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Inspection on 07/10/08 for Chestnut Road

Also see our care home review for Chestnut Road for more information

This is the latest available inspection report for this service, carried out on 7th October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Chestnut Road 44 Chestnut Road West Norwood London SE27 9LF The quality rating for this care home is: ADEQUATE A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sonia McKay Date: 0 9 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 41 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 41 Information about the care home Name of care home: Address: Chestnut Road 44 Chestnut Road West Norwood London SE27 9LF 02087613689 02087619457 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Caretech Community Services Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 13 Number of places (if applicable): Under 65 Over 65 13 13 0 0 learning disability physical disability Additional conditions: The registered person may provide the following category of the service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Physical disability - Code PD The maximum number of service users who can be accommodated is: 13 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 41 A bit about the care home 44 Chestnut Road is one of a number of residential homes owned and managed by Caretech. It provides care and accommodation for thirteen younger adults with learning disabilities. It is divided into two separate units. The ground floor has eight bedrooms and is suitable for people with learning and physical disabilities. The first floor has five bedrooms. The second floor provides a supported living service that is not part of the registered service. All units have appropriate numbers of bathroom and shower facilities and have their own kitchens and communal areas. A passenger lift is available. At the rear of the premises is a wheelchair accessible garden, part laid to a lawn and a paved area. The home is located close to the main shopping area and public transport links in West Norwood. There is limited parking available on the driveway and on the roadside. Care Homes for Adults (18-65 years) Page 5 of 41 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: ADEQUATE Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 41 How we did our inspection: This is what the inspector did when they were at the care home This unannounced key inspection was carried out over three days by one inspector. On the first day of the inspection the inspector was accompanied by a Commission regulation manager. The last key inspection on this service was completed on 25th January 2008. The methods used to assess the quality of the service being provided were as follows. Discussion with the home manager and area manager. Discussion with residents and staff. Telephone discussion with a relative and a day service provider. Telephone discussion with a placing authority monitoring officer. Looking at the Annual Quality Assurance Audit (this is sometimes called an AQAA and it provides the Commission with information about the service). A tour of the premises. Looking at records of the care provided to three of the residents. Observation of the daily activities and routines. Looking at records about staff training. Looking at how medication is handled in the home. The Commission would like to thank all who kindly contributed their time, views and experiences to this inspection. Care Homes for Adults (18-65 years) Page 7 of 41 What the care home does well There is booklet called a service users guide. This provides good information about the home and how it is run. The guide has pictures and photographs, which makes it easier to understand. The home is clean and it is close to transport links and high street shopping. Many staff have worked in the home for a long time and know the residents well. When new staff are recruited to work in the home the people running the home make sure that they check their background properly. This makes it safer for residents who are vulnerable. Residents said that they enjoyed the food. A resident said that she liked the staff and found them helpful. Residents said that they know who to talk to if they have a problem or are not happy about something. Residents have their own bedrooms and there are bathrooms that have been adapted to make them easier to use if someone has a physical disability. Care Homes for Adults (18-65 years) Page 8 of 41 What has got better from the last inspection There is better information about the type of service that each person needs. This includes any individual staff support that may be required. There are better records of what each person has to eat at mealtimes and there is more food in the house for staff to prepare. More staff are attending training in how to provide care. Staff keep better records of the amount of medication that one of the residents take. People who have made a complaint say that the home manager has looked at what they have complained about and taken action to make things better. Staff make sure that people who visit the home sign a visitors book when they come in. This makes it safer for residents. There is a new house vehicle and some of the staff drive. The vehicle is adapted so that people who use wheelchairs can be carried in the vehicle. Staff who supervise other staff have been trained to help them to do this properly. Care Homes for Adults (18-65 years) Page 9 of 41 What the care home could do better Staff must be better trained to meet the needs of some of the residents, who have specialist nutrition and personal care needs. Staff must keep better records of the food and water that they give to people who need extra help to eat. There must be better plans for how people who use the respite service need to be cared for. The people who run the home should think about the people who live in the home all of the time and whether they want to share their home with people using the service for just a few days at a time. The kitchen on the first floor is too hot and there is not enough ventilation, and there are a lot of repairs to do to make the home safer. Carpets in the communal areas and some of the bedrooms must be replaced, as they are old and dirty. The people who run the home must look at what needs to done each day and make sure that there are enough staff on duty for people to do what they planned to do. Care Homes for Adults (18-65 years) Page 10 of 41 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sonia McKay 4th Floor Caledonia House 223 Pentonville Road London N1 9NG Office Tel: 0207 239 0330 Office Fax: 0207 239 0309 E: enquiries.london@csci.gsi.gov.uk If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 11 of 41 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 41 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The statement of purpose and service users guide provide good information but there is not enough information about the respite service. Not all staff are adequately trained to meet the needs of a resident regularly admitted to the service on a respite basis. Contracts contain greater detail about the service each person is supposed to receive but they have not been agreed in some cases. Prospective residents are able to visit the service before making a decision to move in. Evidence: The service users guide and statement of purpose were reviewed in July 2008 by the new home manager. Copies of the documents were supplied during the inspection. The documents provide the information required by regulation. The service users guide is written in plain English and has pictures and photographs. This makes it more accessible to the target user group who have learning disabilities. There is little information about the arrangements made for people using the service on a respite basis. The addition of this information was recommended in the previous inspection report. There is no mention of the fact that although the ground floor is registered for people with a physical mobility, the kitchen is not adapted to those who Care Homes for Adults (18-65 years) Page 13 of 41 Evidence: use wheelchairs. It was recommended that this information be included in the guide. During the last inspection a requirement was made, as staff were not sufficiently trained to meet the specialist support needs of a resident regularly admitted to the service on a respite basis. During this inspection a training matrix supplied by the home manager indicates that nine members of staff have yet to receive training in stoma care and eight members of staff have yet to receive training in peg feeding. The home manager said that a second training session was cancelled by the trainer earlier in the year and is yet to be reorganised. The home manager contacted us after the inspection to say that the training has been re-booked for late October 2008. There are four new residents. All were moved in an emergency, as there was an environmental safety issue in their home, which was taken over by Caretech earlier this year. These residents were not referred by a local authority. Two of the new residents said that they had visited the home to meet residents and staff and to have a look around before moving in. There is also a record of the time they spent visiting the home. Staff and residents are not sure whether these moves are temporary or permanent. There is a placements officer employed within the company. This person assists the home to market vacant bed spaces and look at referral information to see which Caretech home would be best able to meet a persons needs. Individual contracts of occupancy are in place and contain details of any additional support required, for example one to one staffing arrangements. Individual service contracts are available on file but have not been signed by any party. Care Homes for Adults (18-65 years) Page 14 of 41 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Individual support plans for permanent residents have improved and residents are consulted about their own life goals and aspirations, which are included in the written plans. Essential care planning and risk information for a person using the service on a respite basis are not in place. This is unsafe for the resident. Evidence: The AQAA (Annual Quality Assurance Audit) states that there are a set of individual support plans and risk assessments for each resident. The key staff aim to review each plan and risk every six months and if changes occur to update them. Individual planning records for three residents were looked at. One resident had a good set of plans. The plans and risks had been reviewed recently by the home manager and the views of the resident, including his personal goals, are included. Plans for a second resident who has recently moved in are also good, containing clear and concise information about support needs and risk areas. Individual support plans cover areas such as personal care, communication, sexuality, nutrition and emotional needs. Plans for one of the people who uses the respite service (one ground floor bedroom is set aside for respite care) were not available. Staff are Care Homes for Adults (18-65 years) Page 15 of 41 Evidence: working to plans written by a relative of the resident 12 months ago (October 2007). Whilst the knowledge of the relative is essential this information must be available in home support plans along with up to date information about risks. This is unsafe. Whilst there is evidence that staff have an understanding of some of the cultural needs of the current residents these have not been developed into specific support plans. One resident spoke about planning meetings with her key worker and was familiar with the content of her written plans. Each resident has a key worker who is responsible for meeting with the resident on a regular basis to discuss how things are going. Care Homes for Adults (18-65 years) Page 16 of 41 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents engage in a range of activities appropriate to their age and personal interest, although staffing levels and shift planning difficulties sometimes reduce the opportunity for valuable occupation. Residents are supported and encouraged to maintain their family links and friendships. Food supplies are adequate although residents with specialist feeding needs are at risk as staff are not adequately trained and records indicate incorrect feeding or poor record keeping. Evidence: The AQAA (Annual Quality Assurance Audit) states that all residents are encouraged to have a full and active week that includes both educational and practical interests. These include clubs and local amenities such as exercise classes and the cinema. All residents require staff support to access the community and there is an adapted vehicle available to help with transport to and from appointments, activities and day services. One resident, who moved to the home recently, is continuing to enjoy regular Care Homes for Adults (18-65 years) Page 17 of 41 Evidence: training in martial arts. Another resident spoke of going to church and enjoying a birthday party in the home. Some other residents have additional one-to-one staff support for specific activities. Over the course of the three days of this inspection staff were observed to have difficulty in meeting the activity and appointment plans for some of the residents. Changes in day service arrangements for one of the respite residents meant that staff had a two-hour round trip to drop him at a day service. Another resident was taken for the two-hour round trip so that the member of staff left behind did not have too many residents to look after. Later in the day late shift staff prepared the same resident to do the round trip again to collect the person from the day centre. I questioned whether this was of any value to the resident who had already sat in a wheelchair in the house vehicle for two hours in the morning. Staff reconsidered and left him at home. Feedback from a local authority contracts monitoring officer who was visiting the home on the first day of the inspection, indicated that one-to-one hours put in place for activities for the resident she was reviewing had not taken place on that day due to staffing level difficulties. One resident on the ground floor was observed to be placed in her wheelchair in front of a television in the communal lounge for extended periods of the day. Staff on duty said that it is sometimes difficult to support each persons planned activities, as there are not enough staff on duty. There has been a complaint from one day service about the inconsistent staff support that residents receive when attending community-based activities. Staff support residents to keep in touch with their friends and families and some residents can do this by themselves. The home manager has an understanding of the importance of addressing peoples sexual needs. Residents are encouraged to look after their own bedrooms where possible, although staff assist with cleaning and tidying up as necessary. Each floor of the home has its own kitchen. Food stocks were adequate during this inspection and included fresh fruit and vegetables. A record is kept of the meals that each person eats and there are also menu plans that residents are encouraged to contribute their ideas to. Cultural and personal preferences are considered and included. Residents who commented said that they enjoyed the meals. Some of the ground floor residents have complex nutritional needs and swallowing difficulties. This means that they are fed either entirely or additionally with PEG feeding tubes. This involves careful monitoring and recording. During this inspection it was found that records showed incorrect recording of fluid input; the volumes required in a feeding and fluid plan, dated 14th January 2008, for a respite resident, had not been administered correctly. The records seen were not in accordance with a nutritional and fluid intake plan. It must be noted that a relative made a complaint that the resident may not have been given enough fluid whilst staying in the home for a period of respite care. This issue was the subject of a requirement in the last two inspection reports, and an area of recording that staff have found consistently difficult. Fluid intake records for another resident are also not in accordance with a nutritional feeding plan. The Care Homes for Adults (18-65 years) Page 18 of 41 Evidence: previous requirement is not met. It must also be noted that not all staff working on the ground floor (where specialist feeding is in place for three people) have received the training that the Commission required during the last inspection. Copies of these nutritional plans and records of fluid and food intake were taken away and retained by the Commission and we are currently considering taking enforcement action on this matter. Care Homes for Adults (18-65 years) Page 19 of 41 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The quality of information about how each person is to be assisted with their personal care is varied, some support plans are good and some are poor. Staff keep good records of healthcare appointments and call for external advice as necessary. All staff must be properly trained to meet the specific health and personal care needs of the residents that they are working with. Record keeping is poor in regards to specialist nutrition and there is a danger that residents do not receive the correct amount of liquid food and water. Medication is being handled safely but there must be better information for staff about when emergency medication is to be used and who can authorise use. This must be done to ensure that residents receive their medication, without delay, when it is needed. Evidence: There are individual support plans for how each person is to be assisted with their personal care. Of the three sets the plans examined two were sufficiently detailed and one set of plans were prepared by a relative. This is inadequate. Residents require varying levels of support with personal care from total hands-on support to verbal prompting and monitoring. Some residents require staff assistance to move from their bed to their Wheelchair. Hoists are available for this. The home aims to provide same Care Homes for Adults (18-65 years) Page 20 of 41 Evidence: gender personal care support. Some residents require two members of staff to assist with lifting operations, and it cannot be guaranteed that the person assisting with the lifting is of the same gender. There are more female residents than male residents and there is a high ratio of male staff. This is not ideal. One person using the service on a respite bases has had particular problems in having his personal care needs met consistently. Not all staff have been trained in the specialist assistance he requires (urinary catheter and care of stoma). Records relating to fluid and food intake are not in accordance with fluid and feeding plans. There are good records of health appointments that the residents attend and when a health professional visits the service consultations or treatment are carried out in the privacy of bedrooms. Visiting health professionals, like specialist nutrition team and district nurses, complete their own records. Staff demonstrate an understanding of the process for making health treatment decisions in someones best interest if the resident is unable to fully understand the implications of treatment or cannot make a decision for themselves. This involves consultation with health professionals care managers, relatives and advocates as necessary. Health action plans that are accessible to residents with a learning disability are not in place. This would be of benefit to residents who may find text only documents difficult to understand. Medication is stored securely in wall mounted steel cabinets. There is also refrigerated medication storage. The refrigerator used for medication on the ground floor has an integral thermometer that is not working properly. Regular temperature checks are not taken or recorded. This is dangerous because medication may be stored either too cold or to warm to be effective. Medication is supplied by a local pharmacy who provide printed medication administration records and supply prescribed medication in blister packs where possible. Medication protocols are in place for each resident within the medication administration record file. Information about side effects and when to seek medical attention is also available. There are no apparent gaps in recording in the medication administration records and a justified stock check of a prescribed medication proved accurate administration. There were no controlled drugs in stock or prescribed at the time of the inspection and all prescribed medication is in stock. A stock balance check is done each day by a senior member of staff. This is a way of checking whether staff are administering correctly. Guidelines are in place for the use of as required medication that should only be administered in certain circumstances. Guidelines about medication to be administered when one resident is having a bad seizure indicates that staff should contact the company on-call manager by telephone to authorise the administration. This may cause unnecessary and dangerous delay. This was the subject of a requirement in the last inspection report. This requirement is not met. These guidelines must be reviewed to ensure that staff Care Homes for Adults (18-65 years) Page 21 of 41 Evidence: have clear information about who makes the decision and authorises the use of each of the as required medications in use at the home. There are no reported mistakes or accidents relating to medication administration by staff. None of the residents are self-medicating at this time, although lockable storage can be provided in bedrooms if necessary. Care Homes for Adults (18-65 years) Page 22 of 41 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents and relatives can be assured that the new home manager is responding properly to any concern or complaint that they might have and is taking effective action to address issues when she is made aware of them. The complaints procedure is readily available and has been produced in an easy read document to make it more accessible to people who find text only documents hard to understand. Procedures are in place for responding to potentially abusive situations and incidents. The majority of staff are trained to recognise abuse and what action they must take if they suspect abuse is taking place. This includes notifying all appropriate authorities. Evidence: There is a complaints policy and procedure. It is available in an accessible format with pictures and photographs to make it easier for people with a learning disability to understand. Discussion with two residents indicates that if they were unhappy about anything they would talk to staff and they are confident to make complaint or raise a concern if they need to. Some residents do not communicate verbally and it would be difficult for them to make a complaint. The AQAA states that residents are provided with opportunities to discuss issues about the service and the running of the home. Key workers have regular one-to-one sessions with residents and there are occasional group meetings where residents can discuss things altogether. Each resident has a copy of the complaints procedure in his or her own bedroom. Care Homes for Adults (18-65 years) Page 23 of 41 Evidence: Records relating to complaints that the home manager has dealt with since the last inspection in January 2008 were looked at. These records show that the home manager has investigated each complaint, taken appropriate action and kept a record of what was done to address the complaint. A relative complained that a resident may not have had been given a sufficient amount of fluid during his respite care stay in the home, as when he got home his urine was dark. This is significant in that we found records in regards to fluid and nutritional intake for the resident to be not in accordance with a fluid and feeding plan during this inspection and previous inspections. Another complaint was from a day service who were concerned about the quality and consistency of staff support that a resident was receiving to attend daytime activities (poor attendance, late attendance and poor support during planned music session activities). I spoke with the complainant who said that the complaint had been investigated; feedback given and there has been an improvement in the quality and consistency of staff support for the resident since. I also spoke with a relative who had made a complaint about poor communication about health matters. The relative said that communication has improved considerably since the new manager took over. This indicates that complaints are being investigated properly and appropriate action is being taken to address any service deficits identified. The new home manager has also introduced a visitors guide to the home. This contains information about how to raise a concern or give feedback to the service. Almost all of the staff have attended training in safeguarding vulnerable adults. The training was supplied by the local authority. Staff who were unable to attend should be trained as soon as possible so that they recognise abuse situations and take appropriate action to report. The local authority safeguarding procedures are available for staff reference. There been two safeguarding investigations since the last inspection visit. There are regular safeguarding meetings chaired initially by the Lambeth safeguarding co-ordinator. These meetings are now chaired by Lambeth contracts and monitoring and are attended by managers and area managers on behalf of the registered provider. These meetings were arranged because of a high number of safeguarding issues. The number of safeguarding alerts has decreased and the managers and staff are aware of how and when an issue should be referred for investigation. During the last inspection it was noted that some people were coming in and out of the home without signing the visitors book, which is located in the reception. A requirement was issued about this, as this does not provide adequate protection for the residents. During this inspection it was noted that staff are asking people to sign the book, and the book has many daily entries. The requirement is therefore met. Care Homes for Adults (18-65 years) Page 24 of 41 Evidence: Residents need assistance to manage their money and financial affairs. The nature of the assistance required is documented in a specific plan. A spot check of money held in safe keeping for one resident tallied with the associated record. Receipts for any expenditure made are also retained. A representative of the registered provider checks these records and money held in safekeeping on a regular basis during monthly monitoring visits conducted in accordance with Regulation 26. Staff also do a daily check during handovers between shifts. This provides adequate safeguard from financial abuse. Care Homes for Adults (18-65 years) Page 25 of 41 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is suitable for people who use wheelchairs, although kitchen facilities on the ground floor are not fully accessible. Staff keep the home clean but there are many outstanding repairs and these must be done swiftly to improve the safety and quality of the home environment. Evidence: The home is divided into two units, the ground floor unit and a first-floor unit. Entry to each unit is via key code. There is a second-floor but this does not provide a registered service. It is used for people who require lower levels of support. The home is close to transport links and high street shopping. The ground floor is suitable for people with physical disabilities who use wheelchairs. There are wide hallways and hoists to assist with transfers in bedrooms and bathrooms, although kitchen facilities are not fully accessible to those who use wheelchairs. There are an adequate number of bathrooms, toilets and hand washing facilities, well stocked with soap and hand towels. There is a passenger lift between floors. Access to a passenger lift equipment room is Care Homes for Adults (18-65 years) Page 26 of 41 Evidence: via the ground floor office. The flooring is damaged at the threshold of the room and must be repaired to prevent trips and falls. There is a small level garden at the rear with direct access from the ground floor lounge. The garden is south facing and gets good afternoon sun. There is front of house parking. There is a small garden shed in the rear garden. The door to the shed is broken and it is leaning against it and glass in a window is also broken. This is unsafe. A garden gate is also very wobbly and should be repaired or replaced to ensure safety. The premises were clean and pleasant smelling throughout although areas of the home are due for redecoration. The bedrooms seen were well furnished and, other than the bedroom used for respite care, personalised. A resident said that she did not have enough shelves that she is able to reach in her bedroom. One of the bedrooms in the ground floor unit is set aside for use by people on a respite basis. People using the respite service share the main communal areas with permanent residents. This is not ideal. During a tour of the premises it was noted that carpets in the communal areas of the home are old and dirty. They need to be replaced. The kitchen on the first floor does not have a window and is not adequately ventilated. A bathroom extractor fan is also not working. This is causing high temperatures and difficult working and living conditions for those on the first floor. There is also exposed pipe work connected to a central heating boiler in the kitchen. These pipes must be covered to prevent contact burns. The kitchen ceiling is in need of redecoration and kitchen cabinets are in a damaged state and should be replaced. The door closure device does not work and should be repaired or replaced. The laundry room on the first floor is also used to store substances hazardous to health, such as cleaning materials. A lock has been removed from the door leaving a large hole in it. This means that the door is ineffective as a fire door. This is dangerous. One of the first floor bedrooms is rather small, and the resident has many possessions that are in piles on the floor. Suitable storage should be available in this room. A net curtain on a window in one of the resident’s bedrooms on the ground floor is too short and should be replaced with something that provides adequate privacy to preserve the residents dignity. A wardrobe is also partially obscuring the light from the window. One of the bathrooms on the ground floor is being turned into a laundry room, as the current laundry room is too small. This bathroom is not in use and should be locked, Care Homes for Adults (18-65 years) Page 27 of 41 Evidence: as there is a broken electrical point with exposed wires. The extractor fan is broken and the thermostatic valve on the radiator is also broken leaving the radiator permanently on. The ceiling in the ground floor laundry room is damaged by water leak and must be redecorated. On the day of the inspection the ventilation was reported as broken and there were high temperatures in the laundry room. Some areas of the building have a flat roof. The edges of the flat roof are exposed in some areas and must be repaired to prevent water from getting into the building and causing damage. The AQAA states that a programme of redecoration is on going but swift action must be taken to improve the quality and safety of the physical environment. Care Homes for Adults (18-65 years) Page 28 of 41 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . There is progress in ensuring that residents are supported by competent and qualified staff however not all staff have received training in meeting the specific health needs of some of the residents. A previous requirement made in this regard is not therefore met although the home manager has moved quickly to book the necessary training to address this. Staff recruitment practices ensure that residents are protected. Evidence: The home is staffed on a 24-hour basis. The stated staff ratio of the service is one support worker for two residents, however some of the current residents have higher or additional care needs and placing authoritys have purchased additional hours of care that are to be delivered on a one-to-one basis. At the time of this inspection there are five residents on the ground floor. There were three members of staff on duty during the day and two members of staff on duty at night. There are five residents on the first floor and three members of staff are scheduled to work each daytime shift. Some residents require the support of two staff to assist in moving and handling and personal care. During the course of this inspection staff were observed to have difficulty in planning the shift to ensure that people attended their daytime activities and received their oneCare Homes for Adults (18-65 years) Page 29 of 41 Evidence: to-one staffing hours. This was, in part, caused by changes in the daytime activity plans for one of the respite care residents which meant that four hours of staff time were being used to take him to a day centre and to collect him at the end of the day. This meant that two members of staff were required for each two hour round trip in the house vehicle, leaving only one member of staff on duty with four residents. Feedback from a local authority representative also indicates that staff on the first floor were also unable to deliver planned one-to-one care for one resident because of staff shortages due to sickness which could not be covered by an agency used. The placing authority are concerned that this was not recorded and there is no apparent mechanism for delivering the extra care at another time. There are three vacant placements on the ground floor, so there are fewer staff on duty and less opportunity for economy of scale. Staffing levels were increased as a result of the last inspection and a requirement was issued to ensure that adequate staffing levels are maintained at all times. Given the changes in one-to-one staffing and planned activities for some residents. The staffing levels should be reviewed again to ensure that an adequate number of staff are on duty to meet the needs of all residents. Staff on duty on the ground floor said that they found it difficult to meet everybodys needs with current staffing levels, especially when respite residents with higher care needs are using the service. Staff duty rotas indicate that many staff are working every weekend. Several staff said that they are unhappy about this as it impinges on family life. The home manager supplied the Commission with the staff-training matrix. This shows that the home is making progress in developing a qualified staff team. There are 25 staff on the team, including the managers. 15 members of staff have already attained a National vocational qualification in care at either level 2, 3 or 4. One member of staff is currently undertaking the award and a further three members of staff are booked to commence the course later in 2008. Of the five remaining staff, one is leaving the service and the remaining four are to be booked on to an NVQ course as soon as possible. It should also be noted that some members of staff who have attained an NVQ level 2 will also be commencing a course at level 3. The training matrix details the training the staff have already attended and also the date when a refresher course is due. The home manager contact the company training department to arrange training as required. Essential training in stoma care is rebooked for the 28th of October 2008. This training is booked to ensure that staff who missed the last training session are adequately trained to meet the needs of one of the residents uses the service on a respite bases. Seven members of staff including the home manager are yet to receive training in PEG feeding. The training that is available is in first aid, stoma care, Peg feeding, epilepsy and rectal diazepam awareness, report writing, adult protection, autism awareness, infection control, supervision (supervisors only), risk assessment, diabetes and gluten-free diets, the mental capacity act, non-violent crisis intervention, alternative communication, medication (senior staff only) mental health, food hygiene, fire Care Homes for Adults (18-65 years) Page 30 of 41 Evidence: training and moving and handling (client based). There is a structured induction programme in place for new staff. All staff are provided with a copy of their job description which details all areas of work. This work is monitored through supervision and appraisal. A record of team meetings held on the ground floor shows that staff have attended five team meetings in 2008. The service aims to have a staff meeting each month but this has not been achieved in some months. There is progress in ensuring that all staff in a supervisory role have attended training in supervision, as required in the previous inspection report. Many of the staff of work in the home for years and know the residents well. Feedback from a relative and from two of the residents indicates that staff are valued. Caretech is a large national company. The Commission has assigned a provider relationship manager to the service. As part of this role the provider relationship manager has looked at the recruitment process that the company uses and has sampled the recruitment records of new and existing staff. He has deemed the recruitment procedures to be good. This means that the company has taken up adequate checks against new members of staff including a check of their criminal records background. Care Homes for Adults (18-65 years) Page 31 of 41 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The service had undergone significant management change in the last 12 months and a period of management stability would be of benefit to staff and residents. The new manager not yet registered but she is experienced and there is positive feedback about her management style. The registered provider is monitoring the running of the service on a regular basis. Quality assurance reports are not available although a quality monitoring team has been appointed. Procedures are in place to ensure environmental health and safety. Evidence: The previous registered home manager left the service in January 2008 soon after registering with the Commission. A new home manager joined the team in February 2008, and is in the process of being assessed as a fit person to manage and registering with the Commission. The manager is experienced and feedback from relatives, residents and staff is that she is approachable and communicates well. The manager facilitated this inspection and completed that AQAA (Annual Quality Assurance Audit), a document that provides the Commission with information about the service. There is only one deputy manager in post at this time; there were two at the last Care Homes for Adults (18-65 years) Page 32 of 41 Evidence: inspection, one for each floor of the home. The new home manager said that this has been done to try and unify the management of the ground and first floor staff teams. The area manager visits the service in each month in accordance with regulation 26. These visits are to monitor and report on the running of the home on behalf of the registered provider. Copies of the outcomes of these visits are supplied to the manager. Gas and electrical equipment are safety tested each year and the passenger lift and portable lifting equipment are tested professionally on a regular basis. Policies and procedures relating to health and safety issues are in place and are reviewed regularly. Fire escape routes are well posted, as are fire evacuation procedures and a building floor plan. There is a new quality assurance team in place and quality assurance systems are being developed. A full quality assurance assessment is due for completion. The outcomes of the quality assessment should be supplied to the Commission. Care Homes for Adults (18-65 years) Page 33 of 41 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 34 of 41 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 3 18 Ensure that staff are adequately trained to meet the needs of any resident offered respite placement in the home. To ensure the health and safety of the resident. 25/11/2008 2 6 15 27/11/2008 The support needs of all residents must be developed into written plans for how they are to be cared for. This must be done to ensure that staff have up-to-date information on how each person is to be cared for and supported. Care Homes for Adults (18-65 years) Page 35 of 41 3 9 13 Risk areas must be identified 27/11/2008 and reviewed regularly. This must be done to ensure the safety of the residents. 4 17 12 Residents who require PEG feeding must be given the correct amount of food and water. 27/11/2008 To ensure their physical health and to provide adequate nutrition. 5 19 12 Staff must be adequately 27/11/2008 trained to meet the needs of a resident with a urinary catheter. To ensure that staff know how to support a resident who has a urinary catheter. 6 19 12 27/11/2008 Staff must be adequately trained to meet the needs of a resident who require stoma care. To ensure that residents who require Stoma care are cared for correctly 7 20 12 The registered person must 27/11/2008 review the guidelines in place that assist staff in making decisions about administering a medication that is prescribed to be used as required. Guidelines must be clear and must not involve unnecessary or dangerous delays in Page 36 of 41 Care Homes for Adults (18-65 years) administration. To ensure that residents receive treatment in a timely manner. 8 24 23 Water damage in the ground 27/01/2009 floor laundry room must be repaired and the room redecorated. To cover water damage. 9 24 23 The door closure device on the first floor kitchen door must be repaired or replaced. 27/12/2008 To ensure that the door closes properly when the fire alarm is activated. 10 24 23 A ground floor bathroom that 27/12/2008 is not in use must be locked or the electrical socket repaired to make the room safe. Ventilation in this room must also be repaired if the room is used. To ensure the safety of residents and staff. 11 24 23 Net curtains in a ground floor 27/12/2008 bedroom must be long enough to provide privacy for the occupying resident To ensure privacy and dignity are maintained. Care Homes for Adults (18-65 years) Page 37 of 41 12 24 23 The first floor laundry room door must be a fully functioning fire door without holes in it. 27/12/2008 To prevent the spread of smoke during a fire. 13 24 23 The first floor kitchen ceiling must be repainted. 27/01/2009 To remove water damage marks. 14 24 23 Stained carpets in the communal areas must be replaced. 27/12/2008 To provide a pleasant home environment. 15 24 23 Exposed pipe work connected 27/12/2008 to a central heating boiler in the kitchen must be covered. To prevent contact burns. 16 24 23 Ventilation in the first floor kitchen must be improved. 27/12/2008 To provide better living and working conditions and to reduce high temperatures. 17 24 23 The garden gates must be repaired. 27/12/2008 To prevent injury. 18 24 23 The garden shed door and window glass must be repaired 27/12/2008 Care Homes for Adults (18-65 years) Page 38 of 41 To prevent injury. 19 24 23 The floor in the passenger lift 27/12/2008 equipment room must be repaired to provide a level and safe walking surface. This must be done to prevent trips and falls. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 1 1 The statement of purpose and service users guide should contain information about the respite service. The service users guide should tell prospective residents that ground floor kitchen facilities are not accessible to people who use wheelchairs. All parties should sign individual contracts of service. Each persons cultural needs should be developed into individual plans. Health action plans that are accessible to residents should be developed so that they can be more involved in the crucial area of planning for pro-active healthcare. There should be a photograph of each resident in their associated medication administration record. The temperature of the refrigerated medication storage cabinet must be checked and recorded on a regular basis to ensure appropriate storage temperatures are being maintained. Staff who have not yet attended training in the safeguarding of vulnerable adults should be trained as soon as possible to ensure that they recognise abusive situations and know what to do to protect people. Damage to the flat roof at the rear of the premises should be investigated and repaired to prevent water entering the building. Page 39 of 41 3 4 5 5 6 19 6 7 20 20 8 23 9 24 Care Homes for Adults (18-65 years) 10 24 The registered provider should review the suitability of offering respite placement on the ground floor. Communal space and staffing are shared with permanent residents and it is difficult to see how this benefits either group of users. Staffing levels should be reviewed in light of the changing needs of current residents (including anybody using the service on a respite bases) and additional staff put in place if assessed as required. All staff should be trained in PEG Feeding. 11 33 12 19 Care Homes for Adults (18-65 years) Page 40 of 41 Helpline: 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 We want people to be able to access this information. 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