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Inspection on 26/07/07 for 48 Burton Road

Also see our care home review for 48 Burton Road for more information

This inspection was carried out on 26th July 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 18 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff within the home are committed to providing a good service under difficult circumstances. The staff have developed good relationships with people who use the service and have a good knowledge of individual`s needs. Staff communicated with individuals in an appropriate manner and used appropriate forms of communication. Staff had a relaxed and positive relationship with the individuals living in the home. Individuals have a detailed support programme for identified behaviour in the home. This records proactive and reactive strategies to support staff to work together and in a consistent manner.

What has improved since the last inspection?

This key inspection did not identify improvements within the service.

What the care home could do better:

Staffing within the home does not reflect protocols written by the registered person, or reflect the level of support identified within the plans of care and assessments of risk. This means that individuals have had limited access to community activities and education opportunities. Limited staffing has also resulted in staff and people who use the service being placed at risk due to the support required to manage complex behaviour. The home needs to ensure there are robust recruitment procedures, where staff are awaiting a Criminal records Bureau Check. Suitable supervision arrangements need to be in place to ensure the protection of all individuals. Where individuals are working with only one member of staff, the registered person needs to ensure that staff have received necessary training to manage complex behaviour to ensure people are safe, and in line with policies and procedures of the organisation. People who use the service have two plans of care and there is no evidence of involvement in the formation or agreement of the plan. The plans are not dated and there is poor evidence of review to ensure the information reflect peoples needs. Some assessments of risk are duplicated and contain conflicting information regarding support and strategies to reduce risk. The homes medication practices were not robust, the examination of medication administration records, evidenced that people using the service did not always receive their medication as directed by their General Practitioner. Individual protocols for the use of PRN (when required) medication could not be followed as medication was not available for individuals in the community and staff were not aware of the protocols. Suitable monitoring arrangements by the service provider have resulted in poor outcomes for people. The registered person needs to monitor the qualityof the service provision and where shortfalls are identified provided suitable resources to maintain standards of care. Due to the poor outcomes for individuals in relation to individual needs and choices, personal healthcare and support and conduct and management of the home, and unmet requirements from the previous report, the home will be subject to a Management review by the Commission for Social Care Inspection. A management review is a key part of the enforcement process whereby the Commission sets out what we will do to get the care provider to improve their service. The action the Commission will take will depend upon what effect this is having on the people using the service and how the care service provider responds.

CARE HOME ADULTS 18-65 48 Burton Road, Branston Burton On Trent Staffordshire DE14 3DN Lead Inspector Mrs Mandy Brassington DRAFT Unannounced Inspection 26th July 2007 10.30 48 Burton Road, DS0000004923.V342186.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 48 Burton Road, DS0000004923.V342186.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. 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 48 Burton Road, Address Branston Burton On Trent Staffordshire DE14 3DN 01283 545370 01283 545370 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) Robinia Care Homes (2) Limited Vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd August 2006 Brief Description of the Service: The service is registered to provide 24-hour support and care for four younger adults with a learning disability and complex needs, and may have a diagnosis on the Autistic Spectrum Disorder. The home currently provides accommodation for three male individuals. The property is a period semi-detached house located in the residential area of Branston, on the outskirts of Burton-on-Trent. The home is conveniently situated close to a town, on a bus route and close to shops and amenities. The premises are set back from the main road and have tall metal gates leading to the gravel frontage and drive. The building is on three floors and comprises: four bedrooms, an office/sleep-in room, lounge, dining/activity room, bathroom and toilet facilities, laundry room and additional storage. One of the bedrooms has an en-suite shower and toilet facility. Parking space is adequate and to the rear of the house is a large grassed area and patio. The proposed care manager informed the Commission for Social Care Inspection on 8 August 2007 that the current annual fees within the home range from £96,816 to £135,172. 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was an unannounced key inspection and therefore covered all of the core standards. The inspection took place over 7.5 hours by one inspector who used the National Minimum Standards for Younger Adults as the basis for the inspection. Prior to the inspection the manager completed an Annual Quality Assurance Audit (AQAA) for the Commission for Social Care Inspection. From information received questionnaires were three Care Managers within the Local Authority and three General practitioners for feedback on the service. A tour of the home was undertaken. On the day of the inspection, the home was accommodating three people. The inspection included an examination of records, indirect observation, discussion and observation of three people who use the service, and five staff on duty. Case tracking of three care plans was undertaken. Three staff records were examined and observation of daily events took place. Inspection of the storage system and medication procedures were inspected. An Immediate requirement notice was issued on the day of the inspection in relation to staffing within the home and supervision of staff whilst awaiting a Criminal records Bureau Clearance, and a further sixteen requirements and three recommendations were made as a result of this visit. What the service does well: The staff within the home are committed to providing a good service under difficult circumstances. The staff have developed good relationships with people who use the service and have a good knowledge of individual’s needs. Staff communicated with individuals in an appropriate manner and used appropriate forms of communication. Staff had a relaxed and positive relationship with the individuals living in the home. Individuals have a detailed support programme for identified behaviour in the home. This records proactive and reactive strategies to support staff to work together and in a consistent manner. 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Staffing within the home does not reflect protocols written by the registered person, or reflect the level of support identified within the plans of care and assessments of risk. This means that individuals have had limited access to community activities and education opportunities. Limited staffing has also resulted in staff and people who use the service being placed at risk due to the support required to manage complex behaviour. The home needs to ensure there are robust recruitment procedures, where staff are awaiting a Criminal records Bureau Check. Suitable supervision arrangements need to be in place to ensure the protection of all individuals. Where individuals are working with only one member of staff, the registered person needs to ensure that staff have received necessary training to manage complex behaviour to ensure people are safe, and in line with policies and procedures of the organisation. People who use the service have two plans of care and there is no evidence of involvement in the formation or agreement of the plan. The plans are not dated and there is poor evidence of review to ensure the information reflect peoples needs. Some assessments of risk are duplicated and contain conflicting information regarding support and strategies to reduce risk. The homes medication practices were not robust, the examination of medication administration records, evidenced that people using the service did not always receive their medication as directed by their General Practitioner. Individual protocols for the use of PRN (when required) medication could not be followed as medication was not available for individuals in the community and staff were not aware of the protocols. Suitable monitoring arrangements by the service provider have resulted in poor outcomes for people. The registered person needs to monitor the quality 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 7 of the service provision and where shortfalls are identified provided suitable resources to maintain standards of care. Due to the poor outcomes for individuals in relation to individual needs and choices, personal healthcare and support and conduct and management of the home, and unmet requirements from the previous report, the home will be subject to a Management review by the Commission for Social Care Inspection. A management review is a key part of the enforcement process whereby the Commission sets out what we will do to get the care provider to improve their service. The action the Commission will take will depend upon what effect this is having on the people using the service and how the care service provider responds. 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. 48 Burton Road, DS0000004923.V342186.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 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessments of new referrals would be carried out to ensure the service could meet the needs of individuals. People who use the service do not have a suitable contract detailing terms and conditions of occupancy and the support provided including any additional one to one hours. EVIDENCE: The people who use the service have been resident in the home for a number of years and there is one vacancy. Staff reported that if a person were referred to the service, the manager would carry out an assessment to ensure the home could meet the needs of the individual. There was no evidence available in the home that individuals have a contract which details the terms and conditions of occupancy, and includes details of the fees and any additional one to one support. It is required that each person has a contract in a suitable format that identifies the support provided, and a breakdown of fees including the number of one to one hours, if any are 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 10 funded. Evidence of the fees and additional hours is to be forwarded to the Commission to support the requirement regarding the review of staffing. 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Each individual has a care plan but practice of involving people who use the service in the development and review of the plan is variable. Assessments of risk do not always reflect the person’s needs and may give conflicting information. There is some evidence that individuals are involved in some decision making about the home, though due to current resources, areas where individuals can affect change are limited. EVIDENCE: The service provider has developed new plans of care that are to be implemented into the home. Staff reported that there has been insufficient 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 12 direction as to how to use the new plans, and when they should be implemented. This has resulted in each person having six folders with information relating to care. Staff reported they are working with the existing plans of care at present until further instructions has been received. The plans are written in the first person and include information about the person, how I communicate, important people and things in my life, things I enjoy and things I don’t like, things I can do for myself and support required. Information is detailed and discussion with staff revealed Key workers completed the plans. Examples of information given in the plans included a dislike of airports, ice and lemon drinks and being ignored. One part of the plan gave staff information regarding how to be successful when supporting the person. The plans were not dated and did not record who was involved in the formation of the plan. There was no evidence of consultation or agreement with the people who used the service and the plan had not been reviewed. The new plans also reported information in the first person and included details relating to ‘my support, my emotions, my autism, and my future’. These plans were currently not in use within the home. A behaviour support programme had been developed and included comprehensive information regarding any identified behaviour, triggers, reactive and proactive management strategies and possible consequences. The plan was not dated and did not demonstrate how this information had been obtained and by whom. There was no evidence of consultation or agreement with the person who used the service. Some assessments of risk were within the plan of care and others were within a joint folder for all individuals, along with environmental risk assessments. Inspections of records revealed many assessments were duplicated but contained conflicting information. A number of assessments were generic and did not reflect individual’s actual needs or support required to manage identified risk. A number of plans were devised as far back as 2003 and the only evidence of review was a date and a tick. The home accommodates individuals with complex behaviours; one assessment recorded that one person needed one to one support, the plan of care and one other assessment record 2:1 support in the community. There was no information relating to the support required by staff when in the community; staff reported that close supervision and contact was required at all times, but this was not reflected in the assessment of risk, plan of care or behaviour support programme. Assessments of risk recorded that when in the community ‘as required’ (prn) medication should be considered, but the protocol for administration of as 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 13 required medication did not include any reference to protocols within the community and staff confirmed that medication was not taken with them. In addition, general assessments of risk had been complied for staff in the community but did not relate to working with any individual, rather reporting that there was an identified risk of injury when in the community with a person who used the service. From observation and discussion with staff it was evident that people who used the service were supported to make decisions about their daily routine. Staff reported that people are consulted regarding activities and daily chores and are able to choose how to spend their day in the home. The plan of care did not always record information to support this; one plan recorded one person was to be woken up at 8am, although staff were not aware of the reason for this and the person did not need to arise for a particular task. Staff confirmed that this person was able to choose to get up at a time of his choosing. 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are limited opportunities for people to be involved in community activities or to follow educational interests or training courses. The staff try to be flexible and attempt to provide a service that is as individual as possible within limited staff resources. Individuals are supported to prepare and cook a varied balanced diet, and the service provides a choice of culturally suitable foods. EVIDENCE: Staff within the home demonstrated a positive commitment to supporting people who use the service to be involved with activities in the home including domestic activities. On the day of the inspection one individual was supported 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 15 to complete puzzles and another individual received one to one support with preparing and cooking the evening meal. The current staffing provided restricts the opportunities for individuals to be involved in activities in the home and the community. Assessments of risk recorded that two individuals need one to one support in the community and one person requires two to one support. Inspection of daily records since 9 July 2007 revealed that one person has been on five ‘drives’; Staff explained that the person enjoys travelling in the car. Other activities focused on watching DVD’s in the home. Other people living in the home have been able to participate in shopping, going to a local Gateway Club, and a weekly session is booked for carriage riding at a local Stables; staff reported that one person may choose to spend time looking after the horses if they do not want to participate with carriage riding. Within the AQAA the previous manager reported that ‘Service Users are supported to undertake activities and hobbies that interest them. Where possible these activities are undertaken in the local community’, though there was little evidence of suitable community activities in line with individuals hobbies and interests. Due to people’s complex needs and staffing resources, opportunities for people who use the service to be involved in community activities, educational interests or training courses is limited. Individuals may attend an Art Therapy session at another home managed by Robinia, but due to Annual Leave there were limited weekly sessions over the summer period. The manager recorded within the AQAA that ‘educational courses that are suitable for service users living at 48 are limited in this area’. Individuals are able to maintain relationships with family and friends. One person visits the family home on a monthly basis and the family take an active role in the care and support of the family member. Staff reported that a menu plan is displayed but people who use the service are able to choose each meal and a record of foods served was maintained. The regulations state that the home needs to demonstrate that a balanced diet is provided, and therefore it is acceptable that the staff continue with the practice of supporting individuals to plan each meal on a daily basis. On the day of the inspection, one individual was supported to prepare the evening meal. Staff reported that one person purchased food relating to his cultural preferences and records demonstrated the foods were provided on a regular basis. 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use services have access to health care services both within the home and in the local community. Health needs are monitored and appropriate action and intervention taken. Medication records demonstrates that some medication is not administered as instructed, and clear administration directions have not been suitably recorded. As required medication does not always correspond to individual’s protocols or current practices in the community. EVIDENCE: Within the three plans of care, a record of any medical diagnosis and health needs were recorded, and individuals had a health care action plan. Within the 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 17 plan there was a record of visits to health care services, details of appointments and outcomes of visits. Individuals are able to receive a service from an external Psychology Agency and a record of any assessment and visits or support sessions was recorded. Staff reported that support from the organisation is included within the contract price and additional support can be sought if a need is identified. Staff were aware of people’s interests and plans of care recorded how people like to receive personal care and support. Staff were observed communicating effectively with people including responding to an individuals own personal forms of non-verbal communication. The home operated the Boots Monitored Dosage System (MDS). The staff stated that there were no controlled drugs in use. The Annual Quality Assurance Audit (AQAA) completed by the former registered manager stated that ‘All staff that administer medication receive training and are assessed as competent to do so’. Discussion with staff and inspection of records confirmed staff have undertaken medication training. The examination of the Medication Administration Record (MAR) identified that individuals have a protocol for ‘as required’ (prn) medication. The Protocol had not been reviewed since June 2006. Assessments of risk identified that prn medication could be used in the community, but staff reported medication was not taken on activities and would not be availble if required. Two named medications were recorded ‘As directed’. All medication must clearly record the persons name, name of the medicaton, the dose of medication, when to be administered and how. Medication not labelled in line with the Medicines Code 1968 must be returned to the dispensing pharmacy and be re-issued. Two named medications had not been administered as directed each day. Staff reported that the medication was now only administered when required. There was no evidence of the change of instructions from the General Practitioner. The former registered manager within the AQAA stated that ‘Company policy and government legislation are adhered to in relation to administering. controling and storage of medication’. Staff must administered medication as prescribed and the registered person must develop suitable robust systems to ensure medication procedures are followed. 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is clearly written and is available in a number of formats. The complaints procedure is supplied to everyone living at the home and is displayed in a number of areas within the service. The home understands the procedures for Safeguarding Adults and staff have a good knowledge of procedures and how to respond to an alert. EVIDENCE: The home has a complaints procedure that is clearly written and easy to understand using a suitable system of pictures. The complaints procedure was displayed around the home and staff reported that a copy is available to all people. The CSCI office contact details were not correct and need to be changed to the regional office. Staff reported there have been no complaints made since the last inspection. The induction for staff includes safeguarding adults. One person on duty has not received an induction and has worked at the home for three months and therefore not received any training in this area. Discussion with the member of staff revealed training had been provided within a previous employment and all staff on duty demonstrated a good knowledge of the safe guarding adults procedure and how to respond to an alert. 48 Burton Road, DS0000004923.V342186.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, 28, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The home is a pleasant, safe place to live the bedrooms and communal rooms have been decorated and personalised to reflect the interest of individuals. EVIDENCE: This home is a semi-detached house situated in a residential area of Burton upon Trent, on a busy road through Branston, and is not distinguishable as being a care home. The front of the property has been laid out with a double brick paved entrance, leading to a similarly brick paved parking area. Access is through iron gates protected with a security lock. 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 20 The home has been decorated to a good standard with modern pictures and fittings. Some furniture has been provided to house electrical appliances, and can be locked due to the risk of items being damaged or used to harm others. The furniture was of a suitable design not institutional. The home was generally well maintained. Due to the complex needs of individuals there was a continuous programme of refurbishment and renewal due to damage. Individuals have a single room, one of which is en-suite. Individuals are able to personalise their bedrooms according to their interests. One bedroom is currently vacant and used for staff to sleep-in. There is a separate laundry room on the first floor with professional equipment with sluicing facility. During parts of the washing cycle the vibrations cause the home to significantly shake. This needs to be addressed to ensure individuals are not disturbed. 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Recruitment procedures are not robust and suitable supervision arrangements for staff awaiting a Criminal records Bureau Check have not been implemented. The staffing levels do not relate to identified needs and agreed staffing protocols, and is not based around delivering outcomes for the people using the service. EVIDENCE: On the day of the inspection the staff on duty consisted of: 1 Team Leader working 7.30am-3.00pm 1 Team Leader working 10.00am-3.00pm 1 Support worker, working 7.30am-3.00pm For the afternoon shift there was: 1 Team Leader working 2.30pm-10.00pm 1 Support worker, working 2.30pm-10.00pm 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 22 During the night there was one waking night staff working from 9.45pm to 7.45am and one member of staff on a sleep-in. The home has a written protocol for staffing completed in October 2006. The protocol clearly states ‘there should be one Team Leader and two Support workers on each shift and where possible there should also be a Support worker from 10.30am on days where there are planned activities’. Inspection of the roster and discussion with staff revealed it was common practice for only two staff to be on duty on each shift. The home’s protocol records that ‘no service user should be left alone with another service user, staff should always be present’ and ‘The team Leader should identify on the shift planning sheet a 1:1 member of staff for each Service user.’ The current staffing did not allow for the protocol to be followed and put people who use the service and staff at risk. Individual’s contracts were not available and there was no record in the home of the additional support purchased by the Placing Authority and therefore it was unclear as to how whether individuals were funded for one to one hours in the home. One member of staff had completed a Criminal Records Bureau Check (CRB) and Protection of Vulnerable Adults Check (PoVA First) but was awaiting CRB Clearance. This person was working as the second member of staff and was not suitably supervised. In addition, the person had not received an Induction with the Service provider, and had not received training for managing complex behaviour. This means that people who used the service and staff had been placed at risk, as necessary supervision arrangements were not in place and suitable support for managing complex behaviour was absent. This was a serious concern to the Commission and an Immediate requirement Notice was issued in relation to providing adequate staffing, and where people are awaiting CRB Clearance, suitable supervision arrangements are to be in place. It is required that a review of staffing is completed to demonstrate the core care hours provided and one to one funding individuals receive. The review is to demonstrate how this support is provided to meet individual’s assessed needs. Inspection of three staff records demonstrated required pre-employment documentation, including a copy of identity, appropriate work permits, two references was in place. Two people had a copy of a CRB Clearance and one person was working in the home not suitably supervised whilst awaiting CRB Clearance. Inspection of the roster and discussion with staff revealed that one member of staff was working for a period of seventeen days including sleep in’s and double shifts. The registered person must ensure that staff receive suitable 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 23 time off work to carry out their job to a good standard and to consider the guidelines within the Working Times Directives. The proposed Care Managers hours were not recorded on the homes roster, these hours are to be recorded to demonstrate the support in the home. Inspection of records and discussion with staff revealed that staff had opportunities to attend training courses for management of behaviour, Safe administration of medication, Makaton, Food Hygiene, First Aid and Autism. Staff spoke highly of the training opportunities provided by the service provider. Observation of staff interaction demonstrated that the staff within the home are committed to providing a good service under difficult circumstances. The staff have developed good relationships with people who use the service and have a good knowledge of individual’s needs. Staff were observed supporting individuals who exhibited complex behaviour in a suitable and sensitive manner, and supporting colleagues to ensure people were safe. 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 24 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, 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. All staff have not had sufficient or recent training to enable them to work safely in the home and within the current staff provision. The service provider has not adequately monitored the service to ensure suitable staffing has been provided, care plans and assessments of risks reflect individuals needs and identified outcomes for people are met. EVIDENCE: 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 25 The registered manager has recently moved to another home within the company and the Deputy Manager has been recruited to Care Manager and had previously informed the Commission a CRB Clearance was to be applied for. The position of registered Care Manager is currently vacant; an application to begin the Fit person process is to be submitted upon satisfactory CRB Clearance. The concerns raised regarding care planning and assessments of risk, staffing, supervision of staff and poor procedures for medication demonstrate that the management arrangements have not been effective and people who use the service are not adequately protected in the home. Since the last key inspection in August 2006 staff resources have been cut and not all staff have received suitable training to enable them to work safely. Care plans do not demonstrate up to date needs and some assessments of risk give contradictory information, which means that it was difficult to demonstrate how individual’s needs could be suitably met. The service provider has failed to ensure the safety of individuals as one member of staff has been worked partially unsupervised whilst awaiting CRB Clearance. In 2006 the home carried out a Quality Assurance review. Previous visits to the home have required a copy of the report to be complied and made available to the Commission for Social Care Inspection. This requirement has not been met and will be considered at the Management review. Prior to the Inspection the former Registered manager completed an Annual Quality Assurance Audit for the Commission for Social Care Inspection. The registered person must ensure that all information included within the audit accurately reflects the service provision in the home. Inspection of records demonstrated that :Weekly checks of the call systems were carried out, The Gas Safety Test was completed in July 2007, Weekly Fire checks were completed The Portable Appliance Checks were due in April 2007 and there was no evidence this had been completed. Due to the poor outcomes for individuals in relation to individual needs and choices, personal healthcare and support and conduct and management of the home, and unmet requirements from the previous report, the home will be subject to a Management review by the Commission for Social Care Inspection. A management review is a key part of the enforcement process whereby the Commission sets out what we will do to get the care provider to improve their service. The action the Commission will take will depend upon what effect this 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 26 is having on the people using the service and how the care service provider responds. 48 Burton Road, DS0000004923.V342186.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 2 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 1 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 1 X LIFESTYLES Standard No Score 11 X 12 1 13 2 14 1 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 2 X 1 X X 2 X 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation Requirement Timescale for action 14/08/07 (5)(1)(bb)(bc)(c) The Service User Guide does not include the current rate of fees charged, including any additional fees and a breakdown of how those costs are calculated. The registered person must ensure that people accessing the service are aware of all costs. 5(b)(c) 2 YA5 People who use the service 30/08/07 need to have an up to date contract detailing the terms and conditions of occupancy and financial arrangements. Plans of care for people who 27/08/07 use the service must be up to date and reflect individuals needs and support required to ensure that people receive appropriate care. Plans of care for people who 27/08/08 use the service must evidence consultation with individuals or their DS0000004923.V342186.R01.S.doc Version 5.2 Page 29 3 YA6 15(1) 4 YA6 15(1) 48 Burton Road, representative to demonstrate that the plans have been agreed by the person 5 YA9 13(4)(b) Assessments of risk for people who use the service need to reflect the actual support required in the community to ensure individuals and members of staff are not placed at risk. Assessments of risk for people who use the service need to record accurate information and reviewed regularly to ensure they record up to date information and all reviews need to demonstrate how decisions have been made. In consultation with people who use the service, staff need to support people to become part of, and participate in, the local community in accordance with assessed needs and the individual Plans. In consultation with people who use the service or their representative, make arrangements to enable individuals to engage in local, social and community activities. When medication is administered to people who use the service, instructions must be followed as recorded by the general practitioner. Where medication needs to DS0000004923.V342186.R01.S.doc 27/08/08 6 YA9 13(4)(b) 27/08/08 7 YA13 16(2)(m) 27/08/07 8 YA14 16(2)(m) 30/08/07 9 YA20 13(2) 14/08/07 10 YA20 13(2) 20/07/08 Page 30 48 Burton Road, Version 5.2 be administered on an ‘as required’ basis’ specific guidelines must be followed and to consider protocols within assessments of risk. 11 YA33 18 (1) Staffing provided in the 07/08/07 home must be sufficient to meet people’s needs and ensure people are safe. A review of the staffing provided is to be carried out to demonstrate how this is achieved. Previous timescale on visit 02/02/07 and 22/08/07 not met. Appropriate levels of staff 28/07/07 must be provided in the home in line with the home’s own protocol, and assessments of risk and plans of care to ensure individuals are not placed at risk. Hours worked by the manager are to be included on the roster to demonstrate how sufficient support is provided as schedule 4 (7) 31/07/07 12 YA33 18(1) 13 YA33 17(2) 14 YA33 18(1)(a) Staffing provided in the 07/08/07 home is to demonstrate how additional support hours are provided to meet individuals needs in conjunction with individual’s contracts Where staff are awaiting a Criminal Bureau Records disclosure, suitable supervision must be provided. 28/07/07 15 YA34 19(11)(a)(b) 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 31 16 YA37 8(1) Following satisfactory CRB 30/08/07 Clearance an application to begin the Fit person process must be submitted by the manager Where a quality review has 30/08/07 taken place a developmental action plan is to be produced to demonstrate the review and response of the service Previous time scales on visit 02/02/07 and 22/08/07 not met. Portable Appliance Testing must be carried out in the home to ensure equipment is safe to use 30/08/07 17 YA39 24 (1)(2) 18 YA42 23(2)(c) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA6 YA22 YA24 Good Practice Recommendations The service provider needs to deliver clear guidance regarding the care planning system and documents to be used The complaints procedure need to be amended to reflect the actual address of the Commission for Social Care Inspection The washing machine needs to be suitably placed to ensure minimum disruption to others from vibration and noise 48 Burton Road, DS0000004923.V342186.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Stafford Local Office Commission for Social Care Inspection Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 OES 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. 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