Inspection on 29/08/06 for 32 South Street

This inspection was carried out on 29th August 2006.

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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

32 South Street 07/08/07

32 South Street 05/12/05

32 South Street 07/06/05

32 South Street 29/11/04

32 South Street 24/05/04

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

CARE HOME ADULTS 18-65 32 South Street Sheringham Norfolk NR26 8LL Lead Inspector Jenny Rose Key Unannounced Inspection 29th August 2006 10.50 32 South Street DS0000027522.V310338.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 32 South Street DS0000027522.V310338.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. 32 South Street DS0000027522.V310338.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 32 South Street Address Sheringham Norfolk NR26 8LL 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) 01263 824040 01263 824040 info@prime-life.co.ukwww.prime-life.co.uk Prime Life Limited Miss Katherine Angela Pye Care Home 19 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (19) of places 32 South Street DS0000027522.V310338.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Nineteen (19) Service Users with a mental disorder excluding learning disabilty or dementia, three of whom are over the age of 65 years, may be accom modated. All new admissions must be between the ages of 18 and 65 years. 2. Date of last inspection 5th December 2005 Brief Description of the Service: 32 South Street accommodates 19 service users with a mental disorder. The accommodation provides 19 single rooms some with en suite facilities on three floors. The top floor consists of a three bedroom flat with its own sitting room and bathroom and a bed sitting room with bathroom. This accommodation is used by those service users who are more independent. The remaining service users live together sharing the communal accommodation. There is a service users kitchen for them to make drinks and a variety of lounges including a smoking lounge and a games room. There is also a very attractive garden. The Home is registered to accommodate those who are under 65 years of age and new admissions will meet this criteria. Because of the previous registration, there are some service users who are older than that and the Home is required to monitor their needs carefully to ensure they are catered for. The Home is in a quiet street in a residential area near to the town centre of Sheringham within reach of the beach and the towns facilities. 32 South Street DS0000027522.V310338.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine, unannounced inspection, taking place over 7.5 hours. The manager, Ms Kate Pye, was engaged with a resident’s doctor’s appointment for two hours, but was available for the rest of the inspection. There were 18 residents living in the home, including two on respite care. Preparation had taken place in the CSCI office and there was a completed Pre-Inspection Questionnaire. Policies and records were examined and a partial tour of the premises undertaken. The Commission had also sent out survey forms to be distributed by the Home to the residents and their relatives. Six completed forms had been received from residents, plus three more completed on the day and their views have been taken into account in this report. No surveys had been returned from relatives/representatives, or from healthcare professionals, although two healthcare professionals were spoken to on the day. Two members of staff were spoken to in private; four residents were spoken to in private and one privately in her room; one with a healthcare professional; three in private in a group and two in private in a group. What the service does well: • The residents feel free to come and go from the home as they want and to be private and be by themselves if they prefer. Residents’ families and friends are welcomed to the home. There is good liaison with community health services and the residents have good access to doctors and other professionals who can help them. The manager and staff have commitment to the residents and wish to provide good service, but residents feel there are staff shortages. One resident keeps a dog in the home, which makes a homely atmosphere for those residents who like animals. • • • What has improved since the last inspection? • There have been some developments in the provision of educational opportunities for individual residents, increasing confidence and independence, but this still needs further development. 32 South Street DS0000027522.V310338.R01.S.doc Version 5.2 Page 6 • The food offered in the home and the quantity appears to have improved, but several residents feel there should be a designated cook. The nutritional needs of some residents need to be closely monitored. Several areas of the home have been recarpeted, but needs cleaning on a regular basis. Medication administration has been reviewed, records were in order and there are now safer procedures for administering medication and promoting independence. The staff shortage during the evening has been solved by the sleep-in night staff not going to bed until 10.00pm, however, over the last few months, because of staff shortages, this has caused some staff to be working long hours • • • What they could do better: • • As at the last inspection, the bathrooms were not found satisfactory and a programme of renovation is still required. The pre-assessment process should be more rigorous, and reviews recorded, in order to ensure that prospective residents are more easily integrated into the resident group and that their needs can be met within the home. There has been no designated cleaner in the home for several months, although many residents clean their own rooms, or are supported to do so. As a result, the cleanliness and tidiness of the home was unsatisfactory There is a no designated cook and there were four residents who voiced dissatisfaction with the meals, especially at times of staff shortages and several weeks without a working oven. Some residents would appreciate the use of a microwave so that they can make hot snacks. The home’s own system for reviewing what is going on in the home and seeing where it needs to improve, as required at the last inspection, is still not thorough enough. Although six surveys stated that residents knew to whom to complain, if necessary, four residents spoken to did not feel their views were listened to, Although the fan in the smoking area has been renewed, arrangements for a designated smoking area still impinge on non-smoking areas and some residents are smoking in their rooms, without risk assessments for this activity. • • • • 32 South Street DS0000027522.V310338.R01.S.doc Version 5.2 Page 7 • There needs to be a risk assessment on particular items of furniture, particularly the rocking chair and rocking stool which was in the hall and the cause of an accident to a resident. The residents are supported to take risks as part of an independent lifestyle, but there should be evidence of their involvement in any risk assessment. Bedding needs to be replaced again, although it was replaced following a previous inspection. • • 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. 32 South Street DS0000027522.V310338.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 32 South Street DS0000027522.V310338.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The quality outcome in this area is adequate. This judgement has been made using available evidence, including a visit to this service. Although people who use this service have good information about the home, the personalised needs assessment is not rigorous enough and means that in some cases, people’s diverse needs are not identified and planned for before they move to the home and integrated into the resident group. EVIDENCE: There is evidence from care plans examined and from a previous inspection that there is a process for assessing residents’ needs, with the home’s own format being completed by the social worker and resident, and information was also provided from other healthcare professionals if appropriate. The manager also said that she would visit the prospective resident to assess whether they would fit into the home and they would visit, either for the day, or longer, if appropriate. However, a more rigorous assessment of prospective residents’ diverse needs, which may have changed since they last stayed in the home for respite care, would ensure diverse needs are identified and planned for before they move to the home and would also ensure whether, in principle, that the individual would be suitable to live with the other people already residing in the home. There was no evidence that the care plan for one resident had been reviewed and with his involvement. Although the manager was actively engaged in his 32 South Street DS0000027522.V310338.R01.S.doc Version 5.2 Page 10 referral for professional help on the day of the inspection. There is therefore a recommendation for the above. One resident spoken to said he had been to the home for respite care before making the decision to stay at the home on a permanent basis. He was also aware of his contract with the home and the terms and conditions. Six resident surveys confirmed that they had received information before coming to the home. 32 South Street DS0000027522.V310338.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 The quality outcome in this area is good. This judgement is based on available evidence including a visit to the service. Care plans describe the assistance residents need from the home, who are supported to make their own decisions about their lives as much as they are able. They are also encouraged to be more independent and to take risks as part of their care plan. EVIDENCE: Four care plans were examined at random, all of which were based on the pre admission assessment and all contained a full assessment of residents’ abilities and needs. It was clear from the records what assistance was needed from staff and a specific action plan was in place for particular needs. Staff monitored residents’ health and progress and wrote full reports every two or three days, or as required. There was evidence that residents were involved with their care plans and they are reviewed on a regular basis by the home and also there are social worker and psychiatric reviews. The completed service users’ surveys and residents spoken to all provide evidence that residents make decisions about their lives. “I make my own decisions”, says one residents’ survey…”Yeah, its nice to do what I want”, says another. Residents spoken to confirmed that they made most of the decisions 32 South Street DS0000027522.V310338.R01.S.doc Version 5.2 Page 12 about their lives, like whether to go out, stay in their room and when to go to bed and it was their illness which held them back rather than any restrictions in the home. The Minutes of a previous residents’ meeting on 16 May 2006 was seen, when choice of food was discussed. This is dealt with elsewhere. (YP17). One resident spoken to described the keyworker system and confirmed that he was able to speak to staff if he needed to and that advocacy services had been arranged for him by the home. Risk assessments are in place, although these are mainly to do with the risk of the resident not doing something. Risk assessments are in place to deal with the risk of aggression, neglect, or self harm. However it was not always clear that residents had been involved and that they understood and agreed to limitations, as there was no signature, nor that these were regularly reviewed to ensure their on going relevance. Although it is evident from speaking with the manager and staff that involvement of residents is at the heart of the planning of care. There is therefore a recommendation for this. One resident, at least, was smoking in the bedroom and there was no risk assessment for this, which is dealt with elsewhere in this report. 32 South Street DS0000027522.V310338.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,17 The quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. Support staff are being required to cover ancillary tasks in the home, leaving less time to support residents in meaningful activities both at an individual and group level. EVIDENCE: In this home there are a number of residents who are in the older age spectrum and would not necessarily wish to have the opportunity for employment, sheltered work. Since the last inspection there are no residents involved in such activities. However, the Manager has worked hard to pursue opportunities for one resident who has enjoyed a water colour course and is anticipating three more craft classes. Two residents have also completed Fire and Food and Food Hygiene certificates and since the last inspection, one resident has moved to independent living. Several of the residents are able to go out and use the local shops and facilities, including walking along the beach, sometimes with the dog who lives with a resident in the home. The home shares transport with another local home, but on some occasions staff need to use their private cars, when the residents are then dependent 32 South Street DS0000027522.V310338.R01.S.doc Version 5.2 Page 14 on that member of staff being on duty to take them out, also there are some residents who are too tall to travel comfortably in private cars. There is a games room in the house with a pool table, but this room was out of commission and was being used as a store room on the day of the inspection. There had been a recent outing to the show on the local pier. Some residents are content to sit about and be quiet with an occasional outing for a coffee with a member of staff. One resident spoken to in her room did not wish to have a TV in her room and said she liked listening to the radio and doing her knitting. One resident spoken to said he ‘felt safe’ in the home and that he came and went as he pleased. He liked being able to ask for a clean towel every day. He felt most of the meals were all right, but he would have liked a cooked breakfast and goes to town in the morning to get one. He said that visitors were welcome to the home, providing they should sign the visitors’ book and he also described regular fire drills since he had been in the home. He also said he was supported to clean his room and to do his laundry. The keyworking system is working in enabling some residents to gain confidence. One resident had recently been out with her keyworker to buy new clothes. However, there is still room for improvement for individual and group activities and several residents commented that a pump had been promised for the fish pond in the garden, but this had not yet materialised. There was evidence from speaking to residents and staff that support and encouragement is given to residents to retain family links and friendships. Some keep in touch by phone, or visits to family, and vice versa. There are no restrictions on visitors to the home. Two residents confirmed that their relatives visted the home. Discussions with staff and the Manager demonstrated that there was a good understanding of peoples’ rights and the need for them to make their own decisions in respect of daily living, except where limitations have been agreed through care planning. Also residents’ responsibilities were being encouraged at the same time, especially in the change in the medication procedure, which is dealt with elsewhere. (YP20) The daily routines aimed to be as flexible as possible, with residents sleeping late or being private in their rooms without interference from staff There are issues around smoking and alcohol being brought into the home, which will be dealt with elsewhere. (YP42) There was a requirement from last inspection regarding the quantities in the meals and facilities for residents to make their own snacks and there has been some improvement. The Minutes of a Residents’ Meeting held on 16 May 06 were seen and meals were on the agenda. There is now Brunch once a week on Saturdays later in the morning; meals are saved for when these people are 32 South Street DS0000027522.V310338.R01.S.doc Version 5.2 Page 15 hungry, if they do not come at the usual meal times. This was observed on the day of the inspection and confirmed by staff spoken to. There had been an issue with the oven, which had caused some difficulties over an extended period, although this had now been replaced. A microwave was still not available for residents to make snacks. There were also five residents spoken to who had reservations about the food and the quantities available. One would like a cooked breakfast every day. However, the manager is mindful of the balance needing to be struck between those whose nutritional needs need to be monitored and those on weight reducing diets. This is dealt with elsewhere in the Report. (YP19) There is therefore a recommendation for more facilities to enable residents to make their own healthy snacks, as well as toast, which also is part of a move towards more independence. There is no designated cook, but the manager reported that some members of staff enjoy cooking, the Manager reported, and in the last three months one member of staff has taken on the task of ordering. Fresh vegetables were seen to be available in the kitchen and both residents and staff spoken to said that staff ask for their choices in the morning. That day was going to be pork casserole or veggie drummers. Lunch was seen to be Oxtail soup or prawn sandwiches and one resident was seen to be able to ask for more soup. One resident makes lunch and is moving towards making own dinner, as part of progressing towards more independence and sometimes residents are assisted to do baking. Only three of the residents’ surveys said that they were involved in food shopping or menu planning. A report from the Environmental Health Officer was seen and amongst several issues was the matter of food hygiene training for support staff who are cooking, which is far from ideal, especially when support staff are required to do cleaning in the absence of a designated cleaner. This is dealt with elsewhere in this report. (YP33) 32 South Street DS0000027522.V310338.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 The quality outcome in this area is adequate. This judgement is based on available evidence including a visit to the service. Care plans describe the assistance residents need from the home; they are supported to make their own decisions about their lives, as much as they are able and also they are also encouraged to be more independent and to take risks as part of their care plan. However, more rigorous monitoring of residents’ changing needs both with continence, personal hygiene and weight in relationship to their nutritional needs would further support better healthcare for residents and maintain their dignity. EVIDENCE: Most residents can handle their own personal care, or may just need a prompt from staff. Residents spoken to said they received personal support provided in a private and dignified way. There are problems for some residents with their personal hygiene and continence. In addition, there is alcohol being brought into the house, which is impinging on other residents and was brought to the inspector’s attention by four residents spoken to. There were inco pads on most of the chairs in the communal area, which were unsightly and enfringed residents’ dignity. There is therefore a requirement for this to be remedied. However, the Manager described the work being done for those residents whose changing needs required more specialised help and this was observed to be put in action, particularly in relation to alcohol. 32 South Street DS0000027522.V310338.R01.S.doc Version 5.2 Page 17 The healthcare professional said that she had not visited the home very often, but had found them helpful and efficient when a previous resident’s clothes were mislaid and the home had responded quickly. The staff also sought advice and help with residents. In discussion with the manager it was noted there were a number of residents with problems of being underweight, as well as the opposite, and although these residents were being weighed and this weight recorded, it was not at present being linked with daily nutritional intake. There is therefore a recommendation for this to be undertaken. One resident had fallen off a rocking chair in the hall the previous Saturday and had been taken to hospital on the day of the inspection and had returned to the home with arm in sling with query broken elbow, she had to return the following day. This is dealt with elsewhere in the Report (YP42) The healthcare professional visiting on the day said that she had not visited the home very often, but had found them helpful and efficient when a previous resident’s clothes were mislaid and the home had responded quickly. She also confirmed the staff also sought advice and help with residents, if needed. A medication round was observed and there have been changes in the procedure for administering medication, which was a requirement from the previous inspection. Residents come to the medical room for their medication, which not only promotes independence, but also means that staff are not so easily distracted on to other tasks, when it is possible for mistakes to occur. Should the member of staff need to take medication to a resident’s room, the cabinet and room are locked during the time the staff member is away. The staff member spoken to felt that it was a safer way of administering the medication. The MAR sheets were seen to be in order. Healthcare professionals attend regularly for those residents who require injections, or other medication, one was spoken to on the day. There is a procedure for returned and refused medication. At the last inspection there was a recommendation that a more sturdy cabinet is provided for the controlled drugs, but this has not been carried out and there is therefore a repeated recommendation for this to be implemented. There are residents who are self medicating on a daily basis for whom there are risk assessments signed by residents. The medication dosette was seen to be kept in the locked drawer in the resident’s room where the medication. 32 South Street DS0000027522.V310338.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The quality outcome in this area is good. The judgement has been made using available evidence including a visit to the service. There are procedures in place for residents to voice their concerns and the majority of residents felt staff would listen to them. Residents are protected as far as possible by the home’s policies and procedures, but training for all staff in the protection of vulnerable adults would further ensure the safety of residents. EVIDENCE: The complaints procedure is in the residents’ guide and is pinned on the hall door. All the residents spoken to and all the returned surveys said they knew to whom to complain if they had reason to. The complaints record was seen and there had been no recorded complaints since the last inspection and nothing had come to the notice of the Commission. However, three surveys and one resident spoken to said that they had spoken to the Manager and the Management of the wider organisation about their concerns which were still ongoing and these concerns are dealt with within the Report and also seen to be known to the management of the wider organisation during a recent visit on 2 August 2006. (YP39) The Home has procedures in place for dealing with the protection of vulnerable adults and understand the procedures for the local agencies. It also has a whistle blowing procedure for staff and residents’ financial interested by a code of conduct which includes a gifts policy for staff. There is a new employee induction booklet for staff containing a 5 part section concerning the protection of vulnerable adults and the staff spoken to were aware of the issues. However, there is a repeated recommendation that staff should receive training on abuse, in view of the many available local courses. 32 South Street DS0000027522.V310338.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26,30 The quality outcome in this area is poor. This judgement has been made using available evidence including a visit to this service. The lack of cleanliness, tidiness, improved bathroom and smoking area facilities are not providing a comfortable or safe environment for the residents. EVIDENCE: A partial tour of the building was undertaken including visiting two residents’. rooms by invitation. Both residents said they liked their rooms, as did other residents spoken to and residents were able to lock their doors and had lockable facilities within the rooms in which to keep their personal possessions. All these residents confirmed that they kept their own rooms clean and changed their bedding. One resident was pleased to be able to ask for a clean towel every day. Although the bedding had been replaced, as a result of a recommendation in the inspection before last, there is a need for this to be reviewed again and there is a recommendation for this. The main communal rooms have been recarpeted, but due to the absence of a designated cleaner, it was difficult to appreciate that it was new. The smoking area, which everyone has to pass through to move around the house and to go to the office, has been provided with a new fan, but the smoke still affects the non-smokers and the area was dirty with full ashtrays and rubbish on tables. 32 South Street DS0000027522.V310338.R01.S.doc Version 5.2 Page 20 As dealt with elsewhere in this report, the inco pads on chairs are unsightly and undignified. The management of the wider organisation are aware of the lack of a designated cleaner and seven of the surveys received from residents mentioned the unsatisfactory cleanliness, particularly of the toilets, and the tidiness of the home. There has been a previous requirement regarding the cleanliness of the home (June 2005) and there is therefore another requirement for this. The bathroom facilities could be improved, which have been the subject of two previous inspections. The heating in one bathroom has been attended to, but there have been no other improvements. Several residents brought the attention of the inspector to the fact that the toilet in the same room as the bath on the first floor, made it unpleasant when the toilet had not been cleaned, although it was relatively clean on the day of the inspection. There is therefore a repeated requirement for the bathroom facilities to be reviewed. 32 South Street DS0000027522.V310338.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 The quality outcome in this area was adequate. This judgement has been made based on the available evidence and a visit to this service. Staff show commitment to the residents, but attention to further recruitment and training by the organisation would enable the residents’ needs, and particularly their changing, fluctuating needs, to be more effectively met, both individually and as a group. EVIDENCE: Two members of staff were spoken to in private and their staff files examined. Both these files contained the necessary recruitment documents, including two references and CRB checks and ID. One member of staff was very new, although his file contained evidence of Food Hygiene, First Aid, COSHH and Moving and Handling. The other member had many years experience working in the same care sector, his induction and foundation training, as well as medication training was seen, as well as confirmation of his request for the NAPPI training, which he had missed previously. There are two members of staff with NVQII, two others have commenced training. Four members have received NAPPI training, but none in Protection of Vulnerable Adults (dealt with elsewhere). However, both members gave a good account of the issues surrounding the subject. Both members of staff were enthusiastic about their work, especially when they could see residents’ health improve. They spoke of regular supervision (seen) and said that it was good to work as a team. They also spoke of staff 32 South Street DS0000027522.V310338.R01.S.doc Version 5.2 Page 22 meetings where issues are aired, the Minutes of which were seen, and of handover periods in between shifts, although these are not ‘built in’ to the shifts. From the rota, staff are working 12 hour shifts. The evening staff shortages have been covered by the sleeping in staff coming on shift at 8.00pm and working until 10.00pm, before going to bed. With staff shortages, which are known to the management of the wider organisation, two new staff are about to be recruited, but there is no cleaner and no designated cook, and staff are working for long, continuous periods. In addition, there are some residents whose changing needs are fluctuating and there is a need to balance those needs with the needs of the resident group, which demand the attention of the support workers. The home has been working hard to increase the amount of stimulation to residents and to attend to their mental health needs, particularly through the keyworking system, but at the same time, this home has for some time been reluctant to address the issues regarding staffing and therefore the requirement has been repeated from the previous inspection. One new staff member gave a good account of the procedure following an accident to a resident attempting to sit on a rocking chair and stool. Residents’ surveys, and residents spoken to, had no negative comments concerning the staff and they felt able to approach them with any concerns. 32 South Street DS0000027522.V310338.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 The quality outcome in this area is adequate. This judgement was made on the available evidence including a visit to this service. Lack of a quality assurance system, particularly at a local level, ratified by the national organisation, is failing to ensure that the residents’ concerns are heard. In addition, the lack of an audit relating care practices to residents’ changing needs, together with the lack of risk assessments on furniture and the issues of smoking both in residents’ rooms and its affect on non-smoking communal areas, are all factors which could compromise the health, safety and welfare of residents. EVIDENCE: The Manager has a care qualification and has recently completed her work for her NVQ4 in management and hopes to start the care component in October 2006. She has over two years experience in the post and has the support of this national organisation’s policies and management structure, where the ultimate decision making lies. Both staff and residents spoken to found her to be open and approachable and this was confirmed in the residents’ surveys. 32 South Street DS0000027522.V310338.R01.S.doc Version 5.2 Page 24 Although historically the organisation has some elements of a quality assurance system provided by a comments book, and there are visits by the organisation’s management team, as well as audits of the building, together with lists of jobs recorded as a result of that audit; there is again no evidence of any of any analysis of issues raised by previous surveys at a local level, for example regarding meals, and how the home would tackle these. It was not clear that there is a set of standards showing what would be measured in a quality assurance system, nor does there appear to be an analytical approach to care practices, particularly in relation to residents’ changing needs, and their implications for staff training, nor attention to what residents say. There is therefore a repeated requirement for the establishment and maintenance of a system for reviewing and improving the quality of care provided in the home. The report of which should be supplied to the Commission. The Fire records were examined and were found to be in order and one resident spoken to had confirmed there were regular fire drills, since he had been in the home. However, the present fire record book gave little space for noting anomalies in the testing of the fire equipment and the Manager was hoping to obtain a new one. Staff receive Health and Safety training, and previous inspections revealed that the lift equipment, the valves on taps and electrical equipment was carried out, as well as accident records being in order. However, there are issues regarding the health and safety of the residents surrounding residents who are smoking in the home. The designated smoking area, even with the new fan, still means that smoke affects everyone who comes into the building, as they need to pass through this area and it also impinges on the non-smoking communal areas, as it cannot be closed off. There is therefore a repeated recommendation for this to be reviewed, particularly in the light of recent legislation. In addition, residents are smoking in their rooms and there is a requirement for risk assessments to be carried out for this activity. There is also a requirement for risk assessments to be carried out on some of the furniture, particularly the rocking chair and matching rocking stool placed in the hall, which had been the cause of a recent accident to a resident. 32 South Street DS0000027522.V310338.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 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 X 2 X X 2 X 32 South Street DS0000027522.V310338.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? 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 YA18 Regulation 4(a) Requirement The registered person must provide flexible support to maximise service users’ dignity and control over their lives. (In this case personal hygiene and continence). The registered person must review the bathroom facilities to ensure they are suitable for the service users, are kept in good repair and are heated. This is a repeated requirement The registered must ensure that the premises are kept clean, hygienic and free from offensive odours The registered person must ensure that suitably qualified staff are working at the care home in sufficient numbers for the health and welfare of the service users. This is a repeated requirement The registered person must establish and maintain a system for reviewing and improving the quality of care provided at the DS0000027522.V310338.R01.S.doc Timescale for action 02/10/06 2. YA27 23(2)(j) 03/11/06 3. YA30 23(2)(d) 02/10/06 4. YA33 18(1) 03/11/06 4. YA39 24(1) and (2) 01/12/06 32 South Street Version 5.2 Page 27 home and supply to the Commission a report in respect of any review. This is a repeated requirement 5. YA42 13(4)(c) The registered must ensure that any unnecessary risks to the health and safety of service users are as far as possible eliminated (in this case, the rocking chair and stool in hallway) The registered person must ensure that any activities in which service users participate are free from avoidable risks. (in this case smoking, particularly in residents’ rooms) 02/10/06 6. YA42 13(4)(b) 02/10/06 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 YA2 Good Practice Recommendations It is recommended that a more rigorous assessment of prospective service users’ diverse needs are identified and planned for before they move to the home. It is recommended that service users’ involvement in risk assessments is recorded and regularly reviewed to ensure their ongoing relevance. It is recommended that service users continue to be encouraged with individual activities through the development of the key worker system.(This recommendation is repeated) It is recommended that the location of the smoking room be reviewed to ensure that non-smokers and visitors are able to benefit from a smoke free zone. (This recommendation is repeated) It is recommendation that there are more facilities to make their own healthy snacks as part of a move towards DS0000027522.V310338.R01.S.doc Version 5.2 Page 28 2. 3. YA9 YA14 3. YA16 4. YA17 32 South Street 5. YA19 6. YA20 more independence. It is recommended that an assessment of the service user’s needs is kept under review and revised when necessary, in this case the monitoring of weight loss and nutritional intake. It is recommended that a more sturdy cabinet be provided for the controlled drugs. (This recommendation is repeated) It is recommended that staff are offered the opportunity to attend abuse training. It is recommended that the pillows and bedding in the home are reviewed to ensure they are fit for purpose 7. 8. YA23 YA26 32 South Street DS0000027522.V310338.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 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 32 South Street DS0000027522.V310338.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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