Care Home: Short Breaks Service

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What the care home does well The management and staff team have continued to work well with people and their families/carers so that long before they comes to stay for a short break for the first time a great deal of work has already been done to make sure that the person`s personal care, healthcare and behavioural/emotional support needs are known and that the staff team have the relevant skills and knowledge needed to support that person in the right way. The service achieves this through being part of a joint partnership between the Manchester Learning Disability Partnership (MLDP) and the Mancunian PCT. This is a joint social and health service made up of social and healthcare professionals. Depending on a person`s individual needs, the service may have worked with a Speech and Language Therapist to develop clear guidance on how to help a person eat safely, or to cope with someone`s behaviour that could be challenging, then psychologists and other clinical professionals will develop clear guidance on how to reduce and cope with this behaviour. The service continues to places a lot of emphasis on giving people choices and allowing them to make their own decisions and not have the staff making them or setting their own daily routines. This is helped through the management and staff team understanding how people communicate. Different methods and aids are used to give people a voice so that they can express themselves. People are encouraged to make the small day-to-day choices that give them more control such as what to wear, what to have for dinner and where to go out. People`s families and carers are very positive about the service provided for people at 144 Wythenshawe Road. Comments from events organised by the Short Break Service showed that the service was valued and seen as beneficial to all. One family member commented that, `144 gives me the confidence to allow me to take a break knowing my son is well cared for. I would have difficulty in allowing him to go anywhere else for respite care. The staff are just wonderful. This view was echoed by another family member who stated that, `Without this respite life would prove even more difficult. We have had holidays on our own and with family and friends. This we do knowing our daughter is safe and content.` The importance of working with people`s families and the support that can be offered to the whole family was commented on by a member of staff who stated that, `This service supports individuals also the service users families and friends. We are always at the end of the phone and visit families on a regular basis for home visits. The families are very important as it enables us to get to know the people we support.` Up to 25 people use the home to have a short break. Each has their individual needs and ways that they prefer and have to be supported, especially with their personal and healthcare. Each person has their own personal care checklist and guidance that explains how the person themselves wishes to be supported. The service had continued to work in developing more person centred support plans that were very detailed and full of personal information and told the reader what the person wanted and how they wanted to be helped. The guidance often read as if the person was telling the reader the best way to help them. Staff commented on how they managed to keep up-todate with people`s needs in that, `If there are any changes in peoples needs and support the manager will inform us verbally and also in writing in the profiles.` Staff continue to be supported and encouraged to develop their knowledge and participate in training they require to support people in the right way. They have access to a range of training resources, available from the local authority, external training providers and within the MLDP, especially in relation to health needs. If specific specialist training is required then the management team will find that from other relevant professions and training providers. Staff members were also very positive about the support they received from the service and from the management team in terms of encouragement and development. One member of staff commented that, `there is room for honest talk between staff and managers. There is fantastic support to staff and abundant staff training to meet the needs of the people we support.` One of several ways that the service have taken part in to gather people`s views and experiences has been to use a picture-based questionnaire that allows people to use signs and pictures to express their feelings about their experience of staying at the home. From this information a report was made available to people and their carers showing how they were doing, what people liked and what they did not like. The home used this information to look at how they run the service and how the service could be further improved for people. They are also using different events to try to get people and their families/carers and people who would benefit and are entitled to a service, together to provide information about the service and other aspects of the support they could receive. What has improved since the last inspection? The only area that needed improving found at the last inspection was to improve the emergency lighting. This had been actioned and was integrated with the fire alarm system and further handheld lighting was available for emergencies. CARE HOME ADULTS 18-65 Short Breaks Service 144 Wythenshawe Road Northern Moor Manchester M23 0PF Lead Inspector Steve O`Connor Unannounced Inspection 4 and 5 September 2008 2:00 th th Short Breaks Service DS0000064970.V371617.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 Breaks Service DS0000064970.V371617.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 Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Short Breaks Service Address 144 Wythenshawe Road Northern Moor Manchester M23 0PF 0161 234 4150 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) lgrant@notes.manchester.gov.uk Central Manchester Primary Care Trust Tracey Walker Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home provides accommodation and care (on a respite basis) for a maximum of three adults aged between 18 and 65 years old requiring care by reason of learning disability. The organisation should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The matters detailed in the attached schedule of requirements must be completed within the stated timescales. 12th July 2006 2. 3. Date of last inspection Brief Description of the Service: The care home provides 24-hour accommodation and support for up to three learning disabled adults for short breaks to give their carers/families a break from their care role. The home provides this service for up to 25 people. The home is run, staffed and managed through the Mancunian Primary Care Trust (PCT) and the Manchester Learning Disability Partnership (MLDP) as part of the local Short Break service. The building is a normal domestic dwelling set on a residential street in the south of Manchester with good access to local amenities. The ground floor has a kitchen/dining room, a lounge, and an activity room. The first floor has three bedrooms, a staff room and a bathroom and separate shower facilities. There is a large enclosed garden to the rear of the building. Information about the home and short-break service is available from the Short-Break Team. There are no charges for the service. Short Breaks Service DS0000064970.V371617.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 3 stars. This means the people who use this service experience excellent quality outcomes. The inspection report is based on information and evidence that we (the commission) gathered since the last key inspection in July 2006. This includes an Annual Service Review that was undertaken in October 2007. Additional information that has been taken into account included any incidents notified to us and information provided by other agencies. Between October 2007 and August 2008 eight people and/or their carers returned surveys asking then to comment on their experiences of the home. In addition, in July 2008 eight members of staff completed surveys and submitted them to us. Some of the information gathered through the surveys was used in this report. Before visiting the home, we asked the manager to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helped us to determine if the management of the home viewed the service they provide the same way that we see the service. The home was visited and time was spent talking to the manager of the home, senior staff and support workers. The three people staying at the home at the time of the visit had specific communication needs that made it difficult for us to gather their views directly. However, the way that people and members of staff interacted was observed. Information gathered was used in this report. Relevant records and files were assessed and a tour of the building was made. After the site visit we visited the office where the Short Break Service is based to have further discussions with the manager and to see records that were not stored in the home. The inspection was an opportunity to look at all the core standards of the National Minimum Standards (NMS) and was used to make a judgement on the quality of the service provided by the home and to decide how much work we need to do with them in the future. Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 6 What the service does well: The management and staff team have continued to work well with people and their families/carers so that long before they comes to stay for a short break for the first time a great deal of work has already been done to make sure that the person’s personal care, healthcare and behavioural/emotional support needs are known and that the staff team have the relevant skills and knowledge needed to support that person in the right way. The service achieves this through being part of a joint partnership between the Manchester Learning Disability Partnership (MLDP) and the Mancunian PCT. This is a joint social and health service made up of social and healthcare professionals. Depending on a person’s individual needs, the service may have worked with a Speech and Language Therapist to develop clear guidance on how to help a person eat safely, or to cope with someone’s behaviour that could be challenging, then psychologists and other clinical professionals will develop clear guidance on how to reduce and cope with this behaviour. The service continues to places a lot of emphasis on giving people choices and allowing them to make their own decisions and not have the staff making them or setting their own daily routines. This is helped through the management and staff team understanding how people communicate. Different methods and aids are used to give people a voice so that they can express themselves. People are encouraged to make the small day-to-day choices that give them more control such as what to wear, what to have for dinner and where to go out. People’s families and carers are very positive about the service provided for people at 144 Wythenshawe Road. Comments from events organised by the Short Break Service showed that the service was valued and seen as beneficial to all. One family member commented that, ‘144 gives me the confidence to allow me to take a break knowing my son is well cared for. I would have difficulty in allowing him to go anywhere else for respite care. The staff are just wonderful. This view was echoed by another family member who stated that, ‘Without this respite life would prove even more difficult. We have had holidays on our own and with family and friends. This we do knowing our daughter is safe and content.’ The importance of working with people’s families and the support that can be offered to the whole family was commented on by a member of staff who stated that, ‘This service supports individuals also the service users families and friends. We are always at the end of the phone and visit families on a regular basis for home visits. The families are very important as it enables us to get to know the people we support.’ Up to 25 people use the home to have a short break. Each has their individual needs and ways that they prefer and have to be supported, especially with Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 7 their personal and healthcare. Each person has their own personal care checklist and guidance that explains how the person themselves wishes to be supported. The service had continued to work in developing more person centred support plans that were very detailed and full of personal information and told the reader what the person wanted and how they wanted to be helped. The guidance often read as if the person was telling the reader the best way to help them. Staff commented on how they managed to keep up-todate with people’s needs in that, ‘If there are any changes in peoples needs and support the manager will inform us verbally and also in writing in the profiles.’ Staff continue to be supported and encouraged to develop their knowledge and participate in training they require to support people in the right way. They have access to a range of training resources, available from the local authority, external training providers and within the MLDP, especially in relation to health needs. If specific specialist training is required then the management team will find that from other relevant professions and training providers. Staff members were also very positive about the support they received from the service and from the management team in terms of encouragement and development. One member of staff commented that, ‘there is room for honest talk between staff and managers. There is fantastic support to staff and abundant staff training to meet the needs of the people we support.’ One of several ways that the service have taken part in to gather people’s views and experiences has been to use a picture-based questionnaire that allows people to use signs and pictures to express their feelings about their experience of staying at the home. From this information a report was made available to people and their carers showing how they were doing, what people liked and what they did not like. The home used this information to look at how they run the service and how the service could be further improved for people. They are also using different events to try to get people and their families/carers and people who would benefit and are entitled to a service, together to provide information about the service and other aspects of the support they could receive. What has improved since the last inspection? The only area that needed improving found at the last inspection was to improve the emergency lighting. This had been actioned and was integrated with the fire alarm system and further handheld lighting was available for emergencies. Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People’s needs and support are clearly identified prior to them coming to stay at the home. EVIDENCE: People who use the short break service at the home have a range of often complex communication, behavioural and/or health needs. Therefore, prior to anyone using the service the management and staff team have worked with the person, their family, the referring care management team and other relevant agencies and providers to develop a clear and detail picture of a person’s holistic support needs. The service has a clear referral process that can only be accessed through the Manchester Community Learning Disability Team Care Management system. As part of this referral process a care management assessment of need and an initial risk assessment has to be provided. In addition, if for example, a person has any specific needs relating to their emotional health and behaviour or eating and drinking then specialist providers can be accessed to provide these assessments and support guidance. Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 11 The service also undertakes its own in-house assessment through visits to see the proposed person and then coming to stay at the home for a visit or overnight stays. This process is agreed with the person’s care manager and family and an introduction plan is developed based on an individuals specific needs and situation. An example was seen where it was determined that the person be visited at their day service rather than at home and detailed records were maintained of the visits, staff observations and interactions with the person. When a person came to visit the home records were maintained by staff on how the stays went and also observational information about a person’s needs and ways of communicating. Examples were seen where health needs such as epilepsy had been identified during this introduction process and a specialist epilepsy care plan had been developed. From all the information gathered during the introduction process the staff team and management work with people and their families to try to make sure that the short break service meets the persons and families needs prior to them using it. Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is a clear system and practices for identifying the support people need and any hazards they may experience. Risks and hazards that people experience are identified and acted upon to allow them to be supported correctly and safely. People are encouraged to make choices and decisions about their day-to-day experience of the home. EVIDENCE: From the time that a person is referred as needing the short break service at the home the staff team and management are developing a support plan of the person’s needs and support. This plan is based on all the different sources of information gathered during the introduction process. The scope of the support plan depends on the scale and complexity of a person’s needs and could include specialist health guidance around epilepsy, eating and drinking or other health issue. It could also include detailed guidance on how to work with Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 13 people who present a challenge to the service through the behaviour they express themselves and their communication. Whatever needs and support is identified the staff team and management have further developed their person centred approach to identifying and recording people’s needs in the way that they wish. Examples were seen of support plans that are written as if the person themselves was telling the reader about their daily routines, their likes and dislikes, what they like to do for fun and enjoyment and how they want staff to help them in the areas they need. The support plans samples also used pictorial images to communicate what the person wanted to say. It is recommended that the individuals support plan identify the people who were involved in developing and recording the plan and where possible to show that the person and/or their carers agree with the plan. People may not be using the short break service for some time and so to make sure that changes in people’s needs were identified the person’s carer/family is contacted just before their next visit to see if there is anything the staff team and management need to know about changes in a person’s needs and support. Examples of the Stay Review Checklist were seen where, for example, medication regimes had been changed. In addition to the care management review process undertaken by the local authority the home carries it its own review of people’s needs and support. At a minimum this is addressed every six months and takes the form of either a meeting, visit to the family/carer or telephone call depending on the complexity of the person’s support needs. Examples of these were seen where issues such as any significant events, changes in health and wellbeing, medication, frequency of visits and the person’s experience of the visits are recorded. The staff team and management work with people, their family/carers and other relevant people to find out about their normal daily routines and what they like and do not like in terms of meals, activities, environments and how they like best to communication. By understanding people’s needs and how they communicate their own needs and preferences the staff team and management offer them day-to-day choices and decisions that reflect their needs. Restrictions of choice are only made to safeguard the person and only as a result of a full risk assessment. As part of the initial referral and assessment process comprehensive information is gathered on risk assessments that look at specific areas such as moving and handling needs, falls, personal care, communication and risks associated with the community and environment. Those areas that are identified as known or potential hazards will be assessed further by the Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 14 relevant specialist provider and support guidance in minimising those hazards and risks would be developed. A range of examples were see of risk assessments and guidance in supporting people’s behaviour and emotional wellbeing, hazards from eating, drinking and swallowing, the management of medication and looking after the person’s finances. The manager was very clear about the service role in assessing risk and in understanding how the Mental Capacity Act 2005 impacts on how risks are supported by the home. Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 are supported and encouraged to participate in meaningful social and leisure activities. People’s routines are based on their own preferences and activities. Meals are based on peoples’ needs and choices and appear nutritionally balanced. EVIDENCE: People come to stay at the home for short periods of time to give them and their carers a chance for a break. If a person already goes to a specific day service then they will continue to go during their stay. The service has access to transport and so can be more flexible in supporting people to maintain their normal routines. In addition, people are supported, where possible, to carry on going to the social and leisure activities that they enjoy in the evening. Many Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 16 people attend evening groups and discos and are supported by staff to continue going or to go for the first time. People also have the opportunity to try different social and leisure experiences whilst staying at the home. This may include visits to local cafes, restaurants, pubs and other facilities such as the cinema or bowling. Trips to local attractions are also organised on a regular basis such as visiting Blackpool. Where possible people continue to be supported in maintaining their own independence skills through undertaking domestic tasks within the home, shopping, preparing and cooking meals. The activities they take part in are based on their abilities, needs and goals. The home tries to maintain the normal routines that people have developed at their own homes in terms of the day services and other activities that they would normally take part in. This is reflected through people’s support plans where information about people’s morning, daytime and evening routines and preferences are recorded in detailed with a person centred approach. Visitors are welcome to come to the home at reasonable times but the home provides a short break away from peoples’ carers/family and so this would not happen on a regular basis. Mealtimes are usually taken together with staff providing any assistance required. As the home provides a service for up to 25 people so choice of meals has to remain flexible and is dependent on the dietary needs of the people staying at the home at the time. Information on peoples’ food likes and dislikes is used to decide the choice of meals and the home encourages a healthy balanced diet with the availability of fresh fruit and vegetables. Giving people the opportunity to eat out at cafes and restaurants was also seen as an important part of a persons stay. If people need support with their eating and drinking then suitable guidelines were made available for staff to follow to keep people safe. Short Breaks Service DS0000064970.V371617.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 excellent. This judgement has been made using available evidence including a visit to this service. The home supports people to maintain their personal and healthcare needs. The medication administration system has the procedures and practices in place to ensure that people are safe and maintains their health. EVIDENCE: Each person who comes to stay has a clear and detailed personal care checklist with support guidance. In addition, several examples were seen of detailed morning and evening routines that set out what people needed and what they do at these times. The staff team and management had worked with people to further develop support plans based on a person centred approach. The way that the information was written was like the person telling the reader how they wanted to be supported with their personal care and what was important for them. This gave staff clear and detailed guidance in how best to support people. Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 18 Peoples’ healthcare needs and support were identified prior to them coming to stay at the home. A range of examples were seen of health related assessments and support guidance for staff to follow to keep people well and safe. Care plans around people’s epilepsy care, dietary needs, eating, drinking and swallowing and emotional/ behavioural guidance was available where this was required. In addition, each person who came to stay had a completed health Action Plan that set out in further detail people’s health related needs. A further development that the service had made was in developing a tool to aid other health providers as to a person’s health and communication needs. The Traffic Light system was particularly developed for when people where admitted to hospital to make sure that hospital staff were more aware of the person’s needs. Each person has a medication profile that includes an assessment of how people can manage their medication regime and the risks they may face. It also lists all the person’s current medication with information about the medication and any side effects. If a person is prescribed with medication ‘as required’ (PRN) administration guidance was developed and in place for staff to follow. Changes to people’s medication regime would be picked up in the preadmission review prior to the person’s stay. If the medication that arrives with the person is different from that listed then a staff member will contact the relevant prescribing doctor to confirm the changes. All medication that comes with the person is recorded on a Medication Administration Record (MAR). Examples of MAR sheets seen were accurate in recording the dosage of medication administered. The staff and management team regularly audit the medication and MAR sheets. Incidents and errors involving medication were clearly recorded and are past onto senior management for quality auditing purposes. If errors involved staff practice then this would be addressed through the services supervision (called job consultation) process. The management team are responsible for training staff in the medication administration system and also provided evidence that they assess staff competence to administer medication safely and in accordance to the relevant guidelines and policy. Short Breaks Service DS0000064970.V371617.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 excellent. This judgement has been made using available evidence including a visit to this service. The systems and procedures are in place that encourage people and or their carers to express their concerns and worries and for the protection of people from abuse. EVIDENCE: People and their families/carers are able to make use of both the Manchester Adult Social Care and PCT formal complaints procedures. These are clear and established complaints processes and information about how to make a complaint is made available if people want to raise a complaint. According to information provided by the manager one complaint had been received in the past 12 months and that had been resolved. People and their families/carers can also contact the staff or management team direct to discuss issues that they are not happy with or concerns that they have. The team try to resolve any concerns directly or may require the attention of the management team. A record of these concerns was being maintained to show the actions that the staff and management team took to resolve any worries that people had. It is recommended that people and their families/carers are provided with all the information they need to be able to raise their concerns and/or make an informal or formal complaint. Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 20 The staff and management team follow the Manchester Multi-Agency Adult Protection Procedures. The staff and management spoken to during the site visit were all aware of their role in protecting people and following the required adult protection procedures. The staff team are made aware of the procedures to follow during their induction and Learning Disability Qualification and also have access to a rolling programme of adult protection training. Information provided by the manager showed that the service had been involved in making appropriate referrals under the safeguarding procedures. Staff have access to training in general physical intervention and breakaway techniques. The manager stated clearly that if a person required any form of physical intervention then specific guidance and training was provided around the needs of the individual person. People only stay at the home for a short time and so the system of recording peoples’ monies and spending is implemented that shows clearly what has been spent and how much money returns home with the person. Receipts for all transaction were kept and monitoring systems were in place for checking that recording and cash balances were correct. Short Breaks Service DS0000064970.V371617.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 excellent. This judgement has been made using available evidence including a visit to this service. People live in a clean, safe and homely environment that offers the flexibility to meet their needs. Appropriate systems and practises are in place in relation to minimising cross infection. EVIDENCE: The short break service is based in a large domestic house set back from the main road in a residential area of south Manchester. The house is clean, well maintained and has had a number of areas redecorated and new carpeting on the ground floor. The home feels comfortable and homely with good quality modern furniture, fixtures and fittings. The layout of the house allows people to spend time on their own or with others if they want to. On the ground floor is a kitchen/dining room connected to a games room and a separate lounge that leads out to the garden through patio doors. The back garden is large and secure with a BBQ and gazebo that people use during the summer. Opposite the house is one of the largest parks Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 22 in south Manchester, which has a wide range of activities, and facilities that people often, made use of. The three bedrooms are clean and functional reflecting the fact that they are used for short breaks and have to be able to reflect the needs of the person especially in terms of their behavioural needs. People often bring personal items and two of the bedrooms have televisions. One room has an observation window in the door and is only used for people who need to have that level of supervision to keep them safe. Bathroom facilities are modern and offer people the option of baths or the walk-in wet room. Staff spoken to were aware of the need for safe working practices when supporting people with their personal care for effective infection control. The equipment that staff required for this was easily accessible. The domestic laundry facilities are in the kitchen but the home does have the systems in place for infection control practices. Short Breaks Service DS0000064970.V371617.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, 33, 34 and 35 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. People benefit from having an effective and competent staff team who have the skills and knowledge required supporting their needs. The recruitment practices and procedures ensure that staff are safe to work with vulnerable people. EVIDENCE: The team at 144 Wythenshawe Road consists of the clinical manager, assistant clinical manager and seven permanent support workers. Staff cover is based on the level of needs of the people staying at the home but there is always at least two staff on duty. The staff rota showed that flexible shifts were also used if required. The staff team had a mix of gender and ethnicity that reflected the people who used the service. Information provided by the manager in the AQAA self-assessment showed that during the last three months just one shift had to be covered by an outside agency staff. The staff rota showed that over the last 6 weeks around 15 shifts had to be covered by staff who work for the PCT on a more flexible Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 24 basis. These staff were mostly the existing staff team or staff who work in other parts of the MLDP services. This showed a major reduction in the reliance of agency staff who do not know people well and so improves consistency of staff support. From the information provided by staff members through the surveys, talking to two members of staff on duty and observing how they work with people it was shown that they had a very good knowledge and understanding of the needs of the people they support. The staff kept their knowledge up-to-date and communicated effectively between themselves and with the management team. Evidence was seen of regular team meetings where the staff and management team were able to contribute. Comments from members of staff were very positive about the way they felt supported and kept informed by the management team. The staff team had access to an established programme of vocational training. This started with the Learning Disability Qualification that links both the Common Induction Standards (CIS) and units of the NVQ Level 2. Evidence was seen of completed workbooks from the course and confirmation from the manager that the staff member had showed competence and understanding in these areas. From information provided by the manager showed that all the staff team had achieved at least the NVQ Level 2 in Care or were currently studying for the vocational course. Staff who commented and were spoken to were very positive about the level and standard of training they received to meet people’s support needs. The recruitment process is shared between the Manchester Local Authority Adult Social Care personnel department and the MLDP, of which the service is a part. This is a well established process that also includes the involvement of people who are supported by the MLDP and given specific training and support in the recruitment of staff. The manager confirmed that they play a full and active role in the selection of staff they feel is right for the people who use the service. Although not directly involved in the process of checking the required references and Criminal Record Bureau (CRB) certificates, they are kept informed of the process and was able to show evidence that all the staff team had a relevant and up-todate CRB certificate. New members of staff start on a 12-week probationary period that includes their induction to the service and completion of the Skills for Care CIS and core training. Each new member of staff is allocated a mentor who is an experienced senior member of the staff team. It is their responsibility, along with the manager, to make sure that new staff members have gained the key Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 25 skills, knowledge and understanding that they need to work with people and support their needs. Evidence was seen of how members of staff and mentor meet and work together on a regular basis to develop those skills and knowledge. In addition, the manager meets with new staff every four weeks to monitor their progress. At the end of the 12-week period the manager will make the decision as to the competence of the staff member in the core skills and so make their employment permanent. Through the induction/probationary process a staff member’s additional training and development needs are identified and they are supported to access this training. Evidence was seen that information about staff training needs was being fed through the MLDP training group to the Manchester Adult Social Care Workforce Development programme and relevant courses were being developed and provided to the staff team. In addition, due to the multidisciplinary nature of the MLDP staff could access training from specialist staff such as Speech and Language Therapists. Staff who made comments or were spoken to during the site visit were very positive about the training they were offered in their role. The staff spoken to at the service described their own training and development plans and how these had been developed with the manager through the supervision process (called Job Consultation in the service). One member of staff commented, ‘My induction went very well, very welcoming help from mentorship and management sessions.’ Short Breaks Service DS0000064970.V371617.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 excellent. This judgement has been made using available evidence including a visit to this service. The management and operational management systems used ensure that people receive a well-run service. Systems and events for gathering peoples’ views and experiences of the service were in place. Health and safety practices and systems are in place to protect the welfare of the people who use the service. EVIDENCE: The manager of the service at 144 Wythenshawe Road is a qualified nurse and has the job title of clinical manager. They applied and were successful in becoming the registered manager of the service and have obtained the Registered Managers Award. In addition, they have a management and Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 27 leadership qualification and they are undertaking further study to enhance their own development and skills base. Comments and feedback from members of staff were very positive about the level and style of support that they receive from the manager and the management team. As one of the members of staff commented, ‘When I started I had fortnightly JC (Job Consultations) with manager which gave me valuable support in developing my role. The manager is always very approachable and gives us all support in how we work’. The service has a range of systems in place that monitors how the service is run and that key records and documents and tasks are being carried out at the right time and in the right way. Staff use daily handover records for monitoring medication and finances, environment checks are made of the building to make sure people’s health and safety is maintained. The management team has key roles and responsibilities for monitoring the medication, finances and other recording systems. In terms of monitoring the performance and quality of the staff team the management team observe performance, support Job Consultations and arrange team meetings to gather and pass on relevant information about the service. The service sets its own goals for achievement through being part of the MLDP Short Break Service Team Plan. Evidence was seen of plans from previous and the current year, setting out clear goals and aims in what type of service it wants to be and how it can improve. The service gathers information about people’s views and experiences using a range of methods. On an individual basis a person’s support and needs are reviewed a minimum of every 6 months and can be more often depending on the complexity of the person’s needs. People and their families are, where possible, visited at home and asked their views of the service. The service also takes part in larger events organised either by themselves or through the MLDP where people and their families/carers are invited to coffee mornings, health information events and also an event organised for members of the Asian community who are under represented in terms of use of appropriate services. During 2007 and 2008 the Short Break Service had sent out questionnaires to everyone who uses the service. From the questions asked in the surveys the Short Break Service were able to look at issues of quality and how people rated their experiences. From this a set of actions were developed for the Short Break Services, including 144 Wythenshawe Road, to achieve. Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 28 It is recommended that the outcomes from the quality assurance exercise be clearly defined into actions with timescales and recording the person/people responsible for achieving the actions. This could then be used to show who was responsible for achieving what and when. By undertaking the exercise on an annual basis will give the service a measure of achievement and to determine whether they have improved the quality of the service from one year to the next. As has been highlighted above, the service has monitoring systems for checking that the environment is safe for people and staff to be in. Records were maintained of checks in relation to water and fridge temperature and records of regular servicing of fire equipment, gas and electric equipment. The manager was aware of her health and safety responsibilities under the relevant legislation and regulations. This included COSHH and RIDDOR and reporting appropriate incidents to us. The last inspection report highlighted the need for emergency lighting. This had been installed and formed part of the integrated fire/emergency alarm systems. Fire logs of checks were being maintained and fire risk assessments were being reviewed annually. Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 4 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 4 23 4 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 4 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 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 4 4 3 X 4 X 4 X X 3 X Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 30 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations It is recommended that the individuals support plan identify the people who were involved in developing and recording the plan and where possible to show that the person and/or their carers agree with the plan. It is recommended that people and their families/carers are provided with all the information they need to be able to raise their concerns and/or make an informal or formal complaint. It is recommended that the outcomes from the quality assurance exercise be clearly defined into actions with timescales and recording the person/people responsible for achieving the actions. This could then be used to show who was responsible for achieving what and when. 2. YA22 3 YA39 Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 31 By undertaking the exercise on an annual basis will give the service a measure of achievement and to determine whether they have improved the quality of the service from one year to the next. Short Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Breaks Service DS0000064970.V371617.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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