Inspection on 29/10/07 for 35 Lowther Road

This inspection was carried out on 29th October 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 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 14/05/07

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 26th October 2007 10:25 Lowther Road (35) DS0000068520.V353668.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.V353668.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.V353668.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) www.robinia.co.uk Robinia Care South Ltd ****Post Vacant**** Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th May 2007 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. Mr Kevin Nuttall is the Regional General Manager and is the Responsible Individual for 35 Lowther Road. 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. 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. From information supplied by the manager of the home in November 2007, fees charged by the home range from £1200 - £2000 per week. This is based upon individual assessment of need. 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.V353668.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second inspection of the service since its registration as a care home in October 2006. It was a key unannounced inspection, the purpose of which was to assess the home’s progress in meeting the Regulations and key National Minimum Standards. The on-site inspection took place over approximately eleven hours on 26th October and 8th November 2007. During the inspection we were able to take a tour of the home and meet all of the people who use the service. Discussion took place with the manager and some members of staff employed to work at the home. A sample of records was examined including some policies and procedures, medication administration records, health and safety records and service user and staff files. Following the last inspection, an Annual Quality Assurance Assessment (AQAA) was completed by the Area Manager and submitted to the Commission. Surveys were distributed by the home to service users, relatives of people who use the service, care workers in the home, care managers and health care professionals on behalf of the Commission. A total of eight completed surveys were received, information from which is reflected throughout the report. A total of twenty-three standards were assessed at this inspection. What the service does well: People who use the service benefit from having their needs assessed before they move into the home. This helps promote a smooth transition and ensures that care workers have a good amount of information about them on which to base their support. People who live at the home have a support plan which tells staff about what they need and want from their care. People’s independence is promoted with risk assessments in place to ensure that they are kept safe while being able to do activities of their choice and lead ordinary lives. Care workers communicate well with people and are respectful of their individuality. The home continues to work hard to consider ways in which people can lead positive lifestyles, have access to their community and pursue hobbies and interests. People receive personal care and access to health care services to meet their needs. Policies and procedures are in place and observation of interactions between care workers and the people they support indicated that care workers had a good understanding of their requirements. The home Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 6 provides a clean, homely and comfortable place for people to live which promotes their rights to an ordinary life in the community. What has improved since the last inspection? What they could do better: Three requirements have been made as a result of this inspection. The main areas of weakness identified were in relation to staffing, gaps in training and two areas of fire safety practice. The home has been using agency staff on a regular basis which has caused some difficulties in ensuring a consistent approach to care. The manager told us at this inspection that plans are in place to address this and ensure that there are enough permanent staff recruited to ensure continuity of care. Relevant documentation about agency staff had not always been obtained by the home. This was made a requirement at the last inspection and has been repeated at this inspection. This must be addressed so that people who live in the home can be confident that agency workers have had suitable checks on them and appropriate basic training to meet their needs. Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 7 The emergency lighting in the home has not been tested at regular intervals and this must be addressed so that, in the event of an emergency, systems to keep people safe function effectively. A fire risk assessment has been undertaken by the manager, but the manager has not had any training in risk assessment to be able to complete this with confidence. The provider must take suitable action to ensure that people have the necessary competency and support to fulfil their roles and that systems to protect people from harm are robust. 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.V353668.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.V353668.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. People who use the service have their needs assessed prior to admission to ensure that they receive care that is responsive to their individual requirements and a smooth transition is promoted. EVIDENCE: One person has been admitted to the home since the last inspection. There was evidence to show that an assessment had been carried out by the service prior to their admission, which included some good information about the person’s general personal care, health, social and communication needs and routines. A copy of a report from the person’s previous placement had been obtained and there was an assessment and care plan on file from the local authority. A service user responding to the survey told us that they had been asked if they wanted to move to the home and had received enough information about the home before they moved in so that they could decide if it was the right place for them. Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 10 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. People who use the service benefit from a person-centred approach that enables them to receive care that meets their needs and choices and enables them to express their individuality. EVIDENCE: The manager told us that the person centred plan for the person most recently admitted to the home was still being developed. The work done to date was seen, this giving information on the individual’s cultural background, communication, support needs and preferences and routines. The plan referred to what the person can do for themselves and what they needed support with, for example, ‘I know what I want to eat and drink but I need to be reminded what I can or can’t have’. Information was held by the service user in their own room and use of large print and pictures made the format clear and easy to understand. Three out of four care workers responding to Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 11 the survey indicated that they were always given up-to-date information about the needs of the people they support. Observation of people in the home showed that they are enabled to make choices about what they do. In some cases, this meant that staff needed to be aware of people’s specific communication styles and their body language to determine their needs and wishes. There was information in some support plans to advise staff how to respond to people’s communication needs, for example, a section in one plan titled ‘How to ask questions to get accurate responses’. In addition, plans seen emphasised where individuals are able to make choices; ‘Ask X what drink they want’. Permanent staff seen interacting with people who use the service demonstrated awareness of people’s likes and dislikes and they were seen to encourage people’s active involvement in making choices and decisions about their everyday lives. A service user responding to the survey told us that they made decisions about what they do each day. A sample of risk assessments was seen. These covered activities such as accessing the community, swimming, bowling, kitchen activities and managing money. Assessments indicated that the service aims to promote people’s independence, for example, the benefits of a person being able to help prepare a meal, with consideration given to risks and necessary control measures to minimise risks. The manager reported that she was in the process of changing the format of the risk assessments. Assessments seen had been signed and dated. Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 12 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 are supported to lead ordinary lives in their home and community which promotes their independence and inclusion and offers them opportunities to develop as individuals. EVIDENCE: At the start of the inspection, two service users and two staff were present in the home. One was about to go for a walk in the local area with a member of staff, the other was unwell and therefore needed to stay at home with the second care worker. The third service user was attending a day service. Activity boards were seen in the kitchen for each person, comprising colourful photographs and ‘talking labels’. Photographs showed the service users sailing, cooking, going for walks, shopping, bowling, doing craft activities and Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 13 at a pub and café. Discussion with care workers indicated that people are using community facilities such as the local gym and swimming baths. There was evidence in the home of people having opportunities to pursue their particular interests, for example, one person who enjoys trampolining has a trampoline in the back garden. Another person who enjoys drumming has a drum kit at the home and attends regular music sessions at a nearby school. Review of daily records of people’s activities confirmed that people are doing a range of activities to meet their needs. A care manager told us that people living in the home went out frequently to various activities to suit their needs and this was something the service does well. This was echoed by a relative who stated that their family member is encouraged to take part in all activities appropriate to their age and individuality; ‘Clients lead full and active lives appropriate to them’. One care worker commented that there was a more structured approach to activities than at the last inspection. Discussion with the manager and care workers indicated that at the present time there are only two members of staff who are able to drive the home’s vehicle. However, it was confirmed that, when there are no drivers on duty, the service uses taxis or public transport to ensure people have opportunities to go out and attend their scheduled activities. Observation of people during the inspection showed that there is a very person-centred approach to individuals’ care with people being involved in everyday activities in their home. One person was being supported to wash vegetables in preparation for a meal, another service user was enabled to assist with making a cup of tea. Staff spoken with presented as very positive and motivated to support people in fulfilling their potential and leading ordinary lives. One relative told us that they felt that staff ‘go out of their way to support X’s independence’. Discussion with staff indicated that all service users have regular contact with their families. One service user was due to visit their family on the evening of the inspection and staff were observed to facilitate their journey home. A relative of a service user responding to the survey commented that the home helped their family member keep in touch with them and they were informed of any problems and changes by telephone. A menu plan was seen on the refrigerator indicating a variety of meals and snacks being provided. On the day of the inspection, people had poached egg on toast for lunch followed by fruit crumble and cream. In the evening they had a Chinese take-away. A book of recipes was seen in the kitchen containing large colour photographs of meals to enable people to make choices. Inspection of the refrigerator and kitchen cupboards showed a good variety of food, of good quality, being purchased from local supermarkets. A relative told us that they felt food provided is ‘home-cooked, healthy and appetising’. Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. People receive the day-to-day support they require to meet their personal care and health care needs. EVIDENCE: The personal care to be given to people was detailed in individual support plans, for example, ‘After dinner I like to listen to my handheld radio. About an hour after, I like to have my bath’. Records of when people have been supported with their personal care are also maintained in the home. Observation of staff interaction with service users during the inspection showed that routines specified in support plans were being followed. Where people in the home have visual impairments, there was clear information to the reader on using touch to indicate their presence. One person centred plan seen gave information on what staff needed to do if the person had an epileptic seizure. The plan said ‘Please reassure me constantly when I am having a seizure’. During the inspection the person had Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 15 a seizure and staff were observed to follow the care plan also timing the duration of the seizure to ensure that accurate records were kept. A protocol was in place to advise staff when emergency services must be called. A care manager commented in a survey that staff at the home managed their service user’s epilepsy well. One person centred plan seen gave staff information on the individual’s mood and well-being; ‘When I clap I am happy’; ‘I know all the parts of my body so if I am in pain I will sometimes be able to point to where the pain is.’ During the inspection one person was observed to be feeling unwell – staff spoken with gave a clear verbal account of medical issues affecting the individual and were taking precautions to ensure that the person did not go far from the home that day. Inspection of records and discussion with the manager indicated that the service user was being reviewed on a regular basis by an appropriate medical practitioner. Discussion with the manager also indicated that liaison was taking place with Social Services about the provision of moving and handling equipment to support an individual with specific mobility issues and the organisation’s Physiotherapist was scheduled to visit the home to undertake an assessment and ensure safe practice by staff. A care manager responding to the survey commented that they felt the service could communicate with them more and provide better information at reviews. A relative of a service user commented that since the appointment of a new manager communication had ‘dramatically improved’ although felt that the quality of information sharing was dependent on the members of staff on duty. The home has a medication policy which includes information on the ordering, receipt, storage, disposal and administration of medication. Medication is supplied by a local pharmacy and medication administration record (MAR) charts were seen to be printed by the pharmacy. Medication is stored in a lockable metal cabinet which is attached to the wall of the office. Incoming medicines had been documented on the MAR chart. Discussion with the manager and inspection of medication indicated that, on occasion, homely remedies had been supplied for service users by their families for use in the home. The organisation’s policy on homely remedies states that they ‘shall be agreed and authorised by the service user’s GP’. There was no evidence that this had been done or there had been any consultation with a pharmacist to ensure that there were no contra-indications with existing medication. Discussion with the manager indicated that all staff have been booked onto foundation and intermediate medication training in November 2007. The manager confirmed that on occasions when the home has been staffed by agency workers, a suitably experienced permanent care worker has attended to administer medication at the appropriate times. There was no clear audit trail in place at the time of the inspection. Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 16 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. Although basic systems are in place, further development of these systems will help ensure a robust and consistent approach to concerns raised by people who use the service. EVIDENCE: A procedure on how the service should deal with complaints was seen on the wall of the home’s office. This also contained contact details for the Commission for Social Care Inspection. The manager reported that no complaints have been received by the service since the last inspection. The home’s complaints book was seen to have no entries. Discussion took place with the manager around the reporting and recording of concerns as there was no clear procedure in place to record any day-to-day issues that may arise. A relative told us in a survey that they were aware how to make a complaint about the home if they needed to and the service ‘usually’ responded appropriately when they had raised concerns. A care manager also indicated in a survey that the service ‘usually’ responded appropriately to concerns raised. There is no complaints procedure on display in the home in a format that is accessible to people who use the service. This has been identified by the provider as an area for development in their Annual Quality Assurance Assessment. Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 17 A policy for dealing with suspected abuse was seen to be in place. The manager told us that there have been no safeguarding adults referrals or investigations in the past year. Staff training records were seen. Out of five permanent staff, one person had no record of attending training in abuse awareness. There was no evidence to show that agency workers had been introduced to the organisation’s policy on reporting abuse or concerns on coming to work at the home. Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 18 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 provides a clean and comfortable environment for people to live in that reflects their age and interests. EVIDENCE: A tour of the premises during the inspection showed that they were clean and tidy. People’s bedrooms had been personalised according to their individual tastes and interests ensuring that it is a homely place for them to live. This was commented upon by a relative of a service user who told us; ‘The home is relaxed, cheerful, lively and comfortable. The feeling is like you’re walking into your own home, all service users all enjoying their own individual lifestyles. X’s room is as it should be…music, colours, clothes, pictures etc.’ Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 19 A toilet seat was observed to be loose and in need of repair to ensure it was safe to use. Discussion with the manager indicated that the home has access to a person responsible for general maintenance in the home. The home has told us in their Annual Quality Assurance Assessment that they have a policy for preventing infection and managing infection control. They also indicate that they have not used the most recent guidance from the Department of Health, ‘Essential Steps’, to assess their current procedures. Training in infection control forms a part of the organisation’s induction programme. Inspection of training records showed that four staff had completed training in infection control, the fifth care worker being booked onto a forthcoming course. Two staff had also been recorded as attending food hygiene training with a further three people booked onto a future training date. Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Lack of permanent staff and gaps in training compromise some positive outcomes for service users. EVIDENCE: A sample of staff recruitment and training records were seen. These were seen to need some organisation to ensure that all information about each individual is kept together and in good order. Robinia Care South has a five-day induction programme in place for all care workers. Documentation showed that this covers an introduction to the company and sessions on values, disability awareness, moving and handling, infection control, personal care, health and safety, fire safety, food hygiene, care planning, record-keeping and abuse awareness. Review of records indicated that not all permanent care workers in the home have attended all training sessions. The manager has completed a training plan identifying where gaps and the need for updates exist. Discussion with the manager Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 21 indicated that where training dates have been organised by the Regional Office, staff have been booked onto them. However, at the time of the inspection, there were some training courses where no dates are available. The organisation runs several specialist training courses for care workers including training in epilepsy, communication and equal opportunities. All five permanent care workers had completed training in epilepsy although two were due to update their training by 16th November, two out of five had undertaken training in equal opportunities and one had attended a training day in total communication with two further care workers having attended Makaton training. Discussion with the manager indicated that two staff had recently not been able to attend a training day on communication due to staffing levels in the home. Staff spoken with told us that training they had attended through the organisation had been of a high quality and relevant to their roles. One member of staff commented in a survey that they felt they would benefit from some training on visual impairment. A relative responding to the survey commented that staffing levels were ‘always a problem’ and told us that regular staff were often put under pressure by having to work long hours and split shifts with less skilled and experienced agency staff. Inspection of the home’s rota indicated that in the previous week, two shifts had been covered by two agency staff. The majority of other shifts had been covered by one permanent and one agency worker. Staff told us in their surveys; ‘We are very understaffed and always have been…consistency is important…working with agency staff is stressful as they don’t know the service users / house / routines as well’. Another member of staff commented that service users who had been risk assessed as requiring one-to-one support for specific activities did not always get this due to staffing levels; ‘We must carry on ignoring that activities have a specific risk assessment’. Staffing was discussed with the manager who was aware of the shortfalls. Review of the home’s Annual Quality Assurance Assessment (AQAA) also indicated that the provider is aware that difficulties in recruiting have been a barrier to the service’s improvement and is an area for development. The manager told us that two new care workers were due to start in the next month and a part-time worker was to be taking on more hours at their request. The manager anticipated that this would fill the shortfall on the rota and the home would be fully staffed as a result. A requirement has not been made on this occasion due to this plan being in place. There was enough evidence seen to demonstrate that the service recruits their permanent care workers safely. The records for one new care worker showed evidence of a full employment history, two written references and proof of identity. There was evidence on a separate spreadsheet provided by the organisation’s Human Resources department that checks with the Criminal Records’ Bureau had been carried out and the manager confirmed that they were waiting for receipt of a full disclosure before permitting a new care worker to start. All four care workers responding to the survey indicated that the organisation had carried out checks on them before they started work. Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 22 There was less evidence to demonstrate that the home consistently ensures that checks have been carried out on agency workers. On the first day of the inspection, the records of two agency workers who had worked shifts in the previous week were requested. There was no evidence in the home to show that appropriate checks had been carried out for these two workers. The manager was able to obtain this evidence from the agency by the second day of the inspection. The manager told us that the home uses the same agency to supply staff and where possible, they strive to use the same workers to achieve greater consistency and continuity of care. There was no evidence at the inspection that the home ensures that agency workers have a formal orientation to the service and are introduced to the home’s policies and procedures. This was discussed with the manager who found an agency induction checklist on the organisation’s intranet which covers health and safety, fire procedures, risk assessments, reporting procedures, recording and care planning and communication. It was recommended to the manager that this is put in place with immediate effect. Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the overall conduct and management of the home is adequate, some systems in the home are not robust enough to ensure that people who use the service are fully protected. EVIDENCE: The previous manager of the home who was registered with the Commission left the service in June 2007. A new manager has been appointed by the provider who commenced working at the home on a temporary part-time basis in July 2007, this role becoming permanent in August. At the time of issue of the draft report, the manager had not yet submitted an application to register to the Commission. This means that the home has been without a Registered Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 24 Manager for approximately six months. A care manager told us in a survey that they were concerned by staffing and management changes in the home. A summary of the Robinia Care South Operational Plan for 2007 / 2008 was seen on the office wall covering goals for the company’s financial performance, business development, staff recruitment and retention and quality of service. One file seen showed a business plan which had been developed specifically for the home. This contained relevant objectives for the home’s development in person centred planning, training, staffing, creation of a homely environment, ratio of drivers and promoting choices. Actions required had been listed but there was no evidence that the plan had been reviewed since March 2007. The provider has told us in their Annual Quality Assurance Assessment (AQAA) that they need to ensure that a development plan is in place that is a working document. A fire risk assessment was seen to be in place which had been completed by the manager. The risk assessment states that a competent employee has not been nominated to take responsibility for fire safety with a note that training is to be given. The manager has not received any specific training in risk assessment. A sample of fire safety records was inspected, these showing that the manager is carrying out regular checks of call points and visual checks of fire extinguishers. There was a gap in records for visual checks of doors and escape routes between March and October 2007. Inspection of records and discussion with the manager indicated that there have been no checks on emergency lighting in the home. The manager reported that this is because there is no key to operate the system and the testing point is inaccessible. The home’s risk assessment indicates that monthly checks should be done. Records seen indicated that a practice evacuation had been carried out in the home on the afternoon of 20th July 2007. The time of the drill and initials of staff and the two service users present had been recorded. A ‘silent’ fire drill was also recorded as taking place in July 2007 where a scenario had been discussed by four members of staff. The manager was reminded of the need to ensure that all care workers and, as far as practicable, service users have the opportunity to participate in practice evacuations. It was also discussed that drills should take place at various times of the working day, particularly at times when there are reduced staffing levels, to ensure that evacuation plans are effective. The home’s risk assessment indicates that not all staff are versed in the fire emergency procedure in the home which potentially puts people at risk. Records showed that fire safety training is organised by Robinia as part of the company induction and on an ongoing basis. On the second day of the inspection, the manager reported that four care workers had attended in-house training that day. One member of staff had not attended the training and it was unclear what arrangements would be made to ensure that they would updated appropriately. Inspection of documentation indicated that care Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 25 workers’ attendance at fire training had been recorded in more than one place. As a result it was difficult to identify who had attended what training on which date, the content of the training and how this meets the organisation’s expectations. Records within the home showed that four accident records had been completed since the last inspection of the service. The manager has notified the Commission of these incidents in accordance with the regulations. Refrigerator temperatures at the time of the inspection were seen to be within normal ranges. All permanent care workers have been recorded as attending emergency first aid training. At the last inspection of the service an urgent requirement was made regarding the need for review of a risk assessment in relation to one service user and specific safety issues. This was responded to promptly by the provider. A risk assessment has been implemented in the home which staff report is working well. Discussion took place with the manager regarding the need for the assessment to be kept under regular review particularly in response to any changes in the person’s health status. Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 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 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 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 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 2 X Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA34 Regulation 19(4) Requirement 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. This requirement is repeated from the last inspection of the service as the previous timescale of 01/06/07 was not fully met. The registered person must ensure that gaps in training are addressed to ensure that all care workers receive training appropriate to the work they are to perform. This must include initial and update training in aspects of health and safety and specialist training that reflects the needs of service users. DS0000068520.V353668.R01.S.doc Timescale for action 31/12/07 2. YA35 18(1)(c) 31/03/08 Lowther Road (35) Version 5.2 Page 28 3. YA42 23 The provider must make suitable arrangements to ensure that emergency lighting in the home is tested at suitable intervals as identified in the home’s fire risk assessment. The provider must ensure that any person appointed to oversee fire safety in the home and undertake a fire risk assessment has the necessary competence to be able to fulfil this role. 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations An audit trail should be put in place to ensure that medication is given as prescribed. The home should follow the organisation’s policy with regards to the administration of homely remedies and consult a general practitioner / pharmacist for advice on possible contra-indications with existing medication. 2. YA22 The complaints record should contain documentation on any concerns raised about the service. The complaints procedure should be available in a format that is accessible to people who use the service. All care workers employed to work in the home should receive training in abuse awareness and safeguarding adults procedures. The home’s infection control procedures should be assessed in relation to the most recent guidance from the Department of Health, ‘Essential Steps’. There should be enough permanent staff on duty at any one time with the skills and experience to meet service users’ needs. DS0000068520.V353668.R01.S.doc Version 5.2 Page 29 3. 4. 5. YA23 YA30 YA33 Lowther Road (35) 6. YA35 7. YA39 The home should ensure that there is sufficient documentation to evidence that agency workers have received an orientation to the service before commencing work with service users and are aware of the home’s policies and procedures. 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. 8. YA42 Documentation around people’s participation in fire training and practice evacuations should be structured and consistent so that it is easy to see where gaps exist. Lowther Road (35) DS0000068520.V353668.R01.S.doc Version 5.2 Page 30 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.V353668.R01.S.doc Version 5.2 Page 31 - 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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