Care Home: Vaughan House

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What the care home does well This home understands the importance of having sufficient information when choosing a home. The statements of purpose and service user guide are written in a format containing pictures and symbols so that the residents can clearly understand it. This service involves the residents in the planning of care that affects their lifestyle and quality of life, and the staff understand the importance of residents being supported to take control of their lives. Monthly Key Worker sessions indicated that residents are happy to discuss matters that are personal to them with their key workers, and trust that these will be dealt with in a sensitive and confidential way. People who live in this home are consulted on all aspects of life in the home, ranging from menus to decorating to building. The service has a strong commitment to enabling residents to develop or maintain their skills, including social, emotional, communication and independent living skills. Residents are supported to identify their goal and work to achieve them. Contact with family and friends is actively encouraged. People receive personal and healthcare support using a person centered approach with support provided based on the rights of dignity, equality, fairness, autonomy and respect. People are supported to maintain independence. The home has an open culture and encourages residents to express their views and concerns. The manager understands the policies and procedures for safeguarding and will always attend meetings or provide information to external agencies when requested. The home provides a physical environment that is appropriate for the residents. The design allows for small clusters of people to live together a non institutional way, and promotes privacy, dignity and autonomy for the residents. People who live in this home have confidence in the staff who care for them. The staffing allocation is based on delivering good outcomes for residents and is not led by staff requirements.The manager has a clear understanding of the key principles and focus of this service. She is enthusiastic and demonstrates a strong leadership role whilst developing a transparent service that is providing person centered care based on the views of the residents What has improved since the last inspection? Since the Random inspection in April 2008, the flooring on the landings has been replaced. This has eliminated the offensive odour that was evident previously. The manager who has now been in post for six months has worked hard to ensure all the residents are occupied with activities of their preference. An outings diary detailed various trips that have taken place over recent weeks. At the previous inspection in January 2008 we were concerned that Personal Profile Sheets that were filed with individual`s Medication Administration Record (MAR) sheets, were not up being correctly updated as medication prescriptions were being changed, and that this could contribute to mistakes being made. During this inspection we examined all the residents medication files. The profiles that listed `present medication` have now been removed from these files therefore eliminating this risk. At the last inspection we were concerned that residents did not have access to their money unless the manager or her deputy were present. This has now been addressed and two senior carers also have access, therefore there is usually someone on site with access to the safe. There is a healthy petty cash deposit available at all times in the home, and this is replenished as required by the manager via head office. The bathroom on the first floor, which we previously felt, needed some attention, was very clean and had a plant on the windowsill. It was now fit for purpose. Since this time the manager has focused on resourcing training on Mental Health, Epilepsy and Autism, as well as the mandatory training. Records show that with the exception on one bank staff, all have attended as required. Core processes, which caused us concern at the last inspection, such as recruitment and medication, have been addressed by the manager and are now being appropriately managed. What the care home could do better: Evidence indicates that the outcomes are good for these residents, however changes were not always clearly recorded in the care plans that we viewed. Care should be taken to make sure these details are all clearly recorded in their care plans as they happen. CARE HOME ADULTS 18-65 Vaughan House 21 Studley Road Luton LU3 1BB Lead Inspector Mrs Louise Trainor Unannounced Inspection 27th June 2008 13:30 Vaughan House DS0000014979.V367373.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 Vaughan House DS0000014979.V367373.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. Vaughan House DS0000014979.V367373.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Vaughan House Address 21 Studley Road Luton LU3 1BB 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) 01582 734812 01582 415196 Vaughan.house@craegmoor.co.uk Craegmore.co.uk Parkcare Homes Ltd Vacant Care Home 10 Category(ies) of Learning disability (10), Mental disorder, registration, with number excluding learning disability or dementia (1) of places Vaughan House DS0000014979.V367373.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 18-65 years. Maximum number of service users - 10. The category MD is for one service user only named in correspondence dated 24th June 2005. No further service users in the category MD are to be admitted to the home. Date of last inspection Brief Description of the Service: Vaughan House provides accommodation for ten adults with learning disabilities and currently all the residents are males. Craegmoor Healthcare owns the home. The home is situated in a pleasant residential area of Luton a short distance from the town centre, which can be accessed on foot if necessary. Accessible facilities in the centre included a cinema, swimming pool, bowling alley and league football team. The building has been converted from a domestic dwelling to provide ten single bedrooms, with en-suite shower facilities to five of these and four with en-suite toilets. The remainder have wash hand basins. The bedrooms are located on all three floors of the house. Combined bath and toilet facilities are provided on the first and second floors and there is a communal toilet on the ground floor. Also on the ground floor there are a lounge, kitchen with dining area and an office. A laundry area had recently been added to the side of the building. Two further staff rooms are provided on the top floor. There is an enclosed rear garden, which is mainly laid to grass, and at the front of the house there is a paved parking space for three or four vehicles. The fees for this service presently range from £415.22 to £1633.66 per week. Vaughan House DS0000014979.V367373.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 stars. This means the people who use this service experience good quality outcomes. This inspection was carried out in accordance with the Commission for Social Care Inspection’s (CSCI) policy and methodologies, which require review of the key standards for the provision of a care home for Younger Adults that takes account of service users’ views and information received about the service since the last inspection. Evidence used and judgements made within the main body of the report include information from this visit. This was the first Key Inspection for this service this inspection year, although a Random Inspection was carried out in April 2008. Regulatory Inspectors Mrs Louise Trainor and Mrs Sally Snelson carried it out on the 27th of June 2008, between the hours of 13:30 and 17:00 hours. The new manager who was appointed in December 2007 was present throughout the inspection to assist as necessary. The focus of this inspection was to monitor compliance of the requirements made at the previous inspection in January 2008, as we had been unable to check this at the Random Inspection in April 2008 as neither the manager nor the deputy manager had been present, and access to documents was limited. There are presently ten permanent residents living at this home and all except one who was on home leave, were present for periods of the day during this visit. Personal files and documentation for one of the residents was examined in detail during this visit. The inspector also had the opportunity to informally interview and chat with both people who live here and staff who work at the home. A tour of the premises was undertaken. Other documentation examined during this inspection included, documents relating to staff recruitment, training and supervision, Medication Administration Record (MAR) sheets and medication stocks, Personal Allowance records and quality assurance. This was overall a very positive inspection and we would like to acknowledge how hard the new manager has worked to introduce changes over the past six months to improve standards in this home. We expect these improvements to continue. The inspector would like to thank everyone concerned for their assistance and support during this inspection. Vaughan House DS0000014979.V367373.R01.S.doc Version 5.2 Page 6 What the service does well: This home understands the importance of having sufficient information when choosing a home. The statements of purpose and service user guide are written in a format containing pictures and symbols so that the residents can clearly understand it. This service involves the residents in the planning of care that affects their lifestyle and quality of life, and the staff understand the importance of residents being supported to take control of their lives. Monthly Key Worker sessions indicated that residents are happy to discuss matters that are personal to them with their key workers, and trust that these will be dealt with in a sensitive and confidential way. People who live in this home are consulted on all aspects of life in the home, ranging from menus to decorating to building. The service has a strong commitment to enabling residents to develop or maintain their skills, including social, emotional, communication and independent living skills. Residents are supported to identify their goal and work to achieve them. Contact with family and friends is actively encouraged. People receive personal and healthcare support using a person centered approach with support provided based on the rights of dignity, equality, fairness, autonomy and respect. People are supported to maintain independence. The home has an open culture and encourages residents to express their views and concerns. The manager understands the policies and procedures for safeguarding and will always attend meetings or provide information to external agencies when requested. The home provides a physical environment that is appropriate for the residents. The design allows for small clusters of people to live together a non institutional way, and promotes privacy, dignity and autonomy for the residents. People who live in this home have confidence in the staff who care for them. The staffing allocation is based on delivering good outcomes for residents and is not led by staff requirements. Vaughan House DS0000014979.V367373.R01.S.doc Version 5.2 Page 7 The manager has a clear understanding of the key principles and focus of this service. She is enthusiastic and demonstrates a strong leadership role whilst developing a transparent service that is providing person centered care based on the views of the residents What has improved since the last inspection? Since the Random inspection in April 2008, the flooring on the landings has been replaced. This has eliminated the offensive odour that was evident previously. The manager who has now been in post for six months has worked hard to ensure all the residents are occupied with activities of their preference. An outings diary detailed various trips that have taken place over recent weeks. At the previous inspection in January 2008 we were concerned that Personal Profile Sheets that were filed with individual’s Medication Administration Record (MAR) sheets, were not up being correctly updated as medication prescriptions were being changed, and that this could contribute to mistakes being made. During this inspection we examined all the residents medication files. The profiles that listed ‘present medication’ have now been removed from these files therefore eliminating this risk. At the last inspection we were concerned that residents did not have access to their money unless the manager or her deputy were present. This has now been addressed and two senior carers also have access, therefore there is usually someone on site with access to the safe. There is a healthy petty cash deposit available at all times in the home, and this is replenished as required by the manager via head office. The bathroom on the first floor, which we previously felt, needed some attention, was very clean and had a plant on the windowsill. It was now fit for purpose. Since this time the manager has focused on resourcing training on Mental Health, Epilepsy and Autism, as well as the mandatory training. Records show that with the exception on one bank staff, all have attended as required. Core processes, which caused us concern at the last inspection, such as recruitment and medication, have been addressed by the manager and are now being appropriately managed. Vaughan House DS0000014979.V367373.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Vaughan House DS0000014979.V367373.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 Vaughan House DS0000014979.V367373.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, 3, 4, People who use this service experience good quality outcomes in this area. This home understands the importance of having sufficient information when choosing a home. The statements of purpose and service user guide are written in a format containing pictures and symbols so that the residents can clearly understand it. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The home has a Statement of Purpose that had been reviewed and updated in March 2008. Everyone who lived in the home had been issued with a Service Users Guide that had been simply written and included pictorial symbols. Each individual living in the home had been helped to read and understand these documents and had signed to confirm their receipt. A copy of the new document had also been sent to each resident’s parents or representatives. There have been no new residents admitted to the home since 2003. Therefore as the present service user files had been inspected to confirm pre admission assessments, tea visits and trial periods, which were evidenced at the previous inspections, these particular documents were not re inspected during this visit. Vaughan House DS0000014979.V367373.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, 8, 9, 10. People who use this service experience good quality outcomes in this area. This service involves the residents in the planning of care that affects their lifestyle and quality of life, and the staff understands the importance of residents being supported to take control of their lives. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: People who live in this home are consulted on all aspects of life in the home, ranging from menus to decorating the building. There is presently a pictorial ‘decorating calendar’ displayed on the wall in this home. It shows a floor plan diagram of all rooms in the home, and each person’s room is labelled with their name. Residents are encouraged to fill in details of the colour they would like it to be painted. Many had already filled Vaughan House DS0000014979.V367373.R01.S.doc Version 5.2 Page 12 details in. This included specific colour names such as ‘burnt red’ and the particular colour chart they had found their colour on. One resident took us to look at the weekly menu displayed in the kitchen. He went on to explain that if he didn’t like the main menu he could always have the alternative. The residents make choices about their holidays, and how they spend their free time. Five residents have recently returned from a week in Wales, and another was telling us how he is planning a trip to Spain, as he prefers the sunshine. Another person’s file identified that he wanted to go somewhere where he could fly a kite. There are photographs on display in the lounge, which show residents enjoying a range of activities. The residents at this home attend a ‘Your Voice’ meeting every three months. This is an opportunity for them to voice their opinions, and make changes to routines in the home. One very vocal resident regularly acts as representative for the majority. The manager is planning to introduce a new approach to the residents meetings, whereby they ‘chair’ it themselves, and minutes are produced in a ‘service user friendly’ format. Residents and relatives also participate in Health and Safety meetings. Notes from monthly Key Worker sessions indicated that residents are happy to discuss matters that are personal to them with their key workers, and trust that these will be dealt with in a sensitive and confidential way. One person’s file detailed his concerns about a member of staff at their day centre, and how “she is rude and jumps down people’s throats”. Discussions with the manager and the residents in this home indicated that changes are ongoing in their lives, and that these changes are being addressed. This includes their activities, their personal living skills and how they make choices about their lives. Care plans include personal goals and aspirations and the level of assistance required to achieve them. They also included individual’s likes and dislikes, indicating that all these factors are considered when care is being delivered. Evidence indicates that the outcomes are good for these residents, however changes were not always clearly recorded in the documentation that we viewed. Care should be taken to make sure these details are all clearly recorded in their care plans as they happen. Vaughan House DS0000014979.V367373.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): 11, 12, 13, 14, 15, 16, 17 People who use this service experience good quality outcomes in this area. The service has a strong commitment to enabling residents to develop or maintain their skills, including social, emotional, communication and independent living skills. Residents are supported to identify their goal and work to achieve them. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: When we arrived to carry out this inspection, there was only the manager and three residents at home. Four had gone swimming to Woburn, accompanied by two staff, one was at the day centre and one had gone home for the weekend. The ‘swimmers’ returned during the course of this visit and then some of them decided to go off for a drive with staff, whilst others were going about their Vaughan House DS0000014979.V367373.R01.S.doc Version 5.2 Page 14 personal chores, or just relaxing in the lounge. Decisions were being left up to the individuals. Throughout this inspection the atmosphere in this home was relaxed and homely, and there was a friendly banter between staff and residents. Each individual who lives in the home has one day each week, which is dedicated to doing their household chores such as laundry and tidying their rooms. There is also a daily chores rota. One person told us it was his job to clean the floors today. He explained that he would do this at about 8pm. All the residents in this home have been living here for many years, and generally relationships are good. One resident said he was going to see his girlfriend, and another said he sometimes went with him to make sure he behaved himself. This sort of joking and banter was ongoing. It was a pleasure to spend time in this environment, where the residents were so happy and relaxed. Most of the residents attend college or day centres part time throughout the week. The manager who has now been in post for six months has worked hard to ensure all the residents are occupied with activities of their preference. An outings diary detailed various trips that have taken place over recent weeks. This included trips to Bedford by train, trips to the Downs in Dunstable and trips to various pubs and evening clubs. Some residents are also enjoying looking after the garden. There is a small herb garden and there were tomato plants waiting to be planted. There is presently a lot of excitement in the home as several of the residents have new girlfriends that they have met through one of the evening clubs. Some were more bashful than others when discussing this. We heard conversations about inviting friends to tea or to barbeques, and the manager was very clear in telling them. “This is your home you can arrange whatever you wish”. Contact with family and friends is actively encouraged. The home has arranged an ‘Arts in the Park’ afternoon in August. At this event family and friends will be invited to come to the home and attend workshops with the residents, who will be making scones for the afternoon teas. We saw a poster on display inviting residents to audition for a new choir that is being formed by ‘Your Voice’, this is a new venture that everyone is looking forward to. One resident was very excited to tell us that he is applying for a job as a Community support police constable. This is an initiative that the manager has been involved with before and hopes will be successful for this particular resident. Vaughan House DS0000014979.V367373.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 People who use this service experience good quality outcomes in this area. People receive personal and healthcare support using a person centred approach with support provided based on the rights of dignity, equality, fairness, autonomy and respect. People are supported to maintain independence. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Individual care plans for each person identify the level of support and assistance they require in all aspects of daily living. The Person Centred documentation used in this home indicates that individuals’ wishes and feelings are considered in the way their care is managed by staff. The residents sign these documents. Vaughan House DS0000014979.V367373.R01.S.doc Version 5.2 Page 16 Each resident has ‘My Life Story’ which has been completed with the help of staff, and this details personal information such as dates that are special to the individual. A sheet that addresses illness and dying is included in each file. One person had identified that they would like their mother to explain this to them. Each individual has numerous risk assessments in place, and these cover all aspects of their lives. One person, whose file we examined, had risk assessments in place for, misplacing money, difficulties understanding a joke, going in a taxi, appropriate dressing, wandering off in public, as well as for medical conditions, personal care and self medicating. These reflected other information in this persons file and had all been appropriately reviewed in June 2008. Previously we were informed by staff that one resident in this home was taking food from the kitchen and eating it inappropriately during the night. This presented a health hazard to this individual and concerned us. This has now been addressed and this person has is given a ‘goody bag’ before going to bed, containing sandwiches, crisps and fruit. The manager reported that he no longer goes looking for food at night. At the previous inspection in January 2008 we were concerned that Personal Profile Sheets that were filed with individual’s Medication Administration Record (MAR) sheets, were not up being correctly updated as medication prescriptions were being changed, and that this could contribute to mistakes being made. During this inspection we examined all the residents medication files. The profiles that listed present medication have now been removed from these files therefore eliminating this risk. MAR sheets were all appropriately completed with signatures and omission codes, and the reverse of the sheets had been appropriately completed. A sheet in each file identified appointments with other health professionals, such as dentists, opticians and chiropodists, and daily records were being completed twice daily to reflect the individuals’ activities and well-being. All were clearly dated and signed. Vaughan House DS0000014979.V367373.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): People who use this service experience good quality outcomes in this area. The home has an open culture and encourages residents to express their views and concerns. The home understands the policies and procedures for safeguarding and will always attend meetings or provide information to external agencies when requested. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: There is a clear complaints policy in place and it is summarised in the service user guide and accessible to everyone entering the home. It is produced in a pictorial format so that the residents can understand it. There are also comment cards situated in the entrance hall, so that anyone wishing to raise any concerns anonymously has the facility to do so. We viewed the complaints file and the complaints log during this inspection. There was only one complaint from a relative that had been logged since the last inspection. This was relating to a resident’s clothes. This matter had been addressed and the complainant had been responded to in writing within the given time frame. The complaints log also contained numerous complaints from residents. These were either about other residents or about staff. These had all been clearly recorded, as had details of meetings held to resolve these concerns. This very Vaughan House DS0000014979.V367373.R01.S.doc Version 5.2 Page 18 clearly identified that residents know and understand the procedures to follow if they are not happy with something in the home, and also that staff listen to, and act upon information they receive from the residents. The manager and staff in this home have a clear understanding of Safeguarding procedures. Training records show that all the staff, with the exception of one bank carer, have attended training in Safeguarding during the past year. The member of staff who has not attended this training is not being given any work until they have attended this training as required. The records of resident’s personal expenditures were examined. These were all accurately recorded and balanced with funds available. At the last inspection we were concerned that residents did not have access to their money unless the manager or her deputy were present. This has now been addressed and two senior carers also have access, therefore there is usually someone on site with access to the safe. There is a healthy petty cash deposit available at all times in the home, and this is replenished as required by the manager via head office. The company’s Head office invoice all transactions. Vaughan House DS0000014979.V367373.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, 25, 26, 27, 28, 30 People who use this service experience good quality outcomes in this area. The home provides a physical environment that is appropriate for the residents. The design allows for small clusters of people to live together a non institutional way, and promotes privacy, dignity and autonomy for the residents. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: A tour of the premises took place during this inspection. The ground floor communal areas are furnished in a homely way and are clean and well maintained. Generally this home is clean, comfortable and homely for the ten male residents that live there. Since the Random inspection in April 2008, the Vaughan House DS0000014979.V367373.R01.S.doc Version 5.2 Page 20 flooring on the landings has been replaced. This has eliminated the offensive odour that was evident previously. The communal lounge is comfortable and homely and displays photographs of the residents involved in various activities. The dining area, though only small provides sufficient space for the residents to enjoy meals together. However some residents choose to eat in their personal rooms or on occasions in the lounge. Individuals’ rooms are decorated to meet with personal tastes and needs, and include furnishings that have been chosen by the individuals’ and reflects their hobbies and lifestyles. There is presently a plan to have cable and free view television installed into all the residents rooms. New flat screen televisions are already in place in preparation for this. As detailed earlier in this report we saw a pictorial ‘decorating calendar’ displayed on the wall in this home. It shows a floor plan diagram of all rooms in the home, and each person’s room is labelled with their name. Residents are encouraged to fill in details of the colour they would like it to be painted. Many had already filled details in. This included specific colour names such as ‘burnt red’ and the particular colour chart they had found their colour on. The bathroom on the first floor, which we previously felt, needed some attention, was very clean and had a plant on the windowsill. It was now fit for purpose. The garden are was tidy where trees and bushes had been cut back since our last visit, and the residents had tomato plants that they were ready to plant, and were using herbs from a herb garden in the cooking. Vaughan House DS0000014979.V367373.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, 33, 34, 35, 36 People who use this service experience good quality outcomes in this area. People who live in this home have confidence in the staff who care for them. The staffing allocation is based on delivering good outcomes for residents and is not led by staff requirements. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Since our last visit to this home in April 2008, two staff have terminated their employment here. The manager is in the process of recruiting four new staff, however she is presently waiting for Criminal Record Bureau (CRB) checks to be returned before confirming posts. At the last Key Inspection in January 2008 we were concerned that the training was not specific to the needs of the people who live here. Since this time the manager has focused on resourcing training on Mental Health, epilepsy and Autism, as well as the mandatory training. Records show that with the exception on one bank staff, all have attended as required. The Vaughan House DS0000014979.V367373.R01.S.doc Version 5.2 Page 22 one individual, who has not, is not being given any work until this training has been attended. As staff were in and out with residents throughout this visit we did not have much opportunity to speak with them in depth. However previously staff had told us that generally they felt well supported, and were happy with the recent change of management. Records show that staff are receiving regular supervision with the manager. The new manager is presently looking at ways of giving senior staff more responsibility. Rotas identify that there is a minimum of two staff on duty at all times. Due to the cross shift periods, there are usually three staff during waking hours, and one waking and one ‘sleeping in’ during the night. The manager explained that she is presently looking to recruit someone to the team, who is able to work flexi hours and has a driving licence. This will enable her to allocate staff hours to meet the changing requirements of the residents, particularly relating to activities. Vaughan House DS0000014979.V367373.R01.S.doc Version 5.2 Page 23 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, 38, 39, 42, 43 People who use this service experience good quality outcomes in this area. The manager has a clear understanding of the key principles and focus of this service. She is enthusiastic and demonstrates a strong leadership role whilst developing a transparent service that is providing person centered care based on the views of the residents We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The manager has now been at this home for six months. Her application to become Register Manager for this home is in progress at present. Since coming into post she has introduced positive changes and new initiatives to enhance the quality of life of the residents who live in this home. Generally Vaughan House DS0000014979.V367373.R01.S.doc Version 5.2 Page 24 the staff have been receptive and supportive of these changes. Those that have not have opted to leave the service. This manager is very focused on person centred care, and addressing each resident’s care individually. She constantly reinforces to residents and staff that this is their home, and must be treated as such, however consultation with other residents is always a must. One resident is keen to buy a cuckoo clock. Staff have helped him locate one on the Internet, however he has had to liaise with the other residents as to which room it will go in when it arrives. Most have opted for the dining room. The views and opinions of the people who live in this home are a priority. Residents are involved in regular meetings, including the Health and Safety group, and they are consulted on all decision making within the home. The manager is also involving relatives wherever possible, including sharing all inspection reports, in a bid to create an open and transparent culture within the home. Two relatives also attend the Health and Safety meetings. Questionnaires are being sent out every four to six months to relatives and they are also invited to meetings four to six monthly. We were given a list of concerns that had been raised at the last meeting, and the action plan of how these are being addressed. This included matters such as, privacy during visiting, activities, room decoration, offensive odours, nutrition, staff turnover, laundry and forthcoming inspections. These were all to be reviewed and discussed at the next meeting, however evidence at this inspection identified vast improvements in many of these areas already. Core processes, which caused us concern at the last inspection, such as recruitment and medication, have been addressed by the manager and are now being appropriately managed. Accidents and incidents are being reported appropriately both to CSCI and to the safeguarding team, and the manager is working hard to maintain a transparency with other agencies. The standard of record keeping and reporting was generally good, however care plans could be used more effectively as working documents, reflecting changing needs as and when they occur. Vaughan House DS0000014979.V367373.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 3 4 3 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 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 3 3 Vaughan House DS0000014979.V367373.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement Timescale for action 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 The home should consider how care plans could be used more effectively as working documents that reflect ongoing changing needs of the residents. Vaughan House DS0000014979.V367373.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Vaughan House DS0000014979.V367373.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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