Care Home: New Road (33)

Similar services:

• Hillview Farm
• Dalewood Respite Care
• Orchard,The
• REACH Upton Court Road
• Fairways
• Treloar College
• Kestrel House, St Anne`s Opportunity Centre,
• Pinta

What the care home does well Residents are supported to make choices and decisions in relation to aspects of their daily lives. Residents have access to a range of activities and the home has a strong ethos of supporting residents to access facilities in the community. Family involvement is supported and encouraged. Visitors to the home are made to feel welcome. Residents are encouraged to be involved in daily routines. Residents have access to a varied diet. Residents` personal and healthcare needs are met and monitored. The home is clean and homely and systems are in place to maintain this in order to provide a safe environment for service users What has improved since the last inspection? A new path has been laid to the side of the house to improve access for residents around the garden. Some parts of the interior of the home (including residents bedrooms) have been redecorated. Residents were involved in choosing colour schemes. This provides a pleasant and bright environment for residents. Staff turnover is low which means that residents are supported by staff who have a good understanding of their needs and who are willing to acquire new skills and develop the service. What the care home could do better: Staff should date and sign key documents in PCPs (such as assessments) so that the care provided to residents is based on current documents. Ensure that MAR charts include details of any known allergies or sensitivities to avoid adverse reactions. CARE HOME ADULTS 18-65 New Road (33) Aston Clinton Aylesbury Bucks HP22 5JD Lead Inspector Mike Murphy Unannounced Inspection 29th January 2008 10:00 New Road (33) DS0000023078.V357887.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 New Road (33) DS0000023078.V357887.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. New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service New Road (33) Address Aston Clinton Aylesbury Bucks HP22 5JD 01296 632749 01296 632749 33newrd@nildram.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hightown Praetorian & Churches Housing Association Sharon Ann Cook Care Home 3 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 3 residents with learning disabilities, some of whom may also have a physical disability. 24th October 2006 Date of last inspection Brief Description of the Service: 33 New Road is a detached bungalow owned and staffed by Hightown Prateorian and Churches Housing Association. It has been adapted to provide accommodation for three people with learning and physical disabilities. Each person has a large single bedroom and the property has been decorated and arranged to reflect a large family type environment. There is an enclosed rear garden with lawned and patio areas and parking spaces at the front of the building. The home is situated in a quiet residential area with a pub and small shop in the vicinity. Aylesbury town centre is approximately five miles away. There are no direct public transport links. Fees at the time of this inspection were £2307.07 per week. New Road (33) DS0000023078.V357887.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. This means the people who use this service experience good quality outcomes. This inspection was carried out by one inspector in February 2008. The inspection process included a visit to the service, discussion with the registered manager and staff, interaction with service users, observation of practice, examination of documents (including care plans), consideration of information supplied by the manager before the inspection visit and of one CSCI survey form returned before this report was written. The home has good systems for assessing the needs of prospective residents. These include contact with the prospective resident, his or her family and current carers. They also include consideration of whether the home can meet the person’s needs, get on with current residents, and of issues relating to equality and diversity (in which staff have received training). The home itself is a detached bungalow with a pleasant garden. It is situated in a quiet residential street in Aston Clinton, between Tring and Aylesbury. It is just over five miles from Aylesbury town centre, three and a half miles from Wendover, and just under three miles from Tring. There is a limited bus service to and from Aylesbury on the nearby main road, about a half mile walk from the home. The home has been adapted to provide accommodation for three people with learning and physical disabilities. Overall, it provides a spacious, pleasant and safe home for its residents. The home has its own vehicle. Residents are well supported by staff. Care needs are recorded in each resident’s ‘PCP’ (Person Centred Plan). PCPs include details of assessments of need carried out by home staff and by health and social care professionals. These form the basis for a plan of care and support which includes details of the resident’s preferences on how such care is to be provided. Residents are supported in accessing a number of facilities in the community. These include shops, cafes and theatres. In 2007 residents enjoyed a holiday in a selfcatering cottage on the Isle of Wight. Around the time of this inspection in January 2007 residents had been to a pantomime in Aylesbury and were planning to go to forthcoming theatre shows in High Wycombe. Residents’ healthcare needs are met in liaison with local health services. Staff turnover is low (no new staff have been appointed since the last inspection); therefore the present group of staff know the residents quite well. The home is well supported by Hightown Praetorian and Churches Housing Association. It is the conclusion of this inspection that the home is providing good outcomes for its residents. New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are carefully assessed before admission to ensure the home can meet the person’s needs. EVIDENCE: The home has not had a new admission since the last inspection. The process for assessing a person’s needs and deciding whether the home can meet those needs was discussed with the registered manager. There are two potential pathways to admission, each involving assessment by health or social care professionals and by managers of Hightown Praetorian and Churches Housing Association. Through one pathway, prior to admission, the person, their family and the referring care manager are provided with information about the home. The referral, together with supplementary information such as current care plans, is assessed by the service manager and the home manager. A series of contacts are then established. The care manager and members of the prospective resident’s family visit the home to view its facilities and meet residents and staff. If the referral is progressed then the home manager visits New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 9 the prospective resident at their current residence to carry out an assessment of needs and form a view on whether the home can meet those needs. Arrangements are then made for the prospective resident to visit the home, accompanied by family members and the care manager. If it is decided to progress the referral then arrangements are made for a trial admission with a review taking place at three months or earlier if necessary. The process aims to determine what the prospective resident’s needs are, whether the home can meet those needs, whether the prospective resident and those involved in their care believe that the home is suitable, and, whether the person is likely to settle in to the home and get on with current residents. An alternative pathway is through local authority ‘block contract’ and ‘panel’ arrangements. The process is not dissimilar to that described above. A panel of professional staff who have knowledge of the prospective resident’s needs and of the service provided by the home come to a view on whether a referral to the home is appropriate. Where a referral is made then a series of contacts are made as outlined above. These may culminate in a trial admission if all parties are in agreement. New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment of needs, and action to meet needs set out in care plans, aim to ensure that residents needs are met, that their independence is supported, that risk is minimised, and that care is provided in line with the person’s wishes. EVIDENCE: There is a care plan for each resident. Care plans are in person centred plan (‘PCP’) format which aims to make the process more ‘person’ than ‘problem’ centred and to be more accessible to residents. The PCPs seen on this inspection were well structured, well organised, detailed and comprehensive. In the case of one resident, the home, together with the resident’s family, was putting together a ‘Family History Album’ comprised of photographs of the person and people close to them, from early childhood to the present time. It New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 11 is intended that the album need not be confined to photographs but may also include notes and comment and items of interest. This was an initiative which the home was hoping to extend to all three residents in time. The album provided a “life story” of the resident and was of value to the person, their family, and to staff involved in their care. It is a valuable adjunct to the care plan and provides a fuller and more rounded picture of the person. Plans include personal details of the resident, assessments, health information, ‘How I communicate’, the level of support needed, ‘My activities’, ‘Things that are important’, behaviour guidelines and risk assessments, notes of reviews, correspondence and reviews. Documents also include a copy of the service user guide, licence agreement, statement of purpose, and contact details for CSCI. More specifically, the care plans examined included: records of the home’s contact with the person’s family, detailed and informative assessments (however, some of which were not dated and signed), health contacts, relevant information on care relating to certain conditions (such as epilepsy), immunisation records, guidance on communication, detailed notes for care staff on how the person likes to be approached, detailed notes on providing specific care (such as the support required when eating, drinking or toileting), daily routine, weekly timetable, and monthly diary (key events), notes on support required when travelling, and some information on finances. Risk assessments covered such matters as: travelling in the home’s vehicle, seizures, bathing and showering, choking when eating, use of seat belt (in vehicle) or lap belt (in wheelchair), oral hygiene, taking medication, moving around the home, and the risk of falling out of bed. Generic risk assessments cover such matters as: fire, health & safety, security, evacuating the building, COSHH, using wheelchairs, and travel (for example when travelling by ferry on a recent holiday). Care plans are reviewed monthly by link workers and annually with care managers. The residents in this home have significant problems in communications but the staff who have got to know them over time endeavour to involve them in decisions. Examples cited were menu planning and preferences regarding aspects of their care. Staff were seen to inform residents of tasks they were about to carry out or to clarify their understanding of some aspect of communication. Residents have had contact with advocates from Aylesbury Vale Advocates but this has declined following the recent departure of an advocate - and perhaps as a result of changes in the funding arrangements of the agency. New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents lead a varied lifestyle according to their interests and abilities. This ensures that residents experience a range of social and leisure activities and are involved with the wider community. Residents have a varied diet aimed at meeting individual preferences and good nutrition. EVIDENCE: There is an activity timetable in each resident’s PCP and an annual diary for significant events such as birthdays and holidays. Staff support residents in activities, both in the home and in the wider community. The manager said that some residents had attended colleges in Winslow and Bierton in the past but had not enjoyed the programmes on offer. One resident in particular was said to have had a negative reaction to a music session at the college whereas the same resident had reacted much more favourably to music in the home. New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 13 The home is well established in its locality. It is in a quiet residential street and it was said there is not a lot of activity during the day. Staff and residents have established a neighbourly relationship with a neighbour on one side of the home. On the day of the inspection visit all three residents and three staff, including the registered manager, had gone out on a shopping trip to Milton Keynes. While there they visited a large supermarket to shop for groceries for the home and ended the outing with lunch in a fast food restaurant. They returned to the home in the early afternoon. The home has its own vehicle for outings. Staff and residents also go shopping in Aylesbury town centre. Staff and residents had recently been to a Christmas pantomime performed at the Civic Centre in Aylesbury. They were planning to go to some forthcoming shows at the theatre in High Wycombe. The manager said that wheelchair access can be a problem on occasions because of the type of wheelchair which the residents need. These are large and have special equipment and do not always fit into the space generally allowed for wheelchairs. Residents and staff have had two holidays in the Isle of Wight – in a selfcatering house which they have found is ideally suited to their needs (including having the capacity to accommodate the residents wheelchairs). Photos of the holiday were on display around the home. All three of the current residents are in touch with their families and the families have kept in touch with each other over the years. The manager said that staff support residents who wish to attend church. The daily routine is flexible and centred on the needs of residents. Meals are planned in consultation with residents – using picture books and large photographs of dishes. Residents’ likes and dislikes are recorded in their PCP. Details of how residents made their choices are recorded. Staff are trained in food hygiene (for food preparation) and first aid (including immediate action on risk of choking). All residents need assistance with eating. A roast is usually served at Sunday lunch time. Breakfast is generally cold on weekdays. Scrambled eggs on toast can be made if requested. Warm milk is preferred on cereals. Fruit juice, warm beverages and soft toast are also served. A brunch may be served on Saturdays.There are no hard and fast rules on which meal is the main meal of the day – the time varies according activities. Around the time of this inspection main choices included: Chicken Curry and Rice; Shepherds Pie; Sausage, Waffles and Grilled Tomatoes; and (on Sunday), Roast Pork, Roast potatoes, Brussels Sprouts and Peas. Lighter choices included: Cheese on Toasted Buns and Coleslaw; Spam Fritters, Croquette Potatoes and Cole slaw; and, Tuna Salad. Residents may choose their own meal if they wish. The manager said that a dietitian visits annually or on referral. Residents are weighed monthly. New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for supporting residents and liaising with community health services are good. Arrangements for the control and administration of medicines are satisfactory. These ensure that residents’ healthcare needs are met. EVIDENCE: The care needs and preferences of individual residents are set out in detail in their person centred plan (PCP). These include notes on communication, care needs assessments, notes relating to specific aspects of care (such as epilepsy), immunisation records, weight chart, likes and dislikes, how the person wishes to be approached, risk assessments, and the level of support needed in personal care and in carrying out everyday activities. The PCP also includes reviews within the home carried out at the monthly link worker meetings, copies of correspondence with local health and social services, and copies of annual reviews of care and support needs. New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 15 All residents are registered with a local GP practice in Aston Clinton. At the time of this inspection none of the residents in the home were in regular contact with the multi-disciplinary community learning disability team (CLDT). The manager said that the home does, however, receive notes of the relevant learning disability partnership board. For medical reasons residents have blood checks twice a year. Two residents were also under the care of neurologists working with the National Society for Epilepsy centre in Chalfont St Peter. This link can facilitate contact with a specialist epilepsy nurse if required. Residents had no need for contact with community nursing services at the time of this inspection but the manager said prompt referral to relevant healthcare professionals is made when required. Residents had seen a NHS dentist. Physiotherapy and speech and language therapy services were accessed through the CLDT at Manor House Hospital. Arrangements for the storage and administration of medicines is subject to Hightown’s policy on the subject. Residents’ files include a document which provides a record of the resident’s consent to medication. In one sense that practice conforms to standard 20.2 of the ‘Adult’ standards. These are signed by the manager and link worker. However, given the nature of the disabilities experienced by the residents and their severe communication problems, the matter of informed consent is a problem for such a service. Medicines are prescribed by the resident’s GP and dispensed by Lloyds pharmacy in Aston Clinton. Staff training is primarily through the Boot’s Chemists one day course which is provided at Hightown’s head office in Hemel Hempstead but this is supplemented by a Lloyds pharmacy training pack. Staff were due to attend their three yearly update in 2008. Records are made of medicines received and disposed of. A pharmacist checks the home’s arrangements twice a year – an excellent practice. The report of the most recent inspection carried out in November 2007 was seen. Medicines are stored in residents’ rooms. Medicines requiring cool storage are stored in the fridge when prescribed. The importance of ensuring that such medicines are stored in a lockable container was discussed during the visit. The administration of medicines to one resident was observed. This was carried out satisfactorily. The medicines administration record (‘MAR chart’) was completed appropriately. Earlier entries were in order. It was noted that the resident’s MAR chart did not include reference to a potential sensitivity to Penicillin which had been recorded in his care plan (reviewed earlier in the day). Protocols are in place for ‘as necessary’ (‘PRN’) medicines. Information on medicines is sought through patient information leaflets and the British National Formularly (BNF) website. These should be supplemented by guidance from the Royal Pharmaceutical Society, CSCI and a good textbook. Recommendations were made during the inspection visit. New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has procedures for recording and investigating complaints. It has a framework of policy, reporting arrangements and staff training with regard to safeguarding vulnerable adults. Together, these aim to protect service users from abuse and to ensure that complaints are thoroughly investigated. EVIDENCE: The home is required to conform to the complaints policy and procedure of the organisation. A copy of the procedure in picture and easy read form is available in residents bedrooms and in PCPs. The home has book for recording complaints and compliments. It would be advisable for such records to have numbered pages to ensure the integrity of the record over time. No complaints have been recorded since the last inspection. Two compliments have been recorded. CSCI have not received any complaints about this service since the last inspection. The home used to have regular contact with an advocate from Aylesbury Vale Advocates but this has ceased since that person left (see note under ‘Individual Needs and Choices’ above). New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 17 The home is required to conform to the Protection of Vulnerable Adults (POVA) policy and procedures of the organisation. The policy was last revised in August 2007. The contact details for CSCI should be updated to reflect the current position. A copy of the Buckinghamshire joint agency guidance on the subject was available to staff on a shelf in the office. All staff have now attended in-house update training in safeguarding vulnerable adults (Protection of Vulnerable Adults). The organisation offers training in dealing with aggression and violence but the manager said that it was not a concern in this particular home. One member of staff had attended a two day course on the subject. Staff are aware of the Mental Capacity Act 2005 and the manager outlined a recent situation in which the ability of a resident to give informed consent to a medical procedure was considered. Consideration of the case involved home staff, the resident, the resident’s parents, the care manager and an advocate. The situation resolved itself when an alternative approach to the problem was successful. Systems are in place for managing monies on behalf of residents. Staff practice is governed by the policy and financial procedures of the organisation. All transactions are recorded and receipts of expenditure retained. These are reconciled with bank statements and other records. The home’s arrangements are checked at each handover and during Regulation 26 visits by senior managers. New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 18 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. This judgement has been made using available evidence including a visit to this service. The home provides an accessible, pleasant and well-maintained environment which provides people living there with a comfortable and safe place to live. EVIDENCE: The home is a detached bungalow owned by Hightown Praetorian and Churches Housing Association. It is situated in a quiet residential street in the village of Aston Clinton, between Tring and Aylesbury. It is just over five miles from Aylesbury town centre, three and a half miles from Wendover, and just under three miles from Tring. There is limited parking and drop-off space in the small driveway to the front of the home but plenty of unrestricted parking in nearby streets. There is a limited bus service to and from Aylesbury on the main road about half a mile walk from the home. The home has been adapted to provide accommodation for three people with learning and physical disabilities. Overall, it provides a spacious and pleasant home for its residents. New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 19 The accommodation comprises: entrance hall, kitchen/diner, living room, three bedrooms (none with en-suite facilities but each with a hand basin), laundry room, one bathroom (with a shower area which was not used at the time of this inspection), one shower room, and a staff office and sleep-in room. The interior is bright, airy, in good order and well decorated. Two bedrooms were viewed with the residents consent. Bedrooms are of a good size and have been decorated in line with the residents’ wishes. The bathroom includes a special bath (with Jacuzzi if required) and a ceiling mounted tracking hoist. The bathroom includes equipment which can be unfolded to provide an additional area in support of personal care if required. The home has a portable hoist and shower chair. All areas are accessible by wheelchair – each of the current residents has a large powered wheelchair. The living room is a good size and is well decorated. Seating includes large sofas and bean bags. There is a sensory light feature at one end of the room. The living room has a TV, DVD/Video, and a stereo music centre. Pictures of events and trips out adorn the walls throughout the home. The kitchen/diner is sufficient in size for current use. The kitchen is well equipped. A report of a visit by an environmental health officer in December 2007 was seen and it is noted that the home was commended for its health and safety practice. However, on the day of this inspection visit, it was noted that some foods in the fridge had not been date labelled when opened. The laundry includes a sink, store area, washing machine and tumble dryer. Staff said that the washing machine includes sluicing and hot water cycles. Soiled linen is washed in red alginate bags. It was noted that chemicals used in the laundry (detergents and fabric softeners) had not been locked away – nor had latex gloves. This contrasted with the arrangements for the storage of other COSSH materials which were stored in a padlocked cupboard. The manager said that risk to any of the current residents is minimal to nonexistent because each person is not mobile and is continually supervised by staff. The risk would be re-evaluated if the situation changed. There is a pleasant enclosed garden to the rear of the home with lawned and patio areas. New paving had been laid since the last inspection. A side gate was due to be replaced. The garden includes mature shrubs, flowers and a small herb garden. The staff office doubles as the staff sleep-in room and is adequate. Radiators are covered. The temperature of the hot water is regulated. Records of the temperature of fridges, freezers and of hot food served are maintained. New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels, procedures for the recruitment of new staff, and for staff training, development and support are good. These aim to ensure that there are sufficient numbers of appropriately trained and supervised staff to meet the needs of service users living in the home. EVIDENCE: The present staff establishment provides for two staff in the morning, two staff in the afternoon and evening and one waking plus one sleep-in support worker at night. However, staff are flexible and additional staff are provided where required – on the day of the inspection visit for example, three staff accompanied the three residents to Milton Keynes while other staff covered the home attending to other matters (including dealing with some aspects of the unannounced inspection visit). Temporary pressures on staffing (through sickness for example) are generally covered by the home’s own staff, supplemented on occasions by agency staff. New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 21 No new staff have been appointed since the last inspection, therefore evidence in support of the organisations recruitment practice was not available. The home is supported in the recruitment of new staff by the organisation’s human resources department based at its head office in Hemel Hempstead. The organisation’s policy requires the completion of an application form, provision of two references, a statement of fitness for a position, and an enhanced CRB (Criminal Records Bureau) certificate – all as required by the Regulations. Newly appointed staff are required to complete an induction programme which covers both induction to the home and the organisation. All staff have an individual training folder. According to information supplied by the manager in the Annual Quality Assurance Assess (AQAA) four of ten staff have acquired NVQ 2 or above. Six of ten staff are currently working towards NVQ2 or above – five at NVQ 2 and one at NVQ 3. The training plan for the year was on display in the home. The training programme includes; Induction of new staff (one staff respondent to the CSCI survey wrote ‘I was supported to complete an intensive induction pack’), Fire Safety, Medication, Abuse, Diversity, Understanding Learning Disability, First Aid, Moving & Handling, Food Hygiene, Managing Performance, and ‘E’ Learning. A number of the update training courses are of relatively short duration – 30 minutes to one hour. It appeared as if more training was also to be carried out on-line (‘E’ learning). This was discussed during the inspection visit. While this has benefits in terms of cost effectively covering a syllabus, there may also be disadvantages in terms of staff not being exposed to the views of others in a group, of not having opportunities to network with colleagues, and perhaps of not having the opportunity to view their own work from a different perspective. It is understood that this is a new development which is being rolled out across homes. It may therefore be too early to comment on its effectiveness. Individual personal supervision is well established in the home. All staff have a supervisor and sessions take place on a four or six weekly basis. The process is confidential and notes are taken. All staff have an annual appraisal and the organisation has a process for linking remuneration to performance. Staff described the manager as supportive and approachable. One respondent to the CSCI survey wrote ‘With ongoing and updated training and the support I receive from my manager I believe I do have the right support (‘…to meet the different needs of people who use services’ (Q9 of the staff survey refers]. New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 22 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 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well managed home where a positive approach to the quality of the service is providing good care outcomes for residents. Arrangements for health and safety are generally thorough and aim to ensure that the home maintains a safe environment for residents, staff and visitors. EVIDENCE: The registered manager has managed the home for two and a quarter years. Prior to this the manager had worked as a manager, deputy manager and support worker in other care settings including, supported housing, a service New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 23 for older people, and a service for people occasionally presenting with challenging behaviour. The manager was close to completing the NVQ assessors’ course at the time of this inspection. The manager had started but not yet completed the registered managers award (RMA). On completing these two NVQ courses the manager had plans for further professional development. A key quality assurance activity in the organisation is the annual internal audit. This is carried out by two managers from another home. The home was last audited in 2006. A senior manager carries out monthly Regulation 26 visits. A report is completed on each occasion. Reports of recent visits were seen during the course of this inspection visit. The reports include checks on the home’s arrangements under the following headings: ‘Health & Safety’, ‘Maintenance’, ‘Fire Safety’, ‘Occurrences’, ‘Food Hygiene’, ‘Medication’, ‘Residents’ (records), ‘Staff’ (records), ‘Quality’, ‘Finance’, ‘Areas of Good Practice’, and ‘General Comments for this Visit’. Not all sections are completed on every visit. The home does not carry out a stakeholder survey. The manager is required to complete a manager’s report monthly. An audit of medication is carried out twice a year. The home has a development plan for ‘07/08’. This covers the following headings: staffing, staff training, activities for service users, ‘PCPs’, ‘interior & exterior decoration’, ‘driveway & garden’, and , ‘budget’. Each heading includes a summary of the action, lead staff, review date, and completion date. The development plan is written in summary form and in some areas seemed to lack detail on the precise objective to be achieved under each heading and measurable indicators of progress. It does however set out priorities for action and a direction for the period it covers. Arrangements for health and safety appear satisfactory. The organisation has a health and safety policy and the home has a representative on the health and safety committee. The manager is to train as a moving and handling trainer. Arrangements for fire safety appear satisfactory although the manager reports that a fire officer expressed concern at the location of the bed in the staff office. Reference has earlier been made in this report to detergents and gloves being left out and to the home’s opinion of the potential risk to residents. This matter needs to be kept under review. An EHO visit in December 2007 found satisfactory practice in relation to food hygiene. However, greater diligence is necessary in relation to labelling perishable foods (see under environment above). Since the last inspection the home has improved its performance in relation to basic and update staff training in mandatory subjects. New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 3 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 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 3 X New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 (2) Requirement The registered manager must ensure that known allergies or sensitivities are appropriately recorded to avoid an adverse affect on residents. Timescale for action 29/02/08 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 YA6 Good Practice Recommendations The registered manager should ensure that all care documents in care plans (including assessments) are dated and signed. New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 New Road (33) DS0000023078.V357887.R01.S.doc Version 5.2 Page 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!