Inspection on 02/04/08 for 26 Stockdove Way

This inspection was carried out on 2nd April 2008.

CSCI 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 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

26 Stockdove Way 04/04/07

26 Stockdove Way 13/12/05

26 Stockdove Way 10/11/04

26 Stockdove Way 29/07/04

26 Stockdove Way 04/02/04

Similar services:

Ashlong House

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Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 26 Stockdove Way 26 Stockdove Way Perivale Middlesex UB6 8TJ Lead Inspector Jane Collisson Key Unannounced Inspection 2nd April 2008 11:00 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 26 Stockdove Way Address 26 Stockdove Way Perivale Middlesex UB6 8TJ 0208 810 6699 0208 810 8104 hm26stockdove@ealing.org.uk www.supportforliving.org.uk Support for Living 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) Care Home 7 Category(ies) of Learning disability (7) registration, with number of places 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may accommodate LD Service Users who may have a physical disability. One named service user with a learning disability over the age of 65 can be accommodated, as agreed by the Commission For Social Care Inspection, on the 13th October 2005. The home advises CSCI when the service user no longer resides at the home. 4th April 2007 Date of last inspection Brief Description of the Service: 26 Stockdove Way is a care home providing personal care and accommodation for seven people with a learning disability. The home is situated on a housing estate close to the A40 and public transport to Ealing Town Centre. The Registered Provider for the home is Support for Living (formerly Ealing Consortium) and the house is owned and maintained by Notting Hill Housing Trust. It is purpose built and was opened in 1995. The home adjoins 246 Haymill Close, which is also for seven people with a learning disability. Between the homes, which are separated by entry coded doors, is a shared staff sleeping-in room and bathroom. In addition to the office within the Stockdove Way home, there is a shared office with the Haymill Close staff. There are seven single bedrooms situated over two floors, and the home is wheelchair accessible. A passenger lift has been installed since the last inspection. There are four bath and shower rooms, a lounge, dining room and large kitchen. There is access from the lounge to the large, well-maintained garden at the rear of the property. There is parking to the front of the house. The staff team consists of a Manager, three Deputy Managers, and a team of Support Workers. There is one waking night staff and a member of staff from either the Stockdove Way or the Haymill Close staff team sleeps in at night. At the time of the April 2008 inspection, an extra waking night staff was on duty because of the increased needs of one of the people in the home. 26 Stockdove Way DS0000027730.V361603.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 the people who use this service experience adequate quality outcomes. We visited this home for an unannounced inspection on the 2nd April 2008 from 11am to 4pm. The Acting Manager was present. He had commenced work in the home two week earlier, the previous manager having left in February 2008. During the day, two Deputy Managers and five of the staff team were on duty and all seven of the people living in the home were met. The cook was also present. We made a further visit on the 9th April at 2.15pm to look at further records and meet with the Manager and the Support for Living’s Service Manager for the local homes. This was to discuss the outstanding requirements and how they will be met. The inspection took a total of seven hours. We examined a variety of records during the inspection, including care plans, medication records, complaints, maintenance, staff and training records. We toured the home with the Acting Manager and all of the bedrooms and communal areas were seen. Two people were very pleased to show us their bedrooms and we saw that all of the rooms were personalised to suit the people using them. The home is bright and generally well furnished although the Acting Manager was recommended to carry out an audit of the rooms as there were areas where additional items, such as a comfortable armchair and a bed head, are needed for comfort and better safety. Better access is now available to the first floor, which has been particularly pleasing for one person living in the home. At the inspection in 2007, a lift was being installed to the first floor to make the home fully wheelchair accessible. Changes have also been made to the first floor bathrooms and both have showers. The people living in the home continue to attend the adjoining Support for Living day service, which is in the same cul-de-sac, and some did so during the visit. Everyone returns for lunch and a freshly cooked hot meal was provided by the cook. Those who have good mobility are able to access all areas of the home as they wish. Other people are in wheelchairs and were mainly seen in the lounge and dining room. One person had recently suffered a broken wrist and one person had a broken leg, which had necessitated a respite stay in a nursing home. An additional waking night staff is on duty to support the person as she is unable to weight bear. We found there had been changes to staffing structure since the last inspection in April 2007. There are now three permanent Deputy Managers in post, and 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 6 eight support workers. There had been five vacancies and three have been filled, although Criminal Records Bureau disclosures and references were still awaited before they could commence. We noted that there were agency or bank staff on almost all shifts, filling the vacancies on the rota. Most of the people living in the home have little or no verbal communication, although demonstrate that they are generally able to express their wishes. The people living in the home are all in the older age group, between 60 and 83 years of age. One person may have dementia. All of the people are of white British origin, with six women and one man, and there are no cultural or religious needs identified. While the staff team do not reflect the cultural backgrounds of the people living in the home, there is an appropriate gender balance to provide the choice of same gender care. There had been problems with the fire alarm system at the last inspection and some further problems have been noted. Staff said that these have been resolved in the last few weeks. Some other health and safety issues had not been addressed immediately, such as the missing COSHH cupboard key and an open electrical cupboard. Following the first visit, the COSHH cupboard was cleared of hazardous material until the lock could be replaced. There were no hand drying facilities in the toilets to aid infection control. At the second visit, staff records were examined as these had not all been available on the first day of the inspection. The training profiles for a number of agency staff, containing Criminal Records Bureau disclosure numbers, details of references and training were not available and some moving and handling training appeared out of date. The majority of these were available at this visit and the current records obtained. Some of the home’s senior staff completed the Commission for Social Care Inspection’s Annual Quality Assurance Assessment, prior to the new Manager commencing. This provided statistical information about the home, together with details of future plans for the home. Staff spoken to were more positive about the future although recognised that the needs of the people living in the home were increasing. There were twelve requirements at the previous inspection. Five have been repeated and an additional thirteen have been made. What the service does well: What has improved since the last inspection? 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 7 The work carried out to provide a lift to the first floor has ensured that some of the people living in the home are able to retain some independence. More regular reviews have been held to ensure that the needs of the people living in the home are being considered. What they could do better: In order to ensure compliance with the Care Home Regulations 2001 and National Minimum Standards, the Registered Providers must support the new Acting Manager and staff team to complete the outstanding requirements. The information to help the staff to understand the Regulations and Standards needs to be available in the home. To support people to know about the facilities and services that the home has to offer, the Statement of Purpose and Service Users Guide need to be updated and provide all of the information that Regulations require. The aims and objectives of the home, in relation to which needs the home can accommodate, and how these needs are met, must be included. The current care plans are not all up-to-date and do not reflect the needs of the people currently living in the home. These need to be updated and to be compiled, wherever possible, in consultation with the people using the service, or their representatives, so that their wishes can be seen to be taken into account. The health information is not kept in an easily accessible format, which would allow each need to be concisely recorded and monitored. Where guidance is required, such as epilepsy procedures, we did not find them accessible. A better system is required to improve accessibility and the tracking of each identified area. The information to demonstrate that people have access to all of the activities they enjoy, and wish to have, is not clear and there is insufficient evidence to show that opportunities are available. Better monitoring of the medication procedures and administration is required to ensure that errors are minimised but that suitable action is taken when these do occur. To aid infection control, appropriate hand drying facilities need to be available in each toilet. While basic training is generally satisfactory, all staff need to be seen to have the training suitable for their role. Monitoring systems are needed to ensure all staff have the training relevant to their role, and that it is kept up-to-date. More advanced training, and management training for those new to the role, needs to be considered as a matter of urgency. Access to more National Vocational Qualification training is needed to meet the 50 target. 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 8 To ensure that people have been safeguarded by robust recruitment procedures, all of the relevant records for staff need to have been seen to obtained and the records kept for inspection. This includes the agency and bank staff. While people using the service have been asked for their views on a number of subjects recently, the home needs to demonstrate that there is ongoing quality monitoring which looks at all aspects of the running of the home and provides evidence of the development of the quality of care. Staff awareness of health and safety needs to be improved so that any deficiencies, such as unlocked COSHH or electrical cupboards, which could be potentially hazardous to the residents, are dealt with as a matter of urgency. The fire risk assessment needs to be fully completed in line with the current legislation and the company’s policies and procedures. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 26 Stockdove Way DS0000027730.V361603.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 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information available for people who might wish to use the service does not give clear information to support them to make an informed decision about the home. The needs of the people who live in the home, and how they are met, are not fully clarified. Adaptations made to the home have ensured that it is more suitable for the age and mobility needs of the people for whom the home caters. EVIDENCE: We found that the documentation in the home had not been amended to include the changes which have taken place. The Statement of Purpose is not in a format which would support anyone choosing the home to make a decision about its suitability or provide current information to the people already using the service, or their representatives. The Service Users Guide is now in a pictorial format but does not include all of the required information. In particular, the terms and conditions are not included and these would support people to know about the facilities and services that are available. The Acting Manager was advised to ensure that the Care Home Regulations 2001 are followed to make certain that all of the information is included. These were outstanding requirements from the previous inspection and must be met. 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 11 The new Statement of Purpose should also reflect the physical changes in the home and include information as to how the increasing needs of the more frail people are being met. We found that all of the people living in the home need one-to-one staff support for outings and activities outside of the home, so the way in which this is accommodated needs to be detailed. This would help to demonstrate that sufficient staff are on duty. The Acting Manager said he was starting to look at ways in which staff could be better deployed to meet changing needs. No new residents have been admitted since the last inspection so this Standard could not be fully assessed. The staff confirmed that no changes have been made to the assessment procedures, but they were aware of the necessity of ensuring that anyone coming to the home has a thorough assessment to ensure that the placement is the right one. We discussed the situations where people admitted to the home had not always settled in well and the importance of good placements and ongoing reviewing. While internal reviews have been held for most of the people living in the home, the staff said that Social Services representatives have not been invited. Because of changing needs of some of the people living in the home, the need to have reviews which involve care managers should be considered, so that action can be taken regarding the suitability of the placements. With the addition of the lift, and changes to the bathroom, the home is now much better suited to the needs of the people who use wheelchairs. Overhead hoist equipment is also available. One person had a stay in a nursing home, following a hospital stay for a broken limb, as the home was unable to support the nursing care. However, the rooms are of a size which can accommodate people with physical disabilities. 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is some evidence that people have control over their lives but the lack of up-to-date care plans does not evidence this. The current information does not always reflect their needs and wishes. It is not demonstrated whether people, or their representatives, are fully consulted about, or have participate in, their care planning. There is little evidence of independent living skills being retained. Risk assessments are in place but need to be reviewed and reflect the needs recorded in the care plans. Communication with new staff and people outside of the home is enhanced by the use of “communication passports”. EVIDENCE: We examined three of the care plans in detail. All of the care planning, review and health information is contained in one large file, which make access difficult. The proposed new care planning system, mentioned at the April 2007 inspection, has yet to be introduced, but is in the process of being piloted elsewhere in the company. 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 13 In trying to find information regarding people’s health needs, within the care plans, we found guidance could not always be located in the file and, in some cases, was in a risk assessment file. Some care plans had not been updated to take into account the changing needs of the people living in the home. Very little work appears to have been carried out on the care planning process since the 2007 inspection, where it was a requirement that these were improved. The increasing frailty of some of the people living in the home requires there to be systems in place to review very regularly their health and support needs. We found that the daily records, monthly reports and general record keeping did not provide a sufficiently good system to track the progress of a person’s health needs or activities, for instance. It was recommended to the Acting Manager that a different system is introduced to ensure that each medical need has the information, details of appointments and the outcomes kept separately for ease of use. The Support for Living moving and handling assessor was visiting the home to continue an assessment of the needs of one person who has had a recent injury. Following a consultation with the staff, she recommended changes to the information being provided for the staff team to support the person. She is not trained to undertake the risk assessments. We found at the first visit to the home that there were no risk assessments in place for the bedsides which are being used for the person. Those for another person’s were inadequate. We confirmed that none of the staff have attended risk assessment training. In view of the needs of the home’s residents, staff need to have the appropriate training, or have the risk assessments carried out by people qualified to do so. On the second visit, those completed still required improvement as they did not show that all of the potential hazards had been considered and the risks minimised. It was discussed with the then manager, at the 2007 inspection, that the aims and objectives agreed at reviews were not always apparent. They do not support new or agency staff to understand the individual person’s wishes and needs, particularly when non-verbal communication has to be used. The communication passports that have been introduced go some way to providing assistance to new staff or when people go to hospital, for instance, but these need to be extended to all aspects of the person’s support. 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 14 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): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service have the opportunity to access day services. The evidence of other activities is not well documented. There may be limited opportunities for people to retain their skills and increase their independence. Freshly cooked meals are provided which meet individual needs. EVIDENCE: People living in the home continue to access the nearby day services managed by Support for Living. These are adjoining the home and provide activities such as aromatherapy and drama. People are limited by their mobility and disabilities from accessing any activities independently and all use wheelchairs for going outside the home. The location of the home is such that shops have to be accessed by transport and the home has the use of a minibus. There are public transport facilities close by to the Ealing and West Ealing shopping centres. 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 15 A wall planner has information on each person’s weekly programme which includes the day services. One person visits an evening club. However, the daily records examined, and monthly written reports, did not really evidence that many outings had taken place. Because of the lack of verbal communication, written evidence is important to show the opportunities available. People had been to Windsor the previous week and staff said day outings are planned from time to time. One person likes to go to Ealing weekly to visit the bank. Two of the seven people living in the home had a holiday last year. Staff said that they hope to plan for more people to have a holiday, if they wish, in the forthcoming year. We discussed with the Manager that people’s wishes regarding their chosen activities need to be documented and that there is evidence that they are to participate in them. Where there are any restrictions caused, for instance, by insufficient staff on duty, this needs to be recorded. The recording of daily notes varies for each person and it discussed with the Acting Manager that there could be better ways of documenting the information. It was recommended that he looks, with the staff team, at ways in which information is recorded. This needs to be more relevant for the individual needs of each person and provides evidence that care plans, aims and objectives are being followed. As the majority of the people in the home are non-verbal, the use of written records is of particular importance. Just over half of the people living in the home have family, friends or an advocate involved and contact is encouraged. The records did provide evidence that they visit regularly and take people out. They are invited to attend reviews. For the five weekdays, a cook is employed to provide freshly cooked meals. The majority of the residents were seen at lunch and dinner enjoying meals of lasagne and salad for lunch and couscous and vegetables in the evening. Alternatives were available for those who did not like these choices. There is a dining room with sufficient room for the residents to eat together and for the staff to support those who need assistance with their meals. One person prefers to eat separately and this is respected. Where there are eating difficulties, meals are prepared appropriately. Guidance of the preparation of meals was seen for one person who has difficulties, which included the person not being left alone whilst eating. We found that individual needs and choices are met in relation to the food provided and there are no special cultural needs to be met among the current residents. The kitchen is kept locked when not in use. While this may be restrictive for some people, staff said that some residents may try to make drinks and would 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 16 not be able to do so without this being a possible health and safety hazard. They confirmed that people do go to the kitchen with support but none are fully independent in making drinks or snacks. 26 Stockdove Way DS0000027730.V361603.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The documentation to show that people’s health needs are fully supported is not always in evidence. The medication monitoring systems are not sufficiently robust to demonstrate that errors are minimised. EVIDENCE: All of the people living in the home require support with personal care. Personal care assessments have been carried out but did not seem to be incorporated into the person’s care plans. One person requires support from two staff and additional waking night staff are on duty to accommodate this need. The staff team reflects the mainly female person group and we noted information on personal care preferences is noted in the assessments. People are supported by the staff to use community health services facilities. Five people use the same general practitioners’ practice and two other practices are also accessed. As mentioned previously in this report, the information on each individual health issue, such as epilepsy, needs to be clear in regard to the diagnosis, treatment, guidance and risk assessments and the outcomes for each of the issues. It was not clear in the files examined that 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 18 each medical or health concern was detailed in this way. This was an issue which was highlighted at the last inspection but there has been little change to the way in which the information is presented and the requirement is restated. None of the people are able to self-medicate and are supported by staff. A 28day blister pack system is used to administer the medication. In addition, nonblistered and liquid medication is held and, for each person, some PRN (as and when) medicines. It was noted that audits of PRN medication are carried out, but not for the non-blistered medication. On checking a sample of this, there was found to be four tablets too many for one person, indicating that two doses had not been given. Staff were using a system of sticking labels, with dates, on the loose packets to aid correct administration, but some were without these so the system was not ideal. A system to check all of the stock regularly needs to be introduced. It was seen in the audit that a number of non-signings had taken place. We found that the staff asked the staff member responsible to do so retrospectively. This is poor practice, particularly as it could be some days after the medication has been supposedly administered. As non-signing appears to be a regular occurrence, the Acting Manager must ensure that he is aware of which staff are not signing, addresses this with them, and takes appropriate action. Medication training is carried out during the induction process and there are “shadowing” sessions held to access competency. The medication files does not have an up-to-date list of those staff who have been deemed to be competent and not all of the photographs of the people receiving medication were in the file. In one case, the Medication Administration Record sheet did not show that a person could have a PRN medication, although stock was held in their name. It must be clear which medications each person can have, with those which are discontinued, or prescribed, being clarified. One of the staff said that the pharmacist does not always remove discontinued medication from the Medication Administration Record sheet. Discussions need to be held with the pharmacy to improve this situation. It is recommendation that a master medication chart is in place for each person against which the Medication Administration Record sheet can be checked each month. 26 Stockdove Way DS0000027730.V361603.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure which meets the National Minimum Standards and Regulations. It is not fully demonstrated that the non-verbal people living in the home are encouraged to make their concerns known. Staff have the knowledge about safeguarding adults procedures. EVIDENCE: No concerns, complaints or safeguarding issues have been notified to the Commission for Social Care Inspection. One complaint had been logged in the home since the last inspection. This was an internal complaint from the Support for Living day centre regarding non attendance by three of the people living in the home and the Acting Manager was dealing with this. It was not fully demonstrated that the non-verbal people are supported to make staff aware of their concerns and it is recommended that ways are explored in which this can be improved. Not all of the people living in the home have relatives or other representatives who could support them to raise their concerns, and it needs to be shown that ways are found to encourage them to do so. Staff are provided with safeguarding adults training during their induction. The London Borough of Ealing’s safeguarding adults policies and procedures were seen to be in the home. It was recommended to the Acting Manager that the subject of safeguarding adults is a regular agenda item at staff meeting to 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 20 maintain and develop staff awareness and to help safeguard the non-verbal people who live in the home. 26 Stockdove Way DS0000027730.V361603.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An environment is now provided to suit people with mobility needs. The communal and private areas are maintained in good order. The garden provides a pleasant outdoor facility for the people living in the home to enjoy. Staff do not always show a sufficient awareness of health and safety issues and have not acted to protect people from potential hazards. EVIDENCE: We looked around all areas of the home. Two of the people living in the home showed us their bedrooms, and indicated they were happy with the rooms. All of the rooms are pleasantly furnished and personalised with pictures and photographs. However, one person was able to point out where she had had a fall and, because the bed has no headboard, part of the bed base is exposed. While it is was not known if this was the cause, it may have been a contributory factor and the Acting Manager was asked to look at seeing how this situation could be improved. 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 22 One person does not have a chair in her room, and the Acting Manager was recommended to carry out an audit of the rooms to see how improvements, which show that the National Minimum Standards are being met, can be made. This was also noted last year and, in order for people to relax comfortably in their rooms, or to have visitors, sufficient furniture should be provided. It was noted that the staff toilet and other toilets do not have hand drying facilities. This should be remedied in order to support good infection control in the home. A number of the residents have continence problems and a service is used for the disposal of pads. French doors lead from the lounge to the garden, which is well maintained. One of the people living in the home has an interest in growing flowers. Staff said that access to the garden, for one person who particularly enjoys the garden, is becoming restricted because of mobility problems. There is now one domestic staff member in post and the home was seen to be clean. However, it was noted that the person has not been recorded as having health and safety training and this should be in place. Work was completed on the first floor bathrooms to make them more accessible and both have showers. The home has four bathrooms, with assisted baths and shower equipment, to provide a variety of equipment to suit the different needs of the people using the service. Problems with hoist equipment servicing had been noted on the Annual Quality Assurance Assessment. Staff said that this had now been resolved. Moving and handling training was overdue last year but it was seen that staff have now had refresher training. 26 Stockdove Way DS0000027730.V361603.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The majority of staff have had their basic training needs met. There is an awareness of the gaps in advanced training and the management training needed to develop staff. Staff are not fully supported to meet the National Vocational Qualification targets. Not all of the recruitment information is available for inspection or up-to-date. Staff are supported with regular supervision. EVIDENCE: The Annual Quality Assurance Assessment notes that there has been a high turnover of staff in the last year. The home’s Acting Manager had left the employment of Support for Living in February and a new Acting Manager has commenced two weeks before this inspection. Three of the staff vacancies had recently been filled but Criminal Records Bureau disclosures and references were awaited before the staff could commence work. Agency and bank staff were being used to fill the current vacancies on the rota and ten different agency or bank staff being used on the week the first visit took place. 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 24 The team now has three Deputy Managers and all three were met during this inspection. Each shift has a leader who is responsible for the medication and financial checks. At the time of this inspection., there were four members of staff on each shift and a member of staff sleeping in, from either the Stockdove Way or 246 Haymill Close team. An additional waking night staff is on duty in Stockdove Way to support the person who needs two staff to support their manual handling. The post of Deputy Manager has replaced the senior support worker role. No specific training has been made available for the people holding these posts and the Registered Providers needs to ensure that the staff are equipped with the knowledge to fulfil this role. A working knowledge of the National Minimum Standards and Care Home Regulations 2001 in relation to inspection should be encouraged. No copies of the Care Home Regulations 2001 and National Minimum Standards were found in the office. We looked at the information held for each staff member. The information on Criminal Records Bureau disclosures, references and other employment matters are held at Support for Living’s head office. The forms for each person, which summarises the information needed under the Care Home Regulations 2001, was not available. A second visit was made to look at these. Information was available on all but a new staff member, which staff then requested from Support for Living’s Head Office. Where an agreement has been made to keep summarised information, it must be available for inspection at any time and staff need to be aware of its location. The information held for agency staff was not all available at the first visit of the inspection. According to the current rota there were ten staff, mainly from agencies, working that week and profiles for only five were found. Two of these staff had information which showed they did not have up-to-date moving and handling training and had not had training since 2004. As the staff are required to use manual handling with the people living in the home regularly, it should be seen that their training is up-to-date. At the second visit, information was still missing for three people but this was obtained from the agency during the inspection. The information on manual handling had been updated. However, the records for the bank staff were not available. We had required at the last inspection that information on staff working in the home was available and the Acting Manager must ensure that it is available, and upto-date, in the future. At the last inspection a number of the staff were in need of refresher training courses. While this has been provided for most of the staff, and new staff have undertaken the induction programme which includes all of the basic training courses, some are still outstanding. This includes food hygiene training for the cook and health and safety for the domestic staff member. 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 25 Only four of the fourteen staff currently have a National Vocational Qualifications. The home has not met the target, under the National Minimum Standards, of having 50 of the staff team with National Vocational Qualifications Level 2 or above. Staff said that this training is difficult to access. The Registered Providers need to ensure that staff have access to training which will enhance their skills to work with the people living in the home and for personal development. Staff are being supported by regular supervision and evidence of these was seen in the files examined. However, the staff carrying out the supervision have not had the training to support them to do this and have identified this as a training need. 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Insufficient attention has been given to meeting the requirements made at the inspection in 2007. Support and training is needed to assist the management staff to fulfil their roles. Staff do not always show sufficient awareness of health and safety issues. EVIDENCE: The home has continued to undergo changes of staff and management. The Acting Manager was newly in post and has not managed a Registered Care home before. The previous manager was not registered with the Commission for Social Care Inspection although in post for more than a year. The new Acting Manager said that he had started this process and the Registered Providers must ensure that the service has a Registered Manager within a reasonable timescale. The Acting Manager does not currently have either care or management qualification but is currently undertaking the National 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 27 Vocational Qualifications Level 3 and hopes to go on to Level 4. He has experience of managing a non-registered service as well as experience of working in Commission for Social Care Inspection registered services. Support for Living has a development training course for home managers in progress. The requirements made at the April 2007 inspection have not all been met and the record keeping is still in need of improvement. This would help to demonstrate that the support offered to the people living in the home is in accordance with their wishes and is meeting all of their needs. Many of the files needed to be streamlined at the last inspection and this has not been carried out. Systems which would support new and agency staff to fully understand the needs of the people using the service need to be developed and introduced. There is a key worker system in place but there needs to be continuity and monitoring to ensure that information is relevant and accessible. At the last inspection there had been problems with the fire alarm system, resulting in an Immediate Requirement being issued. The problem had been ongoing and had not been investigated sufficiently. Staff reported that there had been further problems with the fire alarm but that these have been resolved. Among the records, we found the fire policy and a fire risk assessment. These were not always accordance with each other. For instance, the precautions put in place were not the same as in the policy and had not necessarily been carried out. An example of this was the frequency of fire drills, of which there had only been once since July 2007. As there have been new staff in post, efforts should have been made to ensure that staff were familiar with the drills, particularly in view of the mobility problems of the people living in the home. We confirmed that one of the senior Support for Living managers was responsible for updating the fire risk assessment and should be visiting to update the fire risk assessment in the near future. Some of the maintenance information could not be located and, again, the files need to be streamlined for ease of use. There had been problems also with the hoist servicing but staff said that this was now satisfactory. Battery operated devices have been installed on bedrooms doors, which are activated by the fire alarm, which allows people to have their doors open as they wish. We have received regular reports of the Regulation 26 visits to the home. Some of the observations made on this inspection, such as the need to take action on medication audits, poor record keeping and the need to reorganise the documentation, need to be addressed by the managers carrying out these visits to ensure that good standards are maintained. People using the service have been asked for their views on questions such as whether they wished to have a job and whether they had any input into choosing their key worker. The surveys had been undertaken with the people living in the Support for Living homes in Perivale and Greenford. These had been analysed to see if improvements could be made. However, a more substantial quality assurance systems should be in place to ensure that all of 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 28 the systems in the home are regularly audited, reviewed and used to review the quality of care in the home. 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X X 2 X 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 30 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. Standard 1 YA1 Regulation 4 (1) Requirement Timescale for action 31/05/08 2 YA1 5 (1) 3 YA6 12 (2)15 (2)(b) 4 YA7 12 (2) The Registered Providers must ensure that the Statement of Purpose is updated to provide information and details of how the specific needs of people admitted are to be met by the facilities and services in the home. (Previous timescale of 30/06/07 not met). The Registered Providers must 31/05/08 ensure that the Service Users Guide is updated to provide information and details of the current facilities and services available. (Previous timescale of 30/06/07 not met). The Registered Providers must 31/07/08 ensure that care plans are updated, and reviewed on a regular basis, to ensure that the health and welfare needs of persons using the service can be fully supported, with their wishes seen to be taken into account. (Previous timescale of 30/06/07 not met). The Registered Providers must 31/07/08 ensure that the wishes and needs of the people living in the DS0000027730.V361603.R01.S.doc Version 5.2 26 Stockdove Way Page 31 5 YA9 6 YA9 7 YA12 8 YA19 9 YA20 10 YA20 11 YA30 home are reflected in their care plans and it is shown that they, or their representatives, are fully involved in this process. 12 (1) (a) The Registered Providers must 13 (4) ensure that risk assessments have been carried out for all activities which there are potential hazards and the way in which they can be minimised are recorded. 13 (4) The Registered Providers must 18 (1)(c)(i) ensure that risk assessments are carried out by staff competent to do so and provide suitable training where necessary. 16 (2) (m) The Registered Providers must (n) ensure that the opportunities for activities outside of the home are regularly available, taking into account the known wishes of the people living in the home. Suitable recording needs to be available to evidence that these are being fulfilled. 12(1)(a)(b) The Registered Providers must ensure that the information to support health needs is maintained in good order, updated regularly, and shows clearly how the needs of the individual person are being met. (Previous timescale of 31/05/07 not met). 13 (2) The Registered Providers must 17(1)(a) ensure that the medication Sch.3 (i) procedures are robust and that there is an audit trail of all medication. 13 (2) The Registered Providers must ensure that action is taken to reduce medication administration errors and that appropriate action is taken when these are found. 13 (3) The Registered Providers must ensure that, to aid infection DS0000027730.V361603.R01.S.doc 31/05/08 31/05/08 30/06/08 31/05/08 31/05/08 30/04/08 31/05/08 26 Stockdove Way Version 5.2 Page 32 12 YA32 18(1)(c)(i) 13 YA34 19 (1) (b) 14 YA35 18 (1) (c) (i) 15 YA37 9 (2)(i) 18 (1)(c)(i) 16 YA39 24 (1) 17 YA42 13 (4) control, suitable hand drying facilities are available in each toilet. The Registered Providers must ensure that training is made available to staff which develops their skills and that basic training is kept up-to-date. The Registered Providers must ensure that the staff recruitment records of agency, bank and permanent staff of all the staff currently working in the home, are available for inspection at all times. The Registered Providers must provide an Action Plan for National Vocational Qualification training, to ensure that the target of having 50 of the staff team trained to National Vocational Qualifications level 2 or above, will be met within a reasonable timeframe. (Previous timescale of 30/06/07 not met). The Registered Providers must ensure that the Acting Manager has the information, training and support to complete the requirements made under the Care Home Regulations 2001 and that he and the staff are fully conversant with their roles and responsibilities. The Registered Providers must demonstrate that there are quality assurance and monitoring systems are in place to look at all aspects of the running of the home, which will provide evidence of the development of the quality of care. The Registered Providers must ensure that staff are fully aware of their health and safety responsibilities and that DS0000027730.V361603.R01.S.doc 31/07/08 30/04/08 31/07/08 30/06/08 31/07/08 31/05/08 26 Stockdove Way Version 5.2 Page 33 18 OP38 23 (4A) deficiencies are reported and action taken to ensure any risks are minimised. The Registered Providers must ensure that the fire risk assessment is fully completed in accordance with the fire legislation (Regulatory Reform [Fire Safety] Order 2005), which came into force in October 2006. and in accordance with its own policies and procedures. 31/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard YA6 YA20 YA22 YA23 YA24 Good Practice Recommendations That a different system is introduced to ensure that each medical need has the information, details of appointments and the outcomes kept separately to ensure easy access. That a master medication chart is in place for each person against which the Medication Administration Record sheet can be checked each month. That ways of communicating the complaints procedure more appropriately, and recording the concerns of the people in the home, are considered. That, to help safeguard people who have limited communication, that the subject of safeguarding adults is a regular staff meeting agenda item. That a room audit is completed to ensure that all of the people living in the home have the items they require, such as a comfortable chair, in their bedrooms. 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 26 Stockdove Way DS0000027730.V361603.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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