Inspection on 18/03/08 for 6 Queensview Crescent

This inspection was carried out on 18th March 2008.

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 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

6 Queensview Crescent 14/07/08

6 Queensview Crescent 04/01/07

6 Queensview Crescent 30/01/06

6 Queensview Crescent 23/09/05

6 Queensview Crescent 29/03/05

6 Queensview Crescent 22/09/04

6 Queensview Crescent 12/02/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

CARE HOME ADULTS 18-65 6 Queensview Crescent Warley Road Scunthorpe North Lincolnshire DN16 1QN Lead Inspector Stephen Robertshaw Unannounced Inspection 18th March 2008 09:00 6 Queensview Crescent DS0000002872.V361898.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 6 Queensview Crescent DS0000002872.V361898.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. 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 6 Queensview Crescent Address Warley Road Scunthorpe North Lincolnshire DN16 1QN 01724 270407 01724 271603 michelle.hammond@dimensions-uk.org www.dimensions-uk.org Dimensions (UK) Ltd 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) Position Vacant Care Home 6 Category(ies) of Learning disability (6), Physical disability (3) registration, with number of places 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2007 Brief Description of the Service: 6 Queensview Crescent is a care home providing personal care and accommodation for six adults aged 18-65 years with learning difficulties. The care home is owned by Dimensions (UK) Ltd and is situated close to two other homes owned by that company. The home is located in a residential area close to the centre of Scunthorpe. It is close to local shops, amenities and public transport. The home is a purpose built bungalow. All the bedrooms are single; bedrooms are fitted with wash hand basins. Bedrooms are decorated and furnished to meet individual service users requirements and preferences. Communal areas of the home are decorated and furnished in a domestic style. Aids and adaptations are provided as required to meet service users’ needs. Information on fees can be obtained from the manager of the home. Information on the service is made available to prospective and current service users via the statement of purpose, service user guide and inspection reports, copies of these documents can be obtained from the manager. The overall rating for the service is 1 star. 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit to the service was unannounced and took place on 18 March 2008. The Commission were at the home for approximately 6 hours. Before the visit took place we sent out questionnaires to the people that live at the home, the care staff and outside professionals. We saw none of the surveys that could be included in the evidence for this report before this report was completed. The visit included meeting and talking to staff, management, visitors and people who live at the home. It also included a tour of the premises, observation of staff and individuals care files and all of the other documents that related to the service. Most of the people that lived at the home had very limited verbal or manual communication skills; therefore the Commission spent time observing activities instead of conducting formal interviews. The Commission also interviewed the manager and three of the care staff. The owner of the home completed a pre-inspection questionnaire and returned this to the Commission within the given timescale. There are a number of requirements from previous reports that remain unmet. The owner and manager of the home must prioritise these for action as failure to meet the regulations could result in enforcement action being taken by the Commission in the future. What the service does well: The home was clean and tidy and provided a very homely and comfortable environment for the people to live in. The atmosphere was very relaxed and the service users were seen to be very happy and comfortable in their surroundings. The inspector found the staff to be very friendly and they knew about the care that the people that use the service needed. The staff spoken to by the Commission said that they enjoyed working in the home. Most of the staff have worked at the home for a long time. This means that they know all of the people that live there and understand how to look after them properly and safely. The meals in the home are good. People are given the foods that they like to eat. 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 6 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. 6 Queensview Crescent DS0000002872.V361898.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 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the people that live at the home have their needs assessed by the service before they are admitted, however these assessments are very basic and may mean that individuals needs may not always be recognised or met through the service. EVIDENCE: We case tracked three of the people that live at the home. This included looking at all of the written information that related to their care, sending out surveys including contact with outside agencies and observation of interactions between staff, individuals and each other at the time of the site visit. All of the people that were case tracked by the Commission had received an assessment of their need before they had been admitted to the home. The initial assessments of need completed by the home before the individuals went to live there were based on a form that had been prepared before the assessment. The information supporting the assessment was very basic and did not provide enough information in relation as to how individual needs affect people in their daily lives and the support that they would require to meet 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 9 these needs. An example of this is the assessments identified that people needed support with bathing, however this did not include any detail in relation to the support would be required for individuals. Observation of the interactions and interviews with the people that live at the home and the staff supported the evidence that the staff have the knowledge and skills to be able to care for the individual needs of the people that use the service. One person that lives at the home that was spoken to by the Commission said that it was ‘nice (to live at the home)’. 6 Queensview Crescent DS0000002872.V361898.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): 6,7,8,9 and 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. This means that the people that use the service are given opportunities for making choices to meet their needs through their daily lives at the home, however their individual care plans must be developed to include how their individual needs should be clearly met. EVIDENCE: The Commission case tracked three people that were living at the home. This means that we looked at their care files and all other documentation in relation to their care held by the home. All of the care files seen by the Commission included individual support plans and these set out the health and personal care needs identified for each of people involved. However the some of the detail included in the plans was very generic and did not detail how individuals would prefer their needs to be met through the support of the home. 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 11 One care plan identified that a person should have a memory book developed to help them with their daily life and activities. There was no evidence to support that this had been instigated. Another persons care plans included seizure records, however the people completing these records had not been identified, as they were unsigned. The service makes good use of photographs involving the young people in their daily lives and activities, however there was no evidence in their care files to support that the individuals concerned or their representatives had given permission for pictures to be taken and used. The care files all had spaces for personal centred care plans, however none of these were available to se at the time of the site visit. One persons care plan identified that restraint had been used. These records need to be improved to identify the type of restraint used, the period of time that it was used, and the names of all of the people involved including their actions. Another persons care file identified that they have no verbal communication, however they had a mobile phone. The Commission were informed that this was no longer an issue as staff used their own mobile phones when they are out, and no longer rely on having the ‘service users’ phone to call the home if support was required in the community. Risk assessment tools for were in position for peoples mobility, tissue viability, bed rail provision, medication, nutrition needs; again the risk assessments were generic and did not provide any detail of how the risks affected the individuals involved. The risk assessments had not been evaluated on any regular basis and therefore may not have been appropriate. The care plans and risk assessments were not in a format that was suitable to most of the people that use the service. As identified in the last inspection report 30/01/2006) the service needs develop ‘the support plans and risk assessments in more suitable formats for the service users as one means of improving the accessibility of these important documents for service users.’ One person’s healthcare plan stated that they had been involved in the development of the plan, however there was no evidence to support that this has happened. The service user guide states that ‘what is recorded ion the plan are best guesses about what we think is important in x’s life’. The service must identify in how the assessment of ‘best guesses’ is accomplished to meet the needs of the individuals involved. There was evidence to support that the appropriate funding authorities regularly reviewed the care of the people that they were responsible for. One 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 12 service commissioner commented that the placement at 6 Queensview was ‘excellent’. The Commission directly observed the interactions between the people that use the service and the staff supported the fact that individuals in the home are encouraged to make decisions for themselves relation to their daily lives at the home. This included what to eat, when to have drinks and whether or not to become involved in any activities. None of the people that use the service have the responsibility for their own finances. The area manager for the service was identified as being the Department of Work and pensions appointee for all of the individuals in the care of the service. This is not good practice and advocates must be sought to ensure that people’s finances are being appropriately managed. There was some evidence some individuals that use the service had purchased their own beds and had also paid for staff to support them to go on holiday by also paying for the staff accommodation. Financial plans did not give guidance for this. The homes statement of purpose and service user guide should also clearly identify that these costs will be incurred to the individuals involved. The registered person must ensure financial support plans provide a clear audit trail for decision-making. This is needed so that the home can demonstrate arrangements are in place to support effective management of the service users’ finances and to ensure appropriate safeguards are in place. 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the people that use the service are encouraged to develop and maintain their personal lifestyles while living at the home, however some of the finances for individual activities need to be reviewed by the management of the service. EVIDENCE: Direct observations supported the evidence that people that use the service are encouraged to maintain and develop their own personal lifestyles. The home does not have an activity co-ordinator, however the support staff try to engage the individuals in daily activities. The staff were very attentive to the people that live at the home, however the individuals concerned were generally not occupied with something that was stimulating for them. The staff commented that due to the limited abilities of the people that live at the home it was difficult to engage them in any regular or stimulating activities. 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 14 Activities included hands massages and nail care, community outings, pub visits and shopping trips. However staff confirmed to the Commission that if they support individuals to go out for a pub lunch gone then the people that use the service also paid for the meal of the support worker that had accompanied. There was no indication in the service user guide or statement of purpose that these charges would be made to the person using the service. It is appropriate that individuals should pay for their own meals to help them understand about their personal finances, however they should not be expected to pay for the staff meal as well. The home has the use of a minibus to transport individual to different places in the community. The service user guide states that people who use the transport will be asked for a contribution towards the fuel costs for the vehicle when the distance travelled is over ten miles. This is acceptable providing that the charges are fair and equitable. The service should also re-consider its policy included in individual finance support plans that state ‘in addition any additional costs such as repairs which are incurred during the year to the vehicle or any changes of the aides and adaptations will be invoiced to each individual on a separate notice’. This does not appear to be fair and equitable. Additional costs should clearly be included in the homes statement of purpose and the people using the service should have access to advocates to support them with any additional financial transactions to make sure that they are in their best interests. These additional costs should also be clearly identified to the relevant funding authorities so that it can be included in their contracts with the service. Observation of documentation in the home and interviews with care staff supported that people that use the service are provided with the opportunity of an annual holiday. However the person that uses the service is responsible for paying for their own accommodation and must also pay for the accommodation for the staff that are supporting them. This is not acceptable. National Minimum Standard 14.4 states that ‘service users in long-term placements have part of the basic contract price the option of a minimum seven-day annual holiday outside of the home which they help to choose and plan.’ The service user guide should clearly identify any contributions that the company will make towards the cost of an annual holiday. The registered person must, on a regular basis consult with the people that use the service in relation to the programme of activities on offer in the home and to make sure that individual support plans reflect the individual’s preferences and capabilities. This should include regular meetings to be held with people that use the service and their families. The information form these meetings could contribute towards the homes quality assurance systems. 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 15 The local authority has recently started to withdraw its day care services for people that use residential care. This service is therefore no longer available to the people that use the service; therefore the individuals are more reliant of the homes staff to develop and provide stimulating activities for them. This must be kept under review by the service to make sure that individuals have their social, emotional, recreational and personal development needs met in an appropriate way. The care files seen by the Commission supported the evidence that people that use the service are encouraged and supported to develop and maintain relationships with their families and friends. Three meals are provided at the home each day, and a snack is provided at suppertime. The individual care files showed the food likes and dislikes of the people that use the service and interviews with the care staff showed that they understood the individual likes and dislikes. Where appropriate specialist nutritional/dietary assessments had been completed by the relevant outside health care professional. We observed one of the meals at the home and it was evidenced that the individuals that use the service were treated with dignity and respect and were given all of the support that they needed to complete their meal. We also looked around the homes kitchen and this had been kept exceptionally clean and tidy and was well organised. 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that personal support is offered in such a way to promote and protect the service users’ privacy and dignity. Arrangements for meeting the healthcare needs of service users are generally satisfactory, however some of the records for interactions with healthcare specialists could be improved. EVIDENCE: Interviews with staff, direct observations and a tour of the premises all supported that dignity, privacy and respect ids offered to the people that use the service at all times. All of the bedrooms in the home are for single occupation and this means treatments and examinations can be carried out in private. The Commission denitrified through reading documentation in the home and interviews with care staff that all of the people that use the service were registered with a GP. A record of routine eye tests, dental and chiropody checks had been maintained and service user weights were being monitored. 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 17 On the day of the site visit three people that use the service were supported to visit a community dentist and another person was supported to visit their General Practitioner. The service records when people have been seen by a healthcare professional, however when these visits record an outcome or a treatment these actions were not always recorded or implemented in individuals care plans. Care workers administer the prescribed medication in the home. None of the people that use the service self medicate. The home uses the monitored dosage system for drug administration to help to make sure that the appropriate medication is given out. There were no controlled drugs in use in the home at the time of the inspection and staff had been provided with accredited medication training. The medication records included photographs of the people that should be receiving them and notes included ‘how I like to take my medication. This was identified as being good practice. The drug stocks are audited on a daily basis in the home, however one stock of Paracetamol had not been recorded since December 2007 and the stock was four over what was accounted for. Nobody at the home had been prescribed a controlled drug. However the home maintains a controlled medication book so that any changes to this can be appropriately recorded. 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the service had a satisfactory complaints system and staff and service users can be assured complaints and concerns will be listened to and acted upon. However the safe guarding adults systems need to be supported through a recognised staff-training programme. EVIDENCE: No complaints had been recorded at the service since the last inspection and no complaints had been received directly through the Commission in the same period. A detailed complaints procedure was in place. Interviews with the care staff showed an understanding of the complaints policy and procedure and knew who to contact to make a complaint and or to raise their concerns to. This means complainants can be assured that their complaints will be listened to and will be acted upon. None of the people that use the service were able to confirm to the inspector their understanding of the complaints process. There had been no referrals made to the local safe guarding adults team since the last inspection report. A procedure for responding to allegations of abuse was available, which reflected the multi-agency procedures in respect of referral and investigation. However some staff training records showed that staff have not received appropriate safe guarding adults training. This is an outstanding requirement from the last inspections and must be addressed to 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 19 promote the health, safe and well being of all of the people that use the service. Some staff stated that their National Vocational Qualification training covered abuse issues, however this did not inform them of the local agreements or reporting systems. It is important that all of the staff have this information to alert the appropriate authorities if they have any concerns of their own, or they have any suspicions or allegations raised to them. 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that environment provided for the people that use the service is homely, comfortable and suitable to meet their needs. However there are some areas that could be improved to create a more homely and safe place to live and work. EVIDENCE: The Commission made a tour a tour of the premises as part of the site visit. The home was clean and tidy and there were no bad smells around the home. The home has had new carpets fitted to the lounge area and one of the bedrooms and two bedrooms had alternative floor coverings fitted. These floors need to have a risk assessment completed to support the use of the new covering. All of the bedrooms seen by the Commission were clean and tidy and were furnished and decorated in a homely style. The evidence was clear that staff 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 21 had supported many of the people that use the service to furnish and decorate their bedrooms with a range of personal items that included their individual choice, tastes and preferences. Specialist equipment needed to make sure that people that use the service have their needs met was observed to be available in the home and this included a mechanical hoist, additional moving and handling equipment and specialist bathing equipment. Service and maintenance records for all of this equipment were all seen to be in place and were up to date. There were two broken toilet seats in the home that needed replacing to support the health and safety of the people using them. One bathroom also included a trolley that had linen towels left on it. This could cause a breach in health and safety in the home and could encourage infections to spread. The bathrooms were well spaced around the unit. The hot water pipes were exposed and were at a high temperature in all of the bathrooms. These pipes need to have a protective cover to prevent any harm to people that use the rooms coming in to direct contact with them. The home keeps a record of the hot water temperatures. These showed that the hot water in the taps range between 30.7º C and 38.9º C. The temperature of the water should be close to 43º C (between –2º C and 2º C) to support the health and safety of the people that use the water system. The homes laundry was well organised. The washing machine was programmable to disinfection and sluicing standards. However there was a hole in the floor covering that could cause a trip hazard or impede infection control procedures in the home. The floor must be repaired or be replaced. In general the decoration of the home is ok, however the corridor leading down to the bedrooms of the people that use the service is in need of decorating. A maintenance and renewal plan was not available at the time of the site visit. The kitchen area was very clean and tidy and was well organised. The sharp knives in the kitchen are kept in an open drawer that anyone can access. The knives must be secured to make sure that only authorised people can access them. Interviews with the care staff identified that there are plans for a herb/raised garden to be developed in the homes grounds in the near future. It is hoped by the staff that this will develop the therapeutic and stimulating activities for the people that will choose to use it. 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that the staff have the knowledge and skills to be able to safely care for the people that they are responsible for. However they are not all up to date with their mandatory training that would support the care that they offer to people that use the service. EVIDENCE: The roles and responsibilities of staff are clearly defined and understood by the people that work in the home. Staff that were interviewed by the Commission clearly understood their own roles and those of their colleagues. Staff commented that in general the staffing levels were satisfactory, however it was stated that extra staff were needed at key times. There was no evidence to show a formal review of staffing had been carried out, despite records and discussion with staff indicating the dependency levels of some service users had increased over the years. At the time of the site visit it was observed that an additional member of staff came in to work early to assist with taking people that use the service to the dentists. 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 23 The Commission were unable to examine the personnel files for any of the staff as the company now holds these centrally. This means the Commission were unable to support that the service takes the appropriate steps to protect people that use the service through sound recruitment and selection practice. Training records showed staff were not all up to date with all of the mandatory training areas. There was some evidence that some staff had had specific learning disability/service user training however this was not the case for all the staff. This needs to be an area of development to ensure staff have the necessary skills and competencies to meet the changing needs of service users. Staff interviewed by the Commission had not received the minimum training that was required of them to make sure that they could fulfil their responsibilities. Two support workers are normally on duty at anyone time. Through the night there is one waking staff. If they require support through the night they must contact one of the sister homes in the local area as this service does not have an additional sleep-in cover. This could leave people who use the service, or staff at risk if there was an emergency during the night. The home had a structured induction programme in position, which met the Common Induction Standards of Skills for Care for new members of staff. The Commission were informed that five out of ten support staff had completed a National Vocational Qualification (NVQ) in care at level 2 or equivalent. This equates to 50 of the staff having achieved the award. Another member of staff is registered on the award and is working towards it. There was no evidence to support that staff receive regular supervision to make sure that they understand their roles and responsibilities and to identify any of their training needs. The management of the service must make sure that staff are provided with a minimum of six formal recorded supervision sessions per year (pro-rata). 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that although the service still has not appointed a manager, the service is supported by the managers of the local sister homes. There is currently still no registered manager for the home. This means current arrangements do not meet legal requirements. EVIDENCE: There is currently no registered manager for the home. This means current arrangements do not meet legal requirements. The area manager of the company supports the home, however due to her other commitments this is happening less often and the staff rely on managerial support from other local home managers. This has been a long outstanding requirement for the service 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 25 and must be acted upon quickly or possibly face further action from the Commission. A specific improvement and development plan for the home was not available. The registered person must implement a quality assurance programme, which fully meets the requirements of NMS 39. This is needed to make sure that everyone is consulted about the running of the home and to ensure continuous improvements are made. This remains an outstanding requirement from previous inspections and must now happen. Any further delay could result in the service facing further action from the Commission. Systems were in place to ensure that all the homes equipment was up to date. This included service contracts for maintenance and service histories. Certificates were also in position for gas; portable electrical appliances; fixed electrical systems and water systems; the water had been tested for Legionella and the building had been tested negative for asbestos. Fire safety equipment records were up to date and had been accurately recorded. The Commission had not received any Regulation 26 visit reports since the last inspection. The responsible individual for the home is required to produce and make available a report under Regulation 26 of the Care Homes Regulations. This is needed to show that the home is being monitored and to meet legal requirements and this must now happen. The home does not have a specific quality assurance and quality monitoring system. It is very important that this is developed to give other people opportunities to say how they think that the home delivers the services to the people that live there. This should include sending out surveys to people who use the services, their families, outside professionals and staff that work at the home. This is an outstanding requirement and as stated in the last report ‘This is needed to make sure that everyone is consulted about the running of the home and to ensure continuous improvements are made. This remains an outstanding requirement from previous inspections and action must now be taken to address this’. Failure by the management of the home to meet previous requirements could result in enforcement action being taken by the Commission. 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 26 The home has all of the required policies and procedures in position. However some of these should be re-looked at as stated earlier in this report especially in relation to individual’s finances. The home maintains all of the records required for the protection of the people that use the service, however as stated earlier in this report the information recorded in some of the documentation including assessments and care plans were basic and included generic and not individual specific information. The management must also make sure that the staff that complete any records in the homes documentation sign their full names so that it can be identified who completed any individual entries. 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 2 28 3 29 X 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 2 12 2 13 3 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 2 2 2 X 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 28 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 YA1 YA14 Regulation 4 Requirement Timescale for action 30/05/08 2. YA2 14 3. YA6 15 The registered person must make sure that all fees payable by people who use the service are included in the homes statement of purpose and service user guide. This must include the services contribution towards a seven-day annual holiday and any costs that may be incurred to people that use the service. This will allow individuals to make a more informed choice in relation to moving to the home. The registered person must 30/05/08 make sure that all assessments completed for people that live at the home are detailed and are specific to their need and are not included on a generic ‘plan’. These assessments must be completed before the person is admitted to the home with the exception of an emergency admission. The registered person must 30/06/08 make sure that individual care/support plans include enough information to make sure that staff can understand the DS0000002872.V361898.R01.S.doc Version 5.2 6 Queensview Crescent Page 29 4. YA11 YA14 4, 13.6 5. YA11 13 (6), (7), (8) 6. YA12 6 7. YA16 20 8. YA20 13 (2) 9. YA23 18 way in which the care should be delivered. This would support the health and safety of the people that use the service. The registered person should make sure that the people who use the service are not expected to pay for staff meals and accommodation when they support individual’s out for lunch or on holiday. Advocates must also be sought to support the people that use the service with their finances. The registered person must make sure that any restraints used in the home are clearly recorded including the nature of the restraint, the time period involved and identify all of the people involved in the restraining. The responsible person must develop support plans in a more accessible format for service users. Daily records should relate to the support plans (previous timescales of 31.3.05, 31.11.05, 31.3.06 and 31.03.07 were not met). The registered person should review the homes policies and procedures for transport. People that use the services transport should not be expected to pay for the maintenance of the vehicles involved and this must not impede their freedom of movement. The registered person must make sure that all medication in the home is appropriately recorded and accounted for to support the health and safety of the people that use the service. The registered person must ensure all staff are provided with adult abuse training. DS0000002872.V361898.R01.S.doc 30/05/08 12/05/08 30/06/08 30/05/08 30/04/08 30/07/08 6 Queensview Crescent Version 5.2 Page 30 10. YA30 16 (J) 11. YA30 16 (J) 12. YA34 19 (Schedule 4) 13. YA36 18 (2) 14. YA37 8 15. YA39 24 (1a&b, 2, 3) The registered person must make sure that the bathrooms are left clear from any objects that may cause the spread of infection to the people that use them. The registered person must make sure that the hot water temperatures at the outlets are close to 43˚ C to ensure the health and safety of the people that use the service. This will protect them from scalds and from infections in the water The registered person must make sure that staff records are open to inspection. This will make sure that employment policies and procedures are followed. The registered person must make sure that all of the care staff receive the recommended minimum of six formal recorded supervision periods per year (pro-rata) to make sure that they have the knowledge and skills to be able to look after the people left in their care. The registered person must ensure a permanent manager is appointed. Once appointed the manager must submit an application to register with the Commission for Social Care Inspection (previous timescales of 30/06/06 and 31.03.07 were not met). The registered person must develop a quality assurance and monitoring system that meets the requirements of this standard and produce an annual development plan based on a systematic cycle of planningaction-review, reflecting aims and outcomes for service users (previous timescales of DS0000002872.V361898.R01.S.doc 20/03/08 30/04/08 30/05/08 30/08/08 30/05/08 30/06/08 6 Queensview Crescent Version 5.2 Page 31 16. YA41 17 17. YA41 26 19.2.04, 31.12.05 and 30.03.07 were not met). The registered person must make sure that the person completing any of the records appropriately signs all of the documentation. The registered person must visit and complete regulation 26 visits. This will help to monitor the progress of the service. 14/04/08 30/04/08 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 YA24 Good Practice Recommendations The registered person should make sure that the corridors in the home are decorated to provide a more homely environment. The broken toilet seats should be repaired or replaced to support the health and safety of the people using these facilities. The registered person should make sure that the floor in the laundry is either repaired or replaced to support the health and safety of the people using this area and to control the spread of infection. 2. YA27 3. YA30 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 6 Queensview Crescent DS0000002872.V361898.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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