Inspection on 23/07/07 for 287 Dyke Road

This inspection was carried out on 23rd July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 15 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 19/01/08

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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Southfields

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Dovedale Court

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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 Unannounced Inspection 23 July 2007 1:30 287 Dyke Road DS0000060762.V336974.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.V336974.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.V336974.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 Limited Vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 287 Dyke Road DS0000060762.V336974.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. 15th June 2006 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 residents 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 range between £1800 £2200 per person per week. Additional costs are charged for hairdressing (£10), chiropody (£10) and external activities for example 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. The home’s most recent inspection is available on request from the home. 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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 unannounced inspection took place on Monday 23 July 2007 and lasted approximately six hours. This enabled the Inspector to observe the evening routine. Seven residents were accommodated on the day of the inspection, six male and one female aged between 18 and 21 years of age. In order to gather evidence on how the home is performing, individual discussions took place with three members of staff, whilst the majority of the inspection was undertaken with the acting Manager of the home. Three care records were examined in some detail for the purpose of monitoring care. Other areas and documentation inspected included: medication practices, the provision of activities, quality assurance systems, complaints procedure and the systems in place to safeguard residents from harm, staffing levels and the provision of relevant training. All communal areas and individual rooms were seen. An Annual Quality Assurance Assessment (AQAA) was completed and returned by the acting Manager of the home prior to the inspection. This provided the CSCI with information in respect of how the service ensures that people using the service views are upheld and incorporated into what they do, how equality and diversity issues are promoted, identify any barriers to improvements that have been faced over the past six months and how the service plans to make improvements within the next 12 months. During the inspection process, telephone contact was made with two relatives and a healthcare professional. Their comments have been reflected throughout this report. What the service does well: 287 Dyke Road offers a friendly and relaxed environment that is kept in reasonably good decorative order. It presents as a clean, well-maintained and homely place to live. Residents are supported to lead varied and fulfilling lifestyles, which encourages them to develop skills and maintain relationships with family and friends. 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 6 The home has good systems in place to ensure that all complaints are dealt with appropriately. Residents are protected from potential harm, neglect and abuse through the home’s robust policies and procedures and through staff receiving appropriate training. Residents’ finances are managed well. Residents are supported by a consistent and well trained staff team. What has improved since the last inspection? What they could do better: There are a number of outstanding requirements from previous inspection reports: - Terms and conditions of individual contracts and funding arrangements are still unavailable for inspection. - The home has failed to update individual epilepsy management guidelines and provide additional training to staff. - The home is still without a qualified Registered Manager. Other areas for improvement include: - The home must improve the systems that are in place to ensure that no person is admitted to the home whose needs cannot be met. Final decisions, 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 7 regarding admissions to the home must be taken in conjunction with the home’s Manager with a clear understanding of what the home is able to provide. - All of the residents living at the home have profound physical and learning disabilities with associated healthcare needs. It is therefore important that individuals’ needs are clearly outlined within detailed plans of care. The home must ensure that all residents have an up to date and person centred plan of care in place based on individual needs and preferences. - In order to better safeguard residents from potential medication errors when they are on social leave, the home must ensure that clear procedures are written up and documented in line with the home’s policies for the safe handling of medicines. - The conservatory area becomes cold and draughty in the winter months. This prevents residents from using their lying boards on the floor in the lounge (as per their postural management guidelines). The home is required to take the appropriate action. - The home must ensure that it implements it’s own systems for reviewing the level of care provided within the service and take the appropriate action to rectify any shortfalls. This should be carried out at regular intervals and involve residents and relatives as much as is possible. Due to these failings and the failure of the Providers to identify and rectify key issues, the CSCI must consider whether any further action is necessary to ensure improvements are made. 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.V336974.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.V336974.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): 1, 2, 4 and 5, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst sufficient written information is available about the services and facilities at the home, this is not routinely offered to residents and their representatives. The home’s pre-admission assessment procedures fail to include the input and judgement of the Manager. Whilst residents have a statement of the terms and conditions of residency within the home, not all are available for inspection. EVIDENCE: The home has an updated Statement of Purpose and Service Users’ Guide in place, which were seen on the day of the inspection. The Statement of Purpose provides the reader with an introduction to CMG including the home’s aims and objectives, details of the Registered Provider and Manager, organisational and staffing structure and colour photographs of the accommodation provided. The Service Users’ Guide offers a good level of information regarding the services and facilities provided, residents’ charter, contact details of the Commission for Social Care Inspection (CSCI) and the arrangements in place for health and social care support. Both documents are presented in an easy to read and understand format, which incorporate the use of colour pictures and symbols. 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 10 Relatives and others spoken with said that they were not offered copies of these documents or the home’s most recent CSCI inspection report in advance of deciding whether or not the home was suitable, although they did confirm that they received ample information about the home during their frequent visits and meetings with the staff team and Manager. It is recommended that the Statement of Purpose and Service Users’ Guide is offered to all prospective residents and their representatives at the earliest opportunity in order to support their decision of whether or not the home is suitable. Due to the high support needs of the residents accommodated, it is crucial for the home to ensure that as much information as possible is gathered prior to admission in order to ensure that the home 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. This should be in conjunction with the home’s Manager. There has been one new admission to the home since the last inspection. Whilst there was some documentary evidence in place to show that the home began planning the ‘transition move’ three months in advance of the proposed admission, which included frequent informal visits to the home, it was concerning to note that there was no pre-admission assessment documentation available for inspection. It was therefore not possible for the Inspector to determine what the person’s primary care needs were or that the home could indeed meet this person’s needs. During the course of the inspection, the Manager informed the Inspector that she had very recently been notified of a potential new placement who was due to be admitted to the home within the next couple of days. However, she had no further details of this person, their care needs, or whether or not the admission was on a temporary or permanent basis. This highlights that the Manager is not being consulted regarding potential placements to the home and that communication between the Assessment Referral Team and Manager of the home is poor. In addition, one relative commented that a breakdown in communication between the assessment team, the home and themselves, resulted in a three month delay of admission. The home is required to ensure that no person is admitted to the home whose needs have not been thoroughly assessed by a person trained to do so. Final decisions, regarding admissions to the home must be taken in conjunction with the home’s Manager with a clear understanding of what the home is able to provide. Documentary evidence of such assessments must be available for inspection. Although the home has appropriate terms and conditions of contract for residents, individual copies including the fees payable were not available 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 11 during this and the previous inspection. The Manager explained that she has requested this information on several occasions from the organisation’s head office, however this has not been made available. This requirement is outstanding from the previous inspection report. 287 Dyke Road DS0000060762.V336974.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 and 9. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ personal and healthcare needs are at risk of not being met due to care plans not being in place, implemented and reflecting actual current practice. EVIDENCE: All of the residents living at the home have profound physical and learning disabilities with associated healthcare needs. It is therefore important that individuals’ needs are clearly outlined within detailed plans of care in order to support care staff to meet such needs. Three care records were inspected in some detail. It was concerning to note that there was no plan of care in place for the most recent admission to the home. The acting Manager explained that she was awaiting a template plan of care from the administration office, however in light of the fact that this person had been living at the home for over three months, this is not considered acceptable. 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 13 All other residents have a template plan of care in place, titled ‘All about me’, which include a pen portrait of the person, their needs and likes and dislikes. It was disappointing to note that there was no evidence to demonstrate that they had been reviewed since the last inspection, updated and were current to reflect the needs of residents. In addition, it was concerning to note that residents’ health booklets remained incomplete and minimal information had been recorded and updated. The home is required to ensure that all residents have an up to date and person centred plan of care in place. These must provide care staff with detailed information regarding the action that is to be taken to meet the personal and healthcare needs of residents. These must be regularly reviewed and updated. Care staff maintain individual daily records for each person. The purpose of this is to record activities of daily living including any activities undertaken and personal and healthcare needs. Those seen were noted to be brief, insufficiently detailed and not person centred to individuals’ needs. For example, on a number of occasions staff had recorded that the person was ‘fine’ or they had ‘sat in their chair’. The home is required to maintain accurate and person centred daily records for each person. Due to the high support needs of the residents living at the home, they 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 risk assessments are in place for all activities of daily living and personal health care needs. It must be noted however, that a number of these had not been reviewed or updated since the last inspection. 287 Dyke Road DS0000060762.V336974.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, 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 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 on a daily basis Monday to Friday. This provides opportunities for some residents to engage in informative and creative activities, including sensory stimulation, art, postural movement, Speech and Language Therapy, physiotherapy, music, and IT. Other residents attend nearby schools and colleges. At weekends, dependent on the weather and the accessibility of transport, residents are supported out into the local community for example to the cinema, park, walk along the seafront, shopping, pub, football match and live music concerts. Some residents go home to stay with relatives for the weekend. 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 15 The organisation has four vehicles that are shared between five homes in the Brighton area and the development centre. Staff spoken with at the previous inspection commented that this posed some restrictions for the home as due to a change in insurance companies the number of drivers permitted to drive the only large vehicle appropriate for needs of the residents at 287 Dyke Road was reduced significantly, consequently impacting on the number of community activities that residents can take part in. The acting Manager confirmed that since the last inspection an additional driver has been recruited and that she has been assured by CMG that some of the older and smaller vehicles will soon be replaced. This will be followed up at the next inspection. CMG has an indoor hydrotherapy pool located at the rear of a nearby home, however this has not been in use for over two years. Members of CMG’s ‘Therapy Team’ comprising of an Occupational Therapist and Physiotherapist, have been working over the past 18 months to get the pool up and running and back in use for each of the homes. To date this is still not in use, which is an ongoing cause of frustration for some relatives who have raised this matter directly with the home. It is strongly recommended that priority be given to making the hydrotherapy pool useable for residents, as this will be a valuable asset to the residents of the home. Most of the residents living at the home are supported by care staff to go on regular holidays or short breaks away. One of the senior care staff explained that due to residents’ high support needs the maximum time for travel is limited to no more than three hours journey. Recent holidays include Bognor in West Sussex and Rye in East Sussex. 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 is currently only one resident who is able to eat food orally. It was noted on the day of the inspection, that this person’s lunch and evening meal had been liquidised together. It is recommended that all food including liquidised meals are presented in a manner which is attractive and appealing in terms of texture, flavour and appearance. All other residents have clear feeding programmes in place, which staff are trained to administer via residents’ specialist feeding tubes. A Speech and Language Therapist is responsible in assessing, planning and reviewing individual needs, including providing training to staff. 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 16 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 poor. This judgement has been made using available evidence including a visit to this service. Whilst residents are supported to access a range of healthcare services to meet their physical and emotional well-being, care plans and health booklets fail to ensure that all residents’ personal and healthcare needs are identified and met. Medication practices are sufficient. EVIDENCE: All residents are registered with a local GP and dentist. The acting Manager explained that unless it is an emergency situation, in which case they would call for the emergency services, CMG requires care staff to request GP appointments via the Healthcare Coordinator (employed by CMG). Some of the care staff spoken with said that this can sometimes be rather frustrating and in some instances cause a delay in residents’ being seen (although the CSCI has no concerns that the emergency services would be called in the event of a person’s health deteriorating). Staff explained that in most instances the GP visits the home although residents are supported to appointments at the surgery if they are well enough. 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 17 The home tries to ensure as much as is possible that a member of staff is allocated to stay with residents for all hospital admissions. 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. Some of the residents living at the home have epilepsy. The home was required at the last inspection to ensure that individual epilepsy management guidelines were reviewed to include a brief history of the person’s seizures, a description of what form the seizure takes and instructions for staff to follow in the event of a seizure occurring. In addition it was further required that epilepsy training be provided for all staff. Both requirements are outstanding. CMG employs a Speech and Language Therapist, Occupational Therapist and Physiotherapist, who are responsible for working into each of the homes, devising specialist programmes and purchasing any additional specialist equipment. Referrals are made to the local Community Learning Disability Team (CLDT) on an individual basis. 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 and due to their high support needs require their medication to be either prescribed in liquid form or crushed prior to administration (as directed by their GP), which are administered via their specialist feeding tubes. The Manager of the home confirmed that only staff who have received the appropriate training are able to give medicines, whilst either the acting Manager or Deputy 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 with clear and accurate records maintained, a minor shortfall was identified in respect of how the home manages medicines that are to be given outside of the home e.g. when a resident goes home for the weekend. The Manager is required to ensure that these procedures are clearly written up and documented within the home’s policies and procedures for the safe handling of medicines. 287 Dyke Road DS0000060762.V336974.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 good. This judgement has been made using available evidence including a visit to this service. The home has good systems in place to ensure that all complaints are dealt with appropriately. Residents are protected from potential harm, neglect and abuse through the home’s robust policies and procedures and through staff receiving appropriate training. Residents’ finances are managed well. EVIDENCE: The home has a detailed complaints procedure in place, which is included within the home’s Statement of Purpose and Service Users’ Guide. 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. The home has a detailed Adult Protection and whistle-blowing policy and procedure in place in accordance with local multi-agency guidelines. Staff spoken with confirmed that refresher training has been provided since the last inspection and that they would feel confident in reporting any concerns of suspected abuse and/or poor practices within the home. No alerts have been raised since the last inspection. A sample of residents’ monies, including expenditure receipts were seen on the day of inspection and found to be in order. 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 19 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, 27, 28, 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 friendly and relaxed environment that is kept in reasonably good decorative order. It presents as a clean, well-maintained and homely place to live. EVIDENCE: The Inspector was shown around all areas of the home by the acting manager. All areas were noted to be clean and well maintained. Residents’ bedrooms are personalised to individual preferences with appropriate specialist equipment in place including electrically operated beds and pressure relieving mattresses for those who need it. All residents have their own television and audio equipment in their bedrooms, some of which have recently been updated with flat screen TV’s. There are a number of photographs displayed throughout the home of each of the residents, all of which have been nicely framed and presented. 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 20 The home has three bathrooms complete with assisted baths, showers and overhead tracking. All hot water outlets are fitted with regulated valves to ensure that hot water is only delivered to a maximum of 43°C. Since the last inspection all exposed hot water pipes have been protected with lagging in order to safeguard residents and staff from potential harm. 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 eight residents at any one time, due to their specialist equipment i.e. wheelchairs, lying boards and specialised seating. These concerns have been raised with the Senior Management Team over the past 18 months by relatives. Whilst the acting Manager has little influence over the final decision as to whether or not this area will be extended or adapted, she has removed some of the additional staff seating and purchased a flat screen TV that is affixed to the wall in order to create more space. In addition, the Manager has raised concerns regarding the draughty conservatory area that adjoins the lounge, dining area and kitchen. She explained that in the colder weather the temperature can drop considerably and due to the ill-fitting windows a draught occurs, which prevents residents using their lying boards on the floor in the lounge (as per their postural management guidelines). The home is required to take the appropriate action to address these shortfalls. 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 21 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. Recruitment procedures are sufficient, although all documentary evidence must be made available for inspection. EVIDENCE: In addition to the acting Manager, the home employs a Deputy Manager, four senior support workers and 13 carers. Two domestic staff are employed. Well over 50 of care staff have achieved at least NVQ Level 2 in Care. This is improved since the last inspection. Staffing rotas confirmed that there is always a minimum of four care staff on each shift in the daytime and two waking night staff. Staff working hours are divided into early and late shifts. The Manager explained that the total number of staff working at weekends is usually six or seven. Relatives commented that the there is usually enough members of staff on duty when they visit. Care staff spoken with said that CMG and the Manager are very supportive in providing additional training. Recent training includes refresher First Aid, 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 22 eating and drinking, Adult Protection, Fire Training and the safe handling of medicines. As previously mentioned, it remains an outstanding requirement for all staff to receive epilepsy training. The staff team has remained relatively stable over the past couple of years, with very few staff choosing to leave. It was pleasing to hear that all the care staff spoken with were happy in their work and spoke positively about the residents and their colleagues. 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) check, health declaration and Equal Opportunities Monitoring Form. The recruitment files for two newly appointed members of staff were examined. It was pleasing to note that application forms were sufficiently detailed and there was evidence of a PoVA First check and Criminal Record Bureau (CRB) check in place, however only one written reference could be found in both files. Whilst the Manager assured the Inspector that the second references were held at the organisation’s HR department, the Manager was reminded of her responsibility to ensure that all recruitment checks are available for inspection at the home. A requirement has been made in respect of this. In light of the minor shortfalls that have been raised regarding staffing matters within the home, the CSCI considers the overall outcome judgement for this area to be good. 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 23 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 and 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The overall conduct and management of the home has declined since the last inspection. The home’s quality assurance systems need to be developed to ensure that a high standard of care is maintained for residents. EVIDENCE: The acting Manager of the home has been working in the care setting for a number of years and with CMG since 2004. She has been the acting Manager of 287 Dyke Road since September 2006 following the departure of the previous acting Manager. She has attended a number of different training courses relevant to her current role, however has yet to complete her Registered Manager’s Award (RMA), although she hopes to start working towards this in the near future. 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 24 It remains an outstanding requirement from the last three inspection reports for an application to be submitted to the CSCI for a person to become the Registered Manager of the home. Seeking feedback from residents is a challenging role for CMG due to individuals’ high support needs and limited verbal communication skills. Relatives did confirm however that their views are sought on a regular basis. The homes own quality assurance systems were inspected. Despite CMG having provided the home with a quality assurance manual, this is still very much in it’s infancy and yet to be implemented. It is of concern that the home’s own monitoring systems have failed to identify the shortfalls that have been raised during this inspection regarding outstanding requirements from the previous inspection and the home’s care planning procedures. In addition, the returned AQAA also failed to highlight any short failings. The acting Manager commented within the questionnaire: “We are very proactive” “There are few areas where we could improve” Due to these failings and the failure of the Providers to identify and rectify key issues, the CSCI must consider the most appropriate action. It was pleasing to note that since the last inspection all ground floor windows have been restricted. This helps to better safeguard residents and staff from potential intruders. Staff raised concerns during the home’s last inspection regarding the home’s call bell and monitoring system. The Manager and staff explained on the day of this inspection that this problem is yet to be resolved. This was discussed in length with the acting Manager, including the action that night staff are currently taking and what the benefits would be of having individual monitors in place for each resident. It must be noted that all residents are being checked hourly throughout the night, which was evidenced by daily records. The home is required to undertake individual risk assessments for each person in order to determine the most appropriate action and monitoring systems that are to be used. 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 25 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 3 2 1 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 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 2 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 2 2 2 X 2 X 1 X X 2 X 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation Requirement Timescale for action 31/12/07 12(1)(a)(b) That no person is admitted to the home whose needs have not 14(1)(a-d) been thoroughly assessed by a person trained to do so. Final decisions, regarding admissions to the home must be taken in conjunction with the home’s Manager with a clear understanding of what the home is able to provide. 2. YA5 5(1)(b) Documentary evidence of all pre-admission assessments must be available for inspection. That copies of residents’ terms 31/12/07 and conditions of contract are kept within the home and made available for inspection. These must be inclusive of the fees payable. 3. YA6 YA9 YA18 [Outstanding from the last inspection]. 12(1)(a)(b) That all residents have an up to 31/12/07 date and person centred plan of care in place. These must: 15(1)(2) (a-d) - provide care staff with detailed information regarding the action DS0000060762.V336974.R01.S.doc Version 5.2 Page 27 287 Dyke Road that is to be taken to meet the personal and healthcare needs of residents - be based on up to date risk assessments and - be regularly reviewed and updated. 17(1)(a) That accurate and person (3)(a) centred daily records are maintained in respect of each resident. 12(1)(a)(b) That individual epilepsy management guidelines are 18(c)(1)(i) updated. These must 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. Epilepsy training must be provided to all staff. [Outstanding from the last inspection]. 13(2) That the procedures for the administration of medicines 17(1)(a) outside of the home (e.g. when residents are on social leave) are clearly written up and documented within the home’s policies and procedures for the safe handling of medicines. 23(2)(a)(b) That the appropriate action is taken to resolve the cold and draughty conservatory area. 19 & Sch 2 That all recruitment checks including two written references are made available for inspection at the home. 18(1)(a) That an application is submitted to the CSCI for a suitably qualified person to become the Registered Manager of the home. 4. YA6 31/12/07 5. YA19 YA35 31/12/07 6. YA20 31/08/07 7. 8. YA24 YA34 31/12/07 31/12/07 9. YA37 31/12/07 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 28 10. YA39 24(1)(a) (b) 24(3) 11. YA29 YA42 16(2)(c) [Outstanding from the last three inspections]. That effective quality assurance systems are in place and implemented in order to review the quality of care provided at the home. That individual risk assessments are undertaken for each resident in order to determine the most appropriate action and monitoring systems that are to be used. 31/12/07 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations That a copy of the Statement of Purpose and Service Users’ Guide is offered to all prospective residents and their representatives at the earliest opportunity in order to support their decision of whether or not the home is suitable. That priority is given to making the hydrotherapy pool useable for residents. That all food including liquidised meals are presented in a manner which is attractive and appealing in terms of texture, flavour and appearance. That in line with Valuing People, Health Action Plans are implemented. 2. 3. 4. YA14 YA17 YA6 YA19 287 Dyke Road DS0000060762.V336974.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. Extracts may not be used or reproduced without the express permission of CSCI 287 Dyke Road DS0000060762.V336974.R01.S.doc Version 5.2 Page 30 - 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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