Inspection on 19/01/08 for 287 Dyke Road

This inspection was carried out on 19th January 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

287 Dyke Road 03/09/08

287 Dyke Road 23/07/07

287 Dyke Road 15/06/06

287 Dyke Road 14/02/06

287 Dyke Road 10/08/05

287 Dyke Road 11/01/05

287 Dyke Road 27/07/04

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

CARE HOME ADULTS 18-65 287 Dyke Road Hove East Sussex BN3 6PD Lead Inspector Niki Palmer Key Unannounced Inspection 19th January 2008 10:50 287 Dyke Road DS0000060762.V357959.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 287 Dyke Road DS0000060762.V357959.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. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 287 Dyke Road Address Hove East Sussex BN3 6PD 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) 01273 566804 jwood@cmg-operations.com www.caremanagementgroup.com Care Management Group Ltd Vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That service users should be younger adults aged between eighteen (18) and sixty-five (65) years on admission. The maximum number of service users to be accommodated is eight (8). That service users to be accommodated have a learning disability, not falling within any other category. 23rd July 2007 Date of last inspection Brief Description of the Service: 287 Dyke Road is a care home, which provides personal care and accommodation for up to eight people with profound physical and learning disabilities. The home is owned and run by Care Management Group (CMG) who are a large organisation that provides care for people with learning disabilities. The home is a large detached property, which is located on a main road on the outskirts of Brighton. There is nearby access to some local amenities and to public transport. There is limited parking available at the home, but on-street parking is permitted. All rooms are for single occupancy with en-suite facilities and are located over three floors. There is a passenger shaft lift available to allow access to all floors. It should be noted that although the home complies with the required communal area, there is no communal area that can accommodate all eight residents at any given time. The home provides personal care and support to residents who are funded by Social Services. The home’s fees as of 23 July 2007 ranged from £1800 £2200 per person per week. Additional costs are charged for hairdressing (£10), chiropody (£10) and external activities such as shows and concerts. Prospective residents and their relatives are provided with written information regarding the services and facilities provided at the home prior to admission. A copy of the home’s most recent inspection report is available on request from the home. 287 Dyke Road DS0000060762.V357959.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. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at 287 Dyke Road will be referred to as ‘residents’. This majority of this key unannounced inspection took place on Saturday 19th January 2008 over five hours. As many of the residents were out on this day the Inspector returned to the home on the evening of Thursday 24th January 2008 for two hours to meet with the appointed Manager of the home and residents. Six men were accommodated at the time of the inspection. For the purpose of monitoring care, three individual plans of care were looked at. Other records and documentation seen included: the home’s medication procedures, complaints procedure and the systems in place to safeguard people from harm, staff recruitment records and the provision of training, the home’s quality assurance systems and some health and safety records. Individual discussions were held with two members of staff and the appointed Manager. Residents living at the home were unable to provide feedback and give their comments. During the inspection process, telephone contact was made with two relatives. Some of their comments have been reflected throughout this report. The Commission did not request an Annual Quality Assurance Assessment (AQAA) prior to this inspection as one had been completed prior to the last inspection, which was less than 12 months ago. What the service does well: 287 Dyke Road offers a friendly and relaxed environment that is kept in good decorative order. It presents as a clean, well-maintained and homely place to live. Albeit that residents’ verbal communication is limited, staff working in the home were observed to interpret individuals’ subtle level of communication and include residents in the daily routines of the home wherever possible. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 6 Residents are supported to lead varied and fulfilling lifestyles, which encourages them to develop skills and maintain relationships with family and friends. The home has good systems in place to ensure that all complaints are dealt with appropriately. Positive feedback was received from relatives: “The staff are able to take him out for a wander as local amenities are quite good”. “The staff are wonderful, no problems” “Staff are very open and don’t mind us asking anything. There is an open door policy.” What has improved since the last inspection? Following the serious concerns that were raised at the last inspection, the Commission held a Management Review Meeting and met with a senior representative of CMG. The home was required to submit a detailed improvement plan to detail what actions they would be taking to improve the service and to meet all of the requirements within the given timescales. Since this time CMG’s quality assurance inspectors and senior staff have monitored the home on a monthly basis and at regular performance improvement meetings. The Commission received regular written updates of the progress made and evidence was seen over the duration of this inspection that the home has indeed improved many areas and outcomes for people who use the service: The Manager and Assessment Referral Officers have begun to work together to make sure that as much information as possible is gathered prior to any new person being admitted to the home. This helps to make sure that only people whose needs can be met by the home are admitted. The Manager and Deputy Manager have attended person centred planning training. This has supported them to review and update all care records and risk assessments. Residents and staff are much better supported by the home’s improved care planning procedures. CMG’s indoor hydrotherapy pool has been certified as safe for use after almost two years. Residents are now able to benefit from using this at least once a week. The home has provided staff with training in the following areas: epilepsy, first aid, food hygiene, fire, manual handling and health and safety. This helps to ensure that staff are competent to meet the needs of residents. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 7 Draught excluders have been fitted to some of the ill-fitting doors and windows in the conservatory area. It is anticipated that these will be replaced with UPVC double-glazing in May/June 2008. The appointed Manager has begun working towards her Registered Manager’s Award (RMA) and has submitted an application to the Commission to become the Registered Manager of the home. What they could do better: 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. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 8 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 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 9 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): 2, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are provided with sufficient information prior to admission in order to support their decision of whether the home can meet their needs and expectations. Improved systems are in place to make sure that only people whose needs can be met by the home are admitted. EVIDENCE: Whilst the home’s Statement of Purpose and Service User’s Guide were not inspected on this occasion, relatives said that they were given copies of these prior to their son moving in. They also said that they were told they could request a copy of the last inspection report at anytime. This is improved since the last inspection. Due to the high support needs of the residents accommodated, it is crucial for the home to make sure that as much information as possible is gathered prior to admission in order to ensure that the home is suitable and can meet their needs. CMG employs a team of centrally based Assessment Referral Officers, who are responsible for considering and assessing all initial referrals for each of the homes alongside the Manager. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 10 There has been one new admission to the home since the last inspection. Care records showed that a thorough assessment of their needs had been undertaken prior to him moving in. There was clear documentary evidence in place to show that this had been in consultation with relatives, health and social care professionals and his previous place of residence. The appointed Manager confirmed that she had been involved in this process. This is improved since the last inspection. Clear evidence was also in place to show that this person’s care needs had been reviewed after living at the home for six weeks. Relatives confirmed that they were involved in this process. Relatives said that they and their son had been given the opportunity to visit the home and to meet with other residents and staff prior to moving in. Newly admitted residents have clear terms and conditions of contract in place. These include how much they will pay and what the home provides for the money. These were seen on the day of inspection. However the Manager is still awaiting confirmation from CMG’s head office in respect of the fees payable for all other persons. Although this information has been requested, this concern has been raised during a number of previous inspections. The Manager is required to make sure that copies of all residents’ terms and conditions of contract are kept within the home and made available for inspection. These must be inclusive of the fees payable. This requirement is outstanding. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 11 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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and staff are better supported by the home’s improved care planning procedures. EVIDENCE: All of the residents living at the home have profound physical and learning disabilities and additional healthcare needs. It is therefore important that their individual needs are clearly outlined in care records in order to support care staff. Three care records were inspected in some detail. It was pleasing to note that the Manager has reviewed and improved all care plans since the last inspection: Care plans are titled ‘All about Me’ and contain a detailed pen portrait of each person. These include photos of ‘people who are important to me’ and ‘my likes and dislikes’. All have been written in the first person and contain up to 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 12 date detailed information and guidelines for staff to follow to meet all activities of daily living and other specialist care needs e.g. pressure area care and postural management. Photos are also in place to provide staff with additional guidance. Whilst on the whole care plans were greatly improved, a concern was raised in respect of epilepsy management guidelines (see under personal and healthcare support). Following the last inspection, the Manager has reviewed the systems for maintaining daily records. Each person now has their own hardback diary book, which care staff are required to write in at the end of each shift. Whilst the information recorded within these was improved since the last inspection, not all had been signed. The Manager was reminded of her responsibility to ensure that good recording keeping procedures are followed at all times. In addition to daily diaries, the home uses a number of additional recording methods; care plans and records, the handover book and communication book (the latter is a staff communication book and should therefore not contain any personal or confidential information relating to individuals). Due to the number of different records being kept, it was not easy for the Inspector to see a clear audit trail of what action and interventions had been taken by staff to make sure that residents’ needs are being met. These minor shortfalls were discussed with the Manager on the day of inspection. It is recommended that the Manager review the number of different daily records and recording methods that are currently being used in order to provide a clearer audit trail in respect of how resident’s health and personal care needs are being met. All residents are reliant on care staff, their relatives and other health and social care professionals to act in their best interests and make decisions on their behalf about many aspects of their lives. Relatives confirmed that they are involved in this process as much as possible. Albeit that residents’ verbal communication is limited, staff working in the home were observed to interpret individuals’ subtle level of communication and include residents in the daily routines of the home wherever possible. Due to the high support needs of the residents, limited risk taking can be initiated, however up to date risk assessments are in place for all activities of daily living and personal health care needs. This is improved since the last inspection. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 13 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, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents continue to lead a varied and fulfilling lifestyle, which encourages them to develop skills and maintain relationships with family and friends. EVIDENCE: CMG owns a development centre, which is accessed by each of the nearby homes Monday to Friday. This provides opportunities for some residents to engage in informative and creative activities, including sensory stimulation, hydrotherapy, art, postural movement, Speech and Language Therapy, physiotherapy, music, and IT. Some residents attend a local college. Some residents stay with relatives at weekends, whilst others are supported out into the local community (dependent on the weather and the accessibility of transport) e.g. the cinema, park, Sealife centre, walk along the seafront, shopping, pub, football matches and live music concerts. One relative commented: 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 14 “The staff are able to take him out for a wander as local amenities are quite good”. On the first day of this inspection five residents were taken ice-skating at Guildford Spectrum. CMG has an indoor hydrotherapy pool located at the rear of a nearby home. This has been certified as safe for use since the last inspection. Relatives expressed their delight in this as it has taken CMG almost two years to get the pool up and running again. Staff said that they are yet to receive training to enable them to support residents with this, although staff from the Brelade centre have been trained and assessed as competent. Most residents are using the pool at least once a week from the Brelade. The Manager and Deputy Manager are due to attend their training in the near future. This will take place over 3 days and will be assessed by an external assessor. Discussions with relatives and staff confirmed that visitors are always made to feel welcome to the home and there are no restrictions placed on visiting times. All visitors are requested to sign in to the home on arrival in a book located at the main entrance of the home. There are currently only two residents who are able to eat food orally. The evening mealtime was observed on the second day of inspection. The appearance of the food and the support offered by staff was improved since the last inspection. All other residents have clear feeding programmes in place, which staff are trained to administer via residents’ specialist feeding tubes. Individual guidelines are in place, which were seen in care plans. Since the last inspection, the Community Learning Disability Team (CLDT) has taken over the overall responsibility for Speech and Language Therapy support at the home. They are responsible for assessing, planning, reviewing individual needs and providing training to staff. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 15 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 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported to access a range of healthcare services to meet their physical and emotional well-being. Improved care plans and health booklets help to make sure that most personal and healthcare needs are met. Medication systems do not always follow good practice. EVIDENCE: All personal care is carried out in the privacy of one of the communal bathrooms or in residents’ own bedrooms. Baths/showers are carried out at flexible times according to the preferences of each individual. These are outlined in individual care records. All residents are registered with a local GP and dentist. Staff explained that unless it is an emergency situation (in which case they would call for the emergency services), CMG requires care staff to request all GP appointments via the Healthcare Coordinator (employed by CMG). Most appointments and reviews take place at the home. Clear documentation was seen in care records that regular monitoring and good communication takes place between the home and the GP. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 16 CMG employs their own Occupational Therapist and Physiotherapist. Up until recently, they also employed their own Speech and Language Therapist who worked regularly into 287 Dyke Road (due to the complex physical and healthcare needs of the residents accommodated in respect of communication and eating and drinking). This person was made redundant by the organisation, which raised some level of concern by care staff, Managers, relatives and other healthcare professionals. The Commission raised these concerns directly with a senior representative of CMG who confirmed that the Regional Director is monitoring the situation closely. (As already mentioned, the CLDT are now working closely with the home). CMG have assured the Commission that if any problems arise such as a delay in residents and staff receiving support due to current waiting lists, then a freelance person will be requested on an individual basis. No concerns were raised by the Inspector on the day of inspection. Health action plans have been implemented since the last inspection. These were seen in care records. The Manager wrote in the most recent improvement plan that they are not as effective or informative as she would like them to be, but that she will continue to make improvements. This will be followed up at the next inspection. Revised care plans were found to be up to date and sufficiently detailed in respect of meeting personal and healthcare needs with the exception of one person’s epilepsy management guidelines; concerns that were raised at the last two inspections. The guidelines that had been written by the home were poor and failed to provide staff with any description about what the person’s seizures looked like. It was noted that a full account and seizure description had been detailed within the person’s pre-admission assessment, but the home had failed to incorporate this into the care plan. In addition to this, the emergency procedures that are to be followed in the event of a seizure occurring were unclear. The person had been prescribed two emergency treatments, but the guidelines failed to state what should be given and when. Staff said that in-house epilepsy training has been ongoing since the last inspection. This has included an overview of epilepsy, it’s care and treatment and the administration of emergency medication (rectal diazepam). The Manager is required to ensure that individual epilepsy management guidelines include a brief history of the person’s seizures, a description of what form the seizure takes and clear instructions for staff to follow in the event of a seizure occurring. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 17 A sample of the home’s medication procedures and records were seen. None of the residents living within the home are able to self-medicate. Due to their high support needs most require their medication to be either prescribed in liquid form or crushed prior to administration (as directed by their GP). Only staff who have received the appropriate training are able to give medicines, whilst only senior members of staff hold responsibility for re-ordering and checking medications in to and out of the home. Monthly audits are carried out, records of which are kept. Whilst all medicines were found to be appropriately stored, shortfalls were raised in respect of medication administration records (MARS): Some medicines such as paracetamol and topical creams appear on the MARS as needing to be given at least once a day, but there were no signatures recorded to show that they had actually been given. Care staff explained that this was because they were to be given on an as and when required basis (PRN). The home is required to liaise with the GP about the frequency of these medicines. This must be accurately reflected on medication records. Other prescriptions such as dietary supplements had also not been signed as given, although care staff said that they were being given daily. This suggests that care staff are routinely administering the supplements without following the home’s safe policies and procedures for the safe handling of medicines. A requirement has been made in respect of this. Improved procedures are in place in respect of how the home manages medicines that are to be given outside of the home e.g. when a person goes home for the weekend. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 18 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 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has sufficient systems in place to make sure that all complaints will be dealt with appropriately. Residents will be better safeguarded from potential harm, neglect or abuse once all staff have received training in this area and are aware of their responsibilities. EVIDENCE: The home has a clear complaints procedure in place. It gives clear guidance with regards to how a complaint can be made and how the complainant can expect it to be dealt with. Relatives spoken with said they would feel confident in raising any concerns directly with the home. No complaints have been received by either the home or CSCI since the last inspection. Two senior members of staff were spoken with on the first day of the inspection in respect of what they would do in the event of reporting suspected harm and abuse towards a resident. It was concerning to note that neither person was familiar with local multi-agency guidelines, or were aware of who the lead agency is. In addition, they were unfamiliar with the home’s whistle-blowing policy and procedure. When they were asked to find the relevant procedures they could not find them in the home [this was largely due to the fact that the policies and procedures file is difficult to use as there is no clear index for staff to follow]. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 19 These matters were raised with the Manager on the second day of the inspection. She explained that urgent external training had already taken place for both members of staff. A copy of the local multi-agency guidelines were available on the second day. Although the Commission acknowledges that urgent action was promptly taken by the home, the Manager is required to make sure that all staff working in the home are fully trained in safeguarding vulnerable adults and know when and how to respond in the event of an alert. Clear policies and procedures must be easily available. Residents’ finances were discussed and looked at with the Manager. Two residents have all their financial interests looked after by relatives, whilst three have their own bank accounts to which only the Manager and Deputy have access. The Manager explained that she is currently in the process of setting up a bank account for one person with the support of his Care Manager. Interim measures are in place to handle this person’s finances. The home’s progress with this will be followed up at the next inspection. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 20 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, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 287 Dyke Road offers a relaxed environment that is kept in good decorative order. It presents as a clean, well-maintained and safe. EVIDENCE: The Inspector did not view all areas of the home on this occasion but did see two individual bedrooms, the medication room, one bathroom and all communal areas. Residents’ bedrooms are personalised to individual preferences with appropriate specialist equipment in place including electronically operated beds and pressure relieving mattresses for those who need it. Residents have their own flat screen television and audio equipment in their bedrooms and there are a number of photographs and pictures displayed throughout, all of which have been nicely framed and presented. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 21 Relatives commented that their son had recently moved to a downstairs bedroom at their request. It is anticipated that this room will be redecorated in the near future. There is a small lounge area on the ground floor of the home. It must be noted that although it meets the minimum requirements of the National Minimum Standards, it cannot accommodate all residents at any one time. This is due to specialist equipment e.g. wheelchairs, lying boards and specialised seating and other moving and handling equipment being in use. Relatives have expressed dissatisfaction with this over the past two years, which has been raised with senior managers of CMG. During the last inspection, relatives and staff expressed concerns about the draughty conservatory area. A senior representative of CMG has confirmed in writing to the Commission that all windows and doors in this area will be replaced with UPVC double-glazing. The Manager said that they hope to begin this work May/June 2008. Staff said that a cleaner visits the home on weekdays. All areas seen were clean, tidy, safe and well-maintained on the day of the inspection. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 22 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 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by a consistent staff team and are safeguarded by the home’s recruitment procedures. EVIDENCE: In addition to the appointed Manager, the home employs a Deputy Manager, five senior support workers and four care staff. Well over 50 of care staff have achieved at least NVQ Level 2 in Care and are working towards Level 3. Staff said that staffing levels have been reviewed by senior management of CMG since the last inspection. Rotas showed that the numbers of staff on duty have been reduced to a maximum of four on weekdays in the mornings. Staff said that this can at times be quite difficult as one person is always allocated to handle medication, whilst all residents require 2-1 support. Staffing numbers are increased at weekends, which enables residents to go out. Staffing rotas showed that a high number of staff work additional hours particularly at weekends. There are always two waking night staff on duty. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 23 Although numbers of staff on duty has reduced, feedback from relatives continued to be positive: “The staff are wonderful, no problems” “Staff are very open and don’t mind us asking anything. There is an open door policy.” Care staff said that the staff team is reasonably stable. The home had two vacancies at the time of the inspection. All job advertisements are advertised in local newspapers, on CMG’s website and at a number of different job fairs. All initial information is coordinated by the organisation’s Human Resources (HR) department who are responsible for sending out application forms, alongside the required Criminal Record Bureau (CRB) and Protection of Vulnerable Adults First (PoVA) (police checks), health declaration and Equal Opportunities monitoring form. Staff recruitment records were seen for the most recently employed member of staff. Their application form was sufficiently detailed and there was evidence of police checks, photo identification, two written references and permits to work being obtained prior to employment. This is improved since the last inspection. Staff said that regular training is offered by CMG, although is sometimes cancelled at short notice. Recent training includes: epilepsy, first aid, food hygiene, fire, manual handling, health and safety and person centred planning (Manager and Deputy only). Forthcoming training events were seen at the front of the staffing rota. Most training is provided in-house and takes place at a local hotel. Staff confirmed that the home uses a Skills for Care induction booklet for new staff to work through under the supervision of a senior member of staff. A completed one was seen on the day of inspection. A summary is completed by the person and their supervisor at the end of their probationary period. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 24 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, 40 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the home has made good progress in improving the overall conduct and management of the home since the last inspection, which has in turn improved the outcomes for people who use the service, the Commission will need to see evidence that this is sustained over a reasonable period of time. EVIDENCE: The appointed Manager of the home has been working in different care settings for a number of years. She has been employed by CMG since 2004 and has been the acting Manager of 287 Dyke Road since September 2006. She has attended a number of different training courses relevant to her current role and began working towards her Registered Manager’s Award (RMA) in November 2007. She is due to submit her final assessment in May 2008. This is improved since the last inspection. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 25 She has submitted an application to the Commission to become the Registered Manager of the home. The South East Regional Registration Team is currently dealing this with. Seeking feedback from residents is challenging for the home due to residents’ high support needs and limited verbal communication skills. Relatives did confirm however that their views are regularly sought. The Manager also confirmed that next of kin surveys were sent out nationally by CMG in October 2007 and that all responses are currently being collated and analysed by head office. CMG employ their own quality assurance team who visit each of the homes on a monthly basis. The purpose of these visits is to undertake an inspection of the service based on meeting the National Minimum Standards. Copies of these visits alongside regular updated improvement plans have been forwarded to the Commission. These increased quality monitoring checks have helped to improve the standard of care and conduct of the home. As already mentioned, the home’s policies and procedures files are difficult for staff to use. It is recommended that an index page that can be crossreferenced be put at the front of the file. This will make the files easier for staff to use and policies and procedures more accessible. A number of health and safety records were seen during the inspection. These confirmed that all appliances and regular health and safety checks including fire-fighting equipment are frequently carried out. 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 3 2 X 3 X 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 27 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. YA5 Regulation 5(1)(b) Schedule 4 (8) Requirement That copies of all residents’ terms and conditions of contract are kept within the home and made available for inspection. These must be inclusive of the fees payable. [Outstanding from the last two inspection reports]. 2. YA6 YA19 YA20 12(1)(a)(b) That individual epilepsy management guidelines include: 18(c)(1)(i) - A brief history of the person’s seizures - A description of what form the seizure takes and; - Clear instructions for staff to follow in the event of a seizure occurring. Medication records must be clear and accurate to reflect this. [Timescales of 31/08/06 and 31/12/07 partially met]. 31/03/08 Timescale for action 31/03/08 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 28 3. YA20 13(2) 17(1)(a) Schedule 3 (i) That the home seeks guidance from the GP in respect of which medicines are to be given on an as and when required basis (PRN). All PRN medicines must be accurately reflected on medication records. The home’s policies and procedures for the safe handling of medicines must be followed at all times. 29/02/08 4. YA23YA35 YA40 13(6) 18(1)(c)(i) That all staff working in the home are fully trained in safeguarding vulnerable adults from potential harm, neglect and abuse. All staff must know when and how to respond in the event of an alert being raised. Clear policies and procedures must be easily available. 29/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations That the Manager review the number of different daily records and recording methods that are currently being used in order to provide a clearer audit trail in respect of how resident’s health and personal care needs are being met. That an index page that can be cross referenced is put at the front of the home’s policies and procedures files in order to make them easier for staff to use. 2. YA40 287 Dyke Road DS0000060762.V357959.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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