Care Home: Tullyboy Homes

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What the care home does well The five people who live at 2 Inlands Close moved in together when the home opened in 1993. Nobody else has moved in since then. Staff members said that the people who live at the home generally got on well together. The staff team know the people who they support very well. Individual plans have been written, which provide a lot of information about people`s needs, preferences and different backgrounds. This helps to ensure that the people who live at the home receive consistent support and have their needs met. People who live at the home receive good support with their health care. Advice is sought from outside professionals, which helps to ensure that people`s individual care needs are met. Detailed records are kept, which means that good information is available when people`s needs are reviewed. People who live at the home have well established routines and they receive support with being part of the local community. The home is in a residential setting and its location means that people can experience life in the village, and make use of its shops and facilities. People have the opportunity to participate in other activities, such as attending music and sporting events, which take place in the wider community. On the day we visited, one person went out with a staff member to see a newly released film. Routines in the home are flexible to fit in with people`s activities and needs. People received good support during the meal that we observed, and were offered choices about what to eat. We saw that the accommodation was meeting people`s needs and providing a good mix of communal and private space. The house and the garden looked well maintained. People at the home are supported by competent staff who are developing their individual skills. Mrs Howie is an experienced manager who is closely involved in all aspects of the home. Systems have been established for monitoring the service that people receive, so that they benefit from a well run home. What has improved since the last inspection? `Lifestyle Plans` are now being completed with the people who live at the home. This is a new development, which will help the home to focus on people`s wants and be more creative in looking at what can be provided. The availability of some local authority run day services has reduced and the home has arranged more external activities to compensate for this. There was a weekly plan, which helped to ensure that people had equal access to activities and to staff support. The home has continued to seek the involvement of outside professionals, such as an occupational therapist, so that people`s specialist needs are met. Some new training events in subjects such as abuse prevention and restraint have been provided for staff. This will help to ensure that the people are safe and are supported in a consistent way by staff members. CARE HOME ADULTS 18-65 Tullyboy Homes 2 Inlands Close Pewsey Wiltshire SN9 5HD Lead Inspector Malcolm Kippax Unannounced Inspection 27th August 2008 10:15 Tullyboy Homes DS0000028632.V369676.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 Tullyboy Homes DS0000028632.V369676.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. Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tullyboy Homes Address 2 Inlands Close Pewsey Wiltshire SN9 5HD 01672 562124 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) Tullyboy Homes Mrs Catherine Howie Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th September 2006 Brief Description of the Service: Tullyboy Homes operates two care homes in Wiltshire, one of which is at 2 Inlands Close in the village of Pewsey. The home is in a residential area and is close to the main shops and village centre. 2 Inlands Close opened in 1993 and is managed by Mrs Catherine Howie, one the owners of Tullyboy Homes. Each person who lives at the home has their own bedroom. Four bedrooms are on the ground floor. One person has a bedroom on the first floor, where there is also a room that is used as an office and by staff who sleep-in overnight. The other bedrooms are on the ground floor. There is a main communal room that is used as a lounge and dining area. A conservatory provides another area for recreation and for listening to music. People who live at the home receive support from a permanent staff team. Agency staff are also used on occasions. The fees range from £947 to £1172 per week. Additional charges are made for some services. Information about the service, and a copy of the last inspection report are available at the home. Inspection reports can also be seen on the Commission’s website at www.csci.org.uk. Tullyboy Homes DS0000028632.V369676.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 that people who use this service experience good quality outcomes. Initially we asked the home to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how well they were performing. It gave us information about what has happened during the last year, and about their plans for the future. We had also carried out an Annual Service Review (ASR) in June 2008, when we had reviewed what we knew about the home. As a result of the ASR it was decided that we did not need to change our inspection plan for the home. We looked at the AQAA and the other information that we have received about the home since the last inspection. This helped us to decide what we should focus on during an unannounced visit to the home, which took place on 27th August 2008. During this visit we met the five people who live at the home. Some people had very little verbal communication but were able to express themselves in other ways. We talked to staff members, examined some records and looked around the home. We made a second visit to the home in order to conclude the inspection with the manager, Mrs C. Howie, and to give feedback about what we had found. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. What the service does well: The five people who live at 2 Inlands Close moved in together when the home opened in 1993. Nobody else has moved in since then. Staff members said that the people who live at the home generally got on well together. The staff team know the people who they support very well. Individual plans have been written, which provide a lot of information about people’s needs, preferences and different backgrounds. This helps to ensure that the people who live at the home receive consistent support and have their needs met. People who live at the home receive good support with their health care. Advice is sought from outside professionals, which helps to ensure that people’s individual care needs are met. Detailed records are kept, which means that good information is available when people’s needs are reviewed. People who live at the home have well established routines and they receive support with being part of the local community. The home is in a residential Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 6 setting and its location means that people can experience life in the village, and make use of its shops and facilities. People have the opportunity to participate in other activities, such as attending music and sporting events, which take place in the wider community. On the day we visited, one person went out with a staff member to see a newly released film. Routines in the home are flexible to fit in with people’s activities and needs. People received good support during the meal that we observed, and were offered choices about what to eat. We saw that the accommodation was meeting people’s needs and providing a good mix of communal and private space. The house and the garden looked well maintained. People at the home are supported by competent staff who are developing their individual skills. Mrs Howie is an experienced manager who is closely involved in all aspects of the home. Systems have been established for monitoring the service that people receive, so that they benefit from a well run home. What has improved since the last inspection? What they could do better: Procedures were in place for the safe recruitment of staff, although records were not all available to show that people who live at the home were fully protected. This could have resulted in the Commission taking enforcement action to ensure that the home meets its statutory responsibilities. Following our visits we received confirmation from Mrs Howie that this matter had been addressed. The training that staff members receive should be developed further, to ensure that it reflects the changing needs of the people they support. This includes ensuring that all staff receive training in moving and handling. Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 7 People’s views are not well reflected in the home’s development plans. A policy on quality assurance should be produced, so that people can be confident that their views will be sought and reflected in the home’s plans. Written information about the home must include details of the arrangements for charging, and for paying for services that are not covered by the fees. This is so that it is clear what people who live at the home will have to pay for out of their own money. A risk assessment needs to be completed in respect of a first floor bedroom window, and action taken as indicated by the outcome of the assessment. We thought that people’s goals and their progress with achieving these could be more fully recorded in their individual plans. This would make it easier to assess the progress that people are making and there would be better guidance for staff about the support that they need to provide. We have also recommended that the content of the agency and relief staff file is reviewed, with the aim of including a wider range of information about the running of the home and its policies and procedures. This is so that staff will have more information readily at hand should they need to respond quickly to events or incidents involving the people who live at the home. 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. Tullyboy Homes DS0000028632.V369676.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 Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good overall. People who live at 2 Inlands Close have most of the information that they need about the home. However there is a lack of information about additional charges, which could mean that people have to pay for things that they were not expecting to. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Tullyboy Homes had produced a Statement of Purpose, which gave details of the services and facilities that were to be provided. Other information had been produced for the people who live at 2 Inlands Close. This included a Service User’s guide, which was available in a pictorial version to help people understand the contents. The information did not include details of those services and items that were not covered by the fees. For example, we were told that people pay out of their own money for podiatry, and for some of the meals that they have outside the home. Standard 2 was not assessed on this occasion. The current residents moved in together when the home opened in 1993 and there had been no changes in occupancy since then. However, we were given information in the AQAA about Tullyboy Homes’ pre-admission procedures and assessments. We were told Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 10 that the admission process had been used with three people at their other home, where it had proved to be successful. Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. People have individual plans, which provide good information about their needs, and their likes and dislikes. People receive support and assessments are undertaken, which help them to exercise choice and make decisions about their daily lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw files in the home that contained information about the individual needs of the people who live there. We looked in detail at the contents of three people’s files. Each person had a ‘Person Centred Care Plan’. The plans were divided into different sections, such as Communication, Activity, Social skills, Sexuality, Cultural needs, Mental capacity, Mobility, and Accommodation requirements. This helped to ensure that staff were aware of people’ diverse needs and the support that they required in different areas of their lives. The plans had been revised in recent months and amended to reflect changes in Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 12 people’s needs. They included a list of those people, including outside professionals, who had contributed to the contents. Some restrictions about what people in the home could do were recorded in the care plans. For example, a decision had been made that one person would not go out without staff support and that they would find some events difficult to attend. The reasons for this were recorded in their care plan. Review meetings were being held, when people’s future needs and wants were discussed. There was information recorded about some personal goals that people wanted to achieve. These included, for example being able to attend some new activities outside the home. We thought that the section on goals could be developed further, in order to show more details about the goals and the progress that people were making with achieving these. We also saw that ‘Lifestyle Plans’ were being completed with the people who live at the home. We were told in the AQAA that this was a new development, which would help the home to focus on people’s wants and to be more creative in looking at what can be provided. Risk assessments were being undertaken for a range of activities and tasks, such as using the stairs, and people’s mobility within the home. Some risk assessments were being cross-referenced to the care plans, although this was not being consistently done. Records were being maintained which showed the safety measures that needed to be in place. We talked to Mrs Howie about how the benefits to the person could also be recorded, as this would help ensure that the positive aspects of participating in an activity were always considered, as well as the hazards. During our visit we saw examples of how people who live at the home made decisions and choices in their daily lives. People were spending their time in different ways. One person had wanted to see a newly released film. They went to the cinema in the afternoon and received one to one support from a staff member with this. People were offered different types of sandwiches for lunch. During the meal there was a discussion about some local events that people might like to attend. Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. People participate in activities and have daily routines that reflect their needs and individual capabilities. People enjoy their meals and the meal arrangements are flexible to fit in with the day’s activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Plans were being made for the day when we arrived at the home. Some people were having a home-based day, with the opportunity to go out for a walk locally. The people who live at 2 Inlands Close also had a regular programme of activities outside the home. This included attending sessions at a local resource centre and visiting other facilities in the area, such as a specialist music therapy centre. The home had an eight seat people carrier that could be used for trips out. Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 14 We were told in the AQAA that the availability of some local authority run day services had reduced and the home had arranged more external activities to compensate for this. There was a weekly plan, which helped to ensure that people had equal access to activities and to staff support. It was also reported in the AQAA that the home would be seeking further opportunities for people to attend activities outside the home. The home was hoping to be able to provide more one to one support for one person who would benefit from going out more. We were told about the contact that people at the home had with their relatives. The details of family contacts were recorded in people’s personal records. There was also information about whether people had any interest in attending religious services. The home was close to the village shops and facilities, which meant that people could be part of a local community. We heard that people helped with the food shopping and attended some of the local events, such as the annual village carnival. Sometimes people went to Marlborough for a wider range of shops and recreational activities. During our visit the people who live at the home were spending their time in different ways and using different areas of the accommodation. People’s own rooms had been individually decorated and showed their different interests. One person liked boxing and they showed us the punch bag that they could use in one of the communal rooms. There was also mood lighting and music equipment in the room, which people could use for relaxation. The main communal room also had leisure facilities, including a television. There were patio doors to an enclosed garden, which we were told was well used when the weather was suitable. People could help with the domestic tasks such as clearing the table, and they were encouraged to participate within their capabilities. The timing of lunch on the day we visited was planned around people’s activities. People had lunch together at the dining table. Staff members ate with the residents, ‘as a family’ as one staff member commented. This also helped to ensure that support was available to people when they needed it. There was fresh fruit available, in addition to a range of sandwiches and ‘toasties’. Residents had their main meal in the evening and these were prepared following a weekly menu. Staff members said that they had got to know people’s particular likes and dislikes and some meat dishes were prepared in different ways according to the residents’ choice. Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 15 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. People’s personal and healthcare needs are well described in individual plans and they receive the support that they require. People are generally protected by the home’s procedures for dealing with medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about the personal and health care needs of the people who live at the home was included in their individual files. There were individual care plans, which described the support that people required, and how staff should provide this. We saw a Health Action plan on one person’s file and a comprehensive ‘Health Needs’ form had been completed for each person. These provided a detailed chronological record of the contact that they had had with health professionals and of any hospital appointments attended. The outcome of individual appointments and health related visits was recorded on ‘Health Record’ forms. We saw examples of the completed forms, which showed the involvement of health professionals in recent months. Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 16 We read about particular health conditions and the support that people received with these. Two people had epilepsy profiles completed and one person’s was being updated at the time of the inspection. Mrs Howie and the staff we spoke to said that people who live at the home received good support from the local Community Team for People with Learning Disabilities (C.T.P.L.D.). This had included the involvement of an occupational therapist and a physiotherapist. People were registered as patients at a GP surgery in the village and had contact with the Community Dental Service. Guidelines had been written about particular needs and how these were to be met. These included the support that people needed with their mobility, to help prevent falls. Risk assessments had been undertaken, including one for the support that was needed during the night. Records were kept of the support that people had received at night. It had been agreed with the C.T.P.L.D. that a listening device could be used to help staff monitor one person’s epileptic activity during the night. We were also given information in the AQAA about people’s health issues and how the home had responded to people’s health needs since they first moved in. The AQAA showed that the home is aware of people’s changing health needs and the type of support that they will require if their health deteriorates, as they grow older. Mrs Howie told us about the efforts being made to seek specialist support for one person. People had their own bedrooms, where support with personal care could be given in private. We thought that the people who live at the home looked well supported with their personal care and appearance. People who live at the home did not manage their own medication. There was a procedure for the administration of medication and staff members said that they had received training. We saw a file that contained information sheets about people’s current medication. Some medication was prescribed on a PRN (‘as required’) basis. This was listed separately. Before being able to administer this medication, staff were instructed to contact the manager or a senior person. This would help to ensure that it was not given inappropriately. We saw that medication was being stored safely and that staff kept appropriate records of its receipt into the home and of its administration. The prescribed medication came to the home in the form of a monitored dosage system, with pre-printed recording sheets. Sometimes instructions had been hand written, when these had not been included on the sheets, or when the printed instructions needed to be amended. We confirmed with Mrs Howie that hand written entries needed to be initialled by two staff to confirm their accuracy. A list of homely remedies had been drawn up and agreed with the residents’ GP. Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. People have limited capacity to express their views, but there are procedures, which help to ensure that they are protected and that any concerns are followed up. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Tullyboy Homes had produced a complaints procedure for the home. There was a version with symbols and photographs, which was intended to be more understandable to the people who live at the home. We were told in the AQAA that the home had not received any complaints during the last 12 months. It was reported in the AQAA that a training package: ‘Whose Secret? Protecting Vulnerable Adults from Abuse’ had been introduced in the last year. It was the intention to provide this training to all staff on an annual basis. We spoke to staff who told us that that they had received training in the prevention of abuse. Tullyboy Homes had produced a policy and procedure about safeguarding adults and the prevention of abuse. A copy of the local multi-agency procedures for safeguarding vulnerable adults was also kept in the home. Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 18 There was a whistle blowing policy, which Mrs Howie said had been amended, as had been recommended at the last inspection. We saw from the minutes that whistle blowing had been discussed at a staff meeting in July 2008. It was reported in the AQAA that there had been no incidents involving restraint during the last 12 months. Mrs Howie had re-qualified as an instructor in non-violent crisis intervention in the last year. Some staff had received this instruction from Mrs Howie and another course had been planned for October 2008. We were told in the AQAA that all staff would be given instruction in the next 12 months. People who live at the home received support with the safekeeping and management of their personal money. There were procedures for staff to follow and we saw examples of the personal money records that were being maintained. Two staff initialled the record when a transaction was made, which helped to ensure that the entries were accurate. Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. People live in a clean and well maintained environment, which is meeting their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 2 Inlands Close was situated in a residential area close to the centre of Pewsey. The house was in keeping with the neighbouring properties and looked like an ordinary domestic type home. There was a parking area at the front of the house and an enclosed garden along one side. The garden looked well established and maintained. When we visited we initially spent time with people in the main communal room. There was a comfortable sitting area with patio doors onto the garden. People also use this room for eating and there was a large dining area on one side of the room. Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 20 Another smaller room was being used as a second communal area. This was for more recreational type activities and for somebody to use if they did not want to be with other people in the main communal room, which was busier. People listened to music in this room and it had some exercise equipment. Somebody used a punch bag in the room during our visit. The environment generally looked well maintained and was decorated in a homely way. It was reported in the AQAA that a lot of redecoration had taken place during the last year. Some of this work had taken place when people were on holiday, so that it would not inconvenience them. Other developments had included the installation of a new shower on the ground floor. An occupation therapist had helped with this to ensure that it met the needs of the people who live at the home. There were no unpleasant odours around the home when we visited. The accommodation and facilities looked clean and tidy, including the toilets. Laundry was done in a separate utility room. Its location in the home meant that people’s washing did not need to be moved through an area where food was prepared or eaten. This meant that there was less chance of crossinfection. Staff members had received training in infection control from Mrs Howie. Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate. People are supported by competent staff who are developing their individual skills. The training that staff members receive should be developed further, to ensure that this fully reflects the changing needs of the people they support. Procedures are in place for the safe recruitment of staff, although records were not all available to show that people who live at the home are fully protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we visited on 27th August 2008 the staff we met appeared to be confident in their roles and in taking responsibility in the manager’s absence. Staff members discussed relevant matters about the day’s arrangements. We observed staff supporting and responding to the people who live at the home in a friendly and respectful manner. We were told that one staff member had phoned in sick before we arrived. Staff members arranged for an agency carer to cover the absent staff member’s shift. We looked at a file that had been produced for agency and relief workers. This contained information Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 22 about people’s daily routines but did not cover some health and safety type procedures that we thought it would be important to know about. We were present for part of a staff meeting when we returned to the home on 4th September. Staff members contributed positively and knowledgeably to the discussions. We looked at the minutes of previous staff meetings, which showed that a varied range of topics was being discussed. We were given information in the AQAA about the staff team and the staff members’ qualifications. The staff team consisted of six permanent staff, of whom two had a National Vocational Qualification (NVQ) at level 2 or above. Another two staff members were working towards a NVQ. One staff member with NVQ at level 2 was now working towards the qualification at level 3. After their induction, staff members were expected to attend a range of courses that were relevant to their role. A form had been produced and boxes ticked to show what training staff had received. The form did not include the dates when courses had been attended, or when refresher courses needed to be arranged. The form could be developed as a training schedule and to give a more detailed overview of the training received. We thought that the range of courses could also be extended, for example to cover subjects such as equality and diversity, and disability awareness. Training records for individual staff members were also being maintained. We met staff members who confirmed that they had received most of the training that they were expected to. We talked to staff and to Mrs Howie about the training that was being planned. A food hygiene course was due to take place in September 2008. One staff member needed to attend a first aid course and this was being arranged. Not all staff had received training in moving and handling. It was agreed with Mrs Howie that this was now a priority and a timescale was confirmed. Since visiting the home, Mrs Howie has told us that a course for staff to attend has been arranged. Mrs Howie confirmed that two new staff members had joined the staff team since the last inspection. Mrs Howie described the recruitment process for new staff. We saw examples of the forms and records that were being completed as part of the process. One of the forms was a checklist, which gave an overview of the recruitment checks that had been carried out on prospective staff members. The checklist covered the appropriate areas, such as Criminal Record Bureau disclosures (including the Protection of Vulnerable Adults list) and references. We saw from the checklist that only one reference had been obtained for one of the new staff members. At the last inspection we had confirmed in a requirement that two references always needed to be received. We discussed this with Mrs Howie, who said that the referee had been contacted and a verbal reference obtained, although this had not been recorded, and the reference had not been followed up in writing. Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 23 We looked at the recruitment records for the other new staff member. These showed that the appropriate checks had been undertaken. We talked to Mrs Howie about the general availability of the staff records. Mrs Howie said that, following advice received about data protection, staff members had been asked whether they wished their records to be available for inspection. We confirmed with Mrs Howie that certain records must be available for inspection, and that these would provide evidence of a robust and safe recruitment process. Since visiting the home, Mrs Howie has confirmed with us that the records would be available for inspection, and that staff were to be informed of this in writing. Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. People benefit from a well run home. Standards in the home are being monitored through a system of quality assurance, although people’s views are not fully reflected in the home’s development plans. People’s health and safety are being promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager, Mrs Howie, set up the home in 1993 and has been closely involved in the day to day running of 2 Inlands Close since then. Mrs Howie has a professional background in learning disability nursing. Courses and events have been attended, which have enabled Mrs Howie to keep up to date with developments affecting learning disability services. Mrs Howie has also Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 25 completed courses which enable her to instruct the staff team in different areas of their work. We were told that Tullyboy Homes was a member of some social care organisations. Mrs Howie completed an AQAA that gave us good information about the home, the improvements that have been made during the last 12 months, and the developments that were being planned. A deputy manager was in post, who had previous experience of managing a learning disablity service. Tullyboy Homes had produced a system of quality assurance which was based around a comprehensive audit of standards in the home. Areas were being reviewed at varying intervals: monthly, quarterly, or annually, and records kept. Annual review was linked to the financial year, and the findings incorporated into the following year’s business plan. We were told in the AQAA that the home was also working towards achieving the ‘Investors in People’ quality assurance award. It was difficult to get feedback directly from the people who live at the home, but the home had made efforts to get people’s views via a questionnaire. We talked to Mrs Howie about other, less formal ways in which feedback from the people who live at the home could be gained. We also confirmed the need to ensure that their views, and the views of other stakeholders, were reflected in in the home’s annual plan. It was agreed that these would be incorporated into next year’s develoment plan. We were given information in the AQAA about the maintenance of equipment in the home and about some of the arrangements being made for health and safety. Some records were looked at when we visited the home. We saw that the temperature of the hot water was being checked and recorded. Repairs and items in need of attention were being recorded in a maintenence book. We saw from the book that staff were reporting jobs and that these were being followed up promptly. We were told in the AQAA about a small number of accidents that had happened during the last year. We saw that accidents reports had been completed and these were kept in the home. Risk assessments were being undertaken. We saw records that had been completed for environmental risks, such as using steps, and for others that concerned individuals, such as somebody who was particularly at risk from sunburn. When we looked at the one bedroom on the first floor we saw that the window did not have a restrictor fitted to limit the amount that it opened. Mrs Howie did not feel that this particular window presented a hazard to people. A formal risk assessment about this had not been recorded and Mrs Howie confirmed that she would now complete an assessment and record the findings. A fire risk assessment had been undertaken. The fire precaution systems were being tested regularly and people participated in fire drills. Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 N/A 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 X Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5 Requirement The written information about the home must include details of the arrangements for charging, and for paying for services that are not covered by the fees. This is so that it is clear what the fees do, and do not cover, and what people who live at the home will therefore have to pay for out of their own money. 2. YA34 19(1) The staff recruitment records must include two written references, including, where applicable, a reference relating to the person’s last period of employment which involved working with vulnerable people. (Requirement outstanding from last inspection). 3. YA34 17(2) Records, as specified in Schedule 4 of the Care Homes Regulations 2001 must be available for inspection by any person authorised by the Commission. 12/09/08 12/09/08 Timescale for action 31/10/08 Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 28 4. YA35 18(1) Staff must receive training in 31/12/08 moving and handling, so that they know how to support people safely. That a risk assessment is completed in respect of the first floor bedroom window, and appropriate action taken as indicated by the outcome of the assessment. 31/10/08 5. YA42 13(4) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations That people’s goals and their progress with achieving these are more fully recorded in their individual plans. This is so that it will be easier to assess the progress that residents are making and there will be better guidance for staff about the support that they need to provide. 2. YA9 That the risk assessment records include the benefits to the person of participating in the particular activity or task that is being assessed. This will help to ensure that the positive aspects of the activity or task are always considered, as well as the hazards. 3. YA32 That the content of the agency and relief staff is reviewed, with the aim of including a wider range of information about the running of the home and its policies and procedures. This is so that staff will have more information readily at hand should they need to respond quickly to events or incidents involving the people who live at the home. Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 29 4. YA39 That a policy on quality assurance is produced, and this shows how the people who live at the home, and other stakeholders, will give feedback about the service that they receive. This is so that people can be confident that their views will be sought and reflected in the home’s development plans. Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tullyboy Homes DS0000028632.V369676.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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