Care Home: Norwood Trust Limited

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What the care home does well Residents were assessed to make sure their needs could be met before they came into the home. One resident who was quite new to the home had visited many times before going to live there and had settled in very well because of this.People are treated as individuals and are able to spend time doing things that interest them. Residents said they had plenty to do and did not get bored. Residents were able to spend time in the local community and had a good social life. All the residents had been on a holiday to Blackpool in April, which several said they really enjoyed. Residents and their relatives thought staff understood the help they needed well and were positive in their comments, which included, "We visit Norwood quite frequently and always find a warm and friendly atmosphere", "All basic care given to a good standard", "I have always found the staff team to be understanding and caring. The fact that my brother greets them with smiles when he returns from a home visit speaks volumes", "My son is happy and contented with his personal needs fulfilled", "I have never had to make any complaints or concerns about my son`s care. It has always been exemplary", "They (staff) make Norwood a `home`. The staff are very caring and make each individual happy in their own way", "It treats the residents as a family and look after all their interests. If any illness happens their care is 100%" and "Norwood provides a very `homely` atmosphere. The staff team are generally very caring". Residents were positive about the food provided and had been involved in devising a new menu for the summer months. All residents and relatives who returned surveys confirmed that they knew how to make a complaint if they needed to do so and all staff also were aware of the complaints procedure. Norwood provides a comfortable environment for people to live in, and residents and relatives confirmed that the home was always fresh and clean. 73% of care staff are trained to at least NVQ level 2. What has improved since the last inspection? Since the last inspection there have been some improvements made to the environment. The remaining double bedroom in the main house had been divided to provide two single rooms. The main house had been rewired and the lounge and hallway in the bungalow had been redecorated and a new carpet, rug and flat screen television purchased. A new suite had been provided in the lounge in the main house, which included two recliner chairs.A sink unit had been put in one resident`s room and bathroom facilities in both the main house and the bungalow had been improved by the installation of wet rooms. Since the last inspection the risk assessments for residents who look after their own medicines had been reviewed to make sure they were still able to do this safely and had no problems. At the last inspection specifications had been as part of her induction used, so new staff were a new induction booklet that met Skills for Care purchased but a new member of staff had not used it training. We saw this time that the booklets had been covering the Common Induction Standards required. What the care home could do better: Although care files contained information about residents` normal routines and the help they needed, and care plans were provided by Social Services, staff at the home did not routinely write care plans. Whilst this system worked alright when residents had no specific problems, the manager needs to make sure that if a resident develops a new care need, a proper plan of care is written to address this so staff know what care they must give. Care needs were communicated and recorded in a variety of ways, which worked well as Norwood has a small staff team who all see each other regularly. However, all the information should be kept in one place to provide a good overview of the residents` needs and the care being provided. The manager needs to start regular staff supervision meetings and make sure a record is kept of these. Supervision should be used to identify staff training needs and to provide support and guidance for staff. A proper record of staff training is also needed, which will show when updates are due in health and safety topics and which will provide evidence that staff are receiving training in specific topics relevant to meeting the care needs of the residents living in the home. Recruitment procedures were not followed robustly enough. Although we recognised that the employee whose file we viewed had returned to work at the home after a period of two years and was well known to the manager and other staff, the correct procedure for obtaining references should still have been followed. Some pipes at the bottom of the stairs needed boxing in; the manager had already identified this but the work had not been done. This must be done as one resident tends to hold them when coming down the stairs and this presents a risk.The manager needs to develop a system to check records and care practices within the home to ensure they meet the required standards. CARE HOME ADULTS 18-65 Norwood Trust Limited 21 Arkwright Road Marple Stockport Cheshire SK6 7DB Lead Inspector Mrs Fiona Bryan Unannounced Inspection 10th June 2008 08:30 Norwood Trust Limited DS0000008570.V365499.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 Norwood Trust Limited DS0000008570.V365499.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. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Norwood Trust Limited Address 21 Arkwright Road Marple Stockport Cheshire SK6 7DB 0161-449 0391 NO FAX norwood.trust@hotmail.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) Norwood Trust Limited Care Home 14 Category(ies) of Learning disability (14) registration, with number of places Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 14 LD. Date of last inspection 9th July 2007 Brief Description of the Service: The Norwood Trust was established in 1985 and is a registered charity. Norwood is a care home providing personal care and accommodation for 14 adults, with a learning disability, ten of who are accommodated in the main house and four who lead semi-independent lives in a purpose built bungalow in the grounds. Norwood is a large, Victorian, semi-detached house with a purpose-built bungalow at the rear of the property. Both buildings are furnished and maintained in a homely manner and are suitable to meet the needs of the current service users. The main accommodation consists of ten single bedrooms, two lounges, dining room, kitchen, laundry and bathrooms. All the bedrooms are located on the two upper floors. There is no lift and the stairs to the second floor are particularly steep. The bungalow consists of four single bedrooms, lounge and separate dining kitchen, two toilets and a bathroom. The home is located in the Marple area of Stockport. The village centre, which is approximately a ten to 15 minute walk away, has a wide variety of shops, banks and a post office, as well as a cinema, restaurants and swimming pool. A regular bus service (with a stop outside the home) is in operation. The train station is a short distance from the property. The fee structure at the home commences at £365 with the current highest fee being £499. Norwood Trust Limited DS0000008570.V365499.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. This key unannounced inspection, which included a site visit, took place on Tuesday, 10th June 2008. The manager was not told beforehand of the inspection visit. All key inspection standards were assessed at the site visit and information was taken from various sources, which included talking with people who live at the home, the manager and other members of the staff team. Two people were looked at in detail, looking at their experience of the home from their admission to the present day. A partial tour of the home was conducted and a selection of staff and care records was examined, including medication records, employment and training records and staff duty rotas. Before the inspection, surveys were sent out to residents, relatives and staff, asking what they thought about the care at the home. Six relatives, two residents and four staff responded and their comments have been considered and included in this report. We sent the manager a form called an Annual Quality Assurance Assessment (AQAA), which asks them to tell us what they think they do well, what they have improved upon and what they need to do better and this was returned to us before the site visit. The information provided by the manager was very limited and did not show us before we visited the home that the manager had identified improvements made over the past year or areas that still needed development. We discussed this with the manager, who had not been sure about how to complete the form but was able to tell us the changes that had happened in the home and her plans for the future. What the service does well: Residents were assessed to make sure their needs could be met before they came into the home. One resident who was quite new to the home had visited many times before going to live there and had settled in very well because of this. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 6 People are treated as individuals and are able to spend time doing things that interest them. Residents said they had plenty to do and did not get bored. Residents were able to spend time in the local community and had a good social life. All the residents had been on a holiday to Blackpool in April, which several said they really enjoyed. Residents and their relatives thought staff understood the help they needed well and were positive in their comments, which included, “We visit Norwood quite frequently and always find a warm and friendly atmosphere”, “All basic care given to a good standard”, “I have always found the staff team to be understanding and caring. The fact that my brother greets them with smiles when he returns from a home visit speaks volumes”, “My son is happy and contented with his personal needs fulfilled”, “I have never had to make any complaints or concerns about my sons care. It has always been exemplary”, “They (staff) make Norwood a home. The staff are very caring and make each individual happy in their own way”, “It treats the residents as a family and look after all their interests. If any illness happens their care is 100 ” and “Norwood provides a very homely atmosphere. The staff team are generally very caring”. Residents were positive about the food provided and had been involved in devising a new menu for the summer months. All residents and relatives who returned surveys confirmed that they knew how to make a complaint if they needed to do so and all staff also were aware of the complaints procedure. Norwood provides a comfortable environment for people to live in, and residents and relatives confirmed that the home was always fresh and clean. 73 of care staff are trained to at least NVQ level 2. What has improved since the last inspection? Since the last inspection there have been some improvements made to the environment. The remaining double bedroom in the main house had been divided to provide two single rooms. The main house had been rewired and the lounge and hallway in the bungalow had been redecorated and a new carpet, rug and flat screen television purchased. A new suite had been provided in the lounge in the main house, which included two recliner chairs. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 7 A sink unit had been put in one resident’s room and bathroom facilities in both the main house and the bungalow had been improved by the installation of wet rooms. Since the last inspection the risk assessments for residents who look after their own medicines had been reviewed to make sure they were still able to do this safely and had no problems. At the last inspection specifications had been as part of her induction used, so new staff were a new induction booklet that met Skills for Care purchased but a new member of staff had not used it training. We saw this time that the booklets had been covering the Common Induction Standards required. What they could do better: Although care files contained information about residents’ normal routines and the help they needed, and care plans were provided by Social Services, staff at the home did not routinely write care plans. Whilst this system worked alright when residents had no specific problems, the manager needs to make sure that if a resident develops a new care need, a proper plan of care is written to address this so staff know what care they must give. Care needs were communicated and recorded in a variety of ways, which worked well as Norwood has a small staff team who all see each other regularly. However, all the information should be kept in one place to provide a good overview of the residents’ needs and the care being provided. The manager needs to start regular staff supervision meetings and make sure a record is kept of these. Supervision should be used to identify staff training needs and to provide support and guidance for staff. A proper record of staff training is also needed, which will show when updates are due in health and safety topics and which will provide evidence that staff are receiving training in specific topics relevant to meeting the care needs of the residents living in the home. Recruitment procedures were not followed robustly enough. Although we recognised that the employee whose file we viewed had returned to work at the home after a period of two years and was well known to the manager and other staff, the correct procedure for obtaining references should still have been followed. Some pipes at the bottom of the stairs needed boxing in; the manager had already identified this but the work had not been done. This must be done as one resident tends to hold them when coming down the stairs and this presents a risk. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 8 The manager needs to develop a system to check records and care practices within the home to ensure they meet the required standards. 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. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People are assessed before they come into Norwood to ensure that the home can meet their needs. EVIDENCE: A service user guide has just been produced in makaton and the manager was planning to display a copy in the reception area of the home and print further copies on request when prospective residents and their representatives visited the home. The majority of residents have lived at the home for many years and the manager was unsure how useful or of how much interest the service user guide would be to them. It was suggested that if residents did want to read the guide their key worker could spend some time reading and discussing it with them. Two residents were case tracked. The most recently admitted resident had visited the home on many occasions before finally coming to live at the home and had been to stay overnight. The manager and staff thought this had contributed greatly to the speed in which the resident had settled into the home and felt the admission process had worked very well. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 11 A full assessment from Social Services was provided for both residents who were case tracked. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 12 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. People are supported to make decisions about their lives; care plans could better reflect the work that is done with residents. EVIDENCE: Two residents were case tracked. Files for both of them were kept in the manager’s office in the basement. Daily records were kept in a separate file on the ground floor, where they were more easily accessible for staff using them on a day-to-day basis. Care plans from social services were in place for both. Neither file had care plans written by staff at the home. Abilities, routines and help needed from staff were described in each resident’s profile. The manager said that none of this information was regarded as a problem requiring a care plan, as this was the norm for that resident. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 13 A discussion took place as to when additional care plans would be written, for example, if a resident had an acute problem that required treatment and monitoring such as an infection or a wound. The manager said that information was shared using a variety of tools, a communication book, the daily record and a staff handover at the beginning of each shift. However, individual care plans were not formally written, additional instructions often being recorded in the communication book. This meant that some information could not be separated from information about other residents and added to individual files. The reader should be able to retrieve all information about each resident from one place so a view can be formed of the holistic care needed. Reviews had been undertaken for many of the residents, which they had been involved in. Since the last inspection, each resident had been allocated a case manager from social services and the review process had improved. Risk assessments had been undertaken for residents’ dependency and for specific issues, such as where the resident was managing their own medicines. A staff member said that the staff team tried to accommodate residents’ preferences and choices, if at all feasible, and felt residents were included in decisions made within the home. During the atmosphere a pleasant relaxed atmosphere was noted. Residents were observed coming in and out of kitchen, chatting with staff and asking for or making drinks. One of the residents who had lived at the home a long time said staff knew her very well and knew what she liked and what help she needed. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 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 are supported to develop their life skills and the social, educational, cultural and recreational activities provided by the home meet their expectations. EVIDENCE: Residents had plenty of opportunities to be involved in social activities and participate in the life of the local community. Some residents had paid employment on a part-time basis and about five residents regularly attended Pure Innovations, where they were encouraged to develop and maintain life skills. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 15 Some residents were busier than others, through choice. One resident liked to help staff with the shopping for the home on a Monday and attended a day centre three times a week as well as Glengarth social club in the evenings. One of the staff had taken him swimming the previous evening and he had been to a drama group on the day of the site visit. Another resident preferred to go to the cinema and out for a meal or shopping, but did not want to attend any of the day centres or Glengarth. This resident said they knew they could do more if they wanted to but they were satisfied with what they did. A daily record was kept of activities undertaken by each resident. This presented a good overview of how residents spent their day. The record for one resident showed that he been out with or visited his parents frequently, and had been away for weekends. Several of the residents told us about a holiday they had taken in April, to Blackpool. The residents said that while they were there they had been to see “Skating on Ice” and had been to the zoo. One of the residents said that there were plans to take smaller groups of residents away later this year; everyone had gone to Blackpool. The manager said that a new menu had just been written for the summer. Residents and staff had had a say as to what meals should be included. As residents had some say in what they wanted on the menu, no choice was offered formally but staff said that if a resident didn’t feel like the meal on offer they could have a sandwich or choose something else from the fridge. Typical food for the main meal of the day included turkey or chicken burgers, tuna pasta bake, sausages, quiche, chilli, fish and chips, roast dinners, cauliflower cheese and sweet and sour chicken. Desserts included fruit and cream, mousse, Angel Delight, jelly and ice cream, cake, baked apples and yoghurts. A menu was not specifically devised for the lighter meal at lunchtime, as it was variable from day-to-day which residents would be in, so residents were asked on the day what they wanted and staff usually made sandwiches. One of the staff said that as many of the residents had an early start during the week, because they were going to work or a day centre and their transport picked them up early, breakfast usually consisted of a choice of fruit, cereal, yoghurt and toast. At weekends many of the residents liked a lie-in and the routine was more relaxed. Breakfast times were staggered to suit individuals and they had a cooked breakfast if they wanted or sometimes “brunch” was prepared. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. EVIDENCE: Records and archived letters confirmed that residents regularly saw podiatrists, dentists and their GP’s. Where necessary, residents were accompanied for hospital visits; one resident told us that her key worker had taken for a hospital appointment the previous day and another resident was seeing their GP on the day of the site visit. Staff had researched better options for aids for one resident who was deaf and they had been fitted with a bone anchored hearing aid. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 17 As stated earlier in this report, specific care plans for acute problems were not written, with staff relying on passing information verbally and in the communication book. However, where other health care professionals had provided written instructions, these were kept with the residents’ daily records so staff could read them. As Norwood Trust is registered to care solely for residents with learning disabilities, personal and healthcare needs seemed to be minimal and uncomplicated, so the necessity for additional care plans would be limited. The manager said risk assessments for issues such as pressure areas and moving and handling were not necessary, as all the residents are fully mobile. It was recommended that the manager gets some information about the Malnutrition Universal Screening Tool (MUST) and ensures that nutritional risk assessments are undertaken for all residents as a matter of good practice. The procedures for managing medicines within the home were looked at. The records for several people were examined and showed medicines had been administered correctly, but several matters that were raised at the last inspection had still not been addressed. Medication administration details had been handwritten for several residents. These transcribed details should have been checked and validated by an additional member of staff. Staff must make sure they sign the records to confirm that medicines have been received into the home in the quantities that are stated. A record was kept of medicines that were disposed of and where residents went out of the home for the day, for example, with their parents, a record was kept of medicines that had been despatched with them, which was good practice. Some residents were self-medicating. Risk assessments had been undertaken to ensure that the residents had the capabilities to manage their own medicines. Since the last inspection the risk assessments for these residents had been reviewed. The manager said that two members of staff always dispense medicines, but was unsure how recent the training in the safe handling of medicines was for all staff. Certificates were seen in two staff files that indicated they had undertaken training in 2007. The manager should check to ensure all staff have received training that is up to date. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 18 Six relatives returned surveys prior to our site visit. All said staff at the home always or usually met the needs of the residents and they were always kept up to date with important issues. Relatives were positive about the care given by staff and comments included “Communication is excellent. Anything urgent is told by phone or letter”, “All basic care given to good standard”, “I have always found the staff team to be understanding and caring. The fact that my brother greets them with smiles when he returns from a home visit speaks volumes”, “Obviously a very mixed bunch of clients but staff seem to cope great with the mix, and different problems”, “X has lived at Norwood for … years and is well cared for, comes to her parents quite regularly for visits. Enjoys our company but is always happy to return to Norwood and seems happier now than ever. We are satisfied that her medical and personal requirements are properly seen to” and “My son is happy and contented with his personal needs fulfilled”. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 19 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. Residents and their relatives feel their concerns are listened to and procedures in place protect residents from abuse. EVIDENCE: The home has a complaints procedure and all the relatives who returned surveys said they knew how to make a complaint and the response to complaints made had been appropriate. One relative wrote, “I have never had to make any complaints or concerns about my sons care. It has always been exemplary” and another commented “Staff always willing to listen to any concerns. Issues brought up in annual reviews are looked into and resolutions passed on”. Two residents who returned surveys both stated that they knew how to make a complaint and that staff treated them well. As at the last inspection, adult protection procedures continue to be in place. There have been no allegations of abuse. Most staff have undertaken adult protection training or are awaiting training with the local authority. One staff member spoken to was very clear about the procedures to follow if she suspected abuse. We spoke with a member of staff from Pure Innovations who commented on the good inter-agency working that had been set up between Pure Innovations and Norwood Trust to protect residents, for example, the immediate reporting of incidents, bruising, etc – staff at the home ring Pure Innovations on an almost daily basis to keep the lines of communication open. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 20 All residents except one have Building Society accounts and withdraw cash from them when needed. Cash is kept in safekeeping for residents and they can access it whenever they wish. Receipts are kept for all transactions and a ledger sheet is maintained that details a running total of the balance of each person’s money. It was recommended that residents are asked to sign the ledger to confirm receipt of the money, as not all of them did every time. This acts as further protection for both residents and staff. One resident’s money was checked and the record corresponded with the cash in keeping for them. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 21 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. Improvements have been made and a homely, clean and comfortable home is provided for residents living there. EVIDENCE: The home is situated near to local community facilities and the service users are able to walk to the local shops, cafes, cinema and swimming pool. Various improvements had been made to the home since the last inspection. The last double bedroom had been divided to make two single rooms and new flooring had been provided in two bedrooms. The main house had been rewired and hot water pipes boxed in. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 22 Some pipes at the bottom of the stairs still need boxing in; the manager had already identified this but the work had not been done. This must be done as one resident tends to hold them when coming down the stairs and this presents a risk. The lounge and hallway in the bungalow had been redecorated and a new carpet, rug and flat screen television purchased. New fitted wardrobes were due to be installed in one of the bedrooms on 20th June 2008 and a new bed and carpet had been ordered. A new suite had been provided in the lounge in the main house, which included two recliner chairs. The majority of windows in the bungalow had been replaced. A sink unit had been put in one resident’s room and bathroom facilities in both the main house and the bungalow had been improved by the installation of wet rooms. On the day of the site visit the home was clean and tidy. Bedrooms were personalised and reflected the individual tastes and interests of the occupants. Between the main house and the bungalow the garden was well-maintained and provided outdoor space for the residents to enjoy. A range of garden furniture and benches were available. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made using available evidence, including a visit to this service. A long standing team of committed and caring staff support residents to lead fulfilling lives; supervision and training records were not detailed enough to demonstrate how staff were supported to develop their skills and knowledge. EVIDENCE: Examination of the staff duty rota showed that there were usually two carers on duty from 7am-11pm then two carers sleeping-in overnight. In addition, there was the manager or the deputy manager on duty between 9am - 3pm or 5pm and a carer who worked in the bungalow during the week between 3pm7pm and at weekends between 10am-3pm. This was because a lot of the residents tended to go out in the afternoon at weekends so staff were not needed late afternoon and early evening. The manager and deputy manager were on the rota to work some weekends and when they were they worked the same shifts as everyone else. The rotas showed that staff shifts and the numbers of staff on duty were arranged to take into account needs of residents. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 24 Most of the staff at the home have worked there a considerable time. Examination of some staff personnel records showed that, in the past, recruitment procedures were not as robust as they could have been but steps had been taken to obtain in retrospect some documents that are required to demonstrate that all the necessary checks have been made. All staff had had CRB and POVA first checks – shortfalls had been in the attainment of references mainly. One staff member who returned to work at the home in November 2007 after a period of two years working elsewhere did not have a reference from her previous employer, although as she had worked at Norwood for ten years prior to that, she was well known to the manager. However, proper recruitment procedures should always be followed. Since the last inspection one member of staff had received induction training using the new induction booklets that had been obtained at our last visit but not used by any of the staff. The booklet meets Skills for Care specifications. The manager reported in the AQAA that 11 of the 15 care staff had NVQ qualifications and the other four staff were undertaking the training. Staff said they had received fire safety and first aid training and one person had successfully completed LDAF. However, there were no proper records of what staff training had been undertaken or what was planned for the forthcoming year. This was raised at the last inspection and no improvement was noted. The manager had recently received information from Stockport MBC about short training courses they were providing and she was asking staff to decide which courses they wanted to attend. Staff were still not receiving regular formal supervision, although staff meetings were held quite frequently. The manager should start to hold supervision sessions with all staff and use these to discuss training needs with them. The minutes of staff meetings showed that staff had been able to make suggestions about things that were happening in the home and each resident was discussed to ensure that all staff were up to date with their current situation. It is recommended that the minutes of the previous meeting are reviewed at the following one, so there is a record of what actions have been completed. In the minutes there were often references to maintenance work that was due but no confirmation in the minutes of the next meeting as to whether the work had been completed. Residents spoken to knew who their key workers were and said staff were kind and all the relatives who returned surveys stated that staff always or usually had the right skills and experience to meet the residents’ needs. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The service would benefit from an increase in management monitoring, reviewing and staff supervision. However, long established practices mean that residents live within a routine that is well known and secure for them and shortfalls in record keeping have a minimal impact on the care they receive. EVIDENCE: Since the last inspection the manager has been on maternity leave and one of the senior staff had acted up in her absence. The manager returned to her post in February 2008 and is in the process of applying for registration with the CSCI. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 26 Norwood Trust has a small staff team made up of people who, in the main, have worked at the home for many years. A lot of communication and information sharing is done quite informally but this seems to work well in this establishment. Staff and residents know each other well and have built up a good rapport over the years. Residents living in the bungalow hold regular meetings. Minutes of these were seen. The manager said the minutes were also sent to interested relatives. Staff said meetings for the residents in the main house were not as useful, and experience had shown them that the residents were able to put forward their views better during individual reviews. Some issues that were raised at the last inspection had still not been addressed. Although we accept that the manager had been off for a significant period of time, she does now need to become more organised in undertaking and recording staff supervision and training, and also needs to develop a proper system of audit, to monitor staff practices and ensure records meet regulatory requirements. The manager returned the AQAA before our site visit. The AQAA provided minimal information and did not say what improvements had been made since the last inspection or provide any evidence to show that the manager was aware of what areas still needed improvement or development. We discussed this with the manager who said that she had had to complete the AQAA very quickly, immediately when she returned from maternity leave. The manager, when prompted, was able to tell us about a number of environmental improvements that had been made and understood that this type of information was required in future AQAA’s, together with her analysis of how the home could continue to develop. Maintenance records showed that the building and equipment were checked and serviced frequently, in accordance with health and safety guidelines. As stated previously, some pipes at the bottom of the stairs in the main house need boxing in. Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 3 X Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement When new care needs are identified for a resident, care plans must be written to address them. This will ensure that staff have the right information to provide the necessary care and monitor its effect appropriately. The registered person must ensure that robust recruitment and selection procedures are in place and followed at all times. (Timescale of 31/08/07 not met). The hot water pipes at the bottom of the stairs in the main house must be boxed in. Timescale for action 15/07/08 2 YA34 19 15/07/08 3 YA42 13(4) 15/07/08 Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 29 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 YA35 Good Practice Recommendations The registered person should ensure that training and development plans record long term and ongoing training to verify employees have the skills to support service users with a learning disability. All information relating to the care of a resident should be kept together to provide a holistic account of their changing needs and the care provided. Nutritional risk assessments should be undertaken for all residents and reviewed as necessary. It is recommended that the manager accesses information and training about the MUST tool as this is the tool used by Stockport PCT. When instructions for medicine administration are handwritten, these should be checked, validated and countersigned by a second member of staff. Medicines received into the home should be checked and the quantity verified as correct by a staff signature, to provide an audit trail of all medicines held at the home. All staff should receive regular, recorded supervision meetings at least six times a year to monitor their work with individual residents and provide support and guidance. The manager should develop a proper quality assurance system to assess the care practices of staff and ensure records meet the required standards and are suitable for purpose. 2 3 YA6 YA17 4 YA20 5 YA36 6 YA39 Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Local Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Norwood Trust Limited DS0000008570.V365499.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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