Inspection on 27/01/09 for 12-13 Exbury Place

This inspection was carried out on 27th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

12-13 Exbury Place 31/01/07

12-13 Exbury Place 21/02/06

12-13 Exbury Place 17/08/05

12-13 Exbury Place 21/02/05

12-13 Exbury Place 15/07/04

Similar services:

Aston Court Nursing Home

Breme

Ravenhurst

Westmead

Ashcroft Hollow Nursing Home

Bricklehampton Hall Nursing Home

Briar Hill House

Radbrook Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 12-13 Exbury Place 12-13 Exbury Place 18 Wingfield Road Trowbridge Wiltshire BA14 9EB     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jean Littler     Date: 2 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: 12-13 Exbury Place 12-13 Exbury Place 18 Wingfield Road Trowbridge Wiltshire BA14 9EB 01905611147 01905612958 andrew.deakin@scope.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): SCOPE Name of registered manager (if applicable) Mr Andrew Joseph Deakin Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 4 Date of last inspection Brief description of the care home The service provider is SCOPE, which is a national organisation and registered charity providing a range of services for people with cerebral palsy and other physical disabilities. Exbury Place was first opened as a care home in 1993 and is part of a local community project called First Key Worcestershire. The First Key office is at Unit 3, Lowesmoor Wharf, Lowesmoor, Worcester, WR1 2RS (tel no. 01905 611147) and the registered manager (Mr Andrew Deakin) is based there. Care Homes for Adults (18-65 years) Page 4 of 35 care home 4 Over 65 0 4 Brief description of the care home Exbury Place provides accommodation with personal care for four adults who have cerebral palsy, or a similar physical disability, and may also have an associated learning disability. Information about the home is provided in a statement of purpose and a service users guide that are available from the home and the SCOPE office. The current fee for the service ranges from fifty-two and sixty-three thousand pounds each year. People have to pay for their own personal costs such as hairdressing, chiropody, personal telephone or internet use, shopping, travel, newspapers or magazines. Funding for activities and holidays is as agreed with each persons funding authorities. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last Key inspection was on 31st January 2007. The service was rated as providing good outcomes for people. We, the Commission, carried out this Key inspection over 6 hours. We looked around the house and spoke with some people who live there. Some records were looked at such as care plans, medication and money. The people living in the Home and staff were asked their views in surveys. Care Homes for Adults (18-65 years) Page 6 of 35 We spoke with four staff and a visiting nurse. The manager, Mr Deakin, sent us information about the service before the visit in the AQAA. (The Annual Quality Assurance Assessment). What the care home does well: What has improved since the last inspection? What they could do better: People could be better helped to plan how to spend their time and try new activities at home and outside. There should always be enough staff to meet peoples needs with dignity and ensure their safety. Peoples care plans could better explain how their complex needs are met and how risks are reduced. Peoples plans could be put into a clearer, person centred style, to make them easier to understand. They could be better helped to work towards personal goals and ambitions. People could have their care reviewed at least twice a year so they can plan ahead with Care Homes for Adults (18-65 years) Page 8 of 35 their supporters more often. The house could be changed to give more dining space. Staff need to attend training to help them better meet peoples health needs and ensure their safety and protection. People should be supported more safely with their mobility needs. Staff should be clear and practice more often what to do if there is a fire. There should be more of a management presence in the house so that communication improves and the service is run better. The owners need to make sure their checks on the service are effective and stop people from being put at risk. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has information to help people decide if they might like to live there and if the service could meet their needs. Procedures indicate that people would have their needs assessed and be enabled to trial the service. Evidence: SCOPE provides appropriate information documents for the home, including a statement of purpose and a service users guide. A copy of the guide is on display in the home and this has been kept under review. There has not been any changes in the resident group for some years. Should a vacancy occur there is written guidance on the assessment of a prospective new persons care needs, with a placement procedure flow chart and a care profile tool. People reported in their surveys that they were given enough information about the home and had a trial period when they moved in. Care Homes for Adults (18-65 years) Page 11 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People generally receive good daily support from staff they like. They cannot be confident that their complex needs and personal goals will be accurately reflected in their care plans. This means they are potentially at risk. People are being enabled to make some decisions in their daily lives, however, more proactive Person Centred Planning would help further develop peoples opportunities. Evidence: Two peoples care records were seen. These included a pen picture that describes the person and information such as their preferred daily routine. These had been reviewed during the year. The information is worded respectfully and is person centred in terms of showing that each individual has specific needs and wishes. The care plan format used is more like an assessment tool and it does not show how peoples complex needs are being met in a clear way. Although people have been consulted about their support they would be better enabled to understand their care plans if a more accessible format were used. Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: Staff record a daily diary for each person and significant events, such as health care checks, family contact and activities participated in. These provide helpful information about their life and wellbeing. Since the last inspection keyworkers have started completing monthly summaries of these records, this is a positive step. However, staff said they have not had time to complete them for the last few months due to other pressures. Mr Deakin said in the AQAA that people all now have Health Action Plans and that Life Books are now being developed. Staff reported that keyworkers have not had the time to work on these very much and one mans has not been started yet. Some risk assessments have been carried out to help staff safeguard people whilst, where possible, promoting their independence. They include moving and handling, going out in their wheelchair, road skills, being left alone in the home and holding their own key. The moving and handling assessments are vague stating that people need the support of one to two members of staff when being moved in a hoist. There is no explanation about in what circumstances one worker is sufficient. The care plans seen did not contain pressure care risk assessments. Both people are at risk of developing pressure sores, as are all the people in the home. Clear guidance should be in place about pressure care arrangements and the need for pressure relieving equipment and personal care practices. District nurses are able to complete assessments and lead on care planning in this area. A risk assessment was not found regarding choking or the safety of the person who cannot move his position once in bed. These risks may also apply to two other people in the home. A Speech Therapist swallowing assessment should be requested for the people have some difficulties eating or drinking. There is information in one persons plan about epilepsy which used very old fashioned and out of date descriptive medical terms. There are no details of potential triggers such as constipation or how the condition affects the person, even though incident reports showed that seizures are happening and sometimes result in a fall. The epilepsy risk assessment does not cover what risks there are for the person during the night, while bathing or swimming. One person has specific nutritional needs that are met through supplements being provided through a gastric feeding tube. This is described briefly in his pen picture. The care plan did not contain clear guidance on this invasive procedure, such as hygiene measures or how to prevent or respond to any signs of infection at the tube entry site. Two people have medication prescribed on an as needed basis. Their care plans did not Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: contain clear guidance about when these should be administered. Incident reports showed that people are being supported appropriately when they become upset. The guidance for staff about one persons behaviour when upset did explain potential triggers and how staff should respond. It does not state that the person can target one of their peers during incidents and staff have to be quick to protect him. As reported at the last inspection the plans do not include detail of peoples personal goals or ambitions. This is an important part of Person Centred Planning. Staff said actions for the year ahead are discussed at the annual reviews that social workers are invited to. However, the report from one mans last meeting, in February 2008, could not be found to establish this. The Younger Adults Standards recommend that review meetings are held at least every six months to help ensure people have the opportunity to plan ahead regularly. These meetings should be the focus of the Person Centred Planning process to ensure short and longer term plans are made and put into action. People said they are being supported to make choices in their lives. One man did feel he would like to go out more frequently. Staff were observed to ask people for their choices during lunch and conversations about the days activities. Two people are able to express themselves articulately. It was clear staff have the skills to understand people when they communicated through methods such as body language. Discussions confirmed that peoples views are respected in regards to the activities they wish to take part in. People are being consulted about some decisions in the home, such as food purchasing. For the majority of 2008 Mr Deakin has been requiring one of the two workers on duty each weekday evening to go and support a person living in the community with their care needs. One man said he did not like this as it meant he has to eat and go to bed by a certain time. There was no evidence in peoples care plans to indicate that they have been consulted about this change in their support arrangements. Care Homes for Adults (18-65 years) Page 14 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to pursue individualised activities of their choice and to mix within the community. Activity opportunities are limited due to the staffing arrangements. Personal development goals are not being focused on. People are supported to maintain contact with their families and they enjoy their meals. Evidence: In respect of daily routines staff said people choose their own as far as is feasible. Most people need a high level of assistance with their personal care, so this takes up a significant part of their daily routines. One man said he had to go to bed early because of one worker going elsewhere to work in the evening. Staff said this man and two others often get tired and choose to go to bed early, the other person stays up later but can get ready for bed more independently. One mans routines are restricted because three mornings a week he has his health care needs met by district nurses. Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: Staff could not say why his treatment could not be given in the evening to free up his days and improve his quality of life. This man said in his survey that he would like to go out more often so this routine should be reviewed as a starting point. Each person has at least one set activity they take part in. Two attend the Snoozelan centre and one goes to the Bradbury centre. Two people went out after lunch to a regular music session at the Snoozelan centre and said afterwards that they had enjoyed it. One persons care plan contained an activities plan showing the music session on a Tuesday and a day centre on Thursday. Nothing was shown as planned for a Monday, Wednesday or Saturday. The Friday activity is Hydro Therapy that is bimonthly. Staff said the community enabler who used to provide support with outings on a Sunday has not been available lately. This person said the hydro therapy and a holiday are the favourite pastimes. Each person has an allocated day with their keyworker each month for personal shopping, a hair cut or pub lunch etc. One person said he prefers to spend most of his time at home. He is now attending hydro therapy, which is offered to him twice a month, but he sometimes declines this. He has his bedroom set up for his interests including entertainment equipment and internet access. His records showed he has not been out very often recently, even locally. There is no record to show if he has been offered an outing or a different interesting indoor activity and declined, or if these have not been made available to him. The staffing levels do not enable any spontaneous activities to take place because three people need one to one support to go out. Other than the regular outings described above trips have to be planned ahead so a third worker can be provided. These are called flexi shifts. Staff reported that there has only been four flexi days during January 2009. Some staff feedback indicated that the level of additional hours provided has decreased over the last year. On the day of the inspection the team coordinator went to work at a nearby service to cover a gap in their rota. Staff said this happens quite often. Had he been in the home on his planned administration duties this would have increased the opportunity for someone to go out that morning as he could have helped the remaining worker if needed. Mr Deakin reported in the AQAA that two people have been on holidays of their choice in the last year. Staff reported the funding means only one member of staff can support a person on a holiday. It is positive that people are supported to choose personalised trips rather than group holidays. However, by only one worker going it does not enable staff to have a break or in some cases provide enough support for moving and handling tasks. This has led to staff being less willing to volunteer for holidays. Mr Deakin also reported that the plans for 2009 include, exploring further options Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: available in Worcester for people to integrate into the local comminity and with neighbours, to find more activities and social events, introduce a monthly activity monioring report, and to further improve independence skills. Care plans do not include much information about peoples social and developmental needs and goals. Records do not clearly show if people have enjoyed and benefited from activities, or that staff are encouraging them to take up meaningful activities even if they refuse them. There was a pleasant and relaxed atmosphere in the home. People have contact with their families if they wish, and can telephone them. Their keyworker support them to visit their relatives if needed. One person said she likes to call her mother in the evenings. There is a limit to how far people can take responsibility for the day-to-day running of the household, due to their disabilities. Staff cook and carry out most tasks, but try to involve people when they can. One person said in their survey that they like getting the housekeeping money. One person can communicate verbally and another uses a communication aid very effectively. The staff on duty for the next 24 hours is displayed to inform people in the home, but no other forms of accessible information was seen around the home to promote communication, understanding and involvement. People do reportedly join the first part of the team meetings, but the meeting minutes seen did not record what was discussed with them. Regarding food provision each person has their own housekeeping money for food and household products. They choose to put this together and have joint meals. Staff support people to shop locally and then prepare the meals. People confirmed they liked the food and can choose what they want. They choose their own breakfast and snack meals and main meals are decided by all each day. Nobody requires a special diet but some people have to monitor their weight and some are at risk of choking so food needs to be prepared in a certain way. As already reported, the current evening staffing arrangements mean the evening meal has to be finished by a certain time. It also means people cannot have takeaways later in the evening. These were very popular as most people do not go out for meals. Because three people need to be fed, and there are only two staff, these people are not able to have the dignity provided by personalised support during group meals. Care Homes for Adults (18-65 years) Page 17 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are generally having their personal, health care and medication needs met on a day to day basis, but shortfalls in care planning, staff training and some care practices are putting them at potential risk. Evidence: People looked well presented and staff interacted with them with kindness and respect. One person said staff always come to assist him when asked. There is a privacy policy and feedback from the district nurse team indicated that staff always respect peoples privacy, dignity and diversity. The nurse manager said, Patients always look cared for and appear happy. The service usually seeks and acts upon advice given to meet peoples health needs. The care plans outline the assistance people need from staff with their personal care and health needs, however, as mentioned there are significant gaps in the information that need to be addressed, such as risk assessments for pressure care and choking. The plans did guide staff to promote independence where possible. We were told by staff that although the moving and handing assessments state that Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: three people need to be transferred by hoist they are currently being manually lifted. A variety of reasons were given for this, equipment not being suitable, difficulties getting slings under people in their wheelchairs, and that two men prefer to be manually lifted. Mr Deakin had not provided an additional hoist power pack although one had been requested. As mentioned one member of staff is lone working for some of each weekday evening, which has led to staff lifting people alone. We were told that Mr Deakin has been made aware that staff are manually lifting people. He has not reviewed arrangements and put clear and effective guidance in place, but informed staff they are doing this at their own risk. The Responsible Individual, Mr Walsh, was written to after the inspection to highlight the need for urgent action to be taken to reduce the potential risks to peoples safety. Records showed that people are being supported to have routine health checks such as the dentist, optician & chiropodist. Mr Deakin said in the AQAA that each person now has a health action plan and is having health checks. Discussions showed that people have not yet been offered cholesterol checks. Records are being made after appointments and specialists are involved to meet specific health needs. Staff seem to be meeting peoples needs well on a day to day basis but they have not been provided with formal training about epilepsy, pressure care or the gastric feeding tube. They pass on information to new staff in an informal way. There is no clear guidance in place about these health needs. Staff did not seem consistently informed about peoples health needs, for example two staff named different people as the ones who have epilepsy when both have the condition. The team coordinator did not seem well informed about how the female residents health needs are monitored. He may not provide personal care for her but he is responsible for everyones wellbeing and needs to be overseeing arrangements. Staff meeting minutes showed that general issues are discussed rather than peoples needs. More frequent discussion may ensure staff are all well informed. Regarding medication SCOPE provides general policies and procedures for the management of medicines in all their care services and there are also specific procedures for Exbury Place. The medicines are safely stored in locked drawers in peoples bedrooms and records are being maintained appropriately. Each person has a written medication profile with a list of their prescribed medicines and information about their use and possible side effects. New staff receive instruction about medicines during their induction and then receive accredited training from an external trainer before they are allowed to administer in the home. Two people have medication prescribed to only be used in certain circumstances. These medicines seemed to be being given appropriately and a senior has to be consulted before doses are given, which provides a safeguard. However, as mentioned, no care plan guidance or protocol Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: has been drawn up to guide staff about when to administer these. Care Homes for Adults (18-65 years) Page 20 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place to support people and their representatives to raise concerns and to provide protection, but people cannot be confident that these will be effective. Evidence: SCOPE provides a formal complaints procedure and employs a Complaints Resolution Manager to investigate complaints about its care services. There is a complaints procedure for people in the home and a video explaining the procedure. Since the last inspection no complaints or vulnerable adults concerns have been raised with the Commission. People said in their surveys that they know who to raise concerns with and would feel able to talk to staff or their family. Staff said in surveys they would report any concerns or complaints and record them. A worker reported that people are offered access to advocacy services but only one man uses this. SCOPE provide staff training on responding to complaints. One man was asked about his view of staff going to another service twice each weekday evening. He clearly said he was unhappy about it but had not made an official complaint. People sometimes find it difficult to make formal complaints to managers because of feeling disempowered, so it is important that they are regularly asked if there is anything they are unhappy about. If Mr Deakin has consulted people about their views on this change to their support arrangements then he does not Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: appear to have acted on their views. Staff have raised concerns about this issue in several staff meetings and one family has reportedly also raised concerns with Mr Deakin. These are not recorded in the homes complaints log and Mr Deakin reported in the AQAA that no complaints have been received in the last year. One persons social worker said he had not been consulted about this change to his clients staffing arrangements, even though he attended a review at the home in December 08. Mr Deakin reported in the AQAA that there is a new adult protection policy. All new staff are trained in both safeguarding and whistle blowing as part of the induction programme. There is a whistleblowing policy and all staff are trained in the safeguarding of vunerable adults. The team coordinator said he has not attended a refresher course on safeguarding in the recent past. We were told that staff and the Fisr Key Moving and Handling trainer have raised concerns about the moving and handling arrangements with Mr Deakin but no action has been taken. People may have been put at risk as a consequence. It is concerning that staff, who have a duty of care, have not spoken out about these risks to others in the company when Mr Deakin failed to act. Mr Deakin has also allowed people to be at risk by not ensuring staff are aware of clear fire safety arrangements. As mentioned, incidents of aggressive behaviour between people in the home are recorded but the guidance should be expanded to show that one person is particularly at risk. People have their own cash tins to keep their personal allowance in and savings accounts. One persons records were seen and these showed that systems are in place to help protect them from financial abuse. Balances are checked at handovers and audited monthly. Receipts are also kept when anything is bought for them. Care Homes for Adults (18-65 years) Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have an ordinary, clean and comfortable home within the community that has been suitably adapted. A review is needed to ensure people have their moving and handling needs met safely. Evidence: The property is owned by a social landlord who lease it to SCOPE. It is an ordinary bungalow, which therefore is compatible with other housing around it. The home is a bungalow on a large modern housing estate, which is a couple of miles from Worcester city centre and close to Junction 7 of the M5 motorway. There are local shops, public houses, a superstore with a cafe and other amenities nearby. The home provides two suitably adapted vehicles to facilitate access in the wider community. One man has his own car which his family keep and use with him. The bungalow was especially adapted for people with physical disabilities so all internal areas are accessible to wheelchair users. People have single bedrooms that have been nicely personalised. None of these have en-suite facilities. The size of some bedrooms helps with accessibility and independence. Records showed that people attend wheelchair clinics to ensure they are seated comfortably. Mr Deakin reported in the AQAA, that Occupational Therapy (OT) assessments have been carried out and three Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: new shower chairs are being provided. Two new high profiling beds have also been purchased. As mentioned under the Health section, the arrangements for moving and handling need to be reviewed. The OT should be asked to come back and help with this process. There is a reasonably sized sitting room, kitchen-dining area, shower room and assisted bathroom for all to use. There is also a utility room and staff sleep-in room that doubles as the office. The kitchen has low-level surfaces to make it easier for wheelchair users to help with food preparation and cooking. The layout means the dining table has to be against a wall so there is not enough room for all four people to fit comfortably around it with the staff, who are needed to support them during meals. One worker said they are hoping a conservatory will be added to improve this arrangement. The general impression of the home is homely and comfortable and the inside was seen to be clean and tidy. The garden can be accessed through patio doors off the lounge. Mr Deakin reported in the AQAA that the garden has been made more accessible and the new patio doors also help access. The lounge and kitchen have been redecorated and new kitchen worktops, a cooker, hob and extractor fan have been provided. The team co-ordinator said the landlords are responsible for major repairs. One mans family, who visit regularly, have redecorated most of the home and carry out minor repairs on an as needed basis. Staff receive training and there are policies & procedures relating to infection control within the home. They are responsible for all domestic duties. A nurse said the house is always clean and smells fresh when she visits. The service was rated as 4 Star at a recent Environmental Health inspection. The Safer Food Better Business kitchen audits are used to help maintain standards and these were up to date. A generic food risk assessment was also seen and this had been recently reviewed. Care Homes for Adults (18-65 years) Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are being supported by a small staff team who they like and who know them well. Staffing levels are not always enough to meet peoples needs in a safe, flexible and dignified manner. Staff are provided with relevant training but some gaps need to be addressed. The homes recruitment procedures help to protect people from abuse. Evidence: After a national management restructure early in 2008 the senior left and a team coordinator was appointed from another SCOPE service. He is responsible for the day to day running of the home and is accountable to Mr Deakin, who is office based. Two other staff have left in the last year. There is currently a full staff team of eight but one worker is on long term sick leave. People all said they liked the staff and they treat them well. One said they had a great time on holiday with their keyworker. Of the team of eight only two staff are men. The team could be better balanced as three people in the home are men. Four staff were spoken with during the inspection and surveys were also sent out. Rotas in the home showed that two staff work during the day and one sleeps in at night. However, these are not accurate. As reported, for most of the last year one member of staff has been going to provide support elsewhere, for two periods of time Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: during each weekday evening and on some weekend mornings. Staff said there is another rota in the office that shows how the Exbury Place team are covering both services. One persons social worker told us that he had not been made aware of the reduction in staffing hours. Staff reported that they do need two staff on duty throughout the day and do not usually complete their tasks until 9.45pm. At the last inspection it was reported that a third member of staff was working flexi shifts three times a week to help enable activities. The frequency of flexi shifts has therefore significantly reduced. Staffing arrangements mean that spontaneous outings cannot take place and that people cannot always have the dignity of one to one support while being fed. The team coordinator is not always having his one day a week allocated specifically for administration and staff said they do not have time to do their keyworker administration duties. The district nurse team leader reported, They seem to run on very low staffing levels and this could be a problem if an emergency situation arose. Staff usually have the right skills and experience to support peoples social and health needs. They are always helpful to nursing staff and answer all questions. In respect of staff recruitment Mr Deakin reported in the AQAA that SCOPE policies are implemented robustly and that people in the home are invited to be on the interview panel. Files are stored at the office and have not been seen, however, two of the staff who have joined the team this year have already worked for SCOPE. Staff feedback indicated that appropriate checks were carried out before they started work and that they had an appropriate induction. SCOPE requires staff to complete mandatory health and safety training. Other relevant courses are provided such as disability awareness, equality and diversity and person centred planning. Staff feedback indicated that a good level of training is provided and requests to attend additional courses or briefings are supported. Mr Deakin reported in the AQAA that he plans to provide all staff with infection control and pressure care training this year. Courses on epilepsy, management of feeding tubes, and updates on adult protection training are also needed. A support worker, who has recently been delegated responsibility for fire safety, noticed that staff fire refresher training was not up to date. She held a fire session in the staff meeting and has ordered a new training DVD. The meeting highlighted that some staff did not know how to operate the fire panel. She has now given demonstrations and put up clear instructions next to the panel. She has taken appropriate action, however, Mr Deakin should not have allowed this situation to arise. Discussions during the inspection highlighted that there is no fire evacuation procedure Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: displayed and staff did not know if they are meant to evacuate people when they are lone working during the day or at night. The team coordinator had reviewed the fire risk assessment in May 08 but has not put into practice the guidance in it. It states that all staff will take part in a fire drill every six months including quiet hours. No night time drills or night scenarios exercises have been held and staff do not know what is expected of them. Four staff now hold an NVQ qualification and one is working towards this award. An NVQ assessor is now working on the team so this should help people gain an award more quickly. Staff said Mr Deakin does not meet with them individually but they get support from the team coordinator. He holds supervision sessions with them at least six times a year and carries out annual appraisals. Staff feel there is good communication in the team, through daily reports, shift handovers and team meetings. It was observed and staff confirmed that the team works well together. Some felt that communication between staff in the home and those in the office could be improved. An example of this was seen as the team coordinator knew a job advert is out for the other service the team are currently supporting in the evenings, but Mr Deakin has not told him if this will mean their involvement will soon end. Care Homes for Adults (18-65 years) Page 27 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is lacking leadership and management presence and as a result people have been put at risk. Evidence: Mr Deakin is suitably experienced and holds a NVQ level 4 in Care. At the last inspection he said he was working to achieve the Registered Managers Award, however, he did not mention in the AQAA if he has now completed this. The management arrangements for this service are unusual as he is based at the First Key office and oversees the running of four services. After a restructure he is now supported by three team coordinators, one of whom is based in Exbury Place. The team coordinator is expected to now gain an NVQ 3. The senior team provide 24 hour on call support for the four services. The visitors book showed that Mr Deakin usually visits two to four times a month, but there is no record of what he does while in the home. There was also a period in the summer where he does not seem to have visited for ten weeks. We are concerned that Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: the registered manager has such little direct involvement with the care home. Evidence in this report confirms there is a lack of direction and oversight in key areas of management and pactice. If management duties are being delegated to the team coordinator then there needs to be clarify about this and the team coordinator may need to be registered. Some staff feedback indicated frustration with Mr Deakin for not listening to their concerns about staffing levels and moving and handling arrangements They feel their staff are unfairly pulled away to support other areas more often than other services in the group. The team coordinator said he is supported well by Mr Deakin who provides him with supervision. Staff reported that not having a computer in the home makes updating care plans difficult as all changes have to be made at the office, which causes a delay. A member of staff has recently donated a computer to try and resolve the problem. Mr Deakin submitted the AQAA when requested and it contained relevant information. It is concerning that this internal quality assurance process did not identify the shortfalls in practice and the risks to people that we found during the inspection. Quality assurance processes are also include monthly monitoring visits by other service managers within the region, annual feedback surveys for people in the home and staff, annual placement reviews and monthly health and safety reports. None of these processes picked up the issues of concern around staffing levels, gaps in care planning, moving and handling and fire safety. Record keeping is not accurate in all cases and although policies have been reviewed they are clearly not all being implemented. It is positive that SCOPE managers are going to start producing monthly reports on their services to help benchmark standards. However, the Responsible Individual needs to ensure the monitoring systems are effective and managers are held accountable for the services they are registered for. Mr Deakin reported in the AQAA that equipment has been appropriately serviced. Records showed that fire extinguishers had not been serviced since 2007, but a sticker found on one device showed that it has been serviced in the last year. Areas of health and safety that need to be addressed have already been reported on. Following the inspection we wrote to the Responsible Individual, the Fire Authority and the Environmental Health Department to inform them of the relevant concerns. Care Homes for Adults (18-65 years) Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 13 Risk assessments need to be 30/04/2009 comprehensive and accurate on all relevant hazards including falls, pressure areas, night time safety, choking and epilepsy. This is to ensure staff are fully aware of how to safely support and protect people. 2 6 15 Clear guidance about how staff should meet peoples complex needs must be included in their care plans. This is essential to provide consistent support, help protect people and ensure their wellbeing. 30/05/2009 3 18 13 Put safe and effective 31/03/2009 moving and handling arrangements in place and ensure staff can consistently implement these. These arrangements are essential to ensure peoples needs are met safely, Care Homes for Adults (18-65 years) Page 31 of 35 consistently and with dignity. 4 20 13 All medication that is to only 31/03/2009 be administered in certain circumstances must have a clear protocol in place about when this should be given. This is essential to ensure the medication is administered safely and in line with the doctors instructions. 5 35 18 Provide all care staff with training on epilepsy, management of gastric feeding tubes, management of pressure care risks and abuse/adult protection. This is essential to ensure staff can meet peoples health needs and be fully informed of their responsibilities to protect vulnerable people from abuse. 6 41 17 Keep an accurate record of the staffing roster and a record of whether this was actually worked. This is essential to demonstrate if peoples assessed need for staffing support has been provided in line with the homes statement of purpose. 7 42 23 Develop clear fire evacuation 13/03/2009 procedures for day and night, and ensure staff are all trained and competent at implementing these. 31/03/2009 30/06/2009 Care Homes for Adults (18-65 years) Page 32 of 35 These arrangements are essential to ensure that in the event of a fire staff will take appropriate action to safeguard people in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 Provide care plan information in a more accessible and clear format to better enable people in the home and new staff to understand how their complex needs are met. Support people to have clear person centred goals for the short and long term. Enable staff to have the administration time needed to complete monthly care plan summaries. Hold review meetings at least every six months to help ensure people get the opportunity to regularly plan ahead. Review the use of accessible information and communication methods to see if two people can be better supported in this area. Review the staffing arrangements for mealtimes so people can have individual support while being assisted to eat. Develop clear care plan guidance about pressure relieving arrangements and what action staff needed to take to monitor peoples skin condition and prevent sores. Liaise with district nurses about the completion of a pressure care risk assessments and the associated care plan. Clear information on peoples specific type of epileptic seizures should be included in their care plan to enable staff to record accurate descriptions to inform the persons consultant. People should be offered all general health checks that are available to the public such as cholesterol tests. A record should be made in the home when people raise concerns to demonstrate how these are responded to. Provide additional dining space so everyone can fit around 2 3 4 5 6 6 6 11 6 7 18 19 8 19 9 10 11 19 22 28 Care Homes for Adults (18-65 years) Page 33 of 35 the table comfortably for meals. 12 33 Discuss peoples care plans and needs more frequently in staff meetings to ensure all staff are consistently well informed. Provide staffing levels in accordance with the Statement of Purpose and contractual agreements with funding authorities. Mr Deakin should complete the Registered Managers Award if he has not already done so. Review arrangements and make sure communication between the home and office based staff is effective. The Responsible Individual should ensure that systems to monitor the quality of services are robust and do not just rely on self or peer monitoring. Increase the level of management presence and oversight in the home. 13 33 14 15 16 37 38 39 17 43 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 35 of 35 - 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!