Care Home: The Haven

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• Hillview Farm
• Dalewood Respite Care
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• Fairways
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What the care home does well The service assesses the individual needs and wishes of prospective residents, prior to the offer of a place, to ensure that they can be met by the home. Staff work with residents towards agreed goals, to develop their skills and enhance their quality of life and level of independence. Though none of the residents is able to manage their own medication, the home has an appropriate system to do this on their behalf, and staff have all received relevant training in this area. Contact between residents and their families and friends is encouraged and supported where possible to maximise residents` wellbeing. Residents are offered a varied diet, which meets individual specialist needs and cultural wishes. The home has an appropriate complaints procedure in place. The manager addresses any complaints appropriately and staff have attempted to explain the procedure to residents.The home has systems in place to protect residents from abuse, and reports concerns appropriately to external agencies. The home provides a comfortable, clean and safe environment for residents, and has specialist equipment to help meet the needs of two residents with physical disabilities. Residents are supported by a stable and well-trained staff team with the skills to meet their needs. The provider has an appropriate staff recruitment process, which offers protection to residents. The home is run in the best interests of residents, by a qualified and experienced manager, who has worked to minimise the effect of staff shortages, on the outcomes for residents. Residents are consulted regularly about their care, and their health, safety and welfare are supported. What has improved since the last inspection? Some improvements have been made to the service information that the home makes available to prospective residents and their families, and to the format of the terms and conditions document The introduction of new Person Centred Plans has led to improvements in the information available to staff about the needs and individual preferences of residents and to residents having a greater input into their care plan. The level of communication with residents has also improved, enabling them to have more say in daily decision making. Risk assessments have also been improved, and better staff awareness of these has increased the range of life experiences available to residents. Residents have had access to more activities within the home and the local community, which has provided a more fulfilling lifestyle, reflecting their individual diversity and interests to a greater degree. They are also involved more in the daily routines of the house. Their involvement in menu planning and making choices is being encouraged through the use of an improved range of communication tools, in order to maximise self-determination. The new Health Action Plans enable the individual healthcare needs of residents to be more effectively monitored and met by the staff. The majority of the home has been redecorated since the last inspection, and new carpets and furniture have been provided in a number of areas. What the care home could do better: At present the opportunities for involvement in meal preparation are limited for wheelchair-users. This could be addressed by the provision of an area of lowered worktop and possibly the inclusion of a hob, as part of the upcoming refurbishment of this area. The residents` version of the complaints procedure could be developed further to maximise its accessibility. The quality assurance and reporting process could be developed further to provide information to support further developments of the service. The home`s fire risk assessment needs to be reviewed to ensure it remains relevant and comprehensive, and portable electrical appliances need to be safety tested to protect residents and staff. CARE HOME ADULTS 18-65 The Haven Radley Road Abingdon Oxfordshire OX14 3PP Lead Inspector Steve Webb Unannounced Inspection 8th January 2008 10:15 The Haven DS0000013091.V348412.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 Haven DS0000013091.V348412.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 Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Haven Address Radley Road Abingdon Oxfordshire OX14 3PP 01235 521801 01235 521801 haroon@caretech-uk.com 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) Caretech Community Services Limited Julie Firth Care Home 6 Category(ies) of Learning disability (6), Physical disability (2) registration, with number of places The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 6. 31st July 2006 Date of last inspection Brief Description of the Service: The Haven is a home for up to six adults with learning disabilities two of whom may also have physical disabilities. The home provides 24-hour support for the residents to meet their assessed needs. At the time of this inspection there were five residents at the home and one vacant first floor bedroom. The home is run by CareTech, a private provider of services to people with learning disabilities, although the premises are owned by a housing association. The home is detached and located on the outskirts of Abingdon, a market town seven miles south of Oxford. The home is domestic in appearance and has a very large garden. The residents are helped to use local services and facilities. At the point of inspection, the fees for this service were £1,077.83 per week. The Haven DS0000013091.V348412.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 inspection included an unannounced site visit from 10.15 am until 6.30 pm on the 8th January 2008. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with the manager, some of the staff members on duty during the day, and some feedback from service users. The inspector also observed the interactions between service users and staff at various points during the inspection. The inspector examined the majority of the premises, including some of the bedrooms, with the consent of residents. It was evident that the service is well managed on a day-to-day basis by the manager who had worked to improve care planning and ways of working to increase the focus on the wishes and preferences of individual residents. What the service does well: The service assesses the individual needs and wishes of prospective residents, prior to the offer of a place, to ensure that they can be met by the home. Staff work with residents towards agreed goals, to develop their skills and enhance their quality of life and level of independence. Though none of the residents is able to manage their own medication, the home has an appropriate system to do this on their behalf, and staff have all received relevant training in this area. Contact between residents and their families and friends is encouraged and supported where possible to maximise residents’ wellbeing. Residents are offered a varied diet, which meets individual specialist needs and cultural wishes. The home has an appropriate complaints procedure in place. The manager addresses any complaints appropriately and staff have attempted to explain the procedure to residents. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 6 The home has systems in place to protect residents from abuse, and reports concerns appropriately to external agencies. The home provides a comfortable, clean and safe environment for residents, and has specialist equipment to help meet the needs of two residents with physical disabilities. Residents are supported by a stable and well-trained staff team with the skills to meet their needs. The provider has an appropriate staff recruitment process, which offers protection to residents. The home is run in the best interests of residents, by a qualified and experienced manager, who has worked to minimise the effect of staff shortages, on the outcomes for residents. Residents are consulted regularly about their care, and their health, safety and welfare are supported. What has improved since the last inspection? Some improvements have been made to the service information that the home makes available to prospective residents and their families, and to the format of the terms and conditions document The introduction of new Person Centred Plans has led to improvements in the information available to staff about the needs and individual preferences of residents and to residents having a greater input into their care plan. The level of communication with residents has also improved, enabling them to have more say in daily decision making. Risk assessments have also been improved, and better staff awareness of these has increased the range of life experiences available to residents. Residents have had access to more activities within the home and the local community, which has provided a more fulfilling lifestyle, reflecting their individual diversity and interests to a greater degree. They are also involved more in the daily routines of the house. Their involvement in menu planning and making choices is being encouraged through the use of an improved range of communication tools, in order to maximise self-determination. The new Health Action Plans enable the individual healthcare needs of residents to be more effectively monitored and met by the staff. The majority of the home has been redecorated since the last inspection, and new carpets and furniture have been provided in a number of areas. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 7 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. The Haven DS0000013091.V348412.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 Haven DS0000013091.V348412.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): Standards 1, 2 and 5: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some improvements have been made to the information available to prospective residents and their families, to better support their decisionmaking about the appropriateness of the home. The individual needs and wishes of prospective residents are assessed, prior to the offer of a place, to ensure that they can be met by the home. Each resident has a statement of terms and conditions, giving them information about the service that they can expect, and the format has been improved to some degree by the inclusion of pictures in some areas. EVIDENCE: The manager reported that the provider had developed a new Statement of Purpose and Service User Guide, which are to be available in CD format for viewing as well as on paper. However these were not yet available in the home. In the interim, the manager had revised the previous documents including pictorial elements to assist staff when they go through the document with the resident. Whilst this new version was an improvement over the previous written format, it was acknowledged to be an interim step, whilst awaiting the provider’s new format. The manager indicated that the existing The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 10 Service User Guide has been explained to residents individually, and any comments noted on the back of their copy. The home has an appropriate pre-admission assessment process in place, which includes an assessment of the potential compatibility of a prospective resident with the existing group, as well as assessing their needs, identifying the individual’s wishes and arranging pre-admission visits. Where the needs of the prospective resident can be met, the assessment leads to an individual transition plan for the resident’s move to the home, including visits and overnight stays. The manager undertakes the assessments herself and said she had received training on undertaking assessments. The assessment formats were examined for one resident and included consultation with the resident and their family as well as with relevant professionals. The pre-admission process was applied flexibly to assist one resident to make the move from their previous placement with the minimum of upset. This included staff from the home visiting and working with the individual at their previous home to get to know them and develop trust, before they came for visits to The Haven. The resident’s parents also visited the home during the assessment period. The assessment included reference to cultural origin and spiritual needs as well as support and healthcare needs, and the preferences of the individual. Residents have a copy of the terms and conditions, which have recently been reviewed and are now in a format that includes pictorial elements to make them more user-friendly when being explained to them. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. The needs and individual preferences of residents are increasingly reflected in the new Person Centred Plans, which have led to residents having a greater input into their care plan. Improved communication with residents has also enabled them to have more say in daily decision making. Risk assessments have improved, and better staff awareness of these has enabled a broader range of life experiences to be available to residents. EVIDENCE: Each resident has a case record comprised of a number of separate files, including various care plan formats. Person Centred Care Plans (PCP’s) had been introduced, though some older formats were still present within current files, which could lead to some confusion. A sample of three residents files were examined in the course of this inspection. Each resident has a Person Centred Plan (PCP) in place, which has been devised with a view to improving accessibility to the resident, through the The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 12 use of numerous photographs, and other visual elements. One PCP file in particular demonstrated the resident’s enjoyment of a range of activities through photographs of her engaged in these pursuits. The PCP’s also included evidence that cultural and spiritual needs are addressed, identified the first language of a resident, where this was not English, and also identified the key people in the residents life. One resident’s PCP still needed additional visual elements to support the written information to improve its accessibility. PCP’s included lists of residents likes and dislikes, though in one case two lists were present, one of which was more extensive than the other. The relevant items need to be clarified. The care plans include individual guidelines for supporting the resident with a range of activities and tasks, clarifying the support desired, in detail. They also include the setting and subsequent review of specific goals to focus staff on supporting residents to develop their skills in identified areas. For example the goal for one individual was to be able to make herself a hot drink. The goal was risk assessed and specialist equipment was obtained, in the form of a kettle tipper to manage the risk elements of the process. Plans also included details regarding the preferred communication methods of each individual, including a “We think this means” record, where individuals are unable to communicate verbally. Work is also being done to develop individual communication skills. There is a system of written monthly review and reporting by the keyworker, detailing individuals’ progress on their goals, and any other relevant issues relating to their needs, and periodic formal reviews also take place, to which other relevant parties are invited. It was noted that not all documents within care records were signed or fully dated, which made it hard to be sure of the order of events in some cases. All records should be signed and dated to enable their place in the life history of the resident to be clear. The care plans had improved with the introduction of the PCP format and this was also identified in a quality monitoring review by the commissioning local authority in September 2007. The manager said that the opportunities for residents to make choices and express their preferences had been improved with the introduction of the Person Centred Care Plans, the use of more pictures and other methods to enhance communication, and the associated training provided to the staff. She said that residents had been consulted and involved in choosing the colour scheme, furniture etc. during the recent refurbishment of the home, and two of the residents confirmed this had been the case. One added that she had chosen to go to a cookery course at college and chose how she wanted to spend her time in general. Residents were offered choices regarding drinks, food, where they wanted to eat lunch and in other aspects of daily life, during the inspection, and from their reactions, this appeared to be the norm. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 13 Observation of the interactions between care staff and residents during the inspection indicated a positive relationship and a focus on encouraging residents to do what they can for themselves, with support provided as and when required. Two of the residents attend a local self-advocacy group called “My Life, My Choice”. Risk assessments had been reviewed since the last inspection. A range of individual risk assessments were present on each of the files examined, which made reference to how to address the risk in question to enable the activity etc. to take place. Staff had signed to confirm they had read the risk assessments. In response to risk assessment, since the last inspection, alternative arrangements had been made in terms of the availability of trampolining to one resident, via a local sports centre, though that individual had since moved from the home. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. Residents have had access to more activities within the home and the local community, which has provided a more fulfilling lifestyle, reflecting their individual diversity and interests to a greater degree. Contact between residents and their families and friends is encouraged and supported where possible to maximise residents’ wellbeing. Residents’ involvement in daily routines has improved and their rights are respected through greater opportunities for decision-making and choice with regard to their daily lives and their environment. They are offered a varied diet, which meets individual specialist needs and cultural wishes. Involvement in menu planning and making choices is being encouraged through the use of an improved range of communication tools, in order to maximise self-determination, though opportunities for involvement in meal preparation are currently limited for wheelchair-users. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 15 EVIDENCE: The range of activities available to residents has been improved since the last inspection, especially those provided by the care staff, and this was confirmed by the last Quality Monitoring review by the commissioning local authority. The manager stated that each individual now has a structured planned activity programme. However, the reduced staffing levels due to maternity leave and sickness have impacted on the availability of activities and access to the community at times, in the last six months. External activities support workers (ASW’s), provide some planned activities and time out in the community for residents. One resident attends a cookery course at college one day per week and the manager plans to explore possible college courses for others. During the inspection two residents were out with ASW’s on planned activities during the morning and one resident attended her cookery course, and all returned around lunchtime. The home has a wheelchair-adapted vehicle to ensure that all of the residents can access the community. The activities and community facilities accessed includes a local sports centre “Oxrad”, which includes a gym, swimming pool, Jacuzzi, sensory room and a bar which some of the residents also enjoy. Residents also attend “Spice Drum Club”, an intensive interaction music workshop, and the “Spice Sensory group”. Individuals may go on shopping skills trips, and have visited the theatre as well as enjoying meals out. As already noted, two residents attend a self-advocacy women’s group. One resident demonstrated an interest in the birds in the garden, which has led to her joining the RSPB and helping put up a bird feeding station in the garden, within view of the conservatory. She takes responsibility for replenishing the food as required. Access to the majority of these activities is appropriately funded from fees, though residents do pay a reasonable contribution to some activities and expenses. All staff costs are met from the home’s budget according to the manager. Individual risk assessments were on file where necessary for the various activities. From care plans it was also evident that individual goals were now being agreed with residents to develop their social and practical skills, which may lead to new educational and social opportunities. Four of the residents have annual holidays. One resident has a series of days out instead at present, though there are plans to try another overnight stay in the future as part of care plan goal to work towards full holidays, according to the manager. There are also plans for another resident to build up to having an overseas holiday. As noted earlier, residents’ cultural and spiritual needs are recorded together with their individual preferences with regard to social and community activities, The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 16 and each has a social diary record of planned activities on file, which are now supplemented by more ad hoc activities and outings led by the staff. From photos in the PCP care plans, discussion with the manager and staff and with some of the residents, it was evident that the cultural needs of residents of different faiths were supported and provided for. Opportunities are provided for attendance at appropriate community events and festivals, traditional costume and family contact are supported and encouraged. Support to attend places of worship is available if desired. One resident chooses to attend church. Links with family and friends are encouraged and supported where possible, though individuals’ level of family contact varies from no contact up to weekly visits and various levels of telephone contact. There was telephone contact with the relatives of two residents during the inspection. An ex member of staff was recently found to be related to one resident who has no other family involved, and is now visiting her regularly. Residents’ next of kin are invited to their reviews, though not all of them attend, and two relatives were invited and had Christmas dinner with residents at the home. One resident also has an independent advocate. Residents are reported to be encouraged to take some part in daily routines such as shopping, meal preparation and tidying their bedroom. They are also encouraged to do more of what they can for themselves to support their independence and dignity. Each resident has a single bedroom, which is personalised, and residents were consulted about their preferred colour scheme when they were recently redecorated. The manager reported that the locks on individual bedroom doors had now been changed to a more appropriate type since the last inspection after concerns had been raised about the previous design. Staff were seen to knock on bedroom doors before going into the room. They were also observed to interact appropriately and respectfully with residents to promote their dignity. The design of the building mostly supports the dignity of residents through the provision of appropriate specialist hoist equipment and a ramp to the garden, to meet the needs of the two wheelchair using residents alongside those of the others. The home’s adapted vehicle also addresses this need. However the needs of wheelchair users are not addressed in the kitchen. The menus provided take account of the dietary needs of residents of different faiths, and offer a varied diet. Soft diets are provided for two residents. One resident had copies of recipes for favourite meals in her PCP care plan and is encouraged to be involved in some meal preparation and baking, since cooking is one of her particular interests. Staff confirmed that the opportunity for involvement of the two wheelchairusing residents in meal preparation is limited at present, by the absence of an area of lowered worktop space in the kitchen. (A requirement is made later under Standard 24 and Regulation 23.) The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 17 The manager indicated that the kitchen refurbishment was due to start in January, but it was not possible to confirm this with the provider during the inspection, nor whether the plans included an area of lowered worktop. The provision of a small hob within the lowered worktop, subject to appropriate risk assessment, might further enhance the developmental opportunities for the two wheelchair-using residents. Pictorial menus are being developed to support improved choice and involvement in menu planning for those residents who are unable to verbalise their preferences. The manager stated that individual practical support for the development of shopping skills was also part of the goal setting in one resident’s care plan, though all take part in food shopping in turn. The conservatory is used both as the dining room and for art and craft sessions, and has been provided with blinds and radiator heating to try to ensure an appropriate temperature throughout the year. Although residents are encouraged to eat main meals together as a group, there did not appear to be sufficient room around the table for everyone to eat together, given that two residents use specialist wheelchairs, and that some of the residents require staff to be sat next to them to provide support. This was confirmed to be the case by staff though it is difficult to see how it might be remedied within the constraints of the existing building. It was noted that one wheelchair-user was supported to eat her meal in the lounge and reported that the resident’s specialist wheelchair does not fit under the dining table. Residents are encouraged to eat independently wherever possible, but observation indicated that any necessary support was provided by staff, and adapted crockery etc. was also available to support independence. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 18 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): Standards 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. Residents now receive support from staff on a more individualised basis, informed by care plans that contain more detail about the resident’s wishes and preferences, as well as their needs. Staff work with them towards agreed goals, to develop their skills and enhance their quality of life and level of independence. The new Health Action Plans enable the individual healthcare needs of residents to be more effectively monitored and met by the staff. Though none of the residents is able to manage their own medication, the home has an appropriate system to do this on their behalf, and staff have all received relevant training in this area. EVIDENCE: As already noted, staff were observed to engage positively with residents and to enable and support them as necessary, during the inspection. The new PCP care plans give staff more information regarding individuals’ needs and preferences to enable them to adopt a more individualised approach, including The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 19 lists of likes and dislikes, as well as identifying goals for staff to support individuals to work towards. It was positive to see the attention to detail where staff had supported residents with coordinated clothes, jewellery, nail varnish etc. to maximise their individuality and dignity. Two residents have overhead tracking hoists provided between their bedroom and their bathroom, to enable staff to support and transfer them safely and each has a ground floor bedroom and full access to the ground floor, although as also noted above, their needs as wheelchair users are not yet addressed in the kitchen. Suitable adapted crockery is available to support independence and a cradle-kettle has been obtained. Individual guidance is provided to staff on how to work effectively with residents in terms of approach, communication, working on agreed goals and managing certain behaviours, and this guidance is supported by an improved range of individual risk assessments. Details are also now present on residents’ preferred communication, together with possible interpretations of residents’ non-verbal cues. Staff have received training on “person centred planning”, “intensive interaction” and “total communication” as well as in other areas since the last inspection, to support improvements in care practice and recording. Most staff have also received training on managing behaviours which may challenge the service, though this training should also be provided to the two remaining staff as a priority so they also have these skill should the need arise. The manager and deputy are link workers for Oxfordshire with “Total Communication”, which provides an opportunity to discuss communication issues with workers across the region. A wider range of techniques are now used to supplement residents’ verbal communication in order to support residents to communicate their wishes and feelings more readily, and staff are developing their skills in this area. Each resident now has a health action plan, which includes records of healthcare appointments, weight-monitoring records etc. Records indicated recent appointments and regular checkups where appropriate. However, it was noted that some of the record sheets were full and in need of replacement. The home has links with appropriate external healthcare professionals, to support the healthcare of residents, and there have been improvements in how well advice and guidance has been actioned by staff. The home has an appropriate system for managing medication on behalf of residents, none of whom are felt able to manage this for themselves. The records provide the required audit trail of medication including records of medication received, when it is administered and of any returns. Copies of medication information sheets are now retained as well. A pharmacy inspection took place last year according to the manager but no report was ever provided. It was suggested that a copy of the report be provided as evidence of the outcome of this audit. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 20 All staff have received training about epilepsy, and specialist training on emergency medication, and a copy of the guidance on its use was present with the medication administration records. The manager indicated that the appropriateness of an alternative to the current emergency epilepsy medication was being explored for two residents to enhance their dignity. All staff have received updated medication training following medication errors since the last inspection. Staff have received both external training via distance learning and in-house assessment. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 21 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): Standards 22 and 23: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an appropriate complaints procedure in place though further development of the format would be beneficial to maximise its accessibility and effectiveness as a communication tool, to ensure that all residents can be supported to express their concerns. The manager addresses any complaints appropriately and has ensured that staff have attempted to explain the procedure to residents. The home has systems in place to protect residents from abuse, and reports concerns appropriately to external agencies. EVIDENCE: The home has an appropriate complaints procedure in place, the format of which had been further developed by the provider to include some symbols to support the text, but it remains a fairly complex document, which could be further simplified. The manager indicated she was considering the development of a more straightforward and accessible format, to support the explanation of the procedure to residents, by staff members. This would potentially also be a communication tool for use with a resident, when trying to explore what they are concerned about. It is suggested that this be discussed with the speech and language therapist. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 22 Three complaints were noted, one of which had been referred to the home for investigation by the Commission. From the records and discussion with the manager, these matters had been addressed appropriately. In conversation with the inspector, two of the residents said they would tell the home manager if they were unhappy about something. Two residents would be likely to require the support of an advocate or staff member to take up any complaint on their behalf, one of whom now has an ex staff member as an advocate who visits her regularly. Two of the residents also attend an external self-advocacy group, and residents could also speak to the provider’s representative about any concerns during Regulation 26 monitoring visits, or raise them in a residents’ meeting. The home has an appropriate procedure on safeguarding residents. The majority of staff received training on safeguarding vulnerable adults in July 2007, and the three remaining staff are scheduled to receive this training in February 2008. One POVA-related incident arose since the last inspection, which related to alleged events whilst a resident was at day services and did not involve staff at the home. The matter was properly reported by the home as a safeguarding issue and fully investigated. Day service provision has since been arranged with a different provider. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 23 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): Standards 24 and 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, clean and safe environment for residents and is well decorated in most areas, though adaptations are required in order to better meet the needs of wheelchair using residents. EVIDENCE: The home was attractively decorated with a large lounge leading to a small conservatory providing the dining facilities, which doubles up as an activities area, and a reasonably sized kitchen. New blinds had been fitted in the conservatory and some areas had also been re-carpeted. The dining table and chairs were also new and some other new furniture had been provided. The home has appropriate laundry facilities to meet the needs of residents, and standards of hygiene were good. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 24 The bedrooms were individualised and attractively decorated and the manager indicated that residents had chosen the colour scheme and bedding with support from staff. Some sensory equipment was also provided in bedrooms. One or two items of furniture within the bedrooms were in need of repair. The manager indicated that the handyman would address these on his next visit. As already noted two residents have ground floor bedrooms equipped with overhead tracking hoists between their bedroom and bathroom, one of whom has an en suite bathroom. Two of the residents indicated that they liked their bedrooms, and confirmed that they had chosen the colour scheme. The ground floor is mostly accessible to the two wheelchair using residents, but as noted previously, the absence of adapted kitchen facilities hinders the opportunities for their involvement in this area, and the dining facilities are not sufficient to accommodate all of the residents at one time together with the staff needed to provide support. Appropriate consideration must be given to the inclusion of an area of lowered or adjustable worktop, in the plans for the kitchen refurbishment, in order to provide for their needs. Staff confirmed that this would be beneficial. Prior consultation with an occupational therapist is recommended. Providing a small hob within the lowered worktop, subject to appropriate risk assessment, would further enhance the developmental opportunities for the two wheelchair-using residents. The manager indicated that the majority of the home had recently been refurbished leaving only the kitchen to be done, and this was due to be done in January, though the start date was not known. The home has a large garden including a patio area with outdoor furniture and a ramp down to a large area of lawn. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 25 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): Standards 32, 34 and 35: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by a stable and well-trained core staff team, who have the necessary skills to meet the needs of residents, and who have, more recently, had access to improved guidance and care plans to support this. The provider has an appropriate staff recruitment process, which offers protection to residents. EVIDENCE: The home has a stable and consistent core staff group, with only one person leaving in the previous year. The manager indicated that they had received a positive response from advertising this post and hoped to be able to appoint very soon. Two staff have also been on maternity leave, and sickness levels have also reportedly been high, over the last six months, leading to increased use of agency staff to cover, where existing staff cannot do so. However, the manager has tried to use a small number of known agency staff who are familiar with the home and residents, in order to maximise consistency and continuity of care, and this was borne out by examination of the rotas. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 26 The manager said that the provider also supports the use of regular, known agency staff, where necessary, by allowing them to access staff training courses, and providing individual supervision. The use of agency staff has begun to reduce more recently. All of the staff have attained NVQ Level 2, with two of them also having achieved Level 3, and a further one working towards this. One staff has been put forward for Level 4. So the team is well trained and qualified to meet the needs of the residents. As noted earlier in this report, improvements have been made in the quality of care plans, with the introduction of Person Centred Plans, and other guidance, which have provided staff with the information to provide a more individualised service and work towards identified individual goals. Observation of the interaction between staff and residents indicated warmth and positive interactions, including appropriate humour, and staff involved residents in general conversations. Staff appeared relaxed and worked calmly and effectively to provide support to all of the residents on an individualised basis, using a variety of approaches, according to individual guidelines. Two of the residents said they liked the staff and got on well with them, and the body language of some of the other residents also suggested this. The staff indicated that there was a positive team spirit and everyone works well together. It was apparent from staff meeting records that the manager addresses any issues that may arise in the team to ensure they are dealt with. Within the provider organisation, the staff had just won their “Top Team” award for the fourth time and certificates relating to this were posted in the entrance hall. The provider retains original recruitment records at head office, where they are subject to periodic inspection by an officer of CSCI. A recruitment checklist is provided to the home to evidence the recruitment process undertaken. One of these was examined and provided evidence of a thorough recruitment and selection process, including confirmation of an enhanced CRB check. Examination of the training records indicated that staff have access to a good range of core training supplemented by additional training in specialist areas as required. All of the staff had attended the majority of core training in either 2006 or 2007, and though three staff had not received training on safeguarding vulnerable adults, (one of whom had been on maternity leave), the manager stated that this was booked in February. Two staff still need to attend the behaviour management (NVCI) training, but as yet no date for this was available. Staff also confirmed that there was a good training programme available, and that they were also supported through regular staff meetings and supervision. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 27 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): Standards 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 run in the best interests of residents, by a qualified and experienced manager, who has worked to minimise the effect of staff shortages, on the outcomes for residents. Residents are consulted regularly about their care, though a more cohesive quality assurance and reporting process might provide useful feedback from a range of other sources in order to highlight possible areas for future service improvement. The home has systems in place which promote the health, safety and welfare of residents, though attention is required to the identified aspects to maximise their protection. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 28 EVIDENCE: The manager is appropriately experienced to run the home and has attained her NVQ Level 4 and Registered Manager’s Award. She attends ongoing training to maintain current knowledge. She has established a regular schedule of supervision for all staff as well as regular team meetings, and staff have access to a set of policies and procedures from the provider to guide their practice. The provider was reported to have established a new quality assurance department, who have reviewed the previous quality monitoring system. This took the form of a management audit process, undertaken by an independent person, leading to an action plan for the manager, but did not include surveying the views of residents and other interested parties. The manager indicated that some questionnaires had been sent to relatives previously, but only two replies had been received, one of which was seen on a resident’s case record file, dating from October 2007. However, as yet no regular survey cycle has been established, and therefore no summary report has been produced of the findings. The manager thought that external healthcare professionals were due to be surveyed next. The current Quality Assurance system as explained, might benefit from a more focused approach, which would enable the results of surveys of relevant parties to be collated into a summary report, and would also feed into the annual development planning for the unit. A business and service development plan for the year 2007 was present in the home, but not yet for 2008. Within the home, staff complete monthly service user reports in consultation with residents, to identify any issues and problems and identify individual wishes for activities etc. There are also monthly residents’ meetings, which are minuted. The provider undertakes regular monthly Regulation 26 monitoring visits and copies of the resulting reports are provided to the manager and filed in the unit, as required. The local Authority also undertake annual accreditation visits to the service, the most recent of which, notes improvement of the service over the past year, in many areas. The home is also subject to quarterly assessment visits as part of the provider’s “Top Teams” initiative, in which the home has achieved considerable success more recently. Examination of a sample of health and safety-related service certification indicates that the majority of these are up to date. However there was no evidence that the required annual safety testing of electrical appliances had been completed. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 29 Fire drills have been held regularly involving residents, and the alarm is tested weekly. The home has a fire risk assessment but it was last reviewed in November 2006 and is now overdue for another review. The manager must ensure that the fire risk assessment is reviewed promptly to ensure that fire safety is maximised, and that portable electrical appliances are tested with appropriate frequency. Copies of completed accident forms were present on individual case records. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 X The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23 Requirement The provider should ensure the needs of wheelchair users are addressed, during the upcoming refurbishment of the kitchen. The manager/provider must ensure that the unit fire risk assessment is reviewed at appropriate intervals and that portable electrical appliances are tested with appropriate frequency to protect residents. Timescale for action 08/04/08 2. YA42 13 & 23 08/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA1 YA6 Good Practice Recommendations The provider should make the new Service User guide in CD format, available to residents, and keep the format and content under regular review. The manager should review the contents of residents PCP and other case records, to reduce any duplication, address any conflicting information, and ensure that all documents are signed and dated, so that staff have a concise and upto-date record to which they can refer, detailing the needs DS0000013091.V348412.R01.S.doc Version 5.2 Page 32 The Haven 3. YA22 4. YA39 and wishes of the individual, and how they should be met. The provider/manager should consider the further development of the complaints procedure, to make it more accessible and supportive when exploring a resident’s concerns. The advice of a speech and language therapist might be beneficial. The provider should consider how to combine and develop the various elements of quality monitoring and quality assurance systems, to include obtaining feedback from a cross-section of interested parties, and produce a summary report of findings, which links with the business and service development planning cycle. The Haven DS0000013091.V348412.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email:inspection.southeast@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. 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