Care Home: Shalom

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What the care home does well Staff are committed to enabling people to stay at the home in the event of any deterioration in their health. Staff have a good understanding of the support people require. People have good access to health care provision in order to ensure their health care needs are met.Meal provision is of a good standard with an emphasis on fresh produce, healthy eating and individual preference. The environment is domestic in style and therefore homely and comfortable. Robust recruitment procedures are in place and a high level of health and safety material is available for staff reference. Staff have good access to a variety of training, which includes topics related to people`s health care needs, as well as mandatory subjects. What has improved since the last inspection? Ms Perry has successfully registered with us to become the registered manager of the service. The content of people`s support plans has been developed. The plans are detailed, up to date and reflect people`s needs. Individual and generic risk assessments are in the process of being updated. Ms Perry has updated many by using a new format, which is clear, ordered and easy to follow. A number of new risk assessments have been developed. Staff are now using specific red alginate bags to transport soiled linen in order to minimise handling and reduce the risk of infection. The number of staff with a National Vocational Qualification has increased. The hallway and dining room have been redecorated and the bathroom has been refurbished with a new shower chair, specific to people`s needs. What the care home could do better: A review of staffing levels is required to ensure there are sufficient staff on duty to meet people`s needs. Ensuring Mrs Perry is not an integral part of the working roster must be part of this review. Staff must ensure that they sign the medication administration record to demonstrate that they have administered people`s medication. All handwritten medication administration instructions should be signed and dated by two members of staff. The application of topical creams should be documented within people`s support plans. People`s risk of developing a pressure sore must be undertaken. Control measures must be in place to minimise a risk, if identified. Documentation should evidence how people are being supported to reach their goals and aspirations. CARE HOME ADULTS 18-65 Shalom 1 Pen Close Manor Lane, Baydon Swindon Wiltshire SN8 2JD Lead Inspector Alison Duffy Unannounced Inspection 19 November 2008 10:00 th Shalom DS0000028445.V373133.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 Shalom DS0000028445.V373133.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. Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shalom Address 1 Pen Close Manor Lane, Baydon Swindon Wiltshire SN8 2JD 01672 541351 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) White Horse Care Trust Julie Victoria Perry Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability- Code LD The maximum number of service users who can be accommodated is 4. Date of last inspection 12th December 2006 Brief Description of the Service: Shalom is a detached bungalow offering accommodation and personal care to four people with a learning disability. The home is one of a number of services owned by the White Horse Care Trust, a voluntary organisation. The home was registered in July 2002 and is situated in the village of Baydon, close to the Berkshire border, some 8 miles north east of Marlborough. The nearest towns to the home are Marlborough and Swindon. People who use the service have their own single bedroom. There is a lounge and separate dining room. There is a patio area to the front of the property and a grassed area to the rear. Staffing levels are generally maintained at three staff on duty throughout the day when people are at home. There is one waking night staff and a member of staff who undertakes sleeping in provision, each night. Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection took place on the 19th November 2008 between 10am and 6.45pm. The registered manager, Ms Julie Perry was available throughout the inspection and received feedback. We met with people who use the service and staff members. Due to people’s health care conditions, we were not able to receive verbal feedback about the service they received. We observed interactions between people and the staff. We observed the serving of lunch. We looked at care-planning information, training records, staffing rosters and recruitment documentation. Ms Perry gave us a tour of the accommodation. As part of the inspection process, we sent surveys to the home for people to complete with support, if they wanted to. We also sent surveys, to be distributed by the home to staff members, peoples’ GPs and other health care professionals. The feedback received, is reported upon within this report. We sent Ms Perry an Annual Quality Assurance Assessment (AQAA) to complete. This was completed on time. Information from the AQAA is detailed within this report. The fees for living at the home are based on people’s care and support needs and currently range form £1307.38 - £1518.62 per week. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. What the service does well: Staff are committed to enabling people to stay at the home in the event of any deterioration in their health. Staff have a good understanding of the support people require. People have good access to health care provision in order to ensure their health care needs are met. Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 6 Meal provision is of a good standard with an emphasis on fresh produce, healthy eating and individual preference. The environment is domestic in style and therefore homely and comfortable. Robust recruitment procedures are in place and a high level of health and safety material is available for staff reference. Staff have good access to a variety of training, which includes topics related to people’s health care needs, as well as mandatory subjects. What has improved since the last inspection? What they could do better: A review of staffing levels is required to ensure there are sufficient staff on duty to meet people’s needs. Ensuring Mrs Perry is not an integral part of the working roster must be part of this review. Staff must ensure that they sign the medication administration record to demonstrate that they have administered people’s medication. All handwritten medication administration instructions should be signed and dated by two members of staff. The application of topical creams should be documented within people’s support plans. People’s risk of developing a pressure sore must be undertaken. Control measures must be in place to minimise a risk, if identified. Documentation should evidence how people are being supported to reach their goals and aspirations. Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The organisation has clear admission procedures in place ensuring people would be fully assessed before being offered a placement. However, people have lived at the home for many years and it is not anticipated that there will be any changes to this. EVIDENCE: There have not been any new people to the service since the last inspection. Ms Perry told us that people using the service have lived together for many years. All placements remain appropriate and it is anticipated that people will continue to live at the home, on a long-term basis. Ms Perry and a staff member both told us about measures, which are being considered, to enable people to stay in the home in the event of any deterioration to their health. They said the staff team are committed to enable people to stay at the home and receive palliative care, if required. Ms Perry told us the support required from health care professionals would be gained in order to ensure the person’s needs would be met. Any additional staff training would also be provided. In the event of a new admission in the future, Ms Perry told us that the organisation has clear admission policies and procedures, which would be followed, as required. This would include a detailed assessment, encouraging the person to visit and stay at the home in order to become familiar with staff Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 10 and the environment. Ms Perry told us the placing authority’s assessment and care plan would also be gained, as part of the home’s assessment process. Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning is of a good standard yet greater focus on people’s individual goals and aspirations would further enhance people’s quality of life. People are encouraged to be involved in day-to-day decision-making. Potential risks are addressed within a recently reviewed risk assessment process. EVIDENCE: Within the AQAA, we saw that person centred planning was something the service does well. The AQAA continued to state that within the next twelve months, additional training would be provided to meet people’s changing needs. We saw that the care plan is split into a support plan and an individual plan. The support plan documents the support people need in relation to communication, choice, culture, health and wellbeing, keeping safe, relationships and work and leisure. The individual plan details people’s likes, dislikes, strengths, needs and goals. Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 12 At the last inspection we made a requirement that the support plan must fully reflect people’s needs. Ms Perry told us that attention had been given to this. We saw, in particular that one person’s changing needs had been addressed. There was detailed information about aspects such as eating and drinking, bathing, getting up and going to bed. People’s preferred methods of communication were stated. We recommended clarification in some areas of documentation. For example, we saw that phrases such as ‘experiencing a lot of confusion’ and ‘provide TLC’ had been recorded. We also saw terminology such as ‘no problems to report,’ ‘XX has been in a good mood today’ and ‘XX has been calm today.’ We advised specific, factual recording. Within one plan it was stated ‘prone to constipation.’ Ms Perry and a member of staff told us that fresh fruit and vegetables are encouraged to minimise this. We advised that the importance of healthy eating be expanded upon within the person’s support plan. The information regarding people’s strengths and needs was comprehensive. There was evidence that personal goals and ambitions had been set. However, there was no information about who was supporting individuals to reach their goals or if in fact, they were being worked towards. For example, one goal identified the wish for hydrotherapy. There was no information to suggest that this had been arranged. We identified the need to demonstrate progress, which had been made in achieving goals set out in the individual plan, at the last inspection. The area therefore remains outstanding. Staff told us that people are encouraged to make decisions in relation to their ability. They said some people are able to inform staff of when they want to go to bed, for example. They said they also observe when people are showing signs of tiredness. One member of staff told us about how one person uses eye contact to show what they want or need. This may involve leading a staff member to the kitchen, indicating they would like a drink or something to eat. Another member of staff told us about a person who now finds decisionmaking difficult due to a deterioration of their health. They told us that they often try to remember what the person would have wanted when they were able to express their views. Another member of staff told us that people are not able to use any alternative communication methods such as makaton due to their health condition. Mrs Perry told us that this was an area she would like to reconsider and develop. At the last inspection, we made a requirement that individual risk assessments must be reviewed at least annually or earlier if the risk to the person changes. We saw that Ms Perry had updated the risk assessments into a new format. They were clear and well written. Ms Perry told us that she had recognised the need for more risk assessments and had completed these. We saw that a recent accident in the entrance area of the home had been addressed within the risk assessment process. The risk assessments detailed aspects, such as whether the person should be left alone in the bath. Mrs Perry told us that due Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 13 to people’s health care conditions, potential risks vary considerably from person to person. She said she had taken this into account when reviewing the assessments, which were previously in place. Shalom DS0000028445.V373133.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 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have access to a range of social activity yet the current staffing situation may impact on the frequency of events. People are supported to maintain important relationships. Meal provision is of a good standard with an emphasis on fresh produce, healthy eating and individual preferences. EVIDENCE: Within the AQAA it states that ‘individual choice in all aspects of daily life’ and ‘integrate into the community’ are aspects the service does well. Staff told us that priority is given to external social activity provision. They said that people were very individual in what they enjoyed. Walks, shopping and visits to places, such as local garden centres were undertaken. People also had meals out and some enjoyed a car drive. Due to the location of the home, transport is required to access leisure facilities. Mrs Perry told us that village amenities would be used, as required. One member of staff told us that Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 15 people’s social interests were more restricted within the home, due to their ability and attention span. Some people liked looking at books, playing musical instruments, watching television or listening to music. Mrs Perry told us that sensory equipment was often very much enjoyed. Staff told us that some people did not want to engage in any activity. In response to this, one member of staff said they spent time with people in the lounge, with general contact appearing important. People are encouraged to spend time with staff while general routines of the home are undertaken. For example, people do not generally assist with housekeeping responsibilities, but would engage with staff while the task was being completed. At the last inspection, we noted that the documentation of social activity provision was limited. We made a recommendation to address this. While acknowledging there was some evidence of activities taking place, the depth of information staff gave us, was not apparent within documentation. When we arrived, two people were out with two members of staff. They had gone to a day service session involving dance. During this time, a person within the home indicated that they wanted to go out. Due to the staffing levels available, this was not possible. Staff told us that they tried to enable each person to go out regularly although there were occasions when taking people to a booked day service placement was given priority. Ms Perry told us that she recognised that staffing was an issue. Within a survey, a staff member told us ‘we do not have enough staff to take individuals out to live the life they appear to be choosing (quite often.) Ms Perry told us that staffing was being addressed although it is further identified within the staffing section of this report. Staff told us that visitors were welcomed at any time and important relationships were promoted. We saw that hospitality was evident. Staff said they always aim to make people feel welcome and offer refreshments during a visit. Within a survey, a staff member told us ‘I think that the food that we provide is of a high standard.’ Ms Perry told us that the menus are devised according to peoples’ known preferences and individual need. There is an emphasis on fresh fruit and vegetables, with most meals cooked from ‘scratch.’ We saw a very varied selection of fruit and vegetables within the kitchen. The staff prepare and cook all meals. Ms Perry told us that the menus are flexible. They can be changed according to seasonal produce and depending on what a person may like on the day. Ms Perry told us to increase nutritional intake, fresh vegetables are often added to a stock for sauces or gravy. During the inspection, people were offered a choice of cheese on toast or sandwiches with varied fillings, for lunch. We saw that some people needed assistance to eat. This was undertaken sensitively and at a pace conducive to Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 16 the person’s needs. There were clear eating and drinking plans within each person’s support plan. Shalom DS0000028445.V373133.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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from good access and support from health care professionals in order to ensure their health care needs are met. Greater focus on tissue viability would minimise any risk of skin damage. Systems for managing people’s medication are clear yet staff need to ensure that they document any administration to minimise the risk of error. EVIDENCE: One member of staff told us about the personal and health care needs of people, in detail. The information they told us was detailed within the support plans we looked at. There was clear information about the support people needed within their day-to-day routines. Within one plan, we advised that details about the person’s health care condition was expanded upon in terms of how it affected their daily life. We saw that one person slept in a ‘cocoon,’ which is a specialised sleep system. We said the reason for this particular sleep system should be expanded upon, as it could be misconstrued, as a means of restraint. Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 18 Ms Perry told us that people receive a good service from the local GP surgeries. People are supported to attend health care appointments, as required. There were records of all visits and intervention. Staff told us that people are supported to the surgery if they are able, as this enables a community presence. We saw that each person has a health care action plan. Ms Perry told us that staff were currently working with health care professionals with the update of Epilepsy Management Plans. We advised that epilepsy if applicable, should also be targeted within people’s support plans. We saw that all staff had received training in the administration of epilepsy ‘emergency rescue’ medication. Within a survey, a GP told us that they were satisfied with the service provided to their patients. They said ‘in my experience – very caring staff – attentive to residents needs. Residents are well cared for and respond well to staff.’ They continued to state in relation to what the home does well, ‘respects individual needs. Offers privacy. Activities within the home. Nice surroundings/caring staff.’ Within the daily records of one person it was recorded ‘has very slight pressure (red) patch on the base of his/her spine. Encouraged to sleep on left side with the use of cushions.’ There was very little other evidence within the care plan regarding the sore area and ways in which it was being managed. Another entry stated ‘XX sacrum still red but not as bad. Cream applied.’ We advised that staff should consult with the district nurse regarding tissue viability and ways in which to promote and maintain healthy skin. Ms Perry told us that staff support people using the service with their medication administration. All staff have undertaken training in the safe handling of medication. Regular competency checks are also undertaken. There are medication policies and procedures available for staff reference. We saw that satisfactory records are maintained of the receipt and disposal of medication. There is a photograph of each person on the medication administration record (MAR) to minimise the risk of error. We saw that two members of staff did not always sign handwritten medication instructions on the MAR. We recommended this. There were five occasions when staff had not signed the MAR to demonstrate that the person had taken their medication. This was also identified at the last inspection. Mrs Perry told us that she would talk to staff about the need to fully record all medication administration. She said she would also monitor the situation. One person was prescribed a topical cream. We advised that documentation should specifically demonstrate where the cream should be applied. We also said that the cream and the reason for its prescription should be identified within the person’s support plan. Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable people and their advocates to raise concerns. A robust adult protection system provides people with clear safeguards from abuse. EVIDENCE: There is a copy of the home’s written complaint procedure on each person’s file. Ms Perry told us that the organisation has invested in other formats such as visual and audible complaint procedures. Staff told us however, that general observations of emotions, body language and behaviours are used as key indicators, to show that a person using the service may not be happy. They said, through experience, they have learnt about people’s individual communication systems. Within the home’s quality satisfaction survey, we saw that people’s relatives had been given a copy of the home’s complaint procedure. Ms Perry told us that there have not been any complaints about the service since the last inspection. Within the AQAA, it states that a prompt response to concerns/complaints is given. Ms Perry told us that adult protection training is part of the home’s mandatory training plan. All staff have yearly updates. One member of staff confirmed this. In the event of an allegation of abuse, they told us that they would report the incident immediately, to Ms Perry. They said if she were not available, they would contact the on call manager. Staff told us that they had received a copy Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 20 of the local adult protection reporting procedures. Ms Perry said that the booklets, ‘No Secrets’ in Wiltshire and Swindon, regarding local adult protection procedures, were allocated to staff on induction. We said a record of this should be made. We saw within the AQAA that staff are regularly reminded of their responsibility within the ‘whistle blowing’ procedure. Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a domestic style environment, which is clean, well maintained and comfortable. EVIDENCE: Each person has a single bedroom, which was decorated and furnished according to individual need and preference. We saw that all rooms were personalised and reflected the person’s personality. There was a spacious lounge and a separate dining room. Both rooms were clean, tidy and comfortable. The dining room contained a range of sensory equipment, which people used after their meal. Ms Perry told us that there is an ongoing redecoration programme. The hallway had recently been redecorated and the bathroom had been refurbished. A new shower chair had been purchased. Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 22 The AQAA stated that the dining room had been recently decorated with a holographic panel to reflect the light. Additional sensory equipment was planned. Within a survey a staff member told us ‘the home is decorated to a high standard and is homely and inviting.’ We saw that the kitchen was clean and ordered and enabled access to the laundry. At the last inspection, we recommended that specific red alginate bags were used to transport soiled linen. This would minimise handling and reduce the risk of infection. Ms Perry told us that the bags are now in use. She said there had not been other changes to the laundry facilities and they continued to meet the needs of the service. Staff told us that they had access to disposable protective clothing, as required. We saw that infection control forms part of the home’s training programme. Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff shortages are currently impacting upon the service people receive. People are protected by a robust recruitment procedure. Training is of a good standard with varying opportunities available to staff. EVIDENCE: As a means to improve the service, the AQAA stated ‘recruit more staff.’ Ms Perry told us that there had recently been difficulties with staff shortages. One member of staff was on long-term sick leave and there was a full and part time vacancy. Ms Perry told us that recruitment was taking place although so far, there had been no success. A team of bank staff were covering the shortfalls. Ms Perry told us that there are generally three staff on duty while people are at home during the waking day. However, there are occasions when there may be two staff on duty with an additional 10am-8pm shift. Ms Perry told us that although this is not ideal, two staff are sufficient at the start and end of the day, due to the times people choose to get up and go to bed. We saw that Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 24 when we arrived, there was one member of staff on duty and Ms Perry. Two people using the service were having a lie in. There had been a visiting health care professional, a health and safety inspection and our inspection. We acknowledged that people were content in bed. However, the staffing levels, with Ms Perry counted, as a member of staff, did not enable flexibility. Later in the day, we saw that one person wanted to go out. They needed to wait until the staff returned from supporting other people at their day service. Within a survey, a staff member told us ‘we are desperate for more staff.’ Another said ‘at our home now, we are short staffed as they have been unable to recruit. With CRB checks etc. this means we will be struggling for some months to come.’ Further comments were ‘the service could improve if we had more staff. The Trust has advertised for staff, unfortunately most of the replies they have received are non drivers who want to work in the Swindon homes’ and ‘we are very short staffed sometimes only 2 carers per shift. This does not meet clients needs/day services criteria.’ Ms Perry confirmed that the service was only managing with existing staffing levels. She acknowledged that service provision including greater one-to-one time with people could be improved upon with more staff. Ms Perry told us that the organisation was aware of the situation and recruitment, although proving challenging, was being undertaken. The AQAA confirmed that recruitment was a system that the organisation did well. It detailed that there was staff recruitment training available to managers. We looked at the recruitment documentation of the three most recently employed members of staff. The files contained the required information. There was a photograph, an application form and two written references. Each staff member had been checked against the Protection of Vulnerable Adults register before commencing employment. Criminal Record Bureau (CRB) certificates were in place. We saw that health care matters identified within application forms had been discussed and addressed, as required. Ms Perry told us that much of the recruitment process, are undertaken centrally within the organisation. She said ‘you can’t fault the organisation on recruitment. They are very thorough and ensure people are right for the job.’ While talking to three members of staff, it was evident that they knew people using the service well. Two staff members had worked with people for many years. They were very clear about people’s needs and appeared committed to providing a good service. They told us that training opportunities were good. They said they were up to date with their mandatory training. Another staff member said ‘you only need to ask about something and they will find training for you. You can also ask if there is something you want to do, that is relevant to your work. It is usually agreed or they tell you the reasons why it’s not.’ Within surveys, two staff told us that courses are often cancelled. Further comments included ‘the service provides good training courses’ and ‘provides an excellent training programme for staff.’ Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 25 Ms Perry told us that there is an organisational training plan and monthly programmes are sent to the service. Staff are allocated onto mandatory training yet are able to select other courses of interest to them. As a means to improve the service, the AQAA stated that greater training for bank staff was planned. It also confirmed that the service ‘has an excellent training plan.’ Ms Perry said that training needs are regularly discussed and staff may be requested to attend certain training in relation to a specific need. In addition to mandatory training we saw that the training plan contained subjects such as the ageing process, bereavement, dementia care and control of substances hazardous to health. There was also training in relation to equality and diversity and individual health care conditions. We saw within one file that information about Alzheimer’s disease had been taken from the Internet. At the last inspection we made a recommendation that the number of staff with a National Vocational Qualification (NVQ) should be increased. Within the AQAA it was confirmed that six staff now have NVQ level 2 or above. The recommendation has therefore been addressed. Shalom DS0000028445.V373133.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): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a manager who is clearly aware of their needs and is looking to develop the service further. People’s health and welfare are promoted through clear systems, which are regularly audited. EVIDENCE: At the last inspection, there was no registered manager in post. Ms Perry was undertaking the role of acting manager. She had been doing this for over a year. We made a requirement that the organisation must appoint and register a manager without delay. In response to this, Ms Perry submitted an application to us and was successful. Ms Perry became the registered manager in July 2007 although she has worked at the home for the last eleven years. Ms Perry told us that she had completed the Registered Manager’s Award (RMA) and was progressing with the NVQ level 4. She said she had also completed a number of short courses. These included epilepsy, MRSA Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 27 awareness, relationships and sexuality, manual handling and the Mental Capacity Act. Ms Perry showed a clear awareness of people’s needs and how she wished to develop the service. Within a survey, a member of staff told us ‘our direct line management are very supportive, caring people who do an amazing job, with limited resources. I think the service we provide would improve if we saw more of them, as sometimes they are seconded to other homes who are short staffed as well.’ As identified within the staffing section of this report, Ms Perry works as part of the working roster. While acknowledging that Ms Perry believes working with people using the service and staff is important, we said she should not be an integral part of the staffing roster. Ms Perry told us that this occurs predominantly when there is staff sickness or annual leave. On the staffing roster, this was a frequent occurrence. Within the AQAA, Ms Perry confirmed that having more time in the office would ensure the administration and management of the home, were kept ‘up together.’ Ms Perry also confirmed that ‘more computer training for managers’ would be beneficial. The home has a quality assurance system that is used within all of the homes within the organisation. The system consists of various audits and questionnaires. Ms Perry told us that a yearly audit involving gaining people’s views is undertaken. People are also consulted on a day-to-day basis. Audits such as checking health and safety, the management of people’s personal monies and the medication systems take place on a more regular basis. Ms Perry showed us the evaluation of the yearly quality assurance system. We saw that the evaluation contained details of all audits within the organisation. The information related to Shalom was not easy to follow. There was not a clear action plan in relation to the findings gained, as part of the audit. Ms Perry told us she would discuss this with her line manager, at their next visit. Ms Perry told us that she is well supported from the organisation. She told us that regular visits take place, as part of regulation 26. We looked at the file containing records of these visits. We advised that the file be reviewed in order to remove out of date information. Ms Perry has informed us of any incident, which has affected the well being of a person under regulation 37. We saw that accidents are addressed through the risk assessment process. Measures are applied to minimise the occurrence of the accident reoccurring. On the day of the inspection, the organisation was undertaking a thorough health and safety audit of the home. This consisted of fire safety, the control of substances hazardous to health, risk assessments, health and safety policies and procedures and staff training. As an audit was taking place and we judged health and safety to be well managed at the last inspection, we did not assess this area of practice, during our visit. Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 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 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 29 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA19 Regulation 12(1)(a) Requirement The registered person must ensure that people are assessed as to their risk of developing a pressure sore. Control measures must be in place to minimise the risk. The registered person must ensure that all staff sign the medication administration record to demote they have administered each person’s medication. The registered person must complete a review of staffing levels to ensure they are maintained at a level, which meets people’s individual needs. Timescale for action 31/01/09 2 YA20 13(2) 19/11/08 3 YA32 18(1)(a) 31/01/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations The registered person should ensure that daily records contain accurate, factual information rather than DS0000028445.V373133.R01.S.doc Version 5.2 Page 30 Shalom 2 3 4 YA6 YA18 YA20 terminology such as ‘no problems.’ The registered person should ensure that people are being supported to reach their goals and aspirations, which are identified within individual plans. The registered person should ensure that the reasons for the ‘cocoon’ style sleep system are evidenced within the person’s support plan. The registered person should ensure that any hand written instruction, which is recorded on the medication administration record is signed and dated by two members of staff. Shalom DS0000028445.V373133.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Shalom DS0000028445.V373133.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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