Care Home: Thistle Close (24, 30 & 33)

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What the care home does well Each person living at the home has a plan they are involved in making. Plans help staff know their preferences and their care needs and how to meet them. People living at the home make decisions in their daily lives and choose their own meals. They are enabled to take part in activities they like and to go out. Staff support people to keep in touch with their family. Relatives say they are made welcome in the home and staff inform them about important matters. Staff help people living at the home to stay in good health and have regular health care checks. They also manage their medicines safely on their behalf. Thistle Close provides a safe, comfortable home that is in a good place for local shops and pubs etc. It offers the people living there the opportunity to live in ordinary housing that is adapted and equipped to meet their physical needs.Staff are trained to help them keep the home and people living there safe. They work well as a team to provide individualised support to people living at the home. New staff are checked to ensure they are suitable to work in care. What has improved since the last inspection? Some parts of the home have been redecorated and have new furnishings and furniture, which makes the home look nicer and better for people living there. All staff attended training about people`s differing needs and how to treat them equally. They also had training to help them plan to meet the care needs and personal goals of people living at the home and how to deal with their concerns What the care home could do better: The home`s plan to help people living there make more person centred care & health plans would better ensure their personal goals are identified and met. Improvements still need to be made to the garden and some areas of the home so they look nicer and provide better facilities for the people living there. When more staff achieve a social care qualification and have more training relating to the specialist needs of people living at the home they should understand and know how to support them and so meet their needs better. The ways SCOPE check that the home is being run well should result in a plan showing how it will improve. This should help ensure the quality of the service is always developing, as people living there want it to and/or for their benefit. CARE HOME ADULTS 18-65 Thistle Close (24, 30 & 33) 24, 30 and 33 Thistle Close St Peter the Great Worcester Worcestershire WR5 3DP Lead Inspector Key Unannounced Inspection 5th February 2008 2.00- Thistle Close (24, 30 & 33) DS0000018693.V346041.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 Thistle Close (24, 30 & 33) DS0000018693.V346041.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. Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thistle Close (24, 30 & 33) Address 24, 30 and 33 Thistle Close St Peter the Great Worcester Worcestershire WR5 3DP 01905 611147 01905 612958 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.scope.org.uk SCOPE Mr Andrew Joseph Deakin Care Home 6 Category(ies) of Physical disability (6) registration, with number of places Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The Home may accommodate no more than 1 resident in 24 Thistle Close, 3 residents in 30 Thistle Close, 2 residents in 33 Thistle Close The Home is primarily for people with physical disabilities but may also accommodate people with associated learning disabilities. The home can accommodate one named person in the category PD/E 24th October 2006 Date of last inspection Brief Description of the Service: This home at Thistle Close is run by SCOPE and is part of a scheme called 1st Key Worcestershire, which was set up in 1993. 1st Key’s office is at Unit 3 Lowesmoor Wharf, Lowesmoor, Worcester, WR1 2RS, (Tel no. 01905 611147) and the registered manager of the service (Mr Andrew Deakin) is based there. The stated aim of 1st key is to provide a community based service with a range of living options for people with cerebral palsy and other associated disabilities and to empower them to lead their own lifestyle. 1st Key runs nine properties, eight in Worcester and one in Tenbury Wells, which together support seventeen people. Thistle Close provides accommodation with personal care for six adults. The home is about two miles from Worcester city centre in easy reach of the M5 motorway and in a good place for local shops and pubs etc. Thistle Close is a cul-de-sac on a large, modern housing estate. The home is three ordinary bungalows next to each other that have been adapted and equipped for people with mobility difficulties. There are ramps, wide hall and doorways, hoists and assisted shower facilities and bathrooms. Bungalow 30 accommodates three people, 33 two and 24 one person. Everyone has their own bedroom, none of which have en-suite facilities. The bedrooms are rather small for people with physical disabilities who may be wheelchair users. Bungalow 30 has a kitchen, dining/sitting area and a substantial conservatory providing extra living space. Bungalows 24 and 33 both have separate kitchens and a sitting/dining room. Information about the home is provided in a statement of purpose and service users’ guide, which are available at the home and through SCOPE. The fee for the service varies depending on the assessed needs of individual service users, as agreed between SCOPE and their funding authorities. Items not covered by their charge include private chiropody, newspapers & magazines, hairdressing, personal telephone calls & travel and other personal items. Fee levels and any additional costs should be specified and agreed in each person’s contract. Thistle Close (24, 30 & 33) DS0000018693.V346041.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 is a key inspection of Thistle Close and so all the Standards that can be most important to people living at care homes have been assessed. This visit was made without telling staff or anyone who lives at the home beforehand. Time was spent talking with three people living at the home about their care and lifestyles. One care worker was asked about the service, their role, training and support. The way the home is being run and any changes since the last inspection were discussed with the service manager. Surveys were left at the home for staff and people living there asking for their views of the home. Six surveys were also sent to their relatives and health & social care professionals involved with their care. The feedback received is referred to in this report. An AQAA (Annual Quality Assurance Assessment) was completed before this visit, as now required. This asks managers to say what they think their home does well and could do better, what has improved in the last year and their plans to improve the service. It includes information about people living there, staff and other aspects of the home. Various records kept by the home were looked at and two of the bungalows visited. All other information received by the Commission about the home since the last inspection was also considered. What the service does well: Each person living at the home has a plan they are involved in making. Plans help staff know their preferences and their care needs and how to meet them. People living at the home make decisions in their daily lives and choose their own meals. They are enabled to take part in activities they like and to go out. Staff support people to keep in touch with their family. Relatives say they are made welcome in the home and staff inform them about important matters. Staff help people living at the home to stay in good health and have regular health care checks. They also manage their medicines safely on their behalf. Thistle Close provides a safe, comfortable home that is in a good place for local shops and pubs etc. It offers the people living there the opportunity to live in ordinary housing that is adapted and equipped to meet their physical needs. Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 6 Staff are trained to help them keep the home and people living there safe. They work well as a team to provide individualised support to people living at the home. New staff are checked to ensure they are suitable to work in care. 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 be made available in other formats on request. Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 7 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 Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 8 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 this visit to the service. Good assessment procedures are in place that should help to ensure the home would be able to suitably meet the needs of prospective service users. EVIDENCE: Required information documents are available for Thistle Close, which include its statement of purpose and a service users’ guide. SCOPE provides written guidance for when referrals are made for a placement at their care services. This covers an assessment made of prospective service users’ needs, a care profile tool that has to be completed and a placement procedure flow chart. No one had moved into this home for a few years but the manager reaffirmed the assessment and admission processes they would follow for a prospective service user. Having first received a copy of their community care assessment from their funding authority he would visit them to assess their needs and give them information about the home. Introductory visits to the home would then be arranged, such as for tea and overnight, so that they could meet staff and the current residents. This to be followed by a three-month trial stay. Review meetings would be held after their trial stay with all relevant people involved. Views of staff, people living at the home and their compatibility would also be considered before the placement confirmed and fee and support levels agreed. Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. Each person living at the home has a plan that shows their needs and support needed to meet them. Risk assessments are also carried out to minimise risks to their safety. Whilst they can make choices in their daily lives and routines if plans focused more on their personal goals they could be better supported to achieve their identified goals as part of developing an independent lifestyle. EVIDENCE: Two care records of the people living at the home were looked at and care planning was discussed during this visit. Records include their photograph, background details, a pen picture, a communication and financial assessment. Staff also complete a daily communication book for each person showing any personal support they receive, their mood, activities, events and visits etc, which provide helpful information about their wellbeing and daily lives. Everyone has a care plan covering relevant areas of need i.e. physical and health, activities of daily living, communication, social, emotional wellbeing and relationships, with objectives and action needed to meet them. Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 10 Every area of need in the plans should include individuals’ goals and views. However this information is not very detailed for example one person’s states their goal is to develop more social activities and activities outside the home but does not describe how this could be achieved. Whilst the home has a “person centred” approach (i.e. people living there are involved in planning their own care and can make choices) it is now expected there should be more focus on identifying and meeting their personal goals and developing their life skills to promote more independent lifestyles. Staff recently received training on person centred planning (PCP) and it is good therefore that one of the home’s stated plans is to introduce more PC plans with people living at the home and to offer to help them set up life books and health action plans. Keyworkers from the staff team are allocated to each person at the home. They try to spend individual time to get to know them and their likes/dislikes well and to support them to plan and review their own care. It is intended keyworkers complete monthly outcome reports in consultation with people allocated to them to show any progress, changes etc. However reports had not been completed for months, due to staff shortages. In view that the role of keyworkers is important in PCP (and their input is clearly valued by people living in the home) it should be ensured they do have sufficient time available to spend individually to monitor plans and outcomes. SCOPE specifies that plans must be reviewed and updated at least six monthly by their services. Annual service reviews are held with funding authorities to review placements and contract terms. Families and relevant others are also invited to attend these review meetings with home staff and the people living at the home. Risk assessments are carried out to minimise safety hazards within the home environment and community and to show the support people need with such as their personal care and finances. Each person has a moving & handling risk assessment, with guidance to support staff about how to support them using aids and equipment. One person has a specific management plan in place in respect of their behaviours to help staff know how to deal with them consistently and minimise risks to others. Progress reports should also be kept by staff in respect of these behaviour management strategies. People living at the home clearly can make decisions about their lifestyle and choose daily routines. Although some choices are limited due to the nature of their disability (and so dependence on staff assistance) or safety risks. In these situations agreements are made with those involved (e.g. time to go to bed) and about restrictions placed on them, so staff can meet their choices to the extent feasible and keep them safe. Such agreements should be recorded and any informed consent issues considered. Regarding issues of equality & diversity the home’s philosophy focuses on meeting individual needs and such as same gender care and needs due to physical disabilities are met. These principles are covered in the staff induction programme & diversity workshop all attended. Their knowledge and skills could also increase with more training in specialist areas e.g. mental health & for managing challenging behaviours. Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 11 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 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. People living at the home are enabled to take part in activities they enjoy and to mix within the community and maintain links with their families and friends. Staff respect their individuality and encourage them to develop their life skills. Everyone chooses their own meals whilst staff aim to promote healthier eating and monitor special diets. Mealtimes are flexible with support given as needed. EVIDENCE: Everyone living at the home has a support package to facilitate their chosen activities, outings and holidays that include funding and support needed. Two people attend life skills sessions at college and one a course run by Worcester Lifestyles. Other activities include swimming, going shopping and to pubs and occasional individual outings with their keyworkers. Staff provide most of the support to enable activities and the home deploys a driver/enabler who has a varying amount of planned time for each person. People who like to go out in the local community are well known and integrated. The home has two suitable vehicles and one person has their own car to provide transport further afield. Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 12 Keyworkers help people identify and access activities they might like to take part in and places they want to visit or go on holiday. One person has a life skills timetable and had completed a first aid course recently. Everyone is also supported to go out to undertake their personal & food shopping and banking weekly. Due to their disabilities their involvement in cooking and household tasks is limited, although staff encourage their independence and respect their choices as far as possible. Plans could still include more information about individuals’ assessed social needs and interests. Some people do not participate in specific activities at home or in the community and whilst this may be their choice their records should show how they spend their time and how staff suggest meaningful activities and offer support. It is good that the home’s AQAA does state however that in the last year they have found more courses and different activities and developed more positive relationships with neighbours. Furthermore it is planned to build on improving people’s existing independent skills and seek more activities and social events out of the home. Staff understand and carry out their role in supporting people who live at the home to maintain links with their family and friends. They can use the home telephone in private and some have their own telephone. One person has regular holidays with their relative and these and regular visits to families are enabled. Relatives confirm they are kept informed about any important events and are invited to attend their annual care reviews. They are made welcome in the home and invited for special occasions and socials etc. The home also supports people to access an advocacy services if they need or want to. Regarding food provision each person has their own housekeeping money and staff support them to shop locally or help them make a list to purchase their food individually. People living there confirm they choose their meals and their preferred mealtimes and staff also make them drinks and snacks on request. The three people living at bungalow 30 usually choose to have their main meal together and everyone has a roast on Sundays. Staff give guidance to promote healthier eating and encourage them to buy fresh vegetables & fruit, yoghurts, wholemeal bread etc. Menus are not drawn up and an individual food record is kept of meals taken. One person is being supported with their special diet and staff had appropriately involved a nutritionist who is monitoring their progress and weight. The mealtime seen was relaxed with staff providing assistance as and when needed in a respectful, unobtrusive way and cooking what everyone wanted. As it was Shrove Tuesday pancakes were also made and residents of all three bungalows had been invited to no. 30 to enjoy them together. Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. People living at the home are supported to meet their personal and health care needs and their medicines are managed safely in the home by trained staff. EVIDENCE: Care records of people living at the home include a plan and checklist of their personal care needs showing any support they require, and have received, to maintain good personal hygiene and manage their medication. Staff also aim to encourage them to retain as much independence as they can and follow their preferred routines whenever possible. The home recognises and deals with diverse needs appropriately, for example one person requires support from the same gender support workers and rotas are arranged accordingly. There is information available about everyone’s medical history, health issues and medication. Keyworkers make sure they have annual health checks and medication reviews. They also support them by arranging routine health care related checks e.g. dentist and chiropodist and they can attend appointments with staff of their choice, when this is feasible. Records are kept of all visits to GPs and health professionals with outcomes, also of accidents or incidents. Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 14 It is good the home plans to introduce and set up Health Action Plans (HAPs), as recommended by the Department of Health. HAPS aim to involve people as much as possible in managing their own health and in promoting a healthier lifestyle. They should include targets, actions needed and outcomes and so should provide a comprehensive picture of all their health care needs and goals and include all preventative, routine and specialist input sought and obtained. Some people living at the home have health related difficulties in addition to their physical disabilities. Whilst the manager and staff are aware of problems that can result (and have consulted relevant health care specialists) the staff team understanding and knowledge to deal with them should improve if they have more opportunities for training in specialist areas; in particular mental health and for the management of challenging behaviours. Medication prescribed for people living at the home is safely stored in locked drawers in their bedrooms and there is a lockable box for medicines needing to be kept in the fridge. 1st Key provides procedures for medicines management and there are also copies available of the general SCOPE policy and the Royal Pharmaceutical Society guidelines for medicines in care homes. Records of medicines administered were found to being maintained appropriately. New staff receive instruction on medicines during their induction. They also attend accredited training from an external trainer before being allowed to administer. Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. People living at the home are enabled to express their views and concerns and procedures are in place to manage complaints about the service appropriately. The welfare and safety of people living there are promoted for their protection. EVIDENCE: SCOPE provides a written complaints procedure and also employs a Complaints Resolution Officer to deal with complaints outside of the home when necessary. It is good that SCOPE plans to provide these procedures in a DVD for staff and service users. People living at the home and one of their relatives confirm that they know about the complaints procedure and who to contact and say that concerns they have raised have been responded to appropriately. All staff had recently attended a training session relating to complaints. People living at the home are also encouraged and supported to express their views and make choices through individual sessions with their keyworkers and house meetings. There are protection policies in place covering abuse and whistle blowing that appropriately refer to Worcestershire’s multi-agency procedures for Protection of Vulnerable Adults (POVA). The team leader for 1st Key is the home’s designated Adult Protection advisor and although staff have received relevant protection training the manager plans to arrange refreshers soon. Several issues affecting the safety and welfare of people living at the home had been notified to the Commission and referred under POVA procedures since the last inspection. It is confirmed the home continues to take appropriate action to manage this situation to protect people living at the home as well as staff. Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 16 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including this visit to the service. People living at Thistle Close benefit from ordinary, comfortable housing within the community, which is suitably adapted and equipped to meet their needs. Some aspects of the accommodation and gardens still need improvement to make the home look tidier, nicer and to provide updated and better facilities. EVIDENCE: Thistle Close is a cul-de-sac located on a large and modern residential housing estate. It is about two miles from Worcester city centre and within easy reach of the M5 motorway. There are shops, public houses and a superstore with a café nearby and the home also has two adapted vehicles to provide transport for people living there. The properties are owned by a social landlord (Branford Housing Association) and are leased to SCOPE. This Housing Association has responsibility for some aspects of the fabric of the premises and maintenance. The home comprises of three ordinary bungalows next to each other. They are adapted for people with physical disabilities and/or wheelchair users and so Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 17 have ramps, rails, wide doorways & corridors and other aids such as bath and hoists as well as an emergency call bell system. Two of the bungalows have a separate kitchen, sitting and dining rooms that provide sufficient and suitable communal space for their three residents. The other bungalow has a kitchen, dining and sitting area in one room with a brick conservatory built on providing additional space for the three people living there to sit in and watch television. Bedrooms all have a wash hand basin, although none have en-suite facilities. They provide less space than 12sq metres, as is now specified in the Standards for wheelchair users. Whilst people living at the home currently have accepted this space, bedroom sizes would have to be considered if any vacancies occur in future to make sure the room available is appropriate to meet prospective service users’ needs. The home would be expected to arrange an Occupational Therapy assessment to obtain confirmation the environment is suitable and the home’s information documents guide should also specify the size of bedrooms. Some improvement has been made in respect of the décor and furnishings in bungalows 30 & 33 since the last inspection. However progress has been slow to follow the home’s upgrading programme and timescales have again slipped. In particular the gardens are untidy with uneven paths, kitchens are shabby and need updating and more storage space is needed. One person living there also says their bathroom needs upgrading. Whilst acknowledging that funding is an issue staff have done some of the decorating, which is not ideal especially in view of ongoing staff shortages. In addition the kitchen area in bungalow 30 is rather cluttered and the overall impression is rather untidy and “lived in”. The manager recognises the need to prioritise and budget for environmental improvements and SCOPE should support this. A quotation has been accepted to start work on the gardens and erect a shed for storage and the sooner that other areas can be upgraded the better for people living there. Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 18 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 & 35 Quality in this outcome area is good overall. This judgement has been made using available evidence including this visit to the service. People living at the home are supported by sufficient and committed staff who work together to provide individualised support. Although staff receive training to help keep them safe their skills and knowledge should improve when more of the team have achieved a care qualification and complete training in relation to their special needs. Thorough recruitment procedures are in place to help ensure that only suitable staff work at the home to protect people living there. EVIDENCE: The home employs eight support workers (including a senior), three relief and a driver/enabler. It is confirmed there are always at least three staff deployed throughout the day and evening with one person sleeping in on call at night. Staff cover during evenings was increased during last year to provide more supervision for people living at the home. Staffing levels would normally be sufficient but due to this and staff absences relief staff are deployed routinely to cover the home. Whilst relief staff know the home and people living there well this has an impact on time available to permanent staff for such as their keyworker role, giving individual support and reviewing plans. The senior has also had less time to provide formal staff supervision. It is good therefore that the staffing situation is settling down, but SCOPE should keep it under review. Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 19 There had not been any new staff appointed since the last inspection. The manager reaffirmed however that SCOPE never allow new staff to start work at their services until they have obtained a satisfactory CRB/POVA check and two written references. The AQAA further states they obtain a full employment history and health declaration as part of applications. All new staff must then undertake a six-month probationary period, during which time they complete the comprehensive SCOPE accredited induction programme. This is followed by an appraisal, before an appointment is confirmed. It is good that people living at the home would be involved in selection and on the interview panel. The expectation of SCOPE is that support staff undertake all the mandatory health & safety training and work towards achieving an NVQ qualification in social care. Currently only 2 permanent and one relief staff had achieved NVQ and progress towards more staff completing this training should continue. Whilst it is good that staff have completed some training in the last year on diversity, complaints and PC planning the plan to carry out a training needs assessment of the whole staff team and to provide more equality & diversity, adult protection and training relating to specialist needs should be actioned. It is evident that the staff team are well motivated and work together for the benefit of people living at the home. Reports on the conduct of the home and staff reflect however that staff shortages had affected the frequency of staff meetings and individual supervision, which clearly can impact on staff morale and so could affect team effectiveness. Management need therefore to also keep staff support under review and to make sure that staff feel valued. Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 20 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 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. The home is run well overall and provides good individualised support to the people living there. There are systems in place to monitor and review service quality, which should result in a plan for the home to keep improving as people living wish and/or for their benefit. Policies, procedures & working practices help to promote the welfare and safety of people who live and work there. EVIDENCE: The registered manager is Mr Andrew Deakin who is suitably experienced and qualified. Mr Deakin is community service manager for 1st key Worcestershire and management arrangements for this service are unusual as he is based at the 1st Key office and so does not run the home day-to-day. He is responsible for 1st key’s business plan, finance, service performance and its policies & procedures. A team manager (also not based at the home) is responsible for Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 21 monitoring service delivery and quality at 1st Key homes and a senior support worker manages the home’s staff team, the care needs of people living at the home and records. Whilst the manager does not spend dedicated time at the home at the home he attends staff meetings and care reviews and is available on call. The team manager visits at least weekly and covers when necessary. SCOPE have implemented a formal system to monitor, review and assure the quality of their services. Part of this process is the required monthly visits from a representative of the organisation to check the conduct of homes and report on this. It is good that these visits now result in more detailed reports and highlight action points based on audits and discussions with staff and people living at the home. Annual surveys are also sent to people living at the home and to their relatives and advocates asking for their views of the service. Feedback from these should be analysed and with the monthly action plans result in an annual development plan for the home that reflects what people living there want and would improve the service for them. The home’s AQAA should provide more evidence of what the service does well and their plans to improve and the manager needs to refer to the Commission guidance called KLORA. SCOPE should also ensure all their policies & procedures are regularly updated so they are in line with current guidelines and legislation (many were last reviewed in 2003/4). Regarding health & safety staff training is arranged in all the mandatory areas including first aid, fire safety, food hygiene, moving & handling and infection control. The AQAA also confirmed the following:• • • • • The fire safety system and equipment are serviced & tested regularly. Portable electrical appliances are tested. The heating and gas installations are serviced regularly. There are COSHH and relevant risk assessments in place/carried out. The water system was checked for Legionella in 2007. There were no safety hazards identified in the environment during the visit. Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 22 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 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 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 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 23 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 persons meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the registered provider to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations The home’s plan to support people living at the home to draw up more person centred care and health action plans should be implemented. This would help to identify their personal goals and action needed to achieve them. The home’s programme to upgrade the accommodation should continue to be actioned. This would improve the quality of some aspects of the environment and provide updated and better facilities for people living at the home. More care staff should achieve an NVQ qualification in social care to enhance the knowledge and skills of the staff team. Opportunities for staff to undertake training relating to the special needs of people living at the home should be sought so they should be better able to understand and know how to meet their needs. The home should produce a plan that reflects the continual development of the service. Improvements planned should reflect the views of people using the service (and significant other people) and/or be for their benefit. 2 YA24 3 4 YA32 YA32 5 YA39 Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Thistle Close (24, 30 & 33) DS0000018693.V346041.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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