Inspection on 10/12/09 for Grosvenor Terrace, 52-60

This is the latest available inspection report for this service, carried out on 10th December 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Grosvenor Terrace, 52-60 05/02/08

Grosvenor Terrace, 52-60 18/12/06

Grosvenor Terrace, 52-60 18/05/06

Grosvenor Terrace, 52-60 18/10/05

Grosvenor Terrace, 52-60 02/06/05

Grosvenor Terrace, 52-60 11/11/04

Grosvenor Terrace, 52-60 23/08/04

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Chatsworth Care - Tudor Lodge

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Grosvenor Terrace, 52-60 Grosvenor Terrace, 52-60 Camberwell London SE5 0NP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mary Magee     Date: 1 0 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Grosvenor Terrace, 52-60 Grosvenor Terrace, 52-60 Camberwell London SE5 0NP 02072771619 02072771619 52grosvenor@odysseycsft.org www.odyssey-csft.org Odyssey Care Solutions for Today Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category of 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 Date of last inspection Brief description of the care home 52-60 Grosvenor Terrace is a small care home for eight people with learning disabilities. It is in a residential street just a short distance from the shopping area of Walworth Road. The home is made up of two large Victorian terraced houses that are interconnected with a garden and patio at the back. There is a disabled parking bay outside the home that is used for the homes minibus. On the ground floor are 2 bedrooms that are wheelchair accessible. No 60 has a specially adapted kitchen for wheelchair users. The home is close to local shops, entertainment and public Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 8 1 8 0 2 2 0 0 9 Brief description of the care home amenities. There is no lift in the home. Residents have tenancy agreements. Fees range from £425 to £1106 per week, the majority of the costs funded by the local authority. The individual contributions from residents towards the costs are £62.35 per week. Residents also contribute towards transport costs. Care Homes for Adults (18-65 years) Page 5 of 35 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We undertook this unannounced key inspection in December 2009, it involved two visits to the service. We met with all eight residents over the two visits. A tour of the premises was made, all communal areas and four bedrooms were viewed. All residents we met with over the two days. They acknowledged us and communicated using signs and gestures, one resident spoke to us and told of his experiences. We discussed how people are supported and the service performance with the advocate, she has worked with the residents for numerous years and has established a successful relationship with them. Present on day one was the the outgoing registered manager, and the the deputy manager. We also met with and had discussions with five support workers. Prior to the inspection we received a completed AQAA. We spoke to the relatives of three residents. Care Homes for Adults (18-65 years) Page 6 of 35 Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 8 of 35 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 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 10 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are long term at the home, and all have their needs assessed on an ongoing basis. The service benefits from the introduction of new staff members to vacant posts, providing consistency and continuity. Evidence: We met with all eight residents during the day. All have lived at the home for many years, including when the service was managed by the local authority. Care management initially referred all current service users. Individual support plans have been developed for each resident. These were developed with residents based on the care management assessments and the homes own assessments and personal history. The home has a number of skilled staff that have worked in the home for some years, in addition they have successfully recruited some enthusiastic new members of staff that residents relate well to.Some of the temporary staff are not of the desire standard however. We observed positive interaction, especially between new members of staff and residents, sign language and pictures were used to communicate Staff are familiar with residents, and know how to meet their needs. We heard that contracts were drawn up by the provider and residents, copies were not available as they were Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: still at head office. Care Homes for Adults (18-65 years) Page 12 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home prepares and develops with each resident care and support plans that reflect the care and support they need. Individuals are supported to lead lifestyles where risks are considered, they are encouraged and supported to take risks without limiting individual choices Evidence: Case tracking was used to evaluate care arrangements. Two residents were selected for this. From both files we found improvements in the support arrangements, in particular to record keeping. Each resident has a personalised individual support plan, all were reviewed and newly developed in recent months. There was evidence that family were invited to attend reviews too. The advocate told us that she attended them too. Residents have all been supported with the development of their communication passport and individual support plans. The plans cover important information such as likes and dislikes, communication Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: needs and any general information, and guidelines that will support the individuals wishes and choices. Support plans are totally individualised and describe the guidance and recommendations on how to manage areas that may be challenging or cause harm. Residents are supported and enabled to take risks, with an emphasis on supporting decision making, and respecting freedom of choice. Reviews focus on what has worked for the individual, the progress, achievements, concerns and identifies action points. Each support plan includes a comprehensive risk assessment, this is reviewed regularly. The management of risk is positive in addressing safety issues , and focuses on improved outcomes for people. Where there are limitations recorded evidence that decisions were made with the agreement of the resident or their representative and are recorded. We found that professionals are involved in risk management. For one resident that requiring support with a standing hoist the physiotherapist was consulted on the method for correct use. A copy of the transfer programme developed by the physiotherapist was held with the risk assessment. Staffspoken to had a good knowledge on using the equipment. Link workers are allocated to support the individual, and to ensure that they are involved in identifying and setting new achievable goals for each quarter. This is closely monitored and reviewed, it is also discussed at the six monthly review meetings. We looked at how residents are supported to manage their finances, records were seen of all incoming and outgoing transactions. During handovers checks are made to ensure accuracy of receipts and money held. Two staff signatures are required for each record of transaction. These records have no evidence that they are independently audited. It is recommended that the personal finances for each resident are regularly audited. Daily records are maintained of progress and state of well being, also too records of participation in events. Weekly house meetings take place which assist residents make informed decisions and choices, alongside taking responsible and reasonable risks. Care Homes for Adults (18-65 years) Page 14 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The facilities for residents are improving, with provision made for residents to lead meaningful lives. Opportunities are available for personal development and to acquire independence. Residents with support from staff access the community and enjoy leisure activities. Evidence: The home makes some provision for residents to promote social leisure and recreational activities that reflect individual preferences. There is room for improveement. Some meaningful activities such as going to the local restaurants residents like to do, staff are allocated in appropriate numbers to enable this. We found that improvements are to be found especially in working practices, the new staff members have made a difference to the quality of time. We heard from a resident that the new staff members relate well to residents, and have made a big Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: difference to the staff team. We observed the positive approach and attitude of new members of staff. Both new staff members made time to communicate with residents, by using signage and pictorials. There were many episodes of engagement with the staff members which resulted in residents sense of well being and positive moods. We observed however a lack of enthusiasm by some staff members (agency and bank). We found that a small number of care staff were seated in the lounge on two occasions as the evening approached. There was not much engagement or interaction with residents. Some of the in house activities that take place include hand and foot massage, music therapy. We found that a number of community activities are not taking place due to cutbacks. The home needs to make sure that residents needs and capacaties are considered and that appropriate stimulating activities take place.. There are consultation meetings for residents, plus pictorial menu and rota boards. New working groups are in the process of looking at improving the menu, garden and the recycling of the house. Residents have been supported to meet new people and form friendships Opportunities are given to residents to be more involved in food shopping, some go to the local market to buy fresh produce with support staff. Food preparation is frequently done by agency or bank staff. We found that permanent staff were not involved in these procedures on both days. Food served on both days consisted of more wholesome food, but some of the dishes are preprepared food taken from the freezer. A recommendation remains in relation to food. It is recommended that the food working party works together with residents on devising appropriate menus Residents have weekly meetings and plan menus with meals that they like. This area needs to be developed further There was some progress made in the menu range. As the majority of residents are not able to verbalise the service might focus on the more able individuals and not always recognise the maximum potential of all people using the service. A recommendation is made that residents meetings are more inclusive with key workers present to enable clearer communication. Each resident is consulted on holiday choice and fully involved in deciding on planning a holiday. Residents enjoyed holidays that they choose in the last twelve months. Previously it was a group holiday for all residents. Each resident is allocated a Chat time every evening to spend time with a staff member of their choice. Photo boards of staff on duty are displayed alongside menu boards. While there are improvements in the promotion of more healthy eating such as low fat spreads, and more wholemeal bread there are more efforts required. For two of the residents the notes recorded that frequent weight monitoring was Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: required due to obesity. We found that body weights are now monitored and weights are recorded consistently. However the records are not held on the relevant sheets, we took some time to retrieve this information. A recommendation is made. Care Homes for Adults (18-65 years) Page 17 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive prescribed medication at times recommended, there are some minor shortfalls in medication procedures.The service promotes the healthcare needs of residents. Residents receive support in a way they prefer, respect is given to promoting privacy and dignity. Individuals are protected by safe medication procedures, but there are some minor shortfalls in medication procedures Evidence: While case tracking we found that each individual has their own personal care guide lines which include information around what level of support that they require. This is incorporated in the communication passports to ensure that the personal care needs are met. The residents are supported to make their own choices in regards to clothes, hair style, makeup, toiletries, bathing or showering. Residents are supported to the shops to purchase clothes that are age and peer appropriate. We observed that residents were dressed in comfortable clothes, attire presented was clean and warm. Individual residents make choices around when they retire to bed, when they rise, and are encouraged to get up on the days that they have a planned activity within plenty of time. There is an information sheet for new agency staff that they are expected to Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: read and understand before starting their first shift, which gives advice and basic information on residents support needs. Improvements were found in areas of health care promotion. Grab sheets have been developed for each resident so new staff can quickly get an overview of the health and care needs of the people that they support. Named support staff per shift works as the team Leader taking responsibility for ensure that all tasks for the shift are completed and to a good standard. Staff are good at monitoring individualsconditions, and act promptly in requesting a consultation relevant professionals if there are any concerns identified. All individuals are supported to access and attend appointment attend regular GP, dental, chiropody and hospital appointments. The team work in a proactive way so as to maintain a good positive working relationship with all outside health, multi disciplinary team workers such as GP, Occupational Therapists, Physiotherapist and behavioural Therapists. Recommendations made by the professionals are incorporated into the support plans. For one of the residents case tracked there is a history of episodes of challenging behaviour, and a refusal to use his bed at night. This is causing some inconvenience to other residents. A referral was made to behavioural specialist in relation to behaviour. Staff took on board recommendations, they record using the behaviouarl charts recommended to monitor any changes or any factors that may be contributing to this. This is used to inform further consultations and reviews. Best interest meetings are held if a medical procedure is deemed necessary, and if the individual is unable to consent. The meeting consists of all relevant professionals in order for a collective decision can be made, that clearly has that persons best interest at the forefront. The advocate also attends. We examined medication procedures, the MAR sheets and prescribed medication for two residents were audited. Medication is received in a dosset system, the amount received is acknowledge on the MAR sheet. There is no inhouse audit. It is stated that monthly audits and spot checks are done of medication procedures to highlight any shortfalls in procedures.. We found on one record an inaccuracy in relation to the dose administered, this related to a medication prescribed PRN for a resident. We explored this further and found it to be a recording error. Individual sachets of the medication stated that the contents of each sachet was 5mls, however the recording made by staff stated incorrectly that 15mls of the medicine was administered. A requirement is stated. Annual medication audits are undertaken by a pharmacist from the Southwark Primary Care Trust with any recommendations discussed with the staff team. The team uses the MDS system from the local pharmacy, and all medications are recorded as received, returned, administered, and securely locked away. Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: MAR sheets provide a full stock audit, and all staff undertake training before they can Handle or administer medication. Some of the routines at the home are a little task driven, we found this due to staffing constraints rather than weakness in practices. It is referred to under staffing. Care Homes for Adults (18-65 years) Page 20 of 35 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 are safeguarded from abuse or neglect by robust procedures. Staff are vetted thoroughly before they are employed at the home. Thye home has a complaints procedure, complaints may be raised via the advocate. But the current complaints procedure it is not accessible to residents. Evidence: We have not had any concerns raised in relation to safeguarding, the advocated attended all internal reviews. Statutory reviews have not been conducted for the majority of residents in the past eighteen months. We spoke individually to five staff members, each one demonstrated a good knowledge of procedures that safeguard vulnerable adults. Staff are not all up to date on training or on deprivation of liberties assesments, this is referred to under training standard. The home has a complaints procedure. All the residents have lived at the home for a number of years and indicate that they are aware of this, they are all familiar with and meet with the advocate in preparation for six monthly reviews. A resident told us he knows who to approach if he has complaint. However it is not accessible to the majority of residents as they are non verbal and need photos to communicate. The service should ensure that the complaints procedure is developed in a suitable format for residents at the home. Care Homes for Adults (18-65 years) Page 21 of 35 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 environment is not maintained to a good standard. Internally the premises appears shabby and uncared for, refurbishment is not done routinely and is affected by budgetary constraints. Equipment supplied to residents is not always well maintained. Evidence: The service is not addressing environmental factors, neither is attention to given to ensuring equipment used by residents is replaced or repaired promptly. Attention is not given to important equipment used by residents. We found that a resident that relies on a dynavox for communication has not the equipment he requires. This machine was out of order for over six weeks. We were told that it was reported, but staff did not indicate any concern about the residents inability to communicate as a result. There was no sense of urgency evident, or of staff chasing up the request for a replaceemnt. The home must ensure that residents are facilitated access to specialist equipment to maximise their independence, for residents supplied with equipment, these communication tools must be kept in good working order. The home does not have an on going maintenance programme. The decor requires upgrading. The quality of life for residents is being made worse by the environment they are living in. There is a lack of respect for individual choice in the home, with people having limited Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: control over the decoration programme, equipment, improvements or facilities being provided. This leads to those with limited communication or more individual needs being highly disadvantaged by the environment they are using. We were told that Odyssey Care Solutions the provider has had to impose a temporary budget freeze since the last key inspection, which has had some effect on the refurbishment of the house and the replacement of some equipment. Southwark Council have also imposed a temporary budget freeze, which has resulted in the house not being refurbished, this was required in the 2008 inspection. We viewed four bedrooms as well as all the communal areas. Some replacement second hand bedroom furniture was purchased locally to replace the broken furniture in residents rooms. The home is spacious and offers good communal facilities. However much of the environment is neglected and shabby, it is not providing a pleasant comfortable environment for people to enjoy. In some of the bedrooms viewed we found that some needed attention to decor, curtains were not attached correctly to the rails in places in bedrooms and in the lounges. The service has failed to respond to the requirements stated in the two previous inspection report. The home is very large and consists of two houses co joined. It needs significant investment to keep it refurbished and in a good state of repair. The paintwork is tired and shabby and the interior in hallways and landings needs redecorating. One shower area was refurbished. Bathroom floors continue to have hard water deposits in the form of lime scale. The interior of the home was clean but it had a strong unpleasant odour on one of days we visited. The service must take action to address odours at the home. We heard of the management of one resident that chooses to sleep in a chair in the lounge at night rather than use his bedroom. There is an issue with how he is supported with promoting continence. Care Homes for Adults (18-65 years) Page 23 of 35 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. Recruitment procedures of the service are robust, staff employed are vetted thoroughly. The staff team are relying on agency and bank staff, this affects the quality of the service. There is a quite a disparity in how staff members operate. Some of the shortfalls in staff skills are not addressed by up to date training and skills development. Evidence: The organisation had a recruitment campaign. It was not completely successful, not all vacant post were recruited to. They still rely heavily on bank and agency staff to supplement vacancies.Forty shifts were covered by agency staff. None of the bank or agency staff act as key workers. The key worker role is allocated to permanent staff members including senior staff. The agency now provides staff profiles for staff sent to the service before the person starts a shift at the house. The manager has met with representatives from Odysseys new preferred agency list to discuss the skills and abilities required for Grosvenor Terrace. This is not resolving the shortfalls in the staff team. Staff recruitment personnel files are held at head office. We examined records of recruitment, copies of Schedule 2 held at the home for the two newly recruited staff were viewed. Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: According to the information seen both staff were fully vetted before appointment. We observed the working practice of staff over the two days, we found that new staff display greater enthusiasm and interact well with residents. One of the new support workers displayed a sense of competency as she used signage with residents. Residents that are non verbal were observed to express themselves and their preferences for spending the evening. Some staff members found to be unsatisfactory are no longer in the left the service but there are issues still in relation to attitude, some of these may relate to contracts and terms. Relatives spoken to have issues in relation to a minority of staff, they speak of weekend staff having less committment, and of the continual use of bank and agency staff. We heard from relatives and advocate that there is less confidence in the service now that the registered manager has left. The organization employs staff that have a variety of terms and conditions due to the transfer from local authority, this is not satisfactory and impacts on the dynamics in the team. We heard from an advocate that there are still some issues in relations to staff approach and conduct. Attitude and approach on occasions is not always appropriate, staff can be impersonal. We observed such shortfalls directly on visits, a few bank and agency staff were seated for a period of time in the lounge, and were seen not to engage or interact with residents, in contrast to other staff present observed during the the visits. Despite frequent supervision there are still shortfalls in staff skills and attitude, conduct. Staff conduct and engagement with residents needs to be more closely monitored on each shift. Staff employed in the home (bank& agency)must demonstrate an aptitude for working with the resident group. We examined training records. A large number of permanent staff have acquired NVQ qualifications. The service recognises the importance of training, and tries to delivers a programme that meets any statutory requirements and the NMS. Not all staff are up to date on training and skills development, areas of mandatory training such as POVA are overdue for staff. The manager is aware that there are some gaps in the training programme, and plans to deal with this in the development programme. Staff must receive all the desired training and development need for their role. The service is also able to recognise when additional training is needed, but is not always in a position to provide this training. The skills and abilities of agency and bank staff are not complimenting the staff team. An incident took place when one staff member supported a resident to daycare facilities. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: We found that there is still a limited understanding of the person centred way of delivering care and support. The routines tend to be task driven but this is due to presence of temporary staff supplementing the team, also staffing levels rather than a negative or blinkered approach. Staff spoken to find that on occasions they are stretched., in particular at night time. Two residents require much one to one support. Staffing levels are not always reflective of this, over both days staff were assisting people attend events outside the home. For residents in the home facilities were quite limited due to presence of fewer staff. At night two support workers are on duty, however two residents require support with personal care that require two staff members for this. It is recommended that staffing levels are reviewed. More work needs to be done on team building. Care Homes for Adults (18-65 years) Page 26 of 35 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 has made some progress. Regular reviews take place of individual needs. Communication passports help improve communications for residents. The management arrangements for the service are unclear since the departure of the registered manager, there is a lack of leadership for the staff team. Evidence: The manager is skilled and competent, He has displayed enthusiasm, and demonstrates the capacity to recognise areas of strengths and weakness in the service. Some issues in relation to previous requirements were addressed appropriately. Others he has found to be outside his control, especially in relation to refurbishment of the environment. Relatives had confidence in the manager, but are concerned now that he has left. We heard from relatives that the organisation is not keeping relatives informed of the management changes or arrangements. Relatives say that the service is not receiving the support it requires from senior managers at Odyssey. All sections of the AQAA were completed and the information gives a reasonable Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: picture of the current situation within the service when the manager was in post. The evidence to support the comments made is satisfactory, although there are areas where more supporting evidence would have been useful to illustrate what the service has done in the last year, or how it is planning to improve. The AQAA gives us some limited detail about the areas where they still need to improve. The ways that they are planning to achieve this are briefly explained. The data section of the AQAA was completed and identified the pattern of using agency staff. The service has experienced some improvements especially in record keeping, hand overs are also more through. Individuals find that they are supported to manage their finances safely, with accurate audit trails held. Quarterly monitoring reports are sent to commissioning describing each residents progress. Annual development plans are built into residents person centred plans, with goals and objectives and these are reviewed six monthly. A values day to get the views of people using services was introduced recently. This is planned to take place annually. This also enables individuals to promote relationship, sample various cultures, make choices. Residents and staff team meetings take place regularly to gain their views. An independent advocate familiar with each resident attends all the annual reviews, relatives are also included. Despite these various methods for seeking views of residents and families there is no outcome.Information is not collated and analysed to get a view overall of the outcome of individual processes or of the service performance. A recommendation was made in the last key inspection report that the home ensures an effective quality assurance process is developed for the service involving residents and that an annual audit takes place to produce the outcome of the QA process. Shift leaders are allocated the role of leading the team on each shift and accountable for roles and duties of staff on each shift. The premises had a full health and safety check carried out, the majority of essential equipment is serviced and kept in good working order. Hot water, and fridge and freezer temperatures are checked out daily. Fire fighting equipment is serviced and tested regularly. Regular fire evacuation procedures take place. When we visited the service there was no heating or hot water, the boiler had broken down the evening before. It was still not working after fourteen hours. There was much confusion about the repair system as it is the responsibility of the local authority. Senior staff on duty were unaware of the priority of the service in case of breakdown, as a result some time elapsed before the boiler was operational again. The service must make sure that the emergency repair service for the heating and hot water system is familiar to all staff at the home. The boiler was repaired promptly when the correct contact was made with the out of hours department. Staff working at the home receive management support from the manager. He Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: allocates duties to senior staff and gives opportunity for development and career progression. We found him to be a good role model for staff, and has developed excellent relationships with residents. Residents relate well with him and feel confident and comfortable with sharing any concerns with him. We were informed by the manager of his plans to move to another organisation in the very near future. Unfortunately at the time of writing this report he has left the service. We spoke with deputy manager, there was no official handover. The deputy managers have not received a visit from an operations manager. We were not kept notified of the management arrangements for the service, in general we find that this service is not getting the support it requires. Visits in accordance with Reg 26 visits are not identifying or taking appropriate acing to address the shortfalls in the service. Relatives too are finding that the service is not operating as effectively as it was when it was run by local authority. A requirement is stated. According to information supplied on the AQAA the majority of policies and procedures were not reviewed in recent years, there is no reference to the changes and deprivation of liberties assessments. Care Homes for Adults (18-65 years) Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes R 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 1 24 23 Attention must be given to 31/03/2010 redecorating the interior of the premises in all communal areas. This remains outstanding due to budget freeze Overdue, a warning letter is issued. The timescale is extended to allow for compliance. To provide a homely comfortable environment 2 27 23 Bathroom and shower areas 31/03/2010 are heavily stained and need to be refurbished, one shower area was refurbished. Floors remain stained by hard water. To provide a pleasant environment for residents to bathe Care Homes for Adults (18-65 years) Page 30 of 35 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 Requirement 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 Requirement Timescale for action 1 12 16 The service needs to make sure that more in house activities take place for residents, As community facilities are becoming more limited alternative arrangements must be in place. 26/02/2010 2 20 17 It is stated that monthly audits and spot checks are done of medication procedures to highlight any shortfalls in procedures. To promote the safety of residents 26/02/2010 3 20 17 Accurate records must be made of all medication administered. To promote the safety of residents 26/02/2010 4 26 16 The service must make sure 29/01/2010 that in bedrooms occupied by residents that furnishings Care Homes for Adults (18-65 years) Page 31 of 35 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 Requirement Timescale for action are kept in good order, curtains must be attached correctly to the rails supplied. For the comfort of residents 5 29 23 The home must ensure that provision is made for residents supplied with specialist equipment to maximise their independence, for residents supplied with equipment, these communication tools must be kept in good working order. To preevt residents becoming isolated if equipment is not avaialble. 6 30 12 The home must be kept free from offensive odours. In order to promote and make proper provision for the health, and welfare of residents. 7 35 18 Staff must receive all the desired training and development need for their role. So that staff have all the desired skills 31/03/2010 26/02/2010 26/02/2010 Care Homes for Adults (18-65 years) Page 32 of 35 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 Requirement Timescale for action 8 36 18 Team building is required to ensure that staff work together as a team , regardless of whether they are agency or bank staff. To ensure effective teamwork 26/02/2010 9 36 18 Staff supervision must involve direct observations of working practices and interaction with residents, this must include agency and bank staff. To make sure that codes of conduct are adhered to 26/02/2010 10 37 8 The organisation must 31/01/2010 ensure that appropriate management arrangements are in place, and appoint a suitable individual to manage the home. Arrangements must be shared with the Commission. To give leadership and direction, and effectively manage the service 11 42 23 The service must make sure that the emergency repair service for the heating and hot water system is familiar to all staff at the home 22/01/2010 Care Homes for Adults (18-65 years) Page 33 of 35 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 Requirement Timescale for action So that residents are not left for long periods without heating or hot water 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 22 23 The service should ensure that the complaints procedure is developed in a format accessible for residents at the home All staff should be updated on safeguarding procedures including the use of the deprivation of liberties assessments. Staffing levels should be reviewed, the needs and numbers of residents should be supported by appropriate levels of suitably skilled staff. Policies and procedures should be updated, codes of practice, all policies and procedures should be dated monitored and reviewed. 3 33 4 40 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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