CARE HOME ADULTS 18-65
111 Crescent Road 111 Crescent Road Crumpsall Manchester M8 5SH Lead Inspector
Steve O`Connor Unannounced Inspection 4th July 2006 12:00 111 Crescent Road DS0000021703.V298565.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 111 Crescent Road DS0000021703.V298565.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. 111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service 111 Crescent Road Address 111 Crescent Road Crumpsall Manchester M8 5SH 0161 740 9405 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) Southfields Care Homes Limited Care Home 3 Category(ies) of Learning disability (1), Mental disorder, registration, with number excluding learning disability or dementia (2) of places 111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One named service user requires care by reason of learning disability. Should this named individual no longer reside at the home then the registration will revert to 3 places for mental disorder (MD) 9th March 2006 Date of last inspection Brief Description of the Service: The care home provides 24-hour accommodation and support for three people who need support because of their mental health problems. In addition one person has additional learning disabilities. 111 Crescent Road is a detached house situated in the Crumpsall area of Manchester. The house is on a main road with access to public transport and local shops. The house has three large bedrooms, two lounges (one of the lounges is a smoking area), a bathroom and downstairs toilet plus a kitchen / dining room. The smoking lounge is also used as sleep-in room and contains a single bed. There is a small room used by staff as an office and a staff sleep-in room. The house has gardens to the front and rear of the property; these are accessible by clear pathways. Information provided by the home showed that the fees ranged from £1400 to £1700 per week. Information about the service can be found either at the home or through the main organisation (Southfield Care Homes Ltd). 111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the home was last inspected in March 2006. This information includes an Action Plan sent in response to the March 2006 report, a monthly report undertaken by a senior manager in the main organisation in May 2006, a survey form, a preinspection questionnaire, completed by the home and submitted in June 2006 and an unannounced site visit to the home on the 4th July 2006. During the site visit time was spent talking to people who stay at the home, staff on duty and how they worked with people and a registered manager from another care home, in the same organisation, who was providing management cover. Documents and files relating to people and how the home is run was also seen and a tour of the building was made. The inspection was an opportunity to look at all the core standards of the National Minimum Standards (NMS) and was used to make a judgement on the quality of the service provided by the home and to decide how much work the CSCI needs to do with the home. What the service does well: What has improved since the last inspection? 111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 6 The previous inspection report highlighted a numbers of areas that the home needed to work on and improve. Improvements have been made to the way the home, and the main organisation, use the Criminal Records Bureau (CRB) systems for checking if prospective staff are safe to work with vulnerable adults. The training audit and analysis had been completed and staff training needs had been identified. Some of the improvements in the medication administration and financial recording practices have been made. What they could do better:
People who live in care homes do so for a variety of reasons but generally they need help and support to allow them to live as independently and safely as possible. Care homes must show that they understand what help people need and so they are required to develop individual care plans that sets out clearly, and in sufficient detail, all the needs and goals that people have and how they are going to support the person. Care plans should be regularly reviewed to see if the care plan is still working and takes into account any changes in people’s needs. A person at the home had received a lot of support from a senior occupational therapist and psychologist in developing a weekly programme of activities that aim to promote and maintain their skills and stimulation. There was little evidence that any of the programme had been recorded in the person’s care plan or that staff were actually supporting the person to take part in these activities. In fact the recording of the support staff give to people was very brief and contained very little detail or evidence that people had been supported to participate in valued activities. In addition, the person’s care plan had not been updated or reviewed for over 12 months and so did not reflect any of the changes to his gaols and activities. The home supports people whose health and/or behaviour need certain support from the staff to make sure that they stay well and safe. The staff were able to describe how they would recognise if a persons’ behaviour was changing and what support, and if needed medication, was needed to be able to calm or cope with that behaviour. However, the staff acknowledged that this guidance was not fully written down in detail that reflected exactly what the staff did to help the person. It was also found that a person had a health risk in relation to how they ate and drank. The main organisation had sent the Commission a copy of the support guidelines written by a speech and language therapist. It was found that the home and the staff did not have a copy of this guidance and had not see the document sent to the Commission. It was also found that they were not following the clear guidance set down in relation to the drinks that the person can have. This could place the person’s health at risk and so the home
111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 7 must make sure that staff have the required guidelines and awareness of how to put them into practice. The home has a medication administration system to support people to take the right medication, at the right time to make sure that they remain healthy. It is important that the system is accurate and that staff know exactly how to use it properly. However, there were several things that were not being done properly and these needed urgent attention. The Medication Administration Records (MAR) were not being filled out correctly all the time. If a person needed medication that was prescribed ‘as required’ (PRN), then there should be clear and detailed guidance for under what circumstances the medication is given. Staff should also be clear about what a prescribed medication is for. One person was being helped to apply a prescribed cream but staff were not very clear what the cream was for and how it should be used. All these problems with the medication system must be resolved. The last inspection report identified that supporting people to manage their personal monies and having systems in place to keep the monies safe, is an important role for the home. There were a number of inaccuracies with the recording, accounting and auditing of people’s money and the home was required to undertake a full audit of people’s monies. In addition the policy and procedures for managing people’s monies, must contain clear procedures for the recording, receipt, auditing and monitoring and a copy of the outcome of the audit and the written procedures must be submitted to the CSCI within the timescales stated. The finance records were checked again and found that there were still inaccuracies in the recording of peoples’ personal money. There was no clear evidence that someone had audited and checked the records to make sure they were correct and the home’s policy and procedures did not appear to include the procedures for the recording, receipt, auditing and monitoring of peoples’ money. This is the second inspection that this has been raised as a concern and must be addressed. The care home is required to provide people with a clean, comfortable, safe and homely environment in which to live. Generally the home is clean and maintained and the layout of the building allows people to spend time together and in private. However, the home’s decoration and furnishings are looking worn, tired and outdated. The main organisation who runs the home have stated that the building will be receiving and major refurbishment but have not been able to give and clear timescales for when this will happen. A number of specific areas and repairs were identified during the inspection and has been recorded in the inspection report under the Environment Section. It is the home’s responsibility to make sure that all the staff who work with people have the required skills, training and knowledge needed to be able to support people correctly and safely. 111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 8 The main organisation did a check of all the staff records to see what training they have and had not completed. From this they put together a programme of training events for staff to attend. At the time of the site visit to the home several of the staff team had still not received training in areas such as adult protection, health and safety, food hygiene, first aid and administering medication. In addition, the home has been told to provide staff with training on how to work with people whose behaviour can be challenging. The main organisation arranged for a two-part programme to be provided for all the staff team. It was found that the second part of the challenging behaviour training has still not been provided. The home has experienced problems appointing a manager for over a year. A person was offered the position but they had to withdraw from the offer. When this happened the main organisation decided to ask the manager of another care home they operate to provide management cover for her own home, 111 Crescent Road and another two small homes (that are next door to each other). They then decided to inform the Commission of the actions they had taken and written confirmation of the organisations management arrangements were received after the site visit. The Commission have written to the organisation asking for more information and clarification of the practical management arrangement as it does not appear that a single manager is able to provide the level of management input the home requires. The home have a responsibility for keeping people as safe as possible while they live at the home. The home should have the right ways of working, the right equipment, monitoring and recording procedures. It was found that there was no record when the battery operated smoke detectors had been checked. The alarms were to high for staff to reach and so the inspector had to insist that the detectors were checked before the end of the site visit. This was arranged and the detectors were checked. The home has no emergency lighting and yet there was no other light sources available in the event of an emergency. And, it was found that a store room used to keep potentially hazardous substances had no working lock. 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. 111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 9 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 111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 10 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): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living at the home had their needs assessed prior to admission to the home. EVIDENCE: No new people had been admitted to the home since the last inspection and each person had a pre-admission Care Management or Care programme Approach (CPA) assessment from the relevant purchasing authority. 111 Crescent Road DS0000021703.V298565.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does encourage people to make choices and decisions that affect them. However, they do not have the systems and practices to ensure that care plans reflect peoples’ needs and goals and that people are supported to cope with hazards and risks in the safest way. EVIDENCE: The home has a care planning system where each person should have their own individual care plan that sets out their main needs and goals and the support the home provided to meet those needs. The plans should include goals relating to people’s personal, healthcare, social and nutritional needs and the care plan would be reviewed with the person. For those people on the Enhanced Care Programme Approach (CPA) ongoing reviews with the local mental health services would be held. However, it was found, from the sample of care plans looked at, that care plans had not been reviewed in over a year and had not been updated to reflect peoples’ changing needs and goals. Support recommendations from a senior occupational therapist had highlighted a number of activities for one person to help increase their stimulation. There was no evidence in the care
111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 12 plan that reflected these recommendations. There was also an activity chart developed by a clinical psychologist for 1:1 activity. There was no recorded evidence that the staff had supported the person in any of these activities. People’s care plans must clearly and accurately reflect fully their holistic needs and goals, changes to their needs and goals and the support required to achieve them. Care plans must be reviewed on a regular and ongoing basis based on the person’s own individual circumstances and to reflect changes in the persons needs/goals. Any restrictions of choice placed on people was based on a risk assessment and support plan to make sure that the person was not placed in unsafe situations. Staff would encourage and support people to make decisions and choices about their day-to-day lives such as activities and meals and encourage people to become involved in keeping their own space and the house clean. One person is supported and encouraged to manage their own personal finances and the others are fully supported The home used a standard format to look at situations, events and behaviours that may cause a risk to people’s wellbeing. Once identified, the home should develop support guidance for staff in how to minimize those risks. The home does support people whose behaviours can present a risk to themselves and others and the previous inspection report had recommended that the home look at the current guidance for working with incidents of challenging and/or aggressive behaviour. The types of challenges that people present were discussed with the staff on duty. They were able to explain the way that they recognised and respond to changes in people’s moods. They were asked if this level of information was included in the relevant risk assessment and it was acknowledged that it was not. All risk assessments and support guidance in respect to responding to peoples challenging behaviour must be reviewed and updated to include clear and detailed guidance. The previous inspection report required the home to ensure that staff had clear guidance on how to respond to a risk of choking for one person. The action plan from the home contained detailed ‘Eating and Drinking Guidelines’ from a speech and language therapist. It was found that the guidance provided to the CSCI was not available in the person’s own file at the home. In addition, the staff on duty had never seen that specific guidance and only had access to a less detailed version. It was found that the staff were not carrying out the guidelines in respect to fluids and this will be addressed in the Personal and Healthcare Section. 111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 13 111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 14 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): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People had access to the support to develop their own routines and maintained links with families and friends if they wanted to. People were offered meals they enjoyed and were provided with the relevant support. The home was not able to show fully that it was offering people valued and meaningful opportunities. EVIDENCE: Between 9:00am and 5:00pm there are three staff available to provide support for people to take part in home and community based activities. With three people living at the home the staff ratio of 1:1 should mean that people have the opportunity to experience a range of meaningful valued activities. However, it has already been highlighted that there was very little evidence to show that the home were supporting a person to participate in a weekly activity plan developed by their psychologist. The home must ensure that
111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 15 people’s activities and specific programmes that meet their assessed needs and goals are fully met and recorded. A record of ‘1:1’ support is maintained that records all the activities offered to people and those that they participated in. It was found that for the person with the activity programme the majority of the recorded activities did not relate to the agreed programme. It was also found that records were still brief and lacked detail showing that the home had not taken into account the recommendation that the recording of people’s activities be in more detail and show how they related to the person’s care plan. The issue of motivating people with long-term mental health problems was raised by the home, especially when a person was experiencing a period of ill health. However, the home must ensure that, as far as is practicable, people are supported to participate in meaningful and valued activities. People were supported and encouraged to maintain links with their families where possible. Visitors were welcomed at any reasonable time and could use both communal and private areas. With three staff on during the day to support three people each person should be able to set there own routines depending on prior arrangements such as health appointments. People have their own keys if the wish and mail is always given direct to the person unless they require help. People have the choice to spend time with other people or in the privacy of their own rooms. The home also had two separate lounges and a kitchen/diner that allowed people to choose where they wanted to spend their time. People were encouraged to decide what that wanted for their meals and it was seen that different choices were offered at all times. The meals provided were based on a persons likes and dislikes and their health needs. Eating and drinking guidance and guidelines had been developed to support a person at mealtime. 111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People’s personal and most of their healthcare needs are supported by the home. However, not all people’s health needs are being appropriately met and the home’s systems and practices for medication administration do not fully protect people. EVIDENCE: People were encouraged and supported to maintain their own personal care as far as possible. Some ‘hands-on’ support was provided and this support was recorded within individuals care plans. The home supported people to maintain their healthcare through accessing general and specialist healthcare providers. Records of health needs and outcomes were clearly maintained in the persons care plan. Medication needs were monitored through the local G.P or allocated psychiatrist. One person has health issues relating to swallowing. Clear eating and drinking guidelines developed by a speech and language therapist were. However, it was observed that these guidelines were not being followed. Staff stated that to follow these guidelines exactly is not possible. It was also found that the
111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 17 person’s file did not contain the same guidelines that were sent to the CSCI as part of the previous inspection report action plan. In fact, staff stated that they had not seen the detailed guidelines. The home must ensure that staff has access to and full understanding of all health guidelines and guidance and that they support people according to those guidelines. The medication administration system was checked and some issues of concern were raised. One person required the application of prescribed creams. The guidance for the use of these creams was unclear with no written guidance for their use. In addition, there were three tubes of a cream found in the storage cabinet. The reasons for this was explained as being due to the staff at the home not having the responsibility for repeat prescriptions. Several medications were prescribed ‘as required’ (PRN). The guidance for PRN administering was unclear and it was found that one prescribed drug had no PRN guidance at all. This was a requirement made in the previous inspection report and was reiterated. There were also gaps in the signing of medication doses on the Medication Administration Records (MAR). The home must review its medication procedures and practices and ensure that staff are aware of the purpose and use of all prescribed medication, that clear and detailed administration guidance is in place for all PRN medication, that MAR sheets are filled in correctly at all times and that the home’s responsibility and procedures for obtaining repeat prescriptions is clear. 111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 18 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 and 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are able to raise their concerns and worries. However, the home does not have the systems, procedures and practices in place to be able to fully protect people. EVIDENCE: The home has a clear complaints procedure and people have been provided with information about how to raise their concerns and worries. The home has an Adult Protection policy and adheres to the Manchester MultiAgency Adult Protection Procedures. Staff were aware of the issues around adult protection and were able to clarify the procedures to be taken in the event of an incident or concern. The previous inspection found errors and discrepancies with the spending recording of people’s personal monies. The home were required to undertake a full audit of the peoples monies and ensure the policy and procedures for recording, auditing and monitoring was clear. On sampling the finance records it was found that the balance of one person’s money was incorrect. The home could give no explanation for the error. There was no clear written evidence that balances and receipts had been regular checked and audited to ensure that the balances were correct. It was found that staff sign the finance records once the relevant items had been bought/paid for and had not recorded the actual money taken out. The new policy and procedure manual was seen and no policy and procedure for the
111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 19 actual management, recording and auditing of peoples’ personal spending could be found. The requirement was reiterated. 111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 20 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the home was generally clean the general condition, decoration and maintenance of the building was not of a satisfactory standard. The home did not have the equipment in place to prevent the risk of cross infection. EVIDENCE: A tour of the building showed that the home was generally clean and reasonably maintained. The layout of the building offers people the flexibility to allow them both communal and private space. The kitchen was found to be in need of decoration and the extractor fan needed repairing, as it did not work. The only ventilation was to keep the back door open and this did not have a fly screen. A kitchen window was cracked and needs replacing. The inspector was told that this had been reported several months ago and had not been actioned. The toilet on the ground floor requires decoration and the sink is cracked and needs replacing. The ground floor hallway is dark and has little nature light. The smoking lounge is also used as a sleep-in room for staff and contains a single bed. The inspector was told that the small office on the first floor was
111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 21 being considered as a second sleep-in room. The lounge requires decoration and the furnishings are looking worn. The lounge contains several pieces of furniture that are broken and need replacing. The inspector was told that the broken furniture and furnishing have been reported and were going to be replaced but there was no time-scale for this to happen. The carpets in the house are still in a good condition. However, there are three different patterns used and are of an old fashion styling. The stair well had cobwebs in the corners. It was explained that staff could not reach this area, as it was too high. The upstairs landing is in need of decoration. The 1st floor bathroom has discoloured grouting and cracked tiles that require repair. There are plans to have people’s bedrooms redecorated and they have been involved in the choice of colours. However, there were no timescales for when this work or other decoration and refurbishment work would be carried out. Southfields Care Homes have discussed the issues around the need for refurbishment of the home but as yet no definitive timescales have been provided. Requirements were made in respect of the issues raised. At the time of the site visit there was no issues with handling soiled waste or items. However, it was found that the bathroom used shared soap and cloth towels. Some of the towels found in the bathroom were ripped and the home was told to remove and replace them immediately. 111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 22 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): 32, 33, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported by a team with sufficient cover who generally have the values and understanding to support their needs. The recruitment systems in place make the required checks to safeguard people and although the home have the systems in place for training the staff team have not received all the training required. EVIDENCE: The staff team currently consists of 5 regular support workers, with one person in an acting senior role, and there were an additional 5 other support workers who provide staff cover. Between 9:00am and 5:00 pm there are 3 staff on duty. At other times there are two on duty. At the present time the home does not have a permanent manager. This issue is raised in the Management section of the report. The recruitment process and procedures were operated by the main organisation, Southfields Care Homes Ltd. The documentation and checks required were maintained at the main office and samples of these files were seen on the 10th July 2006. Files were seen with completed application forms, references received and a contract of terms and conditions. The procedure for obtaining the required Criminal Records Bureau (CRB) and Protection Of
111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 23 Vulnerable Adults (POVA) check had been updated to meet the requirement from the previous inspection and files were seen with the CRB reference numbers and date of issue. From the training information seen 2 of the 5 regular staff at the home had obtained the NVQ Level 2 award in Care, 1 was undertaking the course and 2 were still to begin the course. Staff were seen spending time and talking with people. Staff spoken to were able to demonstrate that they had an understanding of people’s needs and were observed working in a respectful and appropriate manner. The previous inspection report required the home to provide the CSCI with the results of the training audit the main organisation were undertaking. From this audit the home produced a summary of all the gaps in mandatory and core training and a training plan for the period of April to August 2006 was developed. A copy of the audit, training analysis and training programme was provided to the CSCI. The audit showed that a number of the staff team required training in areas such as adult protection, health and safety, food hygiene, first aid and administering medication. The up-to-date training files of two staff were seen and found that some training had been completed since the last inspection but there were still shortfalls in providing the necessary training to the staff team. The previous inspection report highlighted that not all the staff team had undertaken challenging behaviour training. The home had developed a two stage training programme and most of the staff team had undertaken the first stage. The inspector was informed that staff were due to attend the second session but this had been cancelled. Therefore, the requirement to provide staff with challenging behaviour training has been reiterated. The previous inspection report had highlighted that if staff are not on the rota on the day of a planned training/development event then they are not paid for attending that event. It had been recommended that the home’s training programme include the provision of at least five paid training and development days (pro-rata) per year. The inspector was informed that this recommendation had been accepted and implemented. 111 Crescent Road DS0000021703.V298565.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has the systems in place to seek peoples’ views on the quality of the service they received. The management provision of the home is not sufficient to effectively manage the home and the home does not have the systems and practices in place to maintain people’s health and safety. EVIDENCE: The last three inspection reports have highlighted the need for the home to have a permanent manager appointed who should apply to become the registered manager. The home informed the inspector, shortly before the site visit, that the person they had appointed had to withdraw. Verbal information was given for the interim management arrangements of the home and they were requested to provide written information of the management arrangements. The written proposal did not arrive at the CSCI until after the site visit. The management arrangements put in place by the home are that an experienced registered manager from another care home, operated by the
111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 25 main organisation, would provide some on-site management cover and to be available to oversee the operation of the home. In addition, members of the senior management team would offer off-site support to the manager when required. Whilst this does give the staff team some support and management direction the arrangements mean that the one manager is actually covering her own service plus three small care homes. The home must review the management arrangements of the home to ensure that there is sufficient operational management support on site and on-call for the home to be run effectively. The requirement relating to submitting a registered manager application is reiterated. The home had a quality assurance system that included regulation 26 monthly reports. The home was introducing an annual ‘Satisfaction Survey’ to gain the views of the people living at the home, relatives, carers and other relevant professionals. The fire protection system in the home consists of fire equipment and individual battery operated smoke alarms in various parts of the home. Although the home had made checks on the fire equipment there was no evidence that the smoke alarms had been regular tested to ensure that they are working. The home was required to take immediate action and a maintenance person was called and the alarms tested. The home must ensure that the fire protection systems are tested on a regular basis. In addition, although the records stated that the fire alarm was tested weekly, the home does not have a fire alarm and staff could not reach the smoke alarms to test them. The records state that a fire drill was carried out in April 2006. The fire inspection records were disorganised and difficult to clearly establish what checks were being undertaken. It is recommended that the fire log file is set out clearly. The home does not have any emergency lighting but there was no evidence that there was any other source of lighting for emergency situations. Evidence was seen of electrical and gas equipment being regularly serviced. Water and fridge/freezer temperatures were being monitored. The home does not undertake any environmental audits to ensure that people and staff there are not at risk from hazards. A cupboard on the ground floor is used for storing cleaning materials could not be locked. 111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 26 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 3 X X 1 X 111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 27 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 YA6 Regulation 15 Requirement Care plans must reflect fully people’s needs/goals and support and be reviewed on a regular and ongoing basis based on the person’s own individual circumstances and to reflect changes in people’s needs/goals. All risk assessments and support guidance in respect to responding to peoples challenging behaviour must be reviewed and updated to include clear and detailed guidance. The home must ensure that people’s activities and specific programmes, that meet their assessed needs and goals, are fully met and recorded. The home must ensure that all social, leisure, domestic and community based activities are fully recorded. The home must ensure that staff has access to and full understanding of all health guidelines and guidance and that they support people according to those guidelines.
DS0000021703.V298565.R01.S.doc Timescale for action 21/08/06 2 YA9 13 21/08/06 3 YA12 15 21/08/06 4 YA13 YA12 15 21/08/06 5 YA19 18 21/08/06 111 Crescent Road Version 5.2 Page 28 6 YA20 13 1.Administering guidance on all 21/08/06 PRN medication must be updated to reflect current medication and changes in administering. (The timescale of 30/04/06 was not met). 2. The home must review its medication procedures and practices and ensure that staff are aware of the purpose and use of all prescribed medication. 3. That MAR sheets are filled in correctly at all times. 4. That the home’s responsibility and procedures for obtaining repeat prescriptions is clear. 7 YA23 13 1.The policy and procedures for managing people’s monies must contain clear procedures for the recording, receipt, auditing and monitoring. (Timescale of the 14/04/06 was not met). 2. Staff must be fully aware of the procedures for recording and auditing of people’s personal spending monies. The home must ensure that the following issues identified in the report are addressed and an action plan supplied to the CSCI within the timescales stated: 1. The redecoration of parts of the home identified in the report. 2. Make good the repairs identified in the report. 3. Replace the damaged items identified in the report. 4. Put in place the changes to
DS0000021703.V298565.R01.S.doc 21/08/06 8 YA24 23 21/08/06 111 Crescent Road Version 5.2 Page 29 9 YA30 13 10 YA35 18 the use and layout relating to the sleep-in arrangements. The home must ensure that it has the equipment and facilities necessary to minimize cross infection. 1. Challenging behaviour training must be provided to all staff who work in the home. (Timescale of 30/05/06 was not met). 2. Based on the training gap audit, the home must ensure that all the staff team have the necessary mandatory/core training. 1. The manager must submit a registered manager application within the timescale stated. (Timescale of 30/09/05 and 30/05/06 was not met). 2. The home must review the management arrangements of the home to ensure that there is sufficient operational management support on site and on-call for the home to be run effectively. 1. The home must ensure that it has a fire/emergency systems and monitoring/recording procedures that protects people. 2. The home must have the necessary equipment and aids to respond to emergency situations. 3. Substances that could be hazardous to health must
DS0000021703.V298565.R01.S.doc 21/08/06 21/08/06 11 YA37 8 21/08/06 12 YA42 13 21/08/06 111 Crescent Road Version 5.2 Page 30 be securely stored. 4. The home must have the monitoring systems in place to ensure the safety of the environment. 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 YA42 Good Practice Recommendations It is recommended that the fire recording log file is set out clearly. 111 Crescent Road DS0000021703.V298565.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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. Extracts may not be used or reproduced without the express permission of CSCI 111 Crescent Road DS0000021703.V298565.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
