Care Home: Mossmead (15)

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What the care home does well People who live at the home are helped to make decisions about what they want to do. Meetings had recently been held, when people`s daily routines had been discussed with them. As a result, some changes had been made to people`s day activities. One person told us that they now attended a day centre for an extra day, which was what they wanted. There are other times when people can talk about the home and how they are being supported. They discuss things individually with their key workers. They also have meetings together when they are asked about the sort of social events and meals that they would like to have. People enjoy the meals and they help to plan the menus. People said that they had chosen to have bacon sandwiches for breakfast on the day that we visited. People receive support so that they can keep in touch with their families and the local community. Their relatives feel that the home is meeting people`s needs well and providing a good standard of care. People are encouraged to express their views. There are arrangements in place that help to ensure that any concerns are followed up, and that people are protected. There is a settled staff team who know the residents well. Thismeans that people receive support from staff they are familiar with and who know their individual likes and dislikes. The home provides people with a well maintained and comfortable environment. There are some features that people particularly enjoy, such as a summerhouse and a modern looking lounge. What has improved since the last inspection? The main development has been a change in the management of 15 Mossmead. People are benefiting from a settled period in the home after the previous manager left unexpectedly. Mrs Trott was managing another OLPA run home at the time, and then moved to 15 Mossmead shortly after the vacancy arose. Mrs Trott has over ten years managerial experience, and has gained relevant qualifications. Mrs Trott`s application to be registered as the home`s manager was approved shortly after we visited the home. The number of qualifed staff is being increased over time, as more staff have completed or started a National Vocational Qualification. Refurbishment and decorating work has continued in the home, so that people benefit from living in a pleasant and comfortable environment. What the care home could do better: People have not been provided with all the information that they need about the home. In particular there is a lack of agreed terms and conditions, which means that people`s rights are not well protected. People`s individual files should receive attention. This is so that the up to date information about people`s needs and goals is more clearly identified, and their progress can be monitored better. We spoke to Mrs Trott about this, and she was already aware that this was a priority. People are generally well supported with their healthcare and medication. However there are areas that should be followed up, to ensure that people`s needs are always fully met. The training that staff members receive could be further developed, so that people in the home benefit from staff who are increasing their knowledge, for example in subjects such as equality and diversity. Quality assurance systems are improving but people`s views are not yet fully reflected in the home`s development plans. A report needs to be produced which shows how the views of the residents and their representatives have been taken into account, and how the home has responded to matters arising from this inspection. CARE HOME ADULTS 18-65 Mossmead (15) 15 Mossmead Chippenham Wiltshire SN14 0TN Lead Inspector Malcolm Kippax Key Unannounced Inspection 22nd July 2008 9:30 Mossmead (15) DS0000028274.V368428.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 Mossmead (15) DS0000028274.V368428.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. Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mossmead (15) Address 15 Mossmead Chippenham Wiltshire SN14 0TN 01249 461587 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) Ordinary Life Project Association Mrs Teresa Trott Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th August 2006 Brief Description of the Service: 15 Mossmead is one of a number of care homes in Wiltshire that are run by the Ordinary Life Project Association (OLPA). The property is a semi-detached house in a quiet residential area on the outskirts of Chippenham. There is level access to the front and rear of the home and some space for parking at the front. Each resident has their own bedroom. One of the bedrooms has an en-suite shower, and a toilet and basin. There is a bathroom and a separate shower room on the first floor. There is also a downstairs toilet and basin. The communal rooms include a large lounge and dining room, with a separate kitchen and utility room. There is an enclosed garden at the rear of the house, which has a lawn, a summerhouse and a patio area. Residents receive support from a permanent management and staff team. There is always at least one person working when the residents are at home. The home had one vacancy at the time of this inspection. The fees ranged from £933.53 - £950 per week. Information about the service is available in the home’s ‘Statement of Purpose’. Copies of inspection reports are available from the OLPA head office at Beckford House, Gipsy Lane, Warminster, Wiltshire, BA12 9LR. They can also be seen on the Commission’s website at www.csci.org.uk Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Initially we asked the home to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how well they were performing. It also gave us information about what has happened during the last year, and their plans for the future. We sent out surveys, so that we could get people’s views about the home. We had surveys back from three residents and from four of their relatives. We looked at the AQAA and the surveys, and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what we should focus on during a visit to the home, which took place on 22nd July 2008. During this visit we met the three residents, the manager, and a staff member. We looked at some records and went around the home. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. What the service does well: People who live at the home are helped to make decisions about what they want to do. Meetings had recently been held, when people’s daily routines had been discussed with them. As a result, some changes had been made to people’s day activities. One person told us that they now attended a day centre for an extra day, which was what they wanted. There are other times when people can talk about the home and how they are being supported. They discuss things individually with their key workers. They also have meetings together when they are asked about the sort of social events and meals that they would like to have. People enjoy the meals and they help to plan the menus. People said that they had chosen to have bacon sandwiches for breakfast on the day that we visited. People receive support so that they can keep in touch with their families and the local community. Their relatives feel that the home is meeting people’s needs well and providing a good standard of care. People are encouraged to express their views. There are arrangements in place that help to ensure that any concerns are followed up, and that people are protected. There is a settled staff team who know the residents well. This Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 6 means that people receive support from staff they are familiar with and who know their individual likes and dislikes. The home provides people with a well maintained and comfortable environment. There are some features that people particularly enjoy, such as a summerhouse and a modern looking lounge. What has improved since the last inspection? What they could do better: People have not been provided with all the information that they need about the home. In particular there is a lack of agreed terms and conditions, which means that people’s rights are not well protected. People’s individual files should receive attention. This is so that the up to date information about people’s needs and goals is more clearly identified, and their progress can be monitored better. We spoke to Mrs Trott about this, and she was already aware that this was a priority. People are generally well supported with their healthcare and medication. However there are areas that should be followed up, to ensure that people’s needs are always fully met. The training that staff members receive could be further developed, so that people in the home benefit from staff who are increasing their knowledge, for example in subjects such as equality and diversity. Quality assurance systems are improving but people’s views are not yet fully reflected in the home’s development plans. A report needs to be produced which shows how the views of the residents and their representatives have been taken into account, and how the home has responded to matters arising from this inspection. Mossmead (15) DS0000028274.V368428.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. Mossmead (15) DS0000028274.V368428.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 Mossmead (15) DS0000028274.V368428.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): 2 and 5 Quality in this outcome area is adequate overall. People are not provided with all the information that they need about the home. In particular there is a lack of agreed terms and conditions, which means that people’s rights are not well protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standard 2 was not assessed on this occasion, as nobody had moved into the home since April 2005. We were told in the AQAA that the home had one vacancy, which it was planning to fill when a suitable person had been found, and who was compatible with the current residents. We have found at previous inspections that not all the people who live at the home have had an individual contract. We looked at people’s files during our visit and saw that one person had a contract that had been issued by the local authority that funded their placement. These were not seen for the other two people who lived at the home. Mrs Trott said that she would find out what contractual arrangements were in place and confirm these with us. Each person’s individual file included a licence agreement that had been produced by OLPA. These listed some terms and conditions, but as Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 10 agreements they were of little value because they were not understandable to the people living at 15 Mossmead. They had not been agreed by a third party, and had only been signed by a former manager of the home. Fee levels were included in the Service User’s Guides, which also gave information about some services and goods that are not covered by the fees. Chiropody was listed as one additional charge that people in the home. Mrs Trott told us that people also paid for toenail cutting by a chiropodist, as staff did not support people with this aspect of their personal care. This was not made clear in the written information. We thought that people living in the home should not be paying for nail cutting out of their personal allowance money and we will be following up the outcome of the recommendation that we have made. Mossmead (15) DS0000028274.V368428.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 good. People are involved in making decisions about their lives and can be independent within their capabilities. People’s needs are being kept under review. Their individual files would benefit from attention, so that the up to date information about needs and goals is more clearly identified. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Before we visited 15 Mossmead, we had sent surveys to the home for the residents to complete. These were in an ‘easy read’ version. We received three surveys back. The residents had support with filling in the surveys, although we were told that they found many of the questions difficult to understand and to answer. From the responses that were given, people told us that they could make decisions about what to do each day, and that staff listened to them and acted on what they said. Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 12 We also had surveys back from four relatives. Each relative felt that the home always met people’s individual needs. One person commented that staff helped with the ‘special needs’ of their relative in the home, but also recognised their strong points and encouraged them to do things for themself. We saw files in the home that contained a range of paperwork and forms for each person. People had a main care plan, and the most recent ones we saw had been produced in 2007. The care plans included sections on communication, personal care, routines, eating and drinking and contact with friends and families. We saw that one person’s file included a ‘Care Plan Review Sheet’, which showed that their plan had been reviewed in July 2008. The files included other plans, guidance and procedures relating to different aspects of the residents’ needs. We also saw paperwork that dated back ten years and it was difficult to know whether this was still relevant, or had been superseded by other records on the same file. The staff member we spoke to said that they did not find it easy to find information in the files, which they said had been put together by a former manager. We spoke to Mrs Trott about this, and she was already aware that sorting out the files was a priority. Risk assessments were being undertaken for a range of activities and tasks, such as bathing, that could be hazardous to people who lived in the home. People had ‘Person Centred Plans’ (PCPs), in addition to their care and support plans. These gave information about people’s goals for the future, based on their ‘needs and wants’. One person had a new PCP in June 2008. The other two people had PCPs that were dated June 2007, and were due to be reviewed. Mrs Trott told us that the PCP paperwork may not be all up to date, but this was one of the things that she was attending to. One person had left 15 Mossmead during the last year. They had completed an action plan for moving out of the home and we were told that they had been supported successfully with this. Mrs Trott told us that review meetings had been held in the last few months for each of the three residents. Care managers had attended from the residents’ placing authorities. We saw that details of these meetings had been recorded. Residents had talked about new things that they would like to do. Mrs Trott said that all the care plans were now going to be updated, and the residents’ files would be reorganised. During our visit we heard people in the home being asked by staff about what they would like to eat and drink. People met together at monthly house meetings when they could talk about the menus and things that affected them in the home. We saw records of the meetings, which included pictures to help the residents’ understanding. Mossmead (15) DS0000028274.V368428.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, 15, 16 and 17 Quality in this outcome area is good. People make choices about their daily routines and activities, and have meals that they enjoy. People receive support, which helps them to maintain relationships and to be part of the local community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The people who live at 15 Mossmead had a regular programme of activities outside the home. When we arrived at the home, one person had just left to go to a nearby resource centre. They returned to the home later in the morning; this had not been expected, but a staff member was available to support the person with other activities for the rest of the day. Two people went out to another local centre during the morning. They said that they enjoyed going there. At their last review meeting, one person had Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 14 said that they would like to go to this centre for an extra day. The home had been able to arrange this. The centre arranged some day trips and we were told that one person had booked to go on a trip to Bristol Zoo with other people from the centre. The activities that people attended were being recorded in their personal diaries. We were also told that people had enjoyed staying at the caravan that is owned by OLPA. One person said that they went to the local Gateway Club and had made friends there. Mrs Trott told us that there was more ‘double cover’ during the week, which meant that there were more opportunities for people to be supported with leisure activities outside the home. We heard about the sort of outings that people had, such as going to parks and visiting places of interest. One person had been horse riding and they had rosettes displayed in their bedroom. All the bedrooms looked different and showed people’s individual interests and choice of décor. People said that they helped out with some of the cleaning and other household tasks. We were told about the contact that people at the home had with their relatives. Everybody kept in touch regularly, which included visits out and overnight stays with family members. In their survey, one relative stated ‘I am actively encouraged by the care home to visit as much as possible’. Another person commented that they were always encouraged to be part of their relative’s life. Relatives also told us about the choices that people in the home are given. One person commented that staff had to direct things, but always gave choices which were simple and encouraged decision making. Another person commented that their family member who lived at the home never appeared pressured into doing something that they didn’t wish to do. People who live at the home made choices about what to eat and they suggested meals that they would like to have. They talked about this at the monthly house meetings, as well as informally during the day. On the day that we visited people had chosen to have bacon sandwiches for breakfast. We spoke to people about their favourite meals. One person said that they liked spaghetti and we saw from the records that this was one of the meals that people had regularly. Other meals were being prepared which were known to be popular with people, such as stir fries, chicken curry, fish cakes and pasties. Sometimes people had a takeaway. During the visit we saw that there was fresh fruit out in bowls and people had drinks regularly during the day. Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good overall. People receive the personal support that they require. They are generally well supported with their healthcare and medication. However there are areas that should be followed up, to ensure that people’s needs are always fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about people’s personal and health care needs was included in their individual files. There were care plans, which described the support that people required, and how staff should provide this. Mrs Trott said that toenail cutting was one personal care task that staff members did not support people with. Instead, a chiropodist made regular visits to the home. We have commented on this in the ‘Choice of Home’ section of the report. We asked relatives in their surveys whether the home gave the support or care that they expected. Each relative responded ‘always’. One relative told us that they were kept up to date with hospital appointments and with any current medical needs. When we asked what they felt the care home did well, Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 16 one relative commented ‘All the service users at 15 Mossmead appear to be very well looked after and cared for’. People had their own bedrooms, where support with personal care could be given in private. During our visit we heard staff reminding somebody to shut the door when using the toilet, to ensure their privacy. There was an all female staff team, supporting female residents, so cross-gender care was not an issue in this home. Details were recorded about particular health conditions that people have been receiving support with over several years. These included diabetes and epilepsy. There was no overall plan for the management of epilepsy and we recommended that this is discussed with a specialist nurse from the community team for people with learning disabilities (CTPLD). We asked about ‘Health Action Plans’; Mrs Trott said that these were not in place, but agreed that they would be useful. They will help to ensure that good arrangements are in place for meeting people’s healthcare needs now, and in the future. People who live at the home had local GPs and saw a range of health care professionals. Mrs Trott said that there were plans for the further involvement of outside specialists to support residents with their individual needs. One person had been referred for speech therapy and for the involvement of a behavioural nurse. Some additional recording of this person’s activities and behaviour had been started, so that there would be good information about their well-being and what might trigger a change in this. We saw a medication file in the home, which contained a ‘Medication Profile’ for each person. There was a procedure for the administration of medication, and some guidance sheets about medication that had been produced by a training company. Staff had received training from OLPA about the administration of medication. We have recommended at previous inspections that an outside professional should be in the training that staff receive. This recommendation is still applicable. People who live at the home have been assessed as not being able to manage their own medication. We saw that their medication was being stored safely and that staff were maintaining appropriate records. Sometimes people stayed overnight with their family members. Normally, this would involve people taking an appropriate amount of their medication with them, while they were away from the home. Mrs Trott mentioned one situation where other arrangements had been made, and the person involved did not use their usual supply of medication. Mrs Trott said that it was likely that the person concerned had also been prescribed medication from a GP, as a temporary patient, and that this was being used when they stayed with their family. However, there was a lack of clarity about the arrangement and no details had been recorded. We advised Mrs Trott to follow this up, to ensure that suitable and safe arrangements were in place. Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. People can express their views. There are arrangements which help to ensure that any concerns are followed up, and that people are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: OPLA had produced a complaints procedure for the people who live at the home. This included information about people who could be contacted about any concerns, including an inspector from the Commission. Details were provided about how to contact the Commission. Meetings were being held in the home when people could talk about any concerns, either together or individually with their key workers. They also kept in touch with their relatives, and saw people outside the home regularly. Three relatives confirmed in their surveys that they knew how to make a complaint about the home if they needed to. One person responded ‘I cant remember’ but added that if a complaint was needed then they would contact a care manager at social services. We asked in the surveys whether the care service had responded appropriately if concerns had been raised about a person’s care. Three relatives responded ‘always’; the fourth person commented ‘no major concerns occurred’. We saw that a complaints log was kept in the home and that no complaints had been recorded. There was a record of a compliment that had been Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 18 received from somebody who had attended a review meeting. This person had said that they there were very happy with the care being provided and that they had been made to feel welcome. It was confirmed in the AQAA that the home had not received any complaints during the last year, and that no referrals had been made under the procedures for safeguarding vulnerable adults. We saw that the home had a copy of the local procedures for safeguarding vulnerable adults. There was also a copy of the ‘No Secrets’ booklet, which summaries the procedures and provides guidance about what to if there is a concern about possible abuse. The staff member we spoke to said that they were aware of the procedures about reporting abuse, and about whistle blowing. Abuse awareness was included in OLPA’s training programme for staff. The programme did not include refresher training. We recommended at the last inspection that staff who had received adult protection training more than two years ago should attend further training to update their skills and knowledge. We were told in the AQAA that it was planned to have a ‘rolling programme’ of abuse awareness training for all staff. People in the home received support from staff with managing their personal money. We saw that the money was being safely kept and staff were recording when a transaction had been made. Receipts for expenditure were being obtained and there was a system in place for external auditing of the accounts. Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good overall. People live in a comfortable environment and have accommodation that meets their needs. There are some features of the home that people particularly like. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 15 Mossmead is situated on a modern estate in a residential area on the outskirts of Chippenham. The house is in keeping with the neighbouring properties and looks like an ordinary domestic type home. There was level access to the front and rear of the home. There was a parking area at the front of the house and a garden at the rear. The garden had a summerhouse, which was being used during our visit. We were told that this was particularly popular with one of the residents. The garden also had a lawn and looked like a pleasant area for people to use. Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 20 Relatives commented in their surveys that 15 Mossmead was comfortable and that staff encouraged people to feel ‘at home’. When we visited we initially spent time with people in the lounge. This was a well decorated room in a co-ordinated style, which people said that they liked. It had a large, modern three-piece suite, and a flat screen television, which gave a very good picture. The lounge was partitioned off from a dining area, which had patio doors leading onto the garden. The environment generally looked well maintained and thoughtfully decorated. People living at the home had been involved in choosing the colours and furnishings. It was reported in the AQAA that improvements during the last year had included replacement of all the windows and doors, and redecoration of the kitchen and utility room. A maintenance visit had been made to the home in February 2008, and a report produced. This was useful in highlighting work that needed to be done to ensure that a good standard of décor and refurbishment were maintained. The report had an action plan section, which showed who would be responsible for the work, but dates for completion of the items were not identified. We saw that the stair carpet was wearing and that this had been identified in the maintenance report as being in need of attention. It was reported in the AQAA that the carpets were to be deep cleaned, or replaced if necessary during the next 12 months. There were no unpleasant odours around the home when we visited. The accommodation and facilities looked clean and tidy, including the toilets. Laundry was done in a utility room, which was beyond the kitchen. A procedure had been produced for the safe handling of laundry, so that the risk of cross infection was reduced. ‘Hold-open’ devices and automatic closures had been fitted to some doors in the home. This meant that the doors could be kept open safely, and it helped people to move between rooms. The door between the kitchen and the utility room did not have such a device fitted, although the staff member said that this would be useful. Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good overall. People are supported by staff who know them well. The training that staff members helps to ensure that people are safe and their care needs are met, but could be further developed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We were given information in the AQAA about the staff team and the staff members’ qualifications. One permanent staff member had left (retired) since the last inspection. Mrs Trott confirmed that this had been the only change in the staff team, and that arrangements were being made for this person to be replaced. However, the retired member of staff was continuing to work on a relief basis. Mrs Trott said that one change that she had made had been to have more ‘double cover’ at the end of the week, and at weekends, so that people could receive more individual support at these times. We were told in the AQAA that there were plans to increase staffing levels with a recruitment drive. Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 22 We did not look at the current staff members’ recrutiment records at this inspection. These were seen at the previous inspection, when we had reported that the people who lived at the home were protected by a robust recruitment procedure. It was reported in the AQAA that the recruitment system allowed the residents to meet prospective employees, and there was a set procedure for obtaining Criminal Record Bureau checks and references. We were told that new staff members underwent a six-month probationary period, during which time they completed a recognised induction package. Half the permanent staff team had achieved a National Vocational Qualification (NVQ) at level 2 or above. One staff member was close to completing their NVQ at level 2. Staff members had attended a range of training events as part of OLPA’s programme of mandatory training. The programme included first aid, medication, manual handling, abuse awareness, food hygiene, and health and safety. The staff member we spoke to said they were up to date with their training, and would be renewing their first aid training later in the year. They said that they had not attended training about equality and diversity issues. We thought that this training would be relevant for all staff. It was reported in the AQAA that it was planned during the next year to provide a comprehensive training package for staff to help promote equality and diversity. The training events were mainly provided to staff on an ‘in-house’ basis. We talked to Mrs Trott about the involvement of outside agencies and the use of external courses, for example in learning more about medication. We were told in the AQAA that there were plans to revise the staff development plans and to devise a rolling programme of refresher courses. Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good overall. People are benefiting from a settled period in the home following a change in management. Quality assurance systems are improving but people’s views are not yet fully reflected in the home’s development plans. People’s health and safety are being promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager left unexpectedly earlier in the year and we were informed of the reason for this. Mrs Trott was managing another OLPA run home at the time, and moved to 15 Mossmead shortly after the vacancy arose. Mrs Trott has over ten years managerial experience, and has gained relevant qualifications, including a National Vocational Qualification (NVQ) in management and an NVQ in Care at Level 4. Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 24 Mrs Trott’s application to be registered as the home’s manager was approved shortly after we visited the home. Mrs Trott was also managing another similar sized home in the area, which was run by OLPA. Mrs Trott said that she was still working out the best way to divide her time between the two homes, but felt that the task was manageable. Mrs Trott said that it had been agreed with OLPA that her management time at 15 Mossmead was ‘protected’, meaning that she would not be covering shifts in a support worker role. Mrs Trott completed the AQAA for the home, which gave us information about developments that were being planned, and about how the home could improve. We were told that there were plans to ensure that all policies and procedures were updated and accessable to all. The home was also going to ‘embrace and be aware of Mental Capacity Act and it’s implications’ We thought that these would be positive developments, so that information produced for people in the home is more accessible to them and reflects their different abilities. We were also told in the AQAA that the home was ‘striving to seek ways to assess effective quality assurance and monitoring systems’. There was a Quality Assurance file in the home and we saw that the previous manager had produced an annual development plan for the home which was dated June 2007. This identifed a number of objectives, under the headings which included environment, staff training and service users. We have made a previous requirement about developing a quality assurance system, which had been met in part. Mrs Trott said the she would be producing a new development plan for the home and we confirmed what needed to be included in this. There was a file that contained a lot of risk assessment forms. The assessments covered a range of topics, such as lone working, changing a light bulb and shopping. The assessments had been reviewed earlier in July 2008. Mrs Trott said that she would also be reviewing and updating the home’s fire risk assessment. Regular checks were being made of the fire precaution systems. A staff member said that she had received fire instruction and everybody participated in fire drills. We were told that all the upstairs windows had restricted openings for safety reasons. The temperature of the hot water in the bathroom was being checked, to ensure that it stayed at a safe level. Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 N/A 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 N/A 35 3 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 3 3 X 3 X 2 X X 3 X Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 26 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 YA39 Regulation 24 Requirement There must be a quality assurance system in operation and a report must be sent to the CSCI on completion of the survey. (Requirement made at the last inspection, which has been met in part). The new report needs to show how the views of the residents and their representatives have been taken into account, and how the home has responded to matters arising from this inspection. Timescale for action 31/10/08 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 YA5 Good Practice Recommendations That the arrangements being made for supporting people with toenail cutting are reviewed, so that they are not having to pay for this out of their personal money. DS0000028274.V368428.R01.S.doc Version 5.2 Page 27 Mossmead (15) The arrangements should be discussed with the residents’ care managers, to ensure that they are consistent with any contractual agreements. 2. YA5 That written (‘license’) agreements should only be in place if they have been agreed and signed up to by all the appropriate parties. That Health Action Plans are completed with the residents. They will help to ensure that good arrangements are in place for meeting people’s healthcare needs now, and in the future. That the specialist nurse from the CTPLD is contacted about the need for an epilepsy management plan for one resident. That the arrangements being made for medication when a resident stays away from the home are confirmed and a record kept. This is to ensure that appropriate arrangements are in place and there is no risk of the resident not receiving the right medication. That an outside professional should be part of the training in drug administration that takes place within the organisation. (Carried forward from last inspection) That staff who received adult protection training more than two years ago should attend training to update their skills and knowledge. (Carried forward from last inspection) That advice is obtained about the fitting of an appropriate ‘hold-open’ device on the door between the kitchen and utility room. 3. YA19 4. YA19 5. YA20 6. YA20 7. YA23 8. YA24 Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 28 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 Mossmead (15) DS0000028274.V368428.R01.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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