Care Home: Saxonbury

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What the care home does well What has improved since the last inspection? The last inspection report made a number of requirements of the provider. These matters were monitored and action had been taken to comply fully with those requirements made at that time. Since the last inspection site visit the provider has applied to vary conditions, adding facilities to accommodate one more person following the conversion of the large garage. The registration inspector who processed this application had identified a number of issues. These were monitored and the provider had taken action to deal with these matters. CARE HOME ADULTS 18-65 Saxonbury Heathfield Road Freshwater Isle Of Wight PO40 9SH Lead Inspector Richard Slimm Unannounced Inspection 17th June 2008 09:30 Saxonbury DS0000012531.V365527.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 Saxonbury DS0000012531.V365527.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. Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Saxonbury Address Heathfield Road Freshwater Isle Of Wight PO40 9SH 01983 755228 F/P 01983 755228 ian.vallender@islecare.org 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) Islecare `97 Ltd Mr Ian Desmond Vallender Care Home 7 Category(ies) of Learning disability (0) registration, with number of places Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 7. Date of last inspection 30th May 2007 Brief Description of the Service: Saxonbury is a residential home providing care and accommodation for up to six younger adults with Learning Disabilities, one of whom is now over sixtyfive years of age. The home is a detached two-storey property situated in a quiet residential area of Freshwater. It offers single room accommodation, one with en-suite facilities. The town centre of Freshwater with its shops and amenities is about three quarters of a mile away. There is off-road parking for several cars at the front of the building, from which there is level access into the home. An average sized garden is provided at the rear with seating available for residents’ use. Saxonbury is owned by South Wight Housing Association and leased to Islecare ‘97 the homes registered proprietors. Charges range from £283.03 to £436.48 per week. Saxonbury DS0000012531.V365527.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 stars. This means the people who use this service experience good quality outcomes. This inspection was a ‘key unannounced inspection’ of Saxonbury registered care home, a ‘key unannounced Inspection’ being part of the Commission’s inspection programme, which measures the service against the core and/or key National Minimum Standards. The fieldwork visit, the actual visit to the site of the service was conducted over 4 hours with 2 regulation inspectors, where in addition to paperwork that required reviewing we met with a number of people who live at the home, the registered manager and the deputy manager and several care/support staff. The inspection process also involves far more pre fieldwork visit activity, with us gathering information from a variety of sources that may include: the Commission’s database and pre-inspection information provided by the service provider, questionnaires, reports and notifications etc. What the service does well: Choice of Home: Each service user had a Service User Guide that was clear, was presented in a format that resident’s could understand or easily have explained to them, and made good use of diagrams and photographs. Terms and Conditions were clearly written with use diagrams and photographs and made the responsibilities of each party very clear. We were advised that one person was soon to move out from the service, and arrangements were being made to ensure advocacy was available. All new residents have their needs, wishes and aspiration assessed prior to admission. Individual needs and choices: Care plans were written in a manner that centred round each individual and were clear and comprehensive. People were found to be aware of care plans dependant on their particular abilities. Plans contained the aspirations / likes / dislikes of each individual and there was evidence that the service was responding to those needs, wishes and aspirations identified. Care plans are regularly monitored and reviewed. People’s specific individual communication skills and abilities are documented and recorded in their individual “Communication Passports”. There was good use of pictorial communication systems to support people to communicate effectively in their chosen ways. Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 6 Lifestyle: The people living at the home are clearly involved in a range of opportunities providing each individual resident with relevant and appropriate educational and recreational activities. Feedback from one care manager / social worker included – “my client would sometimes like to stay up in the lounge to watch TV after 10 pm, rather than have to go up to their bedroom. This is not always possible due to shift handovers.” There was evidence of people making use of community facilities (pub, shops, going for a drive, steam railways etc) as per their own documented wishes. All activities were recorded, including in-house activities, providing good monitoring of quality of life outcomes. Staff members interventions included supporting people to go out to the local hairdressers, attendance to appointments and other community based activities enabling the ongoing development of daily living skills. There is an emphasis on healthy food, with a good selection of fresh vegetables observed in the kitchen. People had involvement in choosing menus and their input, as well as individual likes and dislikes is recorded. One inspector joined people for lunch and this mealtime was a sociable occasion with good staff support for people who needed help and guidance. People were provided with more food and support staff were pro-active in ensuring people had had enough to eat. There is a house vehicle that is funded by special allowances and some staff members are able to use other vehicles to offer transport to people. Since the last report the service has increased staffing levels, and this has clearly improved opportunities to improve the overall quality of life for people living at the home. Personal and Healthcare Support: There was clear evidence within People’s support plans that they are being supported in accessing appropriate health care services as needed. At the time of this site visit there were no people administering their own medications to any extent at all. Case tracking found all medication administration records to be up to date. Each person’s photo is held within his or her own medication record file. We pointed out the need to ensure such records are stored in a manner that fully protects and promotes confidentiality. There was guidance available to staff on medication procedures and sample staff signatures were held in the medications record file. Staff members confirmed they had been provided with medication training. Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 7 Feedback from a care manager / social worker included “Healthcare appointments and checks are always up to date.” Each resident had their own Health Action Plan, and good liaison with specialist external healthcare professionals was evident. Medication held by staff on behalf of people was being appropriately and safely stored and the medication administration records accurately maintained. Concerns, Complaints & Protection: The home has clear policies that cover these areas, the complaints procedure has been developed in a format that can be readily understood or explained to the people living at the home. Safeguarding guidelines are available to staff members. Staff members receive training in safeguarding. We have received a number of notifications from both the registered provider and the local agency responsible for the promotion of safeguarding adults that indicate the home acts appropriately in this important area of care and welfare. Environment: The home remains in a reasonably good state of repair. with ongoing redecoration work noted during the fieldwork visit. Feedback from a care manager / social worker included – “ Saxonbury provides a well presented homely environment. Staff members are always willing to communicate and discuss any situations.” The provider advises us Saxonbury has just gone through a planned programe of redecoration, the kitchen ,dining room, hallway, one clients bedroom and the main lounge having all been completed. The lounge has had all new furniture fixtures and fittings which the clients helped to choose. The furniture in the dining room is due to be replaced soon and a new shed has been erected for storage purposes in the rear garden. Additional fire bells have been installed and the fire risk assesment has been been updated to accommodate recent changes. People’s bedrooms, visited during a tour of the home, were noted to be individualised and a service user was clear when asked that he had been involved in the decision about his rooms furniture, colour scheme, etc. The home has a large, private, accessible, enclosed and spacious garden. There is ramped access to ensure people who are wheelchair dependent have equal access around their home, and there are other aids and adaptations in place to support less ambulant people to be more independent, and promote safe staff practices. Staffing: The home provides 3 staff on each daytime shift, and at busier times there could be 4 or 5 staff on duty. Staffing levels at the weekends were the same as during the week and there was evidence that action has been taken Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 8 since the last inspection report to ensure there are enough staff to meet the identified support needs of people living at the home. Four staff surveys also provided feedback that staffing arrangements had improved at the service. Staff members were observed to interact positively and spent a lot of time talking with service users and involving them in activities. Case records also provided evidence of improved outcomes for people due to increases in staffing levels. Staff members were observed to be skilled in communicating with service users, some with significant areas of need, and were seen to support them well throughout the day. Case records contained detailed information about how people liked and how they were best able to communicate. Management: The registered manager continues his personal and professional training and development. At present one staff member is doing NVQ Level 4 two have a Level 3 and two have level 2. The home also has a deputy manager who is working closely with the current manager, and we were advised is intending to apply to become the manager of the service in due course. We have been advised that there is an intention to make some changes to the management of the home in due course. The provider has alerted us to these matters as required. Arrangements are in place to ensure people are consulted about the daily running of their home. This includes a clear emphasis on person centred planning, regular resident meetings, key work support and regular monitoring of support packages provided at the home. The provider has advised us that people living at Saxonbury are treated as individuals. Residents meetings are held to seek views and preferences. All the clients have regular care reviews with their care managers external to our organisation. Those attending day centres also have reviews. The company has customer satisfaction surveys that are also used to gain the views of people living at the home and other stakeholders. Staff members at Saxonbury are committed to seek and listen to clients wishes and preferences and implement changes where ever possible through the continual development of individual support plans. The house menu is to be changed shortly as agreed at the last residents meeting. One care manager told us – “This service has improved greatly over the last two years.” The home keeps us advised of any issues that need to be reported under the requirements of Regulation 37. The organisation ensures that there are regular visits to report on the conduct of the home as required by Regulation 26. There were comprehensive policies and procedures available to promote safe daily operation of the home, and to guide staff in their roles. Health and safety is monitored and any action needed taken to promote the safety and welfare of people at the home. There were minor concerns identified at the time of the Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 9 site visit in respect of pitting to the concrete drive, and swooping seagulls in the garden defending their young who were nesting on the roof of the house. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 10 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 Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good We looked at Standard 2: This judgement has been made using available evidence including a visit to this service. The people who use the service and their representatives have the information needed when choosing the home. They have their needs assessed and a contract which clearly tells them about the service they will receive. EVIDENCE: Each service user had a Service User Guide that was clear, was presented in a format that resident’s could understand or easily have explained to them, and made good use of diagrams, pictorial symbols and photographs. Terms and Conditions were clearly written with use diagrams and photographs and made the responsibilities of each party very clear. We were advised that one person was soon to move out from the service, and arrangements were being made to ensure advocacy was available. The service has advised us – “We have in the last two years admitted two new residents. They had access to the homes statement of purpose and the service users guide in pictorial format. To enable them to become familiar with the home and to introduce them to the rest of the client group a number of visits were arranged over a period of time ending up with a weekend stay over night Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 12 during their stay a full assessment was carried out on the level of needs. They both chose to live at Saxonbury and the rest of the client group were quite happy so a contract was drawn up and a copy of which was placed in their support plan.” Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good We looked at Standards 6, 7 and 9: This judgement has been made using available evidence including a visit to this service. Individuals are involved in decisions about their lives, and play an active role in planning the care and support they receive. Care plans are person centred and client focused. EVIDENCE: Care plans were written in a manner that centred round each individual and were clear and comprehensive. People were found to be aware of care plans dependant on their particular abilities. Plans contained the aspirations of each individual and there was evidence that the service was responding to those needs, wishes and aspirations identified. Care plans are regularly monitored and reviewed. Individual personal files contained good risk assessments where necessary and these were also being regularly reviewed and updated as needed. Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 14 People’s specific individual communication skills and abilities are documented and recorded in their individual “Communication Passports”. There was good use of pictorial communication systems to support people to communicate effectively in their chosen ways. We have been informed by the provider that – “During the last year the old format care plans have been replaced by new support plans these have been formatted by the development team with input from the manager and staff at the home each support plan is formulated to suite each individual which contain written records of choices and the support given by staff on a daily basis. Clients are consulted on activities they wish to participate in together with decisions about their every day living wherever they are able to do so. Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good We looked at Standards 12, 13, 15, 16 and 17: This judgement has been made using available evidence including a visit to this service. People who use the service are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individuals expectations staffing levels support this. There is evidence that service users’ rights are promoted and protected. EVIDENCE: The people living at the home are clearly involved in a range of opportunities providing each individual resident with relevant and appropriate educational and recreational activities. We observed people being supported to be involved in household tasks with patient and appropriate support from staff members. People were being supported to be involved in taking responsibility for their home via such activities as restoring garden furniture. Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 16 People are given the opportunity to identify activities they wanted to do and these were recorded in care plans, responded to and supported by individual key staff members. Feedback from one care manager / social worker included – “my client would sometimes like to stay up in the lounge to watch TV after 10 pm, rather than have to go up to their bedroom. This is not always possible due to shift handovers.” There was evidence of people making use of community facilities (pub, shops, going for a drive, steam railways etc) as per their own documented wishes. All activities were recorded, including in-house activities, providing good monitoring of quality of life outcomes. Staff members interventions included supporting people to go out to the local hairdressers, attendance to appointments and other community based activities enabling the ongoing development of daily living skills. There is an emphasis on healthy food, with a good selection of fresh vegetables observed in the kitchen. People had involvement in choosing menus and their input, as well as individual likes and dislikes is recorded. One inspector joined people for lunch and this mealtime was a sociable occasion with good staff support for people who needed help and guidance. People were provided with more food and support staff were pro-active in ensuring people had had enough to eat. There is a house vehicle that is funded by special allowances and some staff members are able to use other vehicles to offer transport to people. Since the last report the service has increased staffing levels, and this has clearly improved opportunities to improve the overall quality of life for people living at the home. We have been advised by the provider that – “Clients at Saxonbury keep in regular contact with family friends and past staff members. One client who doesn’t have anyone has an advocate. With support from staff clients are encouraged to participate in community life with shopping trips to Tesco, coffee out, trips in the house car, swimming, horse riding and a variety of other interests are pursued. The Spinnaker tower was visited last year with a return trip planned soon. Visits are made to the local pub. Residents are encouraged to assist with household tasks cleaning and hoovering their own rooms and general areas. Some clients prepare breakfast and supper for themselves whilst others participate with staff assistance included are such tasks as the prepping of vegetables for the main meal. Saxonbury DS0000012531.V365527.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): Quality in this outcome area is good We looked at Standards 18, 19 and 20: 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. The principles of respect, dignity and privacy are put into practice. EVIDENCE: There was clear evidence within People’s support plans that they are being supported in accessing appropriate health care services as needed. At the time of this site visit there were no people administering their own medications to any extent at all. Case tracking found all medication administration records to be up to date. Each person’s photo is held within his or her own medication record file. We pointed out the need to ensure such records are stored in a manner that fully protects and promotes confidentiality. There was guidance available to staff on medication procedures and sample staff signatures were held in the medications record file. Staff members confirmed they had been provided with medication training. Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 18 Feedback from a care manager / social worker included “Healthcare appointments and checks are always up to date.” Files showed that people were being supported to access healthcare services as necessary and good records were kept of all appointments and necessary follow-up action. One person had had a review of their medication due to a reaction to a particular drug, and this was in the process of being changed as a result, in consultation with the relevant doctors. People interviewed confirmed they had support to access healthcare services as they needed. People’s healthcare needs are being regularly monitored. Each resident had their own Health Action Plan, and good liaison with specialist external healthcare professionals was evident. Medication held by staff on behalf of people was being appropriately and safely stored and the medication administration records accurately maintained. We have been advised by the provider that – “All clients at Saxonbury are registered at the local Health care clinic. This includes Chiropody and dental care, district nurses and GPs. Staff attend visits to outline aliments and to offer guidance and support respecting confidentiality and following company policies and proceedures. Outcomes of visits and treament are recorded in the individuals support plan. Staff input is avalable for the administering of mediaction if this is deemed necessery and the relevent guidlines and recordings are in place for each client. Medication is ordered in accordance with the relevant prescriptions and the home uses the a Monitored Dosage System and staff are trained in this essential area.” Saxonbury DS0000012531.V365527.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): Quality in this outcome area is good We looked at Standards 22 and 23: This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure and are protected from abuse. EVIDENCE: The home has clear policies that cover these areas, the complaints procedure has been developed in a format that can be readily understood or explained to the people living at the home. Safeguarding guidelines are available to staff members. Staff members receive training in safeguarding. We have received a number of notifications from both the registered provider and the local agency responsible for the promotion of safeguarding adults that indicate the home acts appropriately in this important area of care and welfare. We have been advised by the provider that – “Saxonbury has a Complaints Proceedure in place. Proceedures can be acessed in the Care manual situated in the office together with a complaints book and relevent forms. All clients have a copy of the complaints procedure in their support plan in a format they can understand and/or have explained. Included are post cards and envelopes to respond. All staff recieve training in safeguaridng from the company. There are two copies of the adult protection policy and the proceedure is displayed in the home. The area Manager conductes a Reg 26 visit to the home on a monthly basis talking to staff and clients where concerns could be identified. Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 20 The Registered Manager and trainee Manager and Senior Support worker are on shift through out the week to be approached if there are any issues of concern. Saxonbury DS0000012531.V365527.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): Quality in this outcome area is good We looked at Standards 24, 26 and 30: This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence and acknowledges diversity. EVIDENCE: The home remains in a reasonably good state of repair. With ongoing redecoration work noted during the fieldwork visit. Feedback from a care manager / social worker included – “ Saxonbury provides a well presented homely environment. Staff members are always willing to communicate and discuss any situations.” The provider advises us Saxonbury has just gone through a planned programe of redecoration, the kitchen ,dining room hallway, one clients bedroom and the main lounge having all been completed .The lounge has had all new Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 22 furniture fixtures and fittings which the clients helped to choose. The furniture in the dining room is due to be replaced soon and a new shed has been erected for storage purposes in the rear garden. Additional fire bells have been installed and the fire risk assesment has been been updated to accommodate recent changes. People’s bedrooms, visited during a tour of the home, were noted to be individualised and a service user was clear when asked that he had been involved in the decision about his rooms furniture, colour scheme, etc. The home has a large, private, accessible, enclosed and spacious garden. There is ramped access to ensure people who are wheelchair dependent have equal access around their home, and there are other aids and adaptations in place to support less ambulant people to be more independent, and promote safe staff practices. Locks on the individual resident’s bedroom doors do not currently meet the national minimum standards or fully meet the needs of people, as one fails to enable the inhabitant of the room to control the lock when inside the room, and other door locks had mechanisms that could prevent staff from accessing rooms in emergency situations if risk assessed as needing this. Large areas of the roof need to be cleared of debris that has built up over a long period. At the time of the site visit seagulls were nesting on the roof, and due to the male bird’s protectiveness of their young chick we were told the male seagull is swooping on people who come to near. As a result, this is restricting peoples’ safe access to their garden. There are also areas of the concrete drive that are now pitted and holes were visible in some areas causing potential tripping hazards. Waste bins were seen to be overflowing the day before they were due to be collected, leading to some problems in respect of wild animals scavenging from the rubbish having to be left in black bin liners. We were told the manager is about to buy a large wheeled bin in order to overcome this difficulty. We have been advised by the provider that – “There are 7 single rooms at Saxonbury. One of these has recently been converted from the garage. All rooms are very individual and are decorated and furnished according to clients own personnel choice. Clients as part of active interaction, the clients are able and if they wish, to be supported by staff members to clean and tidy their own rooms. Saxo bury has just gone through a planned programe of redecoration. The kitchen, dining room hallway, one clients bedroom and the main lounge having all been done. The lounge has had all new furniture fixtures and fittings which the clients helped to choose. The furniture in the dining room is due to be replaced this month. A new shed has been errected for storage purposes. Extra fire bells have been installed and the fire risk assesment has been been Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 23 updated to accommodate the recent changes. People are also being supported to re-paint the garden furniture.” Saxonbury DS0000012531.V365527.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): Quality in this outcome area is good We looked at Standards 32, 34 and 35: This judgement has been made using available evidence including a visit to this service. Staff members in the home are trained and skilled and supplied in insufficient numbers to support the people who use the service. EVIDENCE: The home provides 3 staff on each daytime shift, and at busier times there could be 4 or 5 staff on duty. Staffing levels at the weekends were the same as during the week and there was evidence that action has been taken since the last inspection report to ensure there are enough staff members to meet the identified support needs of people living at the home. Four staff surveys also provided feedback that staffing arrangements had improved at the service. Feedback from an external professional also indicated continued improvement at the home. Staff members were observed to interact positively and spent a lot of time talking with service users and involving them in activities. Case records also provided evidence of improved outcomes for people due to increases in staffing levels. Staff members were observed to be skilled in communicating with Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 25 service users, some residents with significant areas of need, and were seen to support them well throughout the day. Case records contained detailed information about how people liked and how they were best able to communicate. We have been advised by the provider that – “In the recruitement process potential staff are invited to look around the home to meet the clients and staff and to understand the nature of the position and if this meets mutual satisfaction then a formal intreview is arranged. The employement of successful candidates is subject to Protection Of Vulnerable Adult and Criminal Record checks. New staff members have a full induction into the home working initially as a shadow and each has a personell training and development Port Folio. All new staff have to complete statuary and mandetory training LDQ has been intoduced before the commencement of NVQs other training in specialized subjects is also offered relevant to the nature of the service. Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 26 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): Quality in this outcome area is good We looked at Standards: 37, 39 and 42: This judgement has been made using available evidence including a visit to this service. Managers and staff make best use of resources to deliver a good residential care and support service. Action is needed to contact the housing association who own the building and to monitor upkeep of the premises in respect of keeping the roof clear of debris, to dissuade wild seagulls from nesting there, to monitor the pitting in the drive and to repair this area if needed, and to provide privacy locking arrangements that meet both the needs and wishes of residents and the national standards. EVIDENCE: The registered manager continues his personal and professional training and development. The current Registered Manager has qualifications as C.M.S., C.W.S., NVQ Level 4 in Care Management and the Registered Managers Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 27 Award. BTEC Advanced Award Medicines - The principles of Aministration and Contol - City and Guilds in Computer Studies. BTEC - Intermediate Infection Control. The manager encourages all staff in their on going training . At present one staff member is doing NVQ Level 4 two have a Level 3 and two have level 2. The home also has a deputy manager who is working closely with the current manager, and we were advised is intending to apply to become the manager of the service in due course. We have been advised that there is an intention to make some changes to the management of the home in due course. The provider has alerted us to these matters as required. Arrangements are in place to ensure people are consulted about the daily running of their home. This includes a clear emphasis on person centred planning, regular resident meetings, key work support and regular monitoring of support packages provided at the home. The provider has advised us that people living at Saxonbury are treated as individuals. Residents meetings are held to seek views and preferences. All the clients have regular care reviews with their care managers external to our organisation. Those attending day centres also have reviews. The company has customer satisfaction surveys that are also used to gain the views of people living at the home and other stakeholders. Staff members at Saxonbury are committed to seek and listen to clients wishes and preferences and implement changes where ever possible through the continual development of individual support plans. The house menu is to be changed shortly as agreed at the last residents meeting. One care manager told us – “This service has improved greatly over the last two years.” The home keeps us advised of any issues that need to be reported under the requirements of Regulation 37. The organisation ensures that there are regular visits to report on the conduct of the home as required by Regulation 26. There were comprehensive policies and procedures available to promote safe daily operation of the home, and to guide staff in their roles. Health and safety is monitored and any action needed taken to promote the safety and welfare of people at the home. There were minor concerns identified at the time of the site visit in respect of pitting to the concrete drive, and swooping seagulls in the garden defending their young who were nesting on the roof of the house. Managers need to put in place arrangements for privacy locks that meet both needs and the standards. We have been advised by the provider that – “The staff at Saxonbury have been undertaking active support training and the home has since become more person centered in it’s approach. The staff ar edevloping a deeper Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 28 understanding of clients needs and how they can support them in daily tasks. I will also continue with my Training, as Registered Manager At present the home has one staff member doing NVQ Level 4 two have a Level 3 and two have level 2. Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 29 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 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 30 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 Refer to Standard YA24 Good Practice Recommendations It is recommended that the managers and the provider organisation contact the housing association who own the premises and advise them of the need to clear debris from the roof, to overcome the problem of nesting birds, and to repair any holes in the concrete driveway. Larger refuse bins should also be provided. It is recommended that privacy locking arrangements to bedroom doors is reviewed in line with peoples needs and standard 26.4. 2 YA26 Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Saxonbury DS0000012531.V365527.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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