Inspection on 07/02/08 for 353 Old Whitley Wood Lane

This inspection was carried out on 7th February 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

353 Old Whitley Wood Lane 29/07/08

353 Old Whitley Wood Lane 15/03/07

353 Old Whitley Wood Lane 24/01/06

353 Old Whitley Wood Lane 28/06/05

353 Old Whitley Wood Lane 01/02/05

353 Old Whitley Wood Lane 15/12/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Pinta

Kestrel House, St Anne`s Opportunity Centre,

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

CARE HOME ADULTS 18-65 353 Old Whitley Wood Lane Reading Berkshire RG2 8PY Lead Inspector Ruth Lough Key Unannounced Inspection 7th February 2008 14:10 353 Old Whitley Wood Lane DS0000011348.V357581.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 353 Old Whitley Wood Lane DS0000011348.V357581.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. 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 353 Old Whitley Wood Lane Address Reading Berkshire RG2 8PY 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) 01189 672 369 01189 672 369 multicare@hotmail.co.uk Multi Care Limited Mr Joseph Kingsley Gyamfi Care Home 2 Category(ies) of Learning disability (2) registration, with number of places 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th March 2007 Brief Description of the Service: This residential home has been registered for two service Users aged between 18 and 65, with learning disabilities. The house is situated on the perimeter of a residential area within a short distance from a main link road and the M4 in Whitley Wood, Reading. There are 2 single bedrooms for Service Users, a lounge/ diner, kitchen, 2 bath/shower rooms with toilets, a kitchen, staff sleeping in room/office and a large garden to the rear. The home is owned by an individual proprietor and was registered on 7/01/02. The home has been providing short-term respite care since July 2004 and now has one long-term placement also. 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced key inspection process to review the quality of the services provided and the outcomes for those living and using the service. The inspection process included information provided by the home in the Annual Quality Assurance Assessment, self-assessment document submitted to the commission before a half-day visit to the service. The inspection also included meeting two people who use the service, a relative and two staff during the visit. Care and administrative records were also reviewed. From this inspection process it was identified that the home has not implemented a previous requirement made to improve the outcomes for the people who use the service. What the service does well: What has improved since the last inspection? What they could do better: They are advised to implement a process of assessing that the person coming into the home will be compatible with the current permanent resident and that the facilities and staffing skills will be able to meet their needs. The care planning could be improved with giving staff better guidelines of what the aims objectives in the care to be provided are, how they can achieve these 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 6 with the person concerned, and any specialist interventions they need to implement to meet them. They should ensure that any risks to the individual are identified and included in the care planning. The instructions given to staff for supporting the people who live in the home with their relationships should be reviewed to ensure that staff are able to maintain family links, friendships, and any personal relationships that they may have within the limits of keeping them protected from harm. The manager needs to ensure that the staff have a good understanding of their roles and responsibilities and are provided with the necessary induction training to do so. The management and administration processes to ensure that the home is being run in the best interests of the people living there should be carried out more effectively. The people who use the service should be consulted about their opinion of what is provided with more often. The home should ensure that it has systems in place to monitor its effectiveness in meeting its aims and objective for providing support to the people it supports. This was a previous requirement that should have been met by 30th June 2007. 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. 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 7 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 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 8 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 adequate. This judgement has been made using available evidence including a visit to this service. The home does not assess the prospective service users needs sufficiently in order to assure that they will be able to meet their needs or that it is appropriate admission. EVIDENCE: The records of the one permanent resident and the expected person coming into the home for a period of respite were reviewed as to assess if sufficient information is obtained before admission. The records for the permanent resident, admitted to the home in 2005, showed that the home based the care planning on the information from the social services referral process. Other records to support what the home carried out on its own behalf were not available. The records for the person being re-admitted to the home for a period of respite identified that the care planning had been developed using the information given in the referral from the social services. The home does not have a process or documentary tool to provide evidence that they carried out an assessment before the planned admission. This is reference to the previous admissions and the current one that was occurring on the day of the inspection visit. 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 9 They were advised to implement a process of assessing that the person coming into the home will be compatible with the current permanent resident and that the facilities and staffing skills will be able to meet their needs. 353 Old Whitley Wood Lane DS0000011348.V357581.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 adequate. This judgement has been made using available evidence including a visit to this service. Staff should be given greater instruction in the care planning of how to meet the needs of the individual and to ensure that all the risks to themselves or others are assessed properly. EVIDENCE: The records for both residents were reviewed to assess if the care planning meets their needs and provides staff with sufficient detail and information to give the support they require. The care records for the permanent resident showed that time has been taken to develop a good personal history. Also the recorded knowledge that staff have gained about supporting the individual gives a clear picture of the individuals personality. The records for the person admitted for a respite stay were not so detailed but still gave a basic plan of some of the activities that they need support with. 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 11 Both records could be improved with giving staff better guidelines of what the aims objectives in the care to be provided are, how they can achieve these with the person concerned, and any specialist interventions they need to implement to meet them. This is particularly relevant to some of the behaviour and responses that both service users show when stressed or anxious. There was no evidence that any appropriate policy or procedures were in place for dealing with physical aggression, any physical interventions or restraint that would give staff guidance of how to manage a situation should it occur. The staff record some decision making the individual makes within the text of the personal history and in the general content of the care plan document. They need to develop this in greater depth for the person receiving respite care. The daily records that staff write of the outcomes and experiences for the individual show that personal choices and decision-making are supported in the activities of the day. There are some risk assessments that have been carried out for one individual. On a closer review of the four in place, three were identical to the same topic e.g. Using knives in the kitchen, and one was with reference to the pond in the back garden. All of the risk assessments regarding the use of knives had the same content and had been repeatedly reviewed on the same date by the manager. None appeared to be in place for using the shower or bath when the individual was unsupported without his prosthetic lower limb. 353 Old Whitley Wood Lane DS0000011348.V357581.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. These judgements have been made using available evidence including a visit to this service. The people who use the service are supported to pursue some education and personal development activities. They are also enabled to continue and with family relationships, but insufficient support is provided should they wish to pursue any personal or intimate relationships with other people. EVIDENCE: The information, planning, and implementation of support provided in regard to the continuing education and occupation of the one permanent resident and the person admitted, were reviewed. This was to assess if suitable activities have been arranged and sought to continue with their personal development, interests and involvement with the local community. 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 13 The care planning records for the one resident who lives in the home on a full time basis showed that the individual has a planned programme of activities that includes five days a week at a day centre, evening and weekend leisure interests, and housekeeping tasks. What they could improve is noting down in better detail what the learning and personal development activities that the individual has during the periods at the Day Centre as to ensure that the evening and weekends are balanced and variable topics. They could also improve with providing staff and the person concerned information in the appropriate format how some of the household tasks are to be carried out. Very little was recorded about the spiritual or religious needs of the person concerned and it was unclear whether much information had been sought. The planning for the person admitted for a respite stay had not been fully developed at the time of the visit to the service. The policy and procedures for supporting the people who live in the home with their relationships were reviewed. This was to see what the home’s principles and values are in maintaining family links, friendships, and any personal relationships that they may have. Staff are given brief information about sustaining family links but very little is given about supporting the people living in the home for developing new personal or intimate relationships inside or outside of the home. Information from any social services/ care management assessment or reviews of support, do provide staff with some information about the individuals family links and how they will continue to assist with guidance to maintain these. The home has put a formal meal and menu plan in place. However, through discussion with staff and service users it appears that this is very rarely followed. Nutrition and weight loss for one resident has been highlighted as a concern especially during the day whilst at the Day Centre. Specific guidelines have been put in place to aid staff to improve his nutrition. Staff have implemented purchasing ready meals to be taken each day as to ensure that his diet is not compromised, as he was unable to cope with a packed lunch. The resident did confirm that he liked the food he was provided with and that he was learning to prepare and cook some of the meals himself. The staff usually record in the daily outcomes diary the meals taken and the amount eaten for monitoring purposes. 353 Old Whitley Wood Lane DS0000011348.V357581.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): 18,19,20, and 21. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who use the service are supported with their personal and healthcare needs. The guidance given to staff in regard to medication administration could put the people who use the service at risk. EVIDENCE: The records for personal and health care planning for the individual were reviewed to see if the service is ensuring that they support the person to access any healthcare they require. The records for medication administration including the instruction and guidance given to staff were also review to see if the appropriate procedures are in place. The care planning records for one service user showed that time had been taken to give specific instruction to staff of how to meet their needs in regard to ensuring that a prosthetic limb is fitted and cared for appropriately. Staff during the day provided greater verbal information about how the support is provided for personal care for this one individual than in the 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 15 documented care plan. They were advised to develop the care plan so that better instruction is given to staff to ensure continuity of care. The records for meeting the individual’s health care needs is recorded briefly in a health care record that is completed by the professionals providing the consultation and treatment. The correspondence and supporting information are also kept with the care planning records of the individual. The staff were recommended to look at how they could improve how they keep a health history for each person to aid better planning and monitoring in the future. Any medication requirements are noted in the care planning records for the individual. From information given by staff it was identified that none of the current residents or those that routinely visit the home on a respite basis take the responsibility to self- medicate. The home has since the last inspection process instigated the services of a local pharmacist to use a MDS (Monitored Dosage System) for all regular prescriptions that the residents may have. Medication is stored in a small metal cabinet securely. There are suitable recording tools for any administration of medications and staff are recording in these appropriately. They do not at present support the records with a photograph of the person concerned, but they were advised to do this with particular reference to the regular changes in the people being admitted to the home for respite stays. This would assist staff to check that the right medication is being provided to the intended individual. There was supporting evidence available that the staff team had been provided with updated medication training during the last year. This was through a recognised training provider and copies of certificates of completion were seen in some of the employment records that were seen during the day. The policy and procedure for safe medication administration and storage were reviewed to see what they had in place to guide and support staff. This was in particular to see what processes they have in place should a resident wish to self- medicate or if a member of care staff were required to have specialist skills for a designated nursing task, such as for rectal sedation or catheter care. The details in the policy and procedures were incomplete and staff are not provided with up to date information. There is not sufficient information about the process and safety systems should a resident wish to self- medicate or sufficient information about what the care and support staff for specialist tasks or any over the counter medications that could be requested by the individual. Also the document refers to the responsibilities of a registered nurse and the compliance with the UKCC, which is the previous body to the Nursing and Midwifery Council that came into force in 2002. 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 16 The home is not registered to provide nursing care and therefore the policy and procedures should reflect this and give care staff clear instructions of their responsibilities of their roles. This would also ensure that service users have greater protection from inappropriate medication administration. Like the other polices seen, the registered manager had indicated that these had been reviewed in September 2007. 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 17 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 poor. This judgement has been made using available evidence including a visit to this service. The resident living in the home is confident that his concerns will be listened to. The home has insufficient processes in place to ensure that the people living in the home are protected from possible financial abuse. EVIDENCE: The one service user confirmed that they were confident to tell the staff if they were unhappy. One relative who spoke to the inspector stated that they found staff very responsive to any concerns if they expressed them. The complaints policy is provided in the Statement of Purpose/ Service User Guide document. A copy of the complaints procedure was seen, but it was unclear of what the residents had been provided with or whether this format was suitable to meet their needs. The staff were advised to review and amend the contact details in the complaints procedure for the CSCI to ensure that the give the information about the recent changes. The staff in the home stated that they had not had any formal complaints since the last inspection process. The commission has also not been in receipt of any concerns, complaints, or information about the service in that period. 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 18 The policies, procedures, and information in regard to safeguarding people from possible abuse were reviewed to see what the home has in place to support staff to protect the people who live there. The information in the staff employment files was also reviewed to see what training had been provided to them. The policy and procedure for safeguarding adults was last updated in 2006. The information does direct staff to the local Protection of Vulnerable Adults strategy and will need to be reviewed to ensure that any changes that have occurred are now included. A senior member of staff did confirm that they had already identified that the policy and information may not meet the required standard. The home supplied information in the Annual Quality Assurance Assessment, self-assessment document that all staff had completed training in adult protection since the last inspection process. The staff informed the inspector that the home does take responsibility for handling small sums of money they manage on behalf of the residents. The staff provided information that for one resident the transaction and receipts were audited by the responsible local authority Money Management scheme. These and records for another service user were reviewed to see if the recording and management practices show that it is carried out in the best interests of the individual. During a review of one person’s records it was identified that personal money was being used on the service users behalf for the purchase of food to take to use at the Day Centre additionally to that what is provided in the fees. Also a large amount of toiletries, over £40:00 worth, were being purchased each month. Insufficient information was seen in the care plan records to identify that the resident required and was using the volume of toiletries in that period. This included large numbers of toothpaste, bubble bath, and body sprays. The home was unable to provide suitable evidence that some of the resident’s money was being used in their best interests. Staff were requested to look at this current practice of using one residents own money for the purchase of food to take with him to eat during his day activities. This is with regard to what is included in the agreement to terms and conditions of his stay in the home and additional costs that may incur. There was no documentary evidence in the service users records available that this arrangement for an additional cost has been agreed. The policies and procedures for financial protection for the people who use the home were reviewed to see if staff are given sufficient guidance and instruction. Staff were only able to provide a copy of a policy statement about 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 19 making or benefiting from service users wills. There was no evidence that they had policies or procedures in place for the current practices for handling service users money. These should include the processes carried out for handling residents money and valuables and those for the use of service users bank or building society books and the use of loyalty cards. 353 Old Whitley Wood Lane DS0000011348.V357581.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 adequate. This judgement has been made using available evidence including a visit to this service. The home is not providing to the people who use the service the full bathroom facilities that it states it offers in the Statement of Purpose. EVIDENCE: The home is domestic in nature with sufficient communal space for two residents. There is one larger bedroom that is used by the permanent resident and one bedroom that is slighter smaller that is used for respite purposes. The bedrooms have been provided with a wardrobe and chest of drawers and have suitable bedding, curtains, and floor covering. Neither of them have comfortable chairs should the resident wish to remain in their rooms for privacy or watch their own television. Both rooms do not have hand washbasins. Staff use the upstairs office next to the bathroom for the sleep in duty. On the ground floor there is a lounge diner, kitchen, and bathroom. At registration of the service the home offered the facilities of two bathrooms one upstairs and one downstairs. The staff stated that the bathroom 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 21 downstairs was not fit for purpose and has been awaiting refurbishment. The major concern is the unsafe shower cubical and some of the plumbing is faulty. Staff are now using the resident’s bathroom for personal use whilst they are working and on a sleep- in duty. Staff’s personal toiletries were found to be in the bathroom/ shower upstairs. The bath and shower do not have aids such as handrails to assist the resident who is partially disabled. The staff have not implemented a risk assessment to identify if this appropriate for the individual concerned. A domestic washing machine is situated in the kitchen and meets the needs of the people living in the home. The majority of the home is kept clean and fit for purpose, with the exception of the bathroom facilities downstairs on the ground floor that are not in use. 353 Old Whitley Wood Lane DS0000011348.V357581.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): 31,32,34, and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who use the service are not fully protected by the recruitment and employment processes for staff. EVIDENCE: The residents and family who spoke to the inspector stated that they thought the staff are helpful and friendly. A relative also found them reassuring and supportive. The records for recruitment, employment, and training were reviewed to see if the people who use the service are provided with support from a competent skilled staff team. The records for the duty rota were reviewed to assess if there were sufficient members of staff on duty to meet the needs of the service. The current practice is to record the individual staffs programme of work separately and therefore is was difficult to assess the pattern and how the home was staffed in a twenty-four hour, seven-day week, basis. What was evident was that the registered manager routinely only worked twelve hours each week and just under 50 of this time was with accompanying the permanent resident to an 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 23 activity during the evening. It was unclear what time was spent in management duties. All of the staff appear to have set shifts or days of working, this made it very unlikely that the manager would meet all of the staff on a regular basis. The recruitment records for two employees who had commenced working in the home since the last inspection process were reviewed. Both were required to complete an application form, provide references, and complete a Criminal Records Bureau check. Copies of identity and proof of address were also included. The records seen did not provide information about the selection process, such as interview or the reason to employ. There was no evidence of their induction training programme, or probationary period for staff. The records also did not show that staff had been provided with a job description or contract of employment and it was difficult to ascertain for what role they had been employed. The member of staff on duty who had been employed since the last inspection process was unable to confirm that they had undertaken a recognised formal induction programme or been provided with a contractual agreement or job description. The home has utilised the recommended document (CSCI employment record) to evidence some of the key employment processes that have been carried out. However, both records seen had not been completed fully. One of the senior staff has commenced to assess the training attained by staff by obtaining copies of the training they have attended and has started to look at the training programme. There has not been a formal training need’s analysis of each member of staff to assess is staff have the skills or experience to meet the needs of the people who use the service. From information provided in the Annual Quality Assurance Assessment, self assessment document and from the employment and training records seen it was identified that of the six staff employed all but one has attained an NVQ 2 or above. The manager is currently in the process of completing a RMA (Registered Managers Award). There was minimal evidence of a supervision programme and staff meetings happen infrequently. A senior staff member has recommenced a supervision programme recently. 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, and 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The current management of the home does not ensure that the home fulfils it stated purpose or ensures that it meets the needs of the people living there. EVIDENCE: Comments from residents gave the impression that they enjoyed living in the home. A relative did state that the person they cared for had been looking forward to their coming to stay. The processes for management and administration of the home were reviewed to assess if the people who use the service are benefiting from a well run home. 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 25 The manager has been in post since 2005 and as previously stated does not appear to work more that twelve hours per week. It was unclear who takes the responsibility of managing the home during his absence or of ensuring that the aims and objectives of the home are carried out. It was previously identified during the last inspection process that the home had not implemented an effective quality assurance process or had a regular system for seeking the opinion of the people who use the service. From information given by staff there has not been any formal process carried out since the last in December 2006. What was also apparent the staff do not have regular residents meetings or time set aside to discuss with the one resident their opinion of how the home is run. A requirement was made during the last inspection process in regard to a quality assurance system should be in place by 30/06/07 but there was not significant evidence that this had occurred. This is despite the provider submitting information that this requirement had been following the inspection process in June 2007. Some of the records and information for routine safety checks and safe working practices were reviewed to identify if the home is run safely and in the best interests of the people living and working there. From information available the home has ensured that there has been checks made for PAT (portable appliance testing) for the electrical items, and fire extinguishers have been checked within the last six months. Water temperatures are checked every week. The home has information about the servicing for the gas boiler that was last carried out in January 2007; staff were unable to provide a date for the planned annual assessment. The home was strongly advised to implement a battery operated Carbon Monoxide sensor alarm in the office/ sleep in room where the boiler is situated instead of the current indicator that does not alert the occupants of the home. The records reviewed throughout the inspection process identified a number of elements of ineffective management in particular to providing personal support to individuals and ensuring staff have sufficient knowledge and information to financially protect those in their care. Key areas of concern are potential inaccuracies of assessments and reassessments of care need by the home of the people using the service; ensuring staff have been given the necessary information and support in the services policies and procedures, and that there appear to be no effective processes in place for seeking service users opinion. Of serious concern is the apparent lack of instruction for protecting service users from possible financial abuse. 353 Old Whitley Wood Lane DS0000011348.V357581.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 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 2 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 1 X 1 2 X 3 X 353 Old Whitley Wood Lane DS0000011348.V357581.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 YA9 Regulation 13.4.c. Requirement That the staff carry out assessments to identify any risks to the health, safety and welfare and where possible eliminated. That staff are given clear information about their responsibilities for safe medication practices within the policies and procedures of the home. That a record of all charges including the extra amounts payable for additional services not covered in the contractual agreement are noted with documentary evidence that this is understood by all parties. That staff are provided with information and guidance for the protection of service users money and valuables. That there is documentary evidence that staff are provided with job descriptions and contractual agreements that set out their roles and responsibilities to the service users and the home. That all staff receive the appropriate induction training to DS0000011348.V357581.R01.S.doc Timescale for action 31/03/08 2 YA20 13.2. 31/03/08 3 YA23 17.2. Schedule 4. (points 8 and 9) 31/03/08 4 YA23 17.2 Schedule 4(point 6) 17.2 Schedule 4(point 6) 31/03/08 5 YA31 31/03/08 6 YA32 17.2 Schedule 31/03/08 353 Old Whitley Wood Lane Version 5.2 Page 28 4(point 6) 7. YA39 24 ensure that they are able to meet the needs of the service users. That a formal system is developed to review the Quality of the service provided. This is a requirement from previous inspections and remains not met by 30/06/07. 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA2 Good Practice Recommendations They are advised to implement a process of assessing that the person coming into the home will be compatible with the current permanent resident and that the facilities and staffing skills will be able to meet their needs. Care planning could be improved with giving staff better guidelines of what the aims objectives in the care to be provided are, how they can achieve these with the person concerned, and any specialist interventions they need to implement to meet them. The policy and procedures for supporting the people who live in the home with their relationships should be reviewed to ensure that staff are able to maintain family links, friendships, and any personal relationships that they may have within the limits of keeping them protected from harm. 2 YA6 3 YA15 353 Old Whitley Wood Lane DS0000011348.V357581.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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