Care Home: Porlock House

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What the care home does well The home provides a safe and pleasant environment to live in. The manager and staff team are professional and know the people living at the service well. This enables them to deliver a service tailored to meet their individual needs and aspirations. The TEACCH board with visual symbols is used for the people in residence to sequence events and give structure to each day; this was seen being used effectively. Each person has a member of staff designated as their point of contact each day. The designated person is there to help with any problems requiring supervision, support or help. This contact system was observed being used to direct people and provide them with a consistent and helpful one to one response from staff.Meals are cooked between staff and people in residence as part of daily life. Observation was made of this task sharing on day two as part of the inspection case tracking. This was also a very positive experience. The shift patterns of staff working at Porlock House are geared to the best interests of the people living at the home. Included in this is the active management of the Somerset Court complex where the management seniors have set periods of cover and a structured handover for the site. The home is well maintained and there are facilities and specialist staff on the Somerset Court site to deliver day care and other life skills activities. There is access to transport for community visits and trips out. The inspector heard from a relative that they appreciate that staff escort their relative to their home for holidays. What has improved since the last inspection? Extra space has been allocated through the decommissioning of one room to allow one person to have a quiet sitting area. This has achieved a positive outcome. What the care home could do better: The kitchen in the house was seen to be superficially clean only, on day one. It was more thoroughly cleaned between inspection visits. A rota for deep cleaning on a regular basis has been arranged. Staff must keep chemical storage areas locked at all times. Latex gloves should be stored more safely. Relatives commented that they would like more communication and be better informed about their relative. People asked confirmed that do hear about concerns or serious matters. This may indicate that there is a need for more informal contact with families. CARE HOME ADULTS 18-65 Porlock House Somerset Court Harp Road Brent Knoll Highbridge Somerset TA9 4HQ Lead Inspector Barbara Ludlow Unannounced Inspection 22nd January 2008 13:40 Porlock House DS0000067301.V355351.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 Porlock House DS0000067301.V355351.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. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Porlock House Address 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) Somerset Court Harp Road Brent Knoll Highbridge Somerset TA9 4HQ 01278 760555 01278 760747 Vanessahalfacre@nas.org.uk National Autistic Society Mrs Sarah Ann Matthews Care Home 10 Category(ies) of Learning disability (10), Physical disability (10) registration, with number of places Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th December 2006 Brief Description of the Service: As part of the ‘Somerset Court’ modernisation programme all accommodation areas became separately registered services. Porlock House was registered with the CSCI on 16/06/06 and is registered to accommodate ten services users. The Registered Manager is Mrs Sarah Matthews. The National Autistic Society remains as the Registered Providers. Porlock House comprises of a large purpose built detached bungalow and an attached two-storey cottage situated in the extensive grounds of Somerset Court. The home is registered as one service and currently has two distinct accommodation areas. Six service users are accommodated in one living area and four in the other. One accommodation area has a lounge, a large dining room, domestic style kitchen, and six single bedrooms with full en-suite facilities that are all located on the ground floor. The other accommodation area has a lounge, kitchen/diner and two bedrooms on the ground floor one with full en-suite and two further bedrooms on the first floor with a family type bathroom. The home has some laundry facilities but the majority of the laundry is sent to the main on-site facility. The home has a ‘fenced off’ garden area with areas laid to patio with garden furniture. The inspector was informed that the fees had gone up by 3.9 since the inspection, indicating that the fees now vary from £1,730 to £3,140 per week dependent upon an individual’s assessed need. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor for the seven chapter outcome groups and an overall quality rating is then calculated: : The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The Annual Quality Assurance Assessment was completed for the commission prior to the inspection. This is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives the commission numerical information about the service. This document is used to inform the assessment of the service. Questionairres were sent by CSCI to people living at the service, their relatives, visiting professionals and staff prior to the inspection. The feedback and views of the service provision are incorporated in the inspection report. The key unannounced inspection visits were carried out over one and a half days by one inspector. On day one the manager was attending training until late afternoon. To allow the manager to be present at the inspection and in order to have access to secure files, an announced second visit was arranged. The inspection visits were well received. The staff and people living at the service gave their time to the inspection process. We (the commission) met staff on duty on each day and the people in residence as they went about their daily life and routines. Care plans were sampled and one person shared their personal plan with the inspector. The home is situated in extensive private grounds. Porlock House includes the adjacent Porlock Cottage. The cottage had four occupants. The house is registered for six people but has only five places as one bedroom is currently being used as a private living space. A tour of these homely premises was made during day one. The home was found to be clean and well maintained. Private space was personalised and all accommodation was warm and comfortable. The people living at the service were observed to lead active lives with positive encouragement by staff to achieve independent living skills. Participation in communal living is encouraged. Life skills are learned as part of the routine sharing of household chores such as assisting with the cooking. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 6 Observation of staff interactions with the people during activities, at mealtimes and generally during the time spent at the service was very respectful and positive. The manager is experienced and with her deputy leads a dedicated staff team. There was a good response from the staff team. Staff shared their views and emphasised the values they hold as a team for the benefit and safety of the people in their care. Written feedback supported the views heard at the visits. The organisation ensures training and administration complement the work of the staff in achieving a professional caring service to the people living at Porlock House. Positive feedback was received at CSCI from visiting professionals and from the relatives of people living at the service. Records were sampled including staff recruitment on day two. Inspection feedback was given to the manager and her deputy at the conclusion of the day two. The inspector would like to thank the people living at Porlock House, their families and the staff for their feedback and assistance with the regulatory inspection process. What the service does well: The home provides a safe and pleasant environment to live in. The manager and staff team are professional and know the people living at the service well. This enables them to deliver a service tailored to meet their individual needs and aspirations. The TEACCH board with visual symbols is used for the people in residence to sequence events and give structure to each day; this was seen being used effectively. Each person has a member of staff designated as their point of contact each day. The designated person is there to help with any problems requiring supervision, support or help. This contact system was observed being used to direct people and provide them with a consistent and helpful one to one response from staff. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 7 Meals are cooked between staff and people in residence as part of daily life. Observation was made of this task sharing on day two as part of the inspection case tracking. This was also a very positive experience. The shift patterns of staff working at Porlock House are geared to the best interests of the people living at the home. Included in this is the active management of the Somerset Court complex where the management seniors have set periods of cover and a structured handover for the site. The home is well maintained and there are facilities and specialist staff on the Somerset Court site to deliver day care and other life skills activities. There is access to transport for community visits and trips out. The inspector heard from a relative that they appreciate that staff escort their relative to their home for holidays. 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 Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Porlock House DS0000067301.V355351.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 Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good People coming to live at Porlock House are thoroughly assessed pre admission to ensure that their needs and aspirations can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had been one new admission to the home since the last inspection. There is a detailed statement of purpose and a service user guide available for prospective residents. Pre admission assessments are made and the manager explained that this would be detailed and involve assessment visits to meet and assess the person. Visits in return to see the home and meet the other people living there are encouraged. Care is taken to help people to make the right choice and the transition is carefully managed. An example of a younger person coming to Porlock House was discussed with the manager and her staff team as part of the inspection Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 11 case tracking process. A positive move had been made and key working had played an important role in relationship building to help the person settle in. Contracts and invoicing for fees is managed centrally these records were not requested for inspection. Porlock House DS0000067301.V355351.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): 6,7,9 Quality in this outcome area is good Assistance and support given is tailored to the needs and aspirations of the individual. Risk assessments are carried out and are used to inform and underpin safety in lifestyle activities. Individual records are safely stored. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People are offered choices in their daily lives. There is a range of activities offered and available at Somerset Court, in the home and in the wider community. Somerset Court has a staffed day centre and a gym where people can receive instruction on fitness and diet. The day centre is a short walk through the grounds and is sited in the old main building. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 13 Communication books are developed and used by the individuals to help them with daily living. One person shared their book in which pictures taken from magazines were used to express and inform communication needs with staff and others. The Annual Quality Assurance Assessment (AQAA) was completed for the commission prior to the inspection and gave information about the activities that can be accessed away from the home such as the Lynx Centre in Weston Super Mare. The Lynx Centre is run by the National Autistic Society and there people can undertake art work, metal work, physical activities such as climbing and can learn skills in preparation for work. The home has access to transport for such activities and risk assessments indicate the staffing ratio required to accompany the individuals on outings. Care plans were sampled, two as part of the case tracking process to look at specific risk and challenging behaviours. The care plans are well constructed and informative. A person centred approach to care is achieved and is being built upon with person centred planning meetings. Individuals are helped to express their wants and needs to make sure their aspirations are known and worked towards. Staff spoken with explained how they take people out into the community to do things they want to do such as bowling, swimming or having a meal. Two people had been swimming on the day of the first visit and one person had been out to lunch. Staff explained how they would manage any challenging behaviour and gave examples of behaviours they had experienced and managed when out in the community. Staff spoke confidently, with great respect and with understanding for the individual and for the trigger / reason for their behaviour. Records are held confidentially and securely in the office. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good People have respect and support to enjoy activities that are age appropriate. There are opportunities to engage in leisure and social activities at home and in the community. Healthy meals and mealtimes are structured as family living and participation with the cooking and presentation is encouraged. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Daily life at the home is agreed with the individuals and is planned although there remains a high degree of flexibility in response to the individuals well being or choice at the time. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 15 The people at Porlock House have very different needs and funding has been agreed to meet this accordingly. Where there are risks these are assessed and adjustments are made, for example with staffing levels. Three people were identified that require a minimum of two people to escort them on trips out and away from the home others go out in groups of three with one member of staff. Somerset Court’s day centre is used for leisure activities, computer and life skills. There is a separate staff team for the day centre service. People have opportunities to attend the centre as part of their person centred care planning. There are no service users accessing work placement, volunteer jobs or workrelated training schemes at present. One person said they felt that more community access and work opportunities would be of benefit to their relative. Other relatives have commented to CSCI that they are pleased with the opportunities people have to get out into the local community with their carers and enjoy themselves. During the two days at the home people went out with staff. People had meals out, went swimming at leisure facilities in the nearby towns. Relatives commented that they would appreciate better communication both written and verbal to let them know what is happening. One person said ‘Annual reviews are good. More contact would be welcome’. It was confirmed by relatives that matters of concern and serious issues are raised by telephone or letter. The information gathered indicated that more informal contact and information sharing would be welcomed. The home has an annual day for parents and friends to meet together at the home and spend time and share ideas. Holidays are organised and some people have opportunities to go home for holidays. One relative was pleased that their relative is brought to their home by the staff, for a holiday stay. People who would find a holiday stressful would be offered days out. This is an area the home has identified in the AQAA under ‘what they could do better’. The manager has noted that more individualised trips, community access and access to college courses are areas where they could do better. Each person has a ‘home day’ when they stay at the house spending time with their key worker and undertake personal chores such as the cleaning of their bedroom, managing their laundry, and assisting with the cooking. A record is kept of the home day, which forms a part of the key worker monthly report. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 16 Staff were knowledgeable about the people they key work and care for at Porlock House. Staff use their skills to manage behaviours that can be very challenging. A low arousal environment and ‘Studio Three’ are, the inspector heard usually sufficient for staff working with the majority of people. The people in residence appeared to get along well together but staff are mindful of relationships and of individuals that can become unsettled. Menus are displayed on the notice board. On day two this read; Macaroni cheese, grilled ham, onion rings and bacon followed by fresh fruit and yogurt. Menus are prepared to meet individual taste and choices and appeared to be offering a balanced and varied diet. The kitchen in the main house was seen on day one. The kitchen is small and domestic in scale. It provides an important area for daily living skills to be learned, some routine and a share of the responsibility for people living at the home. Fresh fruit and vegetables were available for use in the kitchen. Staff have food hygiene training and prepare the evening meal with the people in residence on a rota basis. The rota is adhered to but is reliant upon the willingness of the people in residence to cooperate with the cooking and general meal preparation and clearing up afterwards. On day two, this was seen as a fairly smooth operation; the person who was assisting the member of staff was on their ‘home day’ was seen enjoying preparing and cooking the mushrooms that were part of the main meal. The meals looked and smelled appetising and were taken communally and with staff in the adjacent dining room. The kitchen is well used and was in need of more thorough cleaning, this was raised on day one and was attended to between the inspection site visits. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 17 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): 18,19,20 Quality in this outcome area is good Personal support is thoughtfully tailored and delivered. Health and personal care needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans were sampled. These demonstrated detailed attention to personal care and well being. They were person centred and easy to follow. Risks were clearly identified and individually assessed. The people in residence are all independently mobile. People are able to choose when they get up and they retire to bed when they choose. Personal care and for some people support or prompting only is given. Staff support individual peoples need for privacy and dignity with sensitivity. One person who chooses to rest in the lounge was left to settle down peacefully on a beanbag and was quietly observed from time to time. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 18 One to one support and key working was evident at the inspection. One example where a key worker had been changed to meet the particular needs of the person was discussed. Care is taken to match people to the most suitable key worker taking notice of the individual’s preferences and care needs. People are registered with the local GP practice and access can be arranged to medical support services such as psychology and psychiatric services, speech and language therapy and chiropody services. People in residence were all reported to be well with a small number only having minor health care treatments and intervention. Care plans seen showed input by health care specialists such as the doctor. One person receiving chiropody care also had medical input to ensure the treatment did not cause them undue distress. Feedback from one visiting professional indicated under ‘what the care service does well’, was ‘cope well with complex and challenging behaviour’ and an example was given. Another professional said their ‘time was well used’ and ‘advice carefully considered and used’ and ‘A very individual approach is at the centre..’ The feedback also indicated that staff have the right skills and they support people and deliver care well. The systems for medication administration were examined. No one in residence was self medicating at the time of the inspection. All medication was stored securely and safely; people have their medication held in a separate box. There were no controlled drugs prescribed at this time. Medication Administration Records (MAR) were seen. They have photographic identification, a witness sheet and an administration sheet for each person. There was explanation recorded for ‘when required’ (prn) prescribed medication. Two signatures were recorded for medications received into the home, to demonstrate checking and verification of the person, the drugs and quantity received. Allergies were recorded. Special instructions and drinks required with medications were noted down. Details such as the side effects of medication were also clearly recorded. Clear management protocols were recorded for individuals with epilepsy. Staff have undertaken training in medications management. The company has pharmacist input and the inspector was informed that company considers medication management protocols for the home in line with the Medicines Act 2006. Although as a Registered Care Home it is not directly regulated under this Act. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 19 Medication management is closely audited and any errors in administration are addressed. All keys for the home are held by a senior staff member and are signed for when handed on at the end of each shift. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good The service adheres to procedures that are in place to protect the people in their care from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints or concerns have been raised with CSCI. There have been two complaints raised with the home since the last inspection. One complaint concerned the potential for a bullying relationship between the people living at the home, the second a change of mind regarding accommodation. The complaints were discussed, one had been investigated and both have been resolved. Staff spoken with had a good level of awareness of their care responsibilities and of the protection of people from harm and abuse. One visiting professional felt that this was an area that could be improved upon with training in ‘values’ and more on the management of adult protection. Accident reports are monitored, logged and audited. Eleven staff were identified that have received first aid training. Staff are trained in house by a specialist company trainer in Studio Three procedures for the management and defusing of challenging situations. There is follow up and opportunity to discuss case by case identifying training needs Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 21 and the appropriateness of intervention and the outcomes for the person and staff as a result of the behaviour and intervention. Any intervention is logged for analysis. Staff recruitment processing was examined for three staff. 21 Criminal Record Bureau checks held at the home for people employed at the home were seen along with any risk assessments as necessary. A thorough recruitment process is undertaken and is completed before people come to work in the home. Records were inspected that confirmed that staff receive induction training, ongoing training and supervision. The manager confirmed that the homes policies and procedures have been updated since the AQAA was completed and they are now available on the homes intranet. Individual finances were not assessed. No changes to the arrangement were reported and they were found to be safely managed at the last inspection when the following commentary was recorded: The Inspector discussed the arrangements for the management of service user’s finances. The National Autistic Society has corporate appointeeship for all but one of the service users. Service users have individual bank or building society accounts. The Inspector sampled the records kept on the behalf of two service users. Records are kept of the transactions undertaken via the building society and the home also maintains records of financial transactions of monies spent from personal spending. The Inspector was able to follow an audit trail for transactions sampled. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good The home is clean, well maintained and comfortable. There needs to be a raised awareness regarding the storage of chemicals and products that could be hazardous to health if accidentally ingested. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Porlock House is clean, comfortable and well maintained. The house is homely and bedrooms are decorated and personalised to meet the needs and taste of individuals in residence. The facilities are of high standards and the premises are secure and within the extensive gated grounds of Somerset Court. There is a pleasant outlook from the home onto well tended gardens. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 23 People can walk through the grounds to the day care facility. Bedrooms and communal areas are kept clean and hygienic. The small kitchen is well used by staff and people living at the home. Staff commented that it would be an improvement to the home if the kitchen was larger with more work surfaces for people learning and helping to cook. On the first day of the inspection the kitchen was clean but some surfaces such as the drawers, handles and the dishwasher looked less clean. A deep clean was recommended and was carried out before the second visit. The office space and staff facilities are discreet and central within the home but do not detract from the homely environment of Porlock House. The laundry room has a washer, a dryer and ironing facilities. Cleaning materials are stored in the laundry. Their cupboard was unlocked on day one of the inspection. It was locked when pointed out to the staff on duty. A recommendation is made for continuing safer practice. The laundry is not kept locked because it is used by the people in residence who are supported and encouraged to do their own washing. Latex gloves are stored in the laundry. Safer storage is recommended to reduce the risk of harm coming from the misuse of latex gloves. A change to more suitable and safer storage was to be implemented after the inspection. A recommendation is made for continuing safer practice. The Porlock House cottage accommodation is used for less dependent people. They are encouraged and enabled to become more independence in daily living and build their skills and confidence living there. The manager reported that two people were making good progress. One member of staff has pointed out that there is no way of turning the hallway lights off at night. This was not explored at the inspection but may be worth monitoring the impact upon people living in the house. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good Porlock House has a dedicated staff team providing an excellent level of care and support to the people in residence. Staff are care safely recruited to help protect the people in residence from harm. Staff receive training and supervision to meet the needs of the people in their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was well staffed at the inspection visits. Four staff were on duty in the house on arrival on day one. Staff are rostered onto a two week rota. The day shift starts at 07:30 am, staff are allocated to 1: 1 support and one person to work in the cottage. There is a minimum of 5 staff on duty each day. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 25 The afternoon / evening shift commences at 02:30pm with a one hour handover period between shifts. The late afternoon / evening shift concludes at 10:30pm. On each day shift the individual’s point of contact is identified and tasks such as the TEACCH boards, cooking or chores are recorded. There are two staff on duty at night. The current welcome pack indicates that there is only one person on duty at night however staffing has been increased to more safely meet the needs of the people overnight. The site has an on call senior manager on duty each night. Staff are appointed as key workers to named individuals. This role is one of providing support, as ‘point of contact’, when on duty for ‘in house’ days. The inspector heard that staff do have the opportunity to work with all the people in residence to allow everyone to get to know each other. Staff were seen as they worked and some were spoken with in private. We heard praise for the management of the home from staff who found them to be approachable and supportive. Staff confirmed having induction and training which included fire safety, health and safety, food hygiene. Low arousal environment and Studio Three training are taught to staff for the intervention and management of challenging behaviour. Staff have been able to discuss the effectiveness of this in certain circumstances and the manager is currently working with the homes trainer to ensure that best practice is adopted for each individual. Staff confirmed that they could discuss concerns and raise issues of concern with the manager and within the staff team. The manager made time for staff during the inspection visits and part of her management style is to speak to staff straight away or as soon as possible if they ask to see her. Staff recruitment files were checked and 21 CRB notifications were seen. These included the most recently recruited staff. Staff had been safely recruited with all checks having been undertaken before the staff commenced working at the home. Interview records and risk assessments were recorded. All, staff files were securely held and there was restricted access. The inspector was informed that induction is undertaken in the main building away from the home. Induction is a gradual process where new staff are taught for one day then work in the home with supervision and complete a workbook. They return to induction training one day each week for four weeks. Topics covered include basic autism awareness, the principles of care, the role of the support worker, health and safety, infection control, manual handling, protection of vulnerable adults, mental health issues and the public view of autism and learning disability. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 26 The probationary period for new staff is six months in which there are regular reviews and appraisal of staff’s suitability and progress. One new member of staff was seen on their second day at the home. They were enjoying their work experience and confirmed having had recruitment checks taken up prior to commencing work. The inspector heard that there are always enough staff to deal with any problems that arise and the manager would always find cover if needed. The home has links with an agency to ensure suitable staff are deployed if required. The manager stated that the company bank staff have been preferred during periods where new people to the home have required continuity of the staff team to help them settle in. There is a good level of National Vocational Qualification Level 3 qualified care staff with 14 staff having achieved the qualification. A further 8 staff have identified their interest in the training and three places are to be made available. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 27 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): 37,38, 39,42 Quality in this outcome area is good The home benefits having good management and leadership. The company network and systems support best practice in service delivery for the individuals living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is well run and benefits from good management leadership. Staff work cohesively as a team and are supported by the management and the management systems. There is good record keeping in all the areas seen at this inspection. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 28 The manager confirmed that company policies and procedures had been updated since the AQAA was completed. Staff spoken with confirmed that they felt able to approach the homes manager to seek advice and support. One person said they felt listened to and said the manager would take time out to help. The manager’s philosophy where problems arising are given priority and are dealt with seemed to be working. This proactive approach was seen during the inspection. The home has a deputy and good management teamwork was evident for example with the introduction of the person centred care planning and review meetings. Problem solving was seen to be approached as a team, working towards the best interests of the person / people in residence. The company as an employer received praise as ‘a good company to work for’. Records were inspected: The fire risk assessment had been completed and was identified as next due in 12/08. Fire door alarm activated hold open devices had been identified as needed and one had been fitted another was due to be fitted the day after the inspection visit. Fire safety checks included weekly fire alarm tests where the zones were varied each week. The fire alarm had been serviced and certificated. Staff fire training had seven gaps for individuals who were due to receive training in February. Training had been given in January on two dates and once already in February. A monthly fire evacuation is held to include staff and people living at the home. On 2/02/08 one was held and it was reported that it was much quicker and that better responses were made. Weekly hot water checks were made on 30/01/08. Gas safety had been checked in 8/08. The homes vehicle check was made on 21/01/08 Eleven staff have undertaken first aid training. Accident records were in the health and safety file and are stored appropriately on completion. This is either in the staff personnel file or personal care plan for someone living at the home. Accidents and incidents are recorded and these are checked and signed by the manager. Risk assessments are checked should any remedial action be identified. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 29 Accidents are audited each month and Riddor reports if needed are made by a designated person in the main office. Regulation 37 notifications for CSCI are made by the homes registered manager. Regulation 26 management checks for CSCI made on behalf of the company were available at the inspection. The registration certificate and employer’s liability insurance certificate were displayed. Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 30 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 3 33 X 34 3 35 X 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 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 2 X Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 2 3 4 Refer to Standard YA42 YA42 YA33 YA15 Good Practice Recommendations Chemical stores should be securely locked at all times to prevent accidental ingestion or misuse. Equipment such as latex gloves should be stored safely at all times to prevent accidental misuse. The welcome pack should be updated to reflect the current staffing level at night. Informal contact with families should be explored at reviews to make sure people can confirm what they feel about communication and being in touch with their relative’s daily life. ( subject to National Minimum Standards for Adults (18-65), numbers 2 and 6) Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Porlock House DS0000067301.V355351.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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