Inspection on 23/01/08 for Marula House (Varley Road)

This inspection was carried out on 23rd January 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Marula House (Varley Road) 25/09/07

Marula House (Varley Road) 03/04/06

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Marula House (Varley Road) 124 Varley Road Custom House London E16 3NS Lead Inspector Nurcan Culleton Unannounced Inspection 23rd and 30 January 2008 10:00 th Marula House (Varley Road) DS0000065451.V357203.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 Marula House (Varley Road) DS0000065451.V357203.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. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marula House (Varley Road) Address 124 Varley Road Custom House London E16 3NS 020 7473 3818 TBA 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) Marula House Ltd Cleto Mapfumo Care Home 2 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (2) of places Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Male whose primary care needs on admission to the home are within the following categories: 2. Mental disorder, excluding disability or dementia - Code MD The maximum number of service users who can be accommodated is: 2 25th September 2007 Date of last inspection Brief Description of the Service: Marula House is a two-bedded care home offering twenty-four hour individual care and support for men with mental health support needs. The home additionally caters for men who have an accompanying learning disability. The home is owned and managed by a private individual who owns a similar home in the Manor Park area. The home was registered on 16th November 2005. Residents have the opportunity to live an independent lifestyle within a supportive environment. The premises is a terraced property, which blends easily into the neighbourhood and presents as a family home. There is a communal lounge with satellite television and a garden with a small patio area and garden furniture. All bedrooms are located upstairs. The home does not have a passenger lift; therefore it is unsuitable for service users with mobility needs. Marula House is off the A13 road and unrestricted street parking is available. Local amenities include a parade of local shops in Prince Regent Lane. The Custom House and Prince Regent Stations are within walking distance. Buses are also available from Prince Regent Lane. The homes’ fees currently range from £800 per week to £1,500 per week depending on assessed individual needs. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 5 Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The initial visit to conduct this unannounced inspection took place on 23rd January 2008. The inspection however had to be halted in mid progress and rearranged due to the circumstances surrounding a resident at the time of the inspection. The inspection then resumed with a second inspector accompanying the lead inspector on 30th January 2008. The Deputy Manager assisted throughout the inspection day and the Registered Manager was present at the beginning of the second day’s inspection. Both service users were in the house at various times over course of the inspection. As most of the standards were assessed at the last inspection, the inspectors focussed this inspection on what actions have been taken in response to meet previously made requirements and recommendations including checking for any improvements. The inspectors examined the home’s records and documents related to the requirements and recommendations, including both residents’ files, five staff files, complaints logs, minutes of staff and residents meetings and health and safety records. The inspectors also toured the home to inspect the living environment including the bedroom of one of the residents, whom the inspectors also spoke with. The inspectors took into account the homes’ Annual Quality Assurance Assessment (AQUAA) in assessing the overall view of the service. What the service does well: What has improved since the last inspection? Some improvements have been made since the last inspection demonstrating that the home is moving in the right direction in terms of improving standards in the home. Previous requirements met are as follows: One to one sessions with the residents are now occurring weekly. The home is now using a new and improved care plan format for residents and their care plans have been updated. Residents’ needs have been more thoughtfully considered in developing these care plans. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 7 A new Contingency Care Plan has also been introduced identifying usual patterns of behaviour, early warning signs and crisis behaviour and actions. All staff have received medication administration training, to be more informed about safe administration practises. A new monthly key worker checklist in is now in place, including whether care plans and medication charts have been completed and whether key working sessions have taken place. Complaints are now recorded with their outcomes in a complaints book, demonstrating that the home has a more open and positive approach to responding to people’s complaints. Staff now receive more regular supervision and their training records are more complete, providing more information about the level of staff support and the knowledge and skills developed by staff through training. Residents’ records are better maintained in their files. What they could do better: The service needs to be more thorough in how it identifies peoples’ needs and how it responds to meeting those needs to ensure that the welfare and best interests of people using the service are promoted and achieved. The Registered Manager must be more robust in ensuring that existing or improved policies and procedures are implemented and to rethink its service delivery to be certain that the service provides them with satisfactory outcomes. Particular areas highlighted where standards have not been achieved include peoples’ care plans. These still require improvement to ensure that key needs presented by people and actions in response are fully identified. Peoples’ risk assessments still do not comprehensively identify key risks to their own and other peoples’ safety and welfare. There are significant concerns as regards the safety of medication administration practises in the home. The service is unable to demonstrate that people are fully supported to engage in their daily living activities and to access appropriate community and leisure opportunities. The home must further demonstrate that it fully promotes healthy eating for all people using the service and that health and safety practises are consistently observed when storing food. There are significant shortfalls in staff recruitment which needs to be more robust to ensure that only suitable staff are employed to safeguard and support residents. The service needs to demonstrate that peoples’ cultural needs are being met in the home. The Statement of Purpose and Service Users Guide are not ‘user friendly’ and need to be produced in a format more suitable for people with learning disabilities. Timescales have not been achieved in meeting some previous requirements resulting in restated requirements and is viewed seriously by the Commission. The management of the service needs to have firm leadership, skills and direction to effect the changes required in order to meet best practise and minimum standards and to ensure that the safety, welfare and best interests of people using the service remains a priority. The Registered Manager has indicated a commitment to ensuring that these standards are achieved. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 8 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. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 9 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 Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents have access to information about the service. However the Service Users’ Guide is not in a format that is easily accessible to them and may not accurately reflect the conditions of placement. One to one sessions occur frequently providing more opportunities for staff to engage with residents and to be more in tune with their needs. EVIDENCE: Prospective users and people using the service have access to information about the home through the Statement of Purpose and Service Users’ Guide. However these were not available at the last inspection as the inspector was informed that they were in the process of being updated. The Statement of Purpose and Service Users Guide were examined at this inspection. These were considered not to be very user friendly or accessible to people with a learning disability. Additionally, inconsistencies were found between daily practises and what is written in the Service Users Guide. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 11 Whilst the Service Users Guide says that visitors can be received till 11am, the Deputy Manager informed that visitors can be received only until 10am and that staff must be informed in advance when visitors are coming in, though a satisfactory reason for the need to have an advance warning of visitors to staff was not offered at the time of inspection. At the previous inspection, it was identified that the frequency of one to one sessions with residents could not be evidenced as according to the homes’ policies and procedures. At this inspection records were available showing that one to one sessions are occurring weekly, though it is recommended that it is also recorded if people refuse to engage in a session. At the last inspection it was noted that individuals’ cultural or religious needs were being met through their links with their individually chosen churches or social and community groups. As one person however has chosen to be more confined in the house during the winter rather than to engage in their usual activities outside, inspectors questioned whether the persons’ individual and cultural needs are being appropriately addressed and supported in the home. Issues related to this are further raised in the ‘Lifestyle’ and ‘Staffing’ sections of this report. Standards 4 and 5 were examined at the last inspection. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Residents care plans have improved in their design and are more detailed. However they still do not fully identify residents’ needs or actions required to address their needs. Risk assessments have also improved however they too remain inadequate and require further development. EVIDENCE: This inspection followed up any progress made to address the requirement to improve residents’ care plans, as given at the last inspection. Improvements were required to: 1. Ensure residents have adequate care plans which clearly identify their needs. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 13 2. Ensure action plans are clearly identified in residents’ care plans in response to meeting their needs. 3. Ensure all care plans are signed and dated by its author, and where appropriate, by the resident. Both residents’ care plans were examined. These care plans have been updated on 4th January 2008. The home is now using a new and improved care plan format including the clients’ aspirations (though these were left blank on the care plans seen); aims of the plan; short and long term goals; evaluation (also blank); action, by whom, and review. The Deputy Manager and residents had each signed these forms. The care plan contents have also improved compared with the care plans seen at the last inspection with an improvement in how residents’ needs are linked to associated actions. The care plans are now also signed by the residents and author and dated. Further improvement can be seen in the introduction of a new Contingency Care plan used alongside the existing care plans. These identify the person’s usual pattern of behaviour, early warning signs and crisis behaviour, aimed at preventing undesirable behaviours from escalating; giving the description of the behaviour and intervention. This is positive action taken by the home by embarking on a more proactive approach in addressing how to support the people using the service. However, whilst improvements had been made, the care plans still lack sufficient information as they do not fully reflect residents’ presenting needs. This then corresponds to a lack of information about how the home responds to address those needs, including whether other agencies are or need to be involved and the type of intervention in place. Several examples of this became evident throughout the day whilst in discussion with the Deputy Manager about the needs of each resident and how the home responds to these. An example could be seen as regards a particular issue regarding food as identified in one person’s care plan. The associated action was recorded solely as a referral to be made to a dietician. When the Deputy Manager was probed as to whether a referral had been made to the dietician, the inspectors were informed it had not been made for a range of stated reasons, resulting in the resident’s resistance to and avoidance of keeping health appointments. The Deputy Manager informed that the aim was for the person to discuss these psychological issues with a therapist. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 14 However the person’s Care Plan had not identified these additional needs, nor any related actions other than the ultimate aim of the need to make a referral to a dietician. The inspectors identified several further examples of the gap between the needs presented by residents and what is identified as needs in their care plans. A missing person’s form seen stated that one of the residents was physically aggressive, however his care plan made reference only to a mental heath issue and a learning disability. The person’s risk assessment identified the risk of harm to others, however this too was inadequate, not adequately specifying actions required by staff in the event of any display of aggression, as referred to below regarding risk assessments. Another shortfall area the home needs to consider is how other assessments may make a reference to further information about an issue being expanded in people’s Care Plans, however when referring to the care plans, the information is not available. One persons’ risk assessment, for example, identifies an issue as regards sexual behaviour linking it to the person’s Care Plan. However the care plan did not identify the issue in any way and did not refer to any other guidance about it. It was noted in particular that the level of independence of residents or areas where they require support from staff in their daily living skills had not been identified. Further improvement is therefore necessary to ensure that care plans are adequate for their intended purpose and that they fully identify residents’ needs and actions are identified to address them. This requirement will be restated at this inspection. Encouragingly, the Deputy Manager informed that he has approached an Occupational Therapist to assist in developing a Person-Centred Care Plan for one resident and also that the social worker of the other resident has made arrangements for that resident to have a Person-Centred Care Plan as well. An unmet requirement regarding risk assessments had been made twice following the previous two inspections. Reviewed at this inspection was the requirement that all residents must have appropriate and comprehensive risk assessments in place, which are reviewed and updated as appropriate. Risk assessments seen at the last inspection were incomplete and gave the background to the risk behaviour only. Risk assessments seen at this inspection were updated on 4th December 2007. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 15 One residents’ risk assessment noted the risk of harm to others through verbal and physical aggression. The circumstance where the risk could occur had been noted, and warning signs identified. However the management strategies identified key working sessions, one to one sessions and hospital admission if necessary as actions in response. The level of risk had still not been identified, as required in the previous report, neither was it made explicit as to what specific actions staff should take in the event of any aggressive behaviour displayed by the resident. Additionally, on the first day of inspection, the inspector witnessed the Deputy Manager and one resident about to go to the local shop to purchase items for lunch, leaving the other resident in the home alone, other than with the inspectors’ presence during inspection. The Deputy Manager informed that the person was independent in his movements in and out of the house. However there was no risk assessment identifying that the resident was capable of being left unsupervised in the home. The inspector also noted that this resident had a health issue which could also affect any such risk assessment. A recommendation is given related to Standard 7 as regards the need to evidence consultation with the residents. Please refer to Standard 24 in Environment for further details about this. Standards 8 and 10 were examined at the previous inspection and were deemed to be satisfactory. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 16 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): 11, 12, 13, 14, 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People in the home engage in some activities in the home and in the local community. However it is unclear whether individuals are sufficiently encouraged, enabled and supported to undertake activities reflecting their needs or interests either inside or outside of the home. There is a lack of sufficient evidence that the home promotes healthy eating for all residents. EVIDENCE: The inspectors examined a previous requirement to ensure residents’ activities are accurately recorded and updated following any changes. One of the residents maintains activities outside of the home and his activities chart had been updated on 3rd January 2008. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 17 The other residents’ weekly activity chart in their file showed a full programme of activities and had not been updated as this no longer reflects this residents’ week. The inspectors were informed that this resident chose no longer to engage in these activities for reasons given at the inspection. These reasons however had not been documented. Additionally, an alternative programme of indoor activities or further needs associated with devising activities had not been produced in the residents’ file. Without a recorded plan it was therefore difficult for the home to evidence what the home is doing to meet this residents’ needs or what support plan is in place to address these issues. The requirement for residents’ activities charts to be updated is therefore restated. It was recommended at the last inspection that residents are further encouraged to eat more varied, nutritious and balanced meals, given their high consumption of convenience and high fat foods. Residents’ meals were examined at this inspection. Whilst the book recording foods which the residents had eaten showed that residents still eat lots of processed and fatty foods, evidence was seen that some progress has been made. In a residents’ meeting on 15th January 2008, the minutes state that staff should monitor residents when they are preparing meals to ensure healthy eating. One residents’ care plan identifies a need around food and for healthy eating to be promoted with him. This issue is also discussed in the records of a one to one session with the resident, showing that advice had been given that vegetables should be included in meals and that eating fruit once daily was promoted. However there is insufficient evidence that healthy eating is actively promoted or discussed with the other resident in the home despite an issue about food being identified in this residents’ care plan also. Records seen showed that the residents’ meals included a mixture of healthy and processed foods such as pies, sweets and take-away foods. The kitchen cupboards and fridge/freezer showed adequate food supplies however they were mostly tinned, frozen convenience and economy foods and few fresh foods were available. The fridge when checked showed a sandwich filler which had been opened but was not labelled. The packet also stated that it should be used within two days from opening, however it was not known when the packet had been opened. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 18 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): 19, 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home involves and consults with health and local authority professionals regarding individuals’ needs. However people in the home cannot be certain that their health care needs will be appropriately addressed due to poor medication administration practises. The recording of medication administration must also be improved to safeguard residents. EVIDENCE: All staff have now received training in medication by a trainer who is a registered nurse and has appropriate undergone training to give the course. This meets a previously made requirement at the last inspection. However, the inspectors identified a number of issues of concern regarding medication. Peoples’ files show there is evidence of involvement with other health and social services professionals including their reviews and that the quality service surveys completed by professionals expressed positive statements about their working relationship with the home. One person is currently having increased Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 19 involvement including visits and reviews by the local authority as regards his placement needs and the suitability of the placement. According to the Deputy Manager the home is also consulting with an Occupational Therapist for their knowledge and experience in helping the home to develop person-centred care plans, though evidence of this discussion or plan of action remains to be seen. There is however serious concerns about the homes’ medication administration to one person who is regularly being administered an over-the-counter medicine for an apparent cough without authority by way of a prescription by a GP that this medication is required at all and needed on an ongoing basis. Records of administration for this cough medicine dated back until November last year. The inspectors were informed that this medication was requested by the resident each time. The resident had been seen by the GP who following tests decided that there was no need for medication, though a ‘homely’ remedy was recommended to be administered when needed. Possible reasons for the residents’ request for this medicine was explored during the inspection. It was conveyed that no medicine should be administered to a resident on a regular and ongoing basis without being prescribed by a doctor. The home must ensure there further guidance is developed on the use of homely remedies to treat minor ailments is normally limited to 48 hours. Additionally, two different types of cough syrup were being administered with no instructions to staff as to which syrup should be given. The home must also revise the medication policy to include in its guidance in the need to know the in-use shelf life and expiry of all medicines in liquid form. Secondly, a blister pack seen indicated that the medication taken by a resident on the morning of the inspection had not been signed for by the staff member who had administered it. Thirdly, instructions were provided to staff to give one or two tablets of Paracetamol when needed without further guidance as to when one or two tablets should be given. This provides further evidence that the home must develop a more robust policy and procedure on the administration of homely remedies. Progress reports and case file records showed that residents have access to a range of health care appointments, including the GP, dentist and optician, though some residents sometimes failed to keep their appointments. Care Programme Approach reviews are attended by psychologists, psychiatrists, community nurses and social workers. Contact is maintained with the Learning Disability Partnership in the borough. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 20 However the residents’ care plans and recording procedures were poor in identifying the home’s response to meeting identified health needs. This was referred to in the last report and is highlighted again in Standard 6 of this report. Additionally, following new legislation, the home is now required to have in place an appropriate cabinet for the storage of Controlled Drugs regardless of whether controlled drugs are being administered to persons in the home at the time of inspection. A new requirement is given to ensure that a cabinet is available. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The recording of complaints has improved and the home is moving towards taking complaints and responding to them more positively and seriously, though further improvements can be made to the recording format of complaints in order to demonstrate the outcome of complaints and how they are resolved. EVIDENCE: One previous requirement and recommendation were reviewed. The home is responsible for only one person’s finances whose accounts were checked on the day of inspection and were accurately recorded, meeting the requirement about this. A recommendation had been given for all complaints and their outcomes to be recorded in the complaints book, including evidence that the outcome of the complaint has been communicated to the resident. Since the previous inspection, CSCI received several complaints about the service from a family member of one of the residents. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 22 These were referred, investigated and responded to by the home as part of their complaints procedure. Four complaints had been recorded in a complaints book since the last inspection. The records detailed the complaints and a summary of the actions taken. This is an improvement from the previous inspection where complaints were not being routinely recorded. It is however recommended that the format of the complaints recording is improved further in terms of the outcome to complaints, including whether the complaint is substantiated or not. As observed at the last inspection, since the home did not keep a record of all complaints and their outcomes, the home now appears to have taken a more positive approach to dealing with complaints. However it remains for the home to demonstrate that complaints will be consistently and robustly dealt with on an ongoing basis. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24-30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home offers a comfortable, domestic type environment providing suitable accommodation to meet residents’ needs. EVIDENCE: Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 24 One resident allowed the inspectors to view his bedroom. The room was personalised, clean, well furnished and decorated with the residents’ own personal effects and reflecting his individual taste, including a music system and CDs. All residents have single rooms. The communal lounge is comfortable and suitable for shared activities. Satellite television, video, music entertainment system, board games, books and newspapers are available for the residents. The modern fitted kitchen incorporates a dining area and doors lead out to the garden. The washing machine is for domestic use and is located in the kitchen. Separate laundry facilities are not provided. The garden has a patio section and a lawn with garden furniture. A recommendation was given at the last inspection for the home to have more pictures or adornments in the lounge and in the hallway to contribute further to the homely atmosphere. There was no change in the hallway or lounge since the last inspection as there were no new pictures or adornments on the walls. The Deputy Manager stated that residents preferred not to have any more pictures on the walls, however this consultation or these expressed views had not been recorded anywhere. It is recommended, under Standard 7, that the outcome of consultation with residents is recorded when seeking their views about any decisions or matters affecting the home. This home is unsuitable for prospective service users with mobility needs, as all bedrooms are on the first floor and a passenger lift is not available Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 25 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): 32-36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home’s improved records demonstrate that staff receive more supervision and training enabling them to be better informed and supported. However there are significant shortfalls in the staff recruitment process which needs to be tightened and more robust throughout to ensure that only suitable staff are employed to safeguard and support residents. EVIDENCE: Previous requirements related to staffing were examined. These were that two satisfactory references must be obtained for each staff member, all staff to be appropriately supervised, the home to maintain a comprehensive record of all training undertaken by all staff and all staff to have first aid training. It was also recommended for all staff to have annual appraisals. Five staff files were examined. Two references were available, however references seen completed by the referee did not state the person’s position and it was therefore not known in which capacity the referee knew the staff member. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 26 It was noted that the design of the reference request forms did not allow for this. The Manager must ensure that there is full and satisfactory information received in staff references, in particular to state in what capacity the referee knows the applicant and whether the reference, based on the referees’ knowledge of that person, is personal or professional. A compliment slip or company stamp is also recommended to authenticate a reference from a previous employer. Records of one staff member did not confirm that their induction had been completed. An application form for the same staff member showed gaps in their employment history without a satisfactory explanation and which had not been explored during their interview or recruitment process. All other documents required for recruitment purposes were available in staff files, including CRB forms. However in checking one staff members’ CRB, it was evident that they had started work on 18th December 2007, however their CRB was not received until 3rd January 2008. When queried, the Deputy Manager said that they had contacted the umbrella body who confirmed that the POVA check had been done, but there was no evidence to that effect. Duty rosters checked showed that this staff member was working unsupervised prior to the full CRB having been received. It is a requirement that no staff member should be employed without evidence of a POVA check on their file. Additionally staff must not work unsupervised without receipt of a full CRB check. It was also noted that the Deputy Manager did not have a current visa in his staff file. Duty rosters were available only available from 26th December 2007. It was explained that the previous rosters had taken away for payroll purposes. It is a recommended rosters for the previous inspection year are made available for inspection and that copies of rosters are taken if the originals are removed. Records seen showed that staff are now receiving supervision as required. Staff have now also undertaken a first aid course in a local college. Staff training records have improved, in that training undertaken by staff has been identified and it is evident that staff have received a range of training relevant to the roles and responsibilities, including a range of Health and Safety courses, POVA, Disability Awareness and Equal Opportunities training. However the inspectors expressed concern at one staff members’ course completed certificate on 11th January 2008 provided by an external training agency which covered a very large range of subjects, all thought to be considered as training courses in their own right. It was therefore queried as to how much a person can learn in one day and was thought to be quite inadequate. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 27 The latest staff meeting was on 30th January 2008 and in the staff minutes of the meeting on 27th November 2008 staff were informed that they must attend all mandatory staff training. However, whilst improvements have been made, there is no training and development plan for staff. It is recommended that this is developed in the home to demonstrate a positive and pro-active approach to identifying and supporting the training and development needs of staff. Staff appraisals were underway with one staff member having received an appraisal. The other staff members were newly recruited. It was notable at this inspection that all staff members employed are of an African origin and the needs of the only white resident in the home was raised. This resident is now more confined to the house, maintaining close contact with staff and is more isolated from the community, therefore his cultural needs were discussed. The Deputy Manager informed that the home advertises for staff at the local job centre. It is recommended that the home finds alternative or additional ways to advertise to attract a wider pool of prospective candidates in order to reflect more closely the ethnic origin and cultural needs of this resident. The inspectors questioned whether staffing are sufficient in numbers given the needs of the current residents. Presently there is one staff member on duty during the day and one wake-in staff member at night. One resident presents with having one to one staffing needs. This was clearly evident at this inspection when it was necessary to have another staff member to support the resident in order to allow the Deputy Manager to assist with the inspection. The other resident in the house who is more independent in and out of the house with lower level supervision needs in the house presents with very different needs. The Deputy Manager informed that it would not be appropriate to have two staff members in the house when the more independent resident is mostly out during the day. Also that the Registered Manager is available on call when needed and at times when there are planned activities such as shopping when one resident is out and the other may choose to stay in. It was however pointed out that the two residents share the house together and there are times, such as during the evenings, weekends and variably during the week when they do spend more time together. On the first day of this inspection for example, both residents were in the house together as one chose not to engage in his planned activity out of the house that day. Furthermore, records and complaints examined show there have been several occasions when the residents’, with their variable needs, have clashed, leading to conflict and physical aggression between them including the police being called. It is thus required that staffing levels are reviewed. If it is identified in peoples’ care plans and risk assessments that individuals have one to one needs the service must increase their staffing levels to provide for this. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 28 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, 38, 39, 41, 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Improvements in some areas of service show that progress is being made towards achieving standards which is likely to benefit people using the service. However this progress has been slow and the management of the home needs stronger leadership and skills and the service to be run by a competent manager who is able to effect the changes required to meet minimum care standards. EVIDENCE: The inspectors examined previous requirements to ensure that: Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 29 1. Quality assurance surveys for residents or other persons are dated. 2. Residents’ files are well maintained. 3. All forms and charts related to residents’ needs and activities must be signed by the author, and where appropriate the resident, and dated. 4. The home must record the outcome and action when the water temperature is above 43 degrees. A file contained quality assurance surveys in a separate folder from two professionals, both of which were dated in January. Feedback from both were positive, stating, “the facilities are good; changes within the timescale you’re your client or patient are excellent; no problems encountered; staff communicate feedback about the client/patient”. Two surveys from both the residents also gave good feedback, with ticked responses indicating “excellent service; feels safe in the home; is happy with the food; the overall standard of service is excellent.” One resident also stated areas which they wished to see more support for them personally however these had not been identified in the person’s care plan or activities’ sheet. These issues have been raised earlier in this report. The surveys were signed by the residents but not dated and therefore impossible to know when these views obtained were recently obtained or outdated. This previously made requirement is therefore restated. Additionally monthly Regulation 26 visit reports were available on the day of inspection. Residents’ files were this time in good order, well filed and papers well maintained. All other forms and charts related to residents’ needs were signed and dated by their author and the resident and recently dated. The home’s water temperatures do not now go above 43 degrees as the Manager has taken appropriate measures to ensure that the temperature is set and staff cannot turn the temperature up any higher. Recommendations were looked at as follows: 1. To ensure that a discharge policy and disposal of clinical waste/managing incontinence is available. 2. Ensure there is an index at the front of all residents’ files for efficiency and ease of access to information in files. 3. Provide a water safety certificate. The Registered Manager informed that the residents do not have issues with incontinence, as this had been a one off incident with one of the residents a long time ago. An index was available in both residents’ files clearly identifying the files’ contents. A water safety system is also not needed as the Registered Manager informed that the home does not store any water in a tank. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 30 The home has consulted with the fire safety authority to ensure the building complies with fire safety regulations. A new monthly key worker checklist in is now in place, including whether care plans and medication charts have been completed and whether key working sessions have taken place. This was last completed in December 2007. This reflects a further positive step forward in checking whether the home’s policies and procedures are being followed. The inspectors were informed that on 15th January 2008 petty cash went missing from the office and there were reasonable grounds to suspect that one of the residents may have taken the money. This incident was reported to the police, however the Deputy Manager informed it had not also been reported to the CSCI as they were still waiting for outcome of any police action to be concluded. The Deputy Manager was informed that as a significant incident involving a resident, and any theft, had to be reported immediately to CSCI and that not to do so was in breach of regulation. The Registered Manager informed that he has been a Registered Mental Nurse and has worked in social care since 1991. He has worked with people with learning disabilities as well as in a secure unit as a charge nurse. In 1999 the Registered Manager became a Registered Manager for a home for people with mental health needs. The Registered Manager delegates the day- to- day management responsibilities of the home to the Deputy Manager, who is also on rota most days as the sole support worker in the home. The Deputy Manager informed that the Registered Manager is always available on the phone and he also visits every day. The Registered Manager provides regular supervision to the deputy seen in the records of the last supervision in December 2007. The Deputy Manager is undertaking the Registered Managers’ Award. However through interviewing the Deputy Manager and throughout the inspection the inspectors considered that the Deputy Manager needs to further improve their knowledge about care standards and to develop their management skills if they are to continue to be delegated this level of management responsibility and raise standards. The Deputy Manager is therefore likely to require additional support and possibly training to successfully fulfil their front line support and management role and responsibilities. The Registered Manager on the one hand has a suitable background to run this service and is reported by the Deputy Manager to give appropriate support when needed. However, given the shortfalls in service provision identified in previous inspections and the slow response to meeting requirements leading to restated requirements, the Registered Manager must demonstrate that he is has the necessary skills and commitment to comply with regulations and improve the outcomes experienced by people using the service. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 31 The Registered Manager must implement the changes identified in this report within the timescales as stated to ensure that National Minimum Standards are achieved. Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 x 3 3 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 N/A 30 3 STAFFING Standard No Score 31 X 32 x 33 1 34 1 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 x 1 x LIFESTYLES Standard No Score 11 2 12 1 13 2 14 1 15 x 16 x 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 2 1 x 2 2 2 x 1 2 x Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 33 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 YA6 Regulation 15(1)(2) Requirement Ensure adequate care plans are in place which clearly identify residents’ needs. Ensure action plans are clearly identified in residents’ care plans in response to meeting their needs. The previous timescale of 14/12/07 has not been met. All residents must have appropriate and comprehensive risk assessments in place, which are reviewed and updated as required. The timescale of 01/ 06/06 has not been met. 1. Ensure that no medicine is administered to a resident on a regular basis without being prescribed by a doctor. 2. Ensure that medication administration sheets are signed for by staff who administer medication. Timescale for action 30/04/08 15(1)(2) 2 YA9 13 (4) (c) 30/04/08 3 YA20 13(2) 01/03/08 13(2) Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 34 13(2) 3. Ensure there are clear guidelines on the use of homely remedies. This to include guidance to staff to follow instructions by a GP when administering homely remedies in individual cases. 4. Ensure there is guidance in the medication policy on the in-use shelf life and expiry of medicines in liquid form. 5. Ensure an appropriate cabinet is available for the storage of Controlled Drugs. Ensure that all significant events 01/04/08 affecting residents under Regulation 37 are reported immediately to CSCI. Review staffing levels to 30/04/08 ensure that the numbers of staff on duty reflect the needs of people using the service at all times. 28/02/08 1. Ensure that no staff member is employed without first having a POVA check and that this evidence is on their file. 2. Ensure that no staff work unsupervised without receipt of a full CRB check. 3. Ensure that two satisfactory references are obtained including confirmation of the referees position and whether the reference is personal or professional. 13(2) 13(2) 4 YA41 17 (1) a 5 YA33 18 (1)(a) 6 YA34 19 19 19 Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 35 7 YA42 13 (4) (b) (c) Ensure all opened foods are labelled 28/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations 1. Produce the Statement of Purpose and Service Users Guide in a ‘user-friendly’ format which is more accessible to people using the service. 2. Ensure that daily practises, routines and expectations of living in the home are consistent with expectations as set out in the Service Users Guide. To make a record when residents refuse to engage in one to one sessions. Ensure that the outcome of consultation with residents is recorded when seeking their views about any decisions or matters affecting the home. Ensure residents’ activities are accurately recorded and updated following any changes. The Manager to provide evidence that healthy eating is actively encouraged and promoted for each resident. Complaints recording is improved further to state the outcome of complaints, including whether the complaint is substantiated or not. Ensure duty rosters are available for the inspection year, including a record of whether the roster was worked. Ensure there are no gaps in people’s employment history in their application forms. Seek alternative routes of advertising to attract a wider pool of prospective candidates who reflect the ethnic origin and cultural needs of residents. Ensure there is a training and development plan for all staff. Ensure there is a record of when staff complete their induction. Ensure quality assurance surveys for residents or other persons are dated. DS0000065451.V357203.R01.S.doc Version 5.2 Page 36 2 3 4 5 6 7 8 9 10 11 12 YA3 YA7 YA12 YA17 YA22 YA33 YA34 YA34 YA35 YA35 YA39 Marula House (Varley Road) Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Marula House (Varley Road) DS0000065451.V357203.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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