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Inspection on 10/02/09 for 24 Tower Road West

Also see our care home review for 24 Tower Road West for more information

This inspection was carried out on 10th February 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 24 Tower Road West 24 Tower Road West St Leonards-on-sea East Sussex TN38 0RG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michele Etherton     Date: 1 2 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: 24 Tower Road West 24 Tower Road West St Leonards-on-sea East Sussex TN38 0RG 01424427607 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): East View Housing Management Ltd Name of registered manager (if applicable) Sharon Kathleen Fisher Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 4. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD). Date of last inspection Brief description of the care home 24 Tower Road West is a large Victorian house, rented for its services users by East View Housing Management Limited (EVH). The house has a wide hallway and there are two communal rooms on the ground floor. These include a large lounge area and a small dining room next to the kitchen. There is also an office and a downstairs toilet. There is one ensuite bedroom on the ground floor and there are three bedrooms, one bathroom and a toilet on the first floor. The third floor is office space for the Health and Safety Officer of EVH; the CSCI has been assured the office is always locked when Care Homes for Adults (18-65 years) Page 4 of 32 care home 4 Over 65 0 4 Brief description of the care home not in use. The back garden is large and has an uneven terrain. However a newly installed decked area has been added which makes the garden area accessible to all residents. The house is in walking distance to the local shops, and is near the main bus route to Hastings and St Leonard?s on Sea town centres. The house is registered for four younger adults with learning disabilities. The home makes CSCI reports available to prospective residents and their relatives/representatives upon request. The gross weekly fee inclusive of income support is £948 to £1,242 as at April 2008. Residents pay for their own toiletries, hairdressing and magazines. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: A key unannounced inspection of this service has been undertaken, this has taken account of information received from the service and about the service by CSCI since the last inspection, this includes an Annual Quality Assurance Assessment (AQAA) completed by a representative of the organization in the managers absence. We have found that the home has continued to notify us of events that occur and has liaised appropriately with other agencies where necessary. The AQAA we received has been completed to a reasonable standard of content and detail and provided us with some of the information we need, this could be improved by additional information to illustrate how the service has addressed previously outstanding requirements, we also found some inaccuracies that we confirmed during our visit to the home. Attention Care Homes for Adults (18-65 years) Page 6 of 32 must be given to ensuring that information provided within AQAA information is only relevant to the service under assessment and is accurate. Whilst the reader should be aware that the Care Standards Act 2000 often describes those people living in care home settings as Service Users, for the purpose of this report those living at 24 Tower Road West will be referred to as residents. Our inspection of this service has also included an unannounced visit to the home on 10th February 2009 between 10:00 am -16:00 pm and also on 12th February 2009 between 10:00 am - 11:30 am. During these visits we were able to undertake a tour of the premises including visiting three resident bedrooms with permission, viewing all communal areas, we also consulted with staff on duty and the manager, and met all residents speaking with three who are able to give a view about their experience of living there. Survey responses have been sought from staff and residents but to date none have been returned, we will endeavor to Analyse and incorporate any survey information that arrives before the final report is issued. During our visit to the service as well as looking at the environment we have examined a range of documentation to inform us about what the service has done to improve upon previously identified shortfalls, this includes support plans and risk information, activity programmes, menu information, medication administration records and medicine storage, staff recruitment, training and supervision records, complaints, accident and health and safety information. In arriving at our judgment we have tried to be proportionate in considering compliance with regulation and outcomes for residents alongside the overall risks and impacts of identified shortfalls we have found that whilst in many aspects the home provides good outcomes for residents there has been a failure to address fully all of the outstanding requirements, in particular resident care plans and monitoring visits by the provider and as such we are considering taking enforcement action in these areas. What the care home does well: What has improved since the last inspection? What they could do better: There is a need for the service to ensure that the accuracy of AQAA information provided is maintained and the the content makes clear how previous shortfalls have been addressed. The service has not addressed two outstanding requirements in that support plan information is in transition between two different formats and Care Homes for Adults (18-65 years) Page 8 of 32 consequently information relating to goals and risks is not in place within the daily working documents in use we consider the reason for this may stem from an under resourcing of this project to ensure that this was undertaken in a timely manner. There is no evidence either from our discussions with staff, residents and the manager or from documentation that the provider has taken on board their responsibilities to ensure regular monthly monitoring of the service including interviews with residents and staff. Additionally we have made some recommendations for improved practice in relation to health care, medication, complaints, the environment, staffing, household budget and health and safety that we have discussed with the manager who has agreed these would enhance the current service, and will implement those in her immediate control to do so and discuss others with senior managers. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents of the home are provided with information about the service and will benefit from an assessment of need prior to admission to ensure these can be met. Evidence: The Manager reported that since the last inspection Statement of Purpose and User guide information has been updated an audio version of information about the home has been developed for prospective residents. No new admissions have been made to the home since the last inspection, we spoke with the last resident admitted who confirmed this had been an internal transfer from another home within the group. Although initially not enthusiastic about the move they now recognize the benefits of the homes proximity to shops and transport links which are helpful in supporting their development of independent skills and plans for moving on to a less dependent setting. The newest resident confirmed that they had been provided with opportunities to visit prior to moving in. The manager demonstrated an awareness of our previous concerns that internal transfers within the company of Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: residents from house to house were not at that time supported by an assessment of need or compatibility, this has changed and the manager reported all admissions irrespective of internal or external admissions are now subject to an assessment of need. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The establishment of goals and the update and review of risk information would better promote residents quality of life and the support they receive from staff Evidence: Since the last inspection there has been a rationalization of much of the information kept about individual residents with this being reduced to just two files for each resident, these consist of a new more individualized day to day plan called My Life Plan and a supplementary file for relevant documentation called My life plan 2, an examination of the day to day life plans for three residents highlights that these contain clear simple information about individual resident needs and their preferences, this informs staff how to support residents the way they wish. However, much of the information relating to goals, risks and some other key information is still to transfer from previous files. Not all the staff team have established knowledge and understanding of the individual residents being new to the service themselves and are therefore reliant on good up to date information to inform their support. Resourcing of Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: senior staff time has not been set aside specifically to undertake the task of transferring information, and without this it will take some time before these are fully operational documents, consideration needs to be given to facilitating this to happen quicker. An examination of three support plans indicated that whilst in one file short term goals in respect of a residents mobility had been established these had in fact already been met but had not been amended,or new goals added, yet our observations of an expereinced staff member and discussions with them and the manager about the resident concerned indicated some new short term goals e.g discontinue need for hospital bed are already being worked toward by the resident with staff support but this might not be clear to all staff, or the way in which this is to be supported. Another resident who we spoke with is keen to move on having achieved many goals and milestones toward independence, a review of her support plan indicated no goals currently recorded, from discussion with the resident concerned, she is unclear what she now has to work toward or the timescales for doing so. A third file also highlighted no established goals at this time yet discussion with the manager indicated there are short term goals being worked towards in respect of improving communication with the resident. In our discussions with the manager, staff, and residents it is clear that a common sense approach to risk is taken which does not entirely focus on the need to keep the resident safe but acknowledges the need for them to experience risk as part of their day to day routine and development of skills in handling risk, however, we found little risk information in the new my life plan formats, risk information we did view was overdue for review. Whilst we acknowledge that the service has worked hard to develop the new personalized format of the support plans the current shortfalls mirror those highlighted at the previous inspection and which the service was required to address, we do not consider that these shortfalls have been addressed and are considering taking enforcement action in this matter. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lead the lives they wish, they are encouraged to make use of the local community and to develop their independence, they are supported to maintain links with people who are important to them. They are encouraged to eat healthily. Evidence: Residents we spoke with tell us that they can do what they want, some residents are independent travelers and come and go from the house, they enjoy a varied programme of activities attending day centres and making use of community facilities and local public transport, residents who travel independently reported that if they are going to travel on an unfamiliar route staff support them initially until they are confident. When asked what they liked most about the home two residents confirmed its Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: proximity to local transport and shops was important to them. They also liked that they could do what they wanted. The House does not have dedicated transport and makes use of public transport or taxis, one resident has been confined to the house for some months following a fall, they have recuperated slowly and the staff have been supportive in encouraging the resident to mobilize and regain some independence, the resident said that they enjoyed their knitting and listening to their music but clearly would benefit from going out and was heard asking staff if this could happen, the lack of a ramp to the front door from the pavement is currently preventing the resident leaving the premises in a wheelchair and mobility is too fragile to risk negotiating steps at this stage, the home has ordered a ramp to enable the resident improved access to and from the home. Residents are supported to maintain links with important people in their lives and visitors are made welcome. Residents are fully involved in the running of the house undertaking tasks for themselves where possible e,g laundry, ironing, shopping, cooking medication, money, and participating in a rota for general household tasks e.g cleaning, washing up, hoovering. The ethos of the home is to promote and encourage independence and empower residents to exercise control over their lives as much as possible. Residents are consulted weekly by staff about the menu for the following week, menu development takes into account healthy eating for most residents, and dietitian are consulted in respect of individuals. Record of food intake are maintained. Residents help with the shopping and cooking in the house and were observed during our visit making drinks for themselves in the kitchen. Menu information is no longer in a widget format as the home found this to be of no use to the current resident group. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal, emotional and health needs of residents are well supported, but would be further enhanced by the implementation of suggested improved practice. Evidence: Good information is in place about the needs and preferences of individual residents around personal care routines for staff to refer to. Guidance for staff around communication used by residents and what specific behaviors might mean is clear and accessible. Residents we spoke with conformed access to routine and specialist health care appointments and one resident we spoke with confirmed they now make some of their own appointments. Weights are recorded regularly for the majority of residents but consideration must be given as to how this can be achieved for a less mobile resident. Two of the current residents are over 60 years of age and another is nearly sixty, this is an aging household and the staff team will need training in the needs of older persons, and we would recommend that routine nutritional, skin integrity, falls, and continence assessments are implemented for those over 65 years and those under 65 Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: where specific needs in these areas are identified. From our discussion with the manager and a staff member we understand that all care staff initially receive in house training and competency assessment in medication and this is supported by additional medication courses and annual reviews of competency. Two residents are administered medication by staff but we could find no evidence of consents to this yet clearly both would have an understanding and be able to consent to staff administration. The service is actively seeking the involvement of funding authority care managers to establish resident capacity to exercise control over aspects of their daily routines e.g medication, money management. Where incapacity has not been established residents are supported to undertake their own administration of medication and to aid this all have been provided with their own medication cabinets, they retain their own medication record and complete this with staff, some clarity is needed to ensure that records make clear staff are observing and not administering. Changes to medication by the GP or other health professionals are recorded on a contact sheet. The home has been proactive in the development of individualized PRN guidance for staff and in the production of medication profiles, these profiles would benefit from additional information in respect of side effects and preferences in regard to administration e.g times of administration, the home has supported residents in challenging administration times where this impacts on the residents quality of life. A review of medication storage highlights the need to ensure that all prescribed medications received outside of the MDS system should be dated upon opening for audit purposes Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities are provided for residents to express their views but some do not feel confident about doing so formally their concerns may not always be interpreted as such by staff. Systems are in place to safeguard residents from harm. Evidence: Residents are provided with the complaints procedure within the user guide but would benefit from this being more openly displayed within the home. Opportunities are provided through resident meetings, one to one meetings with key workers and through an open door policy operated by the manager and staff for residents to express their views. The AQAA informs us that there have been no complaints received in the last twelve months and a review of complaints records during our visit indicates the last recorded complaint to be in 2004. The AQAA which was not completed by the manager also makes reference to the implementation of a moans and groans book for residents to register everyday issues that irritate or annoy them but neither the manager staff or residents knew of this and confirmed that this has not been implemented currently within this home. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: Three out of the four residents are able to vocalize their concerns and staff and manger feedback indicates that generally residents do exercise their right to do so, however, the absence of recorded complaints suggests that whilst staff may have a good understanding of individual residents and how they express their anger distress and dissatisfaction, staff may not be interpreting this as complaints or concerns and therefore there may be an under reporting in this area, our discussion with one resident also highlighted some concern and lack of confidence at formalizing a complaint, we would recommend that this is an area that needs further development with residents particularly for those who may move on to less dependent settings and will need to be able to assert themselves and make complaints on their own behalf. Staff reported that they have received some in house awareness training about adult safeguarding but have not attended for formal training although this has now been arranged. In discussion staff demonstrated a good understanding of their role and responsibilities to report under adult safeguarding and the different avenues this might take also an understanding of what might constitute adult safeguarding. Detailed behavior guidelines information is in place for staff in relation to individual residents although it is unclear from the absence of updated training information whether staff have received training in low level physical interventions used with at least one resident and this needs to be addressed, one resident had commented that they were unable to go in the kitchen, this was not observed during our visit when we observed residents moving freely around the home and Making drinks for themselves if they wanted to. The manager has made clear in response to our queries that there are no restrictions in place within the home for any resident other than respecting each others privacy. Systems are in place to safeguard residents monies and where possible take responsibility for this themselves, residents complete balance sheets with staff support as and when they spend monies and are provided with room safes, the accuracy of balance sheets is dependent on the resident spending money with staff knowledge, a risk assessment is in place, staff check the balances monthly or each time a resident takes money out whichever is the soonest. Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a pleasant homely environment that will benefit from planned upgrading and suggested improvements to fire and infection control arrangements within the home. Evidence: The home is comfortably furnished and provides a clean pleasant homely environment for residents. A programme of upgrading is underway and substantial investment made in the recent rewiring of the premises, and installation of a new boiler and kitchen, the development of a downstairs lounge into a bedroom with en suite facility suited to a resident with increased mobility issues has also been undertaken. The recent upgrading has taken a toll on some of the decor and this is now in need of renewal, residents have made comment within resident meetings minutes of feeling cold and although the improvements to the heating system have helped with this all the windows are single glazed and in need of either secondary glazing or double glazing to be installed, the manager confirmed this is all under consideration within the general plan for upgrading the premises. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: The home is not currently accessible to and from the street for the only resident with mobility problems, this means they are currently confined to the home because of their limited mobility, the home manager advises that a ramp has been measured and was ordered in November 2008, it is at least a month overdue and we have urged for this to be pursued and is a recommendation. We found residents bedrooms to be spacious, and individually personalized to suit the taste and preferences of each resident, residents commented on their preferences around the redecoration of their rooms and this is also recorded in resident meeting minutes, some bedrooms are in need of redecoration with peeling paper on walls and peeling paint on windows. A chest of drawers on one resident bedroom is in need of replacement and the manager confirmed this is in hand. The lounge is large and pleasant with sufficient seating for residents and staff however a settee is in need of urgent replacement with the seating being broken at one end, incontinence issues amongst some residents has caused some soiling and consideration is to be given as to how this can be sensitively addressed to meet the needs of all residents. Toilet and washing facilities are in need of upgrading, an upstairs single toilet is without means for residents to wash or cleanse their hands if the bathroom is in use, a downstairs toilet has a paper towel holder but this is empty the additional cost of replenishing paper towel stocks is an added burden to the household budget which would seem to already be overstretched, a resident confirmed that a cloth towel in use is changed regularly but we consider that these shortfalls do not promote good infection control and need to be addressed. Staff have received some training in infection control through previous health and safety training but have recognized this is insufficient for their needs and we would concur, the home has demonstrated the ability to cope well with incontinence issues and also the management of hospital acquired infection but staff will benefit from specific training in this area to support and develop their practice. We have looked at the fire log and note that fire drills are held monthly and residents confirmed their involvement and attendance at safety training. Testing of the smoke alarm and visual checks of equipment are also conducted at the same time, guidance within the homes fire log suggests smoke alarms should be tested at least weekly, and staff participate in a minimum of two fire drills annually as we consider these matters impact on overall health and safety we have reflected on them within that section of this report. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: The home has been proactive in ensuring a resident with mobility problems has been provided with all necessary equipment to aid their recovery and a bedroom has been created and adapted for their use enabling them to remain in the property, an OT assessment has been undertaken to ensure that additional grab rails and the most suitable equipment is in place, additional bath seats are also available for use by other residents in the main bathroom. There is a small well equipped laundry area and some residents with staff supervision undertake their own laundry and ironing as part of their skills development and promotion of independence. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from having enough staff to support them, procedures are in place to ensure that recruitment training and supervision of staff safeguards residents and will benefit from suggested Minor improvements. Evidence: The home has continued to experience an unsettled staff team with a further three staff moving on since the last inspection, the manager is hopeful that recent recruitment to a full staff team will bring a period of stability for residents and staff. The AQAA informs us that less than 50 of the staff team have currently achieved NVQ2 but discussion with the manager and staff confirmed the view that East View Housing are a particularly supportive organization in regard to facilitating opportunities for staff to access NVQ training, and that new staff are inducted using the common induction standards and have to complete LDAF (learning disability awards framework) training, we noted workbooks in use for new staff. The manager reported that staff have completed mandatory training although training records have not been updated and a training matrix was not available to view, discussion with staff and a examination of some records regarding booked courses indicates a range of training on offer to staff over the coming months including safeguarding. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: We have examined staff recruitment records and these evidence that all necessary vetting and checks are undertaken prior to commencement of work on shift, interview records indicate that gaps in employment and verification of health and previous care roles are explored but records lack evidence of information received from interviewees and the organisation should ensure that this information is retained and available for reference if needed as part of the interview notes and to support judgments made, the content of staff files is generally good and consistent it would benefit further from the inclusion of start dates and current photographs. We understand that on occasion staff may be expected to use their own cars to transport residents and consideration should therefore be given to maintaining up to date records of the status of staff driving licenses, MOT and insurance details where they are expected to use their own car to transport clients to ensure their fitness to do so. Staff reported feeling well supported at local level with good team working, regular staff meetings were thought to be held monthly but this could not be evidenced through recorded information with only one recorded for 2008 and one to date for 2009, the manager and staff reported improving frequencies to staff supervisions with the manager confirming that an element of observation is incorporated but not necessarily made clear within supervision records. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a lack of oversight and monitoring of the service by the organization to ensure that service quality is maintained Evidence: The manager is experienced and knowledgeable of the client group, she demonstrates an awareness of the need for and commitment to updating practice and personal development and undertakes regular training. Some changes in the management structure have created a deputy post and this also provides a career progression for other staff. An AQAA (Annual Quality assurance assessment) was completed recently during the managers absence by a representative of the organisation, although completed to a reasonable standard of detail and content, we found it failed to reflect on improvements made by the service to address all the previous outstanding requirements and also contained some inaccuracies. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: We have looked at the household budget and the current demands made upon it in addition to food costs e.g, taxi fares, resident toiletries and house cleaning materials, stationary costs, residents have also commented that some treats they had previously enjoyed e.g biscuits with their coffee or tea are no longer provided, paper towels are not provided as these pose additional cost within the budget, whilst we accept that a revision of some foods may be as a direct result of promoting a healthier diet alternative treats that residents enjoy should be available, consideration should also be given to reimbursing the household budget for transport costs paid out in respect of individual residents as these are claimed back from residents by the organisation. We would recommend a review of the household budget. When we spoke with staff they said they felt supported at local level but found senior management to be distanced and could not recall that regular provider visits are undertaken, this was confirmed through discussion with residents who reported that they did not get to see senior management within the organization as often, and an examination of provider visit records confirmed no evidence of any visits taking place since the last inspection, although residents reported that they thought someone had popped in from head office in November to check on the progress of the kitchen work. In view of this failure to address this outstanding requirement we are considering taking enforcement action in this matter. Generally there are mechanisms in place through which residents can be consulted and express their views e.g resident meetings, surveys, 1-1 meetings; analysis of feedback from residents is collated and the manager develops an annual report of findings and action being taken. The home has investors in people Award, and an annual swot (strengths weaknesses opportunities and threats)meeting is held, in addition to regular health and safety manager meetings. Service reviews are undertaken although the frequency of these has slipped. The organization employs a health and safety manager and regular visits are made to the home, in addition there are a number of stand alone audits of internal systems e.g health and safety, medication, finances but these do not currently form part of a cohesive programme of quality assurance to audit and review all systems which if in place this may well have highlighted the continued failings, we would recommend the development and implementation of a quality assurance programme that incorporates much of the good practices already in place. The manager confirmed receipt of supervision from a senior manager but was unable to provide evidence of the regularity of this. There is a general consensus from staff and the manager gained through discussion that East View Housing is a good organization to work for. In most other aspects the service provides good outcomes to residents however there Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: is a lack of oversight by senior management into the running of the home and an over reliance on management at local level to ensure quality is maintained. The lack of regular contact with the home has led to a lack of understanding of the resource implications for implementing changes in the way resident information is recorded and its transfer to new formats, or that its absence could impact on the quality of support offered to residents by staff. Policies and procedures have all been recently reviewed and updated. The provider has confirmed within the AQAA information that all Health and safety checks and servicing are up to date and we have not checked these on this occasion. We have looked at fire records and arrangements within the home and have recommended that in order to safeguard the health and safety of residents and staff the smoke alarm is tested weekly and not monthly in accordance with guidance in the Homes fire log, we also recommend that all staff are made familiar with fire drills and actions to take in the event of a fire and should each participate in a minimum of two fire drills annually. Residents already actively participate in regular drills and have been enabled to attend health and safety training. An examination of records indicates a low level of accidents to residents in the home. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 6 15 In relation to care planning, goals set for residents must be specific, measurable and achievable. Advice must be included on how this can happen. 30/06/2008 2 39 26 The Responsible Individual or 30/04/2008 a representative on his behalf must visit the home unannounced and carry out a report of the findings. The outcome of the report must be copied to the manager and be available for inspection. Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 19 Consideration should be given to implementing routine nutritional, skin integrity, continence and falls assessment of residents over 60 and those where a specific need has arisen Prescribed medications outside of the MDS systems should be routinely dated upon opening. Medication profiles would benefit from detail in respect of side effects and preferences around administration Consents to medication administered by staff should be in place Recording of self administration should make clear staff are observing not administering and this should be made clear in risk information. 2 20 3 22 The complaints procedure should be openly displayed for residents to view. consideration should be given as to whether expressions of anger, distress and dissatisfaction are being correctly interpreted as such by staff and dealt with in some instances as complaints. Care Homes for Adults (18-65 years) Page 30 of 32 4 34 Staff files would benefit from the inclusion of start dates and current photographs. evidence of feedback from applicants during interviews should be maintained 5 6 35 39 The training matrix and individual records of staff training should be maintained and updated Service to develop an overall quality assurance programme to incorporate stand alone audits and reviews currently in place smoke alarm tests to be carried out weekly All staff to participate in a minimum of two drills annually 7 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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