Inspection on 20/06/07 for 1 Old Road

This inspection was carried out on 20th June 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 no outstanding requirements from the previous inspection report, but made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1 Old Road 09/11/07

1 Old Road 10/08/06

1 Old Road 24/11/05

1 Old Road 11/07/05

1 Old Road 11/11/04

1 Old Road 18/02/04

1 Old Road 02/12/03

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 09/07/2008.

CARE HOME ADULTS 18-65 Scic - Old Road, 1 1 Old Road Southam Warwickshire CV47 0HD Lead Inspector Jo Johnson Key Unannounced Inspection 20th June 2007 07:45 Scic - Old Road, 1 DS0000004307.V335298.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 Scic - Old Road, 1 DS0000004307.V335298.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. Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Scic - Old Road, 1 Address 1 Old Road Southam Warwickshire CV47 0HD 01789 298709 01789 296724 pam@stratfordmencap.org.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) Stratford & District Mencap Ms Rachael Sass Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Ms Sass achieves the registered Managers Award by 1st September 2006. The home may accommodate one named service user within existing categories over the age of 65 years. 10th August 2006 Date of last inspection Brief Description of the Service: 1 Old Road is a semi-detached house, which provides accommodation for four adults who have learning disabilities. The ground floor has the communal accommodation, with a lounge that leads into a large open plan dining area and kitchen. There is a small utility room off the kitchen. The ground floor also has one bedroom with its en-suite WC and shower. There are three bedrooms on the first floor in addition to a bathroom and staff sleep in room/office. The organisation also operates a domiciliary care agency supporting approximately ten people in the Southam area from the sleep in room/ office. The manager is the registered manager for both the domiciliary care agency and the care home. The house has a rear garden and parking for cars at the front. Shops and village amenities are available locally. The property is owned by a Warwickshire housing association and held on lease by the care provider. Fees for 2007/8 are £598.17 per week. Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Before the inspection visit, the manager had forwarded to the Commission a pre-inspection questionnaire, a staffing rota, training records and menu records for the home. All pre-requested documentation returned was examined as part of the inspection process and the evaluation included in this report. Questionnaires were sent out to people living at the home and their relatives. Their comments have been included in this report. The views of the funding local authority were sought and have been included in this report. The inspection visit was unannounced and took place on Wednesday 20th June at 7.45am to 3pm. Initially, the inspector could not gain entry to the house for 20 minutes, as the senior support worker was still asleep following a disturbed night. A person living at the home let the inspector in. The inspection involved: • • • Discussions and Makaton signing with the four people who live at the home and the senior support worker, support worker and manager on duty at the time. Observation of working practices and of the interaction between individuals and staff. Two people were identified for close examination by reading their, care plan, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for people. A tour of the environment was undertaken, and home records were sampled, including staff training and recruitment, health and safety, and staff rotas. • The inspector would like to thank the people who live at the home, manager and staff for their hospitality and cooperation during the inspection visit. Scic - Old Road, 1 DS0000004307.V335298.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: People need to be asked about where and with whom they want to live. They need to have independent support to do this. The manager needs to identify when the home is not meeting the needs of the people living there. Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 7 The contract for the home needs to be reviewed to make it clearer what happens when people have or want to move out. Everyone needs to have an assessment and care plan that includes correct information about his or her health conditions. The locking of the downstairs fire doors at night must stop immediately. The risks of people having access to the whole of the house at night must be assessed. Staff need to support people to maintain important personal relationships. People must see health and social care professionals when they need to. Staff need to give and record that they have given the right medication. Medication practices must be made safer and medication plans need to be written. Medication needs to be returned to the chemist when it is no longer used. The manager needs to reassess whether the current staffing levels at night are sufficient. The manager needs to inform the commission when staff have been disciplined. The organisation needs to find alternative premises to operate the domiciliary care agency. 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. Scic - Old Road, 1 DS0000004307.V335298.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 Scic - Old Road, 1 DS0000004307.V335298.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, 3, 4, 5 Quality in this outcome area is poor People are not supported to make informed choices about where they live neither can they be sure that the home will meet their needs and aspirations. The written contract does not make it clear that people may transfer to other homes within the organisation and that their rights and choices may be limited. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new person has recently been transferred from another home in the organisation that it is planning to close. The person was spoken with about their move to the home. They had lived at their previous home for many years with their long-term partner. In the assessment and care plan from their previous home the individual’s ‘aspirations and wishes’ state: ‘I also think about getting my own place and living with …’. When spoken to about the move, they said, “Happy here sometimes, I came to visit, I miss… she phones everyday but hasn’t been here…keeps me awake at night and makes a lot of noise and tells me to shut up. It makes me really grumpy.” Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 10 From records kept about the move to the home, it is clear that the individual was only taken to look at this home and then the process of visits started. The records of the visits were seen and included consultation with the other people living at the home. This aspect of the move was managed well by the home. However, the whole process only took over six weeks and did not consider the previously identified wishes of the individual to move into a place of their own with their partner. The staff at the home did not undertake their own assessment of the individual but used the one from the previous care home. The staff have been working with the person to produce a new assessment and care plan. They said “staff talk to me about what I’ve been doing and what I want to do”. The three other people were asked their views of the new person moving in. One said ‘ I like… he likes Elvis like me, we talk’, another person signed thumbs up and smiled and the other smiled when asked about the new person. It is of serious concern that the manager and the organisation made the decision to move another person into the home when there is one person whose behaviours were already having a negative impact on the two other people living at the home. It is of further concern that the new person moved in so quickly, was not given the option at looking at other homes or housing options, did not have any independent support or consultation such as a care manager or social worker. The person has been separated from their longterm partner and has not been supported to regularly visit them either at their old home or this home and their old home is not closing in the immediate future and no other people have moved out. The funding authority manager raised concerns with the inspector that they were not involved or consulted about this person’s move and were not notified until after the event. They were unclear as to what consultation had taken place with this individual or whether the organisation’s contract reflects that, they may move people to other services. The manager confirmed that the funding authority had not been informed until after the person had moved in. The funding authority manager was also concerned that the organisation is planning to move another person from the home. The manager or organisation has not recently sought any additional support from specialist learning disability teams or funding to manage the situation. Each person has a contract supported by pictures in their care records. This contract refers to the fact that they may be asked to leave the home if they are not able to meet their needs or their behaviour is unacceptable. It does not include that people may be moved to other homes within the organisation nor does it specify what the assessment or consultation process will be. The contract must be reviewed to include how people will be informed that the home can no longer meet their needs and what the process is for leaving and Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 11 who will be involved in the identification of any new home. This is so that peoples’ right are clearly set out and they are supported to make informed decisions about where and with whom they live. A relative survey shows the home always meets the needs of their relative. Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 12 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 poor Peoples’ current and changing needs are not accurately assessed and peoples’ wishes and aspirations are not always taken into account during care planning. The restrictions placed on people living at the home and the lack of proactive of risk taking means that people rights, safety and freedom are limited. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two peoples’ care records were seen, the most recent admission and the individual who has been identified to move from the home. As previously stated a new assessment and care plan is being undertaken with the new person. The care plan in place was from their previous home and some aspects where out of date and not relevant. Staff must make sure that when they are supporting this person to plan for their life, that they include Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 13 their needs and wishes in terms of where and with whom they live and how this will be supported. The information included in the other person’s assessment and care plan was conflicting. There were three different diagnosis of a medical condition. The ‘health action plan’ assessment completed by a learning disability nurse states that they have ‘hypothyroidism’. However, two of the assessment/care documents written by the home refer to ‘hyperthyroidism’. As this person presents particular challenges for the staff and other people living at the home, it is imperative that any medical information about the condition is correct, as it needs to be closely monitored with any changes in behaviours. There was also conflicting information and views as to whether this person has early onset ‘dementia’ or is actively making lifestyle choices that have a negative impact on others who share the home. It is important that staff have the correct information about people’s conditions so that they are able to care for them properly and safely. One person’s assessments and care plans had been recently reviewed. A pictorial care plan covers all aspects of a person’s life and choices. There were some good descriptions of how the two people who communicate differently make their needs known. Another person living at the home has early onset dementia and their shortterm memory is reduced. The manager commented that this person is now struggling to remember staff names and this was evident throughout the inspection. A rota with photographs with staff names on should be developed to assist the person with identifying staff. One person knew that staff kept records about them and said “staff tell me what they write…I don’t mind what people write”. However, as some of the daily recording seen was not person centred, it is not clear if staff are always including people in the recording of their daily records. For example, one of their daily records included the recording ‘…got most stroppy’. Staff should make sure that they keep accurate records that are not based on their judgements. People living at the home should be involved in the recording of their daily records. This is so people are meaningfully involved in keeping details about themselves and their daily lives. People living at the home do not have ongoing ‘life story’ books and when people where asked if they had photos or anything to show what they had been doing they did not have anything accessible. These books have photographs and items in them that show what the person has been doing in their lives. Staff should develop ‘life story’ books/works with people living at the home, as these give a much more interesting picture of how people have been spending their time and people may find them easier to follow than written records. For people who books may not be suitable, other formats such as DVD’s for life story and life history work should be used. Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 14 As people living at the home have changing needs, it is important that ‘life history’ books are also developed that includes details and photographs of their ‘history’ such as family, friends, where they have lived, pets, work etc. These life history books will assist both the person and staff in remembering their past and will assist staff to have a greater understanding of them as an individual. A relative’s survey shows that the home always gives the support and care their relative needs. There were risk assessments in place for individual’s day-to-day lives and activities. On arrival at the home and from discussion with the manager and staff, it was established that during the night the downstairs fire doors to the lounge and kitchen are locked. This is not based on any risk assessments and is a management strategy for one person living at the home. From daily records and discussion with an individual, this is having an impact on their choices and freedom of movement around the home, as they are expected to go to bed when the sleep in staff go and then they are not able to go back downstairs without waking the staff. There has been no additional fire risk assessment or consultation with the fire service for the practice of locking fire doors. This practice is unsafe, places people at risk and impinges on all of the rights and freedom of all the people living in the home. It may also contribute to the negative impact that one person’s behaviour is having on the rest of the people living there. The manager was advised to stop this practice immediately and following the inspection a letter of serious concern was sent to the home. As the practice of locking doors has been a reactive way of managing one person’s nighttime insomnia, the manager must reassess whether the current staffing arrangement of a staff sleep-in is sufficient. This is to make sure that there is enough staff to meet all of the needs of the people at the home without placing restrictions of their rights and movement around the home. From discussion with the manager, there is a reactive approach at the home for managing risks and other aspects of peoples’ day-to-day lives. The manager said that with regard to one person, the situation has deteriorated since the last local authority and learning disability team review in November 2006. This person’s night time insomnia is having a negative impact on the other people at the home and on the day of the inspection two of the people and the staff had been kept awake and up until 4.45am. The individual themselves was observed to be content and cheerful throughout the inspection, whereas the other two people complained of ‘headaches’ and feeling ‘grumpy’. One the people returned to bed for a few hours instead of Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 15 attending their day services. Staff took this person to their day service later in the day. The manager has not approached either the local authority or the learning disability team for support in managing the situation whilst waiting for this person to move, even though it is over seven months since the last involvement by any social care or learning disability professionals. She said a review should have been carried for this individual the day before the inspection but it had been cancelled. During this time, only the learning disability consultant psychiatrist has seen the individual for their epilepsy management. The manager must become much more proactive about identifying when they are not meeting the needs of all the people living at the home and should have the autonomy to determine whether it is appropriate whether additional people move into the home whilst everything is so unsettled. It is strongly recommended that the two people living at the home, who were case tracked, have a person centred plan completed. A referral should be made to the local authority person centred planning co-ordinator. Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 16 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 good. People participate in a range of social, leisure, and educational and occupational opportunities. Mostly they have opportunities to maintain appropriate and fulfilling lifestyles in and outside the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the start of the visit, all four people were at home. One person went to the local day service in a taxi. This person signed that they were going out in a car, that they would be eating out and going bowling. They were clearly looking forward to their day out and very keen to get ready to go. Staff took another person to day services when they were ready. One person stayed at the home all day and another went out to a music session in the afternoon. The person who stayed at home all day appeared to content and spent time walking in both the house and the garden. Staff were observed trying to Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 17 engage them in day-to-day activities. They were knowledgeable about what the person would be happy to engage in and at what point not to pursue a certain activity. Each person has some planned days at day services or community activities. One person said “I’ve got a job at the church on Friday and then I go to …’s to watch videos”. People said that they can have friends and family to visit and they can go and visit friends who live in the locality. However, as previously mentioned the new person’s partner and previous links have not been fully maintained apart from by telephone. Every effort must be made to make sure that the individual’s relationship is maintained and supported, so that they continue to live meaningful and fulfilled lives with people that are important to them. One person is receiving additional bereavement support from the learning disability team following the loss of close family members. This is good practice. A relative’s survey shows that are kept informed of important matters, live the life they choose and that the different needs of people are met. The menus show that people are provided with a well-balanced and nutritious diet. All food being stored in the kitchen looked fresh and was well within the use by date. People go food shopping with staff support if they want to. They said or signed that they enjoyed the food provided by the home. One person said “ I help staff with the cooking…put on my chef outfit”. Another person who does not communicate verbally chooses the food they want by using a photographic menu book. This is good practice. Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 18 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 poor People receive personal support from staff they get on well with. Shortfalls in following up on some people’s health means that they do not receive the health care that they are entitled to. The medication practices are unsafe and place people at risk from medication misadministration. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were positive relationships and interactions observed between staff and the people who live at the home. People commented that they know and get on well with the staff and that they treat them well. One person said, “ I really like…I want him to be my keyworker” another person was able to name their keyworker and said that they get on well with staff. Individuals’ health records and care plans showed that their right to goodquality physical and mental health care is not always being promoted. The records show that people are supported to attend the dentist, optician and chiropodist appointments. Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 19 The manager and staff have been pro-active at promoting one person’s health needs. This was following a number of falls and the deterioration in their mobility. This person now has medication that has reduced the pain from arthritis and their mobility has improved, and the number of falls has been greatly reduced. The person who is presenting challenges to others living in the house has not received adequate health and specialist care. As previously stated there has not been any involvement of the learning disability team for seven months even though the situation has clearly deteriorated for the individual and others living in the home. The differing health information recorded in this person’s assessment and their ‘health action plan’ means that staff have not followed up on their specific health needs. This person had not any blood tests for over a year, although some of the increase in their unusual behaviours may be related to medication and or a health condition. The senior support worker said that he was requesting that blood tests be done with the GP on the day of inspection. A recent letter from a specialist consultant psychiatrist advises that this person’s medication be increased at night. However, this was not happening and there were serious shortfalls in the administration of this individual’s medication, which are detailed below. The manager must make a referral to the learning disability team and other relevant health and social care professionals for this individual to make sure that all of their complex health, behaviour and social care needs are assessed and met. Staff are trained in the medication policies and procedures during induction and there is a medication training programme. During the inspection, a box of medication was left in an individual’s bedroom and was found by the inspector. The inspector supported them to return the medication back to the staff to be safely put away. This person still has a medication plan and risk assessment in place from their previous home that specifically states that they must have their medication administered in their bedroom. This plan must be reviewed and rewritten to reflect the current medication practices if they are assessed as safe for this individual. The medication records for person whose medication was increased by a consultant psychiatrist were not clear or safe. The medication administration record stated that 3mg Melatonin was to be administered at 9pm. The consultant had written on May 17th 2007 that this was to be increased to 6mg at night. The pharmacy pack from the chemist stated that two 3mg Melatonin tablets were to be taken at night but only one 3mg tablet was in the pack. There were 3 separate bottles of 3mg Melatonin in the drugs cupboard with a label on stating that they were to be taken PRN (when required). The individual’s plan for taking this medication did not specify under what Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 20 circumstances it is to be given, how long between doses and what is the maximum dose in 24 hours. PRN (when required) medication plans must be written. The prescribing practitioner or health professional should approve these medication plans where possible. This is so that staff know how and when to safely administer as and when medication. There were gaps in the medication administration records for one person. Staff must sign medication records to show whether medication has been administered. This is so there is record of whether people have been given the correct medication as prescribed. The home produces their own computerised medication administration records, a number of these were incorrect or included medication that is no longer taken. The computerised medication administration records must be accurate again to make sure that people are given the correct prescribed medication. There were boxes of medication in the drugs cupboard that were not listed on the individual’s records, as they are no longer used. All unused or not currently prescribed medication must be returned to the pharmacy. This is so that unused medication is not given to people. Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 21 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 good The people who live in this home are able to express their concerns and know whom to speak to if they are unhappy or feel unsafe. They are supported by a staff team who have a good knowledge of how to respond to any suspicion of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no complaints made to the Commission for Social Care Inspection about the home since the last inspection. The manager went through the record of complaints. Two of the complaints resulted in referrals to the local authority, as they were allegations of abuse. The record of complaints is shared for both the care home and the domiciliary care agency. These complaint records should be separated; this is because there should not be information about other people kept with information about people that live there. People said they felt safe and would know who to talk to if they were unhappy. People have access to a complaints policy, which is in symbol and large print format and includes information about the Commission for Social Care Inspection. Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 22 People who communicate differently were observed with staff and they appeared relaxed and happy to approach them, which may indicate that they feel safe. The staff said all of the people had a pictorial guide on how to keep safe and what things they need to report to staff. Staff spoken with confirmed that they had been provided with prevention of abuse training at various times. They said that Whistle blowing and Protection of Vulnerable Adult information is included in their induction training. There have been two adult protection referrals made to the local authority since the last inspection. A relative’s survey shows that they know how to make a complaint and the home has always responded appropriately to concerns. Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 23 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 The home is maintained and furnished so that people live in a clean, comfortable and homely environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a warm and welcoming atmosphere in the home and at the time of the visit, it was homely and comfortable. People living there were able to move around easily and freely once the downstairs rooms were unlocked. The manager gave a tour of the communal areas of the house and went through the planned and ongoing redecoration and replacement programme. The home was clean and free from any offensive odours. The manager updated the inspector on the progress on the requirements relating to the environment issued at the last inspection. All of the rooms had Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 24 sufficient lighting and the garden path had been made safe. The plan for getting the home ‘dementia’ ready was discussed, as it was a requirement at the previous inspection. The manager stated that she was reluctant to introduce lots of signage to the home, when all of the people living there where still orientated to the whereabouts of all the rooms. This shows some understanding a person centred approaches and previously stated the manager and staff should be proactive at introducing cues, such as the photographic rota, for people as their dementia develops. This is to make sure that people’s independence and well-being is promoted even if their cognitive abilities are deteriorating. Three of the people living at the home showed the inspector their bedrooms. The bedrooms reflected their individual lifestyles, interests and tastes. The chest of drawers in the new person’s bedroom had yellow stickers on the drawers. When asked what they were for they said, “I think they’re there to help me but I don’t know what they say”. However, this person is a man and the labels referred to female garments such as ‘petticoats’. The manager confirmed that the chest of drawers had been someone else’s before the new person moved in. These labels should be removed, as they are not relevant to the individual and do not show a commitment to providing a person centred and personalised care service. Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 25 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 good. The people living in this home are protected by robust recruitment practices and supported by a skilled and competent staff team. Staffing levels during the night place restrictions on people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observation of care practice and discussion with the manager and staff members on duty at the time showed that positive relationships exist between the people and the staff supporting them. People living at the home sought staff out and were comfortable with them. Observation showed that staff were good listeners and communicators and were interested and committed to the work they were doing. Due to the current situation with one individual as previously stated the manager must reassess the current staffing levels. This is to make sure that limitations are not placed on people at the home because there is not the staff support available. Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 26 A member of staff spoken with felt they had the skills and experience necessary for the tasks they were expected to do and this included Learning Disability Award Framework training and NVQ. Pre-inspection information and the training chart in the home shows that staff have accessed training in the full range of mandatory, health and safety related training, (e.g. first aid, food hygiene and fire safety) as well as specialist care courses, such as dementia and epilepsy. The four staff files including the two most recently recruited staff were seen and they included all of the necessary documentation to demonstrate that the staff are suitable to work with people living at the home. They all included CRB (Criminal Records Bureau) checks and three references. Obtaining three references is excellent practice and exceeds both the National Minimum Standards and the Care Homes Regulations. Staff at the home also work for the domiciliary care agency. One member of staff had been through a disciplinary hearing for an incident that happened whilst working for the domiciliary care service. The manager had not notified the commission of this. Even if an incident resulting in disciplinary action happened whilst staff were working for the domiciliary care agency, this still must be notified under regulation 37. This is because it is a shared staff group and there are common employment matters in both settings. Staff spoken with said they had regular supervision and staff meetings. Scic - Old Road, 1 DS0000004307.V335298.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 adequate. The impact of operating a domiciliary care agency, admitting a new person and the current situation with one individual means that people are not currently benefiting from living in a home that is run in their best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for two year and advised the inspector that she has almost completed the Registered Manager’s Award. During the inspection, the conditions of registration of the home were reviewed with the manager and agreement was reached to remove the current conditions. Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 28 When the domiciliary care agency was registered, it was agreed that it could operate from the care home but that this must be kept under review if there were negative impacts on people living at the home. However, at the recent domiciliary care agency inspection, the inspector raised concerns about the agency being operated from the sleep in room/ office and the local authority team manager has also raised concerns about the agency being operated from the care home. They were concerned that service users of the domiciliary care agency and their families phone the care home to contact staff and that this takes away time from the people living at the home. This was the inspector’s finding as well during the inspection; a majority of the calls to the home’s phone were related to the domiciliary care agency. The operation of the domiciliary care agency from the care home also means that there is information relating to service users in the community kept in the peoples’ home. The holding of information about service users in any office constitutes that the office is a branch and the care home is not registered as a branch and must only be used a satellite office. The organisation must find alternative premises to operate the agency, as it is taking the manager and staff time away from the people living at the home. In the current circumstances, there must be a focused approach to managing the home so that the people living at the home receive a better quality service as highlighted throughout the report. The manager said that there have not been regular house meetings as two of the people living at the home have different ways of communicating. She plans to start house meetings now another person has moved in. An employee of the organisation is carrying out monthly monitoring visits. The people living at the home are surveyed for their views on an annual basis. The outcomes of this consultation are summarised and fed into the development plan for the home. Information provided by the manager in the pre inspection questionnaire indicates that relevant Health and Safety checks and maintenance are being carried out at the home. A number of Health and Safety records were checked, including the fire safety log. These records showed that health and safety matters are well managed. Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 1 3 2 4 3 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 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 x 1 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 1 x 2 x 3 x x 3 x Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 30 No 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 YA2 Regulation 12,14 Requirement People must be consulted and be given informed choices as to where and with who they want to live. People must be referred to the funding authority so that they have access to independent support. This is so people have the opportunity to look at different housing options and can choose whom they live with and make sure their views and aspirations are taken into account. The manager must identify when they are not meeting the needs of all the people living at the home and take action to address these unmet needs. This is so people do not live in a home that cannot meet their needs. Peoples’ contracts must be reviewed to include how people will be informed that the home can no longer meet their needs and what the process is for leaving and who will be involved in the identification of any new DS0000004307.V335298.R01.S.doc Timescale for action 01/11/07 2 YA3 12,14 01/08/07 3 YA5 5 01/12/07 Scic - Old Road, 1 Version 5.2 Page 31 home. This is so that peoples’ right are clearly set out and they are supported to make informed decisions about where and with whom they live. 4 YA6 14,15 Peoples’ assessments and care plans must be completed and include the correct information about people’s health conditions. This is so that staff are able to care for them properly and safely. 5 YA9 13 The practice of locking the downstairs fire doors must stop. This is because the practice is unsafe, places people at risk and impinges on all of the rights and freedom of all the people living in the home. Individual and environmental risk assessments must be completed for people accessing the whole of the house at night. 21/06/07 01/08/07 6 YA9 13 01/08/07 7 YA15 12 This is so that any risks identified can be minimised whilst still allowing people the freedom of movement throughout their home. Individuals’ personal 01/09/07 relationships must be maintained and supported by staff. This is so that they continue to live meaningful and fulfilled lives with people that are important to them. The manager must make a 01/08/07 referral to the learning disability team and other relevant health and social care professionals for DS0000004307.V335298.R01.S.doc Version 5.2 Page 32 8 YA19 12, 14 Scic - Old Road, 1 one individual to make sure that all of their complex health, behaviour and social care needs are assessed and met. 9 YA20 13 A medication plan for one person must be reviewed and rewritten to reflect the current medication practices, if they are assessed as safe for this individual. Staff must not leave medication unattended in peoples’ bedrooms. This is so staff know how to safely administer medication to this person and medication is not accidentally taken or given. 10 YA20 13 When a prescribing practitioner has made changes to a person’s medication, the manager to make sure that it has been actioned. This is so people are receiving medication as directed and prescribed by their General Practitioner or Consultant. PRN (when required) medication plans must be written. The prescribing practitioner or health professional should approve these medication plans where possible. This is so that staff know how and when to safely administer as and when medication. 12 YA20 13 Staff must sign medication records to show whether medication has been administered. This is so there is record of whether people have been given Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 33 01/08/07 01/08/07 11 YA20 13 01/10/07 01/08/07 13 YA20 13 the correct medication as prescribed. The computerised medication administration records must be accurate. This is to make sure that people are given the correct prescribed medication. All unused medication or medication that is no longer prescribed must be returned to the pharmacy. This is so that medication is not kept at the home where it might be administered by accident. 01/09/07 14 YA20 13 01/09/07 15 YA33 18 01/08/07 The manager must reassess whether the current staffing arrangement of a staff sleep-in is sufficient. This is to make sure that there is enough staff to meet all of the needs of the people at the home without placing restrictions of their rights and movement around the home. 01/11/07 Regulation 37 notifications must be made for any staff disciplinary action regardless of whether it relates to the domiciliary care service. This is because it is a shared staff group and there are common employment matters in both settings. 16 YA33 37 17 YA37 Care Standards Act 2000 The organisation must find alternative premises to operate the domiciliary care agency. There must be a focused proactive approach to managing the home so that the people living at the home receive a better quality 01/12/07 Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 34 service and have the full attentions of the staff on duty. 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 YA3 Good Practice Recommendations The manager should have the autonomy to determine whether it is appropriate whether additional people move into the home whilst everything is so unsettled. This is so they can be responsible for the welfare of the current people living at the home and any potential new referrals. Staff should make sure that they keep accurate records that are not based on their judgements. People living at the home should be involved in the recording of their daily records. This is so people are meaningfully involved in keeping details about themselves and their daily lives. Staff should develop ‘life story’ books/works with people living at the home, as these give a much more interesting picture of how people have been spending their time and people may find them easier to follow than written records. For people who books may not be suitable, other formats such as DVD’s for life story and life history work should be used. As people living at the home have changing needs, it is important that ‘life history’ books are also developed that includes details and photographs of their ‘history’ such as family, friends, where they have lived, pets, work etc. These life history books will assist both the person and staff in remembering their past and will assist staff to have a greater understanding of them as an individual. A referral should be made to the local authority person centred planning co-ordinator for the two people identified. So that they can have their wishes and aspiration included in their life plans. A rota with photographs with staff names on should be developed to assist one person with identifying staff. The care home and domiciliary care service complaint DS0000004307.V335298.R01.S.doc Version 5.2 Page 35 2 YA6 3 YA6 4 YA6 5 YA6 6 7 YA8 YA22 Scic - Old Road, 1 records should be separated; this is because there should not be information about other people kept with information about people that live there. 8 YA24 The labels on one person’s chest of drawers should be removed, as they are not relevant to the individual and do not show a commitment to providing a person centred and personalised care service. Scic - Old Road, 1 DS0000004307.V335298.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-56 Stephenson Street Birmingham B2 4UZ 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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