relation to the gas was due to be renewed however as the home is to have a new heating a boiler fitted, the check has been delayed until this is completed later in the month. The manager must ensure that this is undertaken and a copy of the certificate held on file. It was also noted on the electric certificate that this was unsatisfactory. Work identified must be completed and evidence provided ensuring the premises is safe. In house checks are also completed completed with regards to temperature checks, fire safety checks and drills and a health and safety monitoring report. As the home is owned by Turning Point arrangements were made by the property management agency to carry out a report in relation to issues and improvements required to the home. Action was identified and as part of the refurbishment some of the areas are being addressed. Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 3 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 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 2 X Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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 YA34 Regulation 19 Requirement That evidence is placed on file for the newest staff member with regards to the checks carried out as outlined within schedule 2. (outstanding requirement) The team leader must make application to CSCI with regards to becoming the registered manager. That risk assessments are reviewed and reflect in detail how risk is managed to ensure the safety of residents. Timescale for action 30/11/07 2. YA37 9 30/11/07 3. YA42 13 30/11/07 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 YA1 Good Practice Recommendations That the statement of purpose and service user guide are reviewed and updated to reflect current arrangements at the home and kept under review. DS0000008455.V339979.R01.S.doc Version 5.2 Page 29 Leigh Bank 2. YA13 YA14 That the team explores with residents how they can improve opportunities for residents social and personal development based on the feedback received. That a system is developed to monitor and audit medication being self administered by residents ensuring this is safe and individuals are not at risk. A programme of work required to the environment to enhance the appearance of the home should be forwarded to the CSCI. Arrangement must be made to ensure that sufficient staffing is available throughout the week ensuring residents have access to staff, particularly at weekends. Evidence that staff have received training in adult protection should be held on their personal files. On completion of the work arrangements should be made for the gas safety check to be carried out and a copy of the certificate held on file. Work identified on the electric certificate should be carried out ensuring the system is in good working order. 3. YA20 4. YA24 5. YA33 6. 7. YA35 YA42 8. YA42 Leigh Bank DS0000008455.V339979.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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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