Inspection on 14/05/07 for 35 Lowther Road

This inspection was carried out on 14th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

35 Lowther Road 06/11/08

35 Lowther Road 29/10/07

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Lowther Road (35) 35 Lowther Road Bournemouth Dorset BH8 8NG Lead Inspector Heidi Banks Key Unannounced Inspection 14th May 2007 13:45 Lowther Road (35) DS0000068520.V339656.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 Lowther Road (35) DS0000068520.V339656.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. Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lowther Road (35) Address 35 Lowther Road Bournemouth Dorset BH8 8NG 01202 391610 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) Robinia Care South Ltd Mr Stuart Victor Chamberlain Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection This is the first inspection of the service. Brief Description of the Service: 35 Lowther Road was registered as a care home in October 2006. It is a detached house situated in a residential area of Bournemouth and is registered to provide accommodation and personal care to up to four adults with a learning disability. The registered provider is Robinia Care South Limited. The regional office of the organisation is in Hindhead, Surrey. It currently supports seventeen services throughout the southern region. Mr Kevin Nuttall is the Regional General Manager and is the Responsible Individual for 35 Lowther Road. Mr Stuart Chamberlain is the Registered Manager for the home. Accommodation at 35 Lowther Road is on two floors. There is one bedroom with en-suite facilities on the ground floor and three en-suite bedrooms on the first floor. There is a communal lounge, spacious kitchen / dining area, conservatory and large garden at the rear of the house. The home is staffed on a 24-hour basis with one waking night member of staff at the present time. The home is within walking distance of a bus stop from which the shopping and commercial centres of Bournemouth, Charminster and Winton are easily reached. Bournemouth’s main railway station is also within reasonable walking distance to enable access to places that are further a field. The home has a paved area at the front of the property for parking and additional parking is available on the road. Up-to-date information about fees at the home has not been supplied to the Commission by the service. Guidance on fair terms in care homes contracts may be obtained from the Office of Fair Trading – www.oft.gov.uk Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection of the service. The inspection took place over approximately ten hours on three separate days in May 2007. The purpose of this inspection was to assess the home’s progress in meeting the key National Minimum Standards since its registration with the Commission in October 2006. At the time of the inspection there were two people living at 35 Lowther Road. During the inspection we were able to take a guided tour of the home, meet both of the people who use the service and observe some interaction between them and staff. Discussion took place with the Registered Manager and Area Manager of the service and some members of the staff team. A sample of records was examined including some policies and procedures, medication administration records, health and safety records and service user and staff files. An Annual Quality Assurance Assessment was completed by the Area Manager and supplied to the Commission following the inspection. Telephone contact was made with relatives of people using the service and a Care Manager who was responsible for placing one service user in the home. Information from these sources has been reflected throughout the report. A total of twenty-three standards were assessed at this inspection. Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: As a result of this inspection, six requirements and ten recommendations have been made. At the time of the inspection, a large amount of medication was not being stored securely and therefore presented a risk to people using the service. An immediate requirement was made for the medication to be put in a safe place or returned to the pharmacy. This was followed up promptly by the provider. Further review of medication practices is recommended to ensure that procedures in the home are robust. Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 7 There was not enough evidence to indicate that recruitment practices in the home fully meet the Regulations. This must be addressed in order for service users to be confident that people employed to work with them are safe to do so. Some shortfalls were identified in relation to health and safety practices in the home including the need for the service to notify the Commission of incidents and accidents occurring in the home. Although a risk assessment was in place regarding a service user using the stairs this was not comprehensive enough to promote the person’s safety in all circumstances. Since the inspection the provider has reported that action is being taken to address this. The home must also complete a full fire risk assessment and ensure that checks on fire safety systems and fire drills are carried out on a regular basis to promote people’s awareness of safe evacuation procedures. Review of activities on offer to people using the service indicated that, on occasion, they had not been able to attend scheduled activities due to staffing issues and a lack of available drivers. It is recommended that this is reviewed by the home to ensure that arrangements are made to meet the individual needs of service users. The home’s complaints procedure is not currently in a format that is accessible to service users. Improvement to the recording of complaints and concerns is also recommended so that issues raised and how these are dealt with are fully documented. This will help evidence how the home aims to achieve positive outcomes for the people who live there. The home should ensure that staff are able to undertake training in total communication approaches so that they have the skills to communicate with people living there. The home’s quality assurance process should be fully implemented, ensuring that there is an annual development plan for the service based on the needs, views and aspirations of the people who live there. 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. Lowther Road (35) DS0000068520.V339656.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 Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good amounts of information had been obtained by the home prior to service users’ admission to ensure that they were able to meet their needs and preferences and facilitate a smooth transition. EVIDENCE: The records for two service users were inspected for evidence of assessment documentation. One service user moved to the home from another care home within the organisation. There was evidence that the Registered Manager at 35 Lowther Road had visited the service user at her former home and day service and that information had been shared including information on the service user’s needs, chosen lifestyle and copies of support plans. Documentation also indicated that the person had been able to visit 35 Lowther Road with two friends and family members. Some documentation on file had not been signed or dated. For the second service user, there was evidence that an assessment of the individual’s needs had been carried out prior to the person moving to the home. This included information on her health care needs, family Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 10 relationships, activities and likes and dislikes. Discussion with the Registered Manager, a relative of the service user and her Care Manager indicated that there had been excellent liaison between all parties prior to the move; ‘The transition could not have gone better’. While the home had been going through the registration process with the Commission, regular contact had been established and maintained between the home and the service user. This had included the opportunity for the Registered Manager to work closely with the service user and relatives in developing a Person Centred Plan. This had meant that the Plans were completed prior to the move and care workers had a good amount of information available to them about the service user’s needs. Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has ensured that the needs and preferences of people who use the service are clearly detailed in support plans and take account of their ability to make choices and decisions in their daily lives. EVIDENCE: The Person Centred Plan for one person who uses the service was seen. This contained some excellent, detailed information about the person’s needs and preferences in activities of daily living and how the service user communicates, for example; ‘I like to have breakfast in my pyjamas and red dressing gown before I have a bath’; ‘I am very quick to learn signs so please encourage me to learn more.’ The Plan also focused on ways in which the service can promote the service user’s independence, for example, ‘How I like to be supported to make a cup of tea. I can open the cupboard myself. I will pick the mug that I want. I like to choose my own teabag...’ It was apparent that Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 12 the Plans are used as working documents with changes and amendments being made as more information about the service user’s needs and preferences was gathered. There was evidence that care workers had signed to show that they had read the Plans and at the time of the inspection an agency worker was reading the Plans so that she had information about the service user’s needs. The Plan was written in the first person and what was written clearly reflected reality, for example, where the service user’s likes had been described as looking at catalogues and listening to music, observation of the person at home showed this to be true. Due to the quality of information in the Plans the standard is considered met. However, it has been suggested to the Area Manager that it is clearly documented on the Plan the names of the people contributing to the Plan, with their signatures where appropriate, the date on which the Plan was written and when additions or amendments are made. The Plans showed evidence that service users’ abilities to make choices and decisions in their daily lives is respected; ‘I like to wear my watch and sometimes a necklace too’; ‘I like to be given the choice of about three outfits to wear that day.’ Observation of care workers’ interaction with service users showed that they are supported to make choices. Care workers are making efforts to understand total communication approaches to maximise two-way communication and ensure they understand the choices that service users are making. Discussion with care staff on duty indicated that they had respect for service users’ abilities to make decisions and were motivated to support them in following these decisions through. Inspection of a service user’s file showed that a series of risk assessments were in place. The risk assessment framework covered a breakdown of the tasks or activity, the person or people at risk, current control measures, the likelihood and consequences of the risk and the risk level. Assessments had been completed for some activities of daily living including eating and drinking, helping with meal preparation and making cups of tea. Documentation had been dated but not signed to indicate who had been involved in their compilation. It was discussed with the Area Manager that risk assessments should be extended to include specific risks when service users are using public transport such as buses, trains and taxis. Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 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. People who use the service generally access a range of activities and experiences to meet their needs both in their home and local community. They benefit from regular contact with their families and promotion of their rights to lead an ordinary life. EVIDENCE: At the time of the inspection, people had been living at the home for approximately six months. Discussion with the Registered Manager and care workers on duty indicated that structured activity plans for individuals were still in an early stage of development. A review had taken place for one person in April 2007 which had been attended by the service user, the service user’s relatives, Care Manager and the Registered Manager. Minutes of the review showed that activities and occupation had been discussed including attendance Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 14 at a day service, the possibility of an exercise class, going swimming and going on holiday. Discussion with the Registered Manager indicated that these were currently under consideration. The current activity timetables for service users are on display in the hallway of the home. It is suggested that the home ensures that this information is not on display in this way in order to protect service users’ confidentiality. A review of the timetables and discussion with a member of staff indicated that the team endeavours to support service users with accessing one communitybased activity in addition to a range of home-based activities each day. Community-based activities had included trips to the neighbouring towns of Poole and Boscombe, Weymouth beach and access to local shops and the Post Office. Observation of service users in their home indicated that staff are making efforts to support them in doing home-based activities they enjoy, such as reading to them and listening to music. A trampoline had been purchased for one service user who was reported to particularly enjoy this and had been set up in the garden. A record of activities is in place for each service user. On the first day of the inspection, service users were scheduled to go to a trampolining session at a leisure centre. Although one service user was unwell and therefore unable to attend the other service user had not been supported to attend either. Discussion with staff on duty indicated that reasons for this included the fact that there was only one permanent member of staff on duty and neither care worker was able to drive the home’s vehicle in order to get to the leisure centre. It was discussed with the Registered Manager and Area Manager that it is important that issues which may restrict service users’ ability to access scheduled activities are identified and plans are put in place to address these. Discussion with staff indicated that service users are supported to walk to local facilities including shops on a regular basis and have made use of public transport. Discussion with relatives of both service users indicated that the home has encouraged their relatives to maintain regular contact with them. One relative stated that the home has provided a speaker telephone system to enable the service user to communicate with them. Both relatives commented that staff at the home made them feel welcome when they visited; ‘Even when we have popped in ‘on spec’ we are made to feel very welcome’ and expressed their satisfaction with the contact they have had with the manager and the staff team; ‘Wonderful, very approachable’. Observation of people living in the home indicated that they are enabled to access all communal areas of the home and their own bedrooms as they choose. Examination of Person Centred Plans showed that they promote service users’ independence and rights to make choices. In addition, Plans indicated that service users are enabled to take responsibility for things such as helping with grocery shopping, for example, putting items onto the Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 15 conveyor belt and then into bags. Observation of care workers’ interaction with service users during the inspection also showed that they had relationships based on respect with care workers offering choices, promoting their autonomy where appropriate and communicating with them with warmth and understanding. Records are kept to evidence what people who use the service eat on a daily basis. These showed that service users were being offered a range of meals. Care workers take responsibility for meal preparation in the home. On the first day of the inspection, a care worker was preparing a home-made fish pie. Discussion with another care worker on duty indicated that she was aware of the need for service users to eat healthily and that this should include fresh fruit and vegetables. The member of staff spoken with showed awareness of service users’ likes and dislikes which are also detailed in their support plans. A relative of a service user expressed confidence that her relative is being provided with a healthy diet in the home and was pleased about this. Individual plans specify the support needed by service users with eating and drinking and what they can do for themselves. Lowther Road (35) DS0000068520.V339656.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 adequate. This judgement has been made using available evidence including a visit to this service. Documentation around service users’ personal and healthcare support is sound and indicated that they are able to access various health services to meet their needs. However, storage of medication at the time of the inspection was unsafe and presented a potential risk to people who use the service. EVIDENCE: Individual plans seen showed that consideration had been given to the person’s needs and preferences in relation to their personal care and the intervention needed from staff to promote this. There was substantial detail about the person’s preferred routines on record so that the care worker would know how to deliver support in order to ensure continuity of care. Personal care records are also in place to chart when people who use the service have received support with baths, hair-washing, oral care and their laundry. The support plan for one service user, however, states that the individual dislikes ‘people helping me with my personal care that I do not know’. It was noted that regular use of agency workers may impinge on a fully positive outcome for this person in terms of personal care preferences. Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 17 Health care appointments are documented in service users’ records. There was sufficient information available to show the date of consultations that had taken place and their outcome. Where one service user has epileptic seizures there were records in place to chart their frequency, duration, recovery time and descriptions of the seizure. Guidelines were also in place which provided information about how staff must respond to seizures, including when to contact emergency services, and measures in place to minimise risks. Correspondence was on file to indicate that appropriate advice had been sought regarding management of the epilepsy. The home has a metal cabinet fixed to the wall of the office which is used for medication storage. Medication is supplied to the home by a local pharmacy, mainly in monitored dosage systems. Medication administration record (MAR) charts are produced by the pharmacy for use in the home and service users’ allergies are noted on them. MAR charts had been signed appropriately which suggests that medication had been given as prescribed. Where a tablet had been refused this was clearly documented. It was not clear from documentation seen how medication is booked in or booked out of the home and there was no evidence of an audit trail being in place. One service user takes vitamin and mineral supplements on a regular basis but there was no system in place for these to be signed for on MAR charts to indicate that they had been administered. The records for two care workers were inspected for evidence that they had undertaken training in medication administration. Both care workers had certificates on file to evidence that they had attended foundation training in the care and control of medicines, which had been provided by a pharmacy service during their induction programme. Records also showed that training had been given to permanent staff on the administration of a specific PRN medication although for one care worker this had not been provided by the organisation until April 2007 which was four months after she had commenced her employment. The care worker indicated that she had received similar training in her previous employment. During the inspection it was apparent that a large quantity of medication that needed to be returned to the pharmacy had been stored in the home’s laundry cupboard. The cupboard was not locked and therefore presented a risk to people using the service. An immediate requirement was made at the time of the inspection for action to be taken to ensure the safe storage or disposal of the medication. On being informed of this, the provider took prompt action to address the issue and ensured that the medication was returned to the pharmacy within 24 hours. Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that people who use the service and their relatives are able to express their views and they are generally protected from harm. EVIDENCE: The organisation’s complaints policy was on display in the office of the home. This states that complaints ‘will always be received positively and will be investigated and responded to without any defensiveness’. It goes on to say that all complaints, whether received verbally or in writing ‘will be treated with seriousness and both will receive a formal written response’. The contact details of the Commission for Social Care Inspection were included in the policy. Discussion with the Registered Manager indicated that the complaints procedure is not available in an accessible format at the present time. Discussion with the relatives of people who use the service indicated that they feel able to raise any issues with the manager and staff at the home and feel that their views are listened to. One relative stated that she had raised a concern around lone working with the management of the service following which staffing arrangements had been discussed at length. The relative reported that although the outcome of the concern was ‘not perfect’ she felt she had been listened to and that the management of the service had liaised with her effectively. The home’s complaints record was inspected but there Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 19 was no record of this concern being raised or how it was dealt with. The Registered Manager, however, was able to give a verbal account of the issues. No complaints or allegations about the home had been received by the Commission prior to this inspection. A copy of Hampshire County Council’s ‘Protecting People from Abuse’ policy was available in the home. It was discussed that the manager should obtain the multi-agency policy for Dorset for staff to refer to in the event of an adult protection issue arising when the revised policy is published. The organisation has its own policy for dealing with suspected abuse which was available in the home. The Registered Manager confirmed that there have been no adult protection issues requiring referral to a statutory agency since the home opened. Training records for two care workers were seen, both indicating that they had attended training in abuse awareness with the organisation. A member of staff spoken with reported that she felt confident of procedures and would contact the manager of the service immediately if she was concerned that a service user was at risk of harm. A copy of a whistle blowing policy was seen. It was noted that this only refers to staff being able to report any concerns about malpractice to the organisation. It did not go on to say that employees can raise their concerns about any malpractice with the Commission for Social Care Inspection and be protected by law in doing so. Some shortfalls were identified in the home’s systems for obtaining enough information about agency workers employed to work in the service. There was also insufficient documentation available in the home to evidence that PoVAFirst checks had been carried out on staff prior to them having contact with service users and their full disclosure from the Criminal Records’ Bureau (CRB) being received. This means that there was not enough evidence to confirm that people who use the service are fully protected by recruitment procedures. Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is spacious, comfortable and clean which means that people who use the service have a pleasant place in which to live. EVIDENCE: 35 Lowther Road is a detached house in a residential area of Bournemouth. It is situated in a neighbourhood of similar properties. There is a spacious entrance hall to the home which leads to a large kitchen / dining room and lounge. There is a conservatory and good-sized garden at the rear of the building for use by service users. One bedroom with en-suite facilities is situated on the ground floor with the remaining three bedrooms, also with ensuite facilities, being on the first floor. The home is comfortably furnished and people who use the service have been able to personalise their bedrooms as they wish. The home presented in good decorative order throughout. A relative of a service user expressed satisfaction with the bedroom that had Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 21 been provided to the service user and commented that having a bathroom ensuite had promoted the individual’s independence in personal care. At the time of the inspection the home presented as clean and fresh. Inspection of staff training records indicated that they had attended infection control training since commencing their employment with the organisation. Discussion with a member of staff indicated that the home has clinical waste bins for disposal of continence pads to minimise risks of infection. Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that, on the whole, care workers who support them access suitable training to meet their specific needs. However, the home’s recruitment procedures are not robust enough to evidence that service users are fully protected by the people employed to work with them. EVIDENCE: The home’s Statement of Purpose states that the majority of staff either hold a National Vocational Qualification (NVQ) or are working towards an NVQ in Care. The Annual Quality Assurance Assessment (AQAA) supplied by the home following the inspection indicates that, out of seven permanent care workers, one has a qualification at NVQ Level 2 or above. The number of staff working towards an NVQ had been left blank. The home’s Statement of Purpose goes on to say that all new staff complete a certificate in working with people with a learning disability within their first six months of employment. This covers information on learning disability, understanding the role of care worker, confidentiality, challenging behaviour and promoting choice, dignity, respect, Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 23 empowerment and individuality. Of two staff records seen there was evidence on file that one care worker had completed her workbook towards her certificate. However, areas that needed to be completed by the assessor, in this case the Registered Manager, were blank. On the first day of inspection there was one permanent senior member of staff on duty who had been working at the home for approximately one month and one agency care worker who had not visited the home before. Inspection of the home’s rota indicated that there is always two staff on duty during daytime hours. During the week of the inspection the rota showed that five shifts were scheduled to be covered by an agency worker. It was noted that on each shift the agency worker would be on duty with a permanent member of staff who would be responsible for supervising them. It was discussed that this could restrict the ability of service users to go out on a one-to-one basis with staff. The Registered Manager reported that at the present time the home is understaffed by one full-time worker. The Area Manager confirmed that efforts are being made to recruit a suitable permanent member of staff so that the use of agency workers can be reduced. Two staff files were inspected for evidence of recruitment documentation. Completed application forms were on file in addition to suitable written references. Copies of enhanced disclosures from the Criminal Records’ Bureau (CRB) were not available in the home although there was a separate chart which specified disclosure numbers and issue dates for both members of staff. However, it was noted that in both cases full disclosures had not been obtained until after the care workers had started in post and would have had contact with service users. There was no evidence on file to indicate that PoVAFirst checks had been done prior to receipt of the full CRB disclosure to ensure that the care workers were suitable to work with vulnerable adults. Information for two other agency workers used by the home was seen. This included their photograph, details of the worker’s CRB reference number and the date on which the CRB disclosure had been received by the employment agency, some information on the training and qualifications of the agency worker and their previous work experience. However, there was no information on the outcome of the CRB disclosure, for example, whether it was ‘clear’ or there were any convictions or cautions listed. It was also not clear whether references had been taken up by the employment agency from care workers’ previous employers. There was no information available for one agency worker who had been working at the home at the time of the inspection. The Registered Manager stated that this had been requested from the agency but not supplied. The Area Manager was provided with a copy of ‘Safe and Sound? Checking the suitability of new care staff in regulated social care services’ published by the Commission which gives guidance to providers on promoting safe recruitment procedures. Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 24 Staff spoken with during the inspection indicated that the training they had been given since commencing employment with the organisation had been of a good standard and had prepared them for their work with service users. Care workers who commenced employment at the time when the home opened had undertaken a two-week induction at the organisation’s Regional Office. This had covered values and standards, personal care, disability awareness, autism awareness, care planning and record-keeping in addition to various aspects of health and safety. Another member of staff who had joined the team approximately two months after the home was registered, however, had not been able to access the induction as a two-week course at the commencement of her employment. In discussion she reported that she was accessing the courses as they came up. Although it was clear that some staff were making efforts to understand total communication approaches and teach themselves some Makaton signs, they had not accessed formal training in this area. The support plan for one service user indicated that it was important for Makaton to be used. The home’s Statement of Purpose states that ‘all staff attend specialised training in communication…Makaton training is also provided’. It is important that this is followed up so that all staff have the skills they need to be able to communicate fully with people who use the service. Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 25 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. Breaches in regulation identified at this inspection indicated that care workers were not benefiting from clear leadership and direction and people who use the service were not fully protected by some procedures in place. Therefore, at the time of inspection, the home was not considered to be well run. EVIDENCE: The home is part of Robinia Care South, the regional office for which is based in Hindhead, Surrey. The home’s Statement of Purpose indicates that the regional office provides a range of support to the home including clinical advice, administration, financial controls, maintenance support, personnel and recruitment advice and training facilities. The Registered Manager of the home, Mr Stuart Chamberlain, has previous experience of managing a Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 26 residential care service. He is supervised by an Area Manager, who is, in turn, accountable to Mr Kevin Nuttall, the Regional General Manager of the organisation. During the inspection, four issues of serious concern were identified which resulted in one immediate requirement and three urgent requirements being made. Discussion with a member of staff indicated that she had not received an appropriate response from the Registered Manager when she had raised a concern about a breach in regulation. The Area Manager reported that she had recently started doing monthly visits to the home to monitor progress. It was discussed that the format for these visits should be made more robust to ensure that breaches in regulations are identified sooner and issues are addressed by the service as they arise. A pre-inspection questionnaire was sent to the Registered Manager on 11th April 2007 and an Annual Quality Assurance Assessment (AQAA) document was sent on 20th April 2007 for completion and return within 28 days. As neither document was returned, a copy of the AQAA was sent to the Area Manager for completion following the inspection. This was received by the Commission on 4th July 2007. Discussion with the Registered Manager during the inspection indicated that he had not been supernumerary in his role, as indicated in the home’s ‘Statement of Purpose’, as he had needed to allocate himself on shifts in order to ensure that people living in the home had adequate support. This had restricted the time available to him to attend to his managerial responsibilities. It was suggested that he discuss this issue with his line manager. Discussion with the Area Manager indicated that, as part of the home’s quality assurance process, a series of audits are carried out over the course of a year. These included an audit by the Human Resources department which focuses on staff personnel and training records, an Operational Audit and a Health and Safety Audit. It was reported that the organisation is in the process of reviewing the format of quality assurance questionnaires to obtain feedback about the service from service users, their families and other members of their support network. This is intended to contribute to the production of a development plan for the service. A sample of health and safety records was inspected. There was evidence that bath temperatures were checked prior to service users having a bath. The record sampled for the week of 12th May 2007 showed all temperatures to be within a safe range (30–35 degrees Centigrade) although it would usually be expected for temperatures to be nearer 43 degrees Centigrade. During the inspection, we held our hand under the running tap of a water outlet in a service user’s en-suite facility – this was of a suitable temperature to promote the person’s safety. Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 27 Records of fridge temperatures were also in place. Although some gaps in recordings were noted, all temperatures documented were within an appropriate range. A sample of fire safety records was inspected. These showed that regular tests of the smoke detectors had been undertaken between October 2006 and February 2007. There were no further entries to show that tests had been carried out since this time. A separate record indicated that call points had been tested on a regular basis between January 2007 and 4th April 2007 but again, there were no further entries to evidence that tests had been carried out since this date. Records showed that monthly tests on the emergency lighting had been carried out between October 2006 and February 2007 but there were no entries for March or April 2007. Records to evidence regular visual checks on fire exits and fire equipment had also not been recorded since March and April 2007 respectively. An urgent requirement was made for the provider to ensure that fire safety systems are reviewed and checked at suitable intervals. The home’s fire evacuation record indicated that for day staff, a fire drill must take place ‘a minimum of twice yearly’ for day staff and ‘a minimum of four times yearly’ for night staff. Two fire drills had been recorded as taking place in December 2006, both occurring during the morning. The names of staff and service users participating in the fire drill were documented as were the times taken to evacuate the building. These were discussed with a member of staff, who, according to the record, had been present at both fire drills. The staff member was not able to recall these drills taking place at the times stated. The Area Manager was informed of this area of concern and agreed to investigate this further. An urgent requirement was made for the provider to ensure that staff and service users have regular opportunities to participate in drills and practice so that they know how to promote a safe evacuation. Review of the fire safety training records for two members of staff indicated that one staff member had received formal training as part of her induction programme. This had included the use of extinguishers, theory of fire prevention and evacuation procedures. There was no evidence on file of the second member of staff receiving fire safety training since commencing in post in December 2006. The Registered Manager reported that he had gone through the procedures with the member of staff concerned but there was no written record to evidence this. At the time of the inspection the Area Manager reported that she would be responsible for drawing up a full fire risk assessment for the home in the next two months. It was discussed that this must include specific evacuation plans for each person living in the home so that there is written documentation available to staff about facilitating a safe evacuation that takes into account service users’ specific needs. Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 28 During the inspection three accident / incident reports were seen. Two reports involved falls by a service user in the home and community, one of which involved the home seeking medical advice. The third report involved a service user being taken to hospital by ambulance following an epileptic seizure. The Commission had not been informed of any of these incidents as required by the Regulations. Discussion with a member of staff indicated that there had been two incidents of a service user falling on the stairs of the home. Although guidelines were seen regarding supporting the person in ascending and descending the stairs, these had not been signed or dated by the person compiling them. The guidelines stated that no physical support was needed by the service user but that staff should be present to offer reassurance and verbal prompts and walk either behind, or in front of, the person. Observation showed that guidelines were being followed but it was stated that at times the service user would climb the stairs independently without staff being aware. This issue was causing staff concern, particularly because at times the service user was reported to be quite unsteady when walking which meant that there was a higher risk of falls. An urgent requirement was made for the provider to make suitable arrangements to risk assess the service user’s needs in this area and ensure that appropriate measures are put in place to minimise risks. The provider has responded promptly to concerns raised and has commenced a review of systems in place to promote the safety of the service user concerned. Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 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 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 1 X 2 X X 1 X Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? N/A 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 YA20 Regulation 13(2) Requirement The provider must make suitable arrangements for the safekeeping and disposal of medicines in the home to promote the safety of service users. An immediate requirement was made in relation to this at the inspection visit on 14th May 2007. The provider must ensure that the employer of agency workers who work at the home has obtained in respect of the workers the information and documents specified in Schedule 2 of the Regulations and has confirmed in writing to the registered person that they have done so. An urgent requirement was made in relation to this on 23rd May 2007. The registered persons must inform the Commission without delay of incidents occurring in the care home that adversely affect the well-being or safety of DS0000068520.V339656.R01.S.doc Timescale for action 15/05/07 2. YA34 19(4) 01/06/07 3. YA37 37(1) 15/07/07 Lowther Road (35) Version 5.2 Page 31 any service user. 4. YA42 13(6) The provider must make arrangements to ensure that risks in relation to a service user using the stairs are fully assessed to promote her safety in the home. Appropriate control measures must be put in place to minimise risks when the service user may be unsafe to use the stairs. An urgent requirement was made in relation to this on 17th May 2007. The provider must make suitable arrangements to ensure that fire safety systems and fire equipment are reviewed and tested at suitable intervals, as identified in the home’s fire risk assessment. The provider must ensure that all staff and, so far as practicable, service users, are aware of the procedure to be followed in case of fire by means of drills and practices at suitable intervals, as identified in the home’s fire risk assessment. An urgent requirement was made in relation to this on 17th May 2007. The provider must ensure that a full fire risk assessment is undertaken to promote people’s safety in the home. This must include evacuation plans for individual service users which take into account their specific needs and promote their safety in the event of a fire. Provision must be made for the Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 32 25/05/07 5. YA42 23 25/05/07 6. YA42 23 31/07/07 appropriate documentation of all fire training taking place in the home including the content of this training. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA9 YA13 YA20 Good Practice Recommendations Risk assessments should include assessment of risks to service users in using different methods of public transport. The provider should ensure that service users have the support and transport they need to access all scheduled activities in the community. The provider should ensure that the organisation provides training in administering specific PRN medication to service users on commencement of care workers’ employment. There should be clear systems and procedures in place to book in and book out medication. An audit trail should be put in place to ensure that medication is given as prescribed. The provider should ensure that records are in place to evidence when vitamin and mineral supplements have been administered to service users. The complaints record should contain documentation on all concerns raised about the service. The complaints procedure should be available in an accessible format. The home’s whistle blowing policy should state that employees can report any instances of malpractice to the Commission and be protected by law in doing so. Care staff should hold an NVQ in Care at Level 2 or above or be working towards achieving this. There should be enough permanent staff on duty at any one time with the skills and experience to meet service users’ needs. DS0000068520.V339656.R01.S.doc Version 5.2 Page 33 4. YA22 5. 6. 7. YA23 YA32 YA33 Lowther Road (35) 8. YA34 Recruitment documentation in the home should show evidence that PoVAFirst checks have been carried out on care workers before they have contact with service users if they are not in receipt of full CRB disclosures. Copies of disclosures from the Criminal Records’ Bureau for staff working at the home should be available for inspection in the home until after the next inspection by CSCI. Total communication training should be provided to all staff working in the home to promote effective communication with people who use the service. The home’s quality assurance process should be fully implemented so that it takes into account the views, needs and aspirations of service users, their families and representatives. An annual development plan should be produced to show how the service aims to develop based on the outcomes of the quality assurance process. 9. 10. YA35 YA39 Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Lowther Road (35) DS0000068520.V339656.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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