Inspection on 31/07/07 for 49 Regents Park

This inspection was carried out on 31st 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

49 Regents Park 26/06/08

49 Regents Park 27/09/06

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 49 Regents Park 49 Regents Park Heavitree Exeter Devon EX1 2NZ Lead Inspector Belinda Heginworth Key Unannounced Inspection 31st July 2007 05:00 49 Regents Park DS0000067537.V342839.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 49 Regents Park DS0000067537.V342839.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. 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 49 Regents Park Address 49 Regents Park Heavitree Exeter Devon EX1 2NZ 01392 423847 01392 201324 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) Regents Park Limited Mr Michael Andrew Cox Care Home 3 Category(ies) of Learning disability (3), Physical disability (3), registration, with number Sensory impairment (3) of places 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th September 2006 Brief Description of the Service: 49 Regents Park is a small registered care home for young adults. It provides individual care for up to three young people with learning or physical disabilities aged between 16 and 25 years. The home provides bright, cheerful and nicely decorated family style accommodation with three single bedrooms. There is also a noisy room with a CD player. There is a garden to the rear of the property. The owner of 49 Regents Park, also runs 47 and 51, and the three gardens are joined together. The inspection report is on display. The cost of the service according to the manager is from £1200 per week with no extra costs. 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days. The first visit took place, unannounced in the evening starting at 5pm and lasting 4.50hours. On this occasion, time was spent observing the interaction between staff and the young people living at the home, and talking to two of the staff on duty. The people living in the home have very complex needs and behaviours that sometimes challenge the service. Some also have limited verbal communication skills. Observations were made throughout the inspection and time was spent talking to two people. During the inspection we “case tracked” three people living at the home. This means we spoke with some of them, made observations, spoke with staff and read records, starting from the admissions process through to the present. Medication practices were looked at and a tour of the building and peoples’ bedrooms took place. During the second visit, on the 2nd August 2007, the home’s paperwork was inspected which included fire records, staff training and recruitment files. Time was also spent discussing the service with the home’s registered manager. The second visit was announced and started at 3.30pm, lasting 3 hours. Prior to the inspection the manager completed a self-assessment and questionnaire. This provides information about how the home reviews its service and how it intends to improve it. The other information provides details about the people living at the home, staffing, and fees and confirms that necessary policies and procedures are in place. This information helps the commission to prepare for the inspection, send out surveys to appropriate people and helps the commission form a judgement on how well the service is run. As part of the inspection, surveys were sent to staff, representatives / relatives of people living in the home and people visiting the service, including health care professionals. Eight staff members, one health professional and one relative responded to these surveys. The responses from these surveys have been included in this report. What the service does well: The atmosphere in the home is relaxed and cheerful. Staff were observed being kind, caring and respectful. They also had an excellent knowledge and understanding of peoples’ needs and how to communicate with them effectively. It was clear through talking to staff and making observations that they have a commitment to providing the best care they can to the people 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 6 living in the home. Staff receive a range of training that helps them to meet peoples’ needs safely. This is continually being improved. Records relating to the people living in the home are informative and clear. They provide staff with the information they require to look after people safely and consistently. The manager said these are under review and how information is recorded will be changing. This will help to meet the improvements needed. These are reflected later on in the report. The people living in the home lead fairly active lives during the day, accessing local facilities for educational and leisure pursuits. Staff spoken with during the inspection demonstrated an excellent knowledge of safe guarding younger adults. There have been no complaints about the service since the last inspection, and the home’s complaints procedure is clearly displayed. The building is homely, clean and well maintained with people benefiting from individually decorated rooms that are personalised. What has improved since the last inspection? What they could do better: The information about the services provided (statement of purpose) should be up to date and accurate, this relates particularly to information regarding, the shared garden and the age range the home can provide for. Care plans need further information; they should include peoples’ wishes and goals to help them towards more independent living. The wording used in daily records should be appropriate, respectful and accurate when describing peoples’ behaviours. Decisions made on behalf of people, albeit for good intentions, should be discussed within a multi-disciplinary setting to ensure the decisions are made in that person’s best interest. The decisions should be agreed, monitored and reviewed regularly. Examples of these are, the use of wrist bands when out, the taking away of items of clothing to control behaviours, restrictions in drinks 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 7 of tea. This was recommended during the last inspection but no action has been taken. This is good practice. When people use wristbands, appropriate risk assessments should be completed for their use. Only one risk assessment and care plan provided this information when it was found two people use them. Medication practices should improve to ensure the safety and welfare of the people living in the home. Examples for improvement are – signing for medication given or using appropriate codes when not given, ensuring handwritten entries are double signed to prevent any errors and all staff receiving or completing appropriate training; and being regularly assessed to ensure they are and remain competent to administer medication. The home should have a system that regularly checks the medication practices this would mean any errors would be picked up quickly The complaint’s procedure should be in a format that is suitable to their communication needs to enable people to raise concerns appropriately. Although the staff had a good knowledge of how to protect people from abuse and further training is to be arranged, the home should have a copy of the local alertor’s guide. This would ensure staff have access to the local procedure for reporting abuse. The home should have a formalised system for reviewing and developing the quality of its services. This would ensure regular checks take place to ensure the quality of care being delivered is good and enable the home to develop and continuously improve. Poor staff recruitment practice continues. There have been previous requirements made in this area, with the imposed timescales unmet. Immediate action was imposed during this inspection, with the home having to tell the commission, within 24 hours, what they have done to improve things. Staff must have appropriate training in safe holding techniques to ensure they and the person being “held” is prevented from risk of injury. Records of peoples’ fiancés should be up to date and available for inspection. The provider should also ensure peoples’ monies are available to them when necessary. The home must consult with the fire authority to discuss the issue of wedged open fire doors and automatic closures not working. 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. 49 Regents Park DS0000067537.V342839.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 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be assured their needs will be met through good admission processes. However, information provided prior to admission does not provide enough up to date information about the home’s services. This means people might not be aware of the facilities and services the home provides. EVIDENCE: The home has had one new admission since the last inspection; this person came from the children’s home next door. The staff therefore knew the person well. There is detailed information about peoples’ needs, including social needs, behaviours, personal care, health needs, habits, communicating, showing frustration, being with others, travelling and much more. Staff were able to describe peoples’ needs and risks accurately and according to the recorded information. The people living in the home were unable to talk about the admission process but a relative’s response in a survey said they were involved in the admission process. It was clear through observations people felt relaxed with staff and were able to communicate effectively with each other. 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 10 The home is registered to take people who are aged 16 to 25. However, the manager thought the registration had changed to adults only and therefore amended the home’s Statement of Purpose. This is a document that provides relatives, other professionals and people who use the service with information about the services that are provided within the home. The manager needs to amend the document again to reflect the age range the home is registered to take (16-25) Discussions took place about the fact the person who was recently admitted was under 18, therefore if the manager was under the impression the home was now adult only, he should have sought advice from the commission about admitting someone under the age range he believed the home was registered to take. The statement of Purpose also needs to be amended to include details about the gardens being shared with number 47 and number 51. 49 Regents Park DS0000067537.V342839.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 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are provided with information to help them to meet peoples’ needs safely. However, they are not always up to date or written accurately. This could lead to inconsistent care. Decisions made on behalf of people are not always done in consultation with others therefore not ensuring the decisions are in peoples’ best interests. EVIDENCE: The complex needs and limited communication skills of some of the people living in the home meant that most of the information relating to care plans, risks and decision-making came from talking with staff, reading documentation and making observations. However, some people did talk about their routines and activities, which have been included later on in the report. Each person has a care plan that provides detailed information about their needs and risks. The information includes clear guidance and action to help 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 12 staff understand and meet those needs and reduce any risks. However, the care plans did not include any goals that people are working towards that would help to improve their lives or become more independent. The manager said a review of the care plans will be taking place shortly and should include goals in the future. Despite not having goals in care plans, staff and the manager were able to talk about the improvements and progression people have made since living at the home. Particularly in relation to improved anxieties and behaviours. The manager said this was due to staff being consistent in their approach. Some of the guidance in some care plans / risk assessments described very “strict and controlling” measures to manage some complex behaviours. This was discussed with the staff at the time and the manager later. Whilst it is understood that these measures might be necessary to prevent people becoming anxious, it should be clear who was involved in the drawing up of the guidance. This is particularly important when some of the guidance restricts peoples’ freedom of movement and choice. For example, the home uses child type wrist bands when out with people. Staff said relatives were insistent they were used to prevent potential injury to people when out. This is a type of restraint albeit for good intentions, therefore their use must be discussed within a multi-disciplinary setting. There should be good records kept of the discussions, the reasons behind their use, what other options might be suitable, the risks of not using them, the agreements reached and future reviews. This will ensure that the decisions to use the bands are open and transparent and made in the best interests of the people on which they are used. It was recommended during the last inspection that a good practice committee might be an appropriate place to discuss their use. This work has not been completed. In addition, there was only information about using the bands in one care plan / risk assessment when staff said they were used for two people. The manager agreed to add this to the appropriate care plan / risk assessment. Another example of “strict and controlling” guidance was at night for one person. The guidance stated that if they continued to come out of the bedroom then an item of clothing that was stated in their care plan as being very important to them, was to be taken away. The same multi-disciplinary approach as above should be used and recorded. The wording used in daily records did not clearly describe peoples’ behaviours. For example, words such as, inappropriate behaviour, uncooperative, agitation were repeatedly used to describe how people had been each day. Staff were able to describe what they meant by using these words. However, there may be slight variations of meaning to each staff. This means that when they write someone has been “uncooperative” it may be for different reasons for each staff. This makes it difficult to interpret and monitor care effectively and is not always respectful to the person being written about. 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 13 A care plan described what staff should do if they have to “hold” a person to prevent injury. However, staff have received no training in safe holding techniques or how to breakaway safely. The manager agreed this training must be obtained and said he would look in to arranging it. (See section 31-36) 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Links with the community are good and ensure that people benefit from a broad range of experiences despite the challenges that their complex care needs present. People benefit from a well balanced diet, which is provided in a supportive environment. EVIDENCE: People benefit from a range of activities; these include art, food preparation, gardening, computing and pet care. Evidence of peoples’ activities was seen, which included photos of people participating in hobbies and trips out. Most of these activities take place at a day centre owned by the provider. Two staff are employed to run the day centre, one of which was recently employed to provide the same gender care to one person living in the home. Discussion with staff and care records show that while at the day centre people also take 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 15 part in swimming, music and art therapy, going out for coffee and visiting shops in the local area. Due to the current complexity of the peoples’ needs, they are unable to participate in employment opportunities at the moment. One person living in the home talked about doing cooking and artwork and said they enjoyed it. Another enjoyed computer work. A relative who responded to a survey said “ I must make a special mention of the day centre and the staff who provide X with new and interesting things and places to go”. Discussions took place with staff and the manager about routines in the home and evening and weekend activities. Staff said that occasional evening activities take place and at weekends they go shopping or for drives to the beach. One person living in the home confirmed this. The manager accepted that some of the routines are sometimes created by the staff, rather than the needs of the people living in the home. For example, each person has a routine chart displayed in the kitchen. They mainly consist of helping with laying tables and clearing up after meals, they also include bedtime and bath time routines that tended to be before 9pm. When staff were asked why people were ready for bed so early, the staff said, “so that the washing could be put in and then night staff could iron it”. The staff member also said the routines were flexible and if they had gone out they would not worry about getting the washing done. Daily records did not show many activities going on in the evenings out of the home. The records mainly described listening to music, relaxation, hand massages, and sensory room. Whilst the people living in the home lead a busy life during the day and therefore may want to just relax in the evening, opportunities for add hoc evening activities should be reviewed and encouraged. The manager agreed to do this. This would ensure routines are for the benefit of the people living in the home and that people have opportunities to have different experiences in the evening. During the first half of the inspection people were seen to choose what they did, this ranged from watching and singing to karaoke, listening to music and watching favourite soaps on TV. In a response to a staff survey, one member of staff, when asked what the care home does really well, said “spending time with clients and knowing them well”. The evening meal, at the time of the inspection, was found to be relaxed with staff being supportive throughout. People knew what was for dinner and talked about their favourite meals. One person asked for cheese on top of their spaghetti bolognaise, which staff provided and offered to everyone. Staff said menus were set because the people living in the home needed the security of knowing what they were having each day. One person was able to describe each meal for the next few days. People helped lay the table beforehand, helped pour out drinks and clear up afterwards. 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 16 Menus could not be found on the day of the inspection but staff described foods provided as healthy and well balanced. During the evening one person asked a staff for a cup of tea and biscuits but was told it was too early. This was what people normally had for supper. The staff offered the person water and tried a variety of distraction techniques, which eventually worked. The staff said, because of this person’s complex needs, if the tea and biscuits were given before the normal time it would continue all night and cause the person to become agitated. This should be clearly written in care plans, again using a multi-disciplinary approach, as it would not normally be acceptable to restrict cups of tea unless it was agreed within a care plan / risk assessment. 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal and health care is provided in a manner, which is acceptable to people, therefore recognising their individuality. On the whole, medication is well managed. However, the lack of training in some instances and some errors in administration records potentially places people at risk. EVIDENCE: Care plans describe people’s preferred routines and how they liked to be approached and cared for. Staff were observed using these approaches and being kind, caring and respectful. Staff demonstrated a good understanding of how to communicate with people effectively. Care plans provided good guidelines on this. Throughout the inspection staff communicated well with people and worked hard to ensure it was effective. Responses from staff surveys confirmed the manager and provider ensured staff were provided with clear guidance on how to care for people safely. 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 18 The home has good health care records that show health needs are monitored and maintained. A response from a health care professional, when asked if the care service sought advice and act upon individuals’ health needs said, always. They also said the home provided high standards of care and always liaised well with health professionals. Medication is supplied in boxes, bottles and liquids. It is stored in a locked metal cupboard in the kitchen and is secured to the wall. Administration records had some errors, some missing signatures, therefore it was difficult to establish if the medication had been given, or the person was on a home visit and no code had been used to indicate this. This was discussed with the manager and it was agreed that there should some form of monitoring the sheets to ensure they are being used correctly. It would also form part of the home’s quality assurance checks and enable errors to be picked up quickly. A handwritten entry for medication was not signed or signed to say it had been checked. This would ensure that the instructions were checked by two people and therefore reduce the risk of an error occurring. The manager said that most staff had received some medication training. However, on the first day of the inspection, the member of staff administering medication said she had been shown how to do the medication but had not completed her medication distance-learning book. The staff member had been working at the home for a year. In discussions with the manager on the second day of the inspection it was found that no staff had been assessed as being competent to administer medication. They had received in-house training and some had completed further training. It is good practice to have a method of assessing staffs’ competencies regularly to ensure they remain safe to administer medication. 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Relatives and people living in the home are assured they are listened to and complaints are dealt with appropriately. However, people would benefit from having better access to a complaint’s procedure that suited their communication needs. There are good systems in place to ensure people are protected from abuse. EVIDENCE: The home has a complaints policy and book to record any complaints. A relative who responded to a survey, when asked if they knew how to make a complaint, answered yes. The complaints procedure has been transcribed into widget to enable people living in the home understand it. However, it is still quite complex in its format and it was suggested this could be simplified to make it more useable. No complaints have been received by the home or the commission since the last inspection. The people living in the home were unable to talk about what they would do if they were unhappy. However, it was clear through observations that staff have a very good knowledge of each person and therefore recognise when someone is unhappy. They work hard to try and find out what the problem is and try to resolve it. This makes the issues raised under section 6 –10, when it was 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 20 highlighted that the wording used in daily records was sometimes unclear, all the more important. For example, if someone who was “unhappy” and therefore not willing to do what was asked of them, be classed as being “uncooperative”? It is important that people living in the home have a method of expressing concerns that are not misinterpreted and recorded as something else. Staff spoken with during the inspection demonstrated an excellent awareness of abuse and understood what they should do if they suspected any. Some staff have received outside training on adult protection. Others have received in-house training. The manager said that all staff, who haven’t already completed outside adult protection training, will be booked to attend it by the end of the year. The manager, when asked, did not have a copy of the local alertors guide. He said he would obtain this. 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a clean, well maintained and nicely decorated house that creates a homely atmosphere. EVIDENCE: The décor and furnishings in the house make the environment cheerful, warm and homely. People’s bedrooms are personalised to their own tastes and preferences. Throughout the home there are photographs of activities and peoples’ art and craftwork displayed. There is a downstairs room, which gives people a space to play music and express themselves. During the inspection, one person used this room and was happily playing music, another person used the lounge to watch and sing to karaoke, the third person was using the dining room to play a tactile game. A staff who responded to a survey felt the home’s heating system could be better maintained as the heating came on in the summer making the house very hot. During the inspections on both days, the house appeared to be at 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 22 comfortable heat. A response from a relative survey indicated complete satisfaction in the environment. Another staff said in response to a survey, “the environment that the clients live in is superb. Every comfort, detail has been implemented. The standards are very high”. The gardens of 49, 47 and 51 are all joined together making one large garden. All three houses are run by the same provider and many of the staff team work in all three homes. The manager said, the inspectors of the children’s home have never indicated dissatisfaction with this arrangement. However, because the gardens are joined together, meaning people from each house have to share the gardens, the statement of purpose must be updated to include this information. (See section 1-5) There is one bathroom on the first floor, which includes a toilet and bath. This door has a lock on it, with an override system in case of emergencies. There is a second toilet next door to a communal area in the basement. There is a variety of communal space. The home has a large and comfortable lounge with a piano and an attractive dining room. During both days of the inspection, the home was clean and free from any offensive odours. 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 23 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. Staff have a good understanding of the people living in the home, and show a commitment to providing quality care. However, the lack of some training and the home’s recruitment process has the potential to put people at risk. EVIDENCE: During the inspection on the first day, staff were observed being kind caring and respectful. Staff communicated effectively with people, using their preferred method of communication. The people living in home appeared to have a trusting relationship with staff creating a fun and relaxed atmosphere. Staff spoken with talked about their roles and responsibilities and how they sought advice when necessary. Staff surveys indicated a committed team who worked well together with good support from the manager. A relative who responded to a survey said “if all care homes were run as well as Regents Park it would be a great relief to relatives. To be able to see there loved one positively blossom, with the encouragement of the staff”. 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 24 On the first day of the inspection, there was two staff on duty but one staff was very new and had not had the appropriate recruitment checks completed prior to starting working in the home. On the second day of the inspection, the manager said another staff should have been working in the home, from the children’s service, making this new staff “extra”. However, this new staff should not have been working in the home at all. (See below when referring to recruitment practices) Information received from the manager, prior to the inspection indicated that staff receive a good range of training. Staff on duty talked about the induction and the in-house training they had received. They were able to talk about what they had learnt and how they implemented it in the care they delivered. On the second day of the inspection, the manager said that over 50 of staff have completed a National Vocational Qualification (NVQ) levels 2 and above. The information also indicated, mandatory health & safety training is up to date, this includes food & hygiene, manual handling and fire safety awareness. Discussions took place with the manager about training relating to holding people safely. A care plan provided information about if staff had to hold someone to prevent them from injury, but staff have received no training in safe holding or breakaway techniques. This must be provided to prevent the risk of the person and staff being injured on such occasions. The manager also talked about ensuring all staff being booked to attend outside training on adult protection. Three recently employed staff files were looked at during the second day of the inspection. The manager said that all new staff are now checked, as part of the police check (CRB), against the Protection of Vulnerable Adults and Children’s list (POVA and POCA), as most staff also work in the Children’s home. However, one staff had started working at the home on 21/05/07 but their POVA check had not been received until 25/05/07. The new staff who was working on the first day of the inspection had no file therefore we were unable to establish what checks taken up prior to working in the home. The manager said he knew CRB and POVA firs checks had not been obtained as he had just applied for them. After the inspection the provider confirmed that references had been taken up on this person but also confirmed CRB and POVA had not been. Two files showed that only one reference had been requested the other had been open, meaning the person came with the reference. The manager said he had verified those references through telephone calls but there was no recorded evidence of this. Discussions took place about the legal requirement to ensure staff are appropriately recruited prior to starting working in the home. This means that staff should not work in the home until a satisfactory CRB is obtained, or a 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 25 satisfactory POVA first check is obtained before someone starts at the home. Even if this is obtained, that staff must not work as part of the normal numbers of the team until the full satisfactory CRB is obtained. This was not the case of the new staff member found to be working on the first day of the inspection. The home has received three previous requirements to improve practices in the area of staff recruitment. Current practice is still potentially unsafe. An immediate requirement notice was served on the second day of the inspection. This notice requires the provider / manager to take immediate action relating to the recruitment practices to ensure the people living in the home are safe. The home must respond to the commission with the action they have taken. The commission is also considering further enforcement action on this repeated failure. 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 26 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, 41 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People benefit from a home, that is, on the whole, run well, but the lack of appropriate recruitment checks and some information, potentially places people at risk. The lack of a formalised system to check the quality of care in the home means there is a risk that some areas are not being reviewed regularly. Systems to review the quality of care have not taken into account relatives’, stakeholders’ and peoples’ views for some time. EVIDENCE: The registered manager is experienced in working with people with a learning disability. He has obtained appropriate NVQ level 4 qualifications and said he has recently completed some additional training in autism. 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 27 Responses from staff surveys indicate a happy staff team who communicate effectively and work well together as a team. One Staff said “we work well as a team and have a good relationship with the manager. Managers always on call (quick response), clients always come first”. A health care professional said in response to a survey, when asked what the home does well, said, “respect individuals, high standards of care and liaise well”. A relative spoke very highly of the staff team and the work they do. There is no formal system in place to review the quality of the care delivered. For example satisfaction surveys have not been sent out to relatives, stakeholders, staff and the people living in the home, since 2005. There is no formal system to carry out checks on things such as medication practices. A formal system would ensure, checks that review the quality of care, are not missed. In addition, the home should have a development plan that shows how it intends to improve the service. A questionnaire was completed by the home prior to the site visit. This provides information about the people living in the home, staff and indicates whether necessary policies are in place. The information helps the commission prepare for the inspection and send surveys to appropriate people. It is also used to help the commission form a judgement as to whether the home is being run appropriately and safely. People have their own bank accounts, operated by the provider where benefits are paid. Currently, the provider does not have a system of petty cash for peoples’ personal spending money. Therefore staff use their own money and are reimbursed for day-to-day spending. Records are kept of the bank accounts and monies spent, however, these were only available up to 2006. These should be up to date and be available for inspection. The manager said the system is being reviewed and a petty cash system was to be implemented soon. During the inspection of the first day it was noticed that one bedroom door was wedged open through the thick carpet. This was at the insistence of the person using this room. The kitchen door is fitted with an automatic closure. This means the door can remain open until the fire alarm system goes off, the door will then automatically close. However, a wedge was found under the closure because the automatic closure did not work. The manager, said during the second day of the inspection, they were not required to have these fire systems in place because they were a small home. However, since the home has chosen to fit these devices, they must check with the fire department about keeping them in working order. Discussion took place with the manager about the information the commission must receive regarding adverse events in the home. A requirement was made in relation to this during the last inspection. The manager agreed that events that “adversely” effect people, through for example complex behaviours, the 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 28 commission must be informed, particularly if these events are not “normal” to that person and do not form part of their care plan / risk assessment. 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X 2 2 X 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 30 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA34 Regulation 19 Schedule 2 Requirement Staff must not start working at the home until the required information and recruitment safety checks are in place. This requirement has been made for a fourth time, and enforcement action is being considered. An immediate requirement was issued. The previous timescale of 15/12/06 has not been met. 2. YA35 13 (6) The home must make arrangements, by training or by other measures to ensure people who have to be “held/ restrained”, for their own safety, are done so by appropriately trained staff. This will ensure that staff and people being held are prevented from possible injury. The home must consult with the fire authority to seek advice on wedged open doors and automatic closures not working. 30/10/07 Timescale for action 07/08/07 3. YA42 23 (4) 04/09/07 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 31 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 YA1 YA6 YA7 Good Practice Recommendations The statement of purpose / service user guide should be updated to include the correct age range the home provides for and information about the shared gardens. Care plans need to reflect people’s wishes and goals. Daily records should use language that is appropriate and accurate. Any decisions made on behalf of people living in the home, that may infringe upon their rights or freedom of movement should be discussed in a multi-disciplinary setting to ensure such decisions are made in their best interests. Such as a local best practice committee, which can be accessed through Social Services. Agreements should be recorded and reviewed regularly. This refers to, for example, the use of wrist bands, “control methods” for behaviours, such as tea restrictions, taking away items of clothing. This is repeated from the last inspection. 4. YA9 Where “restraint” is being used (wrist bands), the risk assessment should clearly detail the risks, the reasons and monitoring. This was only available for one person, when they are used by two people. The home should have a system for monitoring administration records. Records should be checked for missing signatures and the reasons why. Handwritten entries should be double signed to prevent the risk of errors being made. All staff should receive or complete appropriate training. All staff should be assessed regularly to ensure they are competent and remain competent to administer medication. The home should also have a system that monitors medication practice regularly to ensure errors are picked up quickly, therefore protecting people’s safety and welfare. DS0000067537.V342839.R01.S.doc Version 5.2 Page 32 5. YA20 49 Regents Park 6. YA22 Advice should be sought to ensure that the complaints policy is made more accessible to the people living in the home. This is repeated from the last inspection. 7. 8. YA23 YA39 8. YA41 The home should obtain a copy of the local alertor’s guide. The home’s quality assurance systems should be formalised to ensure necessary checks that form part of it are completed within time scales. Satisfaction surveys should be sent to relatives, outside stakeholders, staff and the people living in the home to seek their views on how well the home is run. A development plan should be produced to include information from the surveys and future plans on how the home intends to continue improving. People’s financial records should be up to date and available for inspection. People living in the home should have access to their money for day-to-day spending, without having to rely on staff having enough of their own money. 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 49 Regents Park DS0000067537.V342839.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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