Care Home: Short Break Services

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What the care home does well The scheme offers a vital respite service for adults with learning disabilities and associated physical disabilities and their families. The families who use the service said that they mainly dealt with the deputy manager of the home and found her approachable, fair and caring.Three files were chosen at random of the people who use the service and examined as part of the inspection. The files were very well maintained and included full details of the care required for each individual. What has improved since the last inspection? Each of the residents has a feedback sheet to take home and each of the three people spoken to found these excellent. The feedback form includes information regarding what they have eaten and the activities they have participated in during their stay. The table top shower in the ground floor bathroom has been re-furbished. The hot water system has been re-furbished and is now providing hot water throughout the building at satisfactory temperatures. What the care home could do better: The scheme has a two month back-log of application assessments to carry out and should take action to reduce this. Care plans should be signed where possible by the resident or their representative or family member to demonstrate that consultation has taken place. The scheme must review the way it caters for the female residents. The compilation of the food menus, choices, preparation, presentation and monitoring of quality must be formalised to ensure the elements of Standard 17 of the NMS are met. The scheme has not had the use of a mini bus vehicle for many months and this has disadvantaged the residents. The staff team is carrying 2 vacancies in the senior team and 4 vacancies in the support worker team and this must be given urgent attention to progress recruitment. Staff must receive mandatory training and this must be received at appropriate intervals in accordance with the policies of the Local Authority. Agency staff must receive accredited training of a comparable quality with the Local Authority`s own training. This is with particular regard moving and handling and administration of medication where the policy and procedures of the scheme must be adhered to, to ensure safety.The facilities of the building with particular regard to areas and rooms that are currently not in frequent use should be reviewed. A review of the use of the rear gardens should be made to ensure that residents are able to enjoy them. CARE HOME ADULTS 18-65 Short Break Services 62 Green Lane Hanwell London W7 2PB Lead Inspector Ms Pauline Griffin Key Unannounced Inspection 17th January 2008 12:00 Short Break Services DS0000032384.V355311.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 Short Break Services DS0000032384.V355311.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. Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Short Break Services Address 62 Green Lane Hanwell London W7 2PB 020 8579 9558 020 8579 9592 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) www.ealing.gov.uk London Borough of Ealing Mr Christopher Jones Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th December 2006 Brief Description of the Service: Short Break Service is a respite provision for people aged between 18 and 65 years of age with Learning Disabilities or may also have profound physical and sensory disabilities. There are three aspects to the service - day time, evening or overnight stays within the unit, off-site weekend day time respite care at the Cowgate Centre, Greenford, and an outreach respite service during the summer (for 19 to 24 year olds) whereby residents are collected from their parents’ homes and taken for activities. The only part of the overall service that is covered by the Care Home Regulations and hence CSCI inspections, is the over-night stays within the Green Lane building. This aspect of the service is part of a resource centre, which is owned and managed by the London Borough of Ealing. There are currently between 50 and 60 people on the list who receive the respite service. The building is set on two floors. The ground floor has six bedrooms and two large ‘assisted’ bathrooms - one of these has a shower table facility. There is a large lounge, a sitting room, a dining room, a sensory room and kitchen. There are French doors leading out into the enclosed rear garden. The four bedrooms on the first floor do not meet the minimum size requirements for bedrooms and are used by people who are mobile because the property has no passenger lift. The first floor also has a sitting room and kitchen. The Registered Manager is supported by a deputy manager, 4 seniors (carrying 2 vacancies), ten support workers (carrying 4 vacancies) and the service has a full time cleaner, an administrator (position vacant) and use contractors for the repairs and garden maintenance. Short Break Service is situated in a cul de sac, set back from the main road. The service is within reach of Ealing Hospital, local amenities, recreational facilities and public transport links. Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out during the course of one day for a total of 6 hours. Interviews were conducted with the Registered Manager, a senior support worker, a support worker and a support worker from an employment agency. The Inspector observed the evening meal being served, shared some of the food and sat with the residents whilst they ate. The Inspector spoke informally with some of the residents and members of the staff team. Files for staff and the people who use the service were examined together with a selection of recording systems, logs, policies and maintenance certificates for the building and utilities. Leaflets completed by an advocate service user from Mencap on her impression of the home and the people who were using it at the time of her visits were examined and provided comments on the facilities. Telephone interviews were conducted with the parents of three people who use the service and their comments included remarks like ‘excellent service’, ‘the service is a life line to me’ and ‘the deputy manager is wonderful’. In terms of equality and diversity, about 25 of the people who use the service are female and the remainder are male. Over 50 of the people who use the service are from black and ethnic communities, 12 follow the Muslim faith, 4 Hindu, 7 are Sikh, 22 Christian and the remainder do not follow a religion. Thirteen of the 15 requirements made in the inspection carried out in December 2006 had been complied with and the issues concerning the hot water system had been addressed. Update training in mandatory subjects needs to be provided as a matter of urgency to some members of the staff team. Agency staff used by the home must receive training of the same quality as the rest of the staff team and this is with particular regard to moving and handling and the administration of medication. The staff team is carrying 6 vacancies and some of these are long term. The service has had no administrative support since September 2007. The vacancies mean that more agency staff have to be used. What the service does well: The scheme offers a vital respite service for adults with learning disabilities and associated physical disabilities and their families. The families who use the service said that they mainly dealt with the deputy manager of the home and found her approachable, fair and caring. Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 6 Three files were chosen at random of the people who use the service and examined as part of the inspection. The files were very well maintained and included full details of the care required for each individual. What has improved since the last inspection? What they could do better: The scheme has a two month back-log of application assessments to carry out and should take action to reduce this. Care plans should be signed where possible by the resident or their representative or family member to demonstrate that consultation has taken place. The scheme must review the way it caters for the female residents. The compilation of the food menus, choices, preparation, presentation and monitoring of quality must be formalised to ensure the elements of Standard 17 of the NMS are met. The scheme has not had the use of a mini bus vehicle for many months and this has disadvantaged the residents. The staff team is carrying 2 vacancies in the senior team and 4 vacancies in the support worker team and this must be given urgent attention to progress recruitment. Staff must receive mandatory training and this must be received at appropriate intervals in accordance with the policies of the Local Authority. Agency staff must receive accredited training of a comparable quality with the Local Authority’s own training. This is with particular regard moving and handling and administration of medication where the policy and procedures of the scheme must be adhered to, to ensure safety. Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 7 The facilities of the building with particular regard to areas and rooms that are currently not in frequent use should be reviewed. A review of the use of the rear gardens should be made to ensure that residents are able to enjoy them. 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. Short Break Services DS0000032384.V355311.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 Short Break Services DS0000032384.V355311.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): 1,2,4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who may use the service must have the information needed for them to decide whether the home will meet their needs or not. Assessments of new applicants must be processed within a shorter period of time than is currently the case. Care plans and contracts must be signed by the resident or their representative to ensure that they have written information about the service they receive. EVIDENCE: The home has a Statement of Purpose and a Service User Guide. The Statement of Purpose was last updated in 2003 and requires updating with regard to changes in the staff team. • The complaints statement included in the Statement of Purpose does not include reference to who people can appeal to if they do not feel a complaint has been dealt with appropriately. Standard 1 of the National Minimum Standards for Care Homes for Adults specifies that there needs to be information about how to contact the Care Standards Commission or local Social Services or Health Authorities. DS0000032384.V355311.R01.S.doc Version 5.2 Page 10 Short Break Services • • There is no mention that a copy of the latest inspection report should be made available to the residents and their families. The subject of administration of medication is not described with regard to the detail, scope and limits of what support the staff team can provide. There is no mention as to how people can obtain the information in other languages or formats. • The Service User Guide has been produced in a clear pictorial format. Pages 6 and 7 detail how to contract the Community Team or the Commission for Social Care Inspection and gives a full list of the staff team. This information might be more appropriately included in the Statement of Purpose. Three residents’ files were selected at random to examine against Standard 2 of the National Minimum Standards. Full assessments are made for each resident prior to the commencement of the service by ‘community team’. The Registered Manager said that although information was provided by the professionals requesting the service, the scheme made it’s own assessments and meet the resident and their family to make a full assessment and ensure they were able to meet the needs of the individual. The Registered Manager said that each individual was offered introductory visits to suite their own pace until they felt comfortable. This was confirmed in one of the three files examined by the Inspector of a person who was in the process of being introduced to the home for respite care. The Registered Manager also said that it often took two months to process an application for respite. He said that more members of the staff team should be trained to undertake assessments and process referrals to reduce the waiting time. Emergency admissions are not regular occurrences at the home but when they happened extra staff usually had to be used to meet needs. The Registered Manager said that emergency admissions were short term stays and only lasted until more appropriate accommodation could be found for the individual which was usually within a matter of weeks. The Registered Manager said that there were difficulties in obtaining the signatures of the families on the new contracts and care plans but these would be obtained at the next carer’s meeting. Short Break Services DS0000032384.V355311.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 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals and their representatives are involved in decisions about their lives and play an active role in planning the care and support they receive. Care plans examined were very good but in order to evidence that residents and their families know their assessed and changing needs are correctly reflected. It is recommended that signatures be obtained. EVIDENCE: Three resident files were chosen at random and examined. The care plans on file were up to date, well maintained and contained fully comprehensive information. The plans contained evidence that families had been involved in their production sand reflected the personal needs and wishes of the individual. Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 12 The Registered Manager said that it had been difficult to obtain signatures on the care plans from the resident or their families but that this would be done by approaching them at the next carer’s meeting. The care plans were produced with a ‘person centred’ approach with input from the person, their family and the care staff within a risk managed framework. Daily notes on the files examined were detailed and provided evidence that residents are assisted to make decisions about things they like to do. Risk taking is included in the care planning process and provides detailed information as to how the care should be provided or safety measures to be put into place when accompanying a resident on things like shopping trips or to restaurants. This was confirmed in the two files that were ‘case tracked’ by the Inspector. Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14,15,16 & 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Attendance at day centres and college are supported. The lack of suitable transport is disadvantaging the residents. Residents must be offered a menu of food that has been produced with input from either themselves or representatives. The meals should be ones that they are likely to enjoy and choice should not be restricted unless there are medical or cultural needs. EVIDENCE: The Registered Manager said that none of the people who visit the home are in paid employment although many attend day centres and adult education colleges. Residents who stay at the home, continue to attend their usual day centres, colleges and social clubs to ensure that the respite away from home gives the least disruption to their routine as possible. Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 14 The home provides excursions to the local shopping centre, local pubs and other forms of entertainment enjoyed by individuals. However, the Registered Manager said that the home does not have the use of a mini bus at present and it was, therefore, not currently possible to take groups to the cinema or places of interest or offer people with limited mobility a choice of any social activity in the community. Questionnaires examined that had been completed by residents said that because the home did not have it’s own transport and now relied on other forms of transport, it meant that residents had to get up earlier and returned home later and this was tiring for them. The staff were also effected by the lack of their own transport and had to arrive 30 minutes earlier on their shifts. The Registered Manager said that he is negotiating with the Local Authority to obtain the use of a mini bus that they are under a contractual obligation to provide. Residents to the home for respite live in the community with their families. The Inspector spoke to three parents on the telephone and two said that their sons saw the visit as a break from their routine and they looked forward to it. The third parent spoken to said that her daughter was not enthusiastic about her visits to the home and the reason for this is because the majority of the residents are male and there is a lack of ‘like minded’ companionship for her. She gave an example that her daughter liked the ‘soaps’ but football was given priority in the choice of programmes in the television lounge. During the course of the inspection, it was noted that residents were offered a key to their bedroom if they were able to make the choice. Staff were observed to interact with individuals in a relaxed but respectful manner. The home offers a safe environment with a choice of lounges and quiet rooms. The rear garden is enclosed but requires some attention to ensure that residents can get the full benefit of the grounds. The peer advocacy questionnaires indicated that the garden is not used enough even when the weather is fine. The Inspector was shown the home’s menu and it was noted from the staff meeting minutes that staff choose the menu on behalf of the residents. It was also noted that there was just a choice of fruit and yogurt for dessert on most days of the week. The Inspector watched the preparation of the evening meal and was told that the choice on the day was either lamb bolognaise or vegetable curry. The Inspector was also told that the dessert on the day of the inspection was fruit strudel and custard as well as fresh fruit or yogurt. The Inspector sampled the meal and sat with the residents at the dinner table whilst they ate. The Inspector found the lamb bolognaise unpleasant because it was so greasy. Although the Inspector was told that the meat had been chosen for the benefit of people who did not eat beef, it was also confirmed that only one resident in the home was of the faith that restricted beef. Both Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 15 the food choices were heavy and not suited to those who had any type of digestive problem. The Inspector noted that three of the young women at the table did not want the food and preferred to eat sandwiches. The Registered Manager said that all members of staff were expected to cook the meals. He agreed that some staff members preferred to cook and some didn’t but he felt all staff should be able to do it. The Inspector and the Registered Manager discussed the subject of the food menu, food choices and the practice of using staff members who were not necessarily interested in cooking. The content and appropriateness of the food menu, who chose the menu, who monitored the menu, the quality of the meals and who cooked the food needed to be revised. The Registered Manager agreed that the situation needed review. Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care is taken to provide personal care in the way residents prefer and care plans examined were very good. Health care needs are carefully documented and up to date and medication procedures are satisfactorily carried out. EVIDENCE: The subject of choice of gender when personal care is involved was discussed with the Registered Manager. Male residents make up 75 of people using the respite service. The majority of the staff team are female and the Registered Manager said that this had proved satisfactory and ensured that the choice of carer for personal care was respected. The home offers an all female weekend occasionally. Two resident’s files were chosen at random to examine and case track. The detail in the care plans included personal care goals and how staff should meet them. The files examined included a photograph of the resident as was required in the previous inspection. Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 17 One of the files examined included details of the need to use hoisting equipment and contained risk management information to ensure that procedures are carried out in the safest possible manner. The front sheets of each file examined contained a summary of health needs and medical details. There was an emergency section in each file for use in the event of a resident needing emergency treatment at the hospital and provide basic details of their next of kin and GP etc. Since the service takes the form of short term respite, the home is not involved in healthcare other than occasionally accompanying a resident to a medical appointment. Medication in the home is managed satisfactorily and there have been no medication errors since the previous inspection in December 2006. The Registered Manager said that only members of staff who have received training administer medication. The training spreadsheet of mandatory training did not include administration of medication. The Registered Manager and the Inspector discussed the need for agency staff to receive the same quality of training as is provided by the permanent staff team with special regard to administration of medication/health related tasks and moving and handling. Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The families of residents said that they felt able to express and views or concerns confidently. The scheme has an effective complaints procedure and residents are protected from abuse and have their rights protected. EVIDENCE: The Registered Manager said that there had been no formal complaints received since the previous inspection in December 2006. The Registered Manager said that all permanent staff had received training in the Protection of Vulnerable Adults. The home has policies provided by the Local Authority in Adult Protection and Whistle blowing. Staff should receive regular updates on Adult Protection and Whistle blowing through supervision and team meetings. The Adult Protection Policy handed to the Inspector dated 21/11/05 but because it was in a short form, it did not describe the different forms abuse can take or how to recognise it the signs of abuse. Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 19 The scheme has received three complaints since the previous inspection and these were investigated in a satisfactory manner. The Registered Manager said that complaints were used as a part of the quality monitoring process. Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 20 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): 24,25,27,28 & 29. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents to the home enjoy a comfortable environment but there are areas of maintenance that need to be addressed like the garden and items of equipment. EVIDENCE: The Inspector toured the premises with the Registered Manager and it was noted that the bedrooms on the first floor were under the regulation size required for new buildings. The lounge on the first floor is not used anymore and consideration could given to put it to better use. Standard 24.4 of National Minimum Standards. The premises are safe, comfortable, bright and in good decorative order. There is a planned programme for re-decoration and repair. The rear garden Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 21 is enclosed but requires some attention to ensure that residents can get the full benefit of the grounds. The peer advocacy questionnaires indicate that the garden is not used enough even when the weather The home does not have a passenger lift connecting the ground and first floor and the Registered Manager said that only people who could manage the stairs could stay in the rooms on the first floor. This restriction does not present a great disadvantage. The ‘nurse call’ alarm in one of the large ground floor bedrooms is positioned behind the head of the bed and inaccessible. This room has an hydraulic bed and is usually used by severely disabled residents who may need to use the ‘nurse call’ system. The hot water system has been improved and all the problems associated with it prior to the work being carried out have been resolved. The ground floor has two bathrooms with assisted bathing facilities and an electric hoist. The table shower on the ground floor has been re-furbished. The sit-in shower on the ground floor has been out of order since the Autumn of 2007, leaving just one shower available for use on the ground floor for up to 6 residents. The Registered Manager confirmed that the home had purchased 2 hydraulic beds and aims to purchase more in the future because they are beneficial to both the residents and the staff. The home has two portable hoists and two fixed overhead hoists. The home has benefited by the installation of further ramp access, dropped kerbs, lowered light switches, lower half glass panels in fire doors, portable induction loop and some new moving and handling equipment. The stairs have banisters but there are no grab rails in the corridors. The home was adequately clean and hygienic throughout. Maintenance records and certificates for annual service for utilities and equipment by accredited companies were examined. It was noted that heating, water, gas, lighting, fire equipment, portable electrical equipment, nurse call, hoists, bathing and lifting equipment, temperatures had all been checked within the previous 12 months. The London Fire Brigade has visited the home in the previous week and the Registered Manager said that no issues had been identified. Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 22 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): 31, 32, 33, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The rosta showed that sufficient numbers of staff on duty. Over 50 of the staff team have achieved an NVQ in care at an appropriate level. Training for some members of staff in mandatory subjects needs to be updated. Vacant posts in the permanent staff team need to be filled. Staff are supervised and receive annual appraisals. EVIDENCE: Three staff files were chosen at random and examined. Each file contained a copy of the job description for the individual’s role and responsibilities. The Registered Manager said that as part of the local authority, the staff benefit from corporate and departmental induction, training and appraisals and are made familiar with policies and procedures. LDAF induction standards are in place for new recruits. All staff have annual appraisals and regular one to one supervision. Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 23 Of the 11 permanent staff members, 5 have achieved an NVQ Level 2 or above and 2 are working towards it. Of the 15 agency staff regularly used, 5 have achieved the NVQ Level 2 and 1 is working towards it. Standard 32.6 of the National Minimum Standards, prescribing that 50 of the staff team achieve the NVQ Level 2. The Inspector was handed a mandatory training chart. It was noted that 5 of the 11 permanent staff members had not received moving and handling training for many years. The staff team is currently carrying 10 vacancies, 2 senior posts and 4 support worker posts. There is also one full time vacant post for an administrator. This means that the service has to use agency staff and the permanent staff share the administrative duties between them. Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 24 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): 37,39,41 & 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is based on openness and respect and the residents and their families benefit from a satisfactorily run scheme. Residents and their families are confident that their views are taken into account and the service is monitored by a quality assurance process that takes the views of other stakeholders into account. The health, safety and welfare of residents and staff are promoted by the policies and procedures of the scheme. Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 25 EVIDENCE: The Registered Manager is studying for the Registered Manager’s Award which is a care management qualification. The Registered Manager has over 15 years experience as a senior manager in the provision of respite care for both children and adults with learning disabilities. The scheme has a robust quality monitoring process that consists of several different strands: • • • • • • Post visit questionnaires completed by the carers. Visits by a peer advocate from Mencap to obtain the views of the residents to the home. Monthly visits from a senior manager from the Local Authority covering the building and the service provision. Copies of these reports are sent to the CSCI for monitoring. Monitoring complaints. Carer’s lunch meetings with minutes. Staff meeting minutes. There was no overview of the different areas of sampling and an annual development plan based on the outcomes must be produced and a copy sent to the CSCI in accordance with Regulation 24 of the National Minimum Standards. Recording keeping in the home is good. maintained and up to date. Records examined were well The Registered Manager maintains a safety regime under the Health and Safety at Work Legislation to ensure the health, safety and welfare of the residents and of the staff. Fire safety drills are carried out quarterly, checks of equipment are made regularly and recorded, accidents are reported in accordance with RIDDOR (Reporting of Injuries, Diseases, Dangerous Occurrences Regulations 1995) and assessments of risk are carried out. Maintenance records and certificates for annual service for utilities and equipment by accredited companies were available for inspection and found to be up to date. Safety training must be provided to all staff including agency staff and training/update training must be provided to staff at regular intervals. The London Fire Brigade has visited the home in the previous week and the Registered Manager said that no issues had been identified. Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 26 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 2 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 x 27 2 28 X 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000032384.V355311.R01.S.doc 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 2 14 2 15 2 16 2 17 1 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Short Break Services 3 x 2 x 3 3 x Version 5.2 Page 27 Score 3 3 3 x yes 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 YA1 Regulation 4&5 & Sched. 1 5(3) Requirement The Statement of Purpose and Service User Guide must be reviewed to provide all the information prescribed in Standard 1 of the NMS. A letter, contract, or statement of terms and conditions, sufficient to meet this regulation, must be sent to each service user’s family, confirming the details of the service being offered following the assessment of need. This was a requirement of the previous inspection. Timescale given: 01/04/07. Not met. 3. YA13YA15YA16 16(1) 16(2) (m) Suitable transport must be available to ensure that residents can enjoy their normal routine and a programme of social activities outside the home. 01/04/08 Timescale for action 01/04/08 2. YA5 03/03/08 Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 28 4. YA14 16(2)(m) 16(2)(n) Leisure activities must be supported for all residents. The interests of the smaller percentage of female residents must be considered equally with that of the males. 18/02/08 6. 7. YA16 YA17 8. YA17 9. YA27 11. YA33 12. YA35 23(1)(a)(o) Residents must have the right to enjoy access to the gardens. 16(2)(i) The menu and food provided must be produced to ensure that residents are given choices and have a healthy diet of attractive, well balanced and enjoyable food. 16(2)(i) The menu and food provided must be monitored to ensure it fulfils the criteria of Standard 17 of the NMS. 23(2)(j) The ‘sit in’ shower on the ground floor that has been out of commission for several months must be repaired. 18(1)(a)(b) Recruitment of permanent staff to the large number of vacancies in the staff team must be progressed as a matter of urgency. 18(1) The registered person must ensure that all staff working at the care home receive training (including induction training for temporary staff) appropriate to the work they perform. This was a requirement of the previous inspection. Timescale given: 01/02/07. Not met. 01/04/08 18/02/08 18/02/08 18/02/08 18/02/08 03/03/08 Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 29 13. YA35 18(1) All staff (including agency staff) must receive accredited moving and handling training that is regularly updated. The quality monitoring systems in place must be drawn together to provide an annual overview and the results made available to the people who use the service or their representatives. A copy must be sent to the CSCI. 03/03/08 14. YA39 24 01/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA3 YA6 Good Practice Recommendations The scheme should carry out the assessments of people applying for respite within a reasonable time framework. Each new care plan should be signed where possible by the service user, their representative or a family member, to demonstrate that consultation has taken place and agreement reached concerning the content of the care plan. Residents should be offered a formal choice of same gender care. Agency staff who are required to assist with administration of medication and health related duties, should be provided with the same training received by permanent staff and that is in line with the policy and practice guidance of the scheme. The nurse call emergency alarm in one of the ground floor bedrooms is in an inaccessible position and not fit for purpose. 3. 4. YA18 YA20 4. YA29 Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Short Break Services DS0000032384.V355311.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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