Inspection on 06/03/06 for 14 Phoenix Road

This inspection was carried out on 6th March 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

14 Phoenix Road 18/09/06

14 Phoenix Road 19/12/05

14 Phoenix Road 19/01/05

14 Phoenix Road 06/05/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 14 Phoenix Road 14 Phoenix Road Chatham KENT ME5 8RU Lead Inspector Sue McGrath Unannounced Inspection 6th March 2006 10:00 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 14 Phoenix Road Address 14 Phoenix Road Chatham KENT ME5 8RU 01634 863184 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 Della Marie Averley Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Three people with learning disabilities between 18 and 65 years of age. Date of last inspection 19th December 2005 Brief Description of the Service: 14 Phoenix Road offers accommodation, support and personal care to three adults under the age of sixty-five. The service provided is geared towards domesticity and promoting independence. There have been no admissions since 1995 when the current residents moved in. The registered provider who is in day-to-day charge of the home stated there is no planned intention to accept any future referrals. The property is a terraced house with accommodation set over 2 floors; there are 3 bedrooms and a bathroom upstairs, the downstairs consists of a staff office/sleep in room, a W.C. and 1 room that combines the kitchen and living space for the Service Users. There are small gardens to the front and rear of the property and there is limited parking on the road at the back of the home. The home is a smoking establishment with designated smoking in the lounge/diner. Phoenix Road is located in a residential area a few miles outside of Chatham town centre; it is close to local shops and other amenities and is on a bus route. 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection under the terms of the Care Standards Act 2000 and took place on the 6th March 2006 between 11.00 and 14.00. One inspector was in the home and the main focus of the inspection was on the resident’s health and welfare. During the inspection documentation and records were read, including care plans. A tour of the building was undertaken. One member of staff was in the home during the inspection and assisted the inspector throughout. The inspector did recognise this member of staff was very nervous and appreciated her openness and honesty. At the staff members request, feedback was given to the owner directly, the first convenient date was 10th March 2006. Due to issue raised during this inspection it was a very focussed inspection and limited standards were assessed. What the service does well: What has improved since the last inspection? What they could do better: Several requirements have been made regarding the meals offered, these include the need for menus to be submitted to the Commission and records kept of food actually taken. A requirement has also been made for a professional nutritional assessment to be carried out to ensure the menus offered are nutritional and suitable for the service users. Maintenance of the bedrooms needs to be improved and a programme of redecoration and maintenance throughout the building produced and implemented. The administration of medication needs to be revisited and the home’s written policy updated and then followed. Staff require accredited training in the safe administration of medications. 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 6 Staff also require training in Food Hygiene, Health and Safety and Adult Protection. Staff should receive training in learning disability and relevant mental health issues. Service users would benefit from a better-trained staff team if the Home had an allocated training budget, which took into account staff training needs identified in this report. Service users care plans should be held separately to ensure confidentiality. 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. 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not assessed on this occasion. 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Care plans will be assessed fully at the next inspection. 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 Service users nutritional needs may not be being met and they are being put at risk by poor food hygiene practices. EVIDENCE: When the inspector arrived at the home at 11am three uncovered plates of cold food were seen on the work surface in the kitchen. They consisted of two beef burgers, mashed potatoes and sweetcorn. When asked the member of staff said they were for the residents’ evening meal. On closer examination the mash potatoes contained several long hairs. The members of staff informed the inspector that she had not received any training in Food Hygiene. The registered person has a duty to prevent the contamination of food and must be able to evidence how this is done. Staff should be given instructions to tie their hair back when cooking food. This issue of reheating food also caused concern and was considered bad practise by the inspector. Good practice would mean that food should be cooked when it was needed. If it is the practice of the home to reheat food then they must be able to evidence that the food is piping hot when offered to the residents. To do this safely the food should be probed. No evidence could be found of a food probe in the home. 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 11 The food seen in the fridges and freezers consisted of budget ranges of mince, mince beef pies, burgers, drumsticks, one bag of frozen vegetables, one chicken, one bag of Yorkshire puddings and economy bread. The fridge was poorly stocked with only margarine, 5 eggs, one opened jar of opened chicken paste, a few value cheese slices, 5 carrots and two apples. The staff confirmed that the shopping was not due until 12th Month, another week away. Potatoes were seen to be green and sprouting. Only UHT milk was purchased. The seal on the fridge door was split and needs replacing. If the seal cannot be replaced then the complete fridge would need to be replaced. No records were maintained in respect to food provided and menu plans were not in place. From observation it was the view of the inspector that the home was unable to demonstrate that a well balanced varied diet was offered to the service uses. The home is requested to seek the advice of a nutritionist to ascertain that the food offered within the home is varied, well balanced nutritionally and is of good quality. The home further is required to evidence that service users are offered a choice of menus that meet their dietary needs and individual preferences and that records are kept of food eaten by service users. Special dietary requirements based on dietician/health care assessment should also be provided where a health need has been identified. Any restrictions with regard to access to food for health / behavioural reasons should be agreed within a multidisciplinary team including care management and noted within the service users care plan. During the feed back session with the proprietor the amount of money spent on food was discussed. Receipts were seen for the last month food shopping which totalled £103. A member of staff confirmed that approximately an extra £30 was spent during the month from petty cash. This meant that approximately £130 was spent a month on food for three adults. This equated to approximately £11 per week per service user. This figure appeared to be low to enable a nutritious, varied and balanced meal to be provided three times a day. 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20 Residents are at risk due to poor practices in medication administration. EVIDENCE: All of the Residents were registered with a local G.P. and were assisted to attend appointments made with specialists. Records could not confirm recent appointments with dentists or opticians. The service user at home on the day of the inspection wore glasses for reading and her records indicated that she had not seen an optician since August 2004. The registered person did state that she took herself to the optician. This service user also had lost her false teeth. Her last dental appointment was July 2005. Records confirmed that the last visit from a chiropodist was May 2004. The method of safe administration of medication needs to be re assessed by the home. Whilst the Commission does not want to stop service users who are capable of self-administration of their medication, the home must evidence their capabilities by means of a risk assessment. One of the risk assessments seen indicated that one of the clients would not be safe to self-administer because he would get confused, and states staff must ensure the medication is taken regularly. This client is given a weeks supply of medication at a time, in a Nomad box. The home’s written policy states that service users then sign on a weekly basis. This had not happened during the week of the inspection. Staff 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 13 stated that they give one service user his medication but no records could be found of any staff signatures or any Medication Administration Records. Medication was seen to be stored in a locked cash box in the services rooms. This storage facility fell short of meeting the current guidelines. It was noted that this issue had been raised in January 2005 at an earlier inspection. No records could be found of staff training in the safe administration of medication. The ordering of medication does not follow the guidance laid down by the Royal Pharmaceutical Society of Great Britain in that the manager/designated person must see the prescription to check against the items ordered. It is also the responsibility of the manager/designated person to sign the exemption on the back of the prescription. This is included in the homes medication policy but is not being followed. The home is strongly advised to obtain a copy of the guidelines for the safe administration of medication from the Royal Pharmaceutical Society of Great Britain. 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Service users are not fully protected from abuse, neglect and self-harm. EVIDENCE: The member of staff spoken to appeared to have little knowledge of Adult Protection procedures and was unsure as to whether there were any policies about it in the home. She did state that she had not received any training in this area. A requirement will be made to ensure all staff undertake Adult Protection training. 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users would benefit from improvements in their environment. EVIDENCE: One of the residents who was at home invited the inspector into her room. It was very small and had cobwebs hanging from the ceiling. The back of the wardrobe was hanging off and the door to the built in cupboard had a hole in it. The handle on the door was also broken and was hanging off. The curtain rail was broken, so no curtains were hanging at the window. The service user said it had been like it for some time. The second room viewed and the curtains were found hanging off the rail. As in the first room the handle to the cupboard was broken and hanging off. The room was very dusty. When the issue of damaged items of equipment and furniture in service users’ rooms was raised with the registered provider, she was of the view that sometimes service users did occasionally damage their rooms in a fit of temper and it was the policy of the home to repair the damage in due course. Cobwebs were seen hanging on the hallway. 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 16 The bathroom did not have any blinds and six bars of used soap were seen in the cabinet. This raises concerns that these were shared by the service users. Staff seemed unsure to whom they belonged. Although the kitchen had been refurbished, the living area was in need of redecoration and the planned programme of redecoration that was to have happened early this year had not materialised. 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Assessed as met at the last inspection. 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42.43 Lack of financial planning may be affecting the residents’ quality of life and quality of support given by staff. Residents and staff may be at risk, as recommendations from the fire officer have not been complied with. EVIDENCE: Records indicated that recommendations from the local Fire officer had not been complied with. These included that the domestic smoke alarms should be upgraded to a hardwire interlinked system and the kitchen door upgraded to a FD30S fire door. A number of staff training needs have been identified at this and previous inspections and the owner/manager expressed concerns about the homes ability to finance the training. A recommendation has therefore been made that the Home put in place a training budget that takes into account the training needs identified at this and previous inspections. 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 19 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 X 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 X 23 1 ENVIRONMENT Standard No Score 24 1 25 2 26 2 27 2 28 2 29 2 30 2 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 2 1 X X X X X X 2 2 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 YA35 Regulation 18(1) Requirement Timescale for action 24/04/06 2. YA42 18(1) 3 YA23 13(6) The registered person shall ensure that persons employed to work in the home receive training appropriate to the work they are to perform in that all staff should receive training in learning disability and relevant mental health issues. This requirement has been carried forward form the last inspection report. Action plan required 24/04/06 The registered person shall ensure that persons employed to work in the home receive training appropriate to the work they are to perform in that all staff shall receive training in basic food hygiene and health and safety. This requirement has been carried forward form the last inspection report. Action plan required The registered person shall make 24/04/06 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of abuse or harm. DS0000028850.V285401.R01.S.doc Version 5.1 14 Phoenix Road Page 21 4 YA17 Schedule 3(3)(m) 5 YA17 Schedule 4(13) 6 YA17 Schedule 4(13) 7 YA20 13(2) 8 YA20 18(1)(c) 9 YA24 23 Action plan required A record of the following matters in respect of each service user, (m) Details of any plan relating to the service user in respect of nutrition (menus). Copies to be sent to the Commission. Action by Records are kept of food provided for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation and otherwise, and of any special diets prepared for individual service users. Action by Records of food provided for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation and otherwise, and of any special diets prepared for individual service users in that the home is requested to seek the advice of a professional nutritionist to ascertain that the food offered within the home is varied, well balanced nutritionally and is of good quality. Action plan required. Medicines in the custody of the home are handled according to the requirements of the Medicines Act 1968 and the Guidelines from the Royal Pharmaceutical Society of Great Britain. Action plan required. Care staff to receive accredited trained in the safe administration of medication. Action plan required. The registered person shall DS0000028850.V285401.R01.S.doc 24/04/06 24/04/06 24/04/06 24/04/06 24/04/06 24/04/06 Page 22 14 Phoenix Road Version 5.1 10 YA23 13(6) ensure that the home implements a planned maintenance programme and renewal programme for the fabric and decoration of the premises with records kept. Action plan required. The registered provider shall ensure the adult protection and whistle blowing procedures include clear guidelines describing the action staff must take in the event of any concerns regarding possible abuse/ malpractice. The procedure must include consideration of referral to relevant outside agencies. Action plan required. 24/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations It is recommended that the home obtain a copy of the guidelines for safe administration of medication from the Royal Pharmaceutical Society of Great Britain. It is recommended that the broken handles on the bedroom cupboards are replaced. It is recommended that the curtain rails in the bedrooms be re-fitted. It is recommended that the Home put in place a training budget that takes into account the training needs identified at this and previous inspections. It is recommended that recommendations from the fire officer be complied with. 2 3 4 5 YA24 YA24 YA43 YA42 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 14 Phoenix Road DS0000028850.V285401.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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