Care Home: Valona

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What the care home does well No new people have been admitted to the home in the last year and so we could not look at any recent assessments. However, the manager told us how they intend to assess any possible new people in the future. He told us that the process will be careful, and will give people plenty of opportunity to visit and get to know the home. The staff will gather information from a range of sources, including the person themselves, and will not allow anyone to move in unless they are absolutely certain that Valona is the right place for them. The people who live at Valona have lots of opportunities to go out and about in the local community. On the day of this inspection people were out shopping, or at day services, and later went for a massage. The home provides transport so that people can access a range of services throughout mid and east Devon. We heard that staff have placed a high priority on providing people with lots of choices, including meals. Staff demonstrated good practice by showing people pictures of meals and letting them choose what they want to eat. The home has liaised closely with the local health and social services to make sure that people receive the right treatment and support for any health needs. Regular health checks have been arranged with a local specialist nurse. The care plan files showed that the home has a good understanding of how each person wants to be helped with any personal care needs, for example washing and toileting. Care managers and health professionals told us they were happy with the way people have been supported by staff in this area. Medicines are generally stored, administered and recorded in a safe manner. The staff have received training on this task and have a good basic understanding of safe administration procedures. We were satisfied that, if people have any concerns about their care or the services provided, they know how to complain and their concerns will be looked into and action taken to put things right. Staff have received training on the protection of vulnerable adults and they know what to do if they have any concerns about potential abuse. The staffing levels are good and provide sufficient staff to make sure people get the help they need. Staff have received a good level of on a wide range of topics. What has improved since the last inspection? At the last inspection we found the atmosphere in the home and staff`s confidence in the previous manager was having a negative impact on the people living in the home. At this inspection we found that the atmosphere had improved considerably and the staff team were much more positive, motivated and happy. We received many positive comments including "The new manager has made Valona a good place to work and to be proud of your job." Medicines are generally handled safely. Some improvements have been made in recent months including a new secure medicine cabinet that has been installed (although the controlled drug cabinet should also be secured in a similar way). Many areas of the home have been improved in the last year. The kitchen has been completely refurbished, some areas have been redecorated, new carpets have been provided, and some new furnishings have been provided. The home is now a much nicer place to live. CARE HOME ADULTS 18-65 Valona Valona Cockles Rise Crediton Devon EX17 3JB Lead Inspector Vivien Stephens Unannounced Inspection 13th August 2008 11:00 Valona DS0000048550.V367448.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 Valona DS0000048550.V367448.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. Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Valona Address Valona Cockles Rise Crediton Devon EX17 3JB 01363 776331 01363 776998 patrickvln2@aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Regard Partnership Ltd Post vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th August 2007 Brief Description of the Service: Valona is a small bungalow that has been converted to provide 2 bedrooms on the first floor (converted loft ) and one bedroom on a lower ground floor area (formerly a garage) in addition to one ground floor bedroom. The home is situated in a residential area of Crediton. It is close to all local amenities. At the time of this inspection three adults with a learning disability lived at the home. It is registered for four adults. The home is run by The Regard Partnership Limited who have many homes in various parts of the country. At the time of this inspection fees ranged from £1,500 per week. Additional costs not covered in the fees include massage, hairdressing and personal items such as toiletries and outings. One-to-one support is charged at £28 per hour. Money is put aside by Regard Partnership each year for the residents’ holiday. Current information about the service, including CSCI reports, are accessible in the kitchen. Copies will be given to anyone who is thinking about moving in and/or their representatives. Valona DS0000048550.V367448.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. Several weeks before this inspection took place the home was asked to complete and Annual Quality Assurance Assessment (AQAA). The completed form was returned to the Commission when we asked and it has provided us with some information about the services they provide. We sent survey forms to the home to distribute to the people living there, to staff, and to health and social care professionals. We received five surveys from staff, three from people living in the home (completed with help from the staff) and three from health and social care professionals. Their responses have helped us form the judgements we have reached in this report. This inspection began at approximately 11am and finished at approximately 5pm. During the day we talked to the manager, one member of staff and one person who lives at the home. We also carried out a tour of the house and gardens, and looked at some of the records the home is required to keep, including assessment and care plans, medicines administered, money held on behalf of people living in the home, daily reports, and menus. What the service does well: No new people have been admitted to the home in the last year and so we could not look at any recent assessments. However, the manager told us how they intend to assess any possible new people in the future. He told us that the process will be careful, and will give people plenty of opportunity to visit and get to know the home. The staff will gather information from a range of sources, including the person themselves, and will not allow anyone to move in unless they are absolutely certain that Valona is the right place for them. The people who live at Valona have lots of opportunities to go out and about in the local community. On the day of this inspection people were out shopping, or at day services, and later went for a massage. The home provides transport so that people can access a range of services throughout mid and east Devon. We heard that staff have placed a high priority on providing people with lots of choices, including meals. Staff demonstrated good practice by showing people pictures of meals and letting them choose what they want to eat. The home has liaised closely with the local health and social services to make Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 6 sure that people receive the right treatment and support for any health needs. Regular health checks have been arranged with a local specialist nurse. The care plan files showed that the home has a good understanding of how each person wants to be helped with any personal care needs, for example washing and toileting. Care managers and health professionals told us they were happy with the way people have been supported by staff in this area. Medicines are generally stored, administered and recorded in a safe manner. The staff have received training on this task and have a good basic understanding of safe administration procedures. We were satisfied that, if people have any concerns about their care or the services provided, they know how to complain and their concerns will be looked into and action taken to put things right. Staff have received training on the protection of vulnerable adults and they know what to do if they have any concerns about potential abuse. The staffing levels are good and provide sufficient staff to make sure people get the help they need. Staff have received a good level of on a wide range of topics. What has improved since the last inspection? What they could do better: The Statement of Purpose and Service User Guide was still in the process of being updated. We were told that it will include pictures and symbols to help people who may have difficulty in reading. We recommended that this is Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 7 completed as soon as possible so that anyone who is thinking about moving in can be given good information about the home. We found that some of the information in the care plans was written in a very formal style that some people may find difficult to understand or follow easily. We also found that the home has many different forms in the care plan files, some of which had out-of-date or conflicting information. It was not easy to find some important information. One care plan included a number of documents that had been written in an ‘easy read’ format so that the person could be have a copy that they could understand – this demonstrated good practice. The other two files had not been updated to the same standard. We heard that all staff are now very much involved in drawing up and updating the care plans, and they now use the care plans on a daily basis. We heard that people lead busy lives and are out and about in the community most days. However, we could not see sufficient evidence in the care plans to show how the staff have considered ways of helping people to develop new skills and to give them opportunities for personal development. Some goals were listed in care plans, but there was no explanation how these would be achieved. We suggested that the staff could help each person draw up a more detailed weekly activity plan that includes opportunities for personal development and learning new life skills, using pictures where necessary. There is a high emphasis on individual choice at mealtimes, but we could not see evidence of how the staff have helped people to plan a healthy diet. People have not been weighed regularly. The home does not have a menu plan. Medication records did not clearly explain the circumstances in which ‘as required’ (PRN) medicines should be administered, including any special instructions. The records did not give staff guidance on how, why, where and when creams and lotions should be administered. The guidance should show how the condition should be monitored and what to do if the condition worsens or improves. Creams and lotions had not been dated when opened to show when they should be discarded. No controlled medicines were stored in the home at the time of this inspection, although it was recommended that some should be treated as such. The home had storage facilities for controlled medicines but this had not been secured and could be removed easily. At the last inspection we recommended that monies belonging to the people living in the home, but which are paid directly to Regard, do not form part of the organisation’s assets. We asked the manager to ensure that monies belonging to the people living in the home, but which are paid directly to Regard, do not form part of the organisation’s assets. Since that inspection there has been a change of manager. The new manager was unaware of this recommendation and could not give us any assurance that action had been taken to address this. We found that the home handles people’s money carefully, but the recording forms were falling apart and pages could easily be lost. We also found that it was not easy to see how cash withdrawals from Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 8 bank accounts had been used and suggested some further adjustments and additional safeguards that might make the system even more secure. The home was generally comfortable and well maintained, but a few areas could be further improved. Currently staff who sleep-in have a mattress on the lounge floor. This may limit the use of the lounge for the people who live in the home. We also heard that one bedroom has poor ventilation and can sometimes get uncomfortably hot. Some parts of the garden could be improved to make it more attractive and useable. The home has not maintained an inventory of people’s belongings – we recommended this is done so that the home has a good record of the things people own (especially furniture and items of a significant value). Records of criminal records checks were not stored in the home and this meant that we could not see evidence to show that the home had received confirmation of the person’s suitability before they started work. The home forwarded some evidence after this inspection. One reference had been accepted from a person’s relative – we advised that this was not adequate and a further reference should have been sought. The home has a number of elements of a good quality assurance system, but we could not see how this information had been drawn together to help the home come up with ways to develop and improve its services. 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. Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5 Quality in this outcome area is good. People can be confident the home will be able to support them. People will be given sufficient time and opportunity to get to know the home and their needs will be fully assessed before a decision to move in permanently is made, although written information has not yet been updated or provided in alternative formats for people who have difficulty reading. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection the three people had lived in the home for several years, and no new people have moved in recently. The manager told us that the home’s Statement of Purpose and Service User Guide are currently being updated and they will also be creating a version using symbols so that people who may have a difficulty reading can find out what the home is offering. (This was recommended at the last inspection). The manager said that any person who may be interested in moving in will be given plenty of opportunity to get to know the home before any decision to move in permanently is made. Referrals are usually made through the Regard Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 11 Partnership in the first instance. The home will gather as much information as possible during the assessment stage to be certain that the home will be suitable and can meet the person’s needs. They will also offer plenty of opportunities for the person to visit, stay overnight, or for a few days if necessary so that they can be certain the home is the right place for them. A copy of each person’s contract of residence is held in their files held in the office. Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. The home is developing and improving their methods of helping people to make choices and decisions about important aspects of their lives. However, the information given to staff about how people want to be helped is not always presented in a straightforward style that both staff and the person concerned can understand and follow easily. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We talked to the manager and one member of staff about how they make sure all staff know what help each person wants, and how they are certain that all staff are working consistently. The home has a care plan file for each person living in the home containing a number of different forms providing a wide range of information. The files are divided to help staff find the information they need. At the last inspection it was recommended that care plan files should be organised in such a way that makes finding information easer. It Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 13 was also recommended that the working care plan should be up to date and accurate and important information should be cross-referenced to other document eg, risk assessments. This work has not been completed yet. During this inspection we were told all of the staff team are now involved in reviewing the care plans. The staff now feel much more aware of people’s needs and are enthusiastic about working together to help people gain new skills and achieve their goals. We saw some forms that have been drawn up by staff using pictures and symbols to help one person understand and agree parts of their care plans. This demonstrated good practice. However, we found that the care plan files still contain lots of information, some out of date, and some information was duplicated, and as a result it was not easy to find important information quickly. For example there was a form that showed the goals the home will help people to reach, but there was no explanation to staff about how to go about this. The goals had not been transferred to the care plan document. Some of the forms have been completed using formal language that some people find difficult to follow. We suggested ways in which the home can use the recording tools they already have to draw together all of the information and provide one overall straightforward and easy to read plan that clearly explains the way the person wants staff to support them throughout each day. This could be crossreferenced to other documents, for example risk assessments, if staff need more detailed guidance. In the kitchen there is a large clock that pictures can be stuck on to show the activities for one person living in the home. Below this clock there is a guide for staff on how to communicate with this person. We heard that these tools have been very successful. We suggested that the home should consult with the other people in the home to find out if they might also want a similar facility. The home has also drawn up some new daily recording forms. These use tick boxes to show that some daily of the care tasks have been completed each day. There is also a daily handover book. Separate books are used to record each person’s daily activities. The manager told us that staff have received training on control and restraint, but we were assured that restraint is never used at the home. We were told that the training has helped staff understand why people may become upset or angry, and how to help calm a situation down. By looking at the files and talking to the manager and the one staff present during the afternoon of this inspection we found evidence to show that people are offered lots of choices and are encouraged to make decisions about all aspects of their daily lives. Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. People benefit from a variety of activities both inside the home and in the local community, although more could be done to could improve people’s opportunities for personal development. People are offered individual choice of meals, but the home could do more to help people draw up a menu plan that meets individual and community dietary needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager told us that people go out and about a lot and lead busy lives. On the morning of this inspection all three people were out. At lunchtime one person returned from their day care service. The other two people were shopping in Exeter in the morning and went for a massage/reflexology session in the afternoon (we were unable to meet either of them during our visit.) Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 15 Each person has a weekly timetable of their regular activities. We looked at the plans for two people and saw that they only showed regular planned activities for two or three days a week. The manager said that people do many other ‘ad hoc’ activities such as shopping, walking, and trips to local places of interest. The daily diaries gave evidence of some of the things people have done. The agreed staffing levels for one person are higher than the staffing levels for the other two people. We heard that at times this means that one person may dominate daily activities, although the manager said the staff do their best to give each person equal support. We suggested that the weekly activities plans are completed for each person to show specific activities every day. This will ensure that each person is given equal opportunity to choose what want to do. It can also be used as a tool for staff to focus on helping people work towards their goals, for example, to spend specific time working on independent living skills. The manager told us that the home helps people to keep in touch with their families and friends, and that families are encouraged to visit whenever they want. The home does not plan the menus in advance. This meant that we could not see evidence of how the home ensures people are given a good range of healthy foods. The care plan files suggested that some people may need help to lose weight, but there was no evidence to show how this could be achieved. The staff have not weighed people regularly. We saw a book with photographs of different meals and we were told that people are shown the pictures and can choose what they want each day. This may mean that three different meals are provided at each mealtime. While this showed that staff fully respect people’s right to choose, it did not show how staff have guided or supported people to eat a healthy diet. We suggested different ways the staff can give each person a choice, while at the same time offering people a wholesome diet in a family type setting where people can sit down and enjoy a well-cooked meal together that everyone has helped to contribute towards in some way. We were told that the home has increased the level of fresh fruit people are given, and also reduced the amount of sugary drinks and foods that are offered. They said they encourage people to take plenty of exercise to help increase fitness and improve weight levels. We were also told that people sometimes go to McDonalds, or have a take away meal once a week as a special treat. Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good People receive personal support from staff in the way they prefer and want and their physical and emotional health needs are met. The home manages people’s medicines safely, although there are some aspects of storage and recording that may compromise medicine safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff have worked closely with specialists and with one person to draw up detailed guidance on how to understand and communicate with one person. We heard that this has resulted in the person achieving new skills, gaining confidence, and becoming much happier and calmer as a result. One staff member talked with great pride and satisfaction about this achievement and said the whole staff team have become motivated and enthusiastic about helping everyone to move forwards and become more independent. Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 17 We saw one staff and the manager talking with and helping one person. Their manner showed that they had a very good understanding of that person and how they wanted to be helped. People have recently received a letter to say they will be receiving regular health checks from a specialist nurse in the future. Medication has been reviewed regularly by a GP. One care manager told us “X requires visits to his GP and occasional visits to the local hospital to undergo specialist tests or assessments e.g. dermatological assessments, optical tests etc. No issues have been observed or reported in this area. The support staff has been responding well to X’s needs in this area.” One person who has poor mobility has received advice from an occupational therapist and with their help the home has provided handrails, grab rails and bathing aids to help this person move around safely. The home uses a monitored dosage system of medication supplied by a local pharmacy. Since the last inspection a secure cabinet has been installed for medicine storage. They also have an additional cupboard for any controlled drugs the home may hold. This cupboard was not secured to the wall – we advised the home to check with the pharmacy and CSCI guidelines on controlled drug storage. At the time of this inspection no drugs held in the home were officially categorised as controlled drugs, although it is recommended as good practice to treat some as if they were controlled drugs. The manager said they will make sure that the cupboard is properly secured. The home has good records of all medicines received into the home, those administered, and any unwanted medicines returned to the pharmacy. They have a good accounting system in place so that they can demonstrate that the correct amount of medicines are held. A plan of the staff training was seen on the office wall showing the dates that staff have received training on the safe administration of medicines, and when future training is planned. Some people have been prescribed medicines to be used only when needed (these are known as PRN medicines). We were unable to find clear instructions either in the medicines administration records or in the care plans to explain when these medicines should be administered, or any special instructions. The staff member we spoke was able to explain the circumstances in which the medicines would be administered. However, if new or agency staff were on duty they may not have the same awareness. Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 18 The records had been completed to show when creams had been administered. However, there were no instructions on the medicines administration charts or in the care plans to explain clearly how, where, why or when the creams should be administered, and how the condition should be monitored. The creams had not been dated to show when they had been opened or when they should be discarded – this is recommended as good practice. Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good If people have concerns with their care, they or people close to them, know how to complain. Their concerns will be looked into and action taken to put things right. The care home has good procedures to safeguard people from abuse, neglect or self-harm. Some financial recording systems could be improved to provide even better security for people’s cash and savings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Every person has been given a copy of the home’s complaints procedure. This has been drawn up using symbols as well as words to help those people who may have difficulty reading to understand. One person who lives in the home who we talked during this inspection confirmed that he had been given a copy of the procedure and it had been explained to him. We were told that most of the permanent staff have received safeguarding adults training. The manager said he thought 3 bank staff are yet to receive this training. A plan of the staff training dates was seen on the office wall showing dates that staff have received training and future dates planned. Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 20 No complaints have been received by the agency, or by the Commission, since the last inspection. We looked at the way the home handles cash and savings accounts on behalf or people living in the home. The organisation has set up individual building society accounts. Regard act as “trustees” of the accounts with the manager acting as signatory. Peoples’ benefits are paid to Regard then a cheque is made out for peoples’ own monies to be paid into their building society accounts. At the last inspection statements of the organisation’s bank account were not available for inspection, therefore it could not be established if the money paid from the benefits formed part of the organisation’s assets. The new manager said the system remained the same and was unaware of any discussions that may have taken place since the last inspection to address this matter. There are separate records of money held in the bank accounts, and cash held in the home on behalf of people living in the home. It was difficult to follow some of the transactions in and out of the bank account, and then into the day-to-day cash held in the home. We suggested that the records could be checked periodically either by a financial professional such as an accountant, or by a relative or representative of the person in order to provide additional safeguards and to make sure all withdrawals are correct. The home has kept good records of day-to-day spending with receipts kept. However, the recording books were falling apart and it was possible that pages could easily be lost. We suggested these should be strengthened in some way. Each transaction has been double-checked by a second person to make sure no errors are made. This demonstrated good practice. The records are also spot-checked by the ‘responsible person’ who carries out monthly visits to the home to comply with regulation 26 of the Care Homes Regulations. Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29, 30 Quality in this outcome area is good. Due to recent improvements the home is now a nice place to live, although there are still a few things they could do to make it even more comfortable and attractive, including better sleeping-in arrangements for staff, and better ventilation in one bedroom. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We carried out a tour of the home. We found that, since the last inspection, a number of improvements have been made in a number of areas. A new kitchen has been installed, and some new carpets have been fitted. Handrails have been fitted in the garden and bathroom to help people with poor mobility get around safely. The garden appeared tidy but was not particularly attractive. The manager told us about their ideas to make the garden more attractive and more Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 22 useable. There is a small level area in one part of the garden where people can sit during warmer weather, but they would like to make other areas of the garden accessible also. The house is on three levels with one bedroom with en-suite facilities on the basement level, another bedroom on the ground floor and two more on the second level. There is a bathroom on the ground floor and toilet on the second level. All bedrooms were found to be individually decorated and furnished to reflected the interests and tastes of the person using the room. We heard that one bedroom gets very hot in warmer weather due to poor ventilation, and the manager and staff expressed concerns about the effect the person who used that room. We talked to the manager about the possible actions the home could take to address this problem. The front door has a coded keypad lock which is connected to the fire alarm system. This means if the fire alarms go off the front door will automatically open. The lounge has been comfortably furnished and brightly decorated. However, this room is also used by staff for sleeping-in purposes. A mattress was stored behind the settee. This affected the appearance of the room. We talked to the manager about some of the problems they may encounter when using the lounge for staff sleeping-in. We were assured that the staff do not go to bed until the people living in the home go to bed and that no-one is asked or encouraged to go to bed early because the staff want to go to sleep. We also discussed how this may affect the privacy, dignity and choice of everyone, including the staff. It was acknowledged that this is not the ideal arrangement. Where people have purchased items of furniture or belongings that have a significant value no inventory of these items has been compiled by the home. This means that if a person leaves the home at some time in the future the staff may be unaware that the person owns certain items such as furniture, and the person may leave without taking all of their possessions with them. All areas of the home were found to be clean, bright, and free from any odours. Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is adequate. People are supported by sufficient well-trained and well-supervised staff who understand how each person wants to be helped. The home generally follows good recruitment procedures to ensure people are in safe hands, but improvements are necessary in the way records are stored and made available for inspection, and in the way references are obtained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we arrived at the home all three people living in the home were out, supported by three staff. The manager was on duty working at the home. We found there are normally two or three staff on duty during the day. At night there is one member of staff who sleeps on the premises. This means that there are enough staff to provide people with the support they need. We looked at the way the home has recruited new staff in the last year. We checked the recruitment files for two staff. We found that all job applicants Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 24 have been asked to complete an application form and have attended an interview. The home told us in their AQAA : “The recruitment process (most methodic and detailed) is abided by with CRB and POVA checks occurring ( any other historical information provided) to safeguard this service-user group.” Despite this assurance we were unable to see evidence that criminal records checks (CRB’s) and protection of vulnerable people (POVA) 1st checks have been received before new staff have started work, in accordance with current good practice guidance. We were told that these are held at the company’s head office. The home’s records did not show the date that new staff had started work. No letter of offer of employment was held on file. We were told that staff do not receive a contract of employment until they have worked at the home for six months. Therefore, although we were given reassurance that the home follows good recruitment procedures, the evidence was not available for us to check that this is satisfactory. We asked the home to forward the evidence to us and it was forwarded after the inspection. While most references were found to be satisfactory we found that in one instance a reference had been accepted from a relative. We talked to the manager about the importance of obtaining satisfactory independent references from people who will give an impartial reference. We heard that the person was known to other staff members and therefore the manager was confident the prospective staff member was suitable. However, there was no evidence on file to support this. We looked at the induction procedures for new staff. We saw a copy of an induction booklet that was in the process of being completed. We could see that the topics covered in the induction process were comprehensive and provided staff with a good basic understanding of the range of tasks they will be expected to carry out. We also saw a plan on the office wall that covered the training needs of all of the staff team. The plan showed the dates of the training staff have already received, and when updates are due. We could also see dates of future training planned. The training has included the following topics : Health and safety, fire precautions, manual handling, first aid, basic food hygiene, control and physical intervention, abuse, medication administration, autism and challenging behaviour, communication, and epilepsy. The home employs a total of 12 staff (including bank staff). The completed AQAA showed that 4 permanent staff and 3 bank staff already hold a nationally recognized qualification (known as NVQ) to level 2 or above. 2 staff were in the process of obtaining this qualification. This meant that over half of the staff team already hold a recognised qualification. Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 25 All of the staff who completed a survey form told us they have received a good range of training. Comments included “Training is always offered and updated”. We also heard that staff have been well supervised and supported. Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. The atmosphere within the home has improved following the appointment of a new manager and staff now feel well supported to provide a good service. However, some aspects of the quality assurance systems could be improved to ensure the home is constantly reviewing and improving the services they provide. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new manager has been appointed since the last inspection. He told us that an application to register him will be submitted to the Commission in the next few weeks. Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 27 All of the staff we spoke to or who completed survey forms told us that the atmosphere in the home has improved significantly since the appointment of the new manager. Comments included : “The manager gives you all the support and advice you need.” “It is a small home and it is like we are all one big family. Now the new manager is in place we work as a team.” “The new manager has made Valona a good place to work and to be proud of your job.” “The manager has been in place since Nov 2007. He has shown us more support and makes us feel valued as an individual as well as a staff team.” One health professional also commented on the management of the home: “The home manager provides a relaxed, homely setting while also working to clinical needs, as well as forming connections with the local community and providing suitable social activities.” A questionnaire and self-assessment (AQAA) was completed by the manager prior to the site visit. This provided us with some of the information we wanted to know about the people living in the home, staff, and indicates whether necessary policies are in place. However, some information was not provided in the form – for example, the form did not explain what actions had been taken to address some of the requirements and recommendations made following the last inspection. It did not give us all of the information we needed to form a judgement as to whether the home is being run appropriately and safely. We looked at the way the home reviews and improves the quality of the services they provided. At the last inspection we found that the quality assurance systems could be improved, and we recommended that the systems should be organised to ensure everyone is aware of the work that needs to be completed and by when. We also recommended that the home should devise a system that uses feedback from surveys in an effective manner to help the home come up with ways to develop and improve its services. Before this inspection took place the home told us in their AQAA “Service-user and their families opinions are requested to promote choice and preferences. The new manager has attended training regarding quality assurance and now has a clearer understanding of Regulation 26. The Area Manager frequently visits Valona whilst assessing the home ensuring that it complies with Reg 26 requirements.” This did not give us the evidence we were looking for to show that the home had improved their quality assurance methods. We checked some of the health and safety records maintained by the home including the fire log book and water temperature checks. These showed that the home has good systems in place, including staff training, to make sure that people are safeguarded from potential risks to their safety. Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 x 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 2 27 3 28 2 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 2 x x 3 x Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation 17(2) sch 4 Requirement Records of criminal records bureau checks carried out before new staff are recruited must be kept in the care home or must be made available when required by the inspector in line with current guidance. The home must also be able to provide written evidence of at least two satisfactory references obtained before new staff begin work. Timescale for action 01/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The work on the service user guide and statement of purpose should be finished to include accurate information about the costs of fees and any extra charges. The documents should be drawn up in different formats to help people who may have difficulty reading to know what services the home will provide. Care plans should be organised in such a way that makes DS0000048550.V367448.R01.S.doc Version 5.2 Page 30 2. Valona YA6 3. 4 YA9 YA14 5 YA17 6 YA20 7 YA23 8 Valona YA26 finding information easer. Irrelevant information should be taken out of the working plans. There should be just one working care plan that is up to date and accurate and easy to follow. People should be involved in drawing up and reviewing their care plans and should have a copy of the information in a format that helps them understand what is written about them. Risk assessments should cross-referenced with care plans to ensure staff are aware that the activity they are about to undertake may have risks attached. The home should help people to draw up a more detailed weekly plan of the activities they want to do. This will help people know what they will be doing each day. The plans should be developed to give people opportunities to work toward personal goals. They should be drawn up using a format each person can understand, so that they know what will be happening, and when. (At the moment this facility is provided for one person). The home should help people to plan the menus each week so that everyone is able to choose what they want to eat, while at the same time ensuring that people receive a healthy and varied diet to suit their individual nutrition needs. The home should make a record of the foods each person has eaten each day. The records should clearly explain the circumstances in which ‘as required’ (PRN) medicines will be administered, including any special instructions People’s records should give staff guidance on how, why, where and when creams and lotions should be administered. The guidance should show how the condition should be monitored and what to do if the condition worsens or improves. Creams and lotions should be dated when opened to show when they should be discarded. Storage facilities for any controlled medicines held in the home must be secure. The manager should ensure that monies belonging to the people living in the home, but which are paid directly to Regard, do not form part of the organisation’s assets. The home should consider ways of providing additional safeguards to ensure that withdrawals from individual’s bank accounts are correct and spent wisely, and can be easily followed using the homes’ recording systems. The recording forms used to record transactions carried out by the home on behalf of individuals should be strengthened to prevent them falling apart and pages being lost. An inventory should be maintained of the belongings of DS0000048550.V367448.R01.S.doc Version 5.2 Page 31 9 10 YA26 YA28 11 YA39 each person living in the home, including any furniture or furnishings owned by them. The home should provide adequate ventilation to all areas and ensure no areas are excessively hot. The home should consider how they can provide suitable sleeping arrangements for staff that does not compromise people’s choice, and allows people to access the communal lounge at all times. Quality assurance systems should be well organised to ensure everyone is aware of the work that needs to be completed and by when. The home should devise a system that uses feedback from surveys in an effective manner, which helps the home come up with ways to develop and improve its services. Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 32 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 Valona DS0000048550.V367448.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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