Inspection on 29/04/08 for 4 - 6 Cavendish Road

This inspection was carried out on 29th April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 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 24/05/07

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 27/09/2008.

CARE HOME ADULTS 18-65 4 - 6 Cavendish Road Felixstowe Suffolk IP11 2AX Lead Inspector Mary Jeffries Unannounced Inspection 29th April 2008 10:30 4 - 6 Cavendish Road DS0000048200.V363653.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.V363653.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.V363653.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 Wellbeing Manager post vacant 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.V363653.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. 24th May 2007 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. The Registered Manager post is vacant. 4 - 6 Cavendish Road DS0000048200.V363653.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 was an unannounced 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 took 9 hours over two days. The manager and deputy manager facilitated the inspection, and another carer was spoken with. Three residents were tracked, and all were spoken with individually. We met all of the residents over the course of the inspection, and the relative of one was spoken with. All residents were invited to complete surveys on the day; three did. The administration of medicines was observed and a tour of the communal areas was undertaken. A number of records were examined including residents’ care plans, medication records, training records and records relating to health and safety. There were eleven residents in occupancy at the time of the inspection, and two vacancies. An Annual Quality Assurance Assessment (AQAA) was provided to us in March 2008. What the service does well: Residents 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 to be given opportunities to develop their potential. 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Whilst the current manager and deputy manager demonstrate a good manner with residents and good knowledge of care; neither have residential experience or are familiar with the regulatory framework within which care homes must operate. At the inspection they advised that they were pleased to have this inspection, so that they could direct their efforts accordingly. Unless the home’s management know what regulations need to be met, and are ensuring that they are met, appropriate quality control will not be maintained in he home. The management of the home has been disjointed since the last inspection. The registered manager and the person we had been advised was covering their role have left the home in this period. CSCI were not been notified in a timely way of the changes, or of alternative arrangements for cover put in place. The AQAA states that the staff changes during the last year have been a barrier to improvement. A large group of staff left the home during the last twelve months. Again, CSCI were not notified of this at the time. The home requires adequate support from the organisation while there is not a registered manager in post to ensure that the home operates within the regulations and is managed effectively. The home does not have an emergency admissions policy, but six residents were admitted as emergency placements; full information was not available in a timely way and two of these placements were not appropriate. The current manager had only been in post for six weeks at the time of the inspection, they had completed the AQAA and identified some of the areas that require improvement. The manager had identified that written information about the service could be reviewed; this is the case, the Service User Guide must be reviewed to ensure current residents have the information they are entitled to, and so that prospective residents have all of the information they need to make an informed choice about whether to come to live at the home. The AQAA has identifies recording as an issue, and training for staff is planned on this. 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 7 Whilst outcomes for the residents at the home remain good, improvement is required on care plan and medication recording. This is to ensure that residents’ current needs cannot be overlooked. Any member of staff reading the plan needs to be able to be clear whether a gap in recording reflects an uneventful or routine period of time, rather than a failure to record what could be a significant event. They also need to be able to update themselves on the work that a key worker has done with a resident, and any agreements or plans made arising from this, so that they can be fully aware of resident’s needs and work effectively with the resident to meet them. Although they demonstrated a good understanding of abuse and the importance of inter agency work, the manager was not familiar with locally agreed procedures and there was a risk, therefore, that residents may not be fully protected from abuse. Appropriate Criminal Record Bureau (CRB) checks had not been undertaken for the deputy manager, and evidence of a CRB check and proper recruitment was not available in the home for a worker who came into post the day before the inspection; we were advised that this had been done and documentation had yet to be put into the workers file at the home. All of the recruitment records listed in schedule 2 of Regulation 19 must be available in the home, so that it can be established whether proper processes have been followed. Residents cannot be assured that their health and safety is fully protected. A requirement made based on the fire officer’s requirements had not been met. An internal monthly health and safety check conducted within the home by a member of staff was found not to be accurate on two matters, and cannot therefore be relied on; if delegated work is not spot checked or audited the home’s management cannot be sure that it has been carried out to a satisfactory standard. One matter not identified by these checks, although it was included within them, was that a refrigerator has been running at excessive temperatures for a number of months; this has posed a health risk to residents. There was no risk assessment for the food production process, known as a hazard analysis of critical control points (HaCCP), in the home. Without this residents cannot be assured that all steps have been taken to minimise health risks in the process of delivering meals from purchase, through storage and preparation. Whilst decorating was occurring in the home, the schedule had not been completed, and further redecoration is now also needed. 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.V363653.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.V363653.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): 1,2,3. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective residents cannot be assured that the home will always assess their needs and be confident that they can be met before admission, nor that full current information will be available to enable them to make an informed choice abut whether to live at the home. EVIDENCE: All the residents living in the home are part of the Care Programme Approach process, and their CPA care plan is the assessment that is used as the basis of their care plan for the home. A risk screen is completed by the home based on this. The homes AQAA states that staff are aware of the process and of the needs of the potential new resident, and that full risk assessments and management plans are agreed with the resident and staff prior to moving in. The only residents that have been admitted since the last inspection were admitted as emergency placements in mid 2007. This was due to the fact that the home where they were living in was closed down. Two of these residents spoken with advised that they were told one day they were moving, and moved the next. The deputy manager advised that the residents were admitted a day after this home was contacted. They advised that they had been assured none of six residents required personal care, but that they had not received an assessment or care plan for any of the six residents before 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 10 they were admitted. The home had not acquired the care plans from the home that was to close prior to admission, and no one from the home had attended the home that was closing to assess the residents for themselves. The AQAA stated that there had been four discharges in the last twelve months. It was established at the inspection that two of these were amongst those admitted as emergency placements. The deputy manager advised that when the residents were admitted it was found that two of the six admitted had intimate personal care needs that this home could not meet. In normal circumstances, the home must have an assessment of a resident’s needs prior to admission, and confirm that they can meet these needs before a place is given, so that they are not then in a position where they have accepted responsibility to provide care that they are unable to provide. The home then has to confirm it can meet the assessed needs before offering a place. The home has previously demonstrated that it follows this procedure, and that prospective residents are given the opportunity to visit the home prior to moving in. On this occasion, the Registered Manager was absent from duties, and the arrangements for cover of the Registered Manager’s post that CSCI had been advised of had changed. The new deputy manager did not have experience of managing a care home. At the previous inspection two pertinent recommendations had been made, firstly, that staff who may be the senior person on duty should be familiar with the entrance criteria and allocation process, and secondly, that sufficient routine management support should be provided to the acting manager in the absence of the registered manager. If an emergency admission is to be accepted, the home must have a policy that is followed. The deputy manager advised that there is no emergency admission policy. The deputy manager advised that they had sought permission from the Area Manager to admit the six residents to the six vacant places that were available in the home in the emergency situation presenting. The deputy manager was very clear that they would not admit without an assessment again. They advised that when the new residents arrived at Cavendish Road, the care plans they came with were very poor, and that it took the home two months to obtain CPA care assessments/care plans. The files of two of these residents, who continued to be cared for at Cavendish Road, were inspected on this occasion. They both contained CPA assessments, dated shortly before admission, however, as noted, the deputy manager had advised that these were not received by the home until after the residents were admitted. Care plans were drawn up within nine days of the residents being at the home, but were not, therefore, based on these CPA assessments. 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 11 A resident spoken with said that they may have a Service User Guide (SUG) somewhere, but that they hadn’t been given one this year. The manager advised that they were aware that the SUG needs to be reviewed. The SUG in the home, which is organised in a large folder, did not contain financial information as is required, and did not include details of current staff and management. The latest inspection report is part of the Service User Guide. The latest report that was on display in the home was dated 2005. This was changed when it was brought to management’s attention, and the report of 2007 was placed in reception. 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 12 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. 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 a care plan and to know what goals they are working towards through their participation in the life of the home and selfdevelopment. EVIDENCE: Residents have Care Programme Approach (CPA) 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 plans contain a daily / weekly schedule for some residentsas required, and there is a cardex record for ongoing records. The home’s Statement of Purpose states that residents will be reviewed every six months. The care plans of residents tracked had been reviewed. One advised that they had attended their CPA review very recently. This was noted in their daily notes. They advised that they were aiming to achieve some stability by keeping things very much as they are for another year. They were 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 13 aware of their long-term objective, to achieve independence, and also of the goals that they are working towards on the way to achieving this. They said that they usually look at their care plan with their key worker or by them self. At the last inspection a requirement was made that the suitability of the placement for one resident was reviewed, as there was a query over their diagnosis. The resident had been reviewed and remained at the home; additional support from a support worker had been put in place. The care plan showed that work had been done with the resident to establish a range of coping mechanisms when anxious, and the accident/ incident book indicated that theses were successful- there were no recent entries relating to the resident’s behaviour. A good range of risk assessments, including assessments of the environmental risks and for activities participated in was maintained for each of the three residents tracked. A resident who said that they “get frightened on the street” had a risk assessment for outings in place. One of the residents tracked did not have a risk assessment in respect of a behaviour that had been a serious risk a number of years before. A senior member of staff spoken with about this advised that there was not a risk on this as it had not been a problem in all the time that the resident had been in the home. The resident was spoken with about this and how they currently view any risk. They were very realistic and quietly confident. They advised that they hope they have overcome it the problematic behaviour, and that they had a range of alternative ways of expressing themselves. In these circumstances the resident must, however, have a risk assessment that focuses on the specific behaviour. The AQAA states that documentation could be better at the home, and that training in record keeping and risk assessment was to be arranged in the next twelve months. Daily records inspected showed a number of significant gaps, with no entries at all for several days at a time, for all three residents tracked. The AQAA also stated that staff discuss with the individual resident how they can work together to meet the aims and objectives set out in the care plan. The deputy manager advised that apart from specific incidents that merit daily recording, these would be the important running records. They advised that they were planning training sessions to establish that staff would do good records of key working sessions, that reflected goals detailed in their care plans, but that this was not fully in place yet. Residents spoken with confirmed that they have key workers. One advised that their key worker had helped them sort out their room, which had been “a mess”, and that they had disposed of several black bin bags full of unwanted items. Others spoken with said that they thought their key workers had helped a lot, and were aware of progress that they had made at the home. 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 14 Residents spoken with described their participation in the daily running of the household, which reflected their individual interests. One resident enjoys cooking for all of those who were catered for on one day a week. Another advised that they have some caretaking type duties that they were happy to perform. One resident spoken with said that they had sat in on one interview for staff and that their opinion had been sought. Another said that it was the best home that they had ever been in. When asked what it was that made them think this, they explained that it was small, very professionally run, that they let them do courses and that there were always discussions. One resident spoke of the office door always being closed during staff handovers, none of those spoken with has any concerns about trust or confidentiality in the home. Records were properly stored. 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 15 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): 11,12,13,15,16,17. 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 enjoy living at the home, and to be supported to achieve a lifestyle that meets their needs and develops their confidence, and which gives them rights and responsibilities within the home. EVIDENCE: Over the course of the inspection residents were seen to be moving freely around the home and using different parts of it, including the paved garden area, the sitting rooms and the dining room, the home affording them lots of options as to where their spent time. While each resident had their own individual routine, and there were aspects of daily life where some cooperated with each other. Those spoken with advised that the regular residents’ meetings were appreciated as a way or airing any concerns and supporting the homely atmosphere. Residents approached us to 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 16 participate in the inspection, and offered to assist, which indicates that they are supported and encouraged to feel that this is their home. For some of the residents, practicing and developing their daily living skills is very central to their care plan. One resident advised that they were taking cooking classes and were self-catering, which involved looking after a food allowance provided to them for this purpose. A resident who had moved to Cavendish Road from another home explained that in some ways they felt less secure, but in other ways, more confident. They had saved some money and went out to purchase a new item of clothing on the day of the inspection; they said that they would not have done that before on their own. They spoke of other ways in which they had been supported to develop their independence, including planned outings. They were expecting to receive a bus pass that had been acquired for them. They had started literacy classes but had recently stopped attending. Another recently admitted resident spoken with was planning a short camping trip. It was intended that a member of staff would accompany them, but then leave them for a night alone under canvass. They said; “This is what I have wanted for years.” Residents spoken with advised that they planned the menu together, with input from the carers on healthy eating, and assisted with shopping and preparation. Some residents were self-catering; they received support as necessary, and a budget for shopping. One resident tracked who doses selfcatering chooses to have a special diet. They advised that since they had come to live at the home last year, they had seen a dietician twice for advice. They described the way in which the home’s facilities had been adapted to make self-catering possible. One resident’s relative was visiting during the inspection and they were spoken with. They explained that they visited every week, and that they liked this home much more than where their relative had previously lived. They couldn’t say exactly why this was. During the visit a worker from the home was seen to enquire about the relatives well-being in a very genuine way. Another resident spoke about how the home was helping them try to establish contact with a family member who had not been in contact with them for a number of years. All of the residents spoken with and the three residents who completed surveys indicated that they like living at the home. 4 - 6 Cavendish Road DS0000048200.V363653.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 have receive personal support in a way they find acceptable and helpful, and to be assisted to have their physical and emotional needs met. EVIDENCE: The regulation 26 visit report for Aril 2008 states; “ No personal care given.” Some, but not all residents manage their own medication. One resident spoken with who did not self medicate advised that they could not read very well. Another resident advised that they had been self medicating for over a year. This was supported by a risk assessment. The resident thought that this was going very well; they were keeping their own tablets in a locked cupboard. A third resident spoken with was at an earlier stage of working towards independence with their medication. They are usually given their medication in a dosset box for each day. The procedure for residents who call to collect their medication was observed. Medication was not handled, and it was signed for after being given. Records of medicines administration were inspected and found to be in good order. Tight 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 18 quality control and stock talking procedures were in place, and was also provided to residents who self medicate if they require it. There were no controlled drugs in the home. Records were generally in very good order, but there were some recording omissions. Some residents’ medication is delivered in blister packs; some is not, depending on how frequently their medication is changed and whether the medication can be delivered in blister packs. Some residents now arrange their own prescriptions. In line with this, some residents have printed Medicine Administration Records (MAR) sheets, and some have hand written MAR sheets. On one of the printed records there was an additional entry handwritten in. There was no signature to this. This was discussed with the deputy manager, as unless a written is both supported by a record of the reason for and authority for the change and a signature on the alteration, residents are not protected form unauthorised changes being made to medication plans. Records for all residents from the 21st April were inspected. In one case there was a missing signature, and the tablet for this day and time was still in the blister pack. The deputy manager advised that this can arise, as the resident will be prompted to come for their medication, and if they do not attend they could be late, rather than have missed the medication, However, by the time the next dose is due, this can clearly be counted as missed, and some sort of system if required to indicate that this is recorded. Another resident had a gap for analgesics, which although are not prescribed on an “as required” (PRN) basis, are treated by the resident as if they were. Four entries were missing for these in the period and no code was written in to state why they were not taken. The deputy manager said that they had worked on developing the relationship with the local community health team and that this was now working well. A recent visit from a professional in that team to the home was recorded in the visitors’ book. All of the residents tracked were, in addition to support from the local Community Mental Health Team, receiving appropriate treatment from other health professionals. One resident spoken with advised that they do not need a chiropodist or optician, but that they visit the dentist every six months. Another said that they did see a chiropodist every two months, this supported by their care plan records. The third resident tracked said that they were diabetic, and had an appointment to have their retina photographed as this can be affected by diabetes. One resident was supported to attend a medical appointment during the inspection. One resident advised that the staff were “really good at knowing me.” They said that they were approachable all of the time. They said that they “must be happy, because I think they are all good at their jobs.” Another said that they 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 19 “…have a lot of faith in the deputy manager.” They explained, and gave an example, and stated; “If they say they will do something they will do it. ” Residents are supported to manage their finances if this is required. A resident spoken to explained that since they had been at this home they had been helped to apply for, and had received, Disability Living Allowance. They had not had this at their previous home. They were pleased that they were better off financially now. 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 20 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 that concerns regarding possible abuse will be referred through the proper channels, or that all staff have the proper checks in place to ensure they are fully protected. EVIDENCE: The AQAA states that the home has a robust complaints procedure. The procedure is available in the home. A resident spoken with said that if they did have a complaint that they would tell the staff, but stressed that they did not have a complaint. The AQAA stated that one complaint had been received in the last twelve months, that it had not been resolved within 28 days and that it had not yet been resolved. A requirement was made at the last inspection that where there is any concern that a vulnerable adult may be being abused this must 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. The AQAA stated that there have been no safeguarding referrals in the last twelve months. Whilst we have not received any regulation 37 reports of significant incidents that should have been referred as safeguarding matters 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 21 in the last twelve months, the manager was not familiar with the local agreed safeguarding protocols. They gave a thorough account of how they world respond to any suspected abuse, but they were not aware of the requirement to report to Customer First in the first instance. The manager spoke of liaison with other professionals, considering the necessity for police involvement, of informing the CSI and ensuring the immediate safety of the resident. They did advise that they would inform the resident’s care coordinator, but spoke of instigating an investigation, so long as the police were not going to do so. Failure to use the agreed local protocol could result in residents not being fully protected in the event of abuse. They were advised that the decision regarding who investigates being the responsibility of social care in conjunction with police and CSCI, and that to start an investigation of their own can invalidate any further investigation that Social Care may deem necessary. The AQAA states that staff have had satisfactory pre employment checks. The manager did have a Criminal Records Bureau (CRB) check before coming to work at the home, but there was no CRB available for the deputy manager at the home. The manager advised that the deputy had worked for the same organisation prior to coming to the home, and would have had a CRB check undertaken when they came to the organisation. The deputy confirmed that they were previously employed in a non-care role, as a researcher. This CRB therefore would not be adequate. The PoVA First check for a newly recruited worker was not on file, although the manager advised that this had been received, and was still with head office. This, therefore, could not be inspected. Some money is looked after on behalf of residents, who can have a purse locked in the safe in the office. One resident said that although they have money in their own bank, they sometimes keep a small amount locked in the safe. The purses for three residents were checked. There was a balance sheet that the resident and staff had to sign off every time a purse was deposited or taken. The contents of all three purses tallied with the balance on the record. 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 22 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): 24,27,30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured that their health and safety in the environment is fully protected. Whist they can expect the home to offer some homely communal areas, they cannot be assured that the home will be maintained in good decorative order. EVIDENCE: There are a number of entrances and exits to the home. All of these were inspected and found to be properly secure. A resident who assisted with the tour of the building advised that they had a lock to the front door of the house and their own room. One resident had a key to the home, but it was to the door on the upper ground floor, and they said that they did not like to use that door, as they were fearful of using the high staircase up to it. The deputy manager advised that all resident’s keys fit the first floor door, but that it was brought to attention at the team meeting the previous week that three did not fit the basement level door that many residents use. The resident who is fearful of the stairs to the first floor door, and indeed who had had a fall 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 23 recently, was in the meantime, having to use the door bell to get into the home. The home has a good range of communal space including a quiet room where interviews can be held in private, but it was not in a good state of repair. Some decoration had taken place since the last inspection and further decorating was in progress at the time of the inspection. There was a team of supervised workers from probation carrying out painting and decorating on both days. The halls, landings, stairways and ceilings had been painted. All of the internal locks, including toilet locks had been repaired or renewed. Doors and gloss paintwork throughout the home was badly chipped. The Fire Officer had visited of 20th February 2007 and had required the replacement of intumescent strips where these had been painted over. This did not been done, so fire doors within the building were not as effective as they need to be to properly protect residents. The manager has subsequently advised that this has been commissioned, but evidence of this has not been seen by us. Some rooms that had been previously decorated now require redecoration. The wallpaper in the room that was the smoking room was torn at the level of the height of chair backs. Some bathrooms and toilets require decorating. One toilet in house 6, on the lower floor near the laundry, requires new flooring, as that in place is badly stained. One bathroom on a middle floor in house 4 was out of use. There was stacked wood in bath and it was very dirty. As the home is not full, there were still sufficient bathrooms overall, but this bathroom should be reinstated as soon as possible. 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 that were in use had paper towels and liquid soap, and there were no bars of soap in bathrooms. Staff and residents advised carpets had been cleaned but were now in a bad state. The manager stated on the AQAA that they intend to replace the carpets, and the deputy advised that as an interim measure they were to be cleaned the next day. With the decorators in the home it was difficult to assess the overall impact the current work will have. The deputy manager advised that they were highlighting priorities as they went along, and that they did not have a schedule for the decorating now required. They agreed to prioritise the toilet and bathroom. 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 24 The washing machine and tumble drier were broken at the time of the inspection; a resident said that the tumble drier had “packed up” yesterday. staff were heard arranging for these to be repaired during the inspection. The kitchen is in a good state of repair, clean and tidy. A number of the residents are self-catering an individual cupboard had been allocated for their provisions, as had part of a fridge. However, one of the fridges was not maintained at the correct temperature. At the last inspection one of the fridges was found to have slightly excessive temperatures; this was thought to have been because it was not always closed properly, and it was recommended that a notice be put on the fridge to remind residents to do this. On this occasion, fridge and freezer temperatures were maintained, but the recorded temperature for the fridge on the right was repeatedly excessive, and there was no record or indication of any action being taken. Residents cannot be assured, therefore, that food stored in it during the month had been properly preserved. This fridge had a morning recorded temperature recorded of 11 degrees Celsius for the morning of the first day of the inspection. On all but three days the morning temperatures recorded was above 9 degrees Celsius and on the 13th and 14th April it peaked at 12 degrees. All of the pm temperatures recorded were, with the exception of one record, above 8 degrees Celsius. Records showed that it had been above 5 degrees on every day the temperature was taken in April, which was most days, and residents had, therefore been at risk of eating food hat had not been effectively refrigerated. On the second day of the inspection the deputy manager was found to have checked the contents of the refrigerator with the excessive temperature records for any perishable items that needed to be disposed of. In addition to any health risks, this is concerning because many of the residents are being taught how to cater for themselves, and cannot have been shown any concept of the importance of keeping chilled foods at a sufficiently low temperature. The home did not have a hazard analysis of critical control points in for the production of food, (HaCCP). Advice was given, and on the second day of the inspection we were advised that the District Council had been contacted about this and were sending documentation to the home to enable them to conduct this. There is a resident’s pay phone, with large numbers, in one of the hallways in the home. There is attractive wooden seating in the paved rear garden. Since the last inspection, a shelter in the garden had been provided for those residents who smoke. Residents spoken who smoke were spoken with; they were accepting of this arrangement. 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 25 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): 32,34,35. 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 be supported by approachable and caring staff, but cannot be assured that all of the checks required to be in place before they are recruited have been made, or, therefore, that they are in safe hands. EVIDENCE: A resident spoken with had a key worker, but particularly praised the deputy manager, who they said had “done a lot to help me”. They said that staff “are different”, and commented that they felt the deputy manager really cared. Another resident advised; “I have no complaints about the staff”, but said that a lot of staff had left during the last year and that there had been a lot of agency staff recently. The manager advised that five members of staff had left the home in a threemonth period since the last inspection. Recruitment had been and continued to be carried out, but they advised that there had staffing pressures. They advised that a senior carer had been offered a post subject to satisfactory pre employment checks, and had accepted it. They also advised that an advert for two carers had gone into the local newspaper the previous week. 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 26 The manager advised that during the day and evening, there are always two staff on duty, although the managers aim is for there to be 2 plus a manager on daytime shifts. The manager advised that she has often had to cover one of the care roles. The early shift works from 8.30am until 4pm, and the late shift starts at 1.30, so there is an overlap between 1.30pm and 4.00 pm when there are four staff on duty, which allows for a handover and specific duties such as supporting residents to attend appointments or key working. The night staffing arrangements are one carer sleeping in. Staff confirmed that there is managerial support on call at all times. The home was adequately staffed on during the inspection, with three, including the manager on duty for part of the period each day, and four on duty during the early afternoon. During this time carers were seen to be supporting staff in the kitchen, which is when residents have their man meal. Staff were observed to be responding to one resident who was feeling quite low, as well as helping creating a pleasant atmosphere in the home. One of the carers on duty had only started in post the day before the inspection, but had been a regular agency worker at the home prior to this. The manager confirmed that the home had been and still was using agency staff to maintain staffing levels. According to records and to the advice of staff these had tended to be the same carers regularly employed. The rota for the week beginning 27th April supported this information, there were several shifts where there were only two, including the manager scheduled to be on duty. Staff spoken with confirmed that there are on call arrangements in place. The regulation 26 report for April stated, “Concerns remain that residents do not have much time for one-to-one staff to undertake specific tasks to increase their independence.” Residents were, however, generally satisfied and making progress; the impact of management covering care had fallen mainly on the management of the home rather than the care. Three carers who are employed were employed at the home at the time of the last inspection. They are qualified to NVQ 2 and their certificates had been seen previously. New workers are provided with an induction course. Its was noted in a Regulation 26 report for January 2008, that a new worker had undertaken this. The most recently recruited worker had a Together training pack for induction; part of the induction is based in the home, and part of based on attendance at a course provided by Together. The carer confirmed that they were on induction, and advised that they had already received some training when employed as a regular agency worker, on medication and on food hygiene. The bookings confirmation for a course for food hygiene training for the new worker and for another worker were seen; this was held shortly before the inspection; the manager advised that certificates had not yet been received. 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 27 The most recently employed carer advised of the application and interview procedure that had been undertaken by them, but these records were not at the home at the time of he inspection; the manager advised that these were currently at head office; as these were not available for inspection, as they must be, residents cannot be assured proper procedures have taken place, or that they are properly protected by pre employment checks. Please see the Concerns, Complaints and Protection section of this report. The manager advised that they had not yet developed the training plan for carers for 2008/9, as they were awaiting the details of training available from head office. Evidence of training planned for the deputy manager was seen. This included supervision skills, managing performance, recruitment and selection, effective team leadership, mental health law and legislation and diversity in practice. 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 28 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. Whilst residents can expect to enjoy an open and inclusive style of management in the home, and to enjoy good outcomes, they cannot be assured that all of the records required to protect their best interests are in place, or that their health and safety has been fully protected. 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 was subsequently been appointed. Since the last inspection the Registered Manager and the acting manager have left the home. The first formal communication we received that the manager had left was in the home’s AQAA. We then asked for a regulation 37 report to be provided, confirming that the manager had left, and this was provided to us. We were not notified that the acting manager had also left the home since the last inspection. 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 29 The current manager advised they had been appointed in March 2008, and confirmed that the Registered Manager had left on 11th November 2007. A deputy manager was appointed in August 2008, they are a qualified nurse. The manager advised that they do not have an NVQ, but have applied to do NVQ 4. They advised that they had not previously worked in residential care, but had much experience in managing care provision. The manager advised that they were looking towards de-registration of the home but that there was a need for some personal care. They were advised to seek further advice on this, given that some residents need some considerable assistance with the medication and that the manager anticipates a need for some personal care. Residents spoken with were fully aware of this proposal. They attend regular meetings where current concerns and general developments are discussed. Two residents spoken with commented that they thought this was good, one identified the fact that there were lots of discussions in the home, about everything, as one of the things that made this a well run home. A resident advised that they had represented the home at the providers National Steering group. They were aware that the home is hoping to de register as a care home at some point in the near future, and said that they had brought this up at the conference. One resident said of the home, “There is nothing I would change.” Whist residents are generally very satisfied with the home a requirements made at the last inspection relating to health and safety and protection had not been met, and overall management of the home in the period has not been good. In part this may be due to the changes in management and period without a registered manager operational in post. It may also be due to the fact that managers have been covering care shifts. Regulation 26 monthly quality monitoring reports were seen to be available in the home. There was no report for February 2008 on file. The home maintains a weekly health and safety checklist. It had been completed at not quite weekly intervals, the last three were dated 14th April 2008, 7th April 2008 and 24 March 2008. Items listed to be checked are quite comprehensive, including the Registration Certificate, the first aid box, visual portable electrical appliance checks, and accident book This is potentially a useful safety check, however, the recorded high temperatures for fridge described under the environment section of this report, had not been picked up as requiring any attention. Also, the checks confirmed that the Certificate of Registration was in place when it was not. (The Certificate was displayed during the inspection.) Residents cannot therefore be confident that regular health and safety checks are correctly carried out across the home. 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 30 Records stored in the home were stored appropriately; Care plans were kept in a filing cabinet the office, and the office was locked when no one was in it. Some key aspects of maintenance and health and safety had been attended to by the current manager. There were electricians in the home on the first day of the inspection. They were undertaking a complete electrical check. The manager advised that a check on the gas installation had been carried out the previous day, and there were no requirements arising from this. Their attendance at the home on 24th April was recorded in the visitors’ book. Fire extinguishers were seen to have been serviced recently. The manager advised that a recent fire risk assessment had been carried out, and was able to produce an invoice for a professional service who had undertaken this work, dated 21/04/05. A certificate of employers liability insurance was displayed. A record of fire instructions and drills at, mainly, monthly intervals was available in the home. Cupboards for the storage of substances, which could be hazardous to health, were seen to be locked, and there was a sheet of products in use which confirmed that product data sheets were available. Products in the cupboard were checked against the list. One cleaning product in the cupboard was not on this list, and product data sheet must be obtained. 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 31 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 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 3 36 X 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 3 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 3 3 X 2 1 2 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 32 YES 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 YA1 Regulation 5(1), 5(2), 6 Requirement Timescale for action 30/06/08 2. YA1 5 3. YA3 12(1)(b) 4. YA6 13(4)(c) 14(2) 15(1) An updated Service User Guide showing the current staffing and management arrangements and all of the information required by regulation, including information about fees must be available, so that information people are entitled to is available. An updated and correct Service 30/06/08 User Guide must be made available to all residents and prospective residents, so that people can access the information they are entitled to. If the home is to take emergency 30/06/08 admissions, this must be stated in the Statement of Purpose and supported by an emergency admissions procedure. This is to ensure that it can respond appropriately to requests for emergency placements where a full assessment is not available, and demonstrate that it can reasonably expect to meet the prospective residents’ needs. The home must have a risk 30/06/08 assessment in respect of a behaviour a resident has previously exhibited which has DS0000048200.V363653.R01.S.doc Version 5.2 4 - 6 Cavendish Road Page 33 5. YA20 13(2) 6. YA20 13(2) 7. 8. YA23 YA23 YA34 13(6) 19(1)(b) Schedule 2 9. YA24 13(4)(c) 10. YA24 23(2) 11. YA34 19(1)(b) Schedule 2 potentially serious consequences, so that they are able to recognise any signs that this could reoccur and take appropriate action. Changes must not be made to MAR sheets unless these are signed for and supported by a record; this ensures residents are protected form being given incorrect medication. Where a medication is not taken, an appropriate code must be entered in the record, so that it is clear of and why it has not been taken, and to avoid error. The manager must familiarise them self with local procedures for safeguarding adults. A PoVA First check must be undertaken and a CRB applied for in respect of the deputy manager so that the provider has a knowledge of any relevant offences that may apply and residents can be properly protected. Refrigerators must be maintained at a safe temperature so that residents’ health is not put at risk. The home must maintain the home in a good state of decorative order. This is similar to a requirement made at the inspection of 24/05/07. The home must make have all of the records relating to employment listed in the schedule relating to recruitment available in the home so that they can be inspected and residents advised whether they have been fully safeguarded. Evidence of a PoVA first and CRB check in respect of a recently recruited worker must be provided to CSCI. DS0000048200.V363653.R01.S.doc 30/06/08 30/06/08 15/07/08 30/04/08 30/06/08 30/06/08 30/06/08 4 - 6 Cavendish Road Version 5.2 Page 34 12. YA41 37(1)(2) 13. YA42 23(4) CSCI must be notified, on an ongoing basis, of any significant event, without delay, as detailed under regulation 37, so that residents’ welfare can be monitored. The requirements of the fire officer as detailed in the letter of February 2007 must be fully complied with. This is a repeat requirement of the inspection of 24th May 2007. 30/06/08 30/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 4 - 6 Cavendish Road DS0000048200.V363653.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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.V363653.R01.S.doc Version 5.2 Page 36 - 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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