Care Home: Longcombe

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What the care home does well When asked this, one relative told us, `Creates a homely atmosphere with excellent food. I cannot speak too highly of the effort and enthusiasm of the staff in arranging visits to shows, concerts and festivals`. Another said, `I can only give my highest praise to those who look after my relative`. One noted their relative`s bedroom was kept to a high standard, and they were always dressed smartly for outings with visitors.A healthcare professional answered, ` Allows independence and dignity for its residents`. Another professional thought there was a `really positive family feel, in which each individual has their own role and is valued equally`. Staff felt the home helped people to realise their potential and use their time well with group activities and individual interests. One felt this had improved recently. We found evidence supporting the views above, as well as other positive aspects of the service: There are good pre-admission practices that ensure that the home can meet the needs of those who go to live there. Care plans reflect peoples` individuality, their diverse needs and personal goals, informing staff how to support them in a person-centred way. Their rights and responsibilities are respected, ensuring they are treated sensitively as individuals. They are supported to make decisions and to take appropriate risks, adding to the quality of their lives. Their lives are further enriched through various opportunities to take part in new experiences and relationships, often as part of a wider community, whilst also benefiting from familiar relationships and interests. Individuals benefit from good support to meet personal and health needs, including a balanced diet that takes into account their particular needs. Medication is managed well, with policies and practices that protect people`s wellbeing. They have a homely, clean and adapted environment, promoting their comfort, independence and safety. The home is run in the best interests of the people living there, with everyone at the home benefiting from the management style and experience of the manager. There are sufficient and suitable staff to meet peoples` current needs safely. People are enabled to raise concerns or have their complaints heard, to improve the service provided. What has improved since the last inspection? This is the first inspection of the home as a new service. CARE HOME ADULTS 18-65 Longcombe Ludwell Lane Exeter Devon EX2 5AQ Lead Inspector Ms Rachel Fleet Unannounced Inspection 15th May 2008 09:00 Longcombe DS0000071102.V364830.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 Longcombe DS0000071102.V364830.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. Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Longcombe Address Ludwell Lane Exeter Devon EX2 5AQ 01392 275103 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) longcombe@guinness.org.uk Guinness Care and Support Ltd Miss Sarah Elizabeth Pyne Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 5. Date of last inspection N/A Brief Description of the Service: Longcombe provides care to five adults below retirement age, both male and female, that have a significant learning disability and possibly additional physical disability or sensory impairment. The home does not offer nursing care other than that provided by the local community nursing services. It has existed for several years under different ownership. Guinness Care and Support Ltd. now owns the home and employs most of the staff. A very small number of staff are still employees of the Devon NHS Partnership Trust. The home is a bungalow that has nothing to distinguish it externally as a residential home. There is parking at the top of the short drive from the road to the bungalow. In a peaceful rural location, but within the city boundary, it is a short drive from the citys facilities. The home has its own transport, funded by people living at the home, which is suitable for wheelchair-users. Each person has their own bedroom, with shared use of the bathroom, separate toilet, lounge, kitchen/dining room. There is a shower facility, but it is less accessible than the bathroom. Behind the bungalow is a small terraced garden, and to the front a garden with access from the drive or a ramped walkway from the home. Weekly fees at the time of the inspection were £633.12. These did not include the costs of activities, holidays or transport (which were divided between those participating), hairdressing and toiletries, which are all charged at cost price. Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 5 The Commission for Social Care Inspection (CSCI) inspection reports about the home are available in the home’s office, or from the CSCI website. Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection took place as part of our usual inspection programme. There were five residents at the home on the day of our unannounced visit to the home. Sarah Pyne, the manager, had previously returned a CSCI questionnaire about the home (the Annual Quality Assurance Assessment, or ‘AQAA’), which included an assessment of what they do well, and their plans for improvement. We had also sent surveys to the home for them to give to each person living at the home, their relatives / supporters, and to five staff. We sent surveys to three community-based health or social care professionals who support people at the home. Completed surveys were returned from four relatives, three staff, and two community-based health or social care professionals. We met all five residents when we arrived, although four later went out to the Devon County Show for the day. People were not able to give their views to us in detail because of communication difficulties, but all looked content and cared for, some clearly enjoying communicating with the staff. The inspection included ‘case-tracking’ of three people. This involved looking into their care in more detail by checking care records and other documentation relating to them (medication sheets, personal monies records, etc.), looking at their accommodation, general observation of the care they received, and talking with staff. We looked around the home generally, and spoke with two staff as well as the manager during eight hours spent at the home. Staff files, and records relating to health and safety – such as accident and maintenance records - were seen. We ended the visit by discussing our findings with the manager. Information gained from these sources and from communication with or about the service since it was re-registered is included in this report. What the service does well: When asked this, one relative told us, ‘Creates a homely atmosphere with excellent food. I cannot speak too highly of the effort and enthusiasm of the staff in arranging visits to shows, concerts and festivals’. Another said, ‘I can only give my highest praise to those who look after my relative’. One noted their relative’s bedroom was kept to a high standard, and they were always dressed smartly for outings with visitors. Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 7 A healthcare professional answered, ‘ Allows independence and dignity for its residents’. Another professional thought there was a ‘really positive family feel, in which each individual has their own role and is valued equally’. Staff felt the home helped people to realise their potential and use their time well with group activities and individual interests. One felt this had improved recently. We found evidence supporting the views above, as well as other positive aspects of the service: There are good pre-admission practices that ensure that the home can meet the needs of those who go to live there. Care plans reflect peoples’ individuality, their diverse needs and personal goals, informing staff how to support them in a person-centred way. Their rights and responsibilities are respected, ensuring they are treated sensitively as individuals. They are supported to make decisions and to take appropriate risks, adding to the quality of their lives. Their lives are further enriched through various opportunities to take part in new experiences and relationships, often as part of a wider community, whilst also benefiting from familiar relationships and interests. Individuals benefit from good support to meet personal and health needs, including a balanced diet that takes into account their particular needs. Medication is managed well, with policies and practices that protect people’s wellbeing. They have a homely, clean and adapted environment, promoting their comfort, independence and safety. The home is run in the best interests of the people living there, with everyone at the home benefiting from the management style and experience of the manager. There are sufficient and suitable staff to meet peoples’ current needs safely. People are enabled to raise concerns or have their complaints heard, to improve the service provided. What has improved since the last inspection? What they could do better: There were no suggestions for improvements from relatives or professionals. One staff member suggested there was always room for improvement and the home shouldn’t be complacent despite the good service it offered. Another thought more in-depth staff training would be beneficial. Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 8 Nursing care should be properly arranged and documented, to ensure individuals receive the care they need whether through visiting professionals or the home’s staff. Some of the home’s policies and practices must be reviewed to ensure people living at the home are fully safeguarded from harm or abuse. People would benefit in the long term if staff have regular ‘good practice’ updating, to ensure the home can provide the specialised service it offers and staff are able to meet peoples’ changing diverse needs. And further staff training on the use of bedrails would promote the safety of people living at the home. 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. Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 9 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 Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 10 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. There are good admission practices, ensuring that the home can meet the needs of those who go to live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no admissions for over two years, but the manager described appropriate procedures. These included meeting prospective residents in their current situation to assess their needs (- a comprehensive template was seen for collecting details, which included personal needs and medication), and getting information from carers or professionals supporting the individual at the time. She would find out about any equipment the person needed, and carry out risk assessments related to the person and their needs. Visits to Longcombe are encouraged, sometimes with overnight stays (subject to risk assessment), so that people can meet everyone at the home. Contracts given to new residents included confirmation that the home could meet the person’s needs based on the initial assessment. Longcombe DS0000071102.V364830.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 & 9. Quality in this outcome area is good. Care plans reflect peoples’ individuality, their diverse needs and personal goals, informing staff how to support them in a person-centred way. They are supported to make decisions and to take appropriate risks, adding to the quality of their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans seen were comprehensive – including both physical and social needs - and there was indication that they were reviewed regularly. There was much useful detail, and care needed to be taken that all this information was kept up-to-date. One person’s care plan said they used a symbol for communicating about a specific aspect of care, but staff said this was no longer the case when asked about it, for example. Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 12 The care plans were being re-written a more person-centred way, with shortterm and longer-term personal goals being set for individuals’ development. These ranged, for example, from being able to move between two rooms independently to regular bike rides. Progress towards achieving goals was not always reflected in evaluations of care plans. Such information would be helpful for several reasons. However, we saw someone had achieved one of their goals, as staff had told us. Discussion with staff showed they knew peoples’ needs well. The manager told us she would take steps to ensure details in care plans were accurate, and that progress towards goals was recorded better. Details of peoples’ lives and personalities were being obtained with help from relatives, staff and other professionals supporting people at the home. We saw they had completed questionnaires that included what they thought the person’s strengths and likes/dislikes were. This revealed a great range of personal qualities and information about each person as a real individual, and made very positive reading. Communication care plans included what the person could understand, how you could tell if they didn’t understand, how they communicated, and what help they needed to communicate. We saw staff take time in their communication with people living at the home, waiting for responses to any questions, and checking their understanding before acting. A list entitled ‘Important things’ included attention to privacy, certain outings, and what the person didn’t want. Each person’s list was individualised. One person had no relatives, and the manager was seeking an advocate for them. Another person had an advocate, who supported them in decisionmaking. Risk assessments reflected peoples’ rights to make decisions and take reasonable risks, with support given to promote positive outcomes. Care plans guided staff on how to enable and encourage people to be independent and succeed in looking after themselves where possible – with aspects of personal care or activities, for example. When asked how they promoted choice for people who had complex needs including communication difficulties verbally, staff gave examples: though people couldn’t manage their money, they still went shopping to choose what toiletries they wanted. We asked about the person who did not go out during our visit and how that was decided, since they could not clearly express their choices verbally. Staff were consistent in their responses, saying that they monitored the person’s mood and thus deduced if the person would enjoy going out or if it would be a negative, perhaps stressful, experience on that occasion. The person appeared to spend their time happily at the home, pursuing a particular interest. Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 13 People living at the home were unable to fully manage their financial affairs. There was a corporate appointee for four people living at the home, where no relatives wished to take on this role. We checked personal monies records for three people and found these tallied with cash balances held. Two staff signatures were recorded to verify the transactions shown since people were unable to sign for themselves, with receipts available where sought at random. Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 14 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. Peoples’ lives are enriched through excellent opportunities to take part in appropriate new experiences and relationships, as part of a wider community whilst also benefiting from familiar relationships and pastimes. Their rights and responsibilities are respected, ensuring they are treated sensitively as individuals. They benefit from a balanced diet that takes into account their needs, and can enjoy varied eating experiences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff told us one person helped staff with the gardening, and with cleaning the minibus. They spoke with one person about their 40th birthday celebrations at a local church hall, when relatives of everyone at the home and staff both from the home and community-based services were invited. Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 15 There was some one-to-one time spent with people who lived at the home – a relative telling us that activities were arranged both for groups and according to individuals’ needs. Activity programmes showed someone was read to in the evenings; staff said the person chose the book they wanted to hear. They also told us about a holiday one person was going on at the end of the month; they had obtained a folding hoist and roll-up ramp to make the stay possible. A staff survey said people had been on holiday to North Devon, Dorset and Somerset. Day trips and picnics were on some people’s weekly programme. Peoples’ weekly activity programmes had some similarities to each other to each other (for example, that they listened to the same radio programmes in the evening), but did have person-centred aspects to reflect personal preferences or interests. No activities were planned for weekends, to provide the sense of a break in routine we were told, with activities taking place on a more spontaneous basis. The manager said the rotas were related to the activities programme, with a driver is on duty most days (since half of the staff are able to drive the transport). We saw ten-pin bowling score sheets displayed; staff told us this was a winter activity. Photographs showed people enjoying seasonal parties and festivities. They said people had enjoyed going to a concert last month. We heard staff making arrangements for other events and activities. Care notes showed people had recently been to Exmouth, and used the garden. The home has helped to set up the Parachute Club - a day centre with activities, for the benefit of people living in any GCS Ltd. home. Thus people living at the home are able to meet other people. Activity plans showed some people attended other day centres also. We heard staff consulting people or engaging with them in a friendly, supportive manner. Bathrooms and toilets had privacy signs. Staff asked one person to go with them to get their coat for the outing, rather than just fetching it from their bedroom without them. Care plans included that some people were happy occupying themselves at times, and we saw staff respected this. Two relatives commented that the home provided good food. We saw fresh vegetables and fruit in the kitchen, which staff said were used regularly. During our visit, people had their meals at their own pace, with independence promoted but help also offered sensitively. Specialised plates, etc. were used to help their independence. Menus were varied and balanced, the main meal usually being in the evening because people were often out during the day. Intake charts were kept so that staff could monitor diet in relation to peoples’ health needs. Longcombe DS0000071102.V364830.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 – 20. Quality in this outcome area is good. People living at the home benefit from good support to meet personal and health needs, although involvement of any community health and social care professionals must be properly managed, to ensure this continues in the longer term. Medication matters are dealt with well, with appropriate policies and practices in place to protect people’s wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Records, conversation with staff and observation during the visit showed staff knew peoples’ preferences, routine, etc., and were flexible. A care plan prompted staff to be mindful the person had a health problem prone to affect them in the morning, when staff would be helping them to get up. We were told one person was being encouraged to go on more outings through recognition that they needed to be allowed to get to the minibus in their own time. A relative told us about someone at the home who absolutely loved music, and how the home helped them enjoy this in various ways. Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 17 There was information for staff about how someone’s past experiences affected them now, so staff could understand the person better, and on how they should support the person in the light of their personal history. Where individuals were at risk of harming themselves, there was clear guidance on how staff could try to prevent this, including possible triggers for such behaviour. We saw advice obtained from an Occupational Therapist was followed, with staff telling us it was proving successful. Induction for new staff included maintaining peoples’ privacy and dignity, as well as consideration of equality and diversity issues. Care plans included action staff should take to uphold peoples’ dignity, and we saw this was followed during our visit. During our visit, staff spoke with the people they were caring for in a very friendly but respectful manner. Language in care records was generally appropriate. A healthcare professional was positive about the home, and especially about the staff and how they supported people. Care notes showed that people had annual medical checks by their GP. Staff said one person went to an optician because they concentrated better at the optician’s, whereas two other people were seen at the home. Staff had made arrangements for people to attend a dentist where the diverse needs of people with learning disabilities were especially attended to, so they were not put off by the experience. A new hoist was being obtained for one person, on the advice of specialist staff at GCS Ltd. head office. One person had been seen by community nurses regarding a health problem, but this and involvement of the home’s staff was not reflected fully in their care records. The manager said she would liaise with the nurses, to ensure there were clear records of their involvement, any responsibilities delegated to staff at the home, and any other related action. We looked at three peoples’ medication. They were on relatively little regular medication. Records were well kept. There was very clear information on how and when ‘as required’ medication was to be used, so there would be consistency in their use regardless of who was responsible for medication administration. One person wasn’t on medication regularly but staff ensured they still had annual medication reviews, as did everyone else. There was no medication requiring cold storage but the manager described appropriate arrangements for ad hoc items. No concerns about medication were raised by the health care professional we surveyed. Longcombe DS0000071102.V364830.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. Strategies are in place that enable people to raise concerns or make complaints, to improve the service provided. However, some of the home’s policies and practices do not ensure people living at the home are fully safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A relative said the manager was usually available to discuss any concerns the relative might have. Two relatives said they had never had to make a complaint, and others indicated they had no problems regarding making complaints or raising concerns. Staff said they would try to address the matter if someone made a complaint, appeared unhappy or not their usual self, referring the matter to the manager if they couldn’t resolve it. The Statement of Purpose had the full procedure, including that if people wish to complain they may contact the CSCI at any time during the process. There was no complaints procedure in the Service User Guide we saw. The manager told us a standard version or a pictorial version would be provided as appropriate, at the time the guide was requested. The pictorial version was displayed in the office. Use of bedrails had been risk-assessed, to ensure the benefits of using them outweighed their possible harm. There were inventories of peoples’ own Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 19 property. Transport costs were recorded separately for each person. The manager said people’s personal money records were audited by someone from GCS Ltd. head office. She confirmed that people living at the home do not pay for staff refreshments on outings. We were told staff buy presents on behalf of the people living at the home, to give to other residents or to the person’s family members on special occasions. Such gifts were bought with the money of the person living at the home, and we were told peoples’ relatives were aware of this practice. However, there was no evidence of agreements, policies, guidelines, etc. to ensure transparency and clarity about this practice - when staff are making decisions on how other peoples’ money is to be spent - and to ensure people can feel able not to participate, if they wish. Certain allegations were being investigated under the local authority’s safeguarding procedures. Training records suggested a majority of staff had not had any recent training related to safeguarding, but the manager told us the staff team were currently undergoing updating in the light of the allegations made, with an external professional. Staff we spoke with knew they must report inappropriate or abusive practice, and knew to whom they could report to concerns to within GSC Ltd. and outside. The safeguarding policy we were shown did not give staff guidance in line with the local authority’s Social Services protocol, although the manager described appropriate procedures to be taken should safeguarding concerns be raised or an allegation be made. A new, up-to-date policy was going to be issued by the new registered provider, although the date of this was not known. We noted in one person’s records that staff had appropriately recorded a bruise and a scratch found, but there was no other information – for example, what had been done about these observations. The manager agreed to ensure follow-up action was evidenced fully for such matters. Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. Quality in this outcome area is good. People benefit from a homely and clean environment, adapted to promote their independence and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Peoples’ bedrooms were personalised, some with their artwork or collages of photos, and a range of colours used. During the inspection, some people enjoyed their own space for recreation. The AQAA showed servicing of facilities was up-to date, with an engineer visiting during the inspection to carry out safety tests on electrical appliances. Staff said minor repairs were attended to quickly. We did not see anything in need of repair or urgent attention during our visit. There was a bath hoist. Grab rails were in place to help people use the kitchen door when coming and going from the home. The garden paths were clear and Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 21 had handrails, so people could still safely go out independently if they wished. Staff had ensured an external ramp was accessible for a wheelchair user. All areas looked clean, including the kitchen and other shared facilities. There were no malodours. Staff were expected - by GCS Ltd. - to attend three-yearly infection control updates. Staff we spoke with confirmed they had had recent updates, and that there were sufficient stocks of disposable protective clothing for them to use when needed. The washing machine had recommended programmes for thorough cleaning of laundry. Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35. Quality in this outcome area is good. There are sufficient and suitable staff to safely meet peoples’ current needs, although people would benefit in the long term if staff have regular ‘good practice’ updating - to ensure the home provides the specialised service it offers, and staff are able to meet peoples’ changing diverse needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were three staff on duty with the manager when we arrived. There were usually two care staff during the day as a minimum, but an extra person was on duty because of a planned outing. Staff confirmed it was not unusual that staffing was increased to enable activities to take place. Overnight there is one awake staff and one sleep-in staff. Relatives thought there were usually or always enough staff on duty. Staff we spoke with felt staffing levels were appropriate, with a good team who covered any holiday or other absences rather than resorting to use of agency Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 23 staff. They said two new staff were due to start working at the home soon, who would be particularly welcomed to help with such cover. Recruitment information was seen for recently employed staff, who had transferred from another GCS Ltd. home. There was required information such as a police check and two good references obtained before they transferred - to help confirm they were suitable to be employed in this care home. Three references had been obtained because one reference was brief. The manager told us prospective staff visit the home so that the people living at the home can meet them and it can be seen how well they get on initially, before they are invited for interview. Even though the person had transferred from a home providing care for a similar client group, we saw the staff member had undergone a full induction programme, to ensure they had required skills for looking after the people at Longcombe. Staff induction was in part based on a nationally recognised learning disability-related induction programme. The AQAA said police checks were destroyed after 12 months. We clarified with the manager that they would be kept until the next CSCI inspection, which might be longer than 12 months. Surveys from relatives and professionals told us they thought staff had the skills and experience necessary to look after the people at the home, giving agreed or expected support well, and meeting peoples’ diverse needs well. One professional added they were very impressed with the staff, and a relative also noted staff communicated well between each other. We saw staff had recorded individual supervision sessions with the manager. Staff said they discussed how their practice might be improved, any training requests, and any other suggestions at these sessions. Three of seven care staff had a nationally recognised care qualification (- some being at a higher level), with a fourth currently undertaking the qualification. One staff told us they had had training on writing risk assessments and interviewing prospective staff. Conversation with staff and training records indicated a majority had not had any recent training or updates related to the specialised care offered by the home, however. One staff told us they would be given relevant training or advice if there were an area of care new to them. Staff told us certain keyworkers at the home were very proactive and showed other staff how certain people living at the home could be helped to develop new abilities and enjoy a better quality of life. This progress was reflected in the person’s care notes. We were also told that the Parachute club gave staff opportunities for sharing ideas and learning, because they met staff from other homes whilst accompanying the service users. Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is good. The home is run in the best interests of the people living there, with everyone at the home benefiting from the management style and experience of the manager. Various policies and practices reduce risks to peoples’ health and wellbeing, although some staff would benefit from further training on one matter to fully promote the safety and welfare of people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Surveys from relatives, professionals and staff were positive about the home. The registered manager had run Longcombe for 18 months, and was also the registered manager for another small GCS Ltd. care home. She had recently achieved recognised care and management qualifications. She said she has Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 25 had training on equality and diversity from an external trainer. Staff told us they could discuss any aspect of the home, any issues, etc. with her at any time. She made herself freely available to help us during our inspection, able to provide us with information we asked for. There were no meetings for people living at the home or relatives, but staff said the home carried out surveys, involving relatives, etc., for quality assurance purposes; one told us staff weren’t told about the outcomes from this, however. The manager showed us the report written following the latest ‘quality of care’ survey, which included responses from relatives, visiting professionals and staff. She said senior managers in GCS Ltd. reviewed the action plan included. The provider’s own monthly monitoring reports, on the conduct of the home, were also available. Staff confirmed there were staff meetings every 2-3 months – we saw the last one was held in February 2008 - when they could make suggestions on improving the service, etc. The AQQA showed equipment and facilities had been serviced in a timely way, which staff confirmed. We saw fire extinguishers appropriately had been checked within the last year. Training records showed all staff had had training and /or updates in health and safety topics such as safe handling. Fire safety updates were next taking place in June 2008. All had had first aid training. Staff told us they checked bath water temperatures before anyone got in, a thermometer being seen in the bathroom. New food regulations were being addressed. There were records of bedrail maintenance checks. However, one staff we spoke with was not aware of the safety checks staff should carry out whenever they put the rails up, before leaving the person concerned. Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 26 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 2 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 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X X 2 X Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A 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 YA23 Regulation 13(6) Requirement You must ensure that people living at the home are safeguarded from physical, financial, psychological, sexual or discriminatory abuse, neglect or harm – Including: 1) That written safeguarding policies are robust, up to date and in line with the local authority’s agreed safeguarding protocols; 2) Reviewing the practice of buying gifts on behalf of people living at the home with their money, when they may not be able to clearly consent, so that they are safeguarded by appropriate and transparent decision-making processes; 3) Keeping clear records of action taken regarding unexplained injuries, even when these are minor. Timescale for action 31/07/08 Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 28 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 YA19 Good Practice Recommendations It is recommended you evidence that any nursing care required by individuals living at the home is provided by community-based nurses, or by care staff to whom they have specifically delegated responsibility and trained with regard to that individual’s nursing needs & their consent for this arrangement (however that might be determined). It is recommended that there is a staff training programme that ensures staff can fulfil the aims of Longcombe and meet the changing needs of the people living there – thus including training or updating on topics relevant to peoples’ support needs. It is recommended that all staff know the safety checks they should carry out whenever they use or apply bedrails, to ensure as much as possible the health, safety and welfare of the individual the bedrails are being used for. 2 YA35 3 YA42 Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 29 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. Extracts may not be used or reproduced without the express permission of CSCI Longcombe DS0000071102.V364830.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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