Inspection on 16/07/08 for 374-376 Winchester Road

This inspection was carried out on 16th July 2008.

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

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

374-376 Winchester Road 18/05/09

374-376 Winchester Road 27/11/07

374-376 Winchester Road 18/05/07

374-376 Winchester Road 24/10/06

374-376 Winchester Road 15/02/06

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 374-376 Winchester Road Southampton Hampshire SO16 6TW Lead Inspector Annie Kentfield Unannounced Inspection 16th July 2008 09:30 374-376 Winchester Road DS0000062649.V368598.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 374-376 Winchester Road DS0000062649.V368598.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. 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 374-376 Winchester Road Address Southampton Hampshire SO16 6TW 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) 023 8078 9786 Integra Care Management Ltd Beverley Hambidge Care Home 8 Category(ies) of Learning disability (0) registration, with number of places 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning Disabilities (LD) The maximum number of service users to be accommodated is 8. Date of last inspection 27th November 2007 Brief Description of the Service: 374/376 Winchester Road is a small home providing personal care and support for up to eight residents with a learning disability who may have challenging behaviour and complex care needs. The home has been converted from two detached houses with the addition of a single storey extension that links the two buildings together. The residents have a bedroom of their own and access to a range of communal rooms and a large enclosed garden. The building is accessible on the ground floor but does not have a passenger lift or stair lift. 374/376 Winchester Road is situated close to local shops and Southampton Common. Weekly fees are from £1,530 to £2,966 with additional and varying charges for chiropody, toiletries, clothing etc. 374-376 Winchester Road DS0000062649.V368598.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 1 star. This means the people who use this service experience adequate quality outcomes. This report is a summary of information that we have received, or asked for, since the last inspection of the service in November 2007 and includes the outcome of an unannounced visit to the service on July 16th 2008. The visit was made by two inspectors (Annie Kentfield and Janet Ktomi), who were in the home from 9.30am to 5.30pm. During the visit we spoke to the manager, the responsible individual, operations manager, and members of staff. We spent some time with the residents in the sitting room and looked at other areas of the home including some of the bedrooms and communal areas. We looked at a range of the home’s records including care plans, medication records, staff training and recruitment records and some health and safety records. We received the Annual Quality Assurance Assessment (AQAA). This is a selfassessment by the home that tells us what the home are doing to improve their service and also gives us some numerical information. An additional visit was made to the home in January 2008 to monitor compliance with a previous requirement for the home to keep residents’ financial records in the home and make them available for inspection. The home has complied with this requirement. During the visit we spoke to the manager about immediate concerns to make sure that care plans are reviewed and up to date. We also made immediate requirements for two broken light fittings to be repaired. The registered provider has written to confirm that action has been taken to meet these concerns and comply with the regulatory requirements. We cannot gather formal comments from the residents who are not able to complete survey forms, however, the evidence from the experience of residents living in the home is based on observation of practice and by looking at written care records and reviews. What the service does well: What has improved since the last inspection? 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 6 Since the last inspection the home has taken action to ensure that residents receive independent help to manage their financial affairs. Some of the residents are still waiting for financial appointees but the home took prompt action to change their practice and comply with the regulatory requirement. What they could do better: The home must develop individual communication tools that meet the specific needs of the residents. The home has identified this as an area for improvement and plans to develop opportunities for staff training in communication skills to meet the needs of residents with a learning disability and complex needs including sensory impairment. The home must keep care plans updated and make sure that care staff have clear written guidance on how care is to be provided. Care plans should also clearly record residents’ choices and preferences in all of the activities of daily living including personal goals and aspirations, and choices of leisure activity and how these will be met as part of the proposed Person Centred Care Plans. The storage of controlled drugs must meet current regulatory requirements. Suppliers of CD cabinets can confirm that a cupboard meets the legal requirements. We recommend that care homes request formal confirmation when purchasing a CD cabinet. Guidance on the storage and recording of controlled drugs is available on the Commission website www.csci.org.uk The registered manager must monitor the management of medications to make sure that care staff are following the home’s policies and procedures for the safe storage and administration of medication in the home. This will make sure that residents receive their medication as prescribed at all times. The medication fridge must be checked to make sure that medicine is kept at the recommended temperatures. Guidance for care staff on managing the daily programme for residents who use insulin must be specific to individual needs and provide clear guidance on what staff must do to manage any risks or events. Areas of the home are in need of repair, decoration and refurbishment, particularly the kitchen and sitting room and the entrance and hallway. The home should demonstrate that they have a planned programme for the regular maintenance and repair of the home to improve the quality of life for the residents. The policy and procedures for maintaining good hygiene in the home must be reviewed including staff training and monitoring of practice in the home. The home must develop and maintain a system for reviewing the quality of the service provided. 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 7 Events that happen in the home affecting the well being or safety of the residents must be notified to the Commission in writing. This is a legal requirement. We will be asking the registered person to provide an improvement plan to tell us what they are doing to improve the practice in the home for the benefit of the residents and to comply with regulatory requirements. 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. 374-376 Winchester Road DS0000062649.V368598.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 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. New residents do not move into the home until their care and support needs have been assessed and the home is confident they can meet care needs. The home has not developed communication tools that are suitable for the individual needs of the residents and needs to work towards including all of the residents in the admission process of new residents to the home. EVIDENCE: We looked at the assessment records for the newest resident. The process for assessing new residents before they move into the home is comprehensive and the manager had met with the new resident and gathered all necessary information from other people involved in their care. The manager explained that she usually would invite prospective new residents to visit the home and meet other residents before new residents move in. In this instance, there were reasons for this not happening. We were not able to speak to the new resident to get their feedback on the moving in process. At the last inspection the manager was in the process of developing suitable information about the home and had started to develop information about the home as a book of photographs, so that prospective residents can be provided 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 10 with information about the service in a suitable format. Recent staffing shortages have meant that this has not been developed. However, the need to develop better communication tools has been identified as part of the home’s improvement plan and we will look at this during the next inspection of the home. The home’s current improvement plan also includes plans to improve the staff training and development opportunities so that staff have the necessary skills and knowledge to meet the needs of the residents in the home. 374-376 Winchester Road DS0000062649.V368598.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 adequate. This judgement has been made using available evidence including a visit to this service. The service understands the need to support the right of individuals to make their own decisions and choices. However, this does not always happen in practice. The home needs to develop individual communication styles that will meet the needs of residents with more complex and diverse needs to ensure that their opinions are listened to. EVIDENCE: We looked at the care plans for three residents and spoke to some of the care staff. We also spent some time in the sitting room with some of the residents and staff and observed daily activities in the home. We have previously made recommendations for the home to develop a person centred care planning system as good practice. The home has employed a consultant to produce person centred care plans, and training for care staff in using the new person centred system is planned for September 2008. 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 12 Currently, care staff are still using the old care plans as their working documents and guidance and we found that these care plans vary in how up to date they are. In one care plan, the risk assessment and guidance for staff on what they must do to provide support, had not been updated. For example, the care plan gives specific guidance that a resident should not have anything to drink after 6pm. When we discussed this with care staff, they told us that the care plan had changed, however, the home is reliant on using agency staff that may not know the residents and their care needs. In addition, the care plan had not addressed whether this guidance was appropriate and meets with good practice in managing continence. The detail contained in the risk assessments was good in one care plan but lacked detail in another. For example, one care plan had a separate bowel chart for a resident but this had only been completed for a short period of time. We were told that the chart is only needed if the resident has a problem but there was no information on how staff would know whether the resident needed additional observation and the resident is not able to tell staff. We made an immediate requirement for working care plans to be reviewed and updated and wrote a letter to the home following our visit. The home has confirmed that care plans will be updated and that the new person centred care planning system will be in use as soon as possible. The care plans did not contain a clear record of individual choices and how these are agreed and promoted. There was no evidence about how residents are consulted with on a regular basis to ensure that the care plan reflects their changing needs, goals and aspirations. The care plans did not contain specific guidance for care staff on preferred methods of communication and in one care plan for a resident who has complex communication needs there was no information for new care staff about how to support the resident with social and leisure activities they enjoy and no detail for care staff about what the resident likes to do. For example, during the time that we were in the home, we observed over a period of one and a half hours, that staff made no communication at all with one resident who was sitting in the living room and the resident was not invited to participate in any activity at all during the whole day. At the last inspection the manager showed us how the home was starting to develop a picture based communication tool (PECS), however, staffing issues has meant that no further work has been done to develop this. The development of individual and specific communication tools has been identified as an area that the home needs to improve and staff training in the values and principles of good communication has been arranged for August 2008. The residents are not able to manage their own financial affairs and some of the residents are waiting to have an independent appointee, in the meantime the home is keeping a record of residents’ daily purchases and this will be offset when residents are able to access their personal allowance through a 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 13 designated financial appointee. We did not look at financial records as these had been taken away for audit purposes. 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some of the residents have the opportunity to take part in social and leisure activities but the home has not developed consistent practice that includes all of the residents as part of their person centred care planning approach. This would demonstrate that all of the residents are supported to access meaningful activities of their choice, and individual development and progress could be regularly reviewed. EVIDENCE: We looked at the care plans for three residents. We looked at menus and the kitchen, spoke to some of the care staff and spent some time with residents and staff in the communal areas of the home. When we visited the home, three of the residents were attending day care services and one resident was being supported to visit family. For the other residents in the home there was no evidence of planned activities. The 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 15 activities programme that we saw in the office had a number of activities listed for the residents, but on the day we visited, none of these activities were taking place. The care plans that we looked at did not contain any information for staff in sufficient detail to give them guidance on what residents like to do and what activities could be planned. The television was on in the sitting room although it did not appear that any of the residents were watching it. We were told that some of the residents like to listen to music but staff did not put any music on. The home has a safe and enclosed garden area with a trampoline but we did not see any evidence of outside activities being planned for residents on the day that we visited. The garden furniture is in a poor condition and we were told that new and more robust furniture would be purchased. The manager told us that recent staffing shortages have meant that some activities such as going out with staff, have not taken place. We saw evidence that the home is moving towards developing a person centred care planning approach, and the documents to develop this are in place but not yet put into practice. We looked at the menus and spoke to some of the care staff. Residents are not consulted about menu choices although it is evident that consideration is given to meeting residents’ special dietary needs. At the last inspection we were told that the home planned to develop photographs of all of the menu choices to promote better communication and choice for the residents, but this has not been developed. The menus are decided by care staff and shopping is then done to make sure that all of the ingredients are in stock, however, we were told that some of the menu choices are not particularly popular with the residents or staff, but they have not been changed. The kitchen is in a poor state of repair and at the last inspection we were told that the kitchen refurbishment was “imminent”, but in the 7 months since the last inspection, this work has not started. The kitchen is not accessible for the residents but the store cupboards are outside of the kitchen, and the kitchen door is only lockable from the outside. The worktops, cooker, sink and taps, and flooring are in a poor state of repair. The owner of the home told us that there are plans to extend the kitchen as part of the overall refurbishment of the home. The owner of the home told us that work would be starting in two weeks time. We did not find any evidence in care plans that residents are encouraged or supported to participate in daily living activities if they are able, such as assisting with meal preparation, shopping, laying tables, washing up etc. 374-376 Winchester Road DS0000062649.V368598.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. Individual care plans contain evidence of health care treatment and intervention although there are some gaps in the information that is recorded. The home does not provide suitable storage for controlled drugs to meet amended regulations. The registered manager must ensure that care staff follow the home’s policy and procedures for the safe administration of medication, at all times, to ensure that residents received their medication as prescribed. EVIDENCE: We looked at three care plans, and looked at the procedures for administrating medication in the home. The current care plans vary in the amount of detail they provide for care staff about the resident’s health care needs. We noted that in the new person centred care plans there is a health action plan for each resident, but these are not yet in use. Information in the current care plans must be updated to ensure that staff have clear information and guidance on what they must do to 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 17 meet residents’ health care needs. For example, one care plan contained information about a resident’s gluten free diet but did not explain why this was recommended. There were some gaps in the medication recording charts where staff had not signed to indicate whether medication had been given or not. The policy of the home is that staff must check the medication records daily to evidence that residents have received their medication, as prescribed. The home does not have suitable storage for controlled drugs that meets current regulatory requirements and one medicine was not being recorded as a controlled drug according to current good practice. Guidance on the safe storage and administration of controlled drugs is available on the Commission website www.csci.org.uk Insulin is stored in a separate fridge in the office but the fridge temperatures have not been checked since April 2008 to make sure that the medication was being stored at the correct temperature. The fridge also contained out of date eye drops. Some of the staff have received specific training for giving insulin and testing blood glucose levels. However, more detailed and written guidance must be provided to care staff on what action they must take to meet the specific needs of the resident if blood glucose levels are either high or low. This was not provided in care plans seen to ensure that the needs of resident(s) with diabetes are met. 374-376 Winchester Road DS0000062649.V368598.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. The home supports residents to have access to independent advocacy support but this process should be more positively promoted. The home is aware of the procedures for safeguarding residents from the risk of abuse or harm but must review their systems to make sure that all concerns, allegations or suspicions of abuse are reported promptly in line with the agreed procedures for safeguarding residents. EVIDENCE: Allegations of abuse and concerns about the safety of the residents in the home have recently been investigated by Social Services under their safeguarding adults procedures. The home worked closely with Social Services during the investigation and took appropriate steps to protect the residents in the home. The investigation did not find any evidence to support the allegations, however, some recommendations to improve practice in the home were made. These were about improving and updating the training for staff in good practice in the use of restraint and working with challenging behaviour. The other recommendations were about: improving the way that the home assesses any risks to residents and providing clear guidance for care staff on how risks or events must be managed; and making sure that any events in the home that affect the health, safety or welfare of the residents are promptly notified in writing to the Commission and to Social Services. The home have told us that some of the residents work with independent advocates and this needs to be clearly recorded in residents’ care plans and 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 19 regularly reviewed. However, not all of the residents have access to advocacy support. At the moment, care plans do not contain sufficient and detailed information about how residents rights and choices are promoted and protected, but the home are in the process of developing person centred care planning and training is planned for staff on developing a person centred care approach with residents in the home. This needs to be embedded into practice in the home. 374-376 Winchester Road DS0000062649.V368598.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, 27 and 30 - Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The building is in need of refurbishment, repair and decoration to ensure that the home environment provides a good quality of life and meets the specialist needs of the people who use the service. The home does not demonstrate robust and thorough policies and procedures for the promotion of good practice in managing the control of infection. EVIDENCE: We looked at the communal areas of the home, the garden, kitchen and some of the residents’ bedrooms and bathrooms. We also looked at what the home has told us in the Annual Quality Assurance Assessment (AQAA). At the time of our visit to the home we told them to immediately repair two broken light fittings and we have received written confirmation that the fittings have been repaired. The front garden of the home has been paved to provide more parking spaces but the outside looks neglected with dead plants in the hanging baskets and 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 21 rubbish in the garden that has drifted in from the road. The glass panels in the front door and side windows have been replaced with white plastic panelling, this means that residents and staff cannot see who is at the front door, and from the outside, the entrance does not look homely and welcoming. Some areas of the home need repair and decoration to walls and paintwork that are in a poor state. We saw a broken ceiling light fitting in one bedroom and the ground floor bathroom light was broken, this means that residents using the bathroom had to leave the door open, or use the bathroom without a light. The light had been broken for three days. Several of the toilets used by residents did not have a toilet seat. There were personal toiletries left out in the ground floor (shared) bathroom but the manager told us that the bathroom does not have a lockable storage cupboard to put anything away. A jug of dirty water with soap and loofah in it had been left on the side of the bath. The wood laminate floor in the sitting room is damaged in places and the furniture looks tired and worn. Some of the garden furniture is damaged. The main kitchen is in a poor state with damaged flooring, broken taps and insufficient storage space so that food is stored in cupboards in the sitting room area. The kitchen door can only be locked on the outside and does not have a glass panel so that residents and staff cannot see if there is anyone in the kitchen. At the last inspection we were told that refurbishment work on the kitchen and sitting room would be starting immediately, however, seven months later, the home is still in need of repair and decoration and replacement of some furniture and fittings, and repair work has not been carried out on the kitchen and sitting room. Essential maintenance is only done when a problem has already arisen because we were told that an upstairs bedroom had been repaired and decorated recently when the wall was badly damaged by a resident. The Annual Quality Assurance Assessment (AQAA) does not provide us with detailed evidence of what improvements the home will be making to provide a better home environment for the residents who have specialist care and support needs. We spoke to the owner of the home who told us that considerable refurbishment work is planned, however, we were also told this at the last inspection but the work has not been done to improve the home for the benefit of the residents. The home have told us that that they have a written policy for preventing infection and managing infection control, however, only two of the staff in the home have received training in good practice for the prevention of infection. The AQAA states that the home has not reviewed their policy and procedures, or staff training, in infection control, in line with current good practice guidance. We saw staff wearing gloves and aprons at various times during the day when appropriate and these were easily available for staff to use. Some of the residents require continence care and promotion, this means that floors 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 22 need to be easily cleanable to promote good hygiene, however, the damaged flooring in the sitting room and kitchen cannot be properly and easily cleaned and should be replaced. 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 23 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, 35 and 36 - Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service is aware that residents need an effective and qualified staff team to meet residents’ individual and special care needs; but more work is needed to achieve this. Residents are protected by the home’s recruitment procedures and practice. EVIDENCE: We spoke to some of the care staff, individually, and during the course of the day when they were with residents in the communal areas of the home. We looked at some of the staff recruitment and training records and looked at what the home has told us in the Annual Quality Assurance Assessment. We looked at the recruitment records for a new member of staff and these show that the home has robust recruitment procedures to demonstrate that care staff are suitable to work in the home with the residents. The home has a staff team of 11 people but is reliant on agency or temporary staff to meet staffing needs. Temporary staff may not know the residents well and this may affect how well the home is able to provide person centred care 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 24 or provide activities for the residents. The home told us that they are advertising to recruit more staff to work in the home as permanent members of the staff team – there are currently five staff vacancies. When we spoke to some of the staff they told us they liked working in the home and are keen to develop their skills and expertise; one person told us they had found recent training in ‘protection of vulnerable adults’ and the ‘mental capacity act’ “very helpful”. Staff told us that they usually have team meetings and regular (formal) supervision, but recent staffing shortages have meant that this has not been regularly arranged. However, staff felt that they could speak to the manager or other staff if they needed to. The home has recruited a new member of staff as ‘Operations Manager’. This person will be taking on the role of ‘responsible person’ and will be making regular inspections of the home on behalf of the registered owner. When we looked at the last inspection of the home that had been carried out by the operations manager, we saw that a number of areas of organisation of the home have been identified as needing improvement, including staff training, the staffing rotas, and staff supervision and team meetings. The home has told us that they plan to improve staff training opportunities and showed us the training calendar for the next few months. The home has also identified that they must improve communication skills training to provide staff with the skills and expertise to meet the individual needs of the residents. The home has told us that they plan to appoint an activities co-ordinator to improve opportunities for activities for the residents. The home needs to demonstrate that they will carry out the proposed improvements to develop a skilled and permanent staff team and sustain these improvements for the benefit of the residents in the home. 374-376 Winchester Road DS0000062649.V368598.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, 41 and 42 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager of the home is aware of the need to improve and develop systems that monitor practice and compliance with the plans, policies and procedures of the home. More work is needed to demonstrate that the health, safety and well being of the residents is promoted and protected at all times. The home need to demonstrate that there are efficient systems for monitoring the quality of the service provided. EVIDENCE: We spoke to the manager, operations manager, the home-owner (registered provider) and some of the staff. We looked at what the home have told us in the Annual Quality Assurance Assessment (AQAA). We also looked at some of the home’s health and safety records. 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 26 At the last inspection we noted that the home’s internal audit and inspection systems were not thorough. Since January, the home has not been regularly audited and inspected to monitor how well the home is providing good outcomes for the residents and meeting regulatory requirements. Between March and July 2008 there are no records for monthly inspections of the home that are a legal requirement. However, with the appointment of an operations manager, we have been told that the home will be making improvements to the systems for monitoring practice and quality of the service provided. The home have told us that further management changes are planned and an activities co-ordinator will be appointed. We have asked the registered provider to confirm in writing what the management changes will be. All sections of the AQAA were completed but the evidence to support the comments made is limited in detail about the areas where they still need to improve. The ways that they are planning to achieve this are briefly explained. The home have told us that they plan to further promote equality and diversity in the practice of the home by developing person centred care planning and staff training. However, the home have not started to use the new person centred care plans and we found that some of the care plans and risk assessments lacked detail to guide care staff on how they must manage risks or events in the home. All of these planned improvements need to be imbedded into practice in the home and sustained over a period of time for the benefit of residents in the home. The information in the AQAA did not demonstrate that the policies and procedures for the home have been reviewed and updated. The home need to ensure that policies and procedures are up to date and meet current guidelines for good practice to ensure that staff in the home have clear and relevant guidance on how care is to be provided. For example, the policy and procedures for good practice in infection control need to be reviewed and updated to ensure that practice in the home is robust and thorough. The home has a policy and procedure for the safe administration of residents’ medication but we found some gaps in the medication records. The manager must ensure that practice is regularly monitored to ensure that staff are following the home’s policy and procedures. This will ensure that residents receive their medication as prescribed at all times. The manager must also ensure that the medication fridge is used safely: we found that fridge temperatures have not been checked since April 2008. The home has not been telling us about all of the things that have happened in the home. These are called ‘notifications’ and are a regulatory requirement. This was also a recommendation from the recent safeguarding investigation by Social Services. The home must tell us about any events that affect the safety and well being of the residents to demonstrate that the home are taking prompt and appropriate action to protect residents in the home. Guidance on 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 27 making notifications under Regulation 37 of the Care Homes Regulations is available on the Commission website www.csci.org.uk Records show that action is taken by the home to meet relevant health and safety legislation and protect residents in the home; the manager confirmed that they have done work to meet regulatory requirements for fire safety and food hygiene following inspections of the home by Environmental Health and the Fire Safety Officer. 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 28 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 2 2 2 3 X 4 2 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 1 25 X 26 X 27 1 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 2 X 2 2 X 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 29 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement Individual Care Plans must be regularly reviewed and updated. The storage of controlled drugs in the home must meet the regulatory requirements of The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007. Timescale for action 30/08/08 2. YA20 13(2) 30/10/08 3. YA30 16(j) 4. YA24 5. YA39 6. YA41 There must be suitable arrangements for maintaining satisfactory standards of hygiene and the control of infection in the home. 23(2)(b)(d) The home must be kept in a (h)(p) good state of repair internally and externally and meet the needs of the residents. 24 The registered person must establish and maintain a system for reviewing and improving the quality of the service provided. 37 Any event in the home that affects the well-being or safety of the residents must be promptly notified in writing to the Commission. DS0000062649.V368598.R01.S.doc 30/09/08 30/09/08 30/10/08 30/08/08 374-376 Winchester Road Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 374-376 Winchester Road DS0000062649.V368598.R01.S.doc Version 5.2 Page 32 - 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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