Inspection on 22/07/08 for 112 Wellington Road

This inspection was carried out on 22nd July 2008.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

112 Wellington Road 02/12/08

112 Wellington Road 03/10/07

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 12/03/2009.

CARE HOME ADULTS 18-65 112 Wellington Road Bilston Wolverhampton WV14 6AZ Lead Inspector Deborah Sharman Key Unannounced Inspection 22nd July 2008 09:15 112 Wellington Road DS0000069681.V364472.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 112 Wellington Road DS0000069681.V364472.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. 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 112 Wellington Road Address Bilston Wolverhampton WV14 6AZ 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) 01384 410418 info@Inshoresupportltd.com Inshore Support Limited Post Vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care (excluding nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 3 The maximum number of service users to be accommodated is 3. 2. Date of last inspection 3rd October 2007 Brief Description of the Service: 112 Wellington Road is based in the Bilston area of Wolverhampton and is registered as a care home providing personal care and accommodation for 3 younger adults with learning disabilities. It is part of the Inshore Support Ltd group of housing whose main office is in Halesowen. The home is located close to the centre of Bilston on the main A41 road with good local amenities including access to the metro tram within a twominute walk. It opened in 2007 and consists of a two-storey domestic style terraced property. Each person living at the home has a single room with washbasins. Bathroom and separate toilet facilities are available for shared use. There is a private pleasant garden with patio seating area at the rear of the property. Residents need to be able to access stairs as bedrooms are on the first floor with no lift facilities. The two bedrooms are both for single occupancy with bathrooms and toilets close by. There are two lounges, a kitchen and dining area. There is a smallenclosed garden to the rear of the house. The fee charged is not available publicly as it should be in the Service user Guide and therefore cannot be reported. 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This inspection visit was unannounced; this means that no one associated with the home received prior notification and were therefore unable to prepare. As it was a key inspection the plan was to assess all National Minimum Standards defined by the Commission for Social Care Inspection as ‘key’. These are the National Standards which significantly affect the experiences of care for people living at the home. The inspection was carried out over one day between 9.30 am and 7.00 pm. One Inspector was present for the full duration and the Pharmacy Inspector was present between 10.30am and 6.00pm. This inspection was carried out earlier than anticipated as a result of concerns we had become aware of and there was not time to ask the provider in advance for their written self-assessment – the annual quality assurance assessment or ‘AQAA’. There was also insufficient time to distribute surveys in advance. It is currently our policy not to send surveys to relatives and no relatives were available to talk to during the inspection. Due to the nature of their disabilities people living at the home would not be able to complete a survey or tell us about their care. We compensated for this by observing their experience of care throughout the day where possible, by talking to staff and by reading care records. When we arrived we had difficulty accessing the premises. Staff did not answer the door. We had to go next door to the sister home and ask staff to telephone for us. When we went into the home, two staff were on duty and the acting manager was out returning at approximately 10.30am. Prior to her arrival we took the opportunity to talk to a staff member. The Acting Manager then supported the course of the inspection by answering questions and finding documentation. The Regional Manager made himself available on two occasions during the course of the day. We assessed the care provided to two people using care documentation, discussion and observation. We also audited the safety of medication systems and the administration of medications to all three people who live at 112 Wellington Road. We toured the premises and sampled a variety of other documentation related to the management of the care home such as training, recruitment, staff supervision, accidents and complaints. This all helped to determine a judgement about the quality of care the home provides. What the service does well: 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 6 There are omissions in care planning and risk assessments need to be updated but some of the written guidance available is well structured and provides reasonable guidance to staff about how to carry out appropriate care. Written guidance informing staff how to manage behaviours is particularly well written and according to records there is evidence that behaviours have been diffused or redirected successfully with good outcomes. A process of reviewing care plans has been in place and has been adhered to monthly since April 2008. On the whole new staff are recruited and supported well, providing assurance that they are suitable to work with vulnerable adults. What has improved since the last inspection? What they could do better: We have serious concerns about the quality of the care provided. We believe service users are at risk and that the quality of their day-to-day lives is poor. Concerns arising from the last inspection have not been acted upon and in some instances the situation has deteriorated. For example at the last inspection we judged staffing levels to be safe but not to be enabling quality of life for residents. This inspection has shown staffing levels to at times be unsafe. It is a concern that the Provider Organisation has been aware of staffing constraints and yet action has not been taken to maintain staffing levels to meet service users’ assessed needs until this inspection. It was agreed at the time of inspection that the provider would obtain additional staffing without delay from an agency and this has since been confirmed in writing to us. At the last inspection we asked that steps be taken to improve medication safety and practice. Medication practice has not improved. It is considered to be unsafe and is not enabling people to receive appropriate treatment as prescribed. This inspection was prompted by the knowledge that one service user had not been given antibiotics for 6 days for an ear infection when she has an ongoing known history of ear ill health. Medication record keeping is 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 7 very poor and casts doubt on the integrity of medication administration practice. Service users have profound learning disabilities and have communication challenges. Interaction between staff and service users is poor. We observed no conversation, no fun, no laughter and no stimulation. The only interaction we observed was when service users were being given an instruction or were being told ‘no’. In the same way the level of activity available for service users is very poor. There is little to engage service users within the premises and the frequency of access to the community and community facilities is poor. This is in part a combined result of compromised staffing levels and staff motivation. There is no evidence of how service users are enabled to make positive choices. This is in relation to a range of issues but can be evidenced through meals, activities and communication. Care plans refer to the availability of ‘objects of reference’ to help residents communicate. These are not available. There have been a number of concerns which are being considered as Adult Protection matters by the Local Authority. Systems to protect residents from the dangers presented by the adjacent busy A41 Road have been insufficient. After the last inspection a highly dependent resident with no road safety awareness crossed this road unknown to staff. Since then risk assessments were carried out and a locked door policy created and reinforced. Since this most recent inspection and prior to writing this report we have learned that in similar circumstances a resident, unknown to staff, exited the premises and was missing for 20 minutes. Police were called and located her. On both occasions, this could have had fatal consequences. In addition, subject to Local Authority safeguarding consideration, has been the failure to administer antibiotics and shortfalls in staffing levels. We are also aware that since the last inspection there has been a theft of money from service users. This was not identified satisfactorily as an adult protection matter and the issue has not been satisfactorily concluded. Inspection on this occasion has shown continued weaknesses in financial systems. Most crucially, the atmosphere within the home is not happy. There is a defensive and oppressive feel with little communication with residents. We have identified difficulties in the relationships between staff and managers and a culture of suspicion and lack of cooperation. This will affect the experiences and care of residents and must be urgently addressed. 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. 112 Wellington Road DS0000069681.V364472.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 112 Wellington Road DS0000069681.V364472.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, 5. Quality in this outcome area is adequate. There have been no discharges or new admissions to assess. More could be done to enable people who live at the home and their representatives to know about their rights and responsibilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a stable group of people living at 112 Wellington Road who have been there since the home opened. Therefore there have been no vacancies. We have therefore been unable to assess the homes admissions practices. We can see that brochures, which support the admissions process, have been updated and make it clear the range of people’s needs they feel able to meet. They do not however include the range of fees charged so this information is available to enquirers. Contracts are in place and include fees but are not in accessible formats so have no chance of being meaningful to residents. In addition they have not been signed by anyone independently representing each resident’s interests. 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 10 Staff do not always have a full knowledge of residents’ needs and care plans do not appear to be working documents. There are concerns about how residents’ needs are being met. These will be discussed throughout the report. 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is poor. Although there are some omissions, written guidance available to staff is adequate. People’s needs and goals are not however fully known or met. People are not supported to make decisions about their lives because staff and staffing levels are not promoting choices, opportunities and rights. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans are in place for each person and cover a range of significant needs. Staff have signed care plans. Detail is good particularly in respect of behaviour mananagement and personal routines. There does not appear to be a structured approach to the provision of care guided by care planning. When talking to staff about two service users whose care we were looking at in detail, we got a sense that staff do things in the way they think best rather than in a directed way to ensure that care is consistent and suitable. 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 12 Discussion with staff did not assure us that the individual needs of people whose care we were looking at were fully known. Two people’s needs were described as ‘the same’ although care plans show this not to be the case. Although it is better that care plans now tell staff that a service user does not eat beef and staff seem better aware of this, no other guidance about this lady’s cultural needs is available and knowledge is limited to the beef issue. Two care plans refer to the use of Objects of Reference to help people to communicate. Care plans have been reviewed but have not identified that objects of reference are not available. Care plans therefore are not usefully guiding care. Although there is a care plan in place to account for limitations within decision making for service users there is no evidence of steps that are taken to enable them to influence how the home is managed or to direct their lives on a day to day basis. Menus are not in place and we observed a staff member choose what residents were going to have for lunch. Staff told us they would stop a resident having a drink if they had just had one ‘because they had just had one’. We were told of an occasion when a resident’s request to go out had been declined by a staff member ‘because it was raining’. We observed little interaction between staff and residents other than when residents were issued with instructions or were being told ‘no’. The home is very quiet. This is not a positive basis for service users to be making choices and guiding the detail of their lives. Risk assessments are in place for a number of hazards to service users. Staff had a basic understanding of some actions they take to minimise risks e.g the required staffing ratio in the community, the need to supervise in the bath to prevent the risk of drowning, the need to cut up food to reduce the risk of choking for those residents whose care we looked at. Staff knowledge of risk management systems however and their responsibilities to adhere to these was weak. Written risk assessments have a good structure but are due for review. It is important that staff understand their responsibilities to familiarise themselves with each risk assessment and to adhere to it. Staff told us there aren’t any risks, a short time after a resident has been at risk from the road a second time. A financial risk assessment has not been put in place to minimise risks following the allegation of theft from a service user. Service users have been at risk on several occasions. This is discussed further under ‘Complaints and Protection’. 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is poor. People do not have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff do not support their personal development. People are not enabled to choose and participate in suitable leisure activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A staff member described two people’s needs as ‘the same’. We then found that the two people whose care we looked at had exactly the same activity plans. This does not account for their individual interests and needs. In March staff discussed a range of possible activity options but there is little evidence of their implementation. The activity plans have not been effective. Staff said ‘we try but they show no interest’. Staff said one service user just wants to sit and rock and that certain activities are ‘hard work’. Staff specifically said how service users have no interest in domestic tasks or cooking. As service users cannot tell us we looked at activity records. This told us that for one person 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 14 over a three week period, domestic activity, which is known to hold no interest for the service user, was regularly offered but not carried out as there was ‘no interest’. Other listed activity options were recorded as not having taken place due to there being ‘no staff’. We could see that over this period of time, the service user had had a foot spa, music, spent time in the garden and watched TV. The picture is little different for the second service user. Again records show us that the service user had ‘no interest’ in the opportunities offered or there was ‘no staff’ available to carry out the more interesting ones. In addition other than going for a drive and shopping in a three week period, records for this person show she did little. Some records show she ‘‘remained in the hallway’ and on another day ‘spent most of the time hitting and rocking her legs’. Staff said a service user always goes shopping but staff compile the shopping list based on what has been used. There was no evidence of how service users influence the choice of food provisions. Staff were not aware of dietary needs described in the care plans for individuals whose care we looked at, but said they tried to cook healthy meals. Guidance is now available to show how one service user doesn’t eat beef and staff we spoke to were aware of this. We could see from records that beef was being avoided for the most part but on two occasions we could not satisfactorily be assured that recipes which use beef had contained alternatives. Staff were also aware that they should take steps to avoid the risk of choking to the service user. We could see that the two people whose care we looked at receive visits from their families. However we observed a lack of interaction between staff and service users. We also observed a service user being prevented from entering the kitchen on the basis that she would urinate on the floor. Further exploration of this showed it not to happen very often and that the behaviour itself had become the focus rather than the focus being the reason for the behaviour. 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is poor. The provision of personal care is good and people are supported to be clean and well groomed. People’s physical needs are not always met. Although some changes in health have been identified and responded to, the lack of routine health screening compromises health. The failure to follow medical advice for one resident is likely to have caused discomfort and pain. People are not supported to take their medication safely and this puts them at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We can see that residents are clean and well groomed. Records support this with evidence that personal care is provided daily. Good guidance is available to staff to support this, however following a bathing incident which came to light at the last inspection, it was suggested that the care plan emphasises the function of bathing as a pleasurable activity for one resident to minimise the risk of behavioural challenge. This has not been done. 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 16 We can see from records that residents have been supported to attend their appointments with medical Consultants. They have also been provided with regular chiropody attention to enable good foot health. Two of three residents are not registered with dentists. These are the residents whose care we looked at. One of the residents needed treatment for mouth swelling, apparently an abscess. Whilst it is positive that this change in health was recognised and acted upon to a satisfactory conclusion, regular routine oral screening and treatment may have avoided this decline in health and the associated discomfort. This service user was taken for a hearing appointment but was uncooperative. A home visit was suggested but an appointment has not been received and has not been followed up by staff. The second service user whose care we looked at was taken to the GP for a minor concern. It was at this appointment that it was found that treatment previously prescribed for an ear infection had not been given, leading to investigation by the Local Authority under safeguarding procedures. Our pharmacist inspector found that ear drops which had been given were not antibiotic based as staff had thought but steroid based. These were used not in conjunction with oral antibiotics as intended and this had the potential to exacerbate the ear condition and associated pain. Health records are written satisfactorily and generally give enough information to enable follow up action to be taken giving continuity of care. This is not happening however and must be addressed. The pharmacist inspector visited the home as part of the key inspection and carried out an inspection of the medicines management systems being practiced within the home. The inspection comprised of examining the medication storage area, examining the records kept and having discussions with the care staff. The findings of the inspection were then fed back to the management team at the end of the visit. In summary the medicines within the home were poorly managed and therefore placed the people who used the service at risk. We found that the policies and procedures document for the handling of medicines did not describe in enough detail how the handling of medication within the home should be safely carried out by the staff. The medication records were poor and could not be used to evidence that medicines were being administered as prescribed. The quantity of medication received into the home was not being recorded. Any medication carried over from the previous month was not being taken into account and added to the new quantities at the start of the next month. The home had a weekly stock check sheet to fill in but we found that it had not been done since the 23rd June 2008 in some cases and the 2nd July 2008 in other cases. We also found that not all of the residents’ medication was being checked and recorded on these 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 17 sheets. We found that residents had not been administered some of their medication because the home was out of stock. We also found in some cases that the administration records had been signed but the medication had not been administered. When viewing the archived administration records we found that there had been a change to the directions of a “when required” medicine but none of the staff were aware of this. The records for one prescribed antibiotic showed that on one day the medicine had been administered four time a day rather than the prescribed three times a day. We found no evidence that the doctor had been informed of the incident. We found overall that the care plans were poor for containing information about the administration of medicines. In particular we found little or no information about (i) the administration of “when required” medication, (ii) the administration of as directed medication, and (iii) the changes made to the doctor’s original directions. We found that the staff who were administering medication had completed the safe handling of medicines course within the last 18 months. We were also told that staff had been assessed as competent in February 2008. The company had a drug assessment sheet, which was used on an annual basis to assess the competency of its staff. The home was advised that an annual assessment was possibly too long to prevent poor practices creeping into the handling and administering of medication. We found that the staff lacked knowledge about safe systems and about medication. This may have been a contributory factor in the recent error where a resident did not receive her antibiotics for a period of six days. In light of some of the issues identified during the inspection the assessment of the care staff competency to administer medication safely must be carried out as a matter of urgency. We found that staff were giving medicines to one person on a spoonful of yoghurt. There needs to be informed written consent before putting medication in a person’s food or drink. This action needs reviewing in the light of the Mental Capacity Act with agreement properly recorded from all those involved in this person’s care that the medication and method of administration is in this person’s best interests. 112 Wellington Road DS0000069681.V364472.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is poor. The home has not always safeguarded people from the risk of harm or abuse. There have been some occasions since the last inspection, when service users health, safety and financial well-being have been at risk and outcomes for them have been poor. Adult Protection procedures and responsibilities are not fully understood. Staffing levels continue to put residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been a number of incidents, which tell us that service users have been at risk. There has been an allegation of theft of monies from a resident. Theft of a staff member’s purse has also been reported. It was clear as a result of the initial incident that the service’s responsibilities to report such matters in accordance with Adult Protection procedures were not fully understood. A satisfactory conclusion to this matter has not been reached but inspection has showed gaps in financial procedures. Finances are not being checked each shift as the guidance states and are not always being checked daily. This makes accountability more difficult and errors harder to trace. In addition concerns identified at the last inspection and included in the last report about how it seemed a service user had been removed from the bath against her will potentially using a banned underarm lift has not been investigated by the provider or reported for investigation by the Local Authority under adult protection procedures. This does not enable staff to 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 19 learn, the service to improve, or risks to service users to be minimised. We found no evidence in that available to us, that this had been repeated. A service user with no road safety awareness, left the care home unknown to staff and unsupervised crossed the busy main A41 road next to the home. The service did not identify and report this for consideration by the Local Authority as an adult protection matter. Remedial actions were taken to reduce the risk of a reoccurrence. Since this most recent inspection and immediately prior to writing this report, there has been a reoccurrence with similar trends. A service user with no road safety awareness again left the premises and upon instigating the Missing Persons procedure was located by the police 20 minutes later. Her exit from the building, which had a locked door policy, was unknown to 8 staff who were on the premises at ‘handover’ time when staff and residents had returned from a drive. Like the previous occasion, this incident had the potential to be fatal. Failure to administer prescribed antibiotics to a service user with known ear ill health for 6 days for an ear infection amounts to neglect. This was appropriately reported under adult protection procedures. Steps were taken when the omission came to light to ensure the service user was started on the medication. However steps were not immediately taken to safeguard the situation ie reduce the risk of further error / ensure staff competence until the service was prompted to do so. We have been informed that staff do not believe the error should have been reported and that by doing so, this has caused difficulties within the team. In this case, this shows a lack of understanding of accountability, knowledge of adult protection responsibilities in practice and concern for the welfare of service users. There has been one anonymous complaint made which was received by us and sent to the provider to investigate. It was about the fitness of a staff member. An investigation was carried out and was recorded. The result of this was inconclusive. The investigation states that the complaints procedure had not been adhered to, but information about how to make a complaint is not readily available ie not on view within the premises. This information is in pictorial versions for service users but is held on their personal files. The service users’ disabilities are such that they are unlikely to ask for or to see their files so in effect the guidance is not really accessible to them. This should be reviewed. From the evidence available, it seems as though behaviours are managed appropriately. Staff are trained and where necessary have been retrained. New staff were undertaking recognised training for three days at the time of the inspection. Behaviours are recorded well and it seems that staff diffuse and redirect behaviours to good effect. 112 Wellington Road DS0000069681.V364472.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is adequate. Service users live in a modern property which has been refurbished to a high standard and is clean and domestic in style. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the environment shows a pleasant and well-maintained environment on the whole. It is light, modern, decorated well, has modern yet cleanable comfortable seating and smells fresh. Residents were seen to use and enjoy the outside rear garden. Areas for review are the appropriateness of carpet in the bedroom of one resident who can be incontinent. Her bedroom was not as fresh as all other areas in the house and this is not pleasant for her. Drawer fronts were missing from the bedrooms of 2 residents but we were assured that this was in 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 21 hand. Also we pointed out the practice of labelling the outside of cupboards and drawers with items of clothing as institutional. This is designed to help staff and is not for the benefit of residents, as residents would not be able to read the written words on the labels. Where water temperatures are excessive, namely in the kitchen and laundry, risk assessments are in place and we found the laundry to be locked, reducing risk to service users of scalds. Our primary concern is the appropriateness of the premises for the people placed there. This is in light of the two recent incidents when leaving the premises unattended has placed them at great risk from the main road immediately adjacent to the house. Action has been taken following each incident and we are in receipt of an action plan to address the risk highlighted by the most recent incident. However, it is clear from the action plan that security arrangements are becoming increasingly extreme to ensure safety e.g. the provision of higher fences, chains, double doors at the front etc. Whilst safety must be paramount, deprivation of liberty must be considered and the provider has taken steps to arrange training and support in these new areas. This is in conjunction with one to one staffing. 112 Wellington Road DS0000069681.V364472.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34, 35. Quality in this outcome area is poor. Although checks have been done to make sure staff are suitable, people do not have safe and appropriate support, as there are not enough staff on duty at all times. There are concerns about the effectiveness and motivation of the staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On arrival at inspection we knocked on the door for 10 minutes. We could not gain staff attention. Through the front door we could see a service user sitting unsupervised at the foot of the stairs. When we gained access we found two staff to be on duty instead of four with all three service users present. The rota showed two staff to frequently be on duty, with three at other times, with four staff rarely on duty at any one time. The provider agrees that three staff are needed for safety and four to provide quality by enabling activities. Service users need 2 : 1 staffing in the community, so that even provision of four staff negates opportunities for some in that people will need to take it in turns to go out. Some new staff have been appointed and are awaiting clearance to start. In the meantime it was agreed that agency staff would be recruited to start 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 23 without delay to ensure service users’ supervision. This has been confirmed in writing to us and in spite of the organisations initial reservations about this approach, feedback has been positive. It is vital that agency staff receive full inductions from someone competent to do so. We looked at how two newly appointed staff had been recruited and are satisfied that appropriate steps are taken to ensure they pose no risk to vulnerable adults. We are satisfied too that new staff are supported to settle in, are provided with training and supervision early on and are not left alone. A rolling programme of training is available which we can see on an updated spreadsheet. A staff member told us she had ‘done them all’ (training courses). We could see too that the numbers of staff trained to national approved levels have increased. It is difficult then to explain such poor outcomes for service users. Staffing levels have affected service users experiences of care and we have information that indicates the team is not a happy one. Staff are receiving supervision but have not been effectively supervised and directed on a day to day basis. These issues are affecting the management of the care home and are affecting outcomes for service users. The new acting manager is aware of the complexities and challenges facing her and is keen to improve the service. The effective management of change will be key to improvement. Staff confirmed that staff meetings take place monthly. 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is poor. There are some strengths upon which to build and the new acting manager is committed to making changes. However service users’ experiences have been poor. People have not been getting the right support from the care home because since the last inspection it has not been managed effectively. Staff have not been managed in a way that ensures they always carry out their role properly. Quality assurance systems are in place but do not support the home to maintain appropriate standards. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Senior representatives of the organisation did not welcome the fact that the inspection was carried out on this occasion. They felt that they were not due an inspection and that the timing was intimidating. We were told that had 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 25 another manager been there we would not have been allowed in. Concern was raised with a CSCI manager on the day of inspection. This does not demonstrate an understanding of the regulatory function or enforcement pathways and appears to be a culture engrained also within the staff team some of whom were reluctant to speak fully and frankly to us. The new acting manager has applied for registration with us. She says she is committed to improving standards and feels that her managers recognise the problems at the home. She said she feels her managers are supporting her. However, she repeated that since her appointment she had had little time to spend in 112 Wellington Road as manager. As she also has responsibility for the neighbouring service, she said she has concentrated on making the required improvements there and any time she had spent in 112 has been as a carer due to the staffing shortages. Her lack of familiarity with some of the systems in 112 was evident. She was disappointed at the timing of the inspection and expressed the view that she had hoped she would have had time to make improvements before we inspected. The intention is that the recent appointment of agency staff will release her to manage and improve the service. The numbers of staff qualified in first aid have significantly improved and it is positive to see that accidents are now being recorded. Records showed accidents to be minor in nature. Risk assessments are in place to address hazards in the environment but require review. Other safety monitoring and service maintenance records that we requested were available and were up to date. For example there is a fire risk assessment, recorded fire drills, weekly fire alarm checks, food storage, temperature checks and water temperature checks Quality assurance tools are available to help the service to self assess its performance but given the outcomes at this inspection it is difficult to see how they are effectively helping the service to bench mark and improve its performance. For example Managers said they were aware that staffing levels were not being met and were down to two at times, but sufficient corrective action was not taken in a timely way until the day of inspection. This is not indicative of a service that is being run in the best interests of service users. Most systems are in place and there is a good foundation upon which to build. Strong management is needed to effectively turn the practice within this service around to ensure it is managed openly and transparently and that staff do the things they are supposed to do to improve the quality of life for service users and to ensure they are safe at all times. 112 Wellington Road DS0000069681.V364472.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 2 2 X 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 1 34 3 35 2 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 X 12 1 13 1 14 X 15 3 16 1 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 1 X 1 1 1 X X 1 X 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 27 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 YA3 Regulation 12 Requirement Steps must be taken to ensure that the care home is conducted with due regard to the religious persuasion, racial origin and cultural and linguistic background of service users. Requirement made at first inspection October 2007. Original target date for compliance was 30.11.07. Not met at this inspection. Timescale for action 22/07/08 2. YA9 13 Risk assessments must be carried out that reflect the full range of risks to service users. This will help to minimise risk of injury or harm to service users Requirement made at first inspection October 2007. Original target date for compliance was 31.10.07. Not met at this inspection. 22/07/08 3. YA13 16(2)(m) Arrangements must be made to enable service users to more fully engage in local, social and community activities. This will ensure that service users quality of life improves. 22/07/08 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 28 Requirement made at first inspection October 2007. Original target date for compliance was 31.10.07. Not met at this inspection. 4 YA19 12(1) Steps must be taken to promote and make proper provision for the health and welfare of service users. This will ensure they receive proper care, treatment and health supervision. New requirement arising from this inspection July 2008. 31/07/08 5. YA20 13(2) Medication practice must be reviewed to ensure its safe administration in accordance with prescribed direction and that medication records accurately reflect medication administered. This will better promote the health and safety of service users. Requirement made at first inspection October 2007. Original target date for compliance was 31.10.07. Not met at this inspection. 22/07/08 6 YA20 13(2) The records of the receipt, administration and disposal of all medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. New requirement arising from this inspection July 2008. 15/09/08 7 YA20 13(2) Appropriate information relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and DS0000069681.V364472.R01.S.doc 15/09/08 112 Wellington Road Version 5.2 Page 29 monitor all medication including “when required” and “as directed”, medication to ensure that all medication is administered safely, correctly and as intended by the prescriber to meet individual health needs. New requirement arising from this inspection July 2008. 8 YA20 13(2) Staff who administer medication must be competent and their practice must ensure that residents receive their medication safely and correctly. New requirement arising from this inspection July 2008. 15/09/08 9. YA23 13(6) Arrangements must be made, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse to ensure safety and well being. Requirement made at first inspection October 2007. Original target date for compliance was 31.10.07. Not met at this inspection. 22/07/08 10. YA24 16(2)(k) Steps must be taken to keep the care home free from offensive odours to ensure that the premises provide a pleasant living environment for all where risk of infection cross contamination is minimised. Requirement made at first inspection October 2007. Original target date for compliance was 31.10.07. Not met at this inspection. 22/07/08 11. YA33 18 Staff must be provided in sufficient numbers to support service users’ assessed needs at DS0000069681.V364472.R01.S.doc 22/07/08 112 Wellington Road Version 5.2 Page 30 all times. This will ensure that service users are properly supervised and are provided with appropriate opportunities. Requirement made at first inspection October 2007. Original target date for compliance was 30.11.07. Not met at this inspection. 12. YA37 10(1) Steps must be taken to ensure the care home can be managed with sufficient care, competence and skill. This will include enabling sufficient time for the management of the care home. New requirement arising from this inspection July 2008. 31/07/08 13. YA42 13(4) Steps must be taken to ensure 22/07/08 the health and safety of staff and service users environmentally by ensuring that: All parts of the care home to which service users have access are as far as reasonably practicable free from avoidable risks And: Unnecessary risks to the health and safety of service users based on their vulnerabilities are identified and as far as possible eliminated. This will safeguard service users from risk of accident and injury. Requirement made at first inspection October 2007. Original target date for 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 31 compliance was 30.11.07. Not met at this inspection. 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 YA1 Good Practice Recommendations The Service User Guide should be made available in alternative formats so they are accessible to service users. Recommendation made at previous inspection October 2007. Not met at this inspection. The service user Guide should include the range of weekly fees charged. New recommendation arising from this inspection July 2008. 2. YA5 Service users should be supported by family, friends and / or advocate as appropriate, when drawing up the contract, which should be in an accessible format. New recommendation arising from this inspection July 2008. 3 YA7 Steps should be taken to enable service users to make decisions about their lives with assistance as needed. Systems should be put in place to evidence where decisions made by service users have been made and acted upon. Where decisions are made by others this should be recorded, including why. New recommendation arising from this inspection July 2008. All medication errors should be investigated and acted upon. Recommendation made at previous inspection October 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 32 4. YA20 5 YA20 6 YA20 7 YA20 8. YA22 2007. Not met at this inspection. The policy and procedures for the handling and administration of medicines should be updated to include a detailed procedure for all tasks undertaken within the home. The receipt of all medication should be recorded and the total quantity for each medicine present within the home at the beginning of the month should also be recorded prior to the start of the new month. Written consent to handle and administer medication on the residents’ behalf should be obtained for each resident. Where consent is not possible because of lacking capacity, records must be made of the agreement that the way in which medicines are administered is in the best interests of that particular person. All complaints procedures including easy read formats should be publicly available within the premises. This will ensure everybody knows how to make a complaint in the event of needing to do so. Recommendation made at previous inspection October 2007. Not met at this inspection Steps should be taken to ensure that good personal and professional relationships are maintained between all parties e.g provider, managers, staff and service users. The provider and managers should take steps to encourage and assist staff to maintain good personal and professional relationships with service users. This will ensure that service users benefit from the creation of an open, positive and inclusive atmosphere. New recommendation arising from this inspection July 2008. 9. YA38 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 112 Wellington Road DS0000069681.V364472.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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