Inspection on 15/04/09 for 24 Flambard Avenue

This inspection was carried out on 15th April 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

24 Flambard Avenue 28/08/07

24 Flambard Avenue 10/08/06

Extracts from inspection reports are licensed from CQC, this page was updated on 20/07/2009.

Key inspection report CARE HOME ADULTS 18-65 24 Flambard Avenue Fairmile Christchurch Dorset BH23 2NF Lead Inspector bTracey Cockburn Key Unannounced Inspection 15th April 2009 10:15 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 24 Flambard Avenue Address Fairmile Christchurch Dorset BH23 2NF 01202 474848 01202 474803 Flambard@robinia.co.uk 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) Robinia Care South Limited Manager post vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 4 Date of last inspection 28th August 2007 Brief Description of the Service: Flambard Avenue is a four bedded detached home for four young people with learning disabilities. The home is based in the heart of the local community in Christchurch, Bournemouth. Good public transport facilities, local shops, cinema, restaurants, churches and a library are all within walking distance or a short car journey away. Accommodation is provided on two floors. The ground floor comprises of two lounges, one for quiet, sensory activity and one for TV, a kitchen separate dining room, a laundry and office in addition to one en-suite bedroom. The upper floor has 2 en-suite bedrooms, a further bedroom with an adjacent bathroom and a staff sleeping in room. The secure back garden is mainly laid to lawn, surrounded by mature shrubs and trees. A brick built shed and a further patch of land is sectioned off at the end of the garden. There is also a patio and brick built bar-be-cue. The homes aim is to provide a safe, homely environment for young adults with learning disabilities. Weekly fees range from £1500 to £1600. Further information on fees and contracts can be found on the Office of Fair Trading website: www.oft.org.uk 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate outcomes. We inspected this service without warning, spoke to two staff that work in the service and observed the activities of two people who use the service. We spent five hours visiting the service. We had a short tour of the building, reviewed care records, staff records, supervision records, staff roster, recruitment and activities. We also looked at training for staff within the home. We looked at records of the incidents which occur in the home. In planning the inspection we looked at information from two random inspections in 2008, we also looked at the Annual Quality Assurance Assessment completed by the previous manager. We spoke to contract monitoring staff from a local authority. As part of the planning process the home submitted an Annual Quality Assurance Assessment (AQAA). Regulation 26 visits; Regulation 37 incident reports and survey forms were also used to inform the inspection. What the service does well: Staff record when people make choices in their daily life and encourage individual to think about those decisions each day. People who live in the service are able to take part in activities which interest them and use the leisure facilities in the local community. Staff work hard to respect and maintain an individuals rights to make choices in their daily lives. People who use the service are supported to maintain a healthy diet. People are supported to attend appointments and this is clearly recorded. People using the service are protected by the homes policy and practice in administering medication. People live in a comfortable home. The home is clean and staff receive training in infection control. The recruitment practice ensures that people are protected. 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: At the end of this inspection there are nine requirements and ten recommendations. People must be supported to be involved in the development of their support plans. It is important that people living in the service have access to a complaints procedure. It is important that the skills and experience of staff on duty are balanced in order to ensure that people living in the service are in safe hands. It is important that staff receive they training they need to understand the needs of the people using the service. Staff must receive supervision and be supported to develop their skills and receive help when necessary. 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 7 There must be a manager in post who is in day to day control of the service. The service needs to implement a quality assurance process to be able to demonstrate that they are listening to people who use the service and developing the service with them in mind. When submitting an annual quality assurance assessment to the commission the quality of the information needs to reflect the work in the service. The registered provider has a responsibility to visit the service and ensure that people’s needs are being met. When incidents occur in the service it is important that they are reported correctly otherwise we cannot be sure that people living in the service are protected from harm. When assessing the needs of someone who might be moving into the service it is important to consider the needs of the people already living in the service. There should be a procedure in place for each person who can be aggressive demonstrating how to support them in a positive way. There should not be any blank areas in a care and support plan as this shows either a lack of interest in the person’s needs, wishes or goals or a lack of understanding in how to complete the plan. Care and support plans should be in a format which is accessible to them. Risk assessments should be reviewed otherwise both the people who use the service and the staff who work there could be at risk of harm. Information about how people like to be supported with their personal care needs should be clearly recorded to assist staff in maintaining an individual’s dignity. People who use the service should be able to make decisions about which staff they would like to support them. To ensure there is the right mix of skills and experience working in the home each person should have a completed training profile and there should be a whole team assessment of training strengths and weaknesses to ensure that people’s needs are being fully met. There should be a procedure in place which supports staff that are faced with aggression on a daily basis. There should be weekly audits of the incidents which occur in the home and action taken to address patterns of behaviour. 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. 24 Flambard Avenue DS0000065314.V374830.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 24 Flambard Avenue DS0000065314.V374830.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their individual needs assessed before they move into the service. There needs to be a process whereby the needs of other people in the service are taken into account when considering a new placement. EVIDENCE: There have been no new admissions to the service since the last key inspection. In the annual quality assurance assessment submitted by the manager in August 2008 under this outcome area for what the service does well the manager wrote “care for the individual” and under what they could do better it said “make the home more homelier” under the heading ‘improvements in the last 12 months’ the AQAA said “calmer environment and residents communicate freer” In the statement of purpose it states: “24 Flambard Avenue offers a service which reflects our in depth, understanding of the causes of challenging behaviour, its prevention and how to respond if it occurs” 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 11 The information in the annual quality assurance assessment did not reflect that statement. We found that there are four people living in the service, two people have very different and complex needs. We consider that the service should be mindful of its statement of purpose when assessing people and mindful of the needs of other people living in the home when going through the assessment process. 24 Flambard Avenue DS0000065314.V374830.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual plans of care have information on an individual’s needs but information is not consistently recorded and does not have a person centred approach which raises questions about how involved people are in the development of these plans. Plans are not available in a format which is accessible to the individual. Risk assessments are in place but are not consistently reviewed which can put people at risk of harm. EVIDENCE: In this outcome area in the annual quality assurance assessment under the heading ‘what the service does well’ the report stated ‘menu is considered and diet well ordered’ in evidence section in how they would demonstrate this it states ‘daily diaries show a great deal of staff/resident interaction’. 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 13 We found that the annual quality assurance assessment did not contain and detail and depth of information about the service or how it was meeting the national minimum standards. At the visit we found that the care plans for each person had been improved and contained information on how each person needed to be supported. The support plan has been written from the individual’s perspective. There was evidence that the service had involved an occupational therapist who stated ‘X should have a regular and predictable routine’ We found out from staff who work in the service that the daily routine for one person had been far from regular and predictable. They gave us examples of how this person’s routine had not been well communicated to him and how the previous manager had not been consistent in approach. This has resulted in a high level of incidents mainly targeting staff. The senior support worked explained that they are communicating clearly with the person, making sure he know what is happening each day and that each evening he knows what is happening the next day and this information is on his chart in his room which can be reinforced when he is unsure. Staff felt it was important that when health professionals such as psychologists have appointments with individuals about particular concerns around behaviour it is important to see them in their home environment. In one file we found sections which had been left blank, the sections titled ‘my future’ and ‘my emotions’ were both blank. We also found that other sections although completed in some detail lacked signatures and dates. We found files were poorly organised with minutes of review meetings tucked in behind information on a record of someone’s behaviours. We found the section detailing an individuals communication needs to be very thorough covering how when and why they needed to be communicated with in a particular way and the possible outcome if this was not done correctly. We also found in one care plan that although there was good information on what support people needed with personal care, it did not cover enough detail such as if someone needs support to shave, exactly how do they require the support, this information was missing. We found that support plans gave no indication of the individual’s involvement. We observed staff taking one person out to a local café or shop, within a few minutes they were returning as the trip had not worked out. We did not find any information about how people should be supported if they were prone to aggression and harming people. We found through looking at daily records and discussion with staff that there has been inconsistent communication regarding daily routines for individuals and this has resulted in at least one of the people living in the home being 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 14 confused about his daily routines and not able to make decisions about their life. We looked at two files and both contained information on risks and risk assessments however these need to be reviewed. 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 15 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): This is what people staying in this care home experience: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are able to participate in activities which interest them however the needs of one or two of the people living in the service can affect the provision of activities. People living in the service participate in activities in the community. EVIDENCE: The annual quality assurance assessment states ‘try to run an ordinary home’ under improvements in the last 12 months it states ‘more relaxed atmosphere’ During our visit we did not find the atmosphere relaxing, staff are always on their guard as the unpredictability of two of the people living in the home can result is furniture being destroyed and people being hurt. The television in the lounge is in a protective case as it has been broken in the past. They are never sure of what will happen when one person comes out of their room. 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 16 We found that there are a variety of activities being offered to people living in the home on a daily basis. During the visit one person was waiting for visitors to take him out and another person was going out with staff to a local café. We found that one person attends music therapy. We observed on the day that a variety of activities are suggested and not always taken up. We looked at records for two people and there was information about the activities which take place and people are going out in the community with staff support. Staff do encourage a range of activities with individuals, there is only one mini bus and this can limit individual activity at times. During our visit we looked at the menu plans and food available to people. All the cupboards in the kitchen are clearly labelled with photographs of the items inside which enables people to make their own choice of what they want to eat. One person has their own fridge which is stocked with their particular choices of snack food. We observed staff supporting people to make drinks and their lunch. We were told that the weekly food budget had not increased recently and this was something they were taking to management about. We noted there was fresh fruit for people to snack on and that the fridge and freezer were stocked with a variety of choices. 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inconsistent approaches to the provision of emotional health needs have put pressure on individuals and staff. EVIDENCE: The annual quality assurance assessment states under ‘what they do well’ “listen” We found that staff are very tuned in to the triggers for behaviours with two people who use the service. The incident reports demonstrate they respond quickly to defuse situations and we observed them working to bring structure and routine back into one person’s life. We spoke to staff in the service who told us that until recently routines were not established for one person and when there were established they were sometimes changed without consultation with them and this had led to confusion for the individual about what they were supposed to be doing and this had lead to increased anxiety. 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 18 We also observed that they are frequently hurt in the process. We found evidence that people are receiving health care appointment and seeing specialists such as psychologists. We looked at the care and support files of two people who use the service. We found in one care file we looked at that the part of the plan entitled “my emotions” was blank. We looked at their care and support plan and found that the details of how they need to be supported with their personal care did not contain enough detail. The care plan said ‘needs support with shaving’ there was no other information about how this should be done or the individual’s preferences. When speak to staff we found that individuals are not making choices about who works with them the decision is based particularly with one person, on how well the individual responds to that one member of staff. There was no evidence that people using the service are making those decisions. We looked at medication and found that staff receive training in this area and only staff that have had training are able to dispense medication. We looked at the records and found there were no gaps in recording. 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We are unsure that people’s views are listened to and acted upon. There is evidence that the people who live in the home and those who work in the home are not always protected from harm. EVIDENCE: We found that the service keeps a good record of all the incidents, which occur in the home. We were concerned that for two people who live in the service the record of incidents is very high. This means that there can be several incidents in one shift and they are usually violence against staff which can be anything from being kicked to punched, slapped, scratched, spat at and furniture change be pulled over. We looked at the incidents recorded for three months leading up to the visit. We found evidence of incidents occurring daily and up to ten incidents in one week. We were told that the previous manager had been completing a monthly audit of incidents but we could find no evidence of this. We were told that all records of incidents are passed to senior managers in the organisation but we could find no evidence of this. In the annual quality assurance assessment it stated that there have been no complaints made about the service. We were unsure how people would be supported to make a complaint if they were unhappy with the service. 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 20 We found that staff have received safeguarding training. There has been one safeguarding investigation since the last key inspection and as a result action was taken to address the activities of one person. 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely environment which is clean and hygienic. EVIDENCE: During the visit we looked round the home but not in people’s individual bedrooms. The communal room at the front of the home is used for activities as well as sensory stimulation. The window of this room as shutters on the outside. The lounge has patio doors leading to the garden and the staff told us that the people who live in the home make use of the large garden in the summer months. There is a television in the lounge which is fixed to the wall and protected as one person has damaged it in the past. There is some heavy furniture in the lounge. 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 22 The kitchen is small but modern and all the cupboards have photographs on the front with pictures of the items within such as crockery and food. At the time of our visit the plumbing in the kitchen was being repaired. There is a separate dining room. There is a small office used by staff and the manager when in post. Staff receive training in infection control and the home was clean and free from odours on the day of the visit. There is a large garden with a variety of outdoor activity equipment such as a trampoline which staff say is used by people living in the home. There is outdoor seating. The laundry room is small but able to meet the needs of the people living there and the floor and walls are easy to clean. There is an infection control policy in the home and staff receive training in this area. 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are not supported by senior management in their roles and responsibilities which means that people living in the home are not having their needs fully met by the staff team. The number and skill mix of staff on duty needs to reflect the complex needs of the people living in the home to ensure they are safe. Specialist training is not in place for staff. Supervision is not used effectively to support staff in the work they do putting them at risk and not providing the support needed to work with people living in the home to develop good outcomes for them. EVIDENCE: We found that staff are not receiving the training they need to understand the needs of people with autism and challenging behaviour. We were told that 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 24 there was a course in the previous week on autism and not one member of staff from Flambard Avenue was on the course. We looked at the records kept on agency staff that work in the home and noted that not all the staff who works in this service has had training in physical restraint or challenging behaviour or autism. We could not see any training needs assessment completed for the whole staff team and individual training profiles were completed. We noted that there were forth coming training dates in Food hygiene, Epilepsy, Infection control, manual handling and first aid. We were told that there are no routines or structure in place for one person who lives in the service and we were given an example by staff of how the previous manager would cope with challenging behaviour. We found no evidence that staff receive either counselling or support when they are faced with aggressive behaviour each day. We looked at the supervision records for one person and found there was no discussion about training or support they need. Staff working in the home complete mandatory training however further training such as autism awareness which would enhance their skills and enable them to understand the needs of individual more fully are not taken up consistently for all staff. We were given an example of training in autism which took place the previous week and no support workers from the service were put forward. We found that the information about agency staff was in place and gave details of their experience and training. The service tried to use the same agency staff for consistency. There is enough staff on duty each shift however they need to ensure that there is a balance of skills and experience on duty to ensure the safety of the people living there. We looked at the recruitment records for two people and found that both records contained all the information required such as criminal records bureau checks, proof of identity and two references. 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inconsistent management of the service means that there are adequate outcomes for people and staff are at risk. Quality assurance has not been addressed and therefore people living in the home cannot be confident that their views are listened to and underpin the development of the service. When incidents occur in the home they need to be reported correctly in order to ensure the people living in the home are protected. EVIDENCE: At the time of this key inspection there was no registered manager in post. The person who had been managing the service since March 2008 was no longer in 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 26 post and two registered managers from other local Robinia services were overseeing management of the home. A senior support worker has been brought into the service as she had previous experience of working with people with complex needs, where there needs to be clear support and structure to enable them to be comfortable in their surroundings. The previous key inspection when the service was rated as good was in August 2007. The manager of the service at that time left in October 2007 and another manager was appointed and started work in March 2008, the manager then left the service in March 2009. There has been no registered manager in the service since 2007. We were told at this key inspection that a manager has been appointed but there is no start date. Since the key inspection we have been told that the new manager has started. We were concerned about the culture of violence against staff within the home and disappointed that there has been no management action to address this. Please see outcome area ‘complaints and protection’ for details. We looked at the incident records for two people in the home for the past three months. We found that there are daily incidents of violence against staff, which are clearly recorded and forwarded to senior management within the service. We found that regulation 37 forms have not been sent to the commission regarding these incidents. We looked at the number of regulation 37 forms we had received since the last inspection and we found five. We found that there are incidents of violence against staff sometimes as much as four times in a day. These incidents are witnessed by other people who live in the home. Staff told us that they are at times fearful and know that when they come on shift each day there is a very high likely hood they will be attacked by two of the people who live there. The incident forms support this information. We did not find any information on whether accidents and incidents are audited either weekly considering the frequency or monthly. We did receive an annual quality assurance assessment in August 2008 which contained very little information on the development of the service or the views of the people in the service. We understand from staff that regulation 26 visits which should be completed by the registered provider are completed by other managers in the area. We looked at health and safety records and found that they were in order and up to date. We found that staff are receiving training in mandatory safe working practice such as fire safety, moving and handling and food hygiene. 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 1 X 1 X X 2 X Version 5.2 Page 28 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 (1) Requirement Timescale for action 30/06/09 2. YA22 22 (2) 3. YA32 18(1) (a) The registered provider must ensure that in consultation with the individual and their representative a written plan of their needs in relation to their health and welfare are completed fully. The registered provider must 31/07/09 ensure that the complaints procedure is appropriate to the needs of the people using the service. The registered person shall, 11/08/09 having regard to the size of the care home, the statement of purpose and the number and needs of service users (a) Ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. 4. YA32 18 (c) The registered provider must ensure that all staff working in DS0000065314.V374830.R01.S.doc 31/08/09 24 Flambard Avenue Version 5.2 Page 29 5. YA36 18 (2) 6. YA37 8 (1) the home receive training which is appropriate to the work they do. In this home this would mean ensuring that staff completed training on working with people with autism and the needs of people with learning disabilities as well as challenging behaviour. The registered person must ensure that all staff are appropriately supervised especially when they are faced with aggressive situations on a daily basis. The registered provider must appoint someone to manage the service. The registered provider must establish and maintain a system for evaluating the quality of the services provided at the care home. When an annual quality assurance assessment is submitted to the commission it must contain more than one word answers. It must contain details of the measures being taken to improve the quality and delivery of the service based on the system it has developed. Where the registered provider is an organisation or partnership the care home must be visited in accordance with this regulation by – (a) the responsible individual or one of the partners, as the case may be (b) another of the directors or other persons responsible for the management of the organisation or (c) an employee of the DS0000065314.V374830.R01.S.doc 31/07/09 30/06/09 7. YA39 24 31/08/09 8. YA39 26 31/08/09 24 Flambard Avenue Version 5.2 Page 30 9. YA42 37 (1)(e) organisation who is not directly concerned with the conduct of the care home. The registered provider must inform the commission without delay of any event in the care home which adversely affects the well being or safety of any service user. If people who live in the home are witnessing violence against the staff that support them this could have an adverse affect on their emotional well being. 30/06/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA2 YA6 Good Practice Recommendations The registered provider should consider the needs of other people in the service when assessing the needs of someone who is considering moving in. The registered provider should have individual procedures for people likely to be aggressive or cause harm or self harm focusing on positive behaviour, ability and willingness. The registered provider should ensure that the care and support plan is available to the individual in a format the person can understand and is held by the person. The registered provider should ensure that care and support plans have no blank areas; this shows lack of respect for an individual and their needs and aspirations. The registered provider should make sure that risk assessments are reviewed to reflect changing situations. The registered provider should ensure that information in care and support plans about how people like to be supported with their personal care is clearly recorded. The registered provider should give people using the service opportunity to make choices about which staff work with them. The registered provider should ensure that all staff have DS0000065314.V374830.R01.S.doc Version 5.2 Page 31 3. 4. 5. 6. 7. 8. YA6 YA6 YA9 YA18 YA18 YA35 24 Flambard Avenue 9. YA36 10. YA42 up to date training and development profiles and that a training needs assessment is carried out for the whole staff team. The registered provider should ensure that there are procedures in place to support staff who are dealing with physical aggression directed towards them on a daily basis. These procedures should be acted upon. The registered provider should analyse the incidents which occur within the home on a monthly basis. 24 Flambard Avenue DS0000065314.V374830.R01.S.doc Version 5.2 Page 32 Care Quality Commission South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 24 Flambard Avenue DS0000065314.V374830.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!