Inspection on 05/03/08 for 14-15 St James Road

This inspection was carried out on 5th March 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

14-15 St James Road 03/09/08

14-15 St James Road 23/05/06

14-15 St James Road 27/09/05

14-15 St James Road 25/04/05

14-15 St James Road 22/11/04

14-15 St James Road 15/07/04

14-15 St James Road 16/03/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 14-15 St James Road 14-15 St James Road Exeter Devon EX4 6PY Lead Inspector Sue Dewis Unannounced Inspection 5th March 2008 09:35 14-15 St James Road DS0000021830.V360554.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 14-15 St James Road DS0000021830.V360554.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. 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 14-15 St James Road Address 14-15 St James Road Exeter Devon EX4 6PY 01392 670160 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) Mrs Deborah Veronica Phillips Mr Warwick Nicholas Phillips Post Vacant Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (17) of places 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The manager must obtain NVQ 4 in Care or Registration as a 1st level Nurse with the Nursing and Midwifery Council by 1st December 2006 3rd July 2007 Date of last inspection Brief Description of the Service: 14-15, St. James Road is registered to provide care for up to seventeen people, both men and women who have or have had a mental illness and who are between the ages of eighteen and sixty-five. The home comprises two adjoining semi-detached houses, which have access to each other at second floor level. To the rear of one is a small garden and to the rear of the other is a patio. One house has a roof garden accessible from the first floor. Each house has its own kitchen and living rooms. The home is situated in a residential area close to the city centre and some rooms overlook the Exeter City Football Club pitch. The home’s statement of purpose says that at the home therapeutic care is delivered…To enhance personal esteem and confidence. And ‘to help service users to achieve or regain individual life skills required to attain or return to a more fulfilling lifestyle. Currently the fees of between £375 & £500 are charged. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk . Copies of the inspection report are available from the office. 14-15 St James Road DS0000021830.V360554.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 unannounced visit was made by 2 inspectors over 6 hours, one day at the beginning of March 2008. A pharmacy inspector had visited the home the day before to look at medication procedures. Twelve people are currently living at the home. Written information provided by the owners and previous manager for the last Key inspection (3 July 2007) was also used for this inspection. This confirmed the dates of maintenance of equipment and what policies and procedures were in place. Information from this document was used to write this report. During the inspection 4 people were case tracked. This involves looking at peoples’ individual plans of care, and where possible speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process CSCI likes to ask as many people as possible for their opinion on how the home is run. For this inspection we sent questionnaires out to 12 people living at the home, 10 representatives, 6 social care professionals (care managers) and 10 staff. At the time of writing the report, responses had been received from 7 people living at the home, 2 representatives, 3 health and social care professionals and 1 staff. Their comments and views have been included in this report and helped us to make a judgement about the service provided. During the inspection 2 people living at the home were spoken with individually and 2 others in a group setting, as well as observing staff and people living at the home throughout the day. We also spoke with the owners, one of which was working on the rota as care staff. A full tour of the building was made and a sample of records was looked at, including medications, care plans, the fire log book and staff files 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home must ensure that comprehensive pre-admission assessments are completed prior to any new people moving into the home. Care plans need to be updated. They need to involve the person and staff and should reflect the needs and goals of the individuals. 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 7 People living at the home should receive care in a person centred way from staff who are appropriately trained in mental health issues. There must be a more structured approach to the care provided to enable and promote independence with staff being encouraged to be more pro-active in the care of people living in the home. Personal information should not be recorded in a diary or communications book that may be accessible to other people wishing to see their own records. Recordings should be useful, objective and nonjudgemental. Risk assessments must be completed for all individuals and should show details of how any behaviour that may challenge the system should be dealt with by staff and should include any triggers that staff need to be aware of. The complaints system needs to be improved so that everyone can be assured that if they raise concerns they will be dealt with in an appropriate way. The home should also have a system for recording any complaints, that details the investigation and shows any outcomes. A complete training programme for staff must be introduced to ensure they have the skills to enable them to care for people at the home. They must receive an initial induction that is in line with the Skills for Care programme. Staff should also receive training in POVA (Protection of Vulnerable Adults) issues, infection control, fire procedures and health and safety matters, as well as comprehensive training in up to date mental health care. The home needs comprehensive tidying up, redecoration and refurbishment to ensure people have a safe and comfortable home in which to live. Some recruitment procedures have improved, but the procedure for obtaining references needs to be tightened to ensure accurate and up to date references are obtained, so that the risk of unsuitable people being employed at the home is minimised. Fire procedures and recordings are haphazard and a letter has been sent to Devon and Somerset Fire Service to ask them to visit the premises. There were few risk assessments relating to the building and none in relation to windows above ground floor level or to hot surfaces. This means that people may be at risk of falling from windows or burns from hot surfaces. There is no formal quality assurance system in place which means the home does not have a method of checking the quality of care that is provided or a plan to make improvements where necessary. 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. 14-15 St James Road DS0000021830.V360554.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 14-15 St James Road DS0000021830.V360554.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): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People thinking of moving into the home cannot be confident that the home’s assessment and admission procedures will ensure that their needs will be met. EVIDENCE: The 7 people living at the home who returned survey forms all felt that they had had enough information prior to moving into the home to help them make their decision as to whether they wanted to live there. No one has been admitted to the home for some time and pre-admission details were sketchy. Although there were social services referral forms for the people whose care was looked at. These referral forms were in an ‘essay’ form and it was difficult to see exactly what the needs of the person were, although aims and goals were clearly stated. There were brief pre-assessment details obtained by the home, which were limited to tick box answers. For example under ‘drug or alcohol abuse’ there 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 10 was just a tick under yes. The information in the social services referral letters had not been transferred to the home’s forms and some vital information was not being used, as the referral letters were kept in the back of the files and not easily accessible to staff. 14-15 St James Road DS0000021830.V360554.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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People cannot be assured they will receive sufficient support to achieve their personal goals or that risks to their personal safety and independence will be properly identified and managed. EVIDENCE: Four care plans were looked at, they did not contain any identified goals for people living at the home and they did not show how identified needs should be met. For example, one medical history was a list of places they had lived before. Social care was just ticked and said ‘Mandy’. Expressing sexuality said ‘very masculine’ and did not mention any issues relating to this or how staff are managing them. Another plan said ‘needs firm boundaries’, but did not expand as to what these were. Issues relating to mental health problems were 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 12 not clearly identified. Another plan said that the person had no fears for the future and then stated later that they were ‘less worried.’ Social histories were very scant, especially as the people living at the home had very complex needs and histories that staff would need to be clear about when communicating or managing behaviour. For example, history of drug and alcohol abuse was just ticked yes. Health issues were equally vague with statements such as ‘some health problems’ or ‘occasional diarrhoea’ with no actions or explanations. One plan had ‘verbal aggression’ ticked as occasional with provocation but this was not expanded on as to what the triggers might be or actions staff should look out for. It should be noted that the owner was extremely well informed as to the history, characteristics and needs of the people living at the Home. He gave examples of how staff interact with the people living there. However, he is not available all the time and the records do not ensure that his knowledge is passed on consistently. Restrictions appear to have been placed on people in an arbitrary manner and decisions have not been decided in a multidisciplinary way. Records do not show dates or say who the advocate for the person was or who was involved in the decision. One plan said that someone needed supervision with domestic tasks but did not say why. In 1999 the person had wanted to do their own cooking and gain more independence but this had not been clearly followed up. However people did say that they are generally free to do as they pleased throughout the day. Some plans did show evidence that social and health care professionals visited the home, although relations between some professionals and the previous manager had deteriorated and visits were limited. Judgemental language was used throughout the records such as ‘he’s using exaggerated old fears to justify actions’. The owner was able to tell us that one person was asked what they wanted to do about their relative complaining, which is good practice. However, this is not recorded. Care plans did not clearly show what peoples’ individual risks were or how to minimise them. There was no individual fire risk assessments or details of how staff were monitoring individual smoking habits. There was no indication on the plans of a ‘person centred’ approach to care. This is where the person is put at the centre of their care, and are seen as a ‘whole person’ with their history and future plans taken into account. There was no mention of any specific plans in relation to the mental health of people such as WRAP (Wellness Recovery Action Plan). Although the owner said that 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 13 he hoped to enable staff to undertake training in this system in the near future. Recordings on the progress of the individual were minimal. Most recordings just stated ‘fine’, ‘bad mood’ or ‘snappy’. There was no explanation as to why the individual might be in a particular mood, or any evidence of any work done by staff with individuals during the time period. Individuals’ records are maintained on separate sheets though some personal information is also recorded in a diary and a ‘communications book’. This practice contravenes the Data Protection Act as anyone wishing to see their records would have access to personal information held on other individuals. This was discussed with the owner who has agreed to look at alternative methods of maintaining these records so that all personal information can be kept confidential. 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home enjoy the relaxed atmosphere and the freedom they have along with food they like. However, this seems to be due to lack of staff intervention rather than a proactive approach of support and encouragement. EVIDENCE: One staff member said that the people living at the Home ‘just do their own thing’. There were no formal activities or records of what people living at the Home like to do with their time. One person said that they would have liked a staff member to sit and chat to them or accompany them on a trip out sometimes, but that this did not happen. They said that they never saw staff half the time but that they did not need them. 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 15 One care referral said that the aim of the placement was to ensure support, activity and structure and to develop their interests with help. Records did not show that this was happening but rather stated ‘no interests other than music, chats and company’ and there was no indication of how this need was being met. One person is stated as being a practising Roman Catholic but records do not say how this is facilitated. Another person needed a more structured lifestyle but this was not detailed. The owner said that they had given some thought to getting people at the home to be more occupied and at one person’s request is going to build a ‘smoking’ summer house in the garden with the help of some people at the home. There is a pay phone, which is always available for the use of people living at the home. Care plans did not show how links with the community were aided for people at the home. One plan said that the person would like more people to talk to and that a lack of social contacts was a problem. However, there were no actions documented to show how this was being addressed. One person’s notes said the person thought it was ‘safer to stay in, in case they met strange people’, but this was not supported by staff. One relative commented (via survey cards) that they were not kept informed of matters concerning their relative. People at the home said that they are able to go out and about as they please. However, staff do not seem to have any records of this and how this is affecting the person. People at the home are able to socialise with whomever they choose. However, there are no risk assessments in place in relation to this and problems have been caused by inappropriate friendships being formed. One person said that they regularly go to Springboard groups to meet friends and have a coffee. They also said they played snooker and went to Exmouth and Teignmouth on the train. They said that they always went alone and would like someone (a staff member) to go with them sometimes. Comments received via surveys indicated that people generally enjoyed living at the home and the freedom they had to pursue their own interests. The home has a Residents’ Handbook, which gives information about how people living at the home should behave for the comfort of everyone, for example, House Rules. However, behaviour that does not comply with these general rules has been acted upon wholly inappropriately. Written warnings have been issued that use judgemental language and show no empathy with or understanding of peoples’ backgrounds. It should be noted that these were mainly issued by an ex member of staff, but clear information has not yet been put into care plans in order to avoid these situations arising again. 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 16 People living at the home said that they have what they want for breakfast when they get up. One person said that they often went for a bacon sandwich at a local café. It seems that people have a relaxed lunch when they seem to help themselves to what they want, and when. The main evening meal is more structured and one person living in no. 15 is encouraged to come and socialise with the people living in no. 14. Other people prefer to eat their meals in their rooms. It is not clear how everyone living at the home would eat at the same time in the evening, as there is not enough room in either part of the home. Records do not show what peoples’ dietary preferences are. One staff member makes nice homemade cakes and the food being cooked by staff for dinner looked tasty and filling. The owner discussed problems they faced in relation to encouraging people to cook for themselves. He said that people’s attitude tended to be ‘why bother, when someone else will do it’. He also said that several people had enough money to buy takeaway food on a regular basis, and preferred to do this rather than help with cooking. We discussed why this may be, for example institutionalised behaviour learnt over a long period of time. The owner said they wanted to move back to a more enabling ethos at the home and this was one thing that needed to be addressed to enable people to become more independent. 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 17 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 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst there is evidence that people are supported to live their lives as they choose, the policies and procedures needed to underpin this are not evident. Medication procedures and practices have improved but more improvement is needed. EVIDENCE: Most of the records available were started by and maintained by the previous manager, but they have not been updated since the manager left. Records relating to the care that people living at the home receive are generally unclear and do not indicate good practice in mental health care. For example records stated ‘they have a relatively good rapport with staff depending on how much they have to tell him not to do something’ and ‘much less demanding’. This language is judgemental and shows no insight into the person’s thought processes or how staff can meet the person’s needs 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 18 effectively. There appears to be culture of ‘telling off’ using written warnings to threaten removal from the home with statements in the warnings such as ‘you tried to excuse your behaviour by saying you hadn’t seen your family for a year’. The owner was able to show that they were aware of triggers leading to behaviour that may be challenging, and the ‘ways’ of people at the home. However, it was clear from the records that not all staff are working in such an empathetic way. These threats do not reflect the home’s stated ethos of ‘acceptance’. There was little evidence of multi-disciplinary work to ensure the personal and healthcare needs of people living in the home were met. One reason appears to be the breakdown in communication between an ex member of staff and visiting professionals. However, comments received from social care professionals (via surveys) indicated that they hoped that in the future they would be able to work with the home in order to ensure people’s needs were met. Another professional commented (via surveys) that people receive appropriate medical support. There were some records showing that people had visited their GP and had received other medical help. However, once again this was rather vague and did not show any follow up. For example it appears that one individual suffers from occasional bouts of diarrhoea and sees their GP, but there is no follow up to look for causes or to ensure the person is not contagious. We found that although medicines were stored in a locked room, this was accessible to more than one person. The owner agreed to obtain a new lockable cabinet in which to store the medicines. We found that the system for administering medicines was unsafe, in that medicines for all people are prepared together and then distributed. The owner and the acting manager agreed to move to a safe system for administration of medicines by 4 April 2008. Also records for supply were not always made for people looking after their own medicines and for these people where their risk assessment stated that the medicine use should be monitored there was no information about how to do this available. We also found that one person was not always getting their medicine as prescribed as they did not always return by the time the waking staff went off duty. It was agreed that a risk assessment would be carried out for this person to have their medicine left for them in their room at night time and a monitoring process put in place. We were told by the owner and acting manager that they had found the policy and procedures were not suitable for the home and they had started a process involving the supplying pharmacist to review these. It was agreed that this would be completed by 31 May 2008. 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 22 and 23 Complaints are not dealt with appropriately and individuals are at risk of abuse as staff have not been properly trained to recognise abuse and know their duty to report poor practice. EVIDENCE: The complaints procedure remains the same as at the last visit. This means that although the complaints procedure contains all the necessary details and is displayed in the main hallway, there is no specific system for recording complaints, their investigation, outcomes and any actions to be taken. We have received one complaint since the last inspection and the complainant felt that the concerns they had raised had not taken seriously by the owner. The owner said that he now understood that he needed to be more careful when investigating complaints and needed to ensure all concerns and complaints were taken seriously and investigated thoroughly, whether or not they had been made formally and in writing. One individual said that they felt staff would sort out anything they may be worried about. Others indicated (via surveys) that they knew how to make a complaint. One relative indicated (via surveys) that they had made a complaint but had not received a satisfactory response. 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 20 We were also told by an individual that an ex member of staff ‘was a bully, he was’ and that several people had been scared of this person. There is a good POVA (Protection Of Vulnerable Adults) policy. However, one staff member had completed their entire induction (including POVA) on one day, which would seem to indicate that the topics are not read thoroughly. Staff have not received any formal training in POVA issues. One member of staff on duty during the visit had only been working at the home for two weeks and was not spoken with during the visit. Records indicated that their induction had been limited to being shown where things are. 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 21 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has a poor standard of décor throughout and does not ensure that individuals have a safe, homely and comfortable environment in which to live. EVIDENCE: The home in general needs refreshing and updating. The overall feel was somewhat depressing. This is concerning as some people at the home have a severe mental illness and current thinking suggests that people’s environment impacts on their state of mind and well being. Paintwork was chipped and bedroom furniture old, including mattresses, although the owner has recently purchased some new mattresses. Two rooms had been refurbished and painted in the choice of the occupant, and were 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 22 slightly better. Some areas of the home were very dark and other areas were being used as storage. The home although not dirty was generally shabby and dull. Thick stains from years of smoking in the home were left on the walls in the lounge and around pictures. The Home was dusty and there did not seem to be a regular cleaning programme. Showers had mould around the seals and left room for infection possibilities. Carpets were dirty, especially in bathrooms and around showers. Records indicated that there have been issues with some people urinating on carpets at times, but there is no regular programme for cleaning them. Other bathroom floorings were not well sealed and were cracked and old. The home does not employ a cleaner and cleaning of communal areas is delegated to staff on duty. There are only two staff on duty at any one time in the day and with the needs of people living at the home to meet there is little time for cleaning duties. People living at the home are expected to keep their own rooms clean and tidy. Staff have not received training in infection control procedures. The main kitchen area where meals are prepared was kept clean and has recently been refitted. However, the other kitchen was in need of total refurbishment, and the owner said that he would be doing this. The owner also agreed to start a redecoration programme for the communal areas of the home. Some building work had been undertaken without the involvement of the correct authorities. The owner was reminded of the need to seek approval from these authorities. 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 23 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): 32,34 and 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some people living at the home are unlikely to receive the support they need, as staff do not have the specialist skills and training they need to care for people who have mental health problems. Poor recruitment procedures put people at risk of abuse from staff who may be unsuitable to work with vulnerable adults. EVIDENCE: The staff duty rota indicates that there are at least two staff on duty at all times. On duty at the time of the inspection was a new staff member who was mainly alone on the floor. The other staff member was Mrs Phillips, who is registered as owner of the home with her husband. During the visit she was mainly engaged in administration and preparing wages for staff. She said that she 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 24 ‘sometimes does a bit of caring, I suppose, I do a bit of everything so I get muddled’. There did not seem to be a clear focus as to how people’s needs were met and during the day people living at the home were not seen to interact very much with staff but mainly wondered about ‘doing their own thing’. Generally, most of the interaction was focused around tasks, and not the needs of the individual. The staff have recently had excellent First Aid training and are now working through a mandatory training programme to include POVA (Protection of Vulnerable Adults). There is a high proportion of new staff at present and their induction is not up to the levels required by ‘Skills for Care’. This means that staff are not receiving training appropriate to the jobs they are expected to do. One induction indicated that the person had read all the policies and procedures for the home on one day. There was no record that their understanding of the documents had been tested. One member of staff commented (via survey forms) that they felt they did not receive training relevant to their role, and that they would like to receive NVQ (National Vocational Qualification) training. No staff are training for NVQ’s (National Vocational Qualifications), although one member of staff has already achieved NVQ level 2. Staff recruitment procedures remain poor. References for a recently employed member of staff had not been obtained by the owner, but had been supplied by the staff member and were addressed ‘to whom it may concern’. References must be obtained direct from the referee to ensure the reference is accurate and up to date. Some staff did not have references from their most recent employer. Criminal Records Bureau (CRB) checks were seen for all but one member of staff. This person had worked at the home for some time, but a check must still be obtained. 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 25 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 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are few measures in place to manage the health, safety and welfare of people living and working at the home. EVIDENCE: The registered manager has recently left the home and there is a new manager, who is not yet registered with CSCI. This person works 2 days a week at present but will increase these hours in the future. The owner said that they were well qualified and keen to make improvements. 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 26 One staff member said that they had glanced over the last report but didn’t really take it in. The previous report had identified many areas that need improvement but these had not been seriously addressed since the report was published. The owner is obviously caring and well informed about the people living at the home but this information is not recorded consistently. They said that they felt that if you treat the people living at the home well then there was less challenging behaviour. The owner has plans to introduce and encourage independent cooking and would like to move more towards rehabilitation. The owner has worked at the home a lot since the previous manager left and plays chess and Monopoly with some people, which they seem to enjoy. However, this type of time spent with people is on an ad-hoc basis and not clearly related to any individual’s identified well being goals. Recruitment procedures and lack of staff training do not ensure that people living at the home are protected from the risk of abuse (see Staffing). There is no formal Quality Assurance system in place, although some questionnaires have been sent to people living there. This means that there is no method by which the home can check, maintain or improve the quality of care provided by the home. The owner is looking to start regular meetings for people living at the home, which are not happening at the moment. Some aspects of the home suggested an institutionalised feel such as notes on toilet doors, bed changing lists and the poor environment. Practices in relation to fire procedures were haphazard, including recording of maintenance of equipment, staff training and fire alarm tests. A letter has been written to Devon and Somerset Fire Service asking them to look into these matters. There were limited risk assessments available, and there were none in relation to windows above ground floor level or hot surfaces. This means that people may be at risk of falling from windows or burns from the hot surfaces. There were various tools around the garden such as saws, spades and forks etc. There were no clear risk assessments to indicate that this was safe in relation to the mental health status of people living at the Home. 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 2 X 2 X 2 STAFFING Standard No Score 31 X 32 1 33 X 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000021830.V360554.R01.S.doc LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 2 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 14-15 St James Road Score 2 2 2 X 1 X 1 X X 1 X Version 5.2 Page 28 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13 (2) Requirement Arrangements must be made to ensure that all medicines are administered using a safe system and that they are given directly from the packs in which they are supplied. Arrangements must be made for the safe storage of medicines and access must be restricted to the person designated to administer the medicines. Arrangements must be made to provide medicines safely to those people who are not present at the normal medicine administration times. This timescale has been agreed with the provider. 2 YA20 13 (2) Arrangements must be made to have in place a policy for handling medicines in the home along with a system to monitor and review the procedures. As part of this arrangements must be made for the safe management of medicines that DS0000021830.V360554.R01.S.doc Timescale for action 04/04/08 31/05/08 14-15 St James Road Version 5.2 Page 29 people look after themselves. This timescale was agreed with the provider. 3. YA22 22 All complaints must be fully investigated and recorded following the services own complaints procedure. Records of complaints should be kept. The Commission must be supplied with a statement containing a summary of the complaints made during the twelve months preceding the date of the last inspection. This must include the action that was taken in response to the complaints. (previous timescale of 18/08/08 not met) To ensure the home provides a safe place for people to live and meets current building standards, building work and changes to the layout of the home should be agreed with Building Control Officers All parts of the home must be kept clean and reasonably decorated. All new staff must receive a full and structured induction to ‘Skills for Care’ standards. 31/05/08 4. YA22 22(8) 31/05/08 5. YA24 23 31/05/08 6. YA30 23 (2) 31/05/08 7. YA32 18 (1)(c)(i) 19 (1) schedule 2 31/05/08 8. YA34 Before a new member of staff is 31/05/08 employed the registered person must ensure they have received two current written references, including one from the applicants most recent employer. (previous requirement timescale of 03/08/07 not met) DS0000021830.V360554.R01.S.doc Version 5.2 Page 30 14-15 St James Road 9. YA35 18 (1)(c)(i) All staff must receive training appropriate to the work they perform, especially in relation to Protection of Vulnerable Adults, mental health issues, infection control, food hygiene and health and safety (previous requirement timescale of 12/12/06 not met) The home must be managed with sufficient care competence and skill. A formal quality assurance system should be established that will monitor the quality of care provided at the home. 31/05/08 10. YA37 10 (1) 31/05/08 11. YA39 24 31/05/08 12. YA42 12 (1)(a) The home must be conducted so 31/05/08 as to promote and make proper provision for the health and welfare of people living at the home, this relates in particular to uncovered radiators and unrestricted upper floor windows. 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. 2. Refer to Standard YA2 Good Practice Recommendations Thorough assessment and admission procedures should be in place before another referral is received. Care plans should reflect the needs of people and show how they are to be met, including how people are to develop independent living skills. Individuals should be supported to make decisions that DS0000021830.V360554.R01.S.doc Version 5.2 Page 31 YA6 3. YA7 14-15 St James Road affect their lives 4. YA9 To help ensure the safety and promote the independence of people living at the home. Risks to people’s personal safety and welfare should be assessed and where risks are identified strategies developed, recorded in care plans and action taken to minimise them. Risk assessment should be more detailed particularly regarding the risks to individuals from smoking in bedrooms and unrestricted upper-floor windows. The service should clearly establish how they will make sure everyone who moves to the home has opportunity for meaningful education and occupation. The service should clearly establish how they will improve links with the community in order to ensure people have good social contacts. The service should clearly establish how they will ensure people at the home have the opportunity to form meaningful relationships. The service should clearly establish how they will make sure everyone who moves to the home has the opportunity to benefit from flexible routines. People living at the home should receive the help and support they need from staff at the home. To ensure that people’s mental health is supported properly advice from mental health professionals should be incorporated in their care plans and followed by care staff. 5. YA12 6. YA13 7. YA15 8. YA16 9. 10. YA18 YA19 14-15 St James Road DS0000021830.V360554.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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