Inspection on 24/05/07 for 4 - 6 Cavendish Road

This inspection was carried out on 24th May 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

4 - 6 Cavendish Road 12/05/09

4 - 6 Cavendish Road 29/04/08

4 - 6 Cavendish Road 28/04/06

4 - 6 Cavendish Road 09/01/06

4 - 6 Cavendish Road 11/10/05

4 - 6 Cavendish Road 10/03/05

4 - 6 Cavendish Road 22/11/04

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

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

CARE HOME ADULTS 18-65 4 - 6 Cavendish Road Felixstowe Suffolk IP11 2AX Lead Inspector Mary Jeffries Key Unannounced Inspection 24th May 2007 4:00 4 - 6 Cavendish Road DS0000048200.V341546.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 4 - 6 Cavendish Road DS0000048200.V341546.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. 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 4 - 6 Cavendish Road Address Felixstowe Suffolk IP11 2AX 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) 01394 286990 01394 284878 cavendishroad@together-uk.org Together, working for well being: Working for Wellbeing Mrs Janet Gentry Care Home 13 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (13), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (13) 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users must be under 65 years of age at the time of admittance to the home. 28th April 2006 Date of last inspection Brief Description of the Service: The home is situated in a residential area of Felixstowe within easy reach of the beach and local amenities, such as shops. The home is in two linked adapted domestic houses, providing accommodation on three floors. Cavendish Road has a small back garden, which is accessible to residents and is attractively designed. The home is registered for thirteen residents with mental disorder. Residents are aged below 65 years of age at the time of admission, but may remain at the home over 65 years of age, so long as the home is still able to meet the resident’s physical and mental health needs. The home is owned by Together, working for well being: which was previously known as MACA. The home’s manager is Janet Gentry. The current charge for residents is £649.14 to £678.00 per week. 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which focused on the core standards relating to younger adults. The report has been written using accumulated evidence gathered prior to and during the inspection. The inspection was conducted in the late afternoon and early evening and took approximately five hours. The acting manager was not on duty and the inspection was facilitated by the senior carer on duty. Two other members of staff were spoken with, one in some depth. The inspector sat in on the staff handover at the change of shifts. A resident accompanied the Inspector on a tour of the building. There were nine residents living at the home at the time of the inspection, and four vacancies. All residents were met. A pre-inspection questionnaire was provided in April 2007. Three residents were tracked. Three residents were spoken with individually and privately, another resident and a group of three residents were also spoken with. Four relatives responded to a survey sent out to them at the same time. Five residents responded to a pre-inspection survey. Four members of staff provided staff comment cards. What the service does well: Residents can expect to be assessed prior to admission into the home. They can expect to be treated with respect and have considerable freedom within a risk-assessed framework. They can expect to have an enjoyable lifestyle, with care and support given in a way they find acceptable. Resident’s views are incorporated into the running of the home. They can expect to be able to raise any concerns and to have access to a proper complaints policy. Residents can expect for their health needs to be met, and for the home to liaise with other professionals on their behalf. Residents can expect to be given opportunities to develop their potential. The health and safety of the residents is protected by appropriate risk assessments and remedial actions in respect of their care. 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The environment of this home which has good communal space and facilities, requires attention. The requirements of the fire officer as detailed in the letter of February 2007 must be fully complied with. The home requires some major redecoration and some minor repairs. Food hygiene training for staff must be renewed at appropriate intervals to ensure residents’ health and safety is fully protected. The six monthly CPA reviews do not necessarily take into account the suitability of the placement, and for one resident this needs to be fully reviewed by the home. All concerns that may involve abuse must be referred through Customer First in accordance with agreed County protocol. 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 7 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. 4 - 6 Cavendish Road DS0000048200.V341546.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 4 - 6 Cavendish Road DS0000048200.V341546.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): 2,3,4. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents can expect to be assessed before being allocated a place in the home, to receive full information and to have an opportunity to visit the home before they decide to move in for a trial period. EVIDENCE: Five residents who responded to the survey all stated that they were asked if they wanted to move into the home, and also that they received enough information to make an informed choice as to whether the home was right for them. Staff on duty explained that introductory visits and stays and a trial period were offered, and one of the residents noted that they “came and looked round before deciding to move in.” Only one resident living in the home had been admitted since the last inspection. They had been admitted in November 2006. All the residents living in the home are part of the Care Programme Approach process, and their CPA care plan is the basis of their assessment for the home. A risk screen is subsequently completed by the home based on this; these were seen to be on file, including for the most recently admitted resident. An enquiry regarding a potential resident was received during the afternoon of the inspection; the senior person on duty was unsure of the allocation 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 10 procedure, but felt able to offer a visit. They had access to policy books, but acknowledged that in the absence of the Registered Manager it had been challenging at times to find and know all the required information, even though it was available to them. 4 - 6 Cavendish Road DS0000048200.V341546.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): 6,7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to have a care plan based on, and including, their Care Programme approach plan, and for the single Care Management Plan to be reviewed regularly. They cannot be assured that the home will fully and thoroughly address whether it can meet continue to meet their identified needs. EVIDENCE: Residents have Care Programme Approach plans and reviews, and these form part of their care plans within the home, which also include daily living plans, risk assessments and key worker notes detailing individual interventions. The home’s Statement of Purpose states that residents will be reviewed every six months. A resident tracked confirmed that they have a review every 6 months which a forensic psychiatrist attends. Evidence of these reviews was on the files of the three residents tracked. 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 12 One of the relative’s surveys received by the CSCI included a comment that the home should not just go along with what the CPA decided. The CSCI had been properly informed of an aggressive incident concerning two residents that occurred in February 2007. One of these resident’s file notes included a number of other incidents where they had been verbally aggressive in the home. The suitability of the placement of one of these residents was in some doubt, however no formal measures had been taken by the home in respect of this. The mental health / mild learning disability diagnosis of this resident, who had lived in the home for many years, had been queried by a psychologist in mid 2005. A letter on file from the psychiatrist in July 2006 noted that the learning disability diagnosis could not be established confidently, and that a diagnosis of autism was still not secure, due to a lack of available history and that more details and further observations were required. The resident had subsequently been assessed, and then seen at Walker Close, but their care had been referred back to general psychiatry, and the resident was now under a psychiatrist at St. Clements Hospital. The resident’s medication had not been changed as it had been found to have stabilised their psychiatric symptoms. The CPA care plan review in March 2007 noted that the resident’s challenging behaviour had been linked to environmental factors at the home. Members of staff spoken with had some concerns about the possibility of sensory over load in this home for this resident, although the resident themselves said that they liked living in the home. The CPA review contained a number of day care activities which the resident had subsequently decided not to take up. It provided a good detailed plan of care within the home, including behaviour management plans, and also stated a need to identify a new placement. Staff advised that they understood the resident’s social worker was trying to find a more suitable placement, but were unsure how long this might take. The most recently admitted resident did not have a daily living plan on file. This resident’s care plan and discussion with staff evidenced that the resident was living quite independently, including cooking their own meals, and was due to move out of the home in a short period of time. All five residents responding to the survey stated that they make decisions about what to do each day during the daytime and evenings. One noted, “The staff (key worker and team) are involved in giving us tasks around the house which are voluntary except for the kitchen which is on a rota basis” Two members of staff spoken with in depth showed a very good knowledge of residents’ needs, and a sensitive non-judgmental attitude. In response to the enquiry in the survey, “Do carers listen and act upon what you say, four stated that they did, the fifth commented that they did not have any problems at the 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 13 moment, but if I did, I think they would be put right.” All commented that staff treated them well. At the shift handover all residents were referred to in terms of what they were involved with that day and any current issues. Whilst workers spoke in the office, the radio was on in the lounge; staff advised that this was because of the lack of soundproofing in the room. Relatives were asked in the survey, “Do you feel the care home meets the needs of your friend / relative. Three stated always, one stated sometimes, qualifying this with the statement. “ In every way they can. ….is always shown care and respect, what ever ……..’s needs are.” Another relative commented, “ I sometimes feel they go beyond the what I would expect of the care. Should receive. They are all so kind and helpful towards. ………helping…with all of (their) needs.” One carer spoken was key working a resident who was starting to understand their own needs differently, but was sensitive to the requirement to work at the resident’s own pace. They demonstrated a respect for diversity, and also a willingness to seek advice from other professionals to support them with this. One relative commented, “….… is independent as their health allows but ……. can feel safe in the knowledge that there is 24 hr support at the care home. The carers always encourage ………...to live the life they chose, and help ……….. as much as they can to achieve this.” 4 - 6 Cavendish Road DS0000048200.V341546.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): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have support to work to the goals identified in their Care Programme, with the assistance of a key worker and a daily living plan which takes account of their individual capabilities, needs and vulnerabilities. EVIDENCE: Most residents have a daily living plan, which details routines of daily life and attendance at events. There are very varied, and reflect that the level of input and involvement in household duties reflects residents’ needs. A washing up rota for all residents was on display in the kitchen. One resident spoken with briefly had the major hand in the gardening and had potted up several planters, another took responsibility for garbage and spoke about the home’s recycling efforts. All residents do their own washing and have allocated times when they have first call on the use of the washing machine. Two residents who were planning to leave the project soon did their own cooking. 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 15 A notice board in the home displayed up to date details of local community activities available. These included a series of monthly events through to December 2007, such as a barbeque, and Karaoke evening at this home, a games evening at another home rum by Together, an outing to Great Yarmouth, a sponsored walk, a visit and picnic at an Essex beauty spot, and a visit to Colchester Castle. A number of residents advised they had attended entertainment and events in the community; one was hoping to participate in a healthy walk organised by local health services. Three residents had participated in an organised walk earlier in the year and had certificates confirming this on display on the dresser. One of the residents spoken with explained that they were going to attend a leadership course provided by Together, which would enable them to get more involved with contributing to service delivery. This resident assisted the inspection. They had been at the home for less than two years, and they commented, “I feel proud to live here.” A member of staff confirmed that this resident was booked to attend three elements of Together’s leadership course, self-confidence, where to go next, and an induction. In response to the enquiry, “What do you feel the home does well”, on the relatives’ survey the following comments were made; “Perseveres with challenging behaviour.” “To try to get all of the residents motivated and get on with life despite their needs, but again, with the knowledge that help is at hand.” “Everyone is made to feel part of the home” “They listen to all of their needs and help them as much as they can.” One relative expressed the view that the home could improve communication with those close to residents. Relatives were asked in the survey whether they were kept informed of important issues affecting them. Two thought, yes, one usually and one sometimes. Supporting residents’ contact with relatives was discussed with staff and residents on the day of the inspection. Residents were positive that assistance was given in this respect if they wanted it, staff were trying to assist a resident obtain a contact number for a relative that a resident had lost touch with. Three of the four relatives confirmed that the home assisted the resident to keep in touch with them, one thought it sometimes did. One resident had been out for a meal on the day of the inspection with a relative they had not had contact with for some time. Staff showed interest and sensitivity in discussing this with the resident. Staff explained that the resident’s wishes had a significant bearing on this aspect of care. One relative commented on the survey response, “I phone the care home to speak to ……. at least a couple of times during the course of a week. I’m never 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 16 made to feel a nuisance if a member of staff has to find ………... to come to the phone to speak to me.” Another commented, “ I enjoy visiting …..… at their home as I’m always made to feel welcome.” Diet and meals were discussed with one resident, and then briefly with a group of residents. They explained that residents help themselves to breakfast and tea, and one main meal a day is prepared for them, with residents sometimes participating in this. Staff cook the Sunday roast meal. Some residents choose to do their own main meal, as part of their own programme of daily activities. The menus for the week, drawn up by the residents, were available. In the coming week the menu included, quiche, chilli con carne, Ploughman’s, Roast pork, Chicken Korma, lamb chops, and a pub meal, which the resident advised the home paid for. A resident confirmed that the vegetables used in the home were always fresh, with the exception of frozen peas. Another resident spoken with volunteered,“ It’s good here; excellent food.” One of the residents who was particularly nicely dressed for a day out explained that it was an outfit that they had slimmed own to fit into, and spoke about their successful efforts to loose weight, with staff support. Through out the day residents were observed to be relaxed in their movements around the home, using the paved garden area, the smoking room, the lounge the sitting room and their own rooms as they choose, the home affording them lots of options as to where they spent time. When asked what if anything they would like to see improved, one resident advised that they wouldn’t change anything, another was concerned, only, about the state of the decorating in parts of the home. 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to receive a good quality of support from a caring, competent and sensitive staff team who will liaise with other professionals, and residents can expect to feel confident with the support they receive. EVIDENCE: One resident commented, “Staff support me to believe in myself and have confidence in my self and encourage me.” Care plans evidenced appropriate appointments made and kept with other health care professionals. Two residents advised that they could have the level of support they needed with health appointments, and staff would attend with them if they wanted them to. One resident who feared dentists had had special arrangements for them to be seen at the hospital, however, these arrangements had not worked out despite the best efforts of the home who had worked with the local community health team on this. The home was pursuing this matter. 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 18 This resident had a weekly programme which the local community health team had assisted to devise, and gave support with, although staff reported that the resident did not wish to participate in all of the planned activity. In respect of health needs, a relative’s survey response was, “………’s carers always let me know about doctors and hospital appointments. Another advised, “I’ve recently been taking………... for various appointments and working alongside the carer’s by sharing information such as how the appointment went and whatever treatment may be required.” A resident spoken with explained that they had started to self medicate after living in the project for about a year, and that there had been “a few hiccups” with this, but they had guidance and support in resolving their difficulties. A risk assessment was in place to support this, and a member of staff spoken with was fully aware of the risk and the agreed strategies to reduce risk. Two residents attended the office to receive medications during the inspection. These were appropriately given and signed for. A member of staff advised that there had been changes to the way in which medications were provided for residents who are away from the project without a member of staff. They advised that staff have been advised that they must not prepare a dosset in advance, and if a resident is to be away for a day then they do their own dosset box under the supervision of staff who double check it. Medical administration Records (MAR) sheets were inspected. One gap only was found, relating to the previous day, this had already been picked up by staff and was marked on the staff handover sheet to be picked up. Records contained a running total of stocks, which were checked and found to tally with the medication supplies. 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 19 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): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can be assured that the home has an open atmosphere wherein they are encouraged to express concerns, and that complaints are dealt with properly. They cannot be assured, however concerns regarding possible abuse will be referred through the proper channels. EVIDENCE: All five residents responding to the survey stated that they knew how to make a complaint, and that they knew who to speak to if they were not happy. Two of the residents spoken with confirmed that they had service user guides in their rooms which contained the complaints policy. Two of the four relatives who responded to the survey stated that they did not know how to make a complaint, one did not respond and one stated they couldn’t remember. One noted, “No, because I’ve never had to make one, but I’m sure that if I had to I would speak to the care manager and they would lead me in the right direction.” The pre-inspection questionnaire completed by the home noted that five complaints had been made in the last twelve moths, and all had been partially substantiated, having been dealt with within 28 days. The complaints log was seen. There had been no complaints since April, and most of the complaints prior to then concerned noise from other residents. One concerned a resident feeling somewhat harried about being prompted to keep their room in an 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 20 acceptable state. The enquiry into the complaint had looked fully into this, including references to notes on this subject which were on file. The pre-inspection questionnaire indicated that an advocate had been engaged for one resident who had subsequently left the home. The four members of staff who provided staff comment cards all confirmed that they had received training in the protection of vulnerable adults. The Preinspection questionnaire indicated that there had been one Protection of Vulnerable Adults referral in the twelve moths prior to April 2007. CSCI had not received any notification of this or any other PoVA referral during the during the year, and the senior carer on duty advised that they thought this possibly referred to a concern about family members borrowing monies from a resident which they had referred to the local community health team who had helped them deal with to the resident’s satisfaction, but had not been referred to Customer First as far as they were aware. The carer advised that information on referral routes for PoVa’s is available in the home, but they would have to look this up. Criminal Records Bureau checks for all staff were available in the home. The most recently recruited member of staff had been recruited prior to the last inspection. At two previous inspections the security of the building had been identified as a concern. On this occasion all doors to the front of the building were found to be appropriately closed, and there were notices in place reminding people to close the doors after them. 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 21 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): 24,25, 26,27, 28,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to have a homely environment with good indoors and outdoors facilities, but will find that the interior décor and carpeting of some communal parts of the home whilst clean, is shabby. EVIDENCE: The home has a good range of communal space including a quiet room where interviews can be held in private. The dining room and sitting room were clean and welcoming. Two resident’s bedrooms were seen, these were personalised and attractive. The home was clean and tidy on the day of the inspection, the five residents responding to the survey all indicated that the home was always clean and fresh. There is a resident’s pay phone, with large numbers, in one of the hallways. 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 22 Major refurbishment work in the project had been completed since the last inspection; not all of the proposed decorating had been completed, and some of the newly plastered walls had marks coming through. The corridors and stair well in one part of the home remained was shabby in appearance and some of the carpeting dirty and stained. Staff and residents advised that this part of the building had not been redecorated since Together took over the home. The new carpet in the other part of the home that had been redecorated had worn poorly and was also marked. Staff advised that they had cleaned it as best as they could. A number of tiles were missing in one bathroom, one of the more recently decorated bathrooms with only limited tiling had marked walls, and some paint work on doors including to the sitting room was marked and chipped. Staff advised that some of this work is routinely done by a handyman, but that they were on leave for an extended period. The resident who assisted with the tour who had spoken of their pride in the home was not happy that the decorations expected in the home had not taken place. The kitchen is in a good state of repair, clean and tidy. There was not a great deal of food stored in the fridge, one resident explained that the shopping day was tomorrow. Fridge and freezer temperatures were kept, there was an environmental risk assessment for the kitchen. There were thermometers in both fridges and records of temperatures were maintained. One fridge consistently read higher than the other, but records showed it to be below 8 degrees Celsius. After tea, when this fridge had been in constant use, the thermometer read 11 degrees Celsius. A worker explained that this fridge sometimes failed to close properly if not pushed fully to. There are two toilets and bathrooms on each floor where bedrooms are situated. The ground floor provides toilet facilities accessible from communal areas. Each toilet and bathroom is provided with a hand washbasin, hand wash gel and disposable hand drying towels. Bathrooms are provided with showers or baths, and some provide both shower and bath, so providing residents with choice of bathing facilities. All toilets and bathrooms were viewed to be very clean. Communal toilets had paper towels and liquid soap. There were no bars of soap in bathrooms. A fire door on the stairwell, where a change in the position of the handle had compromised its width had been repaired and the home had provided a copy of the fire risk assessment prior to the inspection. At the time of the inspection there was a smoking room, but all residents were aware that a new smoking policy had been introduced and that this would soon not be available. Staff and residents confirmed that there is a plan to provide a shelter in the garden, but that this would not be available immediately. Residents spoken with thought that that the garden which has garden furniture and is attractively paved would be acceptable to smoke in during the summer months. One resident spoken with was not happy about the changes. 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 23 Two residents were keen to show the inspector their individual rooms, which reflected their own tastes and preferences. Both residents spoke of being very pleased with their rooms. One of these was a large room with a sitting area; the resident explained that they sometimes entertained heir friends in their room. The resident assisting with the tour of the building advised that they had a lock to the front door of the house and their own room, and a key to their medicine drawer, being a self medicating resident. 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 24 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): 32,33,34,35,36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to receive care from an experienced staff team who will relate to them well, anticipate their needs and consult with other professionals, whilst treating them with respect and sensitivity. EVIDENCE: There were two members of staff on duty throughout the day of the inspection with the exception of an hour and a half at midday when a senior manager was present in the project with the carer on duty. A member of staff advised this had occurred as another carer had gone off duty, as they were sick. One of the carers worked a split shift, and so three workers covered the day. Another worker who had been off work was spending some time in the project during the afternoon catching up on paper work. The senior person on duty on the late shift advised that the home was currently a member of staff down on compliment, but were awaiting the recruitment of another carer who had been appointed subject to satisfactory checks. Additionally, the deputy manager has been acting up as manager 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 25 during the Registered Managers absence from the project, and this effectively meant that the home was also down another carer on the staff compliment. Two of the four staff comments cards received indicated there had been staffing pressures. It was not apparent that this had affected the residents directly, although one resident commented that they would like more time to talk with staff. Carers advised that staff were sometimes asked to work additional shifts that they would not choose to do, but worked as they felt a commitment to the residents. They advised that whilst there was always a minimum of two workers on duty during the day, three are needed if carers are to assist residents in the community, for example taking them to an appointment. A member of staff confirmed information entered in the pre- inspection questionnaire, that agency staff are rarely used. Together has three relief staff who are sometimes available for cover, they also work at another home so are not always available, but this arrangement allows for continuity of staff. The staff rota for April showed that there is usually a period from 1.30 to 4pm when more staff are available, for the handover and other duties, and a member of staff advised that agency staff had been used when one resident’s behaviour meant that more support was required. Staff confirmed that there is managerial support on call at all times. One staff member had noted that it is difficult to staff the project whilst team members attended training. At the inspection a carer explained that training opportunities had not, in any case been available to wards the end of the last financial year. On the day of the inspection staff spoken with advised that since April more training had been available to them. The pre-inspection questionnaire stated that 50 of staff has NVQ 2 or above. Staff on duty advised that two of the staff group hold NVQ 4. The certificate of one of these who was on duty on the day of the inspection was seen. The other was a member of staff who had previously managed another Together project and had moved to Cavendish road; staff on duty advised that this worker had been a great support to them. Attendance at a two day Manual Handling training course was evidenced for two carers selected at random. A member of staff had previously been a relief carer had evidence of training in the principals of care, boundaries, and the mental health act and key working since being taken on as a permanent staff member in 2007. The employment file of this worker was inspected and found to be in order with all appropriate pre employment checks. One worker advised that they had only had one day medication training, and was now hoping to get further training. The pre-inspection questionnaire 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 26 indicated that food hygiene update was planned. One carer acknowledged that their food hygiene training was in need of renewal, and that they were aware that other were too. The senior carer advised at they were setting up a file and a tick list to enable them to establish all required training updates were scheduled. All carers who sent in comment cards stated that they received regular supervision. Two carers spoken with on the day of the inspection advised that they normally received supervision once a month, and that this was now occurring regularly although there had been some missed. This was discussed; the frequency of planned supervision was such that the supervision received exceeded the minimum standard required in homes. One residents spoke of the faith they had in staff to notice when they were getting anxious, and to encourage them to speak about their thoughts and feelings. Another resident who was tracked and was spoken with described the trust that they had in staff and in particular their sensitivity to and respect for their feelings, in their interactions. 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 27 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): 37,38,39,42,43 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect the home to have an open atmosphere and for it to be well run on a day-to-day basis, but may find that some matters such as the continued suitability of the placement of one resident, the fire officers requirements, and the PoVA referral are not thoroughly dealt with. EVIDENCE: The CSCI were advised in November 2006 that the Registered Manager would not be working in the home until further notice. An acting manager, Joanne Gillian, has subsequently been appointed. One staff comment card received specifically noted, concerning the acting manager; “ I find my line manager very supportive and approachable.” 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 28 Staff advised that another manager from a different Together project was providing support, but that they had not attended the project to their knowledge since January 2007. Staff advised that a senior manager from Together had attended the home on the day of the inspection to carry out a routine quality control exercise, and the paper work for this was seen. A resident spoken with advised that the residents attended two weekly meetings, one to discuss general matters and the other to decide menus and shopping. Residents are invited to provide agenda items to the general meeting. Staff have weekly meetings and minutes are kept. One resident expressed concern that there were some staff shortages and low resident numbers in the house; they understood that they could not be given the details of why and when other residents were leaving, and that this was private, but worried that there might be plans they did not know about and commented spontaneously, “ I wouldn’t like to be the last one left in the house.” The pre-inspection questionnaire indicated that all residents maintain own benefit books and no one subject to power of attorney. Staff were assisting one resident with budgeting, and retained some monies for them, providing an agreed amount each day. Record of this were checked and found to tally with the small amount kept on their behalf. Care plans were kept in a filing cabinet the office, and the office was locked when no one was in it. A separate folder of risk assessments was maintained, and the main plan indicated the risk assessments that were present. The home’s Certificate of Registration was on display. The pre-inspection questionnaire completed by the home confirmed that a recent fire drill had been carried out, and a resident confirmed that the fire alarm was tested regularly. Fire extinguishers were seen to have been serviced recently. The Fire Officer had visited on the 20th February 2007, and had subsequently written to the home with a scheduled of require work which included magnetic closures on office door and on kitchen door, these had been put in place. The pre-inspection questionnaire indicated that a planned procedure of work was to be done. The Fire Officer also required the replacement of in tumescent strips on where these had been painted over. This did not been done, the carer on duty advised that they believed that the plan was for the doors to be replaced, but they did not have access to the plan. The Fire Officer was telephoned after the inspection, they advised that they did not have a planned follow up visit to the home, so no deadline had been had been given for this work, and in discussion it was agreed that agree that is was 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 29 reasonable for the CSCI to require this work to be completed by the end of July, giving the home six months from the Fire Officer’s letter. Cupboards for the storage of substances which could be hazardous to health were seen to be locked. 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 30 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 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 2 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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 14(2) (b) Requirement Timescale for action 31/07/07 2. YA23 19(6) 3. YA24 12(3) 4. YA35 13(4) The home must review the suitability of the placement for a resident who has been identified as possibly having a changed diagnosis, and if the home cannot meet the resident’s needs, then a suitable period of notice must be given. Where there is any concern that 30/06/07 a vulnerable adult may be being abused this should be initially referred to Customer First in line with agreed County referral routes, to ensure that proper procedures are followed and that a central record is maintained for future reference. A schedule for the completion of 31/07/07 decoration works and provision of the alternative smoking facility will bring the environment up to a good standard for residents must be provided to the CSCI. This work is required to support the rights and dignity of residents, and their choices. Food hygiene training for staff 31/08/07 must be renewed at appropriate intervals to ensure residents DS0000048200.V341546.R01.S.doc Version 5.2 4 - 6 Cavendish Road Page 32 5. YA42 23(4) health and safety is fully protected. The requirements of the fire officer as detailed in the letter of February 2007 must be fully complied with. 31/07/07 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. 2. Refer to Standard YA2 YA6 Good Practice Recommendations Staff who may be the senior person on duty should be familiar with the entrance criteria and allocation process. All residents should have a daily plan, even if this indicates that they will determine own activities and do own domestic tasks, as this is the one document within the care plan that summarises the type of provision being provided within the context of the CPA plan. Criminal Records Bureau checks should not be retained longer than 6 months or until seen by an Inspector, after this a record should be maintained of the name, number, when received, whether satisfactory – or if this is in doubt, reference to other records of considerations made. Sufficient routine management support should be provided to the acting manager in the absence of the registered manager. Residents would benefit from a senior manager attending a residents’ meeting to address concerns about the large number of vacancies in the house and any implications of this. A notice should be out onto the fridge door that sometimes fails to close properly if not shut firmly. 3. YA34 4. 5. YA37 YA38 6. YA42 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 4 - 6 Cavendish Road DS0000048200.V341546.R01.S.doc Version 5.2 Page 34 - 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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