Inspection on 07/11/07 for 1 Lawrence Road

This inspection was carried out on 7th November 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. 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 15/05/07

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 1 Lawrence Road 1 Lawrence Road Basildon Essex SS13 2NB Lead Inspector Ann Davey Unannounced Inspection 7th November 2007 09:30 1 Lawrence Road DS0000018055.V353161.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 Lawrence Road DS0000018055.V353161.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 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 Lawrence Road 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 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th May 2007 Brief Description of the Service: 1 Lawrence Road provides residential care for two adults with a learning disability. The fee for the home is £2849.23 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. 1 Lawrence Road DS0000018055.V353161.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 that stated at 9.30am and finished at 4pm. The last key inspection took place on 15th May 2007. Following that inspection, the Commission requested an Improvement Plan from the registered provider. Information about what has improved and what regulatory shortfalls remain outstanding in the home, are referenced below and within the body of the report. The home had completed and returned their Annual Quality Assurance Assessment (AQAA) to the Commission prior to the inspection. This document gives homes the opportunity of recording what they do well, what they could do better, what has improved in the previous twelve months as well as their future plans for improving the service. The home’s manager and staff were spoken to during the inspection. The service manager (representative of the registered provider/person who has area management responsibility for the home.) was spoken with twice during the day on the telephone. The Commission received eight completed surveys from members of staff. Comments from these surveys included have been included within the report. The day was pleasant and the home co-operative and helpful. The inspection was undertaken with ease. The home has not had a registered manager for two years. The current person in charge of the day-to-day management of the home has been in post since May 2007. A tour of the home took place. Care practices were observed and a random selection of records viewed. A notice advising any visitors to the home that an inspection was taking place is normally displayed, but on this occasion this practice was not thought necessary as no visitors were expected. All matters relating to the outcome of the inspection were discussed with the home’s manager. In addition, specific aspects such as the ‘safeguarding adults from harm’ matters, the Improvement Plan, the day-to-day management of the home and the Regulation 26 visits were discussed over the telephone with the service manager. The home’s manager took notes so that development work could be started. Full opportunity was given for discussion and/or clarification both during and at the end of the inspection. 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The registered provider is not undertaking regulatory monthly visits (Regulation 26 visits) to the home. This does not support the information provided within the home’s Improvement Plan and the AQAA. The ‘safeguarding adults from harm’ procedures within the home are not robust. An identified incident in May 2007 was not recorded properly and not reported to the appropriate authorities. This does not support the information provided within the home’s Improvement Plan and the AQAA. Current practice places residents at potential risk. Medication practices have improved, but the ‘invasive technique’ protocol in place is not robust and has not been endorsed by the clinical advisor, GP or funding authority. This must be addressed for the safety and well being of the resident. 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 7 Social/leisure/occupation activities are improving but considerable development work needs to be undertaken to ensure a meaningful lifestyle is provided for each resident. Residents remain without the support of a named social worker or an independent advocate. Residents would not be able to raise any concern independently. There is no independent person/agency to act on their behalf. No further progress has been made by the home to contact the funding authorities for them to carry out very overdue statutory care reviews on individual residents. No further progress has been achieved by the home concerning the ‘in house’ quality assurance process. 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 Lawrence Road DS0000018055.V353161.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 1 Lawrence Road DS0000018055.V353161.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 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to receive a comprehensive pre admission assessment to ensure their needs are identified. Residents cannot be assured of having access to an independent advocacy to support their best interests within their terms and conditions. EVIDENCE: Both residents have lived in the home since it was opened. There are no plans to change the current living arrangements. No admissions have taken place since the last inspection. The home has an admissions policy. Since the last inspection the home has produced a Statement of Purpose and Service User’s Guide in a text/pictorial style. At the previous two inspections, it was noted that residents terms and conditions had not been signed or dated. Discussions took place on both occasions about this matter. Residents have limited skills, and are unable to understand or endorse these documents. There remains no input from the funding authority, there is no family advocate and the home has been unable to secure independent advocacy arrangements for these residents. This matter is referred to again within the body of the report. 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 10 Within the home’s Improvement Plan, it was stated that a social worker is to be contacted to sign these documents. The findings of this inspection do not support this statement. 1 Lawrence Road DS0000018055.V353161.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have a plan of care drawn up by the home that broadly reflects their assessed needs. EVIDENCE: Care plans were current and orderly. From activity observed during the day and from discussion with staff, care plan documentation provided a good rounded ‘pen picture’ of residents needs. Care plans have no input from the resident’s funding authority or an independent agency/person. Residents have limited skills and abilities and therefore the content is based upon the home’s understanding and perception of needs and health agencies input. Since the last inspection, the home has introduced pictorial aspects to care plan documentation. This means that although residents have limited skills, pictorial information is meaningful to them and this enhances self worth and dignity. 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 12 Residents have complex care needs and because of the lack of any independent person/agency input, totally rely on the home making the majority of decisions for them. A positive discussion took place with staff about the strategies used on a day-to-day basis to assess individual resident’s preferences and wishes. At previous inspections the home said that the funding authorities are not undertaking statutory annual reviews on residents. At this inspection the home said that although further attempts have been made, there has been no progress on this matter. Residents’ were unable to comment on their care. Time spent in their company suggested that they were happy and comfortable. Their demeanour was relaxed and in keeping with their documented care needs. It was clear from observation and engagement with residents, that they felt able to express their feelings to the inspector and/or staff on duty. The home’s permanent staff were on duty in the morning and two agency staff were on duty in the afternoon. All spoken with had a good understanding of documented residents care needs. 1 Lawrence Road DS0000018055.V353161.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): 12,13,14,15,16 & 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 balanced diet but cannot be assured of a full and varied leisure activities programme. EVIDENCE: At the previous two inspections, the corporate and personal leisure/activity and programme was noted as being very limited. This was in the main because residents have very different leisure activity needs and with only two members of staff on duty it was proving difficult to meet assessed needs. This was further compounded by a number of shifts with only agency staff on duty. This restricted the use of the mini bus to transport residents to events/activities. Agency staff provided basic care in the home, but did not take residents out on a regular basis. There are currently limited opportunities for residents to experience new things. 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 14 Since the last inspection, the home has begun to explore and implement a more experiential approach to this aspect of care. The manager expressed the view that the lifestyle of residents had been somewhat ‘regimental’ in the past. The manager said that the working culture within the home and the of ‘mindset’ of staff had/was changing in that they now realise how restricting activities and events were for residents. The manager acknowledged that ‘residents were spending far too long in the home’ and was able to demonstrate what has improved. Staff spoke of different activities/events that are being explored and records demonstrated that residents are going out more. The manager said that as a result, residents tend to be more relaxed when they are in the home. The manager understands that there needs to be a continuing stimulating, imaginative and creative approach to this aspect of care. The manager also acknowledged that the home is totally dependant on agency staff for maintaining minimum staff levels. This poses some restrictions on external/community activities when agency staff are on duty. Agency staff do not drive the minibus and their hours in the home tend to be physical task orientated. This continues to be an issue for the home. The AQAA sent to the Commission acknowledged that there is room for improvement concerning this aspect of care. The views from staff within completed surveys about activities/events for residents identified that they felt that more improvements are needed to fully meet residents needs. They felt that there was a lack of staff on duty to successfully deliver this aspect of care. Also the lack of permanent staff was detrimental, as ‘agency staff don’t have the same commitment’. There is a basic four weekly menu cycle. Since the last inspection the home has developed a pictorial style menu choice document. The breakfast choice, which doubles as a very bright attractive dinner place mat, provides residents with pictures of 13 different options. A record of what residents had eaten was available, but not all documents were dated. 1 Lawrence Road DS0000018055.V353161.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): 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 invasive medication practice documentation requires development to ensure safe practice. EVIDENCE: Care plans demonstrate that residents’ personal and health care needs are assessed and recorded. One set of notes belonging to one resident was found in the other resident’s file. There was evidence within the daily records that residents are presented with choice about what to wear, routines and choice of food according to their ability. Community health care input is recorded well. Residents have complex personal and health care needs and the manager said that the home is supported well by all outside agencies. The manager advised that the home is currently exploring the possibility of obtaining some speech/language and communication sessions from the Occupational Therapist. Since the last inspection the manager said that there has been a full review of medication practices. The medication policy has been reviewed, PRN (as/when necessary) medication reviews have taken place and documentation was in 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 16 place to support this. Staff have attended medication training sessions and the manager is to organise competency assessment sessions. Named staff members have also now attended a training session to instruct them in how to carry out a required PRN invasive technique mediation administration safely. In relation to this procedure, a clear PRN administration protocol was in place but there is no written agreement in place from those consenting to the procedure. An agreement document must be drawn up and signed by all significant agencies/persons. For example, the health/clinical professional who provided the training (with review training dates and competency assessment outcomes), the GP, the home and funding authorities. It would normally be expected that resident and/or next of kin and/or named advocate would sign as well if possible. Medication was stored appropriately and medication administration records were clear and orderly. The manager was reminded that all hand written medication instructions should be signed by two members of staff to minimise recording errors. 1 Lawrence Road DS0000018055.V353161.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 poor. This judgement has been made using available evidence including a visit to this service. Residents would experience difficulty in raising any concern or making their concerns known to an independent source. Residents cannot be assured that the home’s safeguarding adults from harm procedures are effective. EVIDENCE: The manager advised that there has been no reported complaints since the last inspection. The pictorial/text complaints procedure is displayed. Residents have very limited abilities and would not be able to raise any complaint or concern independently. The manager said that contact had been made with an advocacy service regarding the signing of residents’ terms and conditions, but no progress had been made on obtaining a regular visit to the home. Staff explained how residents’ can/would express choices and preferences on day-to-day matters. This is normally through observation of changed behavioural patterns or non-verbal communication processes. The manager said that all staff have attended a ‘safeguarding adults from harm’ training session. The manager has a training session booked for later in November. Whilst looking through documentation, the inspector noticed a record entry made in July 2007 describing a resident/resident physical assault. It was established that the member of staff had made the entry without any reference to the safeguarding procedure, the manager did not know about the matter and the incident had not been recorded in the home’s incident/accident book. As a result, the matter had not been referred to the local authority as a 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 18 ‘safeguarding adults from harm’ matter, the registered provider or the Commission. At the inspection, the manager could not locate the home’s ’safeguarding adults from harm’ procedure, but did have the Essex County Council information booklet. The inspector provided the home with the current ‘safeguarding adults from harm’ referral contact telephone number. The manager was asked to notify the registered provider immediately and instigated a referral to the local authority. The Commission has been notified that this was done. It is also important that as a result of this incident, the manager reviews residents’ risk assessments to ensure that correct procedures are in place. A review must be undertaken to establish if this was an isolated incident or if a pattern of behaviour is emerging. This must be undertaken to ensure that residents are safe and protected from harm. Within the home’s AQAA under ‘what we do well’ it was stated ‘training on POVA and staff supervision’ and ‘reporting of incident/accident’. The findings of this inspection as detailed within this section of the report do not support this statement. Within the home’s Improvement Plan it was stated that there would be ‘unannounced visits weekly by service manager’ and ‘PIC (person in control/registered provider) unannounced (visits) would commence and will be adhered to on the required minimum on monthly basis’. The findings of this inspection as detailed within this section of the report do not support these statements. The home did not follow the safeguarding adults from harm procedures even though staff training had been undertaken. The matter had not been reported on and documented in accordance with current local authority and ‘in house’ guidance and instruction. The manager had not reviewed records. The registered provider does not carry out regulatory visits in accordance Regulation 26 requirements (see management and administration section). This would have provided a further level of monitoring/supervision. Residents living in this home have no named social worker, family connections or receive visits from an independent advocate. Residents have very limited abilities and would not be able to raise any concern or complaint independently. This places residents living in this home in a vulnerable position and at potential risk. This matter was recorded at the last inspection. 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 19 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. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a comfortable and clean environment. EVIDENCE: A tour of the home was made. The environment was warm, airy and comfortable. Bedrooms were decorated and furnished appropriately. Communal areas were clean, homely and comfortable. The kitchen was clean and tidy. The garden/patio area was well kept and provides a very pleasant area for residents. The office was more orderly since the last inspection and records were easily accessible. Since the last inspection, the home has made the environment more ‘user friendly’ by putting up a pictorial notice boards in the lounge and dining areas with a pictorial staff rota, menus, photos. This has created a more homely and personal environment for residents. 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 20 The manager has improved infection control and cross contamination systems/processes within the home. Paper towels and liquid soap were in the bathroom. In the kitchen area, the laundry processes had improved with clear guidance in how to manage soiled laundry. In the previous two inspection reports, it was recorded that the registered provider has plans to carry out some alterations to the home. At the last inspection the home was reminded that no work should be undertaken until plans had been submitted to the Commission and written approval had been received. At this inspection the inspector was advised that residents would need to move out for approximately two weeks to facilitate essential works. The manager was advised that all proposals must be submitted to the Commission and no decisions made without the approval of the Commission. It was understood that planning permission has now been granted. The home must now make application to the regional registration team. Full details about how to do this, was given to the manager. 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to be cared for by a developing team of staff that is totally reliant on agency input to maintain minimum staffing numbers. EVIDENCE: The current staff rota was accurate and reflected staff on duty for the day. There are two members of staff on duty during the day and one ‘awake’ member of staff on duty at night. The home has no ‘sleeping in’ facilities for staff. Rotas demonstrate that the home is totally reliant on agency staff to maintain minimum staffing levels. Some shifts during the week are solely covered by agency staff. The afternoon of the inspection was an example of this. The current situation has been noted in the past three inspection reports. The manager said that the situation is unlikely to improve in the foreseeable future. It was positive to note that the manager’s hours are currently supernumery to numbers on duty. It was explained that this arrangement (which is currently under review) is for the manager to develop management and administration 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 22 systems within the home and to attend training sessions. The manager does not work weekends in the home. At the last inspection it was noted that agency staff undertook all weekend shifts. This situation has now improved and the manager ensures that whenever possible, at least one member of the home’s staff are on duty with agency staff. The manager said that the home tries to ensure that staff sent by the agency are ‘regular’. This means that the residents do see at least see familiar faces. The manager agreed that there is sometimes a different working culture between permanent staff and agency staff that can reflect on the delivery and outcome of care for residents. The inspector observed different practices as the day progressed. During the morning, permanent staff were actively engaging with residents, but during the afternoon when agency staff were on duty, residents were being ‘occupied’. There was little evidence of active engagement and meaningful stimulation. There was no evidence of any forward planning in terms of care provision when agency staff are on duty. The inspector’s observation that afternoon (and that at the previous inspection) may not be typical of all agency staff employed at the home, but outcomes were similar on both occasions. The manager said that staff training has been reviewed and developed since the last inspection. These records will be re assessed at the next inspection when the manager has time to fully complete this piece of work. No new staff (except for the home’s manager - see management and administration section) have been recruited since the last inspection. Two staff have left employment since the last inspection. The manager said that this has reduced the complement of permanent staff even further. No new care staff have commenced work in the home since the last inspection. On this occasion staff induction records were not viewed. The home has a staff induction policy in place. Notices on office walls indicate that staff meetings and staff supervision sessions are planned and take place. The manager said that staff sickness levels are good and morale is improving. The manager said that there had been a numbers of changes in working practices since the last year. For example, routines are more resident focused and permanent staff now work weekends. The manager said that staff have coped and adapted well with the changes. The views from staff within completed surveys concerning staffing matters was mixed. There were positive comments about the recruitment process, staff training, availability of information and staff said they knew how to raise any concerns. The majority of the surveys made reference to a poor skill mix of staff on some shifts, there was too many agency staff on duty and a lack of permanent staff in the home. Reference was also made that agency staff are 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 23 ‘managed’ differently to permanent staff. These views were shared with the manager. The manager felt that there was a lot of potential with the current staffing group and looks to developing the team. The manager acknowledged that the recruitment of staff to the home remains a challenge mainly because of its location. 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 24 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 and 42 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 home where management and administration systems are improving which impacts on the day-to-day care. Residents cannot be assured that the registered provider monitors the quality of care. EVIDENCE: Since December 2005, the home has been without consistent management presence and direction. During this time there has been two ‘acting managers’. The current manager has been in post since 22nd May 2007. At this inspection there was evidence of some improvements within the ‘in house’ management and administration systems. These improvements have been referred to throughout the report. The manager acknowledged the repeated regulatory shortfalls that are still to be addressed. 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 25 At the previous inspection on 15th May 2007 it was recorded: ‘At the last inspection (29th January 2007) 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 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’. At this inspection, since the last visit on 15th May 2007, only two Regulation 26 visits have been recorded as taking place. These were on 12th June 2007 and 8th August 2007. There is a continuing lack of commitment and support from the registered provider to the home. The two statutory inspections (January 2007 and May 2007) have demonstrated that the home has been unable to address regulatory shortfalls. The outcome for residents is that they continue to live in a home where the registered provider does not comply with all their regulatory obligations. Within the home’s AQAA is it stated that these visits are to be carried out monthly. The findings during the inspection do not support this statement. At the previous inspection it was noted that the Commission had not responded to a requested Improvement Plan (Regulation 24) that was made after the inspection on 29th January 2007. Following the last inspection on 15th May 2007 a second Improvement Plan was requested with a return date of 1st August 2007. The Commission prior to this inspection had not received a response. A letter expressing concern was sent to the registered provider on 18th October 2007. At this inspection the service manager said that a completed Improvement Plan had been sent to the Commission. A copy of this letter was brought over from the registered provider’s head office to the inspector. It was dated 17th July 2007. The inspector confirmed that there was no record of this letter being received on the Commission’s ‘in coming post’ log, neither had it been seen by the inspector or line manager. There was no evidence that the home’s internal Quality Assurance system has progressed since the last inspection. Safety and maintenance records sampled were in good order. Since the last inspection, the home has reviewed the fire drill process and a record of them having taken place was available. 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 26 The manager said that residents meetings have now started. The inspector said that as both residents have non-verbal communication abilities, there is no named social worker, advocate or next of kin, the home must look at how the residents best interests are going to be identified. The home’s incident/accident book did not record the incident as referred to in the ‘concerns, complaints and protection’ section of this report. Since the last inspection, the manager has reviewed and updated the safe working and environmental risk assessments. These documents were current and in good order. The views and opinions within staff surveys about management issues/systems was mixed. Some staff thought that ‘in house’ management support was good whilst others thought that it was an area for improvement and development. At least four surveys made the comment that the registered provider does not visit the home enough and that ‘spot checks’ are not happening. 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 27 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 3 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 2 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 3 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 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 2 2 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 28 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 YA5 Regulation 12(3) Requirement Arrangements must be in place to support residents to make an informed choice. Timescale for action 31/12/07 2 YA12 YA13 YA14 16(m) & 18 The home must be able to 31/12/07 demonstrate that adequate, suitable provision and opportunity is made for residents to experience and participate in social/leisure activities and community events of their own preference and/or is in keeping with the client group. Documentation associated with the current ‘invasive technique’ medication administration protocol must be in place in line with the home’s policies and procedures. This must happen to protect and safeguard residents from potential risk. 30/11/07 3 YA20 13(2) 4 YA22 22 Suitable arrangements must be put in place to ensure that residents have access to an independent person/agency. This is to ensure that residents have DS0000018055.V353161.R01.S.doc 31/12/07 1 Lawrence Road Version 5.2 Page 29 free access to an independent person/agency with whom they can raise any concern or complaint and who can act on their behalf and in their best interest. 5 YA23 13 All staff must know how to recognise and act appropriately in all matters relating to ‘safeguarding adults from harm. Residents must know that they safe in the home and process are in place to protect them from harm. 6 YA32 YA33 YA36 18 Adequate numbers of staff who are suitably, trained and skilled must be on duty at all times to meet the assessed needs of residents. This would enable residents to participate in leisure, social and community events of their own choice and preference which is in keeping with their assessed needs. 7 YA37 9 & 10 The registered provider must be able to demonstrate that this home is being competently and effectively managed on a day-today basis for the benefit and wellbeing of residents. The monitoring of the home by the registered provider is not sufficient to ensure the well being of residents. 8 YA39 24 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 DS0000018055.V353161.R01.S.doc 30/11/07 31/12/07 31/12/07 31/12/07 1 Lawrence Road Version 5.2 Page 30 evaluated, monitored and reviewed. The previous timescale of 31/07/07 to meet this required has not been achieved. 9 YA42 12 & 13 The home must ensure that all accidents/incidents are recorded according to the home’s policies and procedures. This would monitor the care of residents. 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. The previous timescale of 15/05/07 to meet this requirement has not been achieved. 30/11/07 10 YA43 26 31/12/07 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 YA5 Good Practice Recommendations Residents should have access to an independent person (advocate) to support their best interests. 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 31 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 1 Lawrence Road DS0000018055.V353161.R01.S.doc Version 5.2 Page 32 - 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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