Inspection on 06/06/06 for 199 Doseley Road

This inspection was carried out on 6th June 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 no outstanding requirements from the previous inspection report, but made 37 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

199 Doseley Road 25/04/07

199 Doseley Road 02/11/06

199 Doseley Road 27/07/06

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Doseley Road - New Era 199 Doseley Road Dawley Telford TF4 3BA Lead Inspector Rebecca Harrison KeyUnannounced Inspection 6th June 2006 10:00 Doseley Road - New Era DS0000066727.V296525.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 Doseley Road - New Era DS0000066727.V296525.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. Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Doseley Road - New Era Address 199 Doseley Road Dawley Telford TF4 3BA 0114 241 2100 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) www.dimensions-uk.org Dimensions (UK) Ltd Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None apply Date of last inspection 6th February 2006 (under the previous registered provider). Brief Description of the Service: 199 Doseley Road is registered with the Commission for Social Care Inspection (CSCI) to provide accommodation and personal care for a maximum of five adults with a learning disability. The property is purpose built and comprises 5 bedrooms, 2 bathrooms, 3 toilets, a fully fitted kitchen, a lounge, dining room and a sensory room. The home is situated close to the village of Dawley, which offers a range of facilities and amenities. Dimensions (UK) Ltd is the new service provider and was registered with CSCI on 3rd March 2006. The responsible individual is Ms Susan O’Loughlin and the manager is Ms Sarah Patten who is yet to apply for registration with CSCI. The manager was unaware of the current range of fees charged per person. Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was carried out by two inspectors and lasted 6.5 hours. It included talking with service users, the manager and members of staff on duty, case tracking two service users, observing work practices, looking at a number of records and a tour of the home. All 22 key National Minimum Standards for younger adults were assessed in addition to Standards 1,3,5,28,33,36,38,41 and a quality rating provided based on each outcome area for service users. These ratings are described as excellent/good/adequate or poor based on findings of the inspection. The service users, manager and staff on duty were welcoming and co-operated fully throughout the inspection. No complaints have been received by the home or the CSCI since the last inspection. One referral has been made under adult protection procedures since the change of provider and a meeting is scheduled. Adult Protection Joint Review Meetings relating to incidents prior to the change of provider continue to be ongoing in relation to the remainder of the service users living at the home. What the service does well: What has improved since the last inspection? What they could do better: A Statement of Purpose, Service User Guide and contract between the organisation and individual service users need to be developed and accessible to staff and service users/ relatives as soon as possible to ensure that Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 6 everyone is familiar with the philosophy of the service offered under the new registered provider. Support plans have yet to be developed under the new provider in addition to risk assessments. Staffing levels and the deployment of staff needs to be urgently reviewed to ensure the safety of service users and staff at all times. The home fails to create a pleasing, safe and pleasant environment for the people accommodated. The lack of investment coupled with the lack of maintenance and effective cleaning regimes, is placing service users at risk. The dietary needs of the people accommodated must be improved and closely monitored to ensure people are provided with a healthy balanced diet and health action plans developed. Record keeping systems need considerable improvement and relevant information transferred and updated onto the new providers documentation. A training needs assessment should be undertaken for the team and a training plan developed and all staff provided with training in safe working practices in addition to service specific training. Discussions held with staff indicate that morale needs to be improved. Staff referred to disputes between them and management and weaknesses in communication. 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. Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 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 Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 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): 1,3 and 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not have appropriate procedures in place that would enable the successful admission of a new service user to the home. EVIDENCE: A Statement of Purpose, Service User Guide and Contract between the organisation and individual service users remain outstanding. There have been no new service users admitted to the home under the new provider; therefore inspectors were unable to assess Standard 2 on this occasion. However there are ongoing Adult Protection meetings in relation to one person who appears inappropriately placed at the home. A letter seen on the service users file from a Health professional dated 15.05.06 stated that the person is ‘obviously inappropriately placed’. Although discussions held with the service user and staff evidence that a new placement has since been sought, introductory visits have yet to take place. Discussions held with the service user and staff indicate that the length of time waiting for the move is causing anxiety for the individual who has packed his belongings some time ago in preparation for the move. Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 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): 6,7 and 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The new provider has failed to develop and implement a clear care planning system to adequately provide staff with the information they need to satisfactorily meet service users needs. The home is failing to involve services users in decision-making processes and people at the home are not protected by the risk management strategies currently in place. EVIDENCE: The new provider has yet to develop support plans for the service users accommodated therefore staff continue to refer to the care documentation provided by the former registered provider. Two service users were case tracked and their care files reviewed. Each individual has been provided with a new file entitled ‘My Plan’ however these have yet to be developed. A Person Centred Plan (PCP) dated 03.08.05 was found on one file, which had been completed by the previous provider in addition to review documentation, Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 10 dated 25.05.05. Staff on duty reported that they no longer write comprehensive daily records instead they have been instructed to use a new file, which has been sectioned off for each individual. The example given for staff to write was ‘All support given as per support plan. All care given as per care plan’. This does not provide sufficient information for staff coming on shift or for staff to refer to at a later stage if required concerning individual service users. The two people case tracked are currently provided with five files to include a file for the last six months, a main file, “My Plan”, a daily file and a bank file. Due to the disorganisation and the numerous files currently in use for each individual the inspector had difficulty establishing what information staff should be working to. This potentially poses difficulties for new staff when supporting people that they are unfamiliar with. One file contained old risk assessments from the service users previous placement dated 2004, which are no longer appropriate. Individual reactive management plans were available on both files however for one individual it stated that ‘two trained staff are necessary for any physical hold’ however on arrival to the home a staff member was found lone working supporting two service users and discussions indicated that she was unsure as to whether she is able to use the training in physical intervention (TPI) techniques that she and staff have been trained in under the previous provider. Relatives and key workers advocate on behalf of the current service users accommodated. However it was very difficult to establish how service users are supported with decision-making processes given the disorganised records available. Risk assessments were seen on the files of the two people case tracked; however all but one of these had been undertaken by the previous provider and had not been reviewed or transferred onto new documentation. The one risk assessment undertaken by the new provider, dated 14.05.06 was for community activities and noise intolerance. However the risk assessment was inconsistent with the overview assessment completed by the local team in relation to staffing requirements and stated ‘refer to support and care plans and activity plan to show evidence of appropriate activity locations’. However these documents were not available. A risk assessment for travelling in a car completed by the previous provider stated that the person must sit in the rear of the vehicle and not behind the driver. However it was reported that all service users now travel in the front of vehicles but the risk assessment to support this has yet to be developed. Incident records evidence that there have been incidents resulting in injury to drivers since this new system has been introduced and staff spoken with were extremely concerned that such actions may result in an accident. They shared serious concerns for the safety of service users being transported and for their own personal safety. Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 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 at the home are provided with good opportunities to access the community however the new activity plans recently developed are unrealistic. Links with families are well established, routines are flexible and service users are able to exercise choice in relation to meals however there are serious concerns relating to how and if the special dietary and nutritional needs of service users are being met. EVIDENCE: On arrival at the home three people were out with two staff who were transporting one service user to a day service and they returned at 10.15 a.m. During the inspection another person was supported to have lunch out before going to work at the local hotel. A further person was supported to walk into Dawley for lunch. Inspectors were advised that new activity plans had recently been developed and implemented from 6.6.06. Although it was evident that staff welcomed Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 12 the opportunity to provide service users with more structured activities it was reported that the plans had not been developed with the key workers who are familiar with the interests of the service users. The activity plan for one service user case tracked was not available and the manager later reported that this had ‘gone missing’. The plan for the other person case tracked was incomplete and it was reported that he ‘likes doing his own thing’. An activity plan for a further individual was randomly selected by the inspector. Although the plan appeared well developed and provided excellent opportunities for community participation and in-house activities it was not realistic. For example the plan for 6.6.06 stated 9am-2pm Train to seaside, 2pm-3pm Pub, 3pm–4pm My Plan, 4pm-5pm Swimming, 5pm-6pm Reading, 6pm-7pm Ironing Support, 7pm-8pm Rest Period. There was no evidence available to support how the individual had been consulted regarding the activities and the plan did not take into account the need for staff to transport another service user to his day service arriving back at 10.15am. A review of other service user activity plans evidenced that consideration had not been given in relation to the staffing requirements to support the one service user who was to remain at home. Family links continue to be promoted and old daily records evidence that the relatives of service users regularly visit and some individuals go on home visits throughout the week and are provided with opportunities to develop friendships with people outside of the home. Individual mailboxes have recently been fitted in the reception area of the home for three service users and people are supported to read their mail as required. It was reported that all service users have been provided with a key to their bedroom door and one person currently chooses to use this facility. Service users’ responsibilities for housekeeping tasks were seen on the files reviewed and it was reported that people are now supported with undertaking laundry and ironing tasks. An overview assessment seen on one file provided comprehensive information as to the skills the individual possesses and his preferences. One service user smokes and during the inspection was observed to smoke outside the kitchen with the kitchen door left open. During a tour of the premises a large plastic bucket was found in the garden full of cigarette ends and rainwater and accessible to service users. Staff stated that formal menus are no longer used and that service users “have what they want and that peoples diet must not be restricted”. A meals and drinks monitoring form has recently been introduced which provides staff with a record of all drinks and food consumed including snacks. A review of the forms for one individual case tracked evidenced that in two days the snacks eaten included five ice creams, six packets of mini-cheddars and a bag of chocolates. It was also reported that on another day he had eaten nine ice creams. The overview assessment seen on file stated that the person is on a ‘healthy eating diet’. A protocol was also on file developed by the previous Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 13 provider for supporting him with a Weight Watchers diet. It was reported that the person has put on nearly one stone in weight in less than a month and one staff member stated, “His health is being neglected”. The other person case tracked was observed to help himself to a handful of ham out of the fridge and sat in the dining room without a plate eating it. He informed the inspector that he does not eat breakfast. He was not observed to eat anything else for the duration of the inspection. A protocol to support the individual using the kitchen was seen on file however observations made evidenced that this was not being followed. Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Systems to monitor the personal and healthcare needs of service users require further development to ensure their health needs are being met. EVIDENCE: As previously stated staff are working to support plans provided by the former registered provider. Records were found disorganised and health action plans have yet to be developed however the manager reported that these are being completed in conjunction with the local learning disability team. The personal appearance of one service user indicated that his hair was in need of washing and his daily records reviewed simply stated ‘All support given as per support plan. All care given as per care plan’. Therefore it was difficult to establish when his personal support needs were being attended to. The lack of health appointments recorded indicate that service users are not accessing the health appointments they require. For example the only appointment recorded on one file since 14.10.05 was for dental care. At the time of this inspection it appeared that medication was being administered, recorded and secured satisfactorily and staff have undertaken Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 15 relevant training. However, on the day of the inspection one service user had refused their morning medication but this had not been recorded on the medication administration record. On further scrutiny of medication administration records it was noted that this had happened on a further three occasions. Although a protocol is in place for when the individual refuses medication this must clearly be recorded as refused on the MAR records. The homes medication policy was not reviewed on this occasion. Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A complaints system is in place however procedures to safeguard service users from potential harm or abuse must be improved to fully protect people living at the home. EVIDENCE: No complaints have been received by the home or the Commission for Social Care Inspection (CSCI) since the last inspection. The last entry recorded in the homes complaint log was dated December 2004. The manager confirmed that there have been no complaints received under the new provider. The complaints log is currently located in the reception however the manager was advised to relocate this or provide a system that would maintain confidentiality as entries recorded contain sensitive information and details of the complainant. A complaints procedure was seen displayed however this was for the previous provider. A service user spoken with had an understanding of who to talk to if he was unhappy with the service provided. One referral has been made under adult protection procedures under the new registered provider and a meeting is scheduled, however this was not evidenced on a recent report provided to CSCI for May 2006, under Regulation 26. Adult Protection Joint Review Meetings continue to be ongoing in relation to the remainder of the service users living at the home. These referrals were made prior to the change of provider. During the inspection the service users who are reliant on the staff team for their personal safety were seen to demonstrate negative body language when they were in the presence of a Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 17 service user whose behaviours challenge the service. An incident occurred during the inspection, which potentially placed service users and staff at risk. Although it is positive to report that the number of incidents have decreased observations made clearly demonstrate that the person concerned very much ‘dominates the service’ and therefore service users do not appear relaxed in his company. This was also documented in an overview assessment on a service users file, which stated, “X does not appear to have taken well to the new tenant that does not allow X personal space and tried to ‘order’ him to do things”. The parents of existing service users have raised serious concerns regarding the welfare of their relatives. Such concerns have been shared at the ongoing Adult Protection Joint Review Meetings. Some staff informed inspectors that they had attended adult protection training on 23rd February 2006. The manager confirmed that the four remaining staff are booked to attend training in September 2006. The finances of the people case tracked were inspected and were an accurate reflection of the records held. All transactions are signed by two staff and receipts held however bank statements had not been reconciled since February 2006 for the two people case tracked which was acknowledged by the staff member who has responsibility for managing these. Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,28 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The standard of the environment is poor with little evidence of improvement through maintenance or future planning. The home does not therefore present a homely, safe and comfortable place to live or work. EVIDENCE: A full environmental tour of the home was undertaken by both inspectors during the afternoon. The home was found unclean throughout with an odour detected in a number of rooms including the lounge, which had no lightshades fitted, a bulb missing and the curtains needed rehanging. The carpet was heavily stained and was covered in food debris. The home is in poor state of repair and the gardens unkept and overgrown. Numerous pieces of gardening equipment were found left lying around the garden in addition to large pieces of wood and numerous slabs. The oven, extractor fan, kitchen worktops, floor and sink were found heavily stained with grease and dirt. The freezer is in urgent need of defrosting and neither a cleaning schedule or a record of fridge/freezer temperatures were available. Paper hand towels were not readily available and liquid soap was not available in the majority of areas including the laundry. There were no Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 19 waste management systems in place and a bag containing clinical waste was found on the doorstep awaiting collection. Service users are currently unable to access the conservatory due to the room containing boxes of files awaiting collection by the previous provider. The majority of the bedrooms were found untidy and unclean in addition to bathrooms and floorings. There was no toilet paper, hand towels or liquid soap available in both bathrooms. Reasons for such were provided however systems must be in place for purposes of infection control and to ensure people are not restricted from such basic needs. The bedclothes in one bedroom were heavily stained with urine and the quilt cover marked with faeces. A number of sinks in the bedrooms were without plugs. Dirty laundry was also left in bedrooms. A very badly damaged wheelchair was found in one bedroom. The manager stated that the person no longer requires this however inspectors requested that this be immediately removed from the room to safeguard the person concerned as it posed a safety hazard. A loose cable running across the doorway in one bedroom is a trip hazard and the taps in another bedroom were broken awaiting repair in addition to the wardrobe door. A number of overhead lights were also broken. A set of bedrails were found on the landing and the manager reported that these have been removed from a service users bed, without a risk assessment being undertaken. Soft furnishings in some rooms were worn. Inspectors identified a lack of procedures for the control of infection. It was reported that none of the staff have undertaken training relating to infection control. Some COSHH risk assessments had been undertaken in April 2006, however it was identified whilst in the laundry that at least three products did not have risk assessments completed for their use. In addition to this there were no manufacturers safety data sheets to accompany any of the products currently in use. The manager stated that these were being obtained by someone at head office. Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, & 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Recruitment procedures could not be inspected at this inspection, therefore a judgement could not be reached on this occasion. The home is not sufficiently staffed and potentially places services users at risk. The home’s performance in terms of staff training, supervision and appraisal is not satisfactory. EVIDENCE: An overall training and development plan for the service was not available. It was stated by the manager that this was in the process of being completed by someone whose name she could not recall at the head office. This is an outstanding requirement from the last inspection made under the previous provider. It was evident from examination of information relating to staff training that some staff have attended Dimensions own induction training in terms of organisational structure policies and procedures. One staff member who was due to attend induction training the day after the inspection reported that her training has been cancelled due to staff shortages and that the next programme for her to attend will be February 2007. Some training is being Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 21 provided; some staff informed inspectors that they had attended adult protection training on 23rd February 2006. The manager confirmed that the four remaining staff to attend this training are booked to attend in September 2006. Training certificates available were photocopied and in unmarked envelopes and handed to the inspector to view. The only training evidenced by certificate since the last inspection is disability awareness, completed by one member of staff. There was no evidence that staff receive equal opportunities training, including disability equality training. It was stated by some staff that they have received TPI training, although this was not evidenced by certificates. It was evident through observations made by inspectors that staff have a good understanding and knowledge of the service user group they work with and in particular during the inspection when a staff member was observed to deal with a potentially volatile situation in a calm and professional manner. Discussions held with staff indicate that morale needs to be improved. Staff referred to disputes between them and management and weaknesses in communication. Many certificates seen by the inspectors were out of date or had been copied twice. Out of the six envelopes given to the inspector only two contained food hygiene certificates, one of which was in need of updating. Four contained first aid certificates, once again not all were valid. During discussion with the manager regarding training she stated that health and safety, manual handling, and first aid were scheduled for June and July 2006. Staff have not received infection control training. In terms of NVQ training, this was not completed on the pre inspection questionnaire completed by the manager as part of the pre-inspection research. On discussion with the manager she was unable to confirm to the inspectors how many staff have completed NVQ training. One member of staff told the inspector they had completed level 2 and were working towards level 3. This was not evidenced in their training certificates shown to the inspectors. The duty rotas were examined for the month of May 2006. The requirement made at the last inspection for the duty rota to include full names, designation of staff and actual hours worked has been produced. For the period examined there were twelve shifts where staffing levels fell below accepted numbers, potentially placing service users and staff at risk. On the morning of the inspection upon arrival inspectors found one member of staff alone with two service users. Through discussion with the manager it was established that the home’s allocated hours are 360 per week; the home is running at 299 carrying 61 vacant hours. It was stated that one vacant waking night post has been recruited to but awaiting the CRB check to arrive. In addition to these vacant hours one member of staff is on long term sick. The manager stated that agency staff are used to cover when needed but despite this there were still times when staffing levels fell below the minimum. Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 22 Recruitment procedures could not reviewed at this inspection. Only skeleton information is held on site. It was stated by the manager that she has begun to undertake supervision with some staff members. This was confirmed through discussion with staff; however, records were not available to support this. The manager stated that there is no lockable filing cabinet on the premises for these to be stored and therefore they are currently being stored in a locked brief case at the managers home. Staff appraisals have not been taking place as per the standard. From discussion with the staff it appears that there has been one staff meeting held since Dimensions gained registration of the service in March 2006. Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 & 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not being managed effectively at present and failing to promote service users’ best interests. The results of working practices do not fully promote and safeguard the health, safety and welfare of service users or staff. EVIDENCE: The manager of the home was appointed by the new provider in March 2006. Through discussions held with her it was established that she does not have two years significant management/supervisory experience in a relevant care setting. Equally her experience with adults with a learning disability and behaviours that may challenge is limited. She informed inspectors that she has put her name forward for NVQ 4 management. She has completed Dimensions own induction training and is undertaking adult protection training in September. Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 24 Whilst her enthusiasm and drive are acknowledged it is apparent through observations made by inspectors and examination of a number of care records that her lack of management experience has an impact on the outcomes for service users and staff. There is no annual development plan in place for the home. Given that there are a number of shortfalls within the environment, which inspectors identified, a plan must be drawn up to address these and other areas relating to the development of the service as a matter of priority. As previously stated, it was apparent through observations made by inspectors and discussion held with the staff team that staff morale is low. Inappropriate directives from the manager recorded in the communication book were discussed with the manager at the inspection. Inspectors observed a situation where apparent lack of communication by the manager resulted in service users and staff members being placed at risk. Currently there is no quality assurance system in place. Staff have not had the opportunity to meet as a group and service users and or family/representatives views are not sought as part of the review of the service to measure whether the service is meeting its stated aims and objectives. A report of a visit undertaken by the organisation on 30.05.06, as required under Regulation 26, clearly identified environmental issues within the home, the general disorganisation of the homes record keeping systems and accessibility. A Management Audit Report from an audit undertaken on 12.05.06 by the manager and Area Manager was forwarded to CSCI and identified a number of shortfalls to include the lack of person centred plans, the poor state of repair of the home, furnishings and training issues. Records required by regulation in relation to service maintenance of equipment and appliances are maintained and kept up to date and accurate, with the exception of fridge and freezer temperatures, which could not be located on the day of the inspection. The last environmental health officers visit took place in January 2005. One requirement was made in relation to the testing of hot food temperatures. No records relating to this requirement were seen on the day of the inspection. During the inspection there were a number of shortfalls in health and safety, which were identified with the manager at the time of the inspection and are detailed as requirements in this report. As previously stated some COSHH risk assessments had been undertaken in April 2006, however there were no manufacturers safety data sheets to accompany any of the products currently in use. Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 25 There were a number of incidents observed at the inspection or noted from incident records that were not being appropriately addressed. These included issues of health and safety relating to both service users and staff. In some instances lack of appropriate risk assessments placed service users and staff at risk. Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 x 3 1 4 x 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 x 26 x 27 x 28 1 29 x 30 1 STAFFING Standard No Score 31 x 32 3 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 x 1 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 2 15 3 16 3 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 1 2 2 x 1 1 x Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A under the new provider. 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 2 Standard YA1 YA1 Regulation 4 Schedule 1 5 Requirement Timescale for action 17/07/06 3 YA3 14 4 YA5 5(c ) The registered person must develop a Statement of Purpose for the home. The registered person must 17/07/06 develop a Service User Guide and provide each service user with a copy. The registered person must 07/07/06 demonstrate the homes capacity to meet the assessed needs of the people accommodated. The registered person must 17/07/06 develop and agree with each service user and their representative a written contract/statement of terms and conditions between the home and the each individual to include all items specified in NMS 5.2 and each service user be provided with a signed copy. Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 28 5 YA6 15(1)17(1) 6 YA7 7 YA9 8 9 YA14 YA17 10 YA17 11 YA17 The registered person must ensure that there is an individual plan for each service user, (drawn up with the service user/representative and relevant agencies) which sets out how the needs of the individual are to be addressed by the home and provides effective individualised procedures for staff to follow. 12(3) The registered person must provide service users with the information, assistance and communication support they need to make decisions about their lives and clearly demonstrate how choices have been made. 13(4)(b) Service users must be enabled to take responsible risks within a risk assessed framework, which is a comprehensively recorded and regularly reviewed and updated. Action must be taken to minimise risks and hazards. 16(2)(m)(n) Activity plans must be drawn up with the service user wherever possible and be realistic. 16(2)(i)(h) The registered person must promote service users health and wellbeing by ensuring the supply of nutritious, varied and balanced meals. Schedule 4 Service users must be offered a (13) choice of suitable menus, which meet their dietary and cultural needs, and which respect their individual preferences. 17 Service users nutritional needs Schedule 3 must be assessed and regularly (m), reviewed including risk factors. Schedule 4 (13) 07/07/06 17/07/06 07/07/06 17/07/06 07/07/06 07/07/06 17/07/06 Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 29 12 YA18 12(1)(b) The registered person must ensure that service users’ preferences with regard to their care are identified and respected and any aids and adaptations required are maintained in safe working order. Service users health must be monitored through annual health checks and outcomes recorded. Staff must record on MAR charts when service users refuse medication. The complaints procedure for the new provider must be available and a copy provided to each service user/their representative. All service users must be safeguarded from potential harm/abuse. The homes premises must be safe and well maintained; meet service users individual and collective needs in a comfortable and homely way. A planned programme of maintenance and renewal for the fabric and redecoration of the premises must be developed and records kept. A range of comfortable, safe and fully accessible shared spaces must be provided for service users in addition to adequate facilities for staff to store personal belongings and appropriate sleeping facilities. 07/07/06 13 YA19 12 13(1)(b) 13(2) 22 07/07/06 14 15 YA20 YA22 01/07/06 07/07/06 16 17 YA23 YA24 13(6) 13(4) 23(2) 01/07/06 07/07/06 18 YA24 23 17/07/06 19 YA28 13(4) 23(2)(b)(3) 17/07/06 Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 30 20 YA30 13(3)(4) 16(2)(j)(k) 21 YA30 13(3) 16(2)(j) 22 23 24 YA30 YA30 YA33 13(3) 13(3) 18(1)(a) 25 26 YA34 YA35 19 Schedule 2 18(1)(c ) 27 28 29 30 YA35 YA35 YA36 YA37 18(1)(c) 18(1) (c) 18(1) (c) 8,9 The premises must be kept clean, hygienic and free from offensive odours throughout and systems must be put in place to control the spread of infection. Policies and procedures for the control of infection to include the safe handling and disposal of clinical waste; dealing with spillages; provision of protective clothing and hand washing must be available and adhered to. Waste management systems and cleaning schedules must be developed and implemented. Risk assessments and data sheets must be available for all COSHH products used. The home must have an effective staff team with sufficient numbers to support service users’ assessed needs at all times and kept under review. Personnel records must be available for inspection. A training needs assessment must be carried out for the whole team and a staff training and development plan developed. Staff must receive induction and equal opportunity training. Each staff member must have an individual training and development assessment. Staff must receive an annual appraisal and formal supervision 6 times per year. An application to register an experienced and skilled manager must be submitted to CSCI. 07/07/06 07/07/06 07/07/06 07/07/06 07/07/06 17/07/06 01/08/06 01/08/06 01/08/06 01/09/06 31/07/06 Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 31 31 YA38 12(5) 32 YA39 24 33 31 YA39 YA41 24 17 32 YA42 13 (6) 23 (4) (d) 33 YA42 13(4)(a) 23 34 YA42 12,13 The management approach of the home must create an open, positive and inclusive atmosphere with a clear sense of direction and leadership. An effective quality assurance system must be developed in addition to seeking the views of service users/relatives and significant others and results published. An annual development plan for the home must be developed. The registered person must ensure that all records required by regulation are well maintained, up to date, accurate, accessible to staff and available for inspection. All staff must receive mandatory training relating to safe working practices and these be updated at the required frequency. The registered person must ensure that all parts of the premises that service users have access to is wellmaintained and safe. Risk assessments must be carried out for all safe working practices and staff made familiar with these. 07/07/06 01/09/06 01/09/06 07/07/06 01/08/06 07/07/06 07/07/06 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 YA6 Good Practice Recommendations It is recommended that person centred plans be developed and implemented as soon as possible. Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Doseley Road - New Era DS0000066727.V296525.R01.S.doc Version 5.2 Page 33 - 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. 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