Inspection on 16/10/06 for 64 Farlington Road

This inspection was carried out on 16th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 33 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

64 Farlington Road 19/08/08

64 Farlington Road 27/02/08

64 Farlington Road 05/09/07

64 Farlington Road 15/02/07

64 Farlington Road 18/11/05

64 Farlington Road 02/06/05

64 Farlington Road 05/10/04

64 Farlington Road 21/05/04

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

CARE HOME ADULTS 18-65 64 Farlington Road North End Portsmouth Hampshire PO2 7HU Lead Inspector Clare Hall Unannounced Inspection 16th October 2006 04:30 64 Farlington Road DS0000011686.V306373.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 64 Farlington Road DS0000011686.V306373.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. 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 64 Farlington Road Address North End Portsmouth Hampshire PO2 7HU 023 9243 1941 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) Independent Care (Portsmouth) Limited Mrs Linda Janice Rosa Walsh Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the category LD are only to be admitted between the age of 20 and 45 years 18th November 2005 Date of last inspection Brief Description of the Service: 64 Farlington Road provides care and accommodation for up to three adults with a learning disability. The home is a terraced property situated in a residential area of Portsmouth. A local shopping centre, including facilities such as a cinema is located approximately one mile from the home. There is a small rear garden. Communal areas consist of a thru-lounge and separate kitchen/dining area 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. On the first day, one inspector undertook a visit to the premises and during the time spent there spoke with all three service users, one care worker and the manager. Service users gave the inspector a full tour of their home and sat with the inspector to complete questionnaires in respect of the service. The pre inspection information requested by the commission was not provided. The manager was unable to recall any request made for additional information pre inspection. Additional information considered was all the recorded contact with the home, including events, Regulation 37 notifications and the information contained in the previous reports. Comment cards were provided to the service pre visit but no responses were received. Staffs were observed throughout the afternoon assisting and supporting clients and their practices were observed for good practice. Service users were observed making use of shared facilities and taking their evening meal. Case tracking was undertaken as part of the evidence gathering process, with the involvement of service users. Due to the concerns raised during this initial visit the inspector made a further two visits to the premises with a second inspector /Regulation Manager, two days later. The responsible person and the registered manager were unable to come to the premises to speak with the inspectors during the second and third visit. Thirty requirements have been raised as a result of this audit process. What the service does well: Observing care delivery it is very clear that the staff are motivated and committed to providing a good service despite the severe shortage of staff in this home. Staffs were observed interacting with service users in a supportive manner despite a lack of formal training or experience in care work. One care worker communicated a clear empathy towards persons with disabilities. Staffs were attempting to make the most of a poorly staffed and poorly supported service by taking clients out in their spare time and working long 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 6 hours. Some care strategies observed caused concern. The staff undertook these with what they thought were in the best interests of the service users. As the staff work alone and had not received any formal training for the management of persons with learning disabilities they felt these strategies were ok. All three services users stated they were happy despite the poor quality of accommodation and were happy with how they were being supported. What has improved since the last inspection? What they could do better: For some reason the manager is unable or unwilling to address the concerns raised by the Regulator. The requirements made on two previous occasions regarding the premises have not been addressed. The manager demonstrates a lack of knowledge of what concerns have been raised by the Regulator previously. Guidance also provided to the manager in respect of displacing one-service users has been ignored. The manager is ill informed about the daily events in her home. She is unable to locate vital information and behaves as if she is not in regular attendance at the home. Both the responsible individual and manager have ignored the requirements to ensure standards are maintained. They have done nothing to audit the standards in the home or address any shortfalls identified over the preceding 12 months. The manager appeared in poor health on the day of the visit and the poor outcomes for the home can only reflect her inability to manage a registered service. Shortfalls have been raised on numerous occasions for the staff to actively engage residents in the process for assessment and care planning. Staff have not ensured the decisions and preferences of individuals are considered in their daily lives. The current activities provided are initiated by outreach services, day care centres and family members .The current staffing level is not conducive to ensuring staff can meet service users individual social needs. 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 7 A more service users led approach; promoting independence for the selfadministering of medicines and money management also needs to be developed. The home has been showing signs of wear and tear for a number of years and both the internal and external environment lacks adequate funding and maintenance. There have been on going water and plumbing issues not adequately addressed by the manager. Areas of the home inside and out are considered dirty, poorly maintained and unsafe. The home is poorly managed and safety checks have not been undertaken. There is a poor standard of practice in relation to the prevention of infection and health and safety, putting service users at risk. The home lacks financial investment. Both the Hampshire Fire Authority and respective social service care managers have been contacted in respect of the concerns raised as a result of this visit. The manager has repeatedly failed to address the requirements regarding the homes staffing levels and for the supervision of staff. The home is severely understaffed. 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. 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this area is good. This judgement has been made using available evidence, including a visit to this home. The findings in this report may indicate that the service is not suitable for housing three service users. EVIDENCE: There have been no new admissions to the home. Assessments are recorded for each resident. The recent inspection has identified concerns regarding the current service and in the interests of the service users a review of the numbers of service users supported in this establishment may need to be undertaken. 64 Farlington Road DS0000011686.V306373.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9, Quality in this area is adequate. This judgement has been made using available evidence, including a visit to this home. The home needs to actively engage residents in the process for assessment and care planning. Service users involvement must be encouraged. Care plans are not identifying the current needs of individuals or programmes to address issues relating to behaviours. The information provided to service users is not up to date or in a suitable format. The decisions and preferences of individuals must be considered in their daily lives. EVIDENCE: The service information is in need of up dating. It is not provided in a format suitable to the client group. There is no recent inspection report available on the premises. The presentation of the current information is poor and not in a suitable format for persons with disabilities. 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 11 The homes care planning processes do not involve the residents. There is clearly scope to involve residents directly in this. This issue has been raised previously. The home’s manager has, at this, and on previous visits maintained that residents do not have the ability to comprehend the care plans, but states, they are always consulted about care and activities. Some care plans and assessments have not undergone regular review and the manager stated service users no longer had reviews involving care managers, representatives and other members of the multidisciplinary team. Reviews were stated to be a paperwork activity only, which did not involve the service users in that review of the current care planning records. The inspector asked a resident if she/he would be willing to sit down and read his/her care plan and to discuss its contents. The resident replied that he/she would like to do this. It was clearly evident that the service user has not been included in the review and planning of care needs. There is also no consultation or agreement made by the service user to their current care plan. Their satisfaction regarding their current placement was also not included in the review process. This concern has been raised on two previous inspection visits. One service user was displaying needs, which clearly needed support and intervention, but this was not being managed. The current management and intervention by staff was considered to be undignified and did not support the needs of the individual. The inspector did not feel withholding this service users toilet paper was dignified or appropriate. The inspector has since referred all concerns to the responsible care management team. One service user assisted the inspector in the inspection process by explaining the layout and routines of the home, and how he /she is involved in the decision-making regarding wishes and activities of every day life. She/he was observed interacting with the manager and discussing everyday events and the goings on within the local community. During discussions it was established that one service user has been displaced to another establishment when the home is not staffed when she /he clearly prefers to remain in her/his home. It was further established that the current staffing levels limit the service users leisure and social opportunities. Records are not reflecting how the choices and desires of individuals regarding activities are met because they can’t be with the present staffing levels. 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 12 There was some confusion from the manager as to what level of capacity the current residents have. There was further doubt to whether one service users guardianship order was still in place and the manager said she was confused regarding who was the named representative of one individual. Risk assessments were identified recorded on files in respect of residents undertaking activities of daily living. Some records were not clear in respect of all risks, especially with regards to being a vulnerable person requiring protection against abuse. 64 Farlington Road DS0000011686.V306373.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this area is poor. This judgement has been made using available evidence, including a visit to this home. It is apparent that outreach services, the day care centres and family members provide a lot of the activities. The current staffing level is not conducive to ensuring staff can meet service users individual social needs. EVIDENCE: The inspector was able to speak with all service users when they arrived home from their day services and outings with outreach workers. It was established that service users meet up with their family members, go about their leisure activities with trips to the pubs, skating and trips to the beach as desired when supported by family members. One service user had their own cat that they cared for and fed daily. The staff member on duty was observed interacting and talking with service users as part of the group discussing daily events. 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 14 Service users stated they are able to exercise choices in respect of what they do, where they spend their evenings and re iterated that they could sit privately in their room when they want and that this is respected. The only limitations are in the respect that there is only one member of staff on duty at any one time so this is limiting the social outings of the service users. They have to go out as a group, rather than on individual one to one basis. Staff stated service users needed to agree where they would go as a group because there was only one staff member on duty at any time. It was further established that at weekends, when two of the service users went to their respective family homes, one remaining service user was sometimes displaced to a sister home. At this home she was accommodated in the staff sleep in room. This was done so staff could have the weekend off. 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 Quality in this area is adequate. This judgement has been made using available evidence, including a visit to this home. The manager has not addressed the concerns identified at the previous inspection. Staffs have not received the necessary training in medication or information regarding the safe administration of medicines. A more service users led approach; promoting independence for the selfadministering of medicines and money management needs to be developed. EVIDENCE: The home maintains a system of recording each resident’s health needs. This includes appointments with opticians, dentists and general practitioners as well as monitoring and recording each resident’s weight at regular intervals. The procedure of dispensing medication is by blister pack. Medication records were clear and completed in full. It was not indicated whether individuals had the capacity and ability to participate in self-medication. At the last inspection in November 2005 it was noted that a revised policy and procedure was needed to reflect the new medication administration system. The manager stated this has not yet been completed. It was further 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 16 established that care workers undertaking medication had not received any formal training. One service user explained how on Sundays the group discuss the week’s food preferences with a care staff member who then writes the menu for the week. It was established that the preferences of individuals are considered. The inspector observed the service users in the kitchen discussing the day’s events with the care staff while the meal was prepared. One service user helped prepare the vegetables for the evening meal. Other service users helped setting the table and drying up the dishes. Staff were observed maintaining safety by securing sharp knives. One area that could be improved is for the promotion for money management. Service users do not have their own money in their rooms. Their money is kept locked away in the staff office. 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this area is adequate. This judgement has been made using available evidence, including a visit to this home. The current processes for the recruitment and selection of staff and protection of individuals is not documented. Recruitment records are not complete or held on the premises. The home has a good complaints procedure in a suitable format. EVIDENCE: All service users, when asked, stated they felt they could tell the staff if they had a concern or were not happy. The homes complaints procedure was seen in an appropriate format and the home does have all the necessary written protection procedures. One resident under a guardianship order did not have clearly identified records indicating why a guardianship order was in place and what actions were necessary in respect of this order. This service user was clearly identified as being at risk and vulnerable, but the management of this risk was not clear. A further concern was the only female client identified as being at risk and vulnerable regarding male company was being accommodated with two male service users and supported by male staff member. The in house recruitment records did not indicate this member of staff held a current criminal record bureau check or POVA declaration. The staff member stated this had been undertaken. 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 18 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this area is poor. This judgement has been made using available evidence, including a visit to this home. The home has been showing signs of wear and tear for a number of years and both the internal and external environment lacks adequate funding and maintenance. Flooring and decor are in need of urgent attention. The homes leaks have not been managed nor the water damage they have caused repaired. Areas of the home are dirty and lack financial investment. EVIDENCE: It was identified during a visit in November 2005 that a leak from the first floor bathroom shower had caused damage to the ceiling below. The leak was stated to have been repaired and the home’s manager also stated that the ceiling would be redecorated in the near future. One month later in December 2005, the residents were displaced, as the work necessary to repair the leak was more extensive than first thought. 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 20 During this visit there was further water damage noted to the hall ceiling and the downstairs toilet. One-service users explained, “When it rains heavily water comes through the ceiling”. During an inspection twelve months ago the first floor bathroom was noted to be in a poor state. The shower tray and wash hand basin were noted to be very dirty. It had also been established that this was the sole wash hand basin for the three service users upstairs. When the service users showed the inspector the bathroom, the ceiling was covered with mildew from condensation and ceiling paint was beginning to peel. It was heavily water damaged and damp. The extractor fan had a heavy fungal growth and the room was not clean. There was also no toilet paper available. The service users accompanied the inspector around their bedrooms. It was noted that bedrooms do not have wash hand basins, as this was not a minimum standard when the home registered under previous legislation. All three bedrooms were seen and these were clean and tidy, containing numerous items of personal possessions. All residents stated they were happy with their bedrooms despite it being noticed that some lacked adequate furnishings/ bedside lights. It was further noted that one bedroom had the smoke detector hanging from the ceiling. The manager stated they were trying to find the necessary parts to repair this. An immediate requirement was issued on the 16/10/07 regarding this and when the inspectors returned on the 18/10/06 this had not been repaired. One waste level upstairs window upstairs was noticed to lack a restrictor. The home also has a ground floor toilet, which had water damage to the ceiling. This leads through to the outer utility area where there was paint peeling off the walls. The towel in this bathroom was heavily soiled and so were the tea towels hanging in the kitchen. Further on, the flooring to the living room and dining areas was observed to be dirty, old, torn in places and not secured in others. At the time of the inspection the central heating system could not be tested but it had been noted on a previous inspection visit that it was not working properly. The entrance hall has a worn and dirty carpet and the carpet on the stairs was torn. 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 21 The mat outside the office curled up at the edges and this is considered a falls risk. The manager asked the care worker to remove this during the visit. In the lounge there is a television, armchairs and two large sofas. One of which blocks a storage cupboard. The homes Hoover and other equipment are stored in the hallway. In this room the view from the window is a brick wall and this room is a general thoroughfare from the hall into the kitchen. The staff office at the front of the house has a nice bay window and would be more suited to be a lounge as it is bright and would be more private, but this is currently being used as an office. A service user showed the inspector into the back garden, which was overgrown with nettles and was housing old furniture/rubbish. The entrance to the home is also sad looking and not inviting. It has broken chipped tiles, peeling paint and holes in the brickwork. It was also noted that the hall light had no bulb and was hanging directly beneath a watermark in the ceiling. Other lampshades were hanging dust and the footstool in the dining room was very dirty. There were only three dining room chairs for the dining table, so the care worker had to eat his meal off his lap in the lounge while the service users ate in the dining room. The covers of these chairs were dirty. Overall the internal and external environment has been neglected and does not indicate any financial investment. During the inspection the manager apologised to the inspector in view of the poor record keeping regarding the homes upkeep and decoration. Further more, the homes infection control policies had not been updated since 1998 and the laundry area needs to be redecorated so to ensure it can be cleaned appropriately because it cannot be adequately cleaned in its current state. It was also noticed there were no fire doors through out the home. The laundry has a sliding door only and the dryer had a large amount of lint in the filter. 64 Farlington Road DS0000011686.V306373.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 Quality in this area is poor. This judgement has been made using available evidence, including a visit to this home. The manager has failed to address the requirements regarding the homes staffing levels and for the supervision of staff. Staff employed show a clear commitment and caring attitude to the service users they support. EVIDENCE: One member of staff has undergone a number of courses in infection control, food hygiene, first aid, dementia, fire and protection of vulnerable adults training. The staff stated they had received training in dementia but had not received specific training relating to learning disabilities. At the last inspection it was noted there was only a provision of 75 care staff hours compared to a total of 153.5 at a previous inspection. A requirement was raised stating staffing levels must be increased to at least 35 hours per resident per week. 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 23 At this visit it was established that there were only two care staff employed to provide care on a 24 hour basis 7 days a week. One staff members weekend hours on duty totalled over 60 hours. It was further established that when staff do get time off service users are being displaced to another home. As there is only one member of staff on duty the service users cannot go out as they wish. They must go out in a group and agree on what they are to do or where they are to go. Care staffs are coming in on their days off to take clients out, as they know clients have limited opportunities to go out. Discussions identified that care staff are committed to supporting the service users. They appear highly motivated and have a genuine interest in providing good support and care in their roles as carers. The inspector noticed that the service user who was at home needed to go with the care worker to pick up another service user from a day centre because other wise they would have been left at home alone. It was also established that the care worker on duty sleeps in the office on a camp bed, as there is no other staff accommodation available. Two staff records were audited. One lacked a criminal record check, both lacked terms and conditions of employment and the necessary records regarding the interview process and how suitability was established or how they would be supported when they had no previous care experience. During the inspection undertaken in November 2005 it was stated that staff supervision records were not available. On this occasion the manager informed the inspector that supervisions were still not being undertaken formally. The requirement to provide staff with regular supervision was raised following a previous inspection and has not been addressed. It was also established that there are no induction records for either of the two staff employed some seven months ago. Staff did state they were put through a period of supervised practice but there are no records of this. The two care staffs employed do not yet hold a national vocational qualification in care but state this will be undertaken after completing twelve months employment. 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 24 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42,43 Quality in this area is poor. This judgement has been made using available evidence, including a visit to this home. For some reason the manager is unable or unwilling to address the concerns raised by the Regulator. The manager was aware of the possible consequences of having not ensured standards are maintained but had done nothing to audit the standards in the home or address any shortfalls identified over the preceding 12 months. The manager appeared in poor health on the day of the visit. The poor standards within the home could only reflect her inability to manage a registered service. It is a further concern that the responsible person is present in the home on most days but has also failed to identify or address the shortfalls. EVIDENCE: 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 26 The manager was present during the first day of the inspection. When the inspector discussed the findings of the previous visit the manager could not recall the issues and did state she felt the inspector was confusing the issues and concerns and requirements made with her other home. When the manager was asked to refer to the previous inspection report she could not recall receiving a copy and needed to be reminded of what the issues of concern were. At this the manager stated, “Have you got the right home, he (the inspector) had a bad habit of getting his houses confused in his reports.” The homes policies were notably out of date and the process of seeking the views of service users and other stakeholders needs significant improvement. The manager lacked knowledge regarding the daily records and events of the home. It was clear she had not been actively participating in the running of the home on a daily basis and staff confirmed this. The inspector did ask the manager how she was during the inspection as it was noted that she appeared unwell. The manager stated she has not yet completed her national vocational qualification in management, as she had to defer it for some time due to ill health. There were a number of further concerns raised during the visit. • • • • • • • • • • The displayed homes liability certificate expired in 2001 and the manager could not evidence an up to date one. The manager was also unable to find service certificates and was unsure of when checks had been undertaken and had to ring members of staff to find out. Staff files were not on the premises and the manager could not find the necessary documents required by the inspector. The manager was unable to recall the last inspection, when it occurred or the outcomes. It was further established that the maintenance certificates for the electrical portable appliances had expired. The certificates for the electrical wiring could not be found nor up to date certificates for the maintenance of the gas and boiler and cooker is demonstrated. The fire log was not available for inspection nor was there a fire risk assessment available. Fire equipment checks had not been undertaken since February 2006. Multiple plugs were in extension leads in the office. The cooker was dirty and the electric kettle dripped water when poured. DS0000011686.V306373.R01.S.doc Version 5.2 Page 27 64 Farlington Road • The homes cleaning rota had not been completed since March 2005. Through out the inspection the manager kept apologising and stated, “We will probably be closed down on the basis of this lot,” and agreed the standard of the administration records were a mess. Policies and procedures had not been reviewed for three years and it was very clear that issues raised by the regulator have been ignored. The home itself has fallen into a poor state and needs significant financial investment. The health and safety of service users has been ignored and the checks necessary to ensure the service users live in a safe environment also ignored. When discussing the need to have records to indicate induction and supervision for staff the manager stated she was putting something together and stated, “I accept it should be done quicker but I haven’t done it and that’s that.” The manager was issued with an immediate requirement in respect of the lack of attention to fire prevention and was informed that there were so many concerns the regulator would need to discuss the outcomes to this visit further. It was decided a further visit should be made to the premises two days later. Neither the manager nor provider was available to accompany the inspectors. Further immediate requirements were made in respect of cleanliness and recruitment checks and liability insurance. It was noted that the homes registered manager does not invest a great deal of time at the premises. Staffs are very much left to manage alone and the responsible person who undertakes administrative tasks is on the duty rota for day cover but does not always fulfil these visits. It was established that the home is very under staffed at times denying the choice of the service users to be at home, undertake activities and have their needs met. 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 3 26 2 27 3 28 1 29 3 30 1 STAFFING Standard No Score 31 2 32 2 33 1 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 X LIFESTYLES Standard No Score 11 3 12 3 13 1 14 1 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 1 X 1 2 X 1 1 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 29 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 YA6 Regulation 15(2) Requirement Residents must be consulted during the assessment and care plan process. The home must be able to demonstrate that this has taken place. This remains outstanding from the two previous inspection reports. Individual residents leisure needs must be assessed and recorded. Arrangements for leisure activities must be recorded and the home must be able to demonstrate that the resident has had the opportunity to take part in leisure pursuits. This is outstanding from the two previous inspection reports. Care plans must describe any restrictions on choice and freedom agreed with the service user and must identify individualised procedures for service users likely to be aggressive. Service users must be DS0000011686.V306373.R01.S.doc Timescale for action 07/11/06 2. YA6 12(1), 14 and 15 07/11/06 3 YA6 15 07/11/06 4 YA7 12 07/11/06 Page 30 64 Farlington Road Version 5.2 5 YA8 YA40 4,5 6 YA9 13 7 YA13 16 8. YA14 12(1), 14 and 15 encouraged to manage their own finances; where support and tuition are needed, the reason for, and manner, of support are documented and reviewed. The homes statement, guide, policies and procedures need development and updating and this must be done with the opportunity given to service users to participate in the process. Risk assessments must be clear and informative. Action must be taken to minimize risks and hazards and risk management strategies must be agreed recorded in the individual plan and reviewed. Support for service users to engage in activities outside the home must be provided flexibly over evenings and weekends and recognised as the staffs’ duties. Individual residents leisure needs must be assessed and recorded. Arrangements for leisure activities must be recorded and the home must be able to demonstrate that the resident has had the opportunity to take part in leisure pursuits. This is outstanding from the last two inspection reports. Adequate dining facilities must provided so that staff and service users can eat together if they wish. Same gender care must be provided where there has been a specific need identified. The home must devise a DS0000011686.V306373.R01.S.doc 30/11/06 07/11/06 30/11/06 30/11/06 9 YA17 16,23 30/11/06 10 YA18 12 30/11/06 11 YA20 13(4) 30/11/06 Page 31 64 Farlington Road Version 5.2 12 YA23 12,16 13 YA24 16,23 14 YA24 16 15 YA24 23 16 YA24 23 written procedure for the receipt, handling, recording, safekeeping, administration and disposal of medication. This is outstanding from the previous visit Staff must support and encourage service users to retain administer and control their own medication within a risk assessment framework. Service users must have the opportunity to manage their own monies and offered safe storage. The registered person must ensure the premises are suitable for its stated purpose. It must be accessible safe and well maintained, meet service users individual and collective needs in a comfortable and homely way. Issues raised regarding walls flooring ceilings furnishings must be addressed. The registered person must ensure the home is clean bright and airy by ensuring there is adequate cleaning undertaken The home must meet the requirements of the local fire service and environmental health department and health and safety. Equipments must be in working order and maintenance checks undertaken. Records for maintenance and cleaning must be maintained. Furnishings, fittings adaptations and equipment must be of good quality and fit for purpose. The homes cooker must be DS0000011686.V306373.R01.S.doc 30/11/06 30/12/06 30/11/06 18/10/06 30/11/07 64 Farlington Road Version 5.2 Page 32 17 YA24 23 18 YA26 16 19 YA28 23 20 YA30 23(2)(d) cleaned. The kitchen cupboard skirting must be fixed. The light fittings must be fixed clean and in working order. The registered person must forward to the commission by the given date a planned maintenance and renewal programme for the fabric and decoration of the premises Service users rooms must be furnished with bedside tables and bedside lights unless they have agreed otherwise. The registered person must ensure the garden is kept in a good state and is fit for purpose and must not use this area to store broken items. The bathroom must be kept clean, including the shower tray, wash hand basin and bath mat. This is outstanding from the previous inspection. 30/11/06 30/12/06 30/12/06 30/10/06 21 YA30 16 All hand towels and other items of linen including tea towels must be washed regularly. The registered person must update the homes prevention of infection policies and ensure practices within the home including the standard of the laundry facilities are compliant with the department of health recommendations (2006). Records must be held on the premises identifying robust recruitment practices have been undertaken. DS0000011686.V306373.R01.S.doc 19/10/06 22 YA30 16 30/12/06 23 YA34 19 18/11/06 64 Farlington Road Version 5.2 Page 33 24 YA36 YA32 YA35 18 25 YA36 18(1) Staff must receive induction training, which is in line with the skills for care council recommendations and with emphasis to staff working in learning disability services. Staff must receive supervision at least 6 times per year. This has been raised previously 30/11/06 30/11/06 26 YA37 17,Schedule 4 27 YA39 24 The manager must submit to the commission the management arrangements in respect of the service and what hours she will be committing to the service in her role as manager. The home must develop a quality assurance system, including a system of audit and an annual development plan. This has been raised previously 30/11/06 30/11/06 28 YA42 23,17,schedule The registered manager must 4 send to the commission evidence that The service certificates for The cooker The portable electrical appliances The electrical wiring certificate The gas safety certificate for the boiler and cooker, Have been undertaken. Schedule 4 The registered manager must consult with the Hampshire fire authority and ensure the home has a fire risk assessment, working and checked fire equipments and DS0000011686.V306373.R01.S.doc 30/11/06 29 YA42 17/10/06 64 Farlington Road Version 5.2 Page 34 record checks undertaken. 30 YA43 25 The registered manager must forward to the commission a copy of the homes liability insurance. 17/10/06 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 YA28 Good Practice Recommendations To reassess the use of the communal space so as to improve the sitting room arrangements so service users have the opportunity to sit in a bright airy room with nice view and have the opportunity to shut the door and be private. 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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 64 Farlington Road DS0000011686.V306373.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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