Inspection on 04/01/08 for 53 Rutland Gardens

This inspection was carried out on 4th January 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Thorndene

Insight - Eastchurch

Southfields

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33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 53 Rutland Gardens Hove East Sussex BN3 6PD Lead Inspector Niki Palmer Unannounced Inspection 4 January 2008 08:10 th 53 Rutland Gardens DS0000070619.V353155.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 53 Rutland Gardens DS0000070619.V353155.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. 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 53 Rutland Gardens Address Hove East Sussex BN3 6PD 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) 01273 328707 garry.cmg@btinternet.com www.caremanagementgroup.com Care Management Group Ltd Mr Garry Lee Norwood Care Home 6 Category(ies) of Learning disability (0) registration, with number of places 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 6. Date of last inspection This is the service’s first inspection. Brief Description of the Service: 53 Rutland Gardens is a care home, which opened in August 2007. It is registered to provide personal care and accommodation for up to six people with learning disabilities. The home’s literature states that it ‘aims to provide care to people with some behaviours of a challenging nature associated with the autistic spectrum’. The home is owned and run by Care Management Group (CMG) who are a large national organisation. The home is a newly refurbished large semi-detached property situated in a quiet residential area of Hove. There is nearby access to some local amenities and public transport. A small car parking area is available at the home, although paid on street time restricted car parking is permitted in the surrounding areas. Accommodation is provided over three floors with some rooms situated on mezzanine levels ‘between’ floors. All rooms are for single occupancy with en-suite facilities. Communal space is provided on the ground floor and comprises a lounge to the front of the house and a dining room to the rear. The home provides personal care and support to people who are funded by Social Services. The home’s fees as 4th January 2008 range from £1600 £2300 per person per week. Written information regarding the services and facilities provided at the home are available on request from the home. 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 use the term ‘service user’ to describe those living in care home settings. The Registered Manager of the home confirmed that they use the term ‘residents’. For the purpose of this report people living at 53 Rutland Gardens will be referred to as residents. This key unannounced inspection took place over six hours on Friday 4th January 2008. This enabled the Inspector to meet with residents, have discussions with care staff, relatives and a visiting District Nurse and view a number of the home’s records and documentation. Three men were accommodated on the day of the inspection. The Registered Manager was available throughout the duration of the inspection. Two individual plans of care were looked at for the purpose of monitoring care. Other records and documentation seen included: the home’s medication procedures, complaints procedure and the systems in place to safeguard people from harm, staff recruitment records and the provision of training and the home’s quality assurance systems. An Annual Quality Assurance Assessment (AQAA) was completed by the Registered Manager and returned to the CSCI prior to the inspection. This gave the service the opportunity to tell the CSCI about how they are performing including: how they ensure that the views of people using the service are upheld and incorporated into what they do, what the service does well, identify any barriers to improvements that have been faced since the home opened in August 2007 and how the service plans to make improvements over the next 12 months. A number of their comments have been reflected throughout this report. What the service does well: 53 Rutland Garden in a newly refurbished and opened service. The accommodation is well presented and decorated to a high standard throughout. Most residents and their relatives are given the opportunity to visit the home in order to help support their decision of whether or not they would like to live there. On admission, all residents are provided with a copy of their terms and conditions of occupancy. These outline what the person can expect from the service for the fee they pay. 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 6 All meals are prepared in the home by care staff and residents are encouraged to help with meal preparation where possible. Staff work well with local GP’s and District Nurses to ensure that residents’ healthcare needs are met. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst people are given the opportunity to visit the home prior to moving in, the home’s pre-admission assessment procedures fail to ensure that people moving into the home are compatible with others. EVIDENCE: The home has a Statement of Purpose and Service Users’ Guide in place, although these were not read in detail on the day of inspection as they were assessed as part of the home’s registration process. Relatives spoken with said that they were not provided with copies of these documents prior to deciding whether or not the home was suitable for their son’s needs, but that they did have the opportunity to visit the home and meet with the Manager beforehand. They commented: “We had more than enough information about what the home could offer”. It is important for the home to ensure that as much information as possible is gathered prior to admitting new people to the home. This is to make sure that the home can meet their needs and that they are compatible with others living in the home. CMG employs a team of centrally based Assessment Referral Officers, who are responsible for considering and assessing all initial referrals for each of the homes alongside the Manager. 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 9 Through direct observation, discussions with staff and the examination of care records, concerns were raised in respect of the compatibility of the residents accommodated: Two care records were viewed. Whilst an assessment had been carried out for one person prior to admission, which showed that their needs could initially be met well by the home, serious concerns were raised in respect of the home’s assessment and judgement processes for another person who moved into the home on a later date on an emergency basis. Although their needs had been assessed by an Assessment Referrals Officer, their move into the home seriously impacted on daily life within the home for the two other residents. Due to increased behavioural needs and a number of incidents, two of the residents cannot be together in the same room, despite having one to one support from staff. Staff commented that the inappropriate placement of this person is at times, detrimental to the needs of others. The home is required to review the compatibility of residents. This is to ensure that individuals’ assessed needs can be met by the home and that all persons are safe. No person must be admitted to the home unless it has been determined that their needs can be met and that they are compatible with others. Care records, staff and relatives confirmed that two of the residents moved into the home shortly after it first opened. Their move was well planned and gave residents the opportunity to visit prior to moving in. Completed copies of terms and conditions of contract were seen. These provide the person and their representatives with information regarding what the person can expect for the fee they pay and sets out the terms and conditions of occupancy. 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents would benefit from a clearer, person centred approach to care. This would promote their individual needs, decisions and choices. EVIDENCE: The information contained within the two care records looked at was variable and not easy to read, understand and follow. One had been written shortly after the person’s move into the home, whilst the other had been transferred from the person’s previous home. Some of the information was outdated and in some instances irrelevant e.g. behaviour charts that had been completed in 2003 and an induction checklist that had been completed by the Manager. In addition, neither care plan had been written using a person centred approach and there was no evidence to demonstrate how the person and/or their representatives had been involved in devising the care plan or determining what is important to each person. 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 11 The Manager said that he has attended training on person centred planning although is yet to put this into practice. The home is required to ensure that all residents have an up to date and person centred plan of care in place. These must provide care staff with detailed information regarding the action that is to be taken to meet the personal and healthcare needs of residents. These must be regularly reviewed and updated and take into account the individual needs, wishes and preferences of individuals. Staff commented that each of the residents are able to express some of their needs and wishes verbally, through using Makaton (although no staff have yet had any training in this), and/or using physical gestures and prompts. Albeit that residents’ verbal communication is limited, staff working in the home were observed to interpret individuals’ subtle level of communication and include residents in some daily routines. However a concern was raised that indicated that care staff do not always respond appropriately to the needs and wishes of residents. A carer had written in one person’s daily records: “He wanted to go out for a drive and wanted to phone his relatives. I advised him that he needs to wait until Monday as per his schedule”. This indicates that care staff are not always flexible in their approach in responding to the needs and wishes of individuals, despite the Manager writing in the AQAA that “We offer choice to the service users throughout daily activities”. A requirement has been made in respect of this. Risk assessments were seen within care plans. These were mainly focused on keeping residents safe (see under complaints and protection). 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home fails to ensure that residents are provided with opportunities to regularly engage in leisure activities outside of the home. Due to the poor compatibility of residents, they have limited opportunities to develop and maintain friendships with each other. EVIDENCE: None of the residents are currently involved in any education, occupation or day service provision. The Manager confirmed that day care allowances/funding is in place for two of the residents and that all receive 1-1 support throughout the day from staff. Activity timetables were seen in care plans, although it was noted that they were brief and insufficiently detailed e.g. in one person’s timetable it stated “Community activities” on a Monday, Wednesday and Friday without any 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 13 further information in respect of what that person likes to do (see under individual needs and choices). The home has access to it’s own transport, which is kept on the driveway outside of the home. The current parking arrangements arranged by the council means that the vehicle is regularly legally blocked in by other cars on the street. Staff and care records showed that this is happening very frequently. This means that residents’ opportunities to go out are severely limited (two of the residents are only able to access the community with the use of transport). When asked what action had been taken in order to resolve this issue, the Manager said that an application had been made by CMG to have the parking arrangements changed prior to the home opening, but that to his knowledge no decision had been made. Following the inspection, he confirmed in writing that the application had been turned down by the council and that the home would need to appeal this decision (this could take up to 12 weeks). It is of concern to note that minimal proactive steps have been taken by the home since it first opened in August 2007 in order to address this matter. A requirement has been made in respect of this. Due to the poor compatibility issues and behaviour needs of the residents accommodated, minimal interaction between them is possible. All doors throughout the home are kept locked, including all communal areas. This means that all residents spend the majority of their time with care staff, have little or no opportunity to engage with their peers or are able to wander freely and safely throughout their home. In-house activities were limited on the day of inspection, despite all residents having 1-1 support. One person was taken out in the afternoon to a local park, whilst the others stayed at home. Care records and comments received on the day confirmed that daily activities are limited. Relatives said that the home does encourage them to maintain contact and visit the home, which they do so regularly and often on an unannounced basis. Four weekly rotational menus were seen, which are kept on display on a notice board in the kitchen (to which residents do not have access). As only one of the residents is able to read, it is recommended that the home works with residents as part of an activity to devise colourful pictorial menus for the week, that are easily accessible. Due to the compatibility issues of residents, they all eat separately from each other. Staff advised that one person does help with meal preparation such as grating cheese. Only two members of the staff team have attended training and obtained a certificate in food hygiene. 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have access to healthcare services. Residents are mostly protected by the home’s procedures for the safe handling of medicines. EVIDENCE: All personal care is carried out in the privacy of residents’ own bedrooms and bathrooms. Staff showed a good understanding individuals’ needs and preferences. All residents are registered with a local GP and dentist and are supported to all healthcare appointments as necessary, although the Manager explained that most appointments take place at the home. Records showed that input from the local Community Learning Disability Team (CLDT) is requested on an individual basis. District Nurses visit the home daily. One person has additional healthcare needs. Although these were outlined within their care plan, there were no specific guidelines in place (although a separate file containing all the relevant information had been compiled by the 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 15 District Nursing Team). Staff commented that they would benefit from additional training in diabetes. One of the residents has a hearing impairment, which is known to have a direct impact on his behaviour. Whilst care staff were observed to speak slowly and clearly with him and use written words to communicate with him, it is recommended that advice be sought from the RNID (Royal National Institute for Deaf and Hard of Hearing) or the local Sensory Impairment Team. This will help to support care staff to communicate better with resident(s) and potentially help to reduce some difficult situations that may arise as a result of the person not being able to hear properly. The home’s medication systems and records were viewed. All medicines are delivered to the home on a monthly basis in pre-packed blister packs, which are easy to use and monitor. A number of other medicines are dispensed from individually labelled containers. None of the residents accommodated on the day of inspection were able to self-administer. Whilst medication procedures were noted to be sufficient, medication records and the medication file was noted to be messy and disorganised and therefore not easy to read and use. Guidelines were in place for some medicines that are to be given on an as and when required basis (PRN), but not all (although this had been highlighted as a shortfall in the home’s own monitoring systems). Some handwritten entries had not been signed or dated. The home is required to ensure that medication records are well maintained. All handwritten entries must be signed and dated. Clear guidelines for the use of all ‘as and when required’ medicines (PRN) must be in place. 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents will be better protected from potential harm, neglect and abuse once all staff have received specific training in this area and are confident in using the correct policies and procedures. The home fails to ensure that residents’ financial interests are safeguarded. EVIDENCE: A clear and accessible complaints procedure was seen on display near the entrance to the home. It had been simplified for residents and detailed how a complaint can be made by and the timescale within which it will be dealt with. The AQAA confirmed that no concerns or complaints have been made to the service since it first opened. Relatives spoken with said that they had recently raised a concern directly with the Manager of the home regarding their son’s finances. They said that the delay in resolving this matter has meant that their relative has not been able to purchase a new television for his room. This will be followed up at the next inspection. The Manager said that the home has a detailed Safeguarding Vulnerable Adults policy and procedure in place in accordance with local multi-agency guidelines. The AQAA confirmed that these procedures have been communicated to staff, although staff training records showed that no staff have received any specific training in this area. The Manager said that booking dates for this course will be arranged for early 2008. Despite clear policies and procedures being in place to safeguard vulnerable 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 17 adults from harm, a concern was raised on the day of inspection in respect of this. An incident occurred in the home whereby one resident was verbally threatened by another. Whilst the home had informed the relevant Care Managers and had implemented safer working practices, the local CLDT were not informed. This indicates that care staff and the Manager are not familiar with or confident in recognising and reporting incidents. A requirement has been made in respect of this. Concerns were raised during the inspection process in respect of how the home manages residents’ finances. Two persons have yet to have a bank account opened, despite having moved into the home in September 2007. The Manager initially explained that this was due to legal implications of the Mental Capacity Act and then following the inspection confirmed in writing that he had encountered difficulties with this due to not being able to provide documentation from the Benefits Office. He said that he had requested this information from CMG’s head office in December 2007, although was still awaiting its receipt. Not withstanding this, this delay has had a direct impact on residents; one person has not been able to buy a new television and all the time their monies are not in an account, residents are not receiving any interests on this. In addition to this, when asked, the Manager was unaware of individuals’ entitlements in respect of receiving a personal allowance. 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 18 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is kept in good decorative order. It presents as clean and wellmaintained. EVIDENCE: Some areas and individual rooms were seen although the Inspector did not undertake a thorough inspection of the home on the day of inspection as the CSCI Registration Team undertook a site visit prior to the service being registered. The environment was assessed as complying with the National Minimum Standards. Individual rooms have been decorated and furnished to a high standard. Each room provides a wardrobe, chest of drawers, bedside table with lockable drawer and a comfortable chair. It was evident that residents and their relatives have been involved in choosing their own accessories and décor. 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 19 All communal areas are located on the ground floor comprising of a lounge, a small domestic kitchen with a large hatch through to a dining room and a small utility/laundry room. In addition, the home has a neat patio garden to the front and a small secure garden to the rear of the property, which provides a decked and a lawned area. The front door of the home is fitted with a keypad entry system in order to prevent residents from leaving the home unsupervised. All communal areas throughout the home are kept locked. The home does not provide much storage space throughout. All radiators are low surface temperature and all hot water outlets have been fitted with thermostatic valves to ensure that hot water is only delivered to a maximum of 43°C. Some windows are older style sash windows, whilst others have been replaced with double-glazing. The Manager confirmed that since the home first opened, all windows throughout the home have been restricted. There is a staff room on the top floor. Care staff are responsible for ensuring that all areas are kept clean and tidy. One resident’s bedroom was noted to be odorous. The Manager explained that this was due to their particular personal care needs. The importance of maintaining a clean and hygienic environment was discussed with the Manager on the day of inspection. This has not been reflected as requirement at this time but will be followed up at the next inspection. 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 20 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 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met by sufficient numbers of staff on duty. Residents are safeguarded by the home’s recruitment procedures. The home’s systems for ensuring that all staff receive regular mandatory training need to be improved to ensure that all staff are competent and qualified to meet the needs of residents. EVIDENCE: A total of 10 staff were employed to work in the home on the day of inspection. Some staff have had previous experience of working in a care setting, although not all. The Manager commented that he feels the varying levels of experience within the staff team works well and that the staff team as a whole are “focused and motivated”. The Manager said that there are always three members of staff on duty in the daytime. Agency staff are being used on occasions to cover vacancies. The Manager said that CMG advertise any vacancies in local newspapers, on their website and through job fairs. All initial information is coordinated by the 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 21 Human Resources department who are responsible for sending out application forms, alongside the required Criminal Record Bureau (CRB) and Protection of Vulnerable Adults First (PoVA) (police checks), health declaration and Equal Opportunities Monitoring Form. The Manager and staff confirmed that there is a selection process in place and that the Manager is involved in this decision making process. Three staff recruitment records were seen. Application forms were sufficiently detailed and there was evidence of police checks, photo identification, two written references and permits to work being obtained prior to employment. The Manager said that the home uses a Skills for Care induction booklet, although none were available for inspection as the Manager said that staff hold on to them whilst they are working through them. The Manager said that the home’s induction consists of a tour of the building and a number of health and safety procedures such as fire evacuation, reading and signing and number of the home’s policies and procedures and ‘getting to know’ the residents by shadowing and working with more experienced members of staff. Staff spoken with said that they had received an induction to the home when they first started. Evidence of this will be required at the next inspection. Some staff have obtained a certificate in NVQ Level 2 in Care, whilst the Manager stated in the AQAA that this will be extended to all staff through CMG’s training programme. This will be followed up at the next inspection. The AQAA identified some shortfalls in respect of mandatory training for staff. These concerns were further highlighted on the day of inspection through talking with staff. In addition, the Inspector asked the Manager to provide a written account of the training needs of all staff following the inspection as this was not available on the day. The home is required to ensure that all staff receive mandatory training in the following areas: Safeguarding Vulnerable Adults from Abuse, Health and Safety, Food Hygiene, First Aid, Infection Control and Moving and Handling. This will help to ensure the health, safety and welfare of residents. 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst a suitably qualified and experienced person is in charge of the home on a daily basis, residents’ rights and best interests are not always promoted and respected. EVIDENCE: The Manager was appointed and registered with the CSCI prior to the home opening. He is a qualified Social Worker with many years experience of working with both children and adults with disabilities and is currently working towards obtaining a Registered Manager’s Award (RMA) certificate. He informed the Inspector on the day of inspection that he has recently resigned from his post and is due to leave at the end of March 2008. It is anticipated that a recently employed Deputy Manager will ‘act up’ in the interim whilst a suitably qualified and competent person is appointed. 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 23 Seeking feedback from residents living in the home is challenging for the Manager and staff at this home. Relatives did confirm however that their views are sought on a regular basis. CMG employ their own quality assurance team who visit each of the homes on a monthly basis. The purpose of these visits is to undertake an inspection of the service based on meeting the National Minimum Standards. A report for the most recent visit (December 2007) was seen on the day of inspection, which highlighted a number of areas for improvement with given timescales. The home’s progress in addressing these and subsequent visits will be followed up at the next inspection. The AQAA was noted to be brief and gave very little information about the service. Nor did it provide an accurate reflection of what was found during the inspection process. Given that the AQAA is a relatively new document produced by the CSCI, this has not been reflected as a requirement at this time. In light of some of the concerns that have been raised in respect of: - the poor compatibility of residents and the impact this has on their daily lives; - the home’s failure to take proactive measures to ensure that the current transport arrangements have been dealt with in a timely manner; - the home’s failure to ensure that residents’ financial interests are safeguarded and; - the home’s failure to ensure that all staff are suitably trained to protect the health, safety and welfare of residents the CSCI does not consider that the home is being run and managed in the best interests of residents. All relevant health and safety certificates were provided to the CSCI during the registration process to demonstrate that the new build complies with all relevant building regulations and legislation. No health and safety records were viewed at this inspection due to it being a newly registered service. 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 24 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 X 2 1 3 1 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 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 2 13 2 14 2 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 1 X 3 X X 2 X 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Not applicable 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 YA2 YA3 YA15 Regulation Requirement Timescale for action 29/02/08 12(1)(2)(3) That the compatibility of residents living in the home be 14(1)(2) reviewed. No person must be admitted to the home unless it has been determined that their needs can be met and that they are compatible with others. 15(1)(2) That all residents have an up to date and person centred plan of care in place. These must provide care staff with detailed information regarding the action that is to be taken to meet the personal and healthcare needs of residents. These must be regularly reviewed and updated and take into account the individual needs, wishes and preferences of individuals. 2. YA6 YA18 29/02/08 3. YA7 YA16 12(2)(3) That staff are flexible in their approach to responding to the individual needs, preferences DS0000070619.V353155.R01.S.doc 29/02/08 53 Rutland Gardens Version 5.2 Page 26 YA18 and wishes of residents in respect of all activities of daily living as outlined in individual plans of care. Residents’ rights and responsibilities must be valued and recognised in their every day lives. 4. YA12 YA13 YA14 YA37 12(2)(3) 16(1)(2) (m)(n) That proactive measures are taken to ensure that the current parking issues do not impact on residents’ daily activities and access to the local community. Residents must be encouraged and supported to take part in a variety of activities both within and outside of the home. These must be reflected in individual plans of care. 29/02/08 5. YA20 13(2) 17(1)(a) Schedule 3(3)(i) That medication records are well maintained. All handwritten entries must be signed and dated. Clear guidelines for the use of all ‘as and when required’ medicines (PRN) must be in place. 29/02/08 6. YA23 13(6) That all incidents relating to suspected, alleged and actual abuse are reported to the relevant agency without delay. That the appropriate action is taken without delay to ensure that the financial interests of all residents are safeguarded. That all staff receive mandatory training in the following areas: - Safeguarding Vulnerable DS0000070619.V353155.R01.S.doc 29/02/08 7. YA23 YA37 20(1) 29/02/08 8. YA32 YA35 YA42 18(1)(a) 18(c)(i)(ii) 31/03/08 53 Rutland Gardens Version 5.2 Page 27 Adults from Abuse - Health and Safety - Food Hygiene - First Aid - Infection Control - Moving and Handling. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA17 Good Practice Recommendations That the home works with residents as part of an activity to devise colourful pictorial menus for the week. These should be easily accessible for residents to see. That advice is sought from the RNID (Royal National Institute for Deaf and Hard of Hearing) or the local Sensory Impairment Team in respect of working with people who have a hearing impairment. That Makaton and diabetes training is provided to all care staff. 2. YA19 3. YA35 53 Rutland Gardens DS0000070619.V353155.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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