Inspection on 23/06/05 for 1, 3, 5, 7 Exmoor Drive

This inspection was carried out on 23rd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

1, 3, 5, 7 Exmoor Drive 07/05/09

1, 3, 5, 7 Exmoor Drive 25/04/07

1, 3, 5, 7 Exmoor Drive 11/05/06

1, 3, 5, 7 Exmoor Drive 27/10/05

1, 3, 5, 7 Exmoor Drive 03/03/05

1, 3, 5, 7 Exmoor Drive 15/09/04

1, 3, 5, 7 Exmoor Drive 18/03/04

1, 3, 5, 7 Exmoor Drive 12/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Exmoor Drive, 1 1 Exmoor Drive Bromsgrove Worcestershire B61 0TW Lead Inspector Penny Wells Announced 23 June 2005 14:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Exmoor Drive, 1 Address 1 Exmoor Drive Bromsgrove Worcestershire B61 0TW 01527 576591 01527 871853 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Worcestershire County Council Care Home 12 Category(ies) of LD Learning Disability - 12 registration, with number of places Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 4 persons may be accommodated in each unit. 2. The home may accommodate 1 named person with an addtional physical disability. 3. The home may accommodate people with a learning disability over 65 years of age. Date of last inspection 3 March 2005 Brief Description of the Service: Exmoor Drive is operated by Worcestershire County Council Social Services Department. It is a care home for 12 adults with learning disabilities. The home is purpose built on one level and opened in 1992. It is located in a residential area approximately one mile from the centre of Bromsgrove, on a bus route and there is a range of community facilities within close proximity to the home. The accommodation consists of three, self-contained units. Each unit has four bedrooms, a bathroom, a separate toilet, an open plan lounge/dining room/ kitchen. All of the service users’ bedrooms have a wash hand basin but no ensuites. Two of the units provide long-term care and one of the units provides respite care. Respite care is provided for 40 service users for varying periods. The staff also offer support to 3 former service users now living in their own accommodation in the community and to one service user who attends the home each week as part of a long standing commitment. The aim of the service is to provide appropriate support, advice and guidance in order to enable the service users to develop their individual potential and to participate as fully as possible within the community. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection based on two visits to the home on 2nd & 23rd June 2005. Eight hours was spent in the home, also time preparing for the visits and reading information provided by the home. The first visit was to attend a meeting with representatives of Social Services and an architect to discuss, primarily, the upgrading of the toilet and bathroom facilities in the bungalows/units. At the first visit the inspectors were advised that the service was about to change, and two admissions were planned for the following week of service users with special needs, even though there was only one permanent vacancy. Concerns about the admission of two service users with differing special needs and discharge of a temporary service user, without an agreed placement, during the week of 4th June 2005, were raised immediately after the first visit, with the Responsible Individual for the County Council. However these admissions and discharge went ahead, which was of serious concern (see page 11 of this report). The second visit was to hear how the changes were being implemented, also to follow up on the outstanding requirements and recommendations from previous visits and reports. At the second visit the Service Manager assured the inspector that the changes were now ‘on hold’ until there had been a review with service users and staff had been consulted. At both visits time was spent meeting with the service users (7 permanent service users and the 3 respite/temporary service users using the service on the days of the visits) and staff on duty. The home has been without a manager for 18 months and the deputy has been acting up but does not wish to take on the manager’s role. The co-operation and time service users and staff gave the inspectors was appreciated. What the service does well: Maintaining a home for the existing permanent and respite service users, who do not have challenging behaviour nor special needs and whom the staff have known for some years. The group know each other well and the atmosphere is relaxed, secure and safe with the service being run as a home for 12 (8 permanent and 4 respite service users at any one time) in a traditional way. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 6 This atmosphere has been sustained by the staff in the absence of a manager for the last eighteen months. The service users spoke positively about living/staying at this home and the support they received form the staff. What has improved since the last inspection? What they could do better: The home needs a manager and full compliment of permanent staff to develop and change the service as proposed by Social Services. In addition to promote independent living in the three bungalows, which could be self-contained, as referred to in the Statement of Purpose. Also to implement fully the National Minimum Standards, as outlined in this and previous reports. Any changes to the service need to be planned, not rushed (as has occurred this month), following consultation with both the existing service users and staff with a programme of guidance, training and phasing in the changes. This should include reviews for the existing service users involving their representatives (families, advocates and social workers) to plan their future goals. The 31 requirements and 19 recommendations in this report, many of which are repeated, explain what needs to be done to improve the home and opportunities for the service users. Enforcement action may be taken if these requirements and recommendations are not met within the timescales given. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5 The information about the home needed updating and a contract introduced. The current service users needs were being met but it was of serious concern that a service user had been admitted to the home whose needs could not be met. Also that there had been poor practice with admissions and a discharge during June 2005. EVIDENCE: The home had a statement of purpose which needed updating to reflect the special needs of some of the service users, how the service could meet their needs and the staffing arrangements. Guidance on developing the statement of purpose was given to the Service Manager. Hence the previous requirement is still applicable. The service user guide had been prepared in an alternative format, widget, which would be suitable for some of the service users. A copy was given to the inspector. However photographs had been proposed for the guides but were still not included. It was not apparent that copies of the guide had been given to the service users nor the previous recommendations implemented. Hence the previous requirement and recommendations were still applicable. It was apparent that the two prospective service users’ needs had been fully assessed, recorded and discussed with staff from their previous homes. The staff group had identified the training and guidance they would need to meet Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 10 the service users’ special needs. The staff group had also raised their concerns about whether the service could meet the needs of one service user, in particular, but Social Services managers decided to still go ahead with this admission. This placement failed within a week, which was of serious concern as it had a negative effect on the individual, other service users and staff. The other new service user was unsettled, spoke of not wishing to stay and will need individual, additional support to enable them to become settled (see also NMS 26). The planned admission of two, new permanent service users, in the same week, and the discharge of a temporary service user, whose future home had not been agreed with him, was not good practice. It was also of serious concern that a service user had been admitted out of category/conditions of registration. An application had been received to alter the categories/conditions of registration to reflect the changes in the service but this application could not be processed until an updated statement of purpose was submitted. A permanent service user, who had become frailer, was being suitably cared for in the home. Introductory visits had been arranged for both prospective service users, as considered appropriate. The contract was still not available (previous requirement) and the Service Manager advised a new draft contract was to be discussed with the Social Services contract department. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9 The service user plans and risk assessments needed further development and reviewing, with a person centred approach. EVIDENCE: The information relating to service users had been re-organised in two files for each individual. In the sample viewed, the current file had recent information including a service user plan and life plan, which was confusing. To follow through, for example, the details and outcome of two healthcare matters, both files had to be searched and the communication book. Health action plans were said to have been completed for the service users, who retained the original document and a copy of part of the plan was on the current file sampled. This health action plan only had basic information. A member of staff was able to advise on the how the two healthcare matters had been addressed which was reassuring. However there was no up to date action plan in the current file or service user plan relating to eating and drinking, despite there being identified dietary needs. It was difficult to ascertain the individual’s daily activities (other than when the person attended a day centre) and how goals were being achieved. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 12 Detailed information had been obtained form the previous homes for the two new service users. Risk assessments were recorded. The service users plans need developing and reviewing, as previously required. The service users individual daily routines were respected by staff and they were asked about choosing meals. The previous requirement regarding senior staff acting as appointees for service users had not been addressed (see NMS 23). Two of the service users had some of their monies paid directly into their bank accounts. When the home has a manager and full compliment of staff, opportunities for the service users to participate in the day to day running of the home should be developed. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11-17 The lifestyles of the service users are being maintained during this period of instability but further work and development is needed to fully meet these standards. It was apparent that the service users had become used to being ‘waited upon’. The meals and snacks offered to the service users need to be healthy, nutritious and varied promoting healthy eating with the service users being more involved at every stage from shopping to consuming meals. EVIDENCE: The providers are committed to maintaining and developing the independent living skills for the service users. This is not happening in practice and is a priority for a new manager to address. The established, daily routines of the service users were being maintained. The majority of service users go out on some weekdays to day centres in Bromsgrove and Redditch. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 14 On 2nd June 2005 the inspectors noted that the six permanent service users, one temporary service user and one respite user were all at home because their day centres were closed for the week. They were getting up in a leisurely fashion and the majority being served breakfast, as they got up, in the communal lounge. Two of the service users appreciated the assistance they had received that morning with personal and healthcare needs. The service users were pottering about the home and congregating in the communal lounge where drinks were readily available, prepared by staff, and the television was on. They presented as contented, suitably dressed and welcomed chatting with us. None of the service users knew of any activities planned for the day, in and out of the home, nor spoke of activities or outings taking place during the week they were not attending their day centres. On 23rd June four of the permanent service users were at home for the day and three permanent service users were attending day centres. The service users who attended day centres spoke positively about their attendance and activities. In the evening the seven permanent service users and two respite service users were at home following their own interests which included one service user sorting his numbers box out, another watching a video in the bungalow, others watching television in the communal lounge and having snacks and drinks in the communal lounge. A service user and member of staff spoke about the board games that used to be played. Two permanent service users were looking forward to a holiday next month in Wales escorted by staff and another service user explained he did not like going away on holiday. Some permanent service users referred to having regular contact with members of their families and the respite service users lived with their families. Promoting independent living skills and introducing a variety of activities in and out of the home are aspects that need developing as previously identified as part of the change to the service. However this can only be achieved when the home has a manager and full, permanent staff group. It was a hot day on 23rd June 2005 and a variety of hot and cold drinks were being offered to the service users. There were no menu plans and it was said that staff knew the likes and dislikes of service users, so shopped accordingly. There was a communal stock of frozen and tinned food with little fresh food evident. Service users chose their main meal from the stock and the individual records of food provided, indicated that meals were repetitive and mainly convenience foods. There was a choice of main meal, on the second visit, but desert was limited to ice cream. The record of food provided was not detailed, as previously required. Hence it was again difficult to ascertain whether the service users were having a Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 15 nutritious, balanced and varied diet. Also see NMS 6 & 19 regarding the management of an eating problem. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20 The service users were supported by staff with their personal and healthcare needs. However the records needed to be more detailed and up to date in order to assure comprehensive information regarding personal and health care needs and to evidence outcomes. EVIDENCE: The health care needs of the service users were being recognized and when a problem arose, medical advice sought. The personal and health care needs were recorded in their files but in various places, not in detail or always up to date, and difficult to quickly access information. For example some of the service users were receiving private chiropody visits when they may well be eligible to free NHS chiropody at local surgeries. The reason for this was not recorded but a member of staff advised it was easier for the service users than going out. Doctors and nurse visits were also being arranged at home, when for routine appointments, service users could attend surgeries, escorted by staff. Also a detailed description of the eating problem a service user had was not in the service user plan, she was not regularly weighed and for some time regularly had fortified drinks. This problem needed reviewing to introduce a variety of foods and drinks with guidance sought from a nutritionist. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 17 It was said that health action plans had been completed and were retained by the service users with a copy of part of the plan in the service users’ file. The majority of staff had recently attended training on Epilepsy and administering an invasive treatment for seizures. This was beneficial, as previously the staff had only worked with service users whose epilepsy was well controlled by medication. The staff were observing and recording, throughout the day and night, the personal and health care needs of two of the service users. Bed monitors should be considered. The staff were monitoring carefully the service users who were suffering from epileptic seizures. Specialist healthcare professionals are involved, when a problem arises, to give guidance to both service users and staff. It was pleasing to hear that there had been a debriefing session for staff led by a specialist healthcare professional after an incident of challenging behaviour. The accident book was viewed and accidents were being recorded. One service user was possibly injuring herself when she fell out of bed and an occupational therapist had visited to carry out an assessment. A pair of bedside rails were in the corridor and bumpers were awaited. The home’s staff will need to carry out a risk assessment prior to these rails being installed to ensure the service user has the ability to use the bed rails safely. One member of staff suggested a larger bed, rather than using the rails and this proposal should be pursued in consultation with the occupational therapist. The medication system was not fully inspected but medication rounds were observed. The Boots monitored dosage system was in use and kept safely in locked cupboards with a carrying case used for medication rounds. The case could not be closed when a large number of medications were being taken around the home and could be difficult to lift - this needs addressing. A trolley may be preferable or medication cupboards installed in the bungalows where the permanent service users live, as there is in the respite unit. The staff were administering the medicines to service user in pairs, which was commendable, although left the service users on their own when there was only two staff on duty (observed at 8.00pm). The charts were being completed when medication was received into the home and after medication had been administered. The medicines for permanent service users were being kept tidily in a lockable cupboard in one office. Senior staff did not recall or evidence when staff had last received training in administering medication. A senior member of staff advised that there had been an invitation to a Boots training session on 22nd June 2005 but due to the shortage of staff, no one attended. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 18 Service users consent to medication being administered and an annual health check were recorded in the sample service user file viewed (previous recommendations). Further training in caring for service users who have increased personal and healthcare needs or getting older/frailer, should be considered, as previously recommended. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 The systems in place helped to ensure the service users were being protected and service users indicated whom they could go to with a complaint. However the communal arrangements for handling service users’ monies needed to be reviewed. EVIDENCE: Service users, who were asked, were clear whom they could turn to if they had a complaint or concern. The home had a complaints procedure. The home had appropriate guidance for protecting vulnerable adults. The home had admitted a service user who had challenging behaviour and in preparation for this, some staff had completed a MAPA course. Staff should be given introductory training in challenging behaviour prior to attending a MAPA course. The handling of the service users’ monies was viewed. For the majority of permanent service users, their monies were still being retained in a communal bank account and staff collecting a sum of money to keep in the home for when service users requested monies. The traditional amount given out was still £4 and none of the service users were directly receiving their full personal allowance and their mobility component on a regular basis. Records were being kept of monies deposited in the communal cash box and outgoings to individual service users, but on one sheet and not on individual sheets, in line with data protection. As previously required, this system needs auditing, then reviewing so that the service users are given their full monies to retain themselves in a suitable lockable place in their bedrooms. Staff could give support to service users who needed assistance in managing their monies. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24-30 The self-contained units/bungalows have potential but need upgrading to meet the changing needs of the service users. The home needs to be kept clean, hygienic and suitably decorated throughout, with repairs addressed quickly. A programme for upgrading the home should be introduced. EVIDENCE: The premises were purpose built thirteen years ago with all the accommodation provided on the ground floor. The home was warm and bright. Fans had been purchased in between the two visits to keep the home comfortable during the hot weather. There was access to local amenities, local transport and relevant support services. The home was in keeping with the local community. The furnishings were homely and comfortable. The home consists of three self-contained units/bungalows, accommodating 4 service users in each unit. The home also has communal facilities - kitchen, lounge, laundry, toilet, two offices, staff sleeping room with en suite shower and toilet. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 21 The units have front doors and another door leading into the main building. The service users did not appear to use their unit front doors (nor have front door keys) and used the communal entrance to the building. The units are selfcontained and the statement of purpose indicates that the aim is for the four service users to live as independently as possible within their unit. However in practice the service users use, and socialize, in the communal areas of the building. The home has an enclosed garden and patio area. Since the last inspection the respite bungalow (3) had become a home for four permanent service users because all the rooms in this bungalow are larger and more suitable for frail service users or those with mobility problems (previous recommendation). It was also being planned that a service user with challenging behaviour could be accommodated in this bungalow (this has not been successful). The respite bungalow is now bungalow 1. In order to accommodate a new service user in bungalow 3, three service users had had to move bedrooms, which is unacceptable practice, particularly as two of these service users had only just moved bungalows. Each bungalow has an open plan lounge/dining room/kitchen, a bathroom, a separate toilet and 4 bedrooms. For fire precautions, see NMS 42. There are 12 single bedrooms, on the small side, especially if a service user has mobility problems or a lot of personal equipment and belongings. However it is accepted as a pre-existing home as at 31st March 2002. The bedrooms did not have all the furniture outlined in NMS 26.2, a previous requirement. It was unclear whether all the service users had been offered keys to their rooms. At the meeting on the 2nd June 2005, it was agreed that the bathrooms and toilets would be upgraded in each of the bungalow, making better use of the space available and converting two store cupboards into shower rooms. At present some service users are using the walk in shower and specialist bath in bungalow 3 because they could not access the baths in their bungalows. The following issues were also identified: • The premises are looking fatigued and all the communal areas and some of the bedrooms need redecorating. • The home has no call bell system, which was acceptable when the service users were low dependency but now the client group is changing, a call bell system is needed. • The bedroom door locks do not have single action release internally and need to be altered or replaced. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 22 • • • Bungalow 3 does not have a washing machine whilst the other two bungalows do have washing machines. There is also a communal laundry serving all three bungalows. Consideration could be given to installing domestic dishwashers in the bungalows in place of the washing machines, which could be re-sited in the laundry (there is not space for both in the bungalow, open plan kitchens). This would be preferable from a hygiene perspective and it is anticipated that that the environmental health officer would welcome this proposal. This should not prevent the service users from washing their own clothes in the laundry. The cookers in the bungalows need checking by an accredited engineer as it was reported by a member of staff, that the knobs were difficult to manoeuvre and the oven temperature unreliable. At the second visit it was said that one cooker was to be replaced. The staff shower had been repaired by the second visit. The home was without a cleaner and parts of the premises needed a thorough spring-clean. Also on the second visit there was a poor odour control in bungalow 3, which needed addressing. At the first visit it was noted that some of the privacy locks on the toilet and bathroom doors had been de-activated. By the second visit the privacy locks had been re-activated to ensure that service users have privacy when using these rooms. The locks can be released, in an emergency, by staff. A new service user’s bedroom still needed the decorating completed and shelves installed so that personal belongings could be displayed – this may well help the person settle. The wardrobes in bedrooms need to be secured to the walls especially if the home is going to admit persons with challenging behaviour. An environmental risk assessment would need to be carried out. As previously required, a review should take place of the aids and equipment needed in the home with service users becoming frailer or having mobility problems. Listening in monitors were in use and should be replaced with a call bell system and monitors that alert staff, without a listening in device. A service user’s walking frame was noisy and again needing attention (previous requirement). The member of staff thought the walking frame was a recent replacement hence an assessment by an occupational therapist may be needed to ascertain whether this is a suitable walking frame for this environment (different floor coverings) and person. A service user’s sleeping arrangements needed an immediate review (see NMS 19) to prevent further accidents. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 23 Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34,35 There were experienced staff on duty but only by using relief (and agency) staff and there was not always a senior on duty. Staffing levels were adequate to support the service users in the home but little flexibility for staff to support service users with activities in and out of home. The home needs an effective, stable, trained staff group and sufficient permanent staff to assist the service users in developing new skills and opportunities. EVIDENCE: There were a suitable number of staff on duty on 2nd June 2005 when all the service users at home. However the three care staff were busy with domestic tasks – laundry, cleaning, breakfasts and drinks and the two senior staff were involved in meetings. This was disappointing as the staff did not have time to be involved in activities with the service users nor were the service users involved in the domestic tasks for their bungalows. The cleaner’s post was vacant. Consideration could be given to the waking night staff undertaking some of the communal domestic tasks to relieve the day care staff. On 23rd June 2005 there were the same number of staff on duty and service users, until 8.00 pm when there were two staff on duty. This limits service users being supported in attending evening activities in the community. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 25 The home was still without a manager and 7 of the 13 permanent staff were off sick. The home was relying daily on relief staff and, with the high level of sickness, also using agency staff. Hence the staffing situation was of concern. For the service to move forward, there needs to be a full permanent staff group. Between the visits another Social Services senior support worker had temporarily joined the staff team, which was of benefit. Seven permanent staff spoke with inspectors and other relief staff, also an agency worker. The staff were endeavouring to maintain the service and remained cheerful with the service users. However morale was low associated with the lack of manager, on going sickness levels in the staff team and the changes occurring to the service. Some permanent staff appeared tired and staff were also anxious about the rushed changes being imposed upon them by Social services. Staff were concerned that they did not have the skills to manage challenging behaviour and how it would impact on the existing service users. The staff were also worried about permanent service users having to move on when Exmoor Drive has been their home for many years. They were supporting service users who had epilepsy and seizures appropriately, which was new to the staff team. The rotas indicated and the inspector had observed, that on some shifts there is no senior on duty. This is essential, particularly at evenings and weekends when all the service users are at home, and with new service users being admitted. The deputy, who is acting manager, is working week days so there is senior cover in the home during these times. If a senior member of staff is not on duty, a designated senior should be identified and indicated on the rota. At night there continued to be a waking member of staff (a relief worker) and a member of a staff sleeping in but not always a senior, so a designated senior also needed to be identified for some of the night shifts. Staff files (for permanent and relief staff) had been introduced since the last inspection and the sample viewed indicated that the staff had been suitably vetted and the majority of information required was on the file. However the records for the recent staff employed were not in the home but the Service Manager gave an assurance that these staff had been vetted because they had worked previously for Social Services in different establishments. There was a file containing copies of all the Staff Criminal Record Bureau (CRB) checks, which is not recommended as per data protection and CRB guidance. As commented in the last report, the home was using agency workers but confirmation had not been obtained from the agency that the person had been suitably vetted and had the relevant experience and training to work in a care Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 26 home providing a service for users with a learning disability. The agency worker on duty had produced a CRB check for the home. The staff training records could not be located nor the training and development programme. It was said that senior member of staff was working on this but was on sick leave. Hence this standard could not be fully assessed. It was pleasing to note that in preparation for service users being admitted with challenging behaviour and/or with epilepsy and seizures, training sessions had been attended by some staff: • Epilepsy and administering an invasive treatment, • MAPA and • Administering oxygen. There were no records of the induction process for the new, relief or agency staff, as previously required. The agency member of staff said that she was introduced to the service users, shown around the home and staff were most helpful. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39,41,42,43 The conduct and management of the home needs to be addressed urgently to ensure the service users benefit from a well run home which safeguards them and encourages their involvement in the running of the home. EVIDENCE: The home was still without a manager. The Service Manager advised that Social Services were re-advertising for a manager. A quality assurance programme was still being devised by Social Services and yet to be introduced to the home. The records required to be kept in a care home had been developed but needed further work to ensure the records were detailed for every person living, staying or working in the home. The standard on Safe Working Practices is wide ranging and could not be fully discussed with the staff on this occasion. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 28 However the following was noted: • Training records in respect of safe working practices in particular quarterly fire training in-house, first aid and protection of vulnerable adults (previous requirements) could not be located. Staff did not mention any training opportunities other than those outlined in NMS 35 in this report and that 6 staff had attended the Fire Warden course in November 2004, The full fire risk assessment could not be located, Records on fire safety equipment were being kept and were up to date, Records of the temperatures of the refrigerator and freezers were being kept, Cooked meats were dated, when open and The freezers needed defrosting. • • • • • Other aspects of health and safety have been commented upon under NMS 3, 19, 20, 23, 24-30, 33 and 35. The management and conduct of the service was of concern especially after the changes had been implemented in a rush. These changes had not been discussed with CSCI nor had an amended statement of purpose been submitted. New service users were admitted out of the agreed categories and conditions of registration. It was said that the annual unit plan outlined the changes but this was not available. There did not appear to have been a consultation period with service users and staff about the changes, and in particular the compatibility of the permanent service users and 40 respite service users with new service users who have differing needs. At the second visit the Service Manager gave an assurance that a review would take place before anymore new service users were admitted to the home. The service has potential and needs developing but it was anticipated that this would take place once a new manager had been registered and was settled at the home to lead and support the staff and service users through a planned period of change. The certificate of registration was not displayed in a public place, as previously recommended. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 2 3 1 Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 2 3 2 2 Standard No 11 12 13 14 15 16 17 2 2 2 2 2 2 2 Standard No 31 32 33 34 35 36 Score x x 2 2 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Exmoor Drive, 1 Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score 1 x 1 x 2 x 2 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 30 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 5,6 Requirement A service users’ guide, that includes all of the information detailed in Regulation 5 and Standard 1, must be available in the home and copies must be given to all current, and any prospective, service users and their families. (timescale of 30.04.05.partially met). The statement of purpose must be updated, to reflect the service that is now being provided, and a copy sent to the CSCI. Service users and their representatives must be notified of any revision within 28 days. (timescale of 30.04.05 partially met). The home must not admit a service user who is out of category/conditions of registration and/or whose needs cannot be met. A contract/statement of terms and conditions, that includes all of the information detailed in Standard 5.2 and in a format appropriate to the service users’ needs, must be provided for all of the service users. (timescale of 30.04.05 not met) Service user plans must cover all Timescale for action 31.08.05 2. 1 4,6 31.08.05 3. 3 12,13 With immediate effect 31.08.05 4. 5 3 5. 6 15 30.09.05 Page 31 Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 6. 7,23 20 7. 16 5 8. 17 17 9. 20 13 of the aspects of care as set out in Standards 2.3,6-21 and Schedule 3, in particular personal health care. All service user plans must be clear, fully and accurately maintained and reviewed with the service users at the request of the service user or at least once every six months and updated to reflect changing needs. Service user plans should be in a format, which the service user can understand and be held by the service user unless there are, clear (and recorded) reasons not to do so. (timescales of 30.04.05 partially met) The practice of senior staff acting as appointee for service users must be reviewed and the service users supported in managing their own finances. (timescale of 30.04 not met) The rules on smoking, alcohol and drugs must be clearly stated in the service users’ contract. (timescale of 30.04.05 not met) The record of the food provided for service users must be developed and maintained in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory. (timescale of 30.04.05 partially met) Care staff must receive accredited training, including: i) Basic knowledge of how medicines are used and how to recognise and deal with problems in use, and (ii) The principles behind all aspects of policy on medicines and records E52 S37488 Exmoor Drive (1) V233379 230605.doc 30.09.05 31/08.05 30.09.05 30.09.05 Exmoor Drive, 1 Version 1.40 Page 32 10. 11. 12. 20 24 24 13 23 13,23 13. 14. 24,30 26 13,23 16 15. 16. 17. 26 26 27 13,16 23 23 18. 29 13,23 The method of carrying medicines around the home must be reviewed. The home must have a programme for spring cleaning, redecorating and upgrading. The cookers in the bungalows must be checked by an accredited engineer and replaced, if necessary. (timescale of 31.03.05 not met) The home must be kept clean and free of offensive odours at all times. All of the items of furniture specified in Standard 26 must be provided in rooms occupied by service users. If the provision of any item poses an unacceptable risk to the service user or they decline the provision, details of the discussions and decision about this should be recorded in the assessment of the service users’ needs. (timescale of 30.04.05 not met) The bedroom door locks must be single action release internally. The decorating and installing of shelves in a bedroom in bungalow 3 must be completed. The bathing and toilet facilities must be upgraded so that all service users can safely toilet, bath or shower in their own bungalow. (timescale of 31.07.05 not yet due) A review of the equipment in the home must take place to ensure that the service users needs can be safely met and any necessary equipment installed, including a call bell system and suitable monitors,if idetified as needed for individual service users. Also a review of the sleeping arrangements for one service 31.08.05 31.08.05 31.07.05 with immedicate effect 31.08.05 31.08.05 31.07.05 31.07.05 31.07.05 Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 33 19. 20. 29 33 13,23 17,12,13 21. 22. 33 34 18 17,19 user. (timescale of 31.07.05 not yet due) A walking frame in use must be repaired or reviewed. (timescale of 31.03.05 partially met) There must be review of the staffing arrangements to ensure consistency of care and that there are sufficient staff on duty who are suitably qualified, competent and experienced to meet the needs of both the current permanent and respite service users, as well as the new service users. The vacant cleaner’s post must be filled. There must be records kept, in the home, relating to all staff who work there, Regulation 17, 19 and Schedules 2 and 4. (timescale of 31.03.05 partially met) A record must be kept of the induction training given to all new staff, including relief and agency staff. There must be a training programme for staff to ensure that all staff have had training in supporting service users with challenging behaviour and epilepsy as well as the core training. (timescale of 31.05.05 partially met) A training needs assessment must be carried out for the staff team as a whole and an impact assessment of all staff development undertaken to identify the benefits for service users and to inform future planning. (timescale of 30.04/.05 not met) A manager must be appointed. 31.07.05 with immediate effect 30.06.05 31.08.05 23. 35 13,18 31.08.05 24. 35,42 18,12,13 30.09.05 25. 35 18,13 31.08.05 26. 37 8 31.08.05 Page 34 Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 27. 39 24 28. 41 17 29. 39,43 24 30. 31. 24,42 26,42 23,13 23,13 A quality assurance system must be introduced in accordance with the requirements of Regulation 24 and all of the aspects of Standard 39. (timescale of 30.04.05 not met) All the records that are required to be kept, must be compiled, detailed, maintained and made available for inspection at all times in accordance with Regulation 17 and Schedules 1, 2, 3 and 4. (timescale of 30.04.05 partially met) An annual development plan for the home based on a systematic cycle of planning, action, review, reflecting aims and outcomes for service users must be provided.(timescale of 31.03.05 not met) The full fire risk assessment must be located and available for inspection A review of free standing bedroom wardrobes must be undertaken and wardrobes secured to the wall if any risk is identified. 30.09.05 31.09.05 31.08.05 31.07.05 31.07.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 8 2,8 1,3,9 Good Practice Recommendations Service users should have opportunities to participate in activities that enable them to influence key decisions in the home as outlined in Standard 8.3. There should be a consultation period with the service users and staff to introduce the changes to the service and ensure compatibility with new service users. There needs to be a review as to whether this is a care home for 12 service users or a service being provided in E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 35 Exmoor Drive, 1 4. 3.9,24.4 5. 6. 7. 8. 9. 10 11 18 20 21 10. 11. 12. 21 23 31,33 13. 14. 15. 33 35 40 16. 17. 18. 43 3,4,10,16 27,42 three self contained bungalows. There should be a review of the permanent and respite services being provided in the same home, particularly with the admission of new, permanent service users with high dependency needs. The home’s statement on confidentiality setting out the principles governing the sharing of information should be issued to partner agencies. Opportunities for the service users’ personal development should be provided based on care planning and assessment, covering NMS 11-17. The staff should have training in caring for service users who have increased personal and health care needs If a service user is self-medicating an assessment should be undertaken and recorded to confirm that this is a safe practice. The agreement with service users and their relatives regarding whether the service users will be able to remain in the home when they grow older and/or if they require nursing care should be recorded in their individual care plans. The staff should have training in dealing with ageing, illness and death. A policy regarding service users’ money and financial affairs that includes all of the issues referred to in Standard 23.6 should be provided. A review should be undertaken to ascertain whether service users could be involved in domestic tasks in their bungalows and some of the communal domestic duties undertaken by the waking night staff. The adequacy of the permanent staffing levels should be reviewed. All staff should receive equal opportunities training, including disability equality training provided by disabled trainers, and race equality and anti-racism training. All of the home’s documents including the policies and procedures should be signed and dated by the manager of the home and written evidence provided to show that all of the staff have read and understood them. A business and financial plan for the establishment should be drawn up, made open to inspection and reviewed annually. The previous recommendations, outlined in the last inspection report, relating to information in the service user guide should be implemented. Consideration should be given to instaling dishwashers in the bungalows and relocating the washing machines to the E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 36 Exmoor Drive, 1 19. 41,43 laundry. The certificate of registration should be displayed in a public place such as the entrance hall. Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 37 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Exmoor Drive, 1 E52 S37488 Exmoor Drive (1) V233379 230605.doc Version 1.40 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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