Keith Lodge & The Bungalow Care Home Service

Transcription

1 Keith Lodge & The Bungalow Care Home Service Arduthie Street Stonehaven AB39 2EY Inspected by: (Care Commission Officer) Type of inspection: Cathie McQueen Unannounced Inspection completed on: 24 May /12

2 Service Number Service name CS Keith Lodge & The Bungalow Service address Arduthie Street Stonehaven AB39 2EY Provider Number dummy Provider Name SP Crossreach Inspected By dummy Inspection Type Cathie McQueen Care Commission Officer Unannounced dummy Inspection Completed Period since last inspection 24 May Months dummy Local Office Address Johnstone House Rose Street Aberdeen AB10 1UD dummy 2/12

3 Introduction Keith Lodge and Bungalow provides residential care for children and young adults with learning disabilities. The service is provided by the Church of Scotland. Keith Lodge and Bungalow provide residential accommodation for a maximum of 5 young people and 4 adults. Up to 6 young people are cared for on the top floor of the Lodge on a respite care basis. The premises are situated within a quiet residential area within easy reach of the centre of Stonehaven. Keith Lodge was registered in April The service was in the process of reviewing the aims and objectives during the inspection. Basis of Report This report was written following an announced inspection by two Care Commission Officers on 24 and 25 May Before the visit the manager returned a Pre-Inspection Return containing information about the service and a self-evaluation form. The method of inspection included a review of records, observation of practice and discussion with the manager and staff of the service. An examination of the premises was undertaken. The Care Commission Officers also looked at a range of policies, procedures and records including the following: Personal Plans. Accident/Incident Records, Training records, Staff files, Fire Tests and Drills and Administration of Medication Policy. A team meeting and staff handovers were observed during the course of the inspection. The Inspection focused on the sections of The Regulation of Care (Requirements as to Care Services) (Scotland) Regulations Statutory Instrument 114 and takes account of the following National Care Standards for People with Learning Disabilities: Standard 1 - Informing and Deciding Standard 5 - Management and Staffing Standard 6 - Support Arrangements Standard 7 - Moving In Standard 18 - Supporting Communication The following National Care Standards for Children and Young People were also taken into account: Standard 6 - Feeling Safe and Secure Standard 9 - Making Choices Standard 15 - Daily Life and Standard 16 Supporting Communication. Feedback was given to the manager on 26 May /12

4 Action taken on requirements in last Inspection Report 10 requirements were made during the last inspection. The service has made progress in relation to each requirement and appropriate action to address these issues had been taken. Appropriate action had also been taken by the service in respect of four recommendations made. Comments on Self-Evaluation A completed self evaluation was returned to the Care Commission. The manager had identified both strengths and areas for development. View of Service Users Views of service users were not able to be ascertained during the inspection due to the level of disability experienced by some service users at the service. Children were observed interacting with staff and being cared for appropriately. View of Carers No parents were available for interview during the inspection. 4/12

5 Regulations / Principles National Care Standards National Care Standard Number 1: Care Homes for People with Learning Disabilities -Informing and Deciding The service had developed a comprehensive introductory pack which was bright and included photographs and the philosophy of the resource. Information regarding the accommodation, keyworker system, financial information, occupancy agreement and contract was provided. This information was also available in pictorial format. Ongoing work in this area was being further developed by the service. Staff and management advised that pre-admission visits would be arranged for service users considering using the service and that the keyworker would be involved in this process. An appropriate policy and procedure in relation to the reporting of accidents and incidents was in place and staff interviewed were fully aware of these. The policy for reporting incidents was under review. The service aims and objectives were being reviewed by the service at the time of the inspection. A clear statement of purpose which defines the work of all parts of Keith Lodge and Bungalow should continue to be developed. This should be specific to the service provided and written in a language that is accessible to the users of the service. This should then be made available to staff within placing authorities, and to parents, carers and young people using the service as required. (See recommendation 1) National Care Standard Number 5: Care Homes for People with Learning Disabilities - Management and Staffing Arrangements As a result of previous concerns in relation to child protection and child-care practice issues within Keith Lodge during the last inspection a task group was established by the Church of Scotland Board of Responsibility. Effective from February 2005 an interim manager and deputy manager were appointed to take forward the action plan submitted by the Board. The task group have begun a review of child protection and care practice. A newsletter was sent out advising parents and carers of the action taken by the Board in respect of these issues. The newsletter was also posted on notice boards within the Units. Subsequently a meeting for parents was arranged to update on progress made and giving parents opportunity to comment on the service provision. The service action plan in relation to requirements and recommendations made at the last inspection was well underway and all staff had received appropriate training in child protection, scip (strategies for managing and preventing challenging behaviour) manual handling and the service whistleblowing policy. The interim manager advised that these training programmes will be rolled out on an ongoing basis in the future to ensure new staff entering the service will receive training appropriate to the post. 5/12

6 New staff in post since May 2005 (3 care workers) were being inducted and this was evidenced in practice and from examination of records during the inspection. Staff were involved in shadowing experienced colleagues and stated that they benefited from this process. A sample of supervision records were examined and this formal mechanism to support staff was being developed further by the service. Staff were currently involved in developing their professional practice by undertaking HNC qualifications in Social Care and SVQ Levels 3 and 4. The service were developing partnerships with colleges and external providers to develop an SVQ plan to provide training opportunities at this level to all staff at Keith Lodge. In relation to staff recruitment the service recognised the need to recruit permanent staff members to the team and reduce the over reliance on agency staff. Agency staff, remained an integral part of the current staff team however a consistent approach had been utilised by the management and some staff had temporary contracts based at Keith Lodge to ensure a level of consistency for service users. A bespoke recruitment campaign developed for Keith Lodge and Bungalow was underway and additional resources were provided by the Board in recognition of the staffing and other difficulties experienced at the Unit. The systems in place relating to recruitment of staff and the selection process of interview and assessment procedures had been developed further by the service and training provided to those involved in the recruitment process. Staffing levels in the Bungalow were found to be at an appropriate level to ensure service users personal care needs were attended to. There was little time available to spend on social interaction with service users. Staff spoken with informed that they had supported service users to attend outings when they were off duty. The service identified within the self evaluation form specific needs in relation to assisting with guardianship and the development of communication skills and systems to further support individual service users. The interim manager also identified within the pre inspection return that appraisals were not part of the management practice within Keith Lodge it is recommended that this be addressed. Parents/carers who attended the meeting on 3 May 2005 at the church hall suggested a parents group be implemented to enable them to contribute to the life of the Unit and is a recommendation that this be taken forward by the service. It is important that staffing levels are reviewed and monitored to ensure they allow the social needs of service users to be met. (See recommendations 2,3,4) In addition, the service is required to ensure that the recording systems in place regarding non prescribed medication are adhered to by all staff. (See requirement 1) National Care Standard Number 6: Care Homes for Children and Young People - Feeling Safe and Secure Management and staff demonstrated that progress had been made in relation to children s needs for safety and security within Keith Lodge. Staff had received appropriate training in relation to SCIP and strategies to manage challenging behaviour were observed in practice 6/12

7 during the inspection. The strategies used were consistent with recordings in the care plan in place for the young person. Consent from parents/carers regarding physical interventions were observed in the files examined. Staff observed knew the children well and were vigilant in respect of the needs of the whole group. Staff were undertaking training in safe care and issues in relation to this topic were discussed during team meetings. The policy on intimate care was reviewed in March 2005 and made reference to the guidelines in the service child protection policy to identify safe working practices. Risk assessments had been updated and were maintained within individual files. Staffing levels at the Lodge were maintained at a minimum of 1:1 staff to service users. Support for service users during the night had been addressed by the management team and an additional night staff member was now part of the team. Four waking night staff now covered the three units. Some evidence of staff training in relation to fire safety was found in the recordings. During the inspection some safety issues were observed regarding security gates being unlocked and slabs in the garden which compromised children s safety and security. It is important that the service interim manager identify a health and safety representative for the unit and that this be taken forward as a matter of urgency to ensure that necessary checks of the environment and accommodation are made and action taken as appropriate. (See recommendation 5) The interim manager acknowledged that work was needed in relation to fire safety, tests and drills and it is a requirement that fire tests and drills are undertaken in line with regulations and that these are recorded. (See requirement 2) National Care Standard Number 6: Care Homes for People with Learning Disabilities - Support Arrangements The four personal plans examined pertaining to the service users in the Bungalow were found to be very detailed. Information was included on health needs and social needs. Attempts had been made to ensure the personal plans reflected the social needs of the service users and incorporated their preferences. The plans were written in a way that promoted the dignity and aspirations of the service users. This approach is commended. It is important that all pertinent information especially relating to complex health care needs is available to go with the service user in the event of an admission to hospital to ensure the service users' receive as much continuity of care as possible and the in depth knowledge of their preferences is utilised. The needs of one service user were discussed in detail with the interim manager. It is imperative that the specialist equipment needed for this service user are put in place as a matter of urgency. This included a mattress that fits the bed used, wheelchair and specially fitted chair. The service has been advocating with the placing authority regarding the funding 7/12

8 for this items. The safety needs must be addressed as a matter of urgency. Risk assessments need to be in place for all equipment used. (See requirement 3) It is important that there is access to independent advocacy for service users to provide this support particularly when dealing with sensitive situations. (See recommendations 6,7) National Care Standard Number 7: Care Homes for People with Learning Disabilities - Moving In Personal plans were found to be very detailed. Keyworkers and co-keyworkers spoken with described spending individual time with service users and were knowledgeable about their needs. There is a need to ensure that appropriate arrangements and equipment are in place for each service user prior to their admission. The needs of one service user were discussed in detail with the interim manager who agreed to take these issues forward. National Care Standard Number 9: Care Homes for Children and Young People - Making Choices Staff advised that whenever possible young people were involved in making choices for themselves in relation to food, clothing, activities etc. During the inspection a unit team meeting was observed and discussion evidenced that PECS symbols and social stories were being used to enable service users choice. Personal plans identified goals and the manager and staff stated that a coordinated approach with education and other relevant agencies focused on appropriate goals and choices. The service identified that greater use of volunteers would provide children and young people with a greater degree of choice and that this was an area for development. It is a recommended that children and young people s choice of food to be further developed. The interim manager advised this was currently under review and that the use of pictorial representations was being further developed to ensure that personal choice in this area was supported. (See recommendation 9) National Care Standard Number 15: Care Homes for Children and Young People - Daily Life During the inspection young people were observed being supported to take part in activities. These included swimming, going out to play and for tea. Personal plans referred to various 8/12

9 activities enjoyed by young people and these were reflected in the daily recordings observed during the inspection. Photographic evidence demonstrated that birthdays were celebrated and plans were underway to celebrate a move for another young person. Evidence of a young person being supported at a medical appointment and the use of pecs in this area was also observed during the inspection. The service advised they are well known in the local community and make good use of community resources. The service identified that service users involvement in menu planning was an area for development and this should be taken forward by the service. National Care Standard Number 16: Care Homes for Children and Young People -Supporting Communication Staff were familiar with the communication needs of the children and young people cared for at the Lodge. They demonstrated a knowledge and understanding of Makaton and Pecs. New staff were supported to learn and develop knowledge and skills in this area and were advised of relevant reading materials. Staff should have access to ongoing training in relation to communication needs. (See recommendations 10) National Care Standard Number 18: Care Homes for People with Learning Disabilities - Supporting Communication Personal plans in Keith Lodge and Bungalow were found to contain detailed information about the individual communication support for each service user. Staff were observed to communicate with service users in appropriate ways and offered service users choices. Staff described developing pictorial aides to support communication such as personal passports and photographic records. Daily notes evidenced considerable efforts have been made to ensure service users remain in contact with their families. Overnight accommodation was provided for the family of one service user who has to travel a considerable distance to visit. There is a need to ensure that service users have access to specialist equipment including 9/12

10 computers and software to support their communication needs. 10/12

11 Enforcement No enforcement action has been taken against this service. Other Information From observations of lunch being served on the first day of the inspection and tea on the second in the Bungalow, there is a need to review meal times with a view to making them more enjoyable therapeutic experiences for service users. This was discussed in detail with the interim manager who agreed to address this issue. The length of time one service user waited for meals to be served was unacceptable. Issues in relation to the physical environment were discussed with the manager on day 1 of the inspection. Appropriate action and improvements had been undertaken prior to the Care Commission Officers visit the following day. A programme of planned refurbishment was underway in respect of the Lodge. Requirements 1. The service is required to ensure that the recording systems in place regarding non prescribed medication are adhered to by all staff. This is in order to comply with: SSI 2002/114 Regulation 19(3)j) - a requirement to keep a record of medicines for the use of service users. Timescale for implementation: 1 week from the publication date of this report. 2. It is a requirement that in relation to fire safety, tests and drills are undertaken in line with regulations and that these are recorded. This is in order to comply with SSI 2002/114 Regulation 19(3)(b,c) - a requirement to keep a record of the procedure which is to be followed in the event of a fire and maintain a record of all tests and drills which have been conducted. Timescale for implementation : 2 weeks from the publication date of this report. 3. The service is required to ensure that the safety needs of particular service users must be addressed as a matter of urgency. Risk assessments need to be in place for all equipment used. This is to comply with: SSI 2002/114 Regulation 4(1)(a) - a requirement to make proper provision for health and welfare of service users. Recommendations 1. A clear statement of purpose which defines the work of all parts of Keith Lodge and Bungalow should continue to be developed. National Care Standards Care Homes for People with Learning Disabilities, Standard 1- Informing and Deciding. 2. It is recommended that the service address the issue of implementing appraisals for all staff. 3. Parents/carers should be given the opportunity to be involved further in the service as requested by them at the meeting on 3 May It is important that staffing levels are reviewed and monitored to ensure they allow the social needs of service users to be met. National Care Standards Care Homes for People with Learning Disabilities, Standard 5: Management and Staffing Arrangements. 5. The service is to ensure that all necessary checks of the building are undertaken to ensure the welfare of the children and young people. National Care Standards Care Homes for Children and Young People, Standard 6: Feeling Safe and Secure. 6. The service should give consideration to how pertinent information especially relating to complex health care needs is available to go with the service user in the event of an admission to hospital to ensure the service users' receive as much continuity of care as possible. 7. It is recommended that the service ensure that there is access to independent advocacy 11/12

12 for service users to provide support particularly when dealing with sensitive situations. National Care Standards Care Homes for People with Learning Disabilities, Standard 6: Support Arrangements. 8. It is recommended that the service ensure that appropriate arrangements and equipment are in place for each service user prior to their admission. National Care Standards Care Home for People with Learning Disabilities, Standard 7: Moving In. 9. The service should give consideration to ensuring that personal choice for service users is supported in relation to food and menu planning. National Care Standards Care Homes for Children and Young People, Standard 9: Making Choices. 10. It is recommended that staff should have access to ongoing training in relation to communication needs. National Care Standards Care Homes for Children and Young People, Standard 16: Supporting Communication. 11. The service should consider service users access to specialist equipment including computers and software to support their communication needs. National Care Standards Care Homes for People with Learning Disabilities, Standard 18: Supporting Communication. Cathie McQueen Care Commission Officer 12/12