Inspection on 15/05/07 for 1 Lawrence Road

This inspection was carried out on 15th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1 Lawrence Road 01/04/08

1 Lawrence Road 07/11/07

1 Lawrence Road 29/01/07

1 Lawrence Road 11/01/06

1 Lawrence Road 29/03/05

1 Lawrence Road 28/09/04

1 Lawrence Road 09/03/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Lawrence Road (1) 1 Lawrence Road Basildon Essex SS13 2NB Lead Inspector Ann Davey Unannounced Inspection 15th May 2007 09:00 Lawrence Road (1) DS0000018055.V335792.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 Lawrence Road (1) DS0000018055.V335792.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. Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lawrence Road (1) Address 1 Lawrence Road Basildon Essex SS13 2NB 01268 590678 01268 590678 linda.bayley@estuary.co.uk 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) Estuary Housing Association Limited Manager post vacant Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th January 2007 Brief Description of the Service: 1 Lawrence Road provides residential care for two adults with a learning disability. The service manger said that the fee(s) for the home are £2774.01 per week. Any additional fees should be discussed directly with the registered provider. The home is a purpose built bungalow situated in a semi-rural area between Southend and Pitsea, on the outskirts of Basildon. Due to the location of the home, transport links to the area are not very good. The home consists of a large lounge, small dining room, two bedrooms, and one toilet/bathroom for residents, staff and visitors and a kitchen and office. The home has a large garden/patio area to the rear of the property. There is limited parking to the front of the property. The home’s Statement of Purpose and Service User’s Guide are available from the home on request. Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced site visit. It started at 9am and finished at 4.30pm. On arrival, two agency staff were staffing the home. The inspector made a courtesy telephone call to the registered provider explaining that an inspection was being undertaken and the service manager for the home came mid morning. A tour of the home was made. A service manager, three agency staff and a permanent member of care staff were spoken with. Time was spent in the company of residents. Care practices were observed and a random selection of records was viewed. The inspector did have a notice explaining to any visitors that an inspection was taking place, but it was decided that on this occasion, it would not be of any benefit to display it. Staff were informed that if there were any visitors, then the inspector would be happy to speak with them. The home forwarded two positive questionnaires from residents. These had been completed on behalf of residents by staff. Residents have very limited communication skills and do not have a named social worker, neither does the home have any active advocacy input. Therefore it was taken that the documents in the main had been completed using the home’s knowledge of the residents. The home does not have a structured Quality Assurance system in place which would allow the service to seek the views of the other professionals and stakeholders about the service it provides. The home was friendly, hospitable and cooperative towards the inspector. The senior agency member of staff on duty on arrival was competent and helpful. The inspection process was rather disjointed at times because of the general lack of management structure within the home. This meant that sometimes documentation could not be found or easily located, care practices and systems sometimes had a different perspective depending on who the inspector was speaking with, but despite this, cooperation and helpfulness of all those involved was appreciated. Following the last inspection which took place on 29th January 2007, the home was assessed/rated by the Commission as a level 1 because of the shortfalls identified and the lack of process made since the inspection before that. Primarily the main concern was the lack of a sound management structure within the home and the impact that this having of the day to day functioning of the home. In addition there was concern about the reliance on agency staff to maintain minimum staffing levels and the lack of provision enabling residents to participate or experience a wider social and leisure lifestyle. As a result, the Commission requested an Improvement Plan with a return date of 24th April 2007. This requested was served in accordance with Regulation 24(a). At the time of the inspection (14th May 2007), there had been no response. The service manager was asked about this but responded by saying Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 6 that she wasn’t aware of where it was and attempts to locate it during the day failed. There was no evidence at this inspection to demonstrate that any significant improvements in the management structure within the home have been made. Neither was there any evidence to demonstrate that the registered provider has made any reasonable attempt to attend, supervise, monitor or assesses progress. All matters relating to the outcome of this inspection were discussed with the service manager. Full opportunity was given for discussion and/or clarification both during and at the end of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Shortfalls identified at the last inspection have not been addressed. These included: Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 7 The home has been unable to recruit adequate permanent care staff and is totally reliant on agency to maintain minimum staffing levels, although the majority of agency staff are regular to the home. Regulation 26 visits are not being carried out in accordance with regulation. Adequate provision is not being made for residents to experience a wider social and leisure lifestyle. Safe working practice/environmental risk assessment are not adequate. Formal staff supervision is not being carried out. ‘User friendly’ formats within documentation haven’t taken place. Residents ‘Terms and Conditions’ have not been overseen by an independent person/advocate. At this inspection, further shortfalls were identified. These include: There was no response to the Improvement Plan that is a statutory requirement. Poor medication practices Inadequate ‘in house’ medication review processes Lack of progress re quality assurance process Fire drills not being carried out Overall, the registered provider has not make adequate day-to-day management provision within the home. There was no evidence of regular management review, supervision, support and monitoring systems in place. Since the last inspection that took place on 29th January 2007, there is no evidence to demonstrate that a representative of the registered provider has been in the home since that date apart from one visit, which was undertaken by the service manager on 26th February 2007. 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. Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has information about what care it can provide, but it is not in a ‘user friendly format’. Residents are provided with Terms & Conditions, but an independent person has not endorsed them. EVIDENCE: The current two residents have lived in the home for many years and there are no plans to change their current living arrangements. Therefore, no admissions have taken place since the last inspection. The home does have an admission policy. At the last inspection, the matter of a ‘user friendly’ Statement of Purpose and Service Use’s Guide was discussed. At this inspection, assurances were given by the service manager that this would be addressed, but the documents remain in a non ‘user friendly’ format for the current client group. Therefore, any prospective new admission would probably not be able to understand what they can expect from the home because the documentation is in text format only. Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 10 At the last inspection it was noted that the clients Terms & Conditions had not been signed or dated and there was no evidence that the resident or a representative had seen the document. These documents have now been signed and dated by the acting manager, there was still no evidence that the documents had been seen/explained to the residents or seen by a representative. Under the circumstances i.e. nature of the care required by residents, for a member of the homes own staff to sign these documents on behalf of the residents, is not considered independent or adequate. Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents assessed care needs are reflected in their care plans, which enable staff to provide appropriate personal care. EVIDENCE: Two care plan files were assessed. Both sets of records were up to date. From the activity seen throughout the day, documentation which included daily activity sheets and daily routines which provided a good pen picture of each of the residents care needs. This means that any member of staff could read the documentation and know what the care needs were and how to meet them. However, documentation is in text form and therefore residents are unable to have an input because of their limited understanding. The service manager said that any format would be difficult for residents to understand, but the home must explore better ways of communicating assessed care needs and how they are going to be met, both for the well being of current residents and also for any prospective new resident. Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 12 The home said that it has experienced difficulty in arranging annual reviews for residents with the respective funding authority. These reviews are very overdue now but documentation supports that they have tried to get reviews organised. The home said that the funding authority have told the home that they are unable to carry out these reviews because of their limited staffing resources. This matter has been raised with the home on previous inspections and the home should pursue this matter further as there is a statutory obligation for these reviews to be undertaken. Both residents have complex care needs and one resident in particular has very limited understanding and relies on staff support for most decisions. In the past, advocates and social workers have supported the home in making sure that the best decisions are made for this resident, but now there are no named advocates or social workers. The home manages this aspect of care by being very careful about how any decisions are made and the rationale behind them is clearly recorded. Residents were unable to comment on their care, however from time spent in their company, they appeared happy and comfortable. Residents were dressed in their own clean clothing, which was appropriate for their age and gender. There is a high proportion of agency staff employed in the home, but the ‘senior’ of the two agency staff in the morning had a good understanding of residents care needs, as did the service manager and a member of the permanent staff group in the afternoon. Lawrence Road (1) DS0000018055.V335792.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. This judgement has been made using available evidence including a visit to this service. Residents can expect to receive a good balanced diet, but will find that both structured and unstructured activities are limited. EVIDENCE: At the last inspection it was noted that structured and unstructured activities are very limited. This is because there are normally only two members of staff on duty and agency staff undertake many shifts. This creates restrictions on who can drive the homes transport and visits into the community don’t happen very often. Current residents have very different needs and requirements concerning activity, social events and leisure activities. This means that it becomes difficulty for the home to meet individual needs without having an impact of the other resident’s needs. The home has an ‘activity record’ which routinely reports activities such as ball games, watching TV, listening to music, playing instruments and visits to the garden centre. The home said that residents are happy with this, but it was pointed out that the home does not Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 14 have the provision to allow residents to experience or try out other social activities, events and community leisure activities. The home must continue to explore ways so that assessed needs are going to be met and make adequate provision for residents to experience and participate in both structured and instructed activities which are appropriate for them personally. The situation means that spontaneous activities, trips and events are rare. It was positive to see that since the last inspection, extra funding has been provided for one shift per week so that one resident has a 1:1 activity input. Whilst this is certainly an improvement, there are weeks where this cannot happen because of staffing resources and the input is limited to one shift per week. There remains a lack of stimulation, imagination and creativity in the home surrounding this area of care. The service manager agreed that both residents have very different expectations and abilities. It was however positive to hear about the holiday that had been booked for the residents the week after the inspection. There are some areas of the home which residents aren’t allowed access unless supervised by a member of staff because of a risk to their personal safety i.e. kitchen, garden and office. This is well documented in the home. The home operates on a 4 weekly menu rota. Residents have very limited communication and decision making skills, but the home has developed successful ways of determining what each resident likes and doesn’t like. The kitchen was clean and tidy. The home has a fridge/freezer and it was noticed that the freezer door wasn’t shut, because food had not been stored properly and the contents were all soft. Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 15 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. This judgement has been made using available evidence including a visit to this service. Residents can expect to receive good health and personal care. Current medication practice(s) within the home pose a potential risk. EVIDENCE: Care plans demonstrate that residents’ personal and health care needs are recorded and the community health care agencies play an active part in meeting the care needs of residents. Residents have complex care and health care needs and the home is supported by the respective appropriate healthcare agencies. The home said that they have a good working relationship with these agencies. Medication practice(s) within the home need urgent review for the safety and wellbeing of residents. The home undertakes an ‘invasive procedure’ which means that it administers a prescribed rectal medication on a PRN (as/when necessary) basis. There is adequate information about when this procedure should be undertaken, but the home did not have an administration procedure in place, neither was there any documentation to demonstrate which staff had undertaken the necessary training, who provided the training, who was the named Community Nurse/Clinical Advisor and who reviews practice. This Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 16 practice is not compliant with current guidance or with the home’s own stated medication policy/procedure. This matter must be addressed without delay for the safety, protection and wellbeing of resident(s). Other PRN (as/when necessary) protocols were recorded as being evaluated in September 2004, but the ‘review date’ box was blank. There was no evidence that any PRN reviews had taken place since 2004. Medication was stored appropriately and medication administration recording sheets were in good order. The service manager agreed that the folder containing all the medication sheets, records and assisted information was in need of ‘sorting out’. This would make reference to records much easier. Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 17 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. This judgement has been made using available evidence including a visit to this service. A Complaints and ‘Safeguarding Residents from Harm’ policy are in place, but residents may have difficulty in expressing any dissatisfaction and have no named social worker or advocate to act on their behalf. EVIDENCE: The home said that there have been no complaints recorded since the last inspection. Information about how to complain is displayed in the home both in text and ‘user friendly’ form. The difficulty here is that current residents would not have the ability to raise a formal complaint, they do not have family connections, a named social worker or receive any visits from an advocate. Staff spoken with had an adequate understanding of how to report any suspected adult abuse. As with any complaint a resident might have, their ability to make contact with any external agency is extremely limited and any advocacy support has to be made through the home. However, the home is aware of these limitations and could demonstrate the practices and procedures in place which they use to determine individual residents likes and dislikes. For example, if food is pushed away or not eaten, this may mean that the resident doesn’t like what has been provided. Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 18 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): 24,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a comfortable, clean and homely environment, but the home lacks structured assessments to minimise known risks. EVIDENCE: On arrival a tour of the home was made. The home was clean, warm and comfortable. It was positive to note that the broken fencing seen at the last inspection had been repaired. As reported at the last inspection, the registered provider has plans to carry out positive alterations to the home that will affect the kitchen, dining room, toilet and office. At the time of this inspection, planning permission was still being obtained regarding this work. The service manager was reminded that no work should be undertaken/started until plans have been submitted to the Commission and written approval has been given. Following the inspection, residents were going on a week’s holiday and a contract cleaning company were going in to ‘deep clean’ the home. Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 19 One resident now requires the use of a wheelchair and the home has ‘confusion locks’ on some doors so that residents can’t enter areas unsupervised which pose a risk to their safety. At the last inspection it was noted that the washing machine is housed in the kitchen area and soiled laundry has to pass through the dining area. To minimise rise of cross infection/contamination the home was required to put in place adequate protocols. The document made available was not adequate as it was ‘multi-purpose’ and covered a number of other non-related issues. This was the only ‘safe working’ risk assessment in place and further reference is made in the ‘Conduct and Management of the Home’ section of this report. Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 20 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 & 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staff team remains undeveloped and the home is totally reliant on agency staff to maintain minimum staffing levels. EVIDENCE: Rotas indicate where staff have/are to attended training sessions, but the staff-training matrix is not currently maintained. Training certificates were found on staff files, but the recording system was inadequate in identifying who had attended what course, and when. The service manager said that the registered provider was aware of the shortfalls with regard to personnel recording issues. Four weeks rotas were looked at. For all shifts except one, which is normally on a Tuesday, two staff are on duty throughout the day and one at night. On a Tuesday, there is normally a third member of staff on duty for one shift to provide 1:1 social activity time with a resident. However, this arrangement doesn’t always happen. Rotas demonstrate that the home is totally reliant of agency staff during the day shifts. Rotas showed that agency staff work every day shifts over weekends, no permanent staff are on rota. This matter was Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 21 raised with the home during the previous two inspections. There has been no improvement in this area. The outcome for residents is that their social activities are limited because all except one agency member of staff can’t drive the home’s transport and whilst most of the agency staff are ‘regulars’, some are not and given that the client group is very vulnerable, the situation remains unsatisfactory. Furthermore, and the working activity of agency staff in the home is not supervised or monitored by management unless a member of the permanent staff is rostered to be with agency. However, at weekends, no day permanent staff are rostered. The home operates on a day-to-day basis because of the staffing situation and as such, there seems to be very little forward planning in terms of the resident care. No new members of staff have been recruited since the last inspection. The service manager said that staff 1:1 supervision takes place, but a member of staff said that ‘group’ supervision takes place during team meetings. Either way, the home couldn’t produce any supportive documentation about permanent staff or agency staff supervision taking place. This was identified as a shortfall at the last inspection. Team meetings were said to have taken place, but last one recorded was 4th October 2006, seven months ago. The service manager said that there is a recruitment drive for a manager and care staff. It was understood that whilst there was nothing positive to report about a new manager, interviews for care staff should take place shortly. In the morning two agency staff were on duty. Agency staff were engaging and interacting well with residents. The ‘senior’ agency had a good understanding of residents needs. During the afternoon, the service manager was with the inspector and a permanent member of staff was asked by the service manager to assist. This left an agency member of staff alone with residents. Later, the inspector sat in an adjoining room to where the agency member of staff and residents were to look through records for approximately 30 minutes. During this time, the agency member of staff provided very little stimulation for the residents. This agency member of staff seemed to sit on the same chair watching TV for most of this observation time and was still there when the inspector left at 4.30pm. At this time, one resident was in their bedroom and the other resident was curled up in a chair. There was little stimulation or interaction. Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 22 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 & 43 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not have a manager and the registered provider has not provided any means of adequate management input. This home is drifting and shortfalls are not being addressed. EVIDENCE: The previous manager left the home in December 2005 and since that time a senior member of staff has been the ‘acting’ manager. At this inspection the service manager said that there has been no progress in recruiting another manager. At the last inspection it was noted that the previous Regulation 26 (visit by registered person) took place on 27th June 2006. At this inspection, the only Regulation 26 visit that has taken place sine January 2007 was on 26th Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 23 February 2007. These visits are required by regulation to take place monthly so that the registered provider can make a judgement about the way the home is functioning and to ensure that regulatory and national minimum standards are being met. According to the home’s records, no management representative has been in the home since that date. There was no evidence to demonstrate that any management monitoring, supervision or reviews have taken place in the home since that date. This lack of commitment and support by the registered provider is very concerning. The Commission requested an Improvement Plan that was to be returned by 24th April 2007. This did not happen and when asked about it at the inspection, the service manager wasn’t sure where it was and was unable to locate it. The service manager said that the last Quality Assurance document was produced in 2005. The home’s documentation states that such a document is a ‘minimum standard’. It was pointed out that this is a regulatory requirement (Regulation 24) and as such, the home should be in a position to demonstrate the progress is being made to meet this requirement. Safety and maintenance records sampled were in good order with the exception of the fire drill record. The last one recorded as having taken place, was on 2nd June 2006. The home’s own policy states that they should happen at least four times a year. At the last inspection, safe working and environmental risk assessments were noted to be in need of review. The situation is still not satisfactory as documents were muddled and multi functional. Clearly, staff do not use these as day-to-day working documents as there was difficulty locating them and one of the regular agency staff (who is left ‘in charge’) didn’t know anything about them. There was a lack of management structure, direction and supervision in this home. The registered provider is aware of this, but there was no evidence of any additional management input to address the situation. Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 24 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 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 1 X 1 X X 2 1 Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 25 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 YA1 Regulation 4 Requirement The Service User’s Guide must be presented in a style that is in keeping with the client group and that would allow new perspective residents to understand the content. This was recommended at the last inspection, but no progress has been made. Any ‘Terms & Conditions’ document that is issued to a resident(s) must be endorsed by an independent person to safeguard both the resident and the home. This must take place when the resident is assessed as having no or limited capacity to understand the document. Arrangements for this to happen should be within the Statement of Purpose and Service User’s Guide. The home must be able to 30/06/07 demonstrate that adequate, suitable provision and opportunity is made for residents DS0000018055.V335792.R01.S.doc Version 5.2 Page 26 Timescale for action 31/07/07 2 YA5 4,12 & 17 (sch3) 30/06/07 3 YA12 YA13 16 & 18 Lawrence Road (1) to experience and participate in social/leisure activities and community events of their own preference and/or is in keeping with the client group. This has direct implications on staffing provision. The previous set timescales for meeting this requirement were 20/03/06, 06/07/06 and 31/03/07 have not been met. Current medication practices associated with ‘invasive techniques’ and the review of PRN (as/when necessary) medication administration protocols must be in line with legislation, current guidance and the home’s own policies. This must happen to protect and safeguard residents from potential risk. Adequate numbers of staff who are suitably, trained and skilled must be on duty at all times to meet the assessed needs of residents. An effective and stable staff team would enable the home to provide consistent planned care for residents and enable residents to participate in leisure, social and community events of their own choice and preference which is in keeping with their assessed needs. The previous set timescales to meet this requirement was 06/07/06 and 31/03/07 has not been achieved. All staff must receive structured induction training within the home. 4 YA20 13 31/05/07 5 YA32 YA33 YA35 18 30/06/07 6 YA36 18 30/06/07 Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 27 This is to ensure that staff undertake good working practices, training needs are identified, regulatory requirements are understood and the home functions in accordance with its stated Statement of Purpose and the Service User’s Guide. The previous set timescale to meet this requirement was 31/03/07 and has not been met. The registered provider must be able to demonstrate that this home is being competently and effectively managed for the benefit and wellbeing of residents on a day-to-day basis in the absence of a registered manager. This is not happening. This matter has been raised on the two previous inspections and the situation has not improved. The home must develop a suitable system and adequate means by which the views and opinions of residents and all other stakeholders are sought and the service provision is evaluated, monitored and reviewed. 7 YA37 9 & 10 30/06/07 8 YA39 24 31/07/07 9 YA42 YA24 12 & 13 This is a regulatory requirement and not a minimum standard as referenced in the home’s documentation. The home must carry out 30/06/07 adequate environmental and safe working practice risk assessments. These documents must be clear and focused on the identified area of risk and how the risk is going to be eliminated or reduced. This includes transporting soiled laundry through the dining area into the DS0000018055.V335792.R01.S.doc Version 5.2 Page 28 Lawrence Road (1) kitchen, areas of risk within the office area etc. Without documentation identifying the known risks and how staff can minimise the risk of harm and danger, both residents and staff are vulnerable. This matter was raised at the last inspection and the timescale to meet this requirement was 31/03/07. This has not been achieved. As a result of the findings from the last inspection an Improvement Plan (Regulation 24(a) was served on the home. The Commission said that this had to be completed and returned by 24th April 2007. The inspection took place on 15th May 2007 and the home could not locate the document. This outstanding document must therefore be submitted with no further delay. The registered provider must demonstrate that that the home is being managed effectively and competently on a day-to-day basis. For this to happen, a Regulation 26 visit (visit by person in control) must take place at least once a month and be unannounced. Since the last inspection only one visit has been recorded as taking place, this was on 26th February 2006. There was no evidence of any other visit by the registered provider (or representative) has taken place to monitor the conduct of the home or supervise any progress from the Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 29 10 YA43 24(a) & 26 15/05/07 last inspection. This matter was raised at the last inspection and a timescale for compliance was 31/03/07. This has not been achieved. 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 Refer to Standard YA6 YA7 YA9 Good Practice Recommendations Adequate provision should be made to ensure that residents, wishes and expectations are sought and recorded in a way that can be understood by all parties. This means that if resident has limited communication skills then an independent person/agency should be involved and act as a representative. The home should pursue contact with funding authorities to ensure that regular placement reviews take place. It is important that the home ensures that residents have access to an independent person i.e. advocacy service. At present there is no independent person acting on their behalf should they have a complaint or concern. It is good practice for a home to have regular staff team meetings to ensure good communication about all matters associated with the home. 2 YA22 YA23 3 YA33 Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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. Extracts may not be used or reproduced without the express permission of CSCI Lawrence Road (1) DS0000018055.V335792.R01.S.doc Version 5.2 Page 31 - 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. 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