Inspection on 29/01/07 for 74 Lifstan Way

This inspection was carried out on 29th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

74 Lifstan Way 03/07/07

74 Lifstan Way 02/03/05

74 Lifstan Way 12/11/04

74 Lifstan Way 22/03/04

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

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

CARE HOME ADULTS 18-65 Lifstan Way (74) 74 Lifstan Way Thorpe Bay Essex SS1 2XE Lead Inspector Mr Trevor Davey Unannounced Inspection 29th January 2007 10:00 Lifstan Way (74) DS0000015445.V329218.R02.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 Lifstan Way (74) DS0000015445.V329218.R02.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. Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lifstan Way (74) Address 74 Lifstan Way Thorpe Bay Essex SS1 2XE 01702 466772 01702 613140 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) www.together-uk.org Together Working for Wellbeing Manager post vacant Care Home 11 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (11) of places Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd. March 2005. Brief Description of the Service: 74 Lifstan Way is a detached property which has been refurbished to provide accommodation and personal care for up to eleven adults with a mental disorder. This includes residents aged 18 to 65 years although some are now over 65 years of age since being admitted to the home. The registration category does not include people who may have dementia or a learning disability. The premises are a two-storey detached house in a residential area situated in Thorpe Bay, Southend-on-Sea and is in close proximity to local community facilities and transport links. The accommodation provides single bedrooms, each with its own wash hand basin, shower and toilet ensuite facilities. In addition, there is a separate communal lounge and dining room, kitchen, toilets and bathroom facilities. A shaft lift is available which serves all floors. The home is located in a residential area close to the local shops and bus routes. Residents have the use of a medium-sized garden/patio area. Car parking space is available. The current rate of fees are between £220 and £388 per week which is supplemented by an annual grant from the Primary Care Trust. This is currently under review. Additional charges are made for hairdressing, toiletries & chiropody. Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Key Inspection site visit took place over a period of 11.50 hours spread over two days. The visit mainly focused on the progress the home had made since the last inspection and covered all key standards. The home was closed on a temporary basis in December 2005 to allow for urgent refurbishment work to take place. Residents were accommodated in alternative registered premises and moved back into Lifstan way in October 2006. Residents from another home in the area operated by the same Registered Provider have also moved into Lifstan way. There is currently no registered manager in post and the acting manager is on sick leave. At the time of the inspection, the deputy manager and other staff were on duty who assisted in the inspection. Staff, residents and social work professionals were spoken with during the inspection. Their comments and the contributions received were helpful in assisting the Inspector to compile this report. In addition, Case tracking took place using some of the personal care records and other official records within the home were also assessed. Comments about the service provided have also been invited from other health care professionals by the Commission for Social Care Inspection. Feedback received was generally complimentary and positive regarding the support received by the staff team and residents liked their new accommodation. The inspection also took into account previous information submitted by the deputy manager including the completed pre-inspection questionnaire. What the service does well: From observation during the inspection, conversations with staff and residents who were prepared to speak to the Inspector, there were positive comments to indicate that residents felt supported and cared for. Staff were approachable who would willingly deal with any issues of concern. Residents spoken to, had a good working relationship with their key workers who sometimes were able to take them out. They also appreciated the new accommodation and the improved bedroom space which had been provided. One social worker who was spoken with during the inspection, confirmed that they had a good working relationship with the home and they felt staff were able to meet the needs of residents. The staff team also keep them in touch with any developments and feels the home is a safe environment. Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There is currently no registered manager in post and this is adversely affecting the daily operation of the home where there is a lack of leadership skills. There are inconsistencies with the Registered Provider’s own policies and procedures compared with the practice which is being followed in the home. This includes pre-admission and assessment procedures as well as the policy for abusive incidents and protection of vulnerable adults which does not comply with the Public Interest Disclosure Act 1998 and Department of Health guidance No Secrets. The Registered Provider’s training and development of the staff team needs to be improved and carried out on a more regular and targeted basis to include specific topics related to individual needs of residents. Professional nutritional/dietary advice needs to be sought to give greater variety and selection of meals for residents. Residents are consulted or listened to regarding their preferred daily routines but this process could be improved to allow for greater flexibility in the home’s response. Robust staff recruitment procedures were not always being followed which could pose a risk to residents. The completion and maintaining of personal care records was inconsistent and did not always include sufficient information. Risk assessments were not in place for a safe working environment and additional measures need to be considered for the safety and security of residents. Consideration should be given to providing improved signage and symbols to assist residents who have a sensory impairment or who are confused. The Statement of Purpose, although recently updated, needs to be amended to ensure all information about the home is available as required by regulation. An up –to- date Service User Guide has not been prepared or made available to residents. The home does not provide a written statement of terms and conditions or a contract which clearly sets out the fees payable and the services which are covered. There is no evidence of quality assurance procedures/surveys which the Registered Provider uses to assess the effectiveness of the service provided. Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 7 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. Lifstan Way (74) DS0000015445.V329218.R02.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 Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 & 5 Quality in this outcome area is poor. The Statement of Purpose does not give full and clear information about the home for prospective users of the service and a Service User’s Guide has not been produced. Prospective residents have not always had the benefit of visiting the home prior to admission or of having individual aspirations and needs properly assessed. Residents do not have an individual written contract or statement of terms and conditions setting out the fees and services provided. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The Statement of Purpose has been updated but some information which is relevant to the home, has not been included or requires clarification. The Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 10 management structure includes the name of the registered manager but this has not been approved as an application is still awaited by the Commission for Social Care Inspection before this can be processed. This position is currently being covered by an acting manager. Some of the professional course details listed for staff, is inaccurate. The Statement of Purpose does not make it clear that the registration category excludes the admission of new residents over 65 years of age. The list of room sizes does not clearly identify the bedrooms or ensuite facilities and other communal areas of the home. Reference is made to involving residents in the selection process for possible new admissions as well as staffing matters but there is no evidence as to what extent if any, this has taken place. The procedure specified for investigating formal complaints is not compliant with Regulation 22 of the Care Homes Regulations where there is an expectation that the Registerd Person shall, within 28 days after the date on which the complaint is made, inform the person who made the complaint of the action (if any) that is to be taken. There was no evidence that Service User’s Guides had been produced in accordance with the amendment to Regulation 5 (dated 1 September 2006), or that this document had been distributed to residents or their representatives. Although there were licence agreements, there were no individual contracts available or terms and conditions which clearly specified the fees payable and which services these covered and by whom. The most recent admission took place over four years ago and it was noted from the records available, that the resident concerned did not fall within the registration category of the home and was over 65 years of age when admitted. Details had been obtained from the social worker in relation to previous mental health illness which included information submitted by the consultant psychiatrist and community psychiatric nurse. Functional assessments including details of independence regarding self-help had been recorded as well as dietary information. Social skills and behaviour had also been noted but there was no record of any pre- admission assessment which had been carried out by the home or that an application form had been completed, as specified in the Registered Person’s own policies and procedures. So far as staff were aware, there had been no visits arranged to the home prior to admission taking place and neither was there evidence that this had occurred in the personal care records. Without a thorough needs assessment being completed which takes into account the abilities/knowledge of staff and facilities available, this could lead to prospective residents being inappropriately placed which could also have a diverse effect on existing residents in the home. Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. Care plans together with risk assessments, were in place which had been drawn up following discussions with residents. Individual needs had been taken into account together with the support to be provided but this information was not always up-to-date or clearly documented. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Case tracking took place in respect of two residents as well as inspecting other personal care records. Where possible, conversations also took place with residents who were willing to talk to the Inspector. Residents were aware of their individual key workers and expressed appreciation of the imput and support received. This included discussion regarding care plans and guidance about organising and pursuing individual daily routines such as domestic chores where residents are encouraged to look after their own rooms. Staff Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 12 had also been involved in assisting with recreational and daytime activities within the community. Recording procedures relating to care plans, risk assessments and review information was not consistent and was sometimes difficult to follow. Care plan information had been documented and dated which included action required and whether the goals had been achieved. Review dates had been set for November/December 2006 e.g. fire safety-deafness, but there was no record as to whether this review had taken place as planned. Other reviews had been referred to in the daily log reports but these lacked specific detail as to the outcome or decisions agreed. In addition, although the daily log/night log reports were being maintained on a regular basis, these were being kept in loose leaf form and some had become detached and there is a risk that personal information regarding residents, could be lost or misplaced. Correspondence and information was available relating to appointments made with other health care professionals which included psychiatric support, dental checks and the issuing of hearing aids. References were also made in the daily log reports regarding various appointments but these had not always been cross-referenced with care plans or previous correspondence. Where possible, care plans had been signed by the resident concerned and a member of staff. There was some evidence that care programmes had been approved by the Primary Care trust e.g. dated June 2005 which set out needs/difficulties, objectives and priorities. These had been signed by the community psychiatric nurse and service user and reviews were recorded for December 2006 and January 2007. When the home re-opened in October 2006, residents from another home which had been closed by the Registered Provider, joined the existing residents in Lifstan way. Both residents and staff said that there had been some difficulties in adjusting/reconciling the different routines of residents from the separate establishments. There had been some improvements and resident meetings had taken place to discuss issues of concern and alternative ideas. However, there is no clear evidence that the previous individual routines and preferences of residents had been fully taken into consideration during this transition period. Areas where residents can affect change appear to be limited. For example, one group of residents were used to having their main meal in the evening and the other at midday. This is now served at midday which does not allow for any flexibility or choice which some residents may prefer. Lifstan Way (74) DS0000015445.V329218.R02.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, 15, 16 & 17 Quality in this outcome area is adequate. The home provides support to residents in pursuing social and recreational activities in accordance with individual needs and choices which is linked into the local community. Where possible, residents are able to enjoy regular appropriate family and personal relationships. Residents’ rights are respected but greater flexibility should be made to allow for residents to have a greater say and involvement in influencing their daily routines. The variety and choice of meals available needs to improve. This judgement has been made using available evidence including a visit to the service. Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 14 EVIDENCE: From discussion, observation and records available, there was evidence to show that residents are encouraged to enjoy and take part in leisure and recreational activities within the local community. Some of the residents spoken to, talked about their hobbies and interests which included visits to a local activity centre for music appreciation, pottery classes as well as some computer work. One of the residents said that the home did at one time have a computer which residents could use. It is understood that this is still available. Residents also had their own collection of videos and enjoyed their own television and radio programmes. Other residents talked about their visits to day centres and how they enjoyed playing cards and taking part in quizzes. Some residents have developed relationships with friends whom they visit and regularly spend time together. Residents spoke about the times they enjoyed being taken out by their key workers for coffee and to the theatre. From comments received, some residents are reluctant to go out on their own and are more reliant on staff to accompany them in these activities. Residents also spoke about places they had visited for holidays in the past and are hoping that similar arrangements can be made for this year. This is an area which should be followed up by the staff team to ensure that so far as possible, individual/small group holidays are arranged in accordance with the expectations of residents. The meal arrangements for some of the residents have changed since they moved into the home. This includes the provision of a midday meal when previously, they were used to this being provided in the evening. This has meant a change in their daily routine which for some, has been difficult to adjust to. Although it is understood that these changes had been discussed with residents, there is no evidence that a more flexible arrangement was considered in order to meet individual preferences and choice. There is no permanent cook on the staff team as this role is covered by a regular member of agency staff. One of the residents explained the new dinner arrangements to the Inspector which involved all residents who are in the home and at the time, going to the main kitchen at lunchtime to fetch their own cutlery and the cook serves up dinner. Residents are encouraged to prepare their own breakfast which includes cereals and at tea time, an assortment of sandwiches are provided. Asked whether a cooked breakfast is ever offered, residents stated that ‘staff do not allow this’. There are normally two choices of main meal which includes a vegetarian dish. Where residents do not like what is on the menu, they sometimes have an omelette instead. The menus which had been previously submitted with the pre- inspection questionnaire, are limited both in variety and alternatives available. Sometimes there are two meals available and at other times, three choices appear on the menu. Often there was only one dessert shown with no alternative although sometimes there is a choice of pudding. Given that some of the residents are diabetic, professional Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 15 nutritional advice should be sought to providing a greater variety of meals. All residents should be consulted on an individual basis regarding their preferred choice and suggestions to provide increased variety. The minutes of a residents’ meeting held recently, confirmed that residents would like more choice and examples were given. The home needs to be as flexible as possible in order to provide a service that reflects individual choice and for using its staff and resources effectively. Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. Assessed and identified care/health and emotional needs were being met appropriately with the support of other health care professionals but this was not always clearly monitored or evidenced in the personal care records. Policies and practices on medication were not always being followed for the protection and well-being of residents. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The staff team are good at interacting with residents and offering the support required. Residents also spoke positively of the staff who they felt were friendly and approachable. Some of the residents spoken to, confirmed that staff discussed their needs and the support required with them and this was evidenced from signatures provided on some of the care plans. There was no reason to suppose that the principles of respect, dignity and privacy were not being upheld. Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 17 As already referred to in this report, there were inconsistencies with the way some information was recorded and examples where brief mention was made that reviews had taken place but without any clear reference as to the outcomes or decisions made, who was involved and any necessary action which needed to be taken. Some review reports were on file but these had not been signed by staff or the resident concerned. Entries had also been made in the daily log/night reports indicating that reviews had taken place but with no details. Visits had also been made by the community psychiatric nurse but there was no record available in the health care records as to the purpose of the visit or what was discussed. In one of the care plans dated November 2006,reference was made to the need for assisting a resident with every meal but no reference was made to this in the daily log report or care plan as to whether this support had been given or was still required. One of the care plans had been reviewed and signed by a staff member and the resident concerned in January 2007. This related to physical health and the need to maintain a consistent weight. Regular weekly weight records had been kept but there appeared to a large discrepancies with the weight recorded for one week to what was recorded the previous week. At the time of the inspection, the deputy manager was unable to explain this discrepancy. Some of the residents have diabetes and a few of the staff have had one day’s, training but feel this is insufficient and that additional and more in-depth training is necessary. Overall, medication records were being maintained in accordance with agreed practices but some transcribing had taken place which had not been supported by two staff signatures and/or confirmation in writing or fax by the doctor, community psychiatric nurse or consultant involved. Some medication details were not clear or specific where the only instruction given was to be taken as directed. There should be clear recognition of staff signatures who have responsibility for administering medication to avoid the possibility of duplication or misuse. Closer monitoring and supervision needs to take place by management to ensure there is a clearer understanding and consistency in the way practices, procedures and recording are followed through for the well-being of residents. Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is poor. People who use the service are able to express their concerns but do not have a copy of the complaints procedure. The home’s policy for the prevention of harm to vulnerable adults is not compliant in accordance with the Public Interest Disclosure Act 1998 and Department of Health guidance No Secrets, which could pose a risk to residents. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Residents are able to express their views and residents confirmed that regular meetings take place. Residents felt that they could approach staff at any time should they have any issues or matters of concern. Reference to the home’s complaints procedure is made in the Statement of Purpose but as already referred to in this report, this document has not been made available for residents within the Service User’s Guide since moving into the newly refurbished building. Although staff spoken to, had a knowledge of the reporting procedures to be followed in cases of abuse or where this was suspected, the Registered Provider’s policies and procedures manual is not compliant and gives wrong Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 19 information which is contrary to the statutory requirements laid down. Section 7.2 of the Registered Provider’s manual refers to abusive incidents and protection of vulnerable adults. Stage 2 refers to the service user’s consent and the policy states that:’Service users should be given choice about the way in which an investigation can proceed. Before a course of action is determined, the consent of the service user must be sought. Wherever possible, you should act in accordance with the wishes of the vulnerable adult’. This means residents in the home could be vulnerable and that such incidents are in danger of being suppressed and not properly dealt with. Staff have a duty of care and responsibility for immediately reporting such incidents to their line management and/or the agencies concerned. The other agencies to be contacted are correctly identified in this section of the Registered Provider’s procedure manual but immediate arrangements must be made for this section of the policy to be updated in line with the Public Interest Disclosure Act 1998 and Department of Health guidance No Secrets. Advice was given to the deputy manager on these issues at the time of inspection. Lifstan Way (74) DS0000015445.V329218.R02.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, 26 & 30 Quality in this outcome area is good. The physical design and layout of the home enables residents to live in a safe, well maintained and comfortable environment, which encourages independence. Overall, the home is clean and hygienic. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Since the last inspection, refurbishment of the premises has taken place which has been purposely designed to meet the needs of residents in accordance with the National Minimum Standards relating to care homes for adults. Completion certificates/correspondence relating to the building, compliance of fire prevention measures, environmental health standards, gas and electricity safety, have previously been made available to the C.S.C.I. Residents spoken Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 21 with, confirmed how pleased they were with their new single bedroom accommodation together with ensuite facilities. All residents have keys to their own bedrooms. Residents had been involved in choosing colour schemes for their individual accommodation. It would be helpful if clearer means of signage with names/photographs of residents could be provided and affixed to bedroom doors to assist residents in identifying their individual rooms. Additional pictures would also be an asset for the corridor walls to enhance a more homely atmosphere. Additional bathrooms and toilets are fitted with appropriate aids and adaptions to meet the needs of people who use the service and are in sufficient numbers. There were good examples of where the home had taken account of particular sensory impairments such as hearing problems and a special fire alarm device had been provided in the bedroom of the resident concerned. Lifstan Way (74) DS0000015445.V329218.R02.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): 32, 33, 34 & 35 Quality in this outcome area is adequate. The number of staff on duty, with support and supervision, was able to meet the needs of residents who have confidence in the care provided. Recruitment procedures and practices are not sufficiently robust to ensure the protection of residents. The training programme needs to be improved to equip staff appropriately to meet the specific needs of residents. This judgement has been made using available evidence including a visit to the service. EVIDENCE: A rota was available which recorded the named staff on duty. This consisted of the deputy manager and two social care workers for the early shift and two social care workers for the late shift. Copies of previous rotas had been sent to the C.S.C.I. prior to the inspection and the levels of staff varied between three people covering the early shift which included the person in charge, and two for the late shift. One ‘sleep-in’ member of staff was rostered each night. It Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 23 was noted that on some occasions there were just two care workers, including the person in charge, on duty for the early shift. At the time of the site visit, the Inspector was advised that two staff, including the acting manager were on long-term sick leave and staff were covering some of the vacant hours together with agency staff. Staff rotas which were available in the home did not always show full details of actual hours and overtime worked. It is understood that the home has recently appointed two care support workers to cover awake duty at night but C.R.B. checks are still awaited before they can commence duty. An additional member of staff is also employed as a cleaner for the communal areas five mornings per week and an agency cook covers five mornings per week. Residents spoken to, felt properly supported by the staff team and interaction observed during inspection was seen to be appropriate. It is important that staffing rotas take into account the needs and routines of the people who use the service and that sufficient experienced staff are always available. A sample check was made of recruitment procedures and copies of Criminal Records Bureau forms were available. Some of these had been completed a few years ago and the Registered Provider needs to consider whether these should be renewed. The overall policy for recruitment procedures and how these were processed was not clear as from the checks made, there were not always references available on file. The deputy manager thought these may be held at head office. Proof of identification, application forms and appointment letters were available. There was no written evidence to show that the employment agency had undertaken full recruitment checks, including C.R.B. applications, for agency staff working in the home. The agency cook working in the home did advise the Inspector that the previous manager had been given a copy of the C.R.B. check and that he had completed health/safety and food hygiene courses two to three years ago. Records of training completed by staff were available and from the sample checks made, this included food hygiene, health and safety and it is understood that all staff have completed infection control procedures. The Inspector was advised that staff are expected to attend training in London every three years as a refresher for core subjects and an exam is taken at the end of the day. Two staff had completed a one-day course on diabetes but staff spoken to, said that they would appreciate a more in-depth course as several of the residents in the home are diabetic. As already referred to in his report, professional advice should be obtained to increase the knowledge of staff regarding alternative dietary food which is available. The Inspector was advised that only one member of staff had completed first aid training and arrangements must be made for other staff to be trained in accordance with Regulation 13(4). Other courses, which should be considered, are physical restraint & managing challenging behaviour and care planning/risk assessment procedures. Records were available to show that staff supervision had taken place. Lifstan Way (74) DS0000015445.V329218.R02.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, 38, 39 & 42. Quality in this outcome area is poor. The home lacks leadership and management skills in the development and daily operation of the home to meet its stated purpose, aims and objectives. There is an absence of evidence to show that self monitoring and review of the service regularly takes place. The health, safety and welfare of service users are promoted but this could be improved. This judgement has been made using available evidence including a visit to the service. Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 25 EVIDENCE: An acting manager has been in post since the previous manager left the home. An application for registration of the manager has not been received by the Commission for Social Care Inspection. At the time of the site visit, the acting manager was on long-term sick leave and the deputy manager was covering this position. Although the staff team work well together, there is a lack of leadership skills and inconsistencies in the way policies, procedures and practices are followed through on a day-to-day basis. Some of the policies had not been reviewed or kept up-to-date and quality assurance monitoring has not been implemented as a core management tool. From the evidence available, staff have not always had sufficient or recent training to enable them to have up- to -date knowledge/skills in relevant areas regarding specific needs of residents. Monthly visit reports by the Responsible Individual, as required under Regulation 26, have not recently been made available to the C.S.C.I. Although personal care and other official records were available, these had not always been maintained up-to-date on a regular basis and administrative systems were sometimes confusing to follow. Agency checks had not been carried out as required. Health and safety issues need to be monitored more closely in the home and at the time of the site visit, there were no risk assessments which had been completed for a safe working environment. There was no audible security/warning device in place on some of the exterior doors to alert staff where residents may be at risk, should they leave the premises unaccompanied. Although staff have attended training in infection control, this should be monitored to ensure hygienic and safe cleaning procedures are used at all times as well as a observing regulations related to the control of substances hazardous to health (C.O.S.H.H.). It was noted during the inspection that the staff ground floor toilet adjacent to the kitchen, did not have paper towels or disposal facilities. This could pose a risk to health and hygiene where food is being prepared. All staff who handle food must complete their food and hygiene training which should be updated at regular intervals. The home needs to be kept aware of any new legislation, guidance and best practice to provide staff with relevant and necessary information which can be used for the benefit of the residents who use the service. Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 26 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 1 2 1 3 x 4 1 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 1 1 2 x x 2 x Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 27 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 Regulation 4 Requirement Timescale for action 30/04/07 2. YA1 5 3. YA2 YA4 14 4. YA5 5A/B The Registered Person shall compile an up –to- date Statement of Purpose for the home incorporating matters as listed in Schedule 1 and a copy of this statement shall be sent to the Commission for Social Care Inspection. The Registered Person shall 30/04/07 produce a written Service User’s Guide in accordance with this regulation (as amended). Copies of this document must be given to residents or their representative, and to the C.S.C.I. The Registered Person shall 31/03/07 not provide accommodation to a prospective resident unless there has been a full preadmission assessment and appropriate consultation/visits, to ensure that the care home is suitable for the purpose of meeting the prospective resident’s health and welfare. The Registered Person shall 30/04/07 provide to each resident a statement setting out the DS0000015445.V329218.R02.S.doc Version 5.2 Lifstan Way (74) Page 28 5. YA6 15 & 17(Sched3) 6. YA7 12(2)&(3) 7. YA16 16(n) 8. YA17 16(i) 9. YA19 17(Sched3) contract/terms and conditions, specifying the fees payable and the services provided by the home, in accordance with this regulation (as amended). This information to be included with the Service User’s Guide. The Registered Person shall, after consultation with the resident, or their representative, maintain up to date care plan information and keep the plan under regular review which should be documented. The Registered Person shall ensure that the care home is conducted so residents are enabled, so far as possible, to make decisions with respect to their care, health and welfare which takes into account their wishes and feelings. This relates particularly to daily routines and meal arrangements. The Registered Person shall continue to consult/ support residents relating to social/recreational activities, including holiday arrangements. The Registered Person shall, having regard to the size of the care home and the number and needs of residents, provide in adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared and available at such times as may reasonably be required by residents. Professional advice from a dietician should be sought to assist in this process. The Registered Person shall maintain in respect of each DS0000015445.V329218.R02.S.doc 15/05/07 30/04/07 15/03/07 15/05/07 30/04/07 Lifstan Way (74) Version 5.2 Page 29 10. YA20 13(2)Sched3 11. YA22 22 12. YA23 13(6) resident, an up -to -date record which includes information, documents and other records specified in schedule 3 relating to health care, appointments and treatment provided. The Registered Person shall make arrangements for the recording, handling, safekeeping, and administration and disposal of medicines received into the care home in accordance with the guidance issued by the Royal Pharmaceutical Society. This refers particularly to clear/ precise dosage instructions and changes in prescription details, which must be confirmed in writing by the health care professional concerned. The Registered Person shall establish a complaints procedure in accordance with the requirements of this regulation which must be made available to residents as well as a summary being included in the Service Uses Guide (Reg 5). The Registered Person shall make arrangements for ensuring the procedure for preventing abuse and reporting procedure is compliant with the Public Interest Disclosure Act 1998 and Department of Health Guidance No Secrets. Arrangements must also be made for staff to be made aware of these changes and for any additional training to be provided as required. (Previous timescale of 31/04/05 not met). DS0000015445.V329218.R02.S.doc 31/03/07 30/04/07 31/03/07 Lifstan Way (74) Version 5.2 Page 30 13. YA34 19 14. YA35 15. YA37 YA38 16. YA39 17. YA39 18. YA42 The Registered Person shall not employ a person to work at the care home unless all recruitment checks have been completed and are available, which includes two written references and evidence of Criminal Record Bureau checks. Written confirmation must also be available of recruitment checks completed by employment agencies for staff working in the home. 18(Sched4) The Registered Person shall, 13(4)(c) ensure that at all times persons employed in the care home receive training appropriate to the work they are to perform including structured induction training (to Skills for Care specification), suitable assistance, including time off for the purpose of obtaining further qualifications appropriate to such work including training in first aid. 8 &9 The Registered Person shall appoint an individual to manage the care home who has the qualifications, skills and experience necessary for managing the home on a dayto -day basis . 24(1) The Registered Person shall establish and maintain a system for evaluating the quality of the services provided at the care home 26 The Registered Person must arrange for at least one monthly monitoring visit to take place and to prepare a written report on the conduct of the care home. 13(3)16(2)(j) The Registered Person shall ensure that suitable arrangements are in place to DS0000015445.V329218.R02.S.doc 31/03/07 31/12/07 30/04/07 30/05/07 31/03/07 15/04/07 Lifstan Way (74) Version 5.2 Page 31 19. YA42 13(4) prevent the spread of infection and that satisfactory standards of hygiene are maintained in the care home. This refers to the need to provide paper towel and disposal facilities in the staff toilet adjacent to the kitchen . The Registered person shall 30/05/07 ensure that all parts of the home to which residents have access are so far as reasonably practicable, free from hazards to their safety and appropriate work place risk assessments are in place and reviewed as required.(this includes having regard to C.O.S.H.H. regulations, necessary). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA20 Good Practice Recommendations The Registered Person should consider a more secure method of recording daily log/night reports to minimise the risk of pages becoming detached or lost. The Registered Person should arrange for staff to attend refresher training in medication procedures which should comply with procedures set out in guidance issued by the Royal Pharmaceutical Society. The Registered Person should consider, in consultation with residents, providing signage and symbols including photographs for bedroom doors to assist residents who may need assistance in identifying their room. Additional pictures/ photographs should also be considered for corridor walls to enhance the homely environment. 3. YA24 Lifstan Way (74) DS0000015445.V329218.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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