Inspection on 16/10/07 for 4 Granville Road

This inspection was carried out on 16th October 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

4 Granville Road 14/04/09

4 Granville Road 28/04/08

4 Granville Road 05/06/07

4 Granville Road 13/12/06

4 Granville Road 09/12/05

4 Granville Road 05/05/05

4 Granville Road 21/07/04

4 Granville Road 04/05/04

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

CARE HOME ADULTS 18-65 4 Granville Road Reading Berkshire RG30 3QD Lead Inspector Mike Murphy Unannounced Inspection 16th October 2007 10:00 16/10/07 4 Granville Road DS0000011054.V352605.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 Granville Road DS0000011054.V352605.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 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 4 Granville Road Address Reading Berkshire RG30 3QD 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) 0118 959 9370 0118 959 9370 granville@paramounthousing.org.uk Paramount Housing Association Limited Ms Denise Williams Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (9) 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No service users to be admitted over the age of 65 years. Date of last inspection 5th June 2007 Brief Description of the Service: 4, Granville Road is a care home providing personal care and accommodation for nine adults with mental disorders, excluding learning disability or dementia, two of whom are over sixty-five years of age. The home is owned by Paramount Housing Association Ltd. and is located on the edge of an estate approximately two miles from Reading city centre. All the service users have their own rooms. The aims and objectives of the home are to provide a secure and comfortable home; encourage and support residents to make decisions and choices in their lives; support and assist service users to make and maintain satisfying relationships; assist service users to develop their skills; and enable service users to engage in valued day time occupation and use of community facilities. The fees at the time of this inspection were £595 per week. 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector in October 2007. The inspection process included a visit to the home, discussion with the registered manager, residents and staff, examination of documents (including the care plans of four residents identified for care tracking), a tour of the home and grounds, observation of practice, consideration of information provided by the registered manager in advance of the inspection, and consideration of the results of completed survey forms returned to CSCI in connection with this inspection. The inspection finds an uneven picture. The residents currently living in the home are secure and are generally happy living there. The home is in an accessible location and the residents have lived there together for many years. The home allows residents to spend their time as they wish, subject to any restriction based on risk assessments and liaison with other agencies (in particular the Community Mental Health Team). The registered manager and deputy manager are qualified and experienced. Staff provide good support to residents as needed. Relations between residents and staff seem good. Since the home opened in the early 1990’s the needs of some residents have changed significantly. In particular they now require more practical assistance with physical care. The home does not appear to have adapted to accommodate these changes. The physical environment has not changed nor staff resources – the latter in terms of skills development or the deployment of staff to meet residents’ needs at all times. Consequently, there appears to be an increasing gap between residents’ care needs and the capacity of the home to meet them. To a limited extent, this gap is bridged by the involvement of a home care service in providing some aspects of physical care to some residents. However, this deficit must be effectively addressed by managers, both in the housing association which is responsible for running the service (at the time of this inspection the association was merging with a larger housing association in the south of England), and by the landlords, Reading Borough Council, who own the building. The home’s systems of care planning are good and it liaises appropriately with health and social care agencies in the community. Some residents are independent and travel into Reading which is about two miles away. Some residents regularly go to a resource centre. The home occasionally organises trips out to events in such places as Oxford or London. Residents are consulted about such matters and other aspects of home life. Procedures are in place for dealing with complaints and for safeguarding vulnerable adults and neither the home not CSCI have received any complaints since the last inspection in July 2007. 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home does not meet the personal care needs of some residents. The premises are in need of redecorating and substantial upgrading. The premises do not meet the diverse needs of all of the residents. Some health and safety matters need to be addressed to make the premises safe for residents. Staffing needs to be reviewed to meet the needs of the residents. Staff training needs to be updated and reviewed to meet the needs of the residents. 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 7 The management of the service is compromised by a lack of clarity of the function and purpose of the home and by accommodation that is unsuitable to meet the needs of some residents. Some health and safety deficits put residents at potential risk. The service must provide evidence that its practice in staff recruitment is conforming to the Regulations and protects residents from the appointment of staff unsuited to such work. 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 Granville Road DS0000011054.V352605.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 Granville Road DS0000011054.V352605.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 and 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with information on the home and have their needs assessed by an experienced manager before admission. This aims to ensure that the person knows what the home has to offer, that the home can meet the person’s needs, and to minimise the chances of admitting a person whose needs it cannot meet. EVIDENCE: The home had recently revised its Statement of Purpose (SOP). This conforms to Schedule 1 of Regulation 4(1)(c). It is noted that in paragraph 7 of the document it is stated that ‘The emphasis of the care home are for all residents to be physically mobile, independent and self sufficient in regards maintaining a level of independence’. This may be an accurate statement of the original aims of the home in the 1990’s. At the time of this inspection however, the care needs of some residents had changed significantly and the home was now accommodating some residents with moderate levels of care needs, including in some cases, a need for support with personal care. Further revisions to the SOP are expected over the next three to six months. A copy of the Service User’s Guide is given to each resident and a copy was made available for this inspection. 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 10 The home has a system for assessing new referrals. Referrals are made to the company’s head office in Newbury, Berks. The ‘Care Co-ordinator’ (the line manager of the registered manager) goes to see the prospective resident to conduct an assessment of needs. Staff from the home, including the registered manager, are not involved at that stage. Where the care co-ordinator believes that the home would be able to meet those needs arrangements are made for a visit to the home. Over the course of the visit the prospective resident has the opportunity to meet staff and residents, view its facilities, and decide whether he or she wishes the referral to move forward. If the referral is progressed then the next stage is to gather further information and arrange a weekend stay. A decision is then made on whether a place should be offered. Where the offer is accepted, arrangements are made for admission, including a one-month introductory admission. A review between all parties – the resident, home staff and relevant staff of the referring community mental health team (CMHT) – is held at the end of that month and a decision made on whether a permanent place should be offered. The home has not had an admission since the last inspection and the process described above is the policy and practice of the organisation with regard to the admission of residents to another home elsewhere in the area. 4 Granville Road DS0000011054.V352605.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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A care plan is in place for each resident. Care plans include risk assessments and evidence of good liaison with health and social care agencies in the community. The participation of residents is sought through care planning and day-to-day encounters. These aim to ensure that people’s needs are met and that the service takes account of residents’ views. However, this aim is compromised by deficits in the environment and in access to staff at night EVIDENCE: Care plans are in place for all residents. Care plans are comprehensive in scope and include basic information on the resident (including a photograph), assessment of needs, risk assessments, identification of needs, action to meet needs, and goals. The level of support required is summarised in a four point rating scale which ranges from ‘Independent’, ‘Verbal Prompt’, ‘Minimal Assistance’, to ‘Needs Full Assistance’. It was noted that some sections of care plans had not been dated or signed. The registered manager explained that some aspects of care plans had been reviewed since the last inspection in June 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 12 2007 and that this process had not yet been completed. Care plans include correspondence with health and social care agencies in the community. The home’s assessment of daily living activities covers; safe environment, communication, breathing, eating and drinking, elimination, personal cleansing and dressing, body temperature, mobilising, cooking, laundry and ironing, household chores, community skills, literacy and numeracy, and behaviour. Risk assessments cover; medication, smoking, diet, behaviour (risk of harm to self or others), water temperature, COSHH, falls, cooking, sharp equipment, electrical equipment, and, vulnerability to exploitation (e.g. financial). The outcome of the assessment process leads to identification of needs and to a plan of care to meet needs as outlined above. The care plan takes account of the content of care programme approach (CPA) care plans drawn up after review meetings with the CMHT. It is noted that a copy of the risk assessment carried out by the CMHT is filed in the care plan. These risk assessments cover; risk of abuse, harm to others, relapse, absconding and non-engagement with services. Monthly reviews covered daily living skills, physical health, mental health, social support, daytime activities, and benefits. However, as noted above monthly reviews were not always dated and signed. Care plans included correspondence with psychiatrists, GPs and housing departments. Care plans also included correspondence on general health, income support and with the local wheelchair service. Residents are encouraged to participate in decision making in day to day encounters with staff and others. Information on a local advocacy service was on display on the notice board in the dining room. The manager conducting the Regulation 26 visit each month seeks the views of residents on matters relating to the home and their care. As recorded above risk assessment processes are comprehensive. However, for some residents, the management of environmental risks arising from the surface temperature of radiators, the temperature of the hot water, the incline of the front path from the front gate to the front door, or associated with the fall of a vulnerable resident at night needs to be improved. Residents seemed settled living in the home and the relationship between staff and residents appeared good. 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supporting in following a varied lifestyle according to their individual interests, abilities and wishes. This ensures that people have experience of a range of social, leisure and other activities and maintain contact with family and friends to the extent they wish. EVIDENCE: Staff and residents decide together how people spend their time. Some residents are more comfortable than others in going out, either individually, with staff support or in a group. In the past residents have attended further education or leisure classes but none were involved in such activities at the time of this inspection. For many this is because their needs have changed. Many are now leading a less active life. Staff and residents have gone to the local theatre together and on day trips to venues such as the Royal Albert Hall or the Earls Court Exhibition 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 14 Centre in London or to Oxford. Some residents and staff occasionally go shopping in Newbury and to musical events at a nearby hotel. Responses to extended time away from the home vary and recent holidays at a seaside resort are reported to have had a mixed reaction from residents. Residents are supported in maintaining links with family and friends. Residents have established a network of friendships, many through the local resource centre, and may receive visitors as they wish. The daily routine of the home varies according to individual needs and wishes. Residents are not obliged to participate in any activity. All residents have a key to their own room and residents’ right to privacy is respected. Residents are supported in looking after their own rooms and some carry out light domestic duties such as tidying up after meals, light dusting or vacuuming. The home employs a support worker who has a lead responsibility for domestic tasks. Breakfast is usually between 8:00 am and 10:00 am. Lunch is between 12:00 and 1:30 pm. Dinner, which is the main meal of the day, is served between 5:00 and 6:00 pm. For nutritional and health and safety reasons refrigerators are not accessible to residents unsupervised out of these times. This practice was discussed during the inspection visit. The registered manager said that the practice is based on experience and is accepted by residents. Breakfast usually consists of cereals, bread, beverages and fruit. Lunch is a light meal and is based on a four week ‘rolling menu’. Choices include (among others): Ham Rolls; Poached Egg; Beans on Toast; Cornish Pasties; and Fish Fingers. Dinner choices from menus around the time of this inspection included: Chicken and Mushroom Pies and Chips; Corned Beef Hash; Grilled Lamb Steaks served with Sautéed Potatoes and Mixed Vegetables; Meatballs in Tomato Sauce with Pasta; Turkey Casserole served with Boiled Potatoes; and, Beef Casserole and Dumplings served with New Potatoes. A roast meal with vegetables is served on Sundays. The alternative to the main choice is ‘Sandwich, Toast, Salad’ or on Sundays ‘Vegi Selection’ only. The predominance of meat based main courses and the almost complete absence of fish or vegetarian main courses was discussed during the course of this inspection. It is noted that of 49 meals included in seven menus between 20 August 2007 and 8 October 2007 only three included fish (Fish, Chips and Peas X 2, and, Fish Pie, New Potatoes and Carrots X 1), and four included a vegetarian main course (Macaroni Cheese and Bread, Macaroni Cheese and Salad, Vegetable Chow Mein (the selection for that meal also included noodles, spare ribs and prawn crackers), and, Filled Jacket Potatoes). It was explained that the menus are drawn up with residents and reflect their preferences. Fluids and fruit are always available. Residents’ nutrition is monitored and all are weighed weekly. 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is an increasing divergence between the changing care needs of residents and the capacity of the home to meet those needs. While the home maintains good liaison with healthcare services in the community, care within the home is compromised by weaknesses in its capacity to effectively meet service users care needs. EVIDENCE: Residents’ wishes in terms of their day-to-day routines and personal care are respected. Residents have a choice in how they wish to spend their day. Personal care is provided in private. The home is not adequately equipped to meet the physical care needs of residents who require a moderate to high level of support. There are three factors to consider in respect of this: first of all, the original aims and objectives of the service did not include providing personal care to residents; secondly, staff were not expected to provide such care and staff skills have not developed in line with the changing needs of residents; thirdly, the building has not been adapted to accommodate those needs. It would appear therefore, 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 16 that, in recent years, there has been an increasing divergence between the needs of residents and the service’s ability to meet those needs. These matters have not been effectively addressed to date. The current statement of purpose (SOP) does not support a service to meets such needs. In paragraph seven it states ‘We are currently providing additional support to some long term residents with support from other professional agencies who are providing personal care i.e. bathing, washing and assistance to bed in the evening. Additional transport services are available to enable residents to continue with community services and integrate into the community, plus additional disposal of sanitary products, this is not intended to be a permanent and service that would be provided in the future. The emphasis of the care home are for all residents to be physically mobile, independent and self sufficient in regards maintaining a level of independence’ (page 2, para 7 of SOP refers). Staff job descriptions and staff development through a programme of relevant training, support and supervision do not appear to have been developed in line with the changing needs of residents. The home continues to operate a sleepin service at night (with the sleep-in room some distance from the most vulnerable residents) and does not have a staff call system. The layout and interior features of the building have not been adapted to meet residents needs. Managers have obtained the advice of an environment health officer and an occupational therapist in respect of different elements of this. Work appears to have started on enlarging the entrance to a shower room with the aim of making it a ‘wet room’. It is not known when this work is likely to be completed. A home care service visits twice a day to provide some aspects of care to some residents. It appears to have been seriously suggested by a representative of a statutory agency that residents who experience incontinence should be taken to another home nearby for bathing. It is difficult to equate such a suggestion with a person’s right to privacy and dignity. The complexities of resolving such matters are not underestimated. In particular when they involve more than one agency. However, these matters are not new and residents remain disadvantaged while agencies fail to reach agreement on the future of the service, fail to adequately invest in developing staff skills, and fail to adequately invest in the building so that it can accommodate the needs of its more dependant residents – who have lived there together since the service started in the 1990’s. All residents are registered with a local GP practice and have annual health checks. A GP respondent to the CSCI survey carried out in connection with this inspection expressed satisfaction with the overall care provided to residents in the home. All residents are in contact with the Community Mental Health Team 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 17 (CMHT). Residents use a branch of a national chain of opticians in Reading. Routine NHS dentistry in Reading is not readily available and according to the manager most residents tend to have emergency dentistry only. One resident is registered with a dentist in Tilehurst. Evidence was noted on file of communications with other NHS healthcare services. There is a policy and procedure governing the storage and administration of medicines. One care worker has lead responsibility for ensuring that practice in relation to the administration of medicines conforms to policy. Medicines are prescribed by the resident’s GP. An exception is Clozapine which is prescribed by a psychiatrist following routine blood monitoring at the hospital and which is then dispensed by the hospital pharmacy. All other medicines are dispensed by Boots Chemists in Reading. Staff will now be trained using the Boots training programme. Staff competence is assessed by the manager or deputy manager and staff are not permitted to administer medicines until deemed competent to do so. The manager said that the process involves staff being observed administering medicines on at least six occasions. The process however is not recorded. Medicines are recorded on receipt in the home and on disposal to the pharmacy. Medicines are stored in a metal trolley in a locked cupboard. Documetation includes a photograph of each resident, the medicines administration record (‘MAR chart’), and a ‘medication record’. The medication record has been drawn up by the home as a means of ensuring that staff have an up to date record of medicines prescribed for residents. Four residents were administering their own medicines at the time of this inspection. Staff do ‘spot checks’ on their supplies every two days. The home’s arrangements were checked by a pharmacist in September 2007 and were found to be satisfactory. No errors were noted on MAR charts or in the home’s arrangements for storage on the evening of the inspection visit. Apart from the organisation’s own policy on medicines the home also had a copy of a British National Formulary (BNF). It would also be advisable for the home to have a copy of the Royal Pharmaceutical of Great Britain (RPSGB) Publication ‘The Handling of Medicines in Social Care’ (published in October 2007) which can either be downloaded from the RPSGB website or purchased from the Society. Two matters in connection with the medication record were discussed with the registered manager; the advantages, disadvantages and format of such records, and stock control. With regard to stock control the registered manager likes to do more frequent checks on stock balances than the simple record of number received recorded each month on the MAR chart allows. If retained the medication record could be adapted to allow space for recording the stock balance at weekly or fortnightly intervals. With regard to the use of such 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 18 records there is a risk that medicines may be incorrectly transcribed or inadvertently dispensed if cancelled on the MAR chart. The home should also review its current method of recording the dosage of medicines on the medication record. These currently include ‘Form Dose’, ‘Issue Dose’ and whether a ‘half’, ‘one’, ‘two’ or more tablets are to be dispensed. The advice of a pharmacist should be sought on this matter. 4 Granville Road DS0000011054.V352605.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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a policy and procedure for reporting and investigating complaints - although this requires a person to put a complaint in writing if not resolved by the home. It has a framework of policy and reporting arrangements with regard to the safeguarding vulnerable adults (POVA). Together, these aim to protect people from abuse and to ensure that complaints are properly investigated. EVIDENCE: The home has a policy governing staff practice in relation to safeguarding vulnerable adults. It has a copy of the Berkshire statutory agencies policy on this matter. Staff were aware of the procedure to follow should they have concerns about abuse and expressed confidence in managers to investigate appropriately. However, staff seemed a little unclear about the precise policy governing this aspect of the home’s work and it would be advisable to raise this matter at a future staff meeting. The home is required to conform to the complaints procedure of Paramount Housing Association. The home has no record of a complaint since the last inspection. CSCI has not received any complaints about this service since the last inspection. The procedure is summarised in the Service User’s Guide (SUG). The policy suggests that the manager should be approached initially. Where the complainant remains dissatisfied the procedure goes on to say ‘If the Manager 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 20 does not deal with the complaint satisfactorily or the complaint is deemed to be serious you will be asked to put it in writing and address it to…(the addresses of Paramount Housing Association, the ‘Care Standards Commission’ (CSCI) and the Independent Housing Ombudsman Limited are given). Both documents require a complainant to put their complaint in writing if he or she is not satisfied with the initial response – the Housing Association at ‘Stage 2 – Formal Procedure’ and the home’s procedure ‘…(if) the complaint is deemed to be serious’. This requirement doesn’t seem to fit well with a service for vulnerable people - nor the distinction between a complaint and a ‘serious’ complaint or categories such as ‘Informal’ and ‘Formal’. It would be better if complaints in this kind of service, which are not resolved at home level, were automatically referred to a higher level without requiring a vulnerable and disabled person to have to put their complaint in writing. If an organisation insists that this is necessary then a person should be provided with information on how to access independent support. It is noted that at Stage 4 of the complaints procedure (June 2007 review) the address of the Housing Ombudsman Service in the Aldwych in London is given, while in the home’s complaints procedure contact details for the Independent Housing Ombudsman Limited in the Strand in London are given. Neither procedure includes reference to the right of a complainant to complain to their care manager or sponsoring local authority, or to the assistance of an independent advocacy service (details of which were however, on display in the home’s notice board). Residents generally expressed satisfaction with the service and appeared to have a good relationship with staff. While the organisation’s procedure appear bureaucratic in terms of this kind of service, there seemed no reason to believe that a complaint by a resident would not be promptly and effectively addressed by staff and managers in the home. A resident respondent to the CSCI survey in connection with this inspection said that he or she knew who to speak to if unhappy and knew how to make a complaint. 4 Granville Road DS0000011054.V352605.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, 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is failing to provide an environment which is suitable for the changing needs of residents. Standards of care are compromised by the limitations of the building and by some aspects of health and safety which pose a risk to residents. EVIDENCE: The home is a detached building in the Southcote area of Reading. It is about two miles from the town centre. There is limited parking to the side of the house but alternative parking is available in nearby streets. There is a regular bus service to Reading. The nearest rail stations are Reading or Reading West, each around 2.5 miles distant from the home. The home is a post war detached house which is owned by Reading Borough Council. It is set in medium sized grounds on the edge of an estate. It was not purpose built. A concrete pathway leads from the front gate to the front door. The path is on a downward slope with a steel handrail on one side. The incline 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 22 is steep for someone in a wheelchair and the home has obtained the advice of an environmental health officer with regard to this. Signs stating that the path may be slippery when wet have been placed at intervals down the slope. At the time of this inspection the incline was still considered to pose a hazard to a person in a wheelchair. Residents have a key to their room. Signs warning of the danger of tripping have been placed on the steps to the entrance hall and office. While these may be necessary given the danger of tripping in these areas, a strip of yellow and black warning tape hardly contributes to a homely atmosphere. The accommodation is on two floors. The ground floor, which has a single storey extension, comprises the entrance hall, office, kitchen, dining room, living room, laundry, shower and WC and four bedrooms. The first floor comprises five bedrooms (only one bedroom is en-suite with WC and hand basin), bathroom, WC, staff sleep-in suite, and small office or quiet room. Bedrooms vary in size. There are two sets of stairs connecting the ground and first floors. The communal areas of the lounge and dining room are a suitable size for the present number of users, are reasonably well furnished and provide a comfortable area for a range of activities. The garden to the rear of the house is of a good size and comprises a seating area, large lawn, mature shrubs and trees and flower beds. A resident was happy to have a chat about the home in her bedroom. The room was of a good size, bright and comfortably furnished. The resident was happy living in the home and with her accommodation. On the downside the resident said that the heating can be unreliable, that the hot water in her hand basin can get very hot at time (it was tested at over 59 Celsius at that time), and she had concerns that if she fell at night she would not be able to communicate with staff because of the distance between her bedroom and the staff sleep-in room. Standards of décor vary but the overall impression is of a home which needs substantial investment to bring it up to standard. Carpets are worn and would benefit from replacement, the paintwork is tired, many radiators are not covered, the temperature of the hot water is not regulated, and bathroom facilities are inadequate given the increasing needs of residents. The location of the staff sleep-in room on the first floor means that at night, staff are some distance from some of the most dependant residents whose rooms are on the ground floor. The home does not have a staff call system. The present situation is reported to be a consequence of a failure between agencies to agree on the future of the home. That may be the case, but such inaction means that residents are living - and staff are working - in a deteriorating environment, in which increasingly, standards of care and safety are potentially compromised. Standards of cleanliness and hygiene are generally satisfactory. 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 23 There are significant problems for the home in meeting the needs of more dependant residents. The home does not have a lift, access by wheelchair is difficult (steep incline to front door, negotiating a wheelchair on the ground floor is very difficult because of the layout of the building and there are numerous doors to manoeuvre through), some bedrooms are too small to facilitate the operation of equipment such as a hoist, the washing machine does not have a sluicing or disinfection cycle, the laundry is located close to an area in which food is prepared, the temperature of the hot water in areas to which residents have access is well in excess of 43 degrees Celsius, radiators are not guarded, the heating system is reported by both residents and staff to be unreliable, and it does not have a call system to enable residents to communicate with staff at night. 4 Granville Road DS0000011054.V352605.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): 31, 32, 33, 34, 35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A consistent quantity and quality of care to residents cannot be provided because of the current level of staff cover at night and weaknesses in the capacity of the home to provide the range of personal care required. The home is unable to provide documentary evidence of satisfactory practice in staff recruitment and training. This potentially places residents at risk through the recruitment of unsuitable staff. EVIDENCE: Staff are provided with a copy of their job description. A copy of the present job description for care staff (‘Care Officer’) was examined during the inspection visit. This was last reviewed in 2003. The job description does not adequately address the need for care staff to provide personal care to residents. This matter was reported to be under consideration by managers and staff around the time of this inspection. A copy of the General Social Care Council (GSCC) Codes of Practice was not readily accessible at the time of this inspection visit. The registered manager undertook to obtain a copy for each member of staff from the GSCC. 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 25 There are seven staff for nine residents. A number of new staff have been appointed in 2007. The organisation is supportive of staff undertaking NVQ at Level 3 in health and social care but had not yet reached the 50 target (Standard 32.6). The staff team bring a range of experience to their work and have the personal qualities required to support residents in this specialist service. Those seen during the course of the visit had a mature attitude to their work and had relevant experience in care and mental health settings before taking up post in the home. The registered manager was seen as supportive and flexible but the stresses of that position were acknowledged. It was felt that the larger organisation could be inflexible but its support for staff training was acknowledged. Relationships between staff and residents appeared good. The equivalence of other qualifications to NVQ 3 was discussed and the registered manager was advised to discuss this subject with the home’s present NVQ provider and to consider CSCI guidance on this matter (accessible Interim through the CSCI professional website - http:/www.csci.org.uk/ guidance from CSCI states that ‘..apart from Scottish Vocational Qualifications there are no equivalents but there are a number of qualifications which will legitimately contribute to the achievement of NVQs. The registered person or staff member would need to approach an NVQ assessment centre, such as a local college or SSD training section, to advise whether specific qualifications would contribute to an NVQ’. The present staffing provides for two staff between 7:30 am and 3:30 pm, two staff between 3:30 pm and 10:00 pm (there is an overlap between the morning and evening staff in the afternoon), and, one sleep-in member of staff at night. These figures include the deputy manager but exclude the registered manager. The provision of ‘sleep-in’ staff at night and the location of the sleep-in room on the first floor (of the main building) in relation to the location of more vulnerable residents on the ground floor (of the extension) is a matter of concern. This was reported to be under discussion between managers and staff around the time of this inspection. Staff recruitment is managed from the organisation’s head office in Newbury. The office deals with advertising, enquiries and the initial processing of applications. Short listing is carried out by the manager and deputy manager. Applicants are invited to visit the home before attending for interview. Interviews are carried out at another home owned by the organisation. Shortlisted candidates are interviewed by the manager or deputy manager and the care co-ordinator. References, CRB checks and POVA First checks are carried out after interview. 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 26 It was not possible to examine evidence of the above process during the inspection visit because staff files are retained at head office - although some papers are held at the home. It is noted that this matter was also raised at the last inspection in June 2007. If an organisation wishes to retain files centrally then it must agree access arrangements with CSCI and should provide evidence in the home that it is conforming to Schedule 2 (of Regulations 7, 9 and 19). The form such evidence should take could be agreed with CSCI at the same time as the access arrangements. A telephone discussion with a member of staff at the head office revealed that CRB disclosures are destroyed after three months. This is at variance with guidance from CSCI published in January 2007 which it has agreed with the CRB. That guidance states ‘Although CRB guidance on some other employment sectors states that Disclosures should be destroyed after 6 months, the guidance states that, for CSCI regulated services, Disclosures should be kept and not destroyed until after the CSCI inspection is complete to enable CSCI inspectors to see a sample at the next inspection, one of the legal requirements for retaining Disclosures’. The guidance is accessible through the CSCI website. The home’s induction programme had not been reviewed recently. It includes, among others, general orientation, fire safety, dealing with violence and aggression, communication, emergency situations, the administration of medicines, dealing with provisions, and confidential information. The programme. The programme did not appear to conform fully to the Common Induction Standards which have been developed by Skills for Care and which are accessible through that organisations website – www.skillsforcare.org.uk The situation on staff training appeared uncertain. This was reported to be due to the imminent merger of Paramount Housing Association with a larger organisation. This is understandable but it will be important for the registered manager to establish the new organisation’s policy on training and agree a training programme for the home as soon as possible. Otherwise, there is a danger that uncertainty on this matter will add to other matters of concern noted on this inspection. A training needs analysis had not been carried out recently. This would be advisable given the challenges facing managers. Staff on NVQ training were well supported. Staff supervision is well established. The registered manager and deputy manager provide personal supervision to all staff on a monthly basis. The process is structured, sessions last approximately 45 minutes and notes are taken. Staff confirmed this process and expressed satisfaction with the present position. 4 Granville Road DS0000011054.V352605.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, 39 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is managed by a qualified and experienced manager who consults residents on some aspects of running the home. However, the benefits of this are outweighed by numerous weaknesses in matters of health and safety which compromise the quality of care and lead to increased risk to residents. EVIDENCE: The registered manager has worked in the home for over 12 years and has been manager for the last four years. The registered manager has acquired the NVQ4 in care and the Registered Managers Award (RMA). The deputy manager has worked in the home for four years and is currently pursuing the NVQ4. The deputy manager has a NEBS management qualification. Lines of accountability within the home are clear. The registered manager is accountable to the care co-ordinator. 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 28 A number of activities make up the home’s approach to quality assurance. They include: an annual tenant satisfaction survey, monthly surveys of a number of aspects of home activity, and Regulation 26 visits and reports by a senior manager. The home does not hold formal meetings with residents but endeavours to discuss developments and other matters (such as menu planning or outings) with residents in small groups of two or three. The results of the most recent tenant satisfaction survey were not available for this inspection. The manager reported that the response to the survey by residents varies. The monthly surveys by the manager and deputy manager cover such matters as maintenance, fire safety, use of agency staff and residents records. This is a good management practice but the results are not communicated to senior managers. There is, therefore, a possibility that significant information may not be acted on by the organisation. The home requires significant investment to provide an environment which fully meets the needs of residents. It was reported that discussions had taken place between the landlords, Reading Borough Council, and Paramount Housing Association, but that agreement had not yet been reached. Arrangements for health and safety are mixed. All staff have received training in moving and handling, first aid, and fire safety. Some staff have received training in food hygiene. No member of staff had received training in infection control at the time of this inspection. There was an expectation that when the merger with another housing association was completed any gaps in training would be filled. The organisation’s support for staff undertaking NVQ 3 is acknowledged. Contracts are in place for the maintenance of fire safety equipment. A fire drill was carried out in July 2007. Portable electrical appliances were tested in September 2007. Wheelchairs are maintained by a wheelchair clinic. The home had been inspected by an environmental health officer earlier in 2007. A handwritten report summarising the findings was left on 17 May 2006 and a follow up typed report was issued on 29 June 2006. The inspecting officer raised a number of matters including; inadequate bathroom facilities for current needs, inadequate lighting, and concerns about night time supervision. Water temperatures are being monitored but are not regulated. The temperature in one residents bedroom was tested at 59.2 Celsius on the day of this inspection visit. Some radiators in residents bedrooms are unguarded. As mentioned elsewhere in this report the gradient of the path from the front gate to the front door can pose a hazard for someone in a wheelchair. Negotiating the ground floor in a wheelchair can be very difficult with numerous doors to open during a journey between the dining room and a resident’s bedroom at the far end of the ground floor extension (this was 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 29 observed after lunch on the day of the inspection visit). Vulnerable residents do not have ready access to staff at night and one resident expressed concern that if she fell at night she would not be heard. It was said that the content of this section of this report will already be known to senior managers in Paramount Housing Association and to managers at Reading Borough Council. There seemed a sense of powerlessness within the home. It has been suggested that the situation is a consequence of a failure to agree on the future of the home. This inspection did not include discussions with those managers. The inspection did however, see evidence of a service which is failing to adapt to the changing needs of its residents, and which requires action at all levels of management if it is to change and improve. 4 Granville Road DS0000011054.V352605.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 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 1 25 2 26 X 27 1 28 3 29 2 30 2 STAFFING Standard No Score 31 1 32 2 33 1 34 1 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 2 2 x LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 3 2 X 3 X 2 X X 1 X 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 31 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 YA18 Regulation 14.1(d) Requirement To accommodate only those service users whose needs it is able to meet. Unmet timescale 01/03/07 Unmet timescale 01/08/07 To ensure staff training is updated. Unmet timescale 01/04/07 Unmet timescale 01/08/07 To review the function of the home so that staffing ratios and service users suitability for placement in the home can be assessed. Unmet timescale 01/04/07 Unmet timescale 01/08/07 Individual Risk assessments should be carried out to identify the waking night needs of the service users and the necessary resources put in place. Unmet timescale 01/08/07 All staff working in the home should have training to meet the mental health needs of the service users, to include a basic DS0000011054.V352605.R01.S.doc Timescale for action 31/01/08 2. YA35 18.1 31/12/07 3 YA37 4.1 31/12/07 4 YA9 13(4) 12/11/07 5 YA35 18 1 15/01/08 4 Granville Road Version 5.2 Page 32 knowledge of mental health and training regarding the specific type of illnesses that affect the service users in the home. 6 YA42 13(4) Unmet timescale 01/08/07 Ensure that hot water is regulated to control the risk of Legionella and the temperatures of hot water from outlets accessible to service users is delivered at a safe temperature to reduce the risk of scalding (43 C) Unmet timescale 30/06/07 The physical environment of the home must be suitable for the needs of service users There must be sufficient care staff on duty at all times to meet residents care needs in a timely way. The registered manager must assess the dependency levels of all residents, and provide staff in sufficient numbers to meet the needs of all residents, also taking into account the layout of the building. Appropriate safeguards must be in place to protect residents where radiators are not guarded and do not have low temperature surfaces. The home must ensure that it provides evidence of conformance to The Regulations in the appointment of new staff. 30/11/07 7 8 YA24 YA33 23(2) 18(1)a 31/01/08 31/01/08 9 YA42 13 (4) 30/11/07 10 YA34 19 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 33 No. 1 Refer to Standard YA30 Good Practice Recommendations The washing machine does not have a sluice facility consideration should be given to purchasing one that has this facility. If the home continues to accommodate service users who have physical care needs it should review its policy of not offering personal care to service users. It is recommended that the registered manager periodically review menus with the aim of ensuring that residents receive a varied and healthy diet. It is recommended that the registered manager seek the advice of a pharmacist on the use and content of its ‘Medication Record’. It is recommended that the registered manager review the home’s complaints procedure with a view towards removing the need for a service user to put a complaint in writing and to include reference to independent support when making a complaint if required. It is recommended that the registered manager review the home’s staff induction programme to ensure that, at a minimum, it includes the common induction standards drawn up by Skills for Care. 2 YA18 3 YA17 4 5 YA20 YA22 6 YA35 4 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU 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 Granville Road DS0000011054.V352605.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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