Inspection on 28/04/08 for 4 Granville Road

This inspection was carried out on 28th April 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

4 Granville Road 14/04/09

4 Granville Road 16/10/07

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 Yvonne Souden Unannounced Inspection 28th April 2008 02:00 4 Granville Road DS0000011054.V360982.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.V360982.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.V360982.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.V360982.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 10th December 2007 Brief Description of the Service: 4 Granville Road is situated in a residential estate approximately 2 miles from Reading town centre and provides residential care and accommodation for 9 people with mental disorders, excluding learning disability or dementia. The registered provider is Paramount Housing Association Ltd. The home is furnished and decorated to a basic standard; the building is owned by Reading Borough Council, and has been identified by Reading Borough Council and the organisation as requiring refurbishment. There is a large enclosed garden and parking facilities at the front of the house. There are 9 single bedrooms, 1 has a toilet and wash hand basin and the others have a wash hand basin only. There is no lift or stair lift and therefore the first floor would be unsuitable for wheelchair users or those who cannot manage stairs. 4 Granville Road has a Statement of Purpose and Service Users Guide available on application to the home. The fees at the time of this inspection were £598 .60 per week. 4 Granville Road DS0000011054.V360982.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. The service has recently changed provider from Paramount Housing Association Limited, a member of HVHS Housing Group to HVHS Housing Group, a member of Wessex Housing Partnership Ltd. The manager completed an Annual Quality Assurance Assessment (AQAA), which is a legal document provided by the commission. The AQAA was used by the manger and provider to review their service and inform the commission of their findings. The AQAA was used as part of the evidence to inform this report. Other evidence used to inform the report includes an 8.5 hour site visit to the service by the inspector; 6 hours was on the 28th April 2008 and 2.5 hours on the 6th May 2008. This enabled the inspector to observe care practice and speak to people who use the service, staff and management of the home. The Commission for Social Care Inspection received 2 completed surveys that had been sent to people who use the service; their relatives, staff and health professionals, their views of the service provided have been used to inform the report. Other evidence used to inform this report was documentation viewed by the inspector at the site visit. From the evidence seen by the Inspector and comments received, the Inspector considers that the home would be able to provide a service to meet the needs of individuals of various religion, race, or culture. The home follows the organisation’s policy and guidelines to manage issues relating to equality and diversity. What the service does well: The service provides a warm and welcoming atmosphere. Staff are aware of the needs of the residents and treat them with dignity and respect, and staff have received health and safety training to promote the safety and well being of the residents. Residents feel valued and respected by the staff team, and are provided with a nutritionally balanced diet that meets specialist dietary needs as chosen by the residents. The residents’ independence is promoted as they go about their lives attending external group activities and accessing the community 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 6 independently or with support, dependant on risk, and dependant on the needs of the resident. The manager demonstrates knowledge of improvements needed to promote choice, safety and well being of the residents and ensures good communication with health and social care professionals to meet the needs of the residents. A resident said, “I preferred Fairmile, miss my friends from Fairmile”, and went on to say “Staff bring breakfast to me in bed, but sometimes I have breakfast in the dining room”, quite nice meals”. Another resident said, “I go to the Resource Centre, we go on holiday, and I see my sister on a Saturday”. What has improved since the last inspection? What they could do better: 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.V360982.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available for those people who are considering using the service and for those who are resident within the home. Prospective residents have their needs assessed, and have their assessed needs reviewed following admission to the home. EVIDENCE: The responsible individual confirmed communication with CSCI Registration Team to change the detail on their registration certificate to HVHS Housing Group as opposed to Paramount Housing Association Limited. The service reviewed their Statement of Purpose and Service Users Guide following the last key inspection, and detail the homes complaint procedure within. The complaint procedure details the main office address omitting the telephone number; the service should ensure the telephone number of the main office is available for the people who use the service that would give them the choice to contact the provider by telephone or in writing, should they have a concern or complaint that they do not want to take to the manager in the first instance. The service users have lived in the home for several years and at the time of this inspection the service had one vacancy. There is documented evidence in the form of health and social care professional needs assessments. Other 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 9 documentation include an assessment of living that documents change, and activities of living that details what the service user can and cannot do. All assessments link with the service users individual care plan and risk assessment as signed by the resident and/or their representative. 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have individual care plans that promote their independence and decision-making, whilst risk assessments promote their safety within the decisions they have made, and care needs identified. EVIDENCE: The inspector viewed the records of two residents. Self-care information records are used monthly as a tool by the keyworker of the resident to review the residents health, personal and social care needs, any changing needs identified are updated within the residents plan of care (referred to by staff and residents as a work plan). Care plans clearly identify that the residents’ personal, health and social care needs are identified and reviewed six monthly within a multi agency care programme approach. Associated risks are identified and have an action plan in place to minimise those risks. A service user said “I see the nurse in May, she comes in to review us, from Prospect up the road”. 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 11 It was clear from observations that residents could choose what they wanted to do as they participated in daily life within the home, or within the community, and that those choices were detailed within their plan of care. Care plans support residents to make decisions in life, and where there is an element of risk identified, plans are in place to support the resident to live their lives within a risk management framework, that enables the resident to go out in the community independently or with support. The previous key inspection 16/10/07 made a requirement within standard 9, regulation 13.4 of the Care Homes Regulations that ‘Individual Risk assessments should be carried out to identify the waking night needs of the service users and the necessary resources put in place’. This requirement was not repeated at the Random Inspection 10/12/07. The service completed a risk assessment October 2007 and has taken action to issue the most vulnerable residents with call bell pendants. On activation the call bell will alert the sleep in staff that assistance is required. This is discussed further within the staffing section of this report. 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are supported to access facilities and be part of the community in which they live that brings value to their lives. People who use the service are enabled to maintain contact with family and friends, and are involved in decision making about the running of the home, and personal choices made within daily living. EVIDENCE: There is a diverse cultural group of residents and staff, who were observed to respect one another, sharing tasks equally and having full participation in decisions made about the home; residents are encouraged to maintain contact with family and friends. The inspector observed a resident who wanted to wash his clothes, staff asked if he would mind leaving the washing until the next day due to repairs underway in the laundry, staff confirmed with the resident that his keyworker 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 13 would support him the next day; the resident was happy to leave the laundry until the next day. The resident showed the inspector the resident rota that details responsibility of chores within the home, for example, washing up, laundry, shopping, helping to prepare meals and cleaning the kitchen. One resident said “I sometimes swap tasks with other residents” and another resident who took part in the conversation confirmed this. A list on the office wall details activities some residents attend. For example, resource centre, walking groups, gentleman’s club, but also refers to some health issues for example blood tests due and time of shower that does not promote the residents privacy and dignity, and should only be recorded within closed files to promote client confidentiality. Residents meetings take place. Records identify that all residents attended the last meeting held 23/4/08, and discussed topics that affect the running of the home, for example, lights kept on 24 hours, decoration of home, holidays, trips, and keeping the home tidy. On the evening of the inspection a resident was preparing an alternative meal of vegetable pasta, as opposed to lemon chicken and rice, prepared by staff for the other residents. The main meal prepared for the residents looked appetising, with plenty to eat, and was observed to be enjoyed by all. The home completes a four-week menu as agreed at residents meetings. Fresh fruit was readily available, and evidence of fresh vegetables used. Meal times are fixed to meet the health care needs of the residents. Reading Borough Council Inspection Environmental Health inspection report dated 22/01/07, states the name of two staff who must attend level 2 food safety training and states that other staff should attend an update if 3 year since their last food safety training. Training records identify that the two staff members have attended food safety training and that the service has obtained a Safe Food Better Business pack from Food Standards as recommended by the environmental health inspector. The dining room has been decorated to offer a homelier environment, with the addition of two small sofas, a radio and a computer in one corner; a resident said that he uses the computer regularly. Redecoration of the residents lounge has also taken place and offers a homelier environment, with a large TV, sofas and coffee table. Residents were observed to be comfortable in their surroundings, sharing the lounge and taking part in conversation with the inspector, staff and other residents. A resident spoke to the inspector about attending Reading Recourse Centre for people with Mental Health. The centre helps residents to learn new skills and arranges day trips etc. One resident said, “I go to resource because I’m made to, I’d rather do nothing”. Another resident said “I like the resource centre, I started a computer course, but it stopped as there was not enough people who wanted to go, but I have three chest computers in my room”. 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 14 A resident spoke of buying a camcorder- staff gave advice and confirmed that they would support the resident on a shopping trip to purchase a camcorder of the resident’s choice and affordability. The resident had a bike and frequently went out into the community throughout the day of the inspection, but returned to the home at a set time as detailed and agreed within the resident’s care plan and risk assessment. 4 Granville Road DS0000011054.V360982.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 adequate. This judgement has been made using available evidence including a visit to this service. People who use the service receive support to meet their health, psychological, personal and social care needs as identified within their agreed plan of care. There is a risk that people who use the service who require assistance with personal care will not have their personal care needs met as and when required throughout the day, and that this puts the dignity of the residents at risk. EVIDENCE: There is evidence that provision has been made to improve the home’s ability to meet the personal care needs of the residents’ since the last key inspection 16/12/07. The home has recently installed a wet room that gives easier access for assisted showering, and is in the process of recruiting a carer to deliver personal care early evenings that will give the residents a choice to have an assisted shower in the evening if preferred, as opposed to mornings only with assistance of a domiciliary carer. Although this offers positive improvement it is still a long way from ensuring that the personal care needs of the residents’ are met as and when required. For example, due to limited mobility and continence management two residents use a commode in their 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 16 room. It was observed that used commode pots could be left for a number of hour’s dependant on when used and arrival of the domiciliary carer. It was also observed that a resident waited patiently for the arrival of the domiciliary carer to assist to wash and get ready for bed. The resident became impatient waiting and put their nightclothes on without washing. The domiciliary carer arrived, emptied the commode pot and stayed 5 minutes out of their allocated 15 minutes. The deputy manager confirmed that this frequently occurs. It is recognised that this will now improve with the employment of a carer to work early evenings; nevertheless existing permanent staff confirmed that it is not in their contract to deliver personal care, and part of personal care is emptying commode pots. The solution to employ a carer to deliver personal care in the evening only, does not address the personal care needs of the resident as and when required throughout the day, and continues to have no respect for their dignity as used commode pots are left in their room next to them whether they have visitors or not and are not emptied until the domiciliary or evening carer arrive. The previous inspection 16/10/07 stated ‘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,’ and ‘the service fails to adequately invest in developing staff skills’. This remains partly unchanged as investment in training and supervision of staff has taken place, but the risk of personal care neglect of residents remain high despite the appointment of an evening carer to deliver personal care. Existing staff contracts are written to support people to live independent lives and does not recognise that the needs of some residents have changed since their admission in the 1990s’, and may require personal care at any time of the day or night. There is clear evidence that residents receive full support to meet their mental and physical health care needs. Staff have recently attended training within Mental Health, Moving and Handling, Medication and Health and Safety. Residents who have limited mobility have mobility aids as assessed by the occupational therapist. Excellent record keeping identifies health care involvement and appointments attended by the residents, and documentation demonstrates regular multi-agency care plan approach reviews. Staff administer residents medication from a monitored dosage system as dispensed by Boots the Chemist; records matched medication kept and all medication was stored securely. Four residents administer their own medication from a monitored dosage system, and risk assessments are in place to minimise risk. Records identify that health care professionals visit the home to administer medication that staff are not authorised to administer. 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and action taken to protect the people who use the service from abuse. Staff are not familiar with safeguarding adult policy and procedures and this could pose a risk in the protection of the people who use the service. EVIDENCE: The service has a complaint procedure, and as discussed in section one of this report needs to include the telephone number of HVHS Housing Group as a point of contact for those who would prefer/or are only able to manage a telephone call to voice their concern, as opposed to putting their concern/complaint in writing. CSCI has received no complaints about the service provided within inspection year 2007/08, and to date. Discussions with the manager and records viewed identify that all concerns and complaints however minor are treated as an incident. Incident report sheet viewed 18/04/08 reports physical aggression by a resident to staff that was then reported to the Community Mental Health Nurse for advice. The manager confirmed that the service was looking at accessing Reading Borough Council training for challenging behaviour. Records identify that a safeguarding strategy meeting was held 13/03/08, with an action plan in place to protect a resident in public situations. CSCI were not informed of the safeguarding adult referral, and information had not been included in the data set of the Annual Quality Assurance Assessment (AQAA) 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 18 completed by the manager. Date of review is identified 19/05/08; the manager must inform CSCI of outcome. A regulation 37 report dated 3/05/08 and forwarded to the Commission by email 9/05/08 referred to a resident who made an allegation of abuse alleged to have happened in the middle of the night. The report informs that the incident was reported to the safeguarding adult team 3 days after the incident and this should have been reported within 24 hours. The report states the incident was investigated and not substantiated. Discussions with staff indicated that they know what constitutes abuse, and that they would inform management if they were to witness a form of abuse or if an allegation of abuse was made by a resident. The home has a copy of the Reading Borough Council multi-agency safeguarding adult policy and procedure and has developed a whistle blowing procedure; staff were unfamiliar with both procedures and the manager confirmed that the whistle blowing policy would be reviewed to conform to the multi-agency safeguarding policy and current good practice. Staff have not attended safeguarding adult training and must attend training to ensure their awareness of what constitutes abuse and action to take; the manager last attended a safeguarding adult course 2006, and should attend a refresher course. Staff attended training on Care of the Elder Person 2/11/07 and Equality and Diversity November 2007. 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 19 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, and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to provide a safer, homelier and comfortable environment for the people who use the service, but further improvement would be required to ensure the layout of the building continues to meet the changing needs of the people who live there. People who use the service are not protected by infection control procedures. EVIDENCE: The previous key inspection 16/10/07 and Random Unannounced Inspection made requirements, to control the risk of legionella and water temperatures from hot water outlets to a safe temperature of between 37 and 43 degrees Celsius, ensure the physical environment of the home is suitable for the needs of the residents, and ensure appropriate safeguards were in place to protect residents where radiators are not guarded or do not have low temperature surfaces. The home has made improvements by meeting those requirements. A wet room/shower room has been installed that will enable those residents who require assistance with showering to have an assisted shower. Hot water 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 20 outlets are regulated to ensure they are within a safe temperature; this was discussed at the staff handover meeting on the day of the inspection, as staff confirmed they had reported to maintenance that the water was too cold from one hot water outlet. CSCI received a copy of the homes risk assessment and management plan to protect residents from radiator burns dated 29/11/08. The assessment confirmed that 14 radiator covers have been fitted in the most vulnerable residents rooms and communal areas most at risk, and this was observed at this inspection. The home has purchased a new washing machine that has a sluice facility and clothes dryer. Two rooms had an offensive odour on the day the day of the inspection due to poor continence management and personal care delivery. The manager confirmed that a new bed had been ordered for one resident, and the deputy manager related to the odour in one room from a chair that the resident sleeps on at night. The home must ensure all areas of the home are clean and fresh for the residents to live. The service has redecorated the communal areas and this has improved the overall homeliness of the home; the manager confirmed that blinds/or curtains would be ordered to replace those taken down to ensure residents’ privacy is respected. Although improvements have been made to the environment to make it a safer and homelier place to live, areas of refurbishment would be required to bring the home up to a good standard, for example some window frames in residents rooms and some communal areas need replacing, bedrooms need redecorating and narrow corridors and lack of en-suite facilities may not meet the continual changing needs of the people who live there, in particular those who are experiencing limited mobility and are wheelchair users. The inspector viewed a vacant room that was to be viewed by a prospective resident. The paintwork on the walls, skirting board, window and door were worn and chipped and needed a fresh coat of paint to welcome a new resident. The room has a wash hand basin with tiles above that did not butt up to the sink creating an area for bacteria to grow, increasing the risk of infection to a resident. The manager said it is policy that the residents take responsibility to decorate their rooms, confirming that she would have to put a request in to the organisation to have bedrooms redecorated. The home should have a programme of renewal for the fabric and decoration of the premises, with records kept and this should include residents’ rooms. The residents have lived there since the 1990’s and have not had there rooms redecorated in that time hence wear and tear is evident. CSCI received a letter 20/09/08 from the providers confirming an update on the timescales for the extension/alterations of the building and stated that 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 21 Reading Borough Council had advised that it is now looking at 2008-11 for the work to be approved, commenced and completed. Discussion with the responsible individual about the fabric and condition of the home 8/05/08 confirms that those dates may have changed. The organisation must inform CSCI of the projected plans to bring the home up to a good standard in the near future. Infection control policies and procedures are in place, but staff have not attended infection control training to be aware of best practice in promoting infection control. Protective clothing was available, but no shoe covers were available for staff to use when assisting resident to have a shower in the wet room. Staff could not confirm where commode pots are emptied and washed as there is no sluice room and the domiciliary carer completes this task. It was confirmed following the site visit that commode pots are emptied into the toilet within the wet room, washed with the shower, and again emptied in the toilet and sprayed with an anti-bacterial spray. The wet room is the only communal bathroom on the ground floor and the residents’ rooms do not have en-suite facilities. Cleaning products were observed in the wet room and not stored to meet COSHH requirements. Infection control is not promoted by washing commode pots in a shower/wet room that is used by all residents, an area that needs to be addressed in the planned alterations. The provider has confirmed that they will inform CSCI within a three-month timescale of the proposed plans to bring the building up to a good standard that will provide better facilities to meet the needs of disabled residents and promote infection control. 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to ensure staff receive training to meet the needs of the people who live in the home. The home has a staff team who are caring and enthusiastic in supporting and meeting the needs of the people who use the service, but this is at risk due to insufficient staff numbers. EVIDENCE: Staff contracts do not require staff to deliver personal care, and discussions with staff confirm that this concerns some staff due to the changing needs of some residents, as discussed in the ‘Personal Healthcare Support’ section of this report. Staff are competent to support the residents lifestyle as is detailed within their job description and communicate with other health and social care professionals to ensure the needs of the residents are met, but they do not have the same confidence and competency to meet the personal care needs of the residents. There are seven permanent staff employed that includes the manager. Three are in the process of completing a National Vocational Qualification in Care that will meet the national requirement to have at least 50 of staff with a care qualification. 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 23 The staff rota did not demonstrate the name of the carers, times that they work and there designated role. Nevertheless discussions with the deputy manager who has the delegated task to complete staff rotas confirmed some clarity around the rota. The deputy manager confirmed that she would review the rota to ensure clarity of staff names, designation and hours worked. The rota identifies two staff on shift between 7 am and 11 pm, with frequent shifts covered by only one staff member. The rota identified that some lone shifts were covered by an agency carer on their first shift within the service, and was also covered by agency carers who have regular shifts. This poses a risk to the residents as one staff on shift would not be effective in managing emergencies; the risk would be greater in having a lone agency carer who has not had the opportunity to work several shifts to familiarise themselves with the building and residents. Following a requirement made at the previous key inspection the home reviewed the staffing levels at night as the needs of some residents have changed and there is no waking night staff. The home based their assessment dated October 2007, on risk of falls and ensuring residents privacy is respected. The homes policy is not to enter a service users room in the night unless in an emergency. There have been no recorded falls. The homes risk assessment came out as high risk and stated that ‘a resident could become injured due to falling, becoming ill or decline in mental health and result in being neglected until such time that a staff member was back on duty’. The risk assessment also referred to two meetings that took place at Prospect Park Hospital due to the concerns of the physical decline of current residents. The outcome of the risk assessment is to issue the most vulnerable residents with a pendant bracelet or necklace that will, if activated alert the sleep in staff member to attend to the resident. The evidence collated on and between the two day visits to the service causes concern that the risk of not having waking night staff, and only having one carer on shift at times throughout the day is too high. Incident report sheet viewed 18/04/08 reports physical aggression by a resident to staff that was then reported to the Community Mental Health Nurse for advice. Records of three residents identify that they require assistance with personal care, and two require assistance to the toilet with the use of a walking frame or wheelchair, or to empty their commode. Confirmation from the manager on day one of this inspection confirmed that one resident is frequently up in the night and sleeps in the day. A resident made an allegation of abuse in the middle of the night and the manager reports that the allegation was unsubstantiated. The needs of the residents are changing and the policy to have sleep in staff only at night, and having only one staff member on shift at various times of the day does not protect residents or staff. Therefore the service must review staffing numbers day and night to reflect the changing needs of the residents. The assessment of staff numbers must be undertaken with advice from the residents care managers/health care 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 24 professionals/stakeholders to ensure an accurate assessment of need and ratio of staff is agreed that will meet the residents needs and protect the residents and staff throughout the twenty-four hour service provided each day. Staff say they feel supported by their manager and receive formal supervision; staff appraisals took place January 2008, and identify the training needs of staff. Since the last inspection staff have attended training on Care of the Elder Person, Equality and Diversity, First Aid, administration of Medication and an 8 week course on Health and Safety. Staff have not attended training on Infection Control or Safeguarding Adults and the manager confirmed that she would request training for staff. Recruitment files of 2 staff were viewed and detailed an application form with full employment history, two references, and interview detail and security checks, for example CRB. 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is a competent, caring and enthusiastic manager who has the qualifications to ensure the safety of the people who use the service and that staff team. The manager ensures records are kept and up-to-date, with some deficits noted within reporting incidents in line with multi-agency policy and procedures. People who use the service feel listened to and feel confident that their views contribute to the running of the home. Staff job descriptions have not been reviewed to meet the changing needs of the people who use the service. EVIDENCE: There have been many changes made since the last key inspection that promotes residents safety. Radiators have been covered and hot water outlets are monitored. A wet room that enables residents to have an assisted shower has been installed, some decoration within the home has taken place to 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 26 provide a homelier environment and staff are supported to meet their training needs. Fire equipment and alarms are regularly checked and maintained and all staff have attended an eight-week health and safety course. Policies and procedures are in place, some need to be reviewed as last reviewed 2006; the deputy manager confirmed that a date has been set 21/05/08 to review the policies and procedures. The manger keeps excellent up-to-date records within risk assessments and care plans, and has good working relationships with health care professionals that ensure the review of residents’ health and social care needs are complete. Records and observation identify that the residents are listened to and their opinions about the service valued. The manager must ensure CSCI are informed of any safeguarding adult referrals in the format of regulation 37 reports, and must detail the data within the Data section of the Annual Quality Assurance Assessment, which is a legal document, provided by the commission annually for the service to complete. The process of recruiting an evening carer is well underway to assist residents with personal care. Domically carers are still commissioned to the care home and will continue their morning visits leaving a large gap at other times of the day where residents may require assistance with personal care. The previous inspection 16/12/07 said: ‘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’ and goes on to say ‘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...’ The manager still appears to have a sense of powerlessness within the home as she recognises areas that need to change to benefit the changing needs of the people who use the service. One of those changes would be to review staff job descriptions, and for all staff to be trained and competent to provide personal care to those residents who require assistance within the 24-hour residential care home in which they live, and for the service to be refurbished to meet a good standard that promotes infection control within continence management, and enables the service to continue with the provision of care to those people who have a physical disability, and to those who are wheelchair users. 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 27 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 3 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 3 23 2 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 X 3 X X 2 X 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA18 Regulation 12. (3) and 12(4)(a) Requirement The provider and manager must ensure that people who use the service receive assistance day and night with personal care as and when required that takes in to account their wishes and feelings in a manner that respects their dignity. The provider and manager must ensure that staff attend safeguarding adult training, and that refresher training is offered to those staff who have attended safeguarding adult training to protect the people who use the service from being placed at risk of harm or abuse. The provider and manager must ensure sufficient staff are on shift twenty-four hours a day to protect and meet the personal, health and social care needs of the people who use the service. To achieve an accurate assessment of staff numbers required day and night the provider and manager must 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 29 Timescale for action 16/06/08 2 YA23 13.6 16/07/08 3 YA33 18(1) a 16/06/08 review the changing needs of the people who use the service, and involve health and social care professionals and stakeholders to ensure an accurate assessment of need and ratio of staff is agreed, that will meet the personal, health and social care needs of the people who use the service with dignity and respect. 4 YA24 23. -(2) (a)(b) The provider must have a programme of renewal for the fabric and decoration of the premises that includes the bedrooms of the people who use the service. The provider must inform CSCI of the projected plans with realistic timescales to improve the physical design and layout of the premises to continue to meet the needs of the people who use the service. 5 YA30 13. - (3) 1. The provider and manager 16/06/08 must ensure staff attend infection control training, to be aware of best practice in promoting infection control. 2. The provider and manager must provide staff with protective clothing in the form of shoe covers for assisting people to shower in the wet room. 3. The provider and manager must ensure the bedrooms of the people who use the service are clean and free from offensive odours to promote infection control. 4. The provider and manager must ensure where bacteria may be harboured between tiles and a sink DS0000011054.V360982.R01.S.doc Version 5.2 Page 30 09/08/08 4 Granville Road that the area is repaired to promote infection control. 6 YA42 37. -(1) (e) The provider and/or manager 16/06/08 must in future inform CSCI of all incidents where an allegation of abuse has been made, and must report allegations of abuse to the safeguarding adult team within twenty-four hours of an allegation of abuse being made. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA10 Good Practice Recommendations The provider and manager should promote the dignity and privacy of the people who use the service by not displaying personal times of blood tests and showering times on the wall of the office, and should ensure client confidentiality of the information. The provider and Manager should ensure blinds and /or curtains are replacing those taken down to ensure residents’ privacy. 2 YA24 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 4 Granville Road DS0000011054.V360982.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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