Inspection on 08/05/06 for 106 Queens Road

This inspection was carried out on 8th May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

106 Queens Road 16/03/09

106 Queens Road 26/03/08

106 Queens Road 28/11/06

106 Queens Road 12/12/05

106 Queens Road 25/10/05

106 Queens Road 01/03/05

106 Queens Road 05/10/04

106 Queens Road 11/12/03

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Insight - Eastchurch

Southfields

Thorndene

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33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 106 Queens Road Littlestone New Romney Kent TN28 8ND Lead Inspector Lois Tozer Key Unannounced Inspection 8th May 2006 10:20 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 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 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 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. 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 106 Queens Road Address Littlestone New Romney Kent TN28 8ND 01797 366620 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) support@communitas.org.uk Evesleigh (East Sussex) Limited Vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th December 2005 Brief Description of the Service: 106 Queens Road is a detached property that offers care and support to a maximum of 4 service users who have learning disabilities. It is situated in the Littlestone area, with access to local shops and other amenities about 15 minutes walk away. The town of New Romney is accessible by foot (30 mins walk), by public bus service or by using the homes dedicated vehicle. The home is owned and operated by Evesleigh (East Sussex) Ltd. Day to day management has recently changed, and is currently conducted by Mrs Jenny Simmons. The home is set in its own ground, with parking for several vehicles to the front and side of the home. An average size, semi secluded garden with patio space to the rear and a garage area for recreation and storage are available. The home offers 3 communal rooms, a lounge, conservatory (where smoking is permitted) and a dining room that joins the kitchen. One communal bathroom and two W.C. facilities are available. All bedrooms are single occupancy; one has full en-suite facilities. The main ethos of the home is the promotion of greater independence in skills, social development and responsible decision-making. It is aimed to achieve this through developing practical skills both within the home and in the community. People are supported to maintain employment in the community. The range of fees are £1,495 to £1,995 per week. 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 8th May 2006 between 10.20 and 16.45, the newly appointed manager, Mrs Jenny Simmons and staff on duty assisted with the process. Three people were living at the home, one was away, one declined to give input but the third was happy to give their impression of the home. The home and service users have experienced considerable disruption over the last 12 months; a new company has recently taken over the management of the home, and a new manager has been in post since early April 2006. The inspection process consisted of information collected before and during the visit to the home, and care management feedback after the site visit finished. Other information seen included incident report forms, assessment and care plans, medication records, duty rota and staff employment and induction paperwork. What the service does well: What has improved since the last inspection? What they could do better: The home is not meeting the aims of the current statement of purpose (SOP) and service user guide (SUG). The home does not offer individuals the support they require. Individual plans have not drawn sufficiently from needs assessments. Personal needs are not being adequately met. Responsible decision-making is inadequately supported. Risk management is poor. 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 6 Service users are still experiencing feelings of uncertainty. A service user said ‘It’s been hard with so many changes, but you just have to get on with it’. When asked about progress with life skills, a service user indicated that there was no motivation to do things for ones self, as staff can do it. Large parts of the day are not meaningfully and developmentally occupied. Service users are not adequately supported in the meal making process. Support of service users to limit conflict within the home needs improvement. Sufficient support has not been given to ensure service users best interests and safety is protected. Lack of consistent management over the last 12 months has left staff disillusioned and discontented. This has resulted in ineffective support. The staff team is limited to a small number of people who are not demonstrating the level of skills needed to meet the service user needs. Supervision of staff is poor and infrequent. The new manager has not received a quality induction, and is crisis-managing situations without the knowledge contained within the care plans. The home and organisation must focus on improving the level of support and opportunity offered to service users by tackling these issues. Staff need training and skills to engage difficult people and offer developmental opportunities in ways that will be of benefit. 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. 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home is not meeting the aims of the current statement of purpose (SOP) and service user guide (SUG). The home does not offer individuals the support they require. EVIDENCE: The manager is aware that the SOP & SUG need reviewing, and has this in hand, but the basic aims of the service are not being met – service users lack the support needed to get the most out of their lives, and remain safe. The manager is not yet familiar with the service user assessments, and must become so in order to review the above documents. The service users needs assessments must inform the skill and staffing levels provided each day, which is not happening. 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Individual plans have not drawn sufficiently from needs assessments. Personal needs are not being adequately met. Responsible decision-making is inadequately supported. Risk assessments are absent and in some crucial areas not being followed adequately. EVIDENCE: Care plans are in place, but are not being followed or actively promoted – service users do not seem interested in engagement to achieve their goals – and evidence of skilful motivation by staff was missing. A service user said they felt they didn’t have to do anything as the staff would do it for them. Decisions are respected, but responsible decision-making is not part of the day-to-day support. Presentation of opportunities does not actively encourage participation in tasks. 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 10 Risk assessments are absent in areas that are clearly highlighted within the needs assessment. Where present they were not being followed. It is vitally important that the manager read and review the support plans and know what support is required of each service user. 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16, 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Service users have voluntary employment places, but large parts of the day are not meaningfully and developmentally occupied. Service users are able to access the community as they wish, and have formed friendships within the local area. Daily routines within the home do not promote service users skills & responsibilities. Individual rights have not been well supported. Promotion of healthy meals is apparent, but service users are not adequately supported in the meal making process. EVIDENCE: Meaningful and socially relevant occupation is not being promoted within the home, although service users have work placements in the community that they enjoy. 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 12 Socially, service users are able to do their own thing but the risks have not been suitably assessed. Staffing provision and skills doesn’t give service users stability and encouragement in participation. Professional conduct by staff needs monitoring to encourage and reinforce respectful relationships. Support has been inadequate resulting in service user rights of access to the home being denied, and a potentially dangerous situation occurring. Independent living skills are not being promoted through daily routines. Staff seem to be catering to service users meal times, rather than their social care needs. Ways of increasing service user skills and independence are absent. 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Staff do not provide personal support, as service users are self caring. Healthcare needs are kept under review and professional help is obtained as needed. Medication management is adequate, but known difficulties in administration have been poorly supported. EVIDENCE: Service users are supported to access their GP and other healthcare facilities as needed. Records of action needed are kept, but problems and medication administration difficulties had not been noted. Medication administration problems had occurred recently. These difficulties were known before the problem, but lacked adequate assessment and support. Action taken after the error showed staff competence in resolving problems. 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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 the service. Observation and support of service users to limit conflict within the home needs improvement. Sufficient support has not been given to ensure service users best interests and safety is protected. EVIDENCE: A service user said they would let staff know if they had problems, but the constant staff changes had been hard to live with. Conflict within the home between service users has been poorly managed, and staff have not had appropriate training. A lack of meaningful focus in the day has left people at loose ends and their whereabouts unknown. Poor decisions have taken place, resulting in an unnecessary risky situation occurring. Care management feedback indicated that poor understanding of care needs has led to a service user being blamed for an avoidable situation. There has been two adult protection alerts raised at the home in the last 10 months, the last of these was closed on 3rd March 2006. Part of the agreed action plan for closure was the new manager have sufficient induction. The organisation has not supplied this. 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home is homely, comfortable and generally safe. Bedrooms are to service users liking. The home is generally clean and tidy but the communal bathroom facilities need to be better maintained. EVIDENCE: A service user said the home was fine, and the décor was nice. The double-glazing has been upgraded and a bedroom has been completely refurbished, including the en-suite facility. The service user lounge is being used to carry out sleep-over duties at night. This is a recent change and prevents service users using the lounge after 11pm. A full kitchen refurbishment is planned to take place in the next few days. 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 16 The home is generally clean and tidy, but better support is needed to keep the bathroom hygienic. 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Lack of consistent management has left staff disillusioned and discontented. This has resulted in ineffective support. The staff team is limited to a small number of people who are not demonstrating the level of skills needed to meet the service user needs. Recruitment practices are robust. Supervision of staff is poor and infrequent. EVIDENCE: Job descriptions were not available on staff files, but observation indicated that the motivation and focus to meet service users assessed needs had been lost. Some staff have had NVQ training, and others were in the pipeline. General training specific to service user needs was poor. No provision for management of conflict or aggression or motivating service users had been given. Relevant training had been cancelled due to staff shortages, so improvement was again delayed. 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 18 Staffing skills and numbers has been poorly managed, with some shifts of 15 hours being covered by one staff member alone. Probationers needs had been put before service user needs. Poor understanding of individuals resulted in avoidable incidents taking place. The team consists of 3 staff, which is insufficient to cover the demands of the home. A recruitment drive is in place. The procedures ensures service user protection. Supervision has been insufficient and staff have not been set service user focused goals and targets to aspire to. 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home is not well run. The new manager has not received adequate support through induction. The assessed needs of service users are not known sufficiently to assure effective quality review. Practical measures to protect health and welfare need improvement. EVIDENCE: The manager has been in post for approximately 1 month, but has not received an adequate induction. As such, has been managing crisis without sufficient background information. 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 20 The aims and objectives of the home as they currently stand are not being met. Quality assurance measures are not in place, although work is being conducted with dissatisfied service users through the organisation. Day to day health and safety measures and checks are in place. Prevention of incidents and assessment of risk needs considerable improvement. There has been two adult protection alerts raised at the home in the last 10 months, the last of these was closed on 3rd March 2006. Within this meeting, the organisation made firm assurance that the new manager would receive a full and thorough induction over several weeks, which has not happened. 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 1 4 X 5 X 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 3 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 1 32 1 33 1 34 3 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 1 X LIFESTYLES Standard No Score 11 1 12 1 13 3 14 X 15 3 16 1 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 1 X 1 X X 2 X 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 13, 14, 15 Requirement Standards YA2, YA3, YA6, YA7, YA9. Needs assessment informs individual plan that is in line with service users personal development needs and accounts for risk management. Previous requirement, timescale 01/01/06 unmet. Staff must support service users in a way that prevents bullying (inter-peer or otherwise). Manager to ensure that service users are not placed at risk through appropriate assessments. Standards YA11, YA12, YA16, YA31, YA33, YA35 Staff to have the skills and knowledge to support and develop the service users appropriately. Adequate emergency cover arrangement to be in place. Staff to be adequately supervised Manager to be familiar with all assessed needs of service users and have appropriate DS0000023147.V292771.R01.S.doc Timescale for action 01/07/06 2 YA16 13 01/06/06 3 YA23 13 08/05/06 4 YA11 16, 18 01/08/06 5 6 7 YA33 YA36 YA37 18 18 9 01/06/06 01/07/06 01/06/06 106 Queens Road Version 5.1 Page 23 induction. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 106 Queens Road DS0000023147.V292771.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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