Inspection on 21/01/08 for 1-5 New Street North

This inspection was carried out on 21st January 2008.

CSCI found this care home to be providing an Poor 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1-5 New Street North 02/04/07

1-5 New Street North 08/01/07

1-5 New Street North 01/06/06

1-5 New Street North 17/01/06

1-5 New Street North 05/07/05

1-5 New Street North 23/03/05

1-5 New Street North 02/12/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 1 - 5 New Street North West Bromwich West Midlands B71 4AQ Lead Inspector Mrs Cathy Moore Unannounced Inspection 21st and 22nd January 2008 09:40 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 - 5 New Street North Address West Bromwich West Midlands B71 4AQ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0121 553 1755 0121 553 4254 enquiries@lonsdale-midlands-limited.co.uk Lonsdale (Midlands) Limited vacant post Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd April 2007 Brief Description of the Service: 1-5 New Street is a care home for 8 younger adults who are learning disabled and require additional support due to presenting behaviour that may challenge. The home comprises of 8 single rooms, a domestic style kitchen, 2 bathrooms, laundry, 2 lounges, an activity area, sensory room and a dining area. A lift services the first floor. Entrance to the home is via a coded door lock at the front, leading to the porch area. The home is situated on a slip road just off the main road adjacent to Dartmouth Park in West Bromwich. West Bromwich town centre is within walking distance and parking space is available at the front of the home. There is a lawned area to the front of the building and a small patio area located to the rear. The service has its own transport and regularly accesses local facilities. The range of fees was is not detailed in the services; ‘ Service User Guide and Statement of Services’ ( date issued 1 September 2007) as they should be. 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days. An inspector and a pharmacy inspector took part in the inspection. Before the inspection we sent questionnaires to a number of people but only received four back. We asked the manager to fill in one of our big questionnaires so that we had up to date information about what is good about the home and was in not so good. We spoke to one person during the inspection and spent some time observing others on the second day. We spoke to three staff, the deputy and the manager. We looked at the care provided to two people who live at the home. We looked at their records, their bedroom, spoke to staff about them and looked at them to see if they were happy or sad. We looked at food records and the kitchen, which, was being planned to be refitted the next week. We looked at staff records to see how well the home employs new staff and trains them. We looked at medication to see how well it is looked after. We looked at parts of the home such as; the lounges, dinning room, three bedrooms, the kitchen and laundry. The Quality rating for this service is 0 star. This means that the people who use this service experience poor quality outcomes. What the service does well: The home belongs to a big company, which means that staff can ask for help and support. The atmosphere is happy and friendly. The home has transport so that it can take people out. The home is in a good place by a town where there are many shops and a park where people can go and have fun. 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3. Quality in this outcome area is good. Written information is available within the service to assist people in deciding if the service can meet their needs. The service recognises that previous shortfalls in assessment processes have placed people at risk and are taking action to ensure that this is corrected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw that a registration certificate for the service was on display in the front entrance hall. The certificate was accurate and up to date. We also saw that a document ‘Service users guide and statement of services ‘ dated September 2007 was available in the front entrance hall. Although this document did not show the range of weekly fees applicable for the service as it should, we were provided with evidence to confirm that this issue is in the process of being addressed. It is positive that a copy of the ‘ service user guide and statement of services’ is also given individually to people who live at the service. It is positive that the ‘service user guide and statement of services’ has been revised since the last inspection giving people who use the service, written upto- date confirmation of what is provided and the services offered. The 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 9 document has been produced in a mixture of pictures and words to make understanding easier. No new people have been admitted to the service since 2004 so we were unable to audit any new admissions processes. We looked at the admissions policy which GW the area manager confirmed; “Was the most up to date”. We asked GW, what the service would do if there was a new admission. She told us ; “Obtain all information from the funding authority, the service would do it’s own assessment, seeing the person more than once in their existing environment, including people who already use the service in admissions process to ensure compatibility, overnight and weekend stays before admission”. GW told us; “In the past New St has been a ‘dumping ground’ .If we had a vacant bed it was filled. Little information about people was obtained and admission processes have been basic, this has caused a big problem here which, we recognise. This will never happen again”. GW also told us; “ We do intend to reduce our numbers by two. A is probably going to independent living and M who is in Orchard Hills for assessment has stated he does not want to come back”. A it is felt, may be better living nearer her family.” We discussed this situation further telling GW that we would be assured further that the risk in the service was lower when numbers had actually been reduced as, there are too many people living at the service who have diverse and complex needs”. 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, 10. Quality in this outcome area is adequate. All people accommodated have a written care plan. The care plans are well presented and generally informative. We found that one agency staff member was not aware of what was written in the care plans for two people he was looking after, which could have placed them at risk. Evidence was lacking for two people that care provided is as what was written in their care plans. Observations showed us that staff do, where possible, encourage people who use the service to make decisions about their lives. Care plans and records are held securely to ensure confidentiality. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We were very pleased to see that a recent ,written, care plan was in place for each person who lives within the service, which is a big improvement. These written, care plans give information about each person so that the staff know how they should be cared for. The care plans we saw were ‘word processed’ so 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 11 were easy to read. Pictures are also used to increase understanding, which is positive. We looked in detail at the care plans for two people who live within the service and did find some shortfalls. We saw that three staff signatures were missing from each ‘JD2’ sheet. This sheet asks each staff member to read the care plans and then sign to confirm that they had done so. We raised this with the deputy manager who told us; “Two of the staff have been off sick, but yes it should have been done I will make sure it is”. We were also concerned on 21.1.08 to observe an agency worker left alone with two people. One of whom had been unwell having seizures the days before and one of whom sometimes displays aggressive behaviour. The agency worker when asked told us he did not know the name of one of the people and that he had not read either persons care plans. Their care plans detailed triggers to behaviours and symptoms before seizure, which this worker did not know about. This lack of knowledge could have placed the people at risk. As this situation was such of a concern to us we issued the service a concern letter to highlight the seriousness of this situation and for them to tell us and assure us it will not be repeated. They responded on 30.1.08 they told us that they will compile a list of regular agency workers , together with dates they have worked and care plans they have read in the expectation that this situation will not be repeated and will significantly minimise any risk. There was a lack of evidence to confirm that some instructions in care plans were being carried out. For example; J care plan 3.10.07 told us that she likes to have a bath in the mornings. We were pleased to see from daily notes 18.1.08, 19.1.08 and 20.1.08 that she does have a bath in the morning as to her preference. The plan then told us ‘ J requires little or no assistance getting in and out of the bath’, but conflicting with this J risk assessment dated 15.9.07 told us ‘ 1.1 support at all times , hoist to be used if J unsteady’. If staff just read the care plan it would not give them the full picture of risk involved and could therefore place the person at risk. Similarly, the care plan said; ‘ J likes to relax in the bath, may become vocal, but most times it will be if the water is not at the right temperature (please check)’, the care plan did not tell us what this ‘correct temperature’ was. We looked at another persons care plan S. This persons care plan told us that because of health concerns he should be weighed weekly. We could not find any weight monitoring records and asked MP if the people are being weighed. MP told us; “ No it is difficult because people can not stand on the scales, we have not got any sit on weighing scales, but I have now asked for some. She told us; “S is weighed when he goes for his checks every six months”. The two people whose care we looked at have complex needs, which include communication difficulties. We did see wherever possible they were offered choices for example; at meals times and what they wanted to do. Care plans showed that where possible they are consulted with about daily routines, encouraging independence and choice. 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 12 We were pleased to see that risk assessments have been produced since the last inspection as with these in place risk to people who use the service should be lowered. As highlighted in the previous section we did note that some information on risk assessment are not being transferred into care plans as it should be to ensure staff have all instruction that they need. The service’s own quality monitoring process undertaken in December 2007 confirmed that some shortfalls in risk assessment were occurring to address this the service has set a deadline of end of February 2008 to rectify these shortfalls. We saw that records for people are stored on a shelf in the mangers office. During the inspection we saw that the door to the office was kept locked when not in use. On the second inspection day before we could enter this office the night person in charge G had to unlock the door. The locking of the door ensures that information relating to people who use the service is secure. 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is adequate. Our observations and record checking showed us that most people who use the service have the opportunity for personal development, accessing the community and to take part in a range of activities. People are encouraged to maintain contact with family and friends. People are enabled to have access to independent advocates who can ensure that their rights are respected. Improvement is needed to ensure that dietary care plans are followed to enable people have a healthy diet appropriate to their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at two people’s files in detail. These two people have complex needs. One has communicated to staff and others by varies means that she does not want to go out often. However, she does go out into the community on occasions with staff, where staffing levels have allowed and she has been willing. We were told by the deputy that this person has recently been 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 14 assessed due to behaviour and needs, to need one staff member allocated to her during day time hours however, to date this one to one staffing has not been fully implemented. Staff were happy to tell us that this person did go out for a meal with them and other people who use the service, before Christmas. They told us this was a big achievement for her. One staff member M told us; “ A week or so ago she went to the shop with us and brought a bar of chocolate, this is big progress for her”. The other person does go out more frequently. He enjoys going to the cinema and out for meals. That he does go out for meals and to the cinema was evidenced by expenditure receipts, which we audited. He also enjoys walking. The area manager told us; “ He is not keen on shopping or crowded areas”. We saw an activity plan in place for both of these people. However due to ill heath and episodes of behaviour they are not being followed every day. We did speak to other people during our time within the service. One person, A told us on 22.1.08; “ I am going to college today. I do computers. I like going to college”. This person has also been reassessed and the service is in the process of assisting him to live elsewhere in an environment where he can be more independent. This person has spent a number of Wednesday night stays at this new place which have been successful. He is now very eager to transfer to the new place permanently. Generally people living within the service access the community on a regular basis examples being; to the shops, cinema or eating out. The location of the service is good to allow access to the community as it has a number of facilities nearby. For example; there is a shop next door and Sandwell Valley Park near by. West Bromwich town centre is also very near. The service has it’s own transport to enable everyday access into the community and further which is positive. Internally the service, in addition to the main lounge has two smaller lounges. One of these is used for leisure time activities; the other plans are being made to change it into a sensory room. One persons relative commented “ They have not done what they said they would when she was admitted. She has not been on holiday for over 12 months”. The service’s ‘Service users guide and statement of services’ page 8, dated September 2007 says; “ You are welcome to invite your friends and family to visit you at home. We will help you to keep in touch with old friends and to make new ones. You can make telephone calls when you want to from the house phone. Please tell us if you want help with this. Your key worker will help you write letters when you want”. 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 15 The two people we case tracked do not have much contact with their families. One was visited by his brother shortly before Christmas 2007 the other has no contact which is the families choice. At least two other people do visit their family regularly. Another A, told us; “ I see my dad every week”. He showed us his mobile phone and told us; “ I text my dad on this and he texts me back”. Diet has been a concern to us for sometime regarding this service. Last key inspection we gave the deputy contact details in order for her to secure nutritional advice regarding meal provision and individual needs. The deputy has on a number of occasions tried to contact this person without success. When looking at care plans we noted that there were concerns about S and weight loss. JD’s care plan told us that she needed to loose weight. We looked at menus, which have improved, which is positive. But we also looked at individual food intake records for S and JD. JD’s food intake record did not suggest that she is having a diet that is suitable for her assessed needs. Monday. Cereal and toast. Tea and biscuits. Lunch sandwiches and crisps. Tea Jacket potato chilli, salad. Tuesday. Cereal and tea. Tea and biscuits. Lunch scrambled eggs, bread and juice. Tea chips sausages and beans Wednesday. Porridge toast and bacon. Tea and biscuits. Lunch- Beans on toast, juice. Tea- beef stew and dumplings. Thursday. Weetabix. Tea and biscuits. Lunch- corned beef sandwiches, tea and crisps. Tea- chips and chicken. There was no evidence that she was having fruit between meals as was stated in her care plan as to what should be happening. Other food intake records were similar in that there was a distinct lack of fresh vegetables and fruit listed. We discussed meal issues with the area manager, and deputy who both told us; “ We always have a lot of fruit available. JD eats a lot of oranges”. We told the manager that records did not evidence this. We suggested that using the internet may secure dietary knowledge and that people should be referred individually to a dietician where there are concerns about weight loss or a need to reduce weight. We also discussed with the area manager the possibility of adding more fresh fruit and vegetables into everyone’s diet by offering fresh fruit smoothies and adding fresh vegetables to soups. These suggestions were received positively by the area manager, who told us; “Purchasing a ‘ smoothie’ maker was a good idea”. The service has the ‘silver’ healthy food award, which is expires in March 2008. We told the area manager that when the award is reassessed that will be a good opportunity to obtain more dietary advice and support. 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is adequate. Some further development is needed in terms of record keeping to show that the needs and preferences of the people who live within the service are being met on a daily basis, this also to include health, physical and emotional needs. Medication systems within the service have been deemed by our pharmacist to operate on an adequate basis needing some development and improvement to ensure utmost safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Record keeping has improved in terms of content and detail. As previously mentioned one person prefers to be bathed in the morning. That the person has this bath in the morning was evidenced by daily records and confirmed by the person who was in charge night 21st January into the 22nd. However, we found in difficult in some areas to confirm by daily records that all preferences are being taken into account. For example; rising times said; ‘ up when we came on shift’ but did not give actual time the person got up. We saw records to confirm that personal preferences concerning who provides personal care, male or female, have been asked of people who use the service. 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 17 On both the 21st and 22nd we saw that the staff group had a good male/female mix in order for personal preferences to be honoured. We saw that all people were appropriately dressed. The area manager told us that staff do purchase clothes on behalf of some people, but for the majority it is the people who go shopping with staff to choose their own. We were pleased to learn from reading records and speaking to staff that healthcare input is improving including both planned and emergency healthcare. Records we viewed confirmed that staff have been more pro-active to ensure people have had access to healthcare. Where they have referred and there have been barriers to access, records have been made to confirm telephone calls to external professionals to chase appointments and meetings. For example; there was a problem with getting S’s blood test done. We saw records to prove that the service chased this. On 21st January 2008 S had his blood test. Similarly, there had been concerns about S and unexplained bruising to his private areas. There was clear written evidence to confirm that the service was not happy with initial diagnosis and pushed for a hospital appointment. They were not happy then with the length of time S had to wait regarding the hospital appointment and chased this again. A letter was on file from the hospital saying;” Due to the home having concerns the appointment has been brought forward”. We saw evidence to confirm that J has been referred to a behaviour therapist and S has been assessed for a wheelchair. One person who was displaying behaviours is at present being assessed in a specialist called unit Orchard Hills. The service has identified through its own quality monitoring that there is still improvement needed concerning referrals for health care for example Speech and Language Therapy and has set a deadline for the end of February 2008 for this to be addressed. We were pleased to see that our previous concern about the storage of incontinence pads has been addressed. We saw that these are now stored in individually named boxes. We were pleased to see training certificates to demonstrate that a number of staff have now received the required training to give rectal diazepam. To conclude this process the service now needs to ask the local Primary Care Trust (doctor) to provide written confirmation to approve these staff to carry out this procedure when needed. We did question the use of ‘drink records’ in terms of health. We asked why drink input records were being used and were told; “ To make sure that S for example drinks enough”. When we asked ‘what was enough for S?’ the staff were unable to give us this information. Further, we saw that drinks taken were recorded as ‘tea’, ‘juice’- records were not made about precise measurement so an accurate record of fluid intake (each day) would not be possible. 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 18 Pharmacist Inspector (Morag Ross) undertook inspection of the control and management of medication within the service to ensure that medication was being administered to residents safely. Medication was stored in a locked cabinet in a neat and organised manner, which enabled people’s medication to be easily located. Overall secure systems were in place to ensure that medication storage was secure, however the person in charge did not hold the medication keys. Medication keys were stored in an open drawer in an open office, which means that unauthorised people could have been able to access the medication cupboard and this increases the risk of harm to people who use the service. The manager agreed that this was not safe practice and said that the person in charge would hold the keys at all times. Written recording systems were in place to ensure that medication was recorded when it arrived into the home and also for medication when it was returned to the pharmacy if it was no longer needed. Records were available for the receipt of medication; total stock remaining and checks made to ensure that medication was available to administer to people who use the service. Overall, the medication records available were well documented with a staff signature to show that medication had been administered or a suitable code had been recorded to explain why medication had not been administered. The amount of medication available was also accurate, which means that the medication records show that medication was given to the person as prescribed by the doctor. One record seen had been hand written by a member of staff, as it was a new medication, however there was no system to ensure that the information documented was correct. Some people were prescribed medication to be given when required. The management care plan for one person who was prescribed medication to help control seizures was seen. It contained sufficient written information to inform staff under what circumstances this medicine should be administered, the dose to administer and what action should be taken if the medication did not help to control the seizure. There was a separate sheet called ‘Administration of PRN (when required) Medication’, which included details of medication that had been administered ‘when required’ and included the date, time, medicine administered, the reason it was administered and the ‘outcome’ for the person and if the medication had worked. This means that the medicine records showed evidence that the medication had been administered according to the doctor’s instructions. There was a list of named members of staff who had received training on the administration of the medication which required a specialised technique, however the list of names seen was not up to date, which means that it was not possible to determine which members of staff could safely administer the medication in an emergency. 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 19 There was no safe system in place to ensure that medication could be taken out of the home, for example for a day out. The medication policy seen was not specific and did not ensure that this practice was safe. It stated ‘ If service users are to be away from the home when medication is due, then medication should be prepared in a separate system which must be labelled appropriately. This must be recorded on the medication administration record’. This describes the unsafe practice of ‘secondary dispensing’, which means that people who use this service are at an increased risk of a medication error. 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is adequate. The service does have a complaints procedure for people who live at the service and their relatives to access if they have the need. Firmer structures need to be in place to ensure that people who use the service are better protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has a complaints procedure, which is included in their ‘Service users guide and statement of services’ document dated 1 September 2007. The complaints procedure has been produced in both writing and words to increase understanding. People we surveyed (relatives of people who use the service) confirmed that they know how to make a complaint. They told us that when they raised concerns these were usually dealt with appropriately. We were pleased that contact has been made with an external advocacy service in order for people to be better supported in ways that they prefer. The male person whose care we looked at has used this service on a number of occasions. That advocacy arrangements should be secured for other people was highlighted in the organisations own quality assurance audit. They have set themselves a deadline for the end of February 2008 for this to be achieved. Our concern still remains about the service’s full ability to protect the people who live there from each other and the preventing of incidents that can cause 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 21 injury. Although the number of incidents of aggression between people who live at the service has decreased somewhat there have still been at least ten incidents between people or incidents where some albeit minor injury has occurred since our last key inspection was carried out in April 2007. We discussed with the area manager things that may contribute to these incidents, which include the use of and distribution of agency staff and the complex mix of needs of people who live within the service. Whilst the service has very much improved in their reporting of aggressive incidents between people who use the service and any untoward incidents both to us and the Local Authority, we were concerned to read about these incidents of aggression towards others in this persons ‘ABC’ records as we had not been informed of these incidents, as we should have been. The record of the incident described hitting but when we asked the deputy manager told us; “ It was not hitting but tapping”. We explained that we were concerned in that it appeared that staff were using wrong words to describe incidents but also that the behaviour whether tapping or hitting could place others at risk and even if they were ‘tapped’ not ‘hit’ this meant they had been touched by another person when they may have not wanted to be and that tapping could still have a detrimental effect on ‘victims’ of this behaviour. Senior management responded in writing to our concerns regarding this incident telling us; “ I have arranged for the quality and performance manager and area manager to meet with staff and clarify the process for reporting incidents imminently”. We were pleased to see when looking at training records that most staff have now received abuse awareness training or have been booked to attend however, from evidence gained during the inspection this does need to be revisited in terms of ‘definitions’ of abuse. We were also pleased to see certificates to evidence that regularly used agency staff have received intervention training. We looked at finances for the two people whose care we looked at. We saw that money was held securely and that it is checked between each shift. We saw that money was correct against recorded balances and that receipts for expenditure were held. We did not see any evidence to confirm that peoples’ money was being spent on household items as we have seen previously. One person had brought a new quilt but this was when she was with her mother who agreed to this purchase. 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is good Generally, the environment is homely and comfortable. Improvements are needed in terms of replacement and redecoration but these are being addressed by the service. Some improvement is needed to ensure that people are fully protected from the risk of infection transmission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at living space provided by the service, which is fairly generous. We saw a main lounge, dining room and two smaller lounges, which can be used for privacy or leisure activity. We looked at three bedrooms and found these to be comfortable. Two of the bedrooms had a lot of the peoples own belongings in them, making then personalised and homely. The third had only a few personal belongings due to risk. The deputy manager told us; “ Work is being carried out with a specialist regarding lighting and other things which could help this person to be more 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 23 relaxed”. We saw that window access in the bedrooms was restricted and radiators guarded to increase safety. We were pleased that a previous issue about wardrobe safety and storage of contents, which may have placed one person at risk, has been addressed. We saw that some refurbishment redecoration and recovering of ripped chairs is needed however, the area manager was able to provide evidence that this is in hand, in that an order had been placed regarding the ripped chairs and the kitchen was due to be refurbished the next week. We did see that efforts have been made to make the environment more pleasant for people who live there such as the provision of pictures and hanging baskets. We were pleased to find that the previous odour by the staircase has decreased making the environment more pleasant for the people who live there. We did identify some shortfalls concerning infection control in that all plastic bath mats were black on their underside. Two were covered in mould. It was clear that staff had not been monitoring the standard of these bath mats. The area manager threw the bath mats away as soon as she saw them and purchased some more. We did, like during our previous inspection, see communal items in bathrooms such as bar soap and a jug, which could pass bacteria from one person to another. We asked and were told that the service has not obtained Department of Health guidance-which has been produced as a tool for services to assess their own infection control systems. 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35. Quality in this outcome area is poor. Competent and qualified staff, in adequate numbers to meet needs are not always provided to support people who use the service, which could place them at risk. Generally recruitment procedures have improved which helps to protect the people living within the service. Further improvement is needed to ensure that all staff are appropriately trained in order that all needs are met consistently and that people who use the service are safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Whilst it was clear from speaking to staff and management attempts have been made to improve staffing. However, the service has a poor track history concerning the numbers and competence of staff and until additional staff are employed people who use the service are placed at risk. On the first day of the inspection two staff members had phoned in sick. To address this an agency staff member had been secured. This agency staff member was left alone in a lounge with two people he did not know. One had 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 25 been having seizures the days before the other had shown challenging behaviours days before which involved other people who use the service we were concerned that this had happened. We were further concerned to be told by this agency worker that he has not had training to deal with seizures which could have placed this person at risk. Senior management have given us written assurance that a core team of agency staff will be identified and used, ones that know the service and people who live there to prevent this happening again. It is positive that the service has recruited some new staff and generally the use of agency staff has decreased. We were told by the deputy that 1.5 posts are vacant one of which has been vacant for some time. We discussed this with the area manager who told us that she is recruiting at the present time. We were told that JD has been assessed as needing one to one staffing because of behaviours and needs. We were told as we have been at previous inspections that the service is negotiating with this persons funding authority for additional money to fully provide this one to one care. We were told by one staff member that if JD had one to one staffing at all times she could go out more. As we have during previous inspections, we explained to staff including the area manager and deputy that where one to one care is needed then it is the services responsibility to provide this regardless of funding arrangements we referred to Regulation 18(1)(a) which confirms the services legal responsibility in terms of providing adequate staff in order to meet needs and make sure people are safe. We observed during the inspection one staff member cleaning. The deputy confirmed that the service does not have a cleaner, they did, but she left. We discussed this with the deputy and suggested that it would be better to have a cleaner, which would then free up more care staff hours. Recruitment processes have improved. However, we did not have access to original documents the service have chosen to use our ‘Annex 4’ form, whereby recruitment information is inputted into this form and all original documents held at the services head office. The Annex4 form told that a full enhanced disclosure was on file and that two written references had been obtained for both. We were pleased to see that the service has a form for each agency staff member, which gives basic details and a clearer photo of each staff member. Training has been an on-going concern to us both in terms of NVQ and mandatory training. We discussed this with the deputy and area manager. The deputy manager told us; “ We know there are gaps, but we are really trying to address this”. She gave us written confirmation to show that training has been arranged and that staff are due to go on a wide range of training sessions. On the first day of the inspection the service was quite chaotic. We observed people who live in the service and found them to be quite agitated. One the second day when there were more staff the atmosphere was calm. We saw a change in behaviour people who use the service were also calm, they were 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 26 smiling and they showed a positive interest in us. Approaching us to touch and kiss us. Staffing issues have been an on-going concern. Until the service has a full staff team which includes the provision of one to one ratios where there is an assessed need and training is fully up to date then safety risks to the people who live at the service remain. Our completed questionnaire from one relative told us; “ They are not keeping up with the things that were agreed when she went into the home. Room for improvement as they are always short of staff and managers”. Another one told us that in the past there had been problems but recent improvements have been made. We spoke to three staff. We were really pleased with their positive attitudes. For the first time it was clear that staff wanted the service to do well, they want improvements to be made. They asked us; “ How are we doing?”, “ Are we doing better?”. 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is poor. The service does not have a registered manager and has not had one for some considerable time. Quality assurance and monitoring processes are in place which need further development. Some aspects concerning health and safety need confirmation such as mandatory training for some staff and the obtaining of service certificates which, were not available during the inspection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We are pleased that since our last key inspection was carried out in April 2007 a new area manager has been appointed. She told us in a meeting in October 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 28 2007 that she was committed to ensuring that the service improves. She has mostly kept to what she told us in that overall the service is beginning to improve. However as detailed throughout this report we have highlighted areas that need further improvement to reduce risks to the vulnerable people who use the service. The area manager is the main ‘driver ’for improvement. Records showed that she spends considerable time at the service and has developed a good professional relationship with staff. Staff we spoke to were very complimentary about the area manager confirming that she is committed to improvements and that she is very supportive. However, the area manager is not the registered manager and she has other responsibilities apart from this service. The service has been without a registered manager for nearly two years. In the last year the service has had three different managers. Nine days before our inspection a new manager commenced employment. We highlighted to her what her legal responsibilities would be if she were to become registered with us. We learnt that this managers back ground and qualifications were mostly in children’s services and told her what are requirements are of a registered manager in terms of experience and qualifications. The manager did not have much involvement with the inspection. The area manager told us; “ This is what we planned as she is so new staff were told to phone me when you arrive”. We highlighted to the area manager that a registered manager needs to be in place as soon as possible. We also highlighted that evidence has shown that many previous problems and risks concerning this service have been due to lack of experienced managers and the lack of instruction, direction and control in the service and unless a strong manager is in place the service and people who live there will remain vulnerable. The organisation is a large national one. It has it’s own in-house structures in place concerning quality monitoring. We were given documentary evidence to show that a person from the organisation carried out a recent audit of the service, which is positive in terms of on-going improvement. We discussed with the area manager and deputy manager and highlighted the fact that in between these full audits in-service audits are needed to find out how well staff are working regarding procedures and practice and to quickly identify any areas of risk. The area manager showed us a form that is to be used for this purpose which is very similar to our own ‘ Annual Quality Assurance Assessment’ form. We have highlighted in the previous section our findings concerning training. That we saw that there are gaps in training, which was confirmed by the deputy manager. We were also given written confirmation that a range of training has been arranged to bridge these gaps. We looked briefly at the kitchen and saw that there have been improvements in terms of food storage and the monitoring of fridge and freezer temperatures 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 29 which is good as this increases food safety. We did not spend any more time looking at the kitchen as it was due to be refurbished the next week. We looked at service certificates and records concerning equipment and fire safety within the service to assess overall safety. We were pleased to see a valid certificate to demonstrate that a check had been carried out by an engineer on the gas appliances and that the emergency lighting had been checked by an engineer in October 2007. We were also pleased to see that the service is regularly checking the fire alarm system and emergency lighting. Other certificates however, were not available as they should be these included service certificates for the lift, and fire alarm. The deputy told us that these had been checked but there were no certificates. We were concerned to see that the staff fire training was not up to date. The deputy told us that arrangements are being made for this. There had been no fire drills since October 2007 although we did see written evidence that one had been planned on 21.1.08 but had been postponed due to our inspection. We identified that there was a problem with the water supply in that temperatures in a number of rooms were too low. An engineer was called straight away and identified that a new part was needed to rectify the situation which was ordered. 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 3 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 2 33 1 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 1 x 2 x x 2 x 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes 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 YA6 Regulation 13(4)(c ) Requirement To ensure that people are safe and protected from risk all staff must be aware of what is written in care plans. To ensure that full health care needs are met and that people are safeguarded evidence must be available to demonstrate that care plans are being fully followed. Suitable arrangements must be made to ensure that medicines are stored securely with restricted access to authorised members of staff to ensure that people who use the service are protected from harm. Arrangements must be made by training staff or other measures to prevent people being harmed or suffering abuse or being placed at risk of harm or abuse. Timescale for action 18/02/08 2 YA19 12(1)(a) 15(1) 18/02/08 3 YA20 13(2) 18/02/08 4 YA23 13(6) 11/02/08 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 32 5 YA33 18(1)(a) To ensure that needs are met and that people who use the service are safe suitably qualified, competent staff must be provided in such numbers as are appropriate for the health and welfare of these people. Outstanding 1.5.07 11/02/08 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 4 5 6 Refer to Standard YA17 YA20 YA20 YA20 YA33 YA37 Good Practice Recommendations Systems must be in place to ensure that dietary needs are being fully met. The medicine policy should be reviewed and updated in order to ensure that the health and welfare of service users taking medication are safeguarded. A system of checking accuracy of any hand written additions to the medication record charts should be introduced to ensure information is correct. There should be an available up to date list of members of staff who are trained and competent to administer medication requiring a specialised technique. A cleaner should be employed to prevent care staff hours being used for cleaning tasks. The manager should apply for registration with us as soon as possible. 1 - 5 New Street North DS0000004798.V358215.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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