Care Home: The Douglas Arter Centre

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What the care home does well A high level of personal care in relation to very complex need is given. Regular consultation and input from specialised health care professionals is received. People are supported through the use of individual communication systems, to make decisions about their every day lives. Staff are committed to their roles and have worked hard to achieve a good standard of care, throughout the organisation`s restructuring process. Relatives are strong advocates and are confident in raising their concerns. There are clear adult protection policies in place. Staff are confident in their use and have used the whistle blowing procedure appropriately. A robust recruitment process is in place giving people additional protection. Peoples` health and welfare are promoted by well-managed health and safety systems. What has improved since the last inspection? Medication administration systems have been tightened to minimise the risk of error. Staff now receive medication training on a three monthly basis. All staff have regular medication competency checks. This involves a senior member of staff observing individual practice when administering medication. The lounge has been refurbished with new furniture, curtains and redecoration. All beds have been supplied with new bumpers for the bed rails. Purpose made doors have been fitted to replace the use of curtains within some toilets. What the care home could do better: Staff must ensure that they record any instructions detailing care intervention within the person`s care plan, not daily records. Nutritional and tissue viability assessments must be in place as part of the person`s care plan. Control measures including regular monitoring of a person`s weight must be maintained. Staff must be vigilant and follow the medication administration procedures when administering medication to people. A review of activity provision should be undertaken to ensure people have sufficient opportunities to meet their social needs. Focus has been given to recruitment of staff yet until fully successful, there is a reliance on agency use. The impact of the organisation`s restructuring programme should be closely monitored to ensure service delivery is not negatively affected. CARE HOME ADULTS 18-65 The Douglas Arter Centre Odstock Road Salisbury Wiltshire SP5 4JL Lead Inspector Alison Duffy Unannounced Inspection 26th June 2008 09:30 The Douglas Arter Centre DS0000028497.V366843.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 The Douglas Arter Centre DS0000028497.V366843.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. The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Douglas Arter Centre Address Odstock Road Salisbury Wiltshire SP5 4JL 01722 320318 01722 421537 heather.russell@scope.org.uk www.scope.org.uk SCOPE 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) Mrs Heather Frances Russell Care Home 9 Category(ies) of Physical disability (9) registration, with number of places The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Physical disability - Code PD The maximum number of service users who can be accommodated is 9. Date of last inspection 9th May 2006 Brief Description of the Service: The Douglas Arter Centre is a residential care home registered to care for nine adults with a physical disability. The home is situated on the outskirts of Salisbury near the citys hospital. The home is managed by SCOPE and the Registered Manager is Mrs Heather Russell. The Douglas Arter Centre is purpose built and also consists of an integral day centre. All areas on the ground floor provide full disabled access. Offices, staff rooms and the sleeping in room are located on the first floor. The home has nine single rooms, which are all personalised and individual in style. There is a small lounge although people are also able to use the main lounge in the day centre, as required. There are specialised bathing facilities and a range of specialist equipment including overhead hoists in bedrooms. During the week, staffing levels are maintained at generally six staff in the morning and four in the evening. At weekends this reduces to a minimum of four within the morning shift. At night one member of staff undertakes a waking night and another provides sleeping in provision. An on call management system is also available. The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection took place over two days. The first day took place on the 26th June 2008 between the hours of 9.30am and 7.30pm. The second day was on the 4th July 2008, between 10am and 2pm. Mrs Russell was available on the first day of the inspection. On the second day, the team coordinators assisted us. We met with people who use the service and the staff members on duty. As people have profound physical and learning disabilities, we were unable to receive significant feedback about the service they received. We observed the interactions between people and staff members. We looked at the management of peoples’ personal monies and the medication systems. We looked at care-planning information, training records, staffing rosters and recruitment documentation. As part of the inspection process, we sent surveys to the home for people to complete with support, if they wanted to. The speech and language therapist supported some people, to complete the surveys. We also sent surveys, to be distributed by the home to peoples’ relatives, their GPs and other health care professionals. The feedback received, is reported upon within this report. We sent Mrs Russell an Annual Quality Assurance Assessment (AQAA) to complete. This was completed in detail and returned on time. Information from the AQAA is detailed within this report. Within August 2007, we completed a random inspection. This was in relation to a high number of incidents, which the home reported to us under regulation 37. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. What the service does well: A high level of personal care in relation to very complex need is given. Regular consultation and input from specialised health care professionals is received. People are supported through the use of individual communication systems, to make decisions about their every day lives. The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 6 Staff are committed to their roles and have worked hard to achieve a good standard of care, throughout the organisation’s restructuring process. Relatives are strong advocates and are confident in raising their concerns. There are clear adult protection policies in place. Staff are confident in their use and have used the whistle blowing procedure appropriately. A robust recruitment process is in place giving people additional protection. Peoples’ health and welfare are promoted by well-managed health and safety systems. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. The Douglas Arter Centre DS0000028497.V366843.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 The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a detailed, well-organised admission procedure, which minimises the possibility of unmet need. EVIDENCE: There have been no new admissions to the service since the last inspection. It was therefore not possible to look at the admission process in detail. Within the AQAA, it was stated ‘most of the service users have lived at the Douglas Arter Centre for a number of years and their needs are continually assessed to ensure we continue to provide the service they need and want.’ Within a survey, one person told us ‘I like living here. My bedroom is being decorated. I would like to live in a smaller place rather than in a big residential setting.’ Mrs Russell told us that in the future, she would like to see people have more choice in where they live. One member of staff told us that there was currently one vacancy within the home. They said people had been considered for the placement yet a final decision had not been made. They said the person would need to fit in with existing people, so a robust admission process was being followed. The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning is of a good standard yet greater clarity with the organisation of information would ensure people’s needs are clearly evident. Systems are in place to support people with making decisions. Peoples’ welfare is promoted through a well-managed risk assessment process. EVIDENCE: All people who use the service have an individual care plan. Due to complex health care needs, people are unable to communicate how they wish their care to be delivered. Staff told us that information has been gained from people’s families and health care professionals. They said many of the long established staff know people well. Experience of people, is therefore an integral part of a person’s care plan. The plans we saw were detailed, well written and up to date. There was good detail about the person’s preferred routines and key aspects, such as bathing, eating and mobility. Photographs were used to describe people’s posture and The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 11 the use of equipment, such as lap straps and wheelchair clamps. Physiotherapy and speech and language programmes formed part of the care plan. We saw that staff had identified that one person was at risk of losing weight. They were not regularly weighed to monitor this. We said nutritional assessments and nutritional care plans should be in place. Within one care plan it was stated that the person needed to be monitored every 20 minutes at night. Another care plan stated ‘needs monitoring at night.’ We advised similar clarity within all care plans. Within the AQAA, it stated ‘there is a tendency to record the information on a daily record but not include it in the care plan and risk assessment. We recognise this and are trying very hard to ensure the information is written and recorded in the right place.’ We saw evidence of this. For example, one daily record highlighted the procedure to follow with an infectious condition. It was not detailed on the care plan. Another daily record gave dietary advice and information about the person’s posture, including the use of arm splints. There was no evidence of this on the care plan. Within a survey, a member of staff told us ‘each key worker updates care plans. More time would be better, so they are well up to date and not rushed.’ Another member of staff said ‘care plans always available and up to date. Daily handovers let us know how each client is and any problems.’ Within surveys, two relatives told us that the home always meets the needs of their relative. Three relatives said it usually did. Under the heading, what the home does well, one relative said ‘most things.’ Another relative said ‘provides our XX with an independent living environment tailored to her particular needs.’ Other comments included ‘our XX is always happy to return to the centre so we feel, she feels, that all her own needs are met. She’s happy – we’re happy’ and ‘good communication, caring, always there if needed, relative extremely happy in environment.’ Also, ‘I feel the care home does well because the staff go out of their way to be friendly and helpful to both parent and member.’ Staff told us that decision-making is promoted in line with the person’s ability. They said that some people, who use the service, might choose what they want to wear, through being given alternatives. Some people however, need staff to make decisions on their behalf. Staff told us, to do this, it was essential to get to know the people who use the service. We saw that decision-making was identified within people’s care plans. Strategies to aid communication such as signing, picture books and push-button lights were in place depending on the needs of the individual. We saw good interactions between staff and people who use the service. One person was looking at some books although a number had fallen on the floor. We saw staff ask the person where they wanted them put. The person was The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 12 able to point to express their view. Another person was being supported to get ready to go out with their family. We saw staff enable the person to choose what they wanted to take. We saw staff talk to people, when going about their tasks. People engaged well and some light banter was apparent. Within a survey, a speech therapist who supported one person, told us ‘carers listen and confirm what s/he has said and explain if they are unable to carry out an action e.g. s/he asks frequently to go on a bus, but this is not always possible.’ People have a range of written risk assessments on their file. These cover matters associated with care provision, daily living and social activities. We saw that one member of staff was undertaking an assessment in relation to a forthcoming outing. Staff told us that any risks identified are minimised as far as possible. They said people are encouraged to undertake meaningful activity despite small risks being present. This may include swimming with a condition such as epilepsy. More extreme risks, such as fairground rides, would be considered unsuitable. The Douglas Arter Centre DS0000028497.V366843.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, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have opportunities for social and leisure activities yet some relatives and staff believe these could be improved upon. People are supported to maintain important relationships. Meal provision is satisfactory yet enabling food to be cooked on the premises would address people’s individual preferences. EVIDENCE: We saw that people continue to attend the integral day service. They are able to choose what they want to do during this time. People are also supported to go into town, to the theatre, cinema or places of interest. Some people go to a local social club. Staff told us that they try to go out with people as much as possible. They said that some people just enjoy a walk or a trip on the bus. Some staff are able to drive the home’s vehicle. One member of staff said public transport is also used. The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 14 We saw people being supported to cook. We also saw people within a music session. They had percussion instruments. People were interacting and there was a positive, lively atmosphere. At the last inspection we recommended that people’s participation in external events be detailed in daily records. We saw little evidence of this although staff told us that social activity is now recorded within people’s diaries. We did not look at diaries on this occasion. Within surveys, relatives told us that people were usually supported to live the life they chose. One relative said ‘due to lack of local facilities and also staffing our XX does not get out as much - outside activities e.g. swimming, horse riding and general socialising, as we would hope for. Also withdrawal of Government funding has curtailed the music therapy at Salisbury College, which our XX enjoyed and benefited from.’ Another relative said ‘to the best of their ability due to the fact that our XX has no speech and they have to go on their knowledge of him/her and his/her likes and dislikes based on facial expressions and various noises made.’ Mrs Russell told us she is looking to develop more opportunities for people rather than daily attendance at the day service. This would enable more choice and opportunities within the local community. Holidays are in the process of being investigated and arranged. Within surveys, two members of staff told us ‘we could do more outings and socialisation.’ Another said ‘we try very hard to get people out into the community. This is something that we could improve on. This will mean getting more staff in to enable our residents to get out more. This could be by getting more funding from clients’ local authorities. They should spend more – we have trouble here persuading them that people deserve lives.’ People are supported to maintain contact with their family and friends. Staff told us that they regularly keep in contact with people’s parents and good relationships have been developed. We saw that one person was going home for the weekend. We spoke to their relative. They said they had nothing but praise for the staff and the care that was given. They told us ‘they let me know about the slightest thing. I don’t have to worry about XX, as I’m totally confident s/he’s in good hands.’ The relative said they were a regular visitor to the home. They said ‘staff are always friendly and free for a chat. They know XX very well and can tell what s/he needs.’ Within surveys, relatives told us that they are always kept informed of events affecting their relative. One person said ‘excellent key worker who regularly answers letters I send XX.’ People are encouraged to make decisions in relation to their ability. Preferred routines are clearly identified within care planning information. There are specific programmes, such as communication, to enable greater clarity. We The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 15 saw that people have regular support from the speech and language therapist. This encourages people to be involved in matters affecting them. Within a survey, one member of staff told us, under the heading what the home does well, ‘giving our clients self-esteem. Keeping them healthy and happy. Respecting individuals. Communication – using many different forms of communication to give people choices in their own lives.’ Food provision continues to be delivered from Salisbury District Hospital, which is adjacent to the home. On a Tuesday, people are supported to cook their own lunch. Mrs Russell told us that she has investigated the option of no longer using the hospital facility. She is aiming to recruit a cook and support people to devise their own menus. Staff saw this as a positive way forward although there was concern that the extent of choice would be reduced. There was also concern of covering the cook in their absence, to ensure a consistent service. Staff told us that at present, the food is satisfactory. One member of staff told us that the evening meal was not so good. In such cases, staff prepare an alternative. We saw people being supported with their lunchtime meal. Staff were attentive and supported people at their own pace. However, due to the number of people in the dining room, noise levels were high. The Douglas Arter Centre DS0000028497.V366843.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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive a high level of support with their personal care routines and have good access to health care provision. Medication systems are well managed yet people are at risk of error through some staff not being vigilant when following medication administrative procedures. EVIDENCE: People who use the service, receive full assistance from staff in all aspects of daily living. This support is detailed within care planning information. A range of individualised equipment is in place to meet people’s needs. Procedures are in place to identify matters such as how wheelchair straps should be positioned. As stated earlier in this report, some people are unable to express how they wish their care to be delivered. In such instances staff rely on gestures, facial expressions, general contentment and individual communication systems. Advice is gained on a regular basis from specialised services such as the physiotherapist and dietician. Staff also work closely with family members, to ensure the care that is given, is appropriate. The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 17 People rely on staff to recognise and act upon any sign of ill health. Staff told us ‘you just know, when someone is off colour.’ They were able to tell us about how individual people express that they are in pain. One member of staff told us that some people could say or point to an area causing discomfort. Some people however, would not be able to verbalise their pain. Staff said pain relief would be given, if there were any signs such as agitation, which may indicate discomfort. Each person had a record detailing any healthcare intervention. The physiotherapist and speech and language therapist had undertaken regular reviews and had contributed to the care plans. Specific programmes, involving aspects such as physical exercises were in place. One person had specific guidelines in respect of behavioural aspects. These had been developed and agreed, with a psychologist. We saw that one person was in hospital. Staff were supporting them on a daily basis, to ensure their physical and emotional needs were met. Staff spoke to us in detail about people’s vulnerability and their risk of developing a pressure sore. They told us about the control measures in place for people. We said tissue viability assessments and a care plan detailing necessary control measure must be in place. A team coordinator started this work immediately. We saw within daily records that one person had a sore area. Cream had been applied yet there was no follow up action or evidence that the district nurse had been contacted. We saw that one person’s epilepsy profile had been updated. A record of the person’s seizures was maintained. We advised that terms such as ‘good recovery’ should be clarified. Within surveys, two GP’s told us that they were satisfied with the service provided to people. A member of staff told us ‘there is enough professional help from outside agencies if we have any problems.’ People who use the service, are reliant on staff for their medication administration. There are clear medication policies and procedures in place. There have been a number of medication errors within the last few months. These have been reported to us under regulation 37. In response to the errors, the procedures have been tightened. All staff have a regular competency check. They are observed administering the medication. Senior staff also check after each medication round, to ensure the medication has been administered. The medication is generally administered from the dining room, at a time when the room is very noisy. One member of staff said, to minimise potential error, the medication was now being dispensed, from the hallway. The medication was stored securely. Records demonstrated that all medication was satisfactorily receipted on arrival to the home. Staff told us that all medication is delivered, as required. Previous difficulties in this area have been addressed. As good practice, all medication had been dated when opened. Two members The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 18 of staff had signed hand written instructions to the medication administration record. A new cupboard to store any controlled drugs had been purchased. At the last inspection we made a recommendation that more staff should be familiar with the organisation of the medication systems, so that they could deal with matters, as they occur. Staff told us that this had been addressed. Staff are now expected to sign in any new medication and not wait for the member of staff responsible for medication, to do so. The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear, well-managed complaint procedure, which relatives and staff are confident in using. The risk of abuse to people who use the service is minimised through the home’s adult protection systems. EVIDENCE: The home has a detailed complaints procedure devised by SCOPE. Within the AQAA it stated ‘we listen to service users and their families and work in partnership to improve service outcomes.’ It continued to state ‘the complaint procedure encourages views to be raised to improve professional practice and the well being of the service users.’ Mrs Russell told us that she encourages an open approach to complaints. She has recently researched advocacy systems, to enable people to express their views more fully. This is especially important as many of the people who use the service, rely on others to recognise any forms of discontentment. Within a survey, a speech therapist who supported a person, said ‘if s/he is sad, s/he cries and then carers try to find problem.’ People’s relatives are strong advocates. One relative told us ‘I wouldn’t have to think about making a complaint. If there are any concerns you just need to ask a member of staff. They would sort it straight way. There has never been any need to make a formal complaint.’ The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 20 Within surveys, all relatives except one told us that they knew how to make a complaint. The majority of people told us that complaints are dealt with appropriately. One relative told us ‘I was not informed why a member of staff was dismissed who was my XX’s key worker. Had no chance to talk to her, as I was not told anything.’ A record of formal complaints is maintained. The records are clear and identify any investigations, outcomes and responses to the complainant. Mrs Russell told us that over the last 12 months, staff have been much better at recording concerns dealt with on a day-to-day basis. There are detailed adult protection policies in place. Specific staff have the designated responsibility of adult protection. They receive regular refresher training to ensure they are competent within their role. Staff told us that they would inform this person or the manager, if there were a suspicion or an allegation of abuse. Staff were aware of the whistle blowing policy. The adult protection policies including the whistle blowing policy had been used appropriately. Staff had informed us of any incident affecting the wellbeing of a person under regulation 37. All staff have had adult protection training. Staff appeared attentive and noted any marks or bruising on people. A record is maintained within people’s daily records. Staff told us that any significant marking would be investigated using the adult protection procedures. A number of people have small amounts of their personal monies, held safely within the home. We looked at the systems for managing this. The cash amounts we checked, corresponded with the balance sheets. Two members of staff had signed all transactions. Receipts demonstrated expenditures. The administrator and Mrs Russell regularly audited the systems. The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from an environment that is clean, comfortable and conducive to their needs. EVIDENCE: The Douglas Arter Centre is a large purpose built building, which includes a day service and a residential area of nine bedrooms. The residential area also contains a small sitting room and bathroom facilities. The ground floor provides full disabled access. There is a range of specialised equipment in place to meet people’s individual needs. All equipment is regularly monitored and serviced, to ensure it remains safe and appropriate. People have a single bedroom. All are individual in style and reflect people’s preferences or personality. Some people have sensory equipment in their room. Mrs Russell told us that she was looking for ways to make people’s rooms more individualised. She said she was looking into having front doors with letterboxes. People would then be given a key, which staff would support The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 22 them to use. Mrs Russell told us that she was also investigating buttonoperated doors to enable people greater independence. There is a small lounge within the residential area. People are also able to use the day service communal space. The small lounge has been decorated and new furniture and curtains have been purchased. This creates a more homely atmosphere. Mrs Russell told us that people who use the service, chose the colour schemes of the room. Mrs Russell told us she would like to develop the environment further yet there were restraints with structure and the layout of the home. We agreed that the small kitchen space adjoining the lounge was not fit for purpose. A sluice was located in a bathroom. Mrs Russell told us she wanted this moved yet space was proving a challenge. We saw that a curtain covering an entrance to a toilet had been replaced with a purpose made door. Mrs Russell told us a specialist commode had been purchased for one person. Bumpers for the bedsides of all bedrails have also been upgraded. Within a survey one member of staff told us cleanliness could be improved upon. They said ‘improve the cleanliness of the building, the standard is poor – cobwebs, sinks with lime-scale over them. Things need updating or renewing, funds improved to purchase better equipment.’ On the day of the inspection, the environment was cleaned to a good standard. There were no unpleasant odours. Staff had access to disposable protective clothing as required. There had been no changes to the laundry facilities. The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The organisations’ restructuring process has significantly impacted upon the roles, responsibilities and morale of staff. Staff have good access to training yet this may be restricted at times, through staff shortages. People are protected through a clear, well-managed recruitment procedure. EVIDENCE: There are generally six staff on duty during the morning and four or five on the evening shift. This includes a team coordinator. An additional staff team support the day service. Staff told us that altogether, to support all people using the service (including the day service) at lunchtime, twelve members of staff are needed. This often proves a challenge. There have been a number of staff vacancies. This has resulted in an on going use of agency staff. Mrs Russell said consistency is being promoted through requesting the same agency staff for the shifts required. There are currently four new members of staff who are taking their induction. Staff told us that once fully inducted, the staffing situation should hopefully improve. The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 24 Staff told us that staffing overall, has been a difficult area over the last few months. SCOPE has worked through a major staff restructuring process, which has been unsettling for people. Staff told us that the role of senior support worker has been withdrawn. There are now team coordinators. All senior support workers had to apply for these positions. As team coordinators do not provide direct support to people, this has impacted upon the role of the support workers. We saw that the restructuring process had affected morale. The team coordinators told us, they were sure matters would improve in time, once staff and systems were more settled. We looked at the recruitment documentation of the three most recently employed members of staff. The files contained the required information. There was a photograph, an application form and two written references. There were details of the person’s interview. Each staff member had been checked against the Protection of Vulnerable Adults register before commencing employment. This ensured they were suitable to work with vulnerable people. SCOPE has a mandatory training plan. Staff said they had access to training, although the staffing situation had minimised their uptake of some subjects. One member of staff said ‘training is really good here. We are supported to do a range of topics.’ Another member of staff told us ‘if anything new crops up to do with a person’s care, they are very good at sorting out training, as soon as possible.’ The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed, yet the impact of the restructuring process should be regularly reviewed to ensure that this is maintained. Peoples’ wellbeing is promoted through clear health and safety systems. EVIDENCE: Mrs Russell has been the manager of the home for approximately two years. She told us that her role is very varied. She completes a high level of work outside of the home. This includes facilitating training sessions and undertaking regulation 26 visits, for other services within the organisation. There is a significant amount of travelling with some visits being completed in Cornwall. Staff told us that since the restructuring process, the day-to-day management of the service often lies with the team coordinators. One team coordinator told us ‘Heather’s role is vast. She is sometimes never here due to The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 26 her other commitments, but then there might be a week when she is here all the time.’ Within a survey, a relative told us ‘the new manager has new ideas for the member’s benefit.’ A member of staff told us ‘organisation takes manager away too often so does not spend enough time at centre.’ They added ‘it is difficult to keep in contact with manager, as always away.’ Mrs Russell told us that quality assurance had not been given recent focus due to other demands of the service. Staff were not aware of a quality auditing system in place. We asked Mrs Russell to send us a copy of the home’s annual development plan, developed from audits and feedback from questionnaires. The organisation has a range of health and safety policies. Health and safety training forms part of SCOPE’s mandatory staff training programme. Generic and individual risk assessments are in place. One member of staff has the designated responsibility of health and safety. Two staff have been trained to give staff instruction in manual handling. The environment is well maintained. We saw that equipment such as hoists and portable electrical appliances had been tested, as required. The fire log book demonstrated satisfactory testing of the fire alarm systems. An up to date fire risk assessment was in place. During the inspection a fire drill took place. Staff told us that drills are undertaken on a monthly basis. A full evacuation of the home and the day service was undertaken. People were aware of the procedures and left the home, without delay. The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 28 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 YA39 Regulation 24 Requirement The Registered Person must ensure that a formal quality assurance system is developed and implemented within the home. This was identified at the last inspection yet there was little evidence it had been addressed. The Registered Person must ensure that care plans identify service users’ changing needs and the individual support required. Timescale for action 20/08/08 2 YA6 15 30/08/08 3 YA19 12(1)(a) 4 YA20 13(2) This has been addressed in part as the information has been detailed within daily records rather than the care plan. The Registered Person must 30/08/08 ensure that nutritional and tissue viability assessments are in place. Control measures must be clearly identified including the monitoring of people’s weight. The Registered Person must 04/07/08 ensure that all staff follow the medication administration procedures to minimise the risk of any medication error. DS0000028497.V366843.R01.S.doc Version 5.2 Page 29 The Douglas Arter Centre RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA12 YA19 YA30 YA37 Good Practice Recommendations The Registered Person should ensure a review of social activity provision to ensure people are being offered sufficient opportunities of going out. The Registered Person should ensure that terms such as ‘good recovery’ should be clarified within documentation. The Registered Person should ensure that the sluice is removed from the bathroom. The Registered Person should ensure that the impact of the organisations’ restructuring programme is monitored so that service delivery is not negatively affected. The Douglas Arter Centre DS0000028497.V366843.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Douglas Arter Centre DS0000028497.V366843.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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