Inspection on 06/09/07 for 75 Hightown Road

This inspection was carried out on 6th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

75 Hightown Road 19/03/07

75 Hightown Road 21/12/05

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Dalewood Respite Care

Orchard,The

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Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 75 Hightown Road Ringwood Hampshire BH24 1NH Lead Inspector Clare Hall Unannounced Inspection 6 September 2007 13:45 th 75 Hightown Road DS0000064991.V344359.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 75 Hightown Road DS0000064991.V344359.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. 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 75 Hightown Road Address Ringwood Hampshire BH24 1NH 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) 01425 461269 www.c-i-c.co.uk. Community Integrated Care Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th March 2007 Brief Description of the Service: This home is registered to provide care and accommodation for four service users who are young adults and have a learning disability. The responsibility for managing this service is by Community Integrated Care (CIC). The property is leased from Hampshire Voluntary Housing. The manager has recently resigned. Accommodation is provided in a large family home, situated in a quiet residential area. It is close to local amenities, shops and public transport. Service users each have their own room on either ground or first floor and share two bathrooms. Access to the first floor can be gained by one flight of stairs. There is a large lounge, dining room, conservatory and kitchen/diner and an enclosed pathed garden. The acting manager confirmed the home charges a standard tariff, which is £1,025.91 per week. 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information used to write this report was gained from the agencies annual quality assurance assessment completed by the manager, a visit to the service, review of comment cards received from staff, relatives, care managers and other health and social care professionals. Other information was gathered from the services history of events, previous inspection reports, direct conversations with staff, analysis of information supplied to and recorded by the inspector. During the visit to the home, the manager and staff assisted this inspector. What the service does well: What has improved since the last inspection? The service review indicates that since the last visit the service has implemented essential lifestyle plans tailored to record the individual aspirations of each resident and that residents have been more involved in all aspects of their lifestyle including meals. They report that since the last inspection they have strived to improve the documentation regarding the administration of medication and that the homes policy for handling residents monies has also been improved. In addition staff are undertaking regular checks of held monies and the complaints procedure is now included in their service guide. The annual review also identifies that new flooring has been placed in one service users room and a new bath has been installed in the downstairs bathroom. 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 6 Also a new bed has been purchased to meet the changing need of one resident and other residents have participated in choosing various indoor and outdoor plants and garden ornaments. The home has also acquired an allotment so that residents have the choice to grow their own fruit and vegetables gaining life skills and independence. What they could do better: A care manager felt the improvement of the service could be the staffing levels. This was also a reported concern of relatives and staff. The services own annual quality assurance assessment indicated they need to ensure all care plans ,essential life plans are reviewed and that all documents are in a legible format. They further comment that records need to show the change in the resident’s needs and how they are supporting the residents to attain their goals. They acknowledge they need to have more regular resident meetings and involve all the family and advocates and that further improvement is needed to ensure residents receive a varied and balanced diet. It was stated that they also need to use better tracking in care plans for individuals visits to healthcare professionals and to improve the procedure in place to document any complaints received. They also state they need to improve the amount of sensory equipment they have and to try and have a better ratio of male to female staff so residents have more choice in who they want to do their personal care. They recognise they need to have more staff qualified to NVQ standard and that the homes manager needs to undertake management training. They state they need to ensure all their paperwork is up to date and stored correctly and ensure all written documents are reviewed regularly and updated whenever necessary. Following a visit to the service by the inspector 11 areas of concern have been raised through requirements, four of which have been raised previously and not addressed. The inspector found shortfalls in care records and assessments ,record keeping and documentation and for the upkeep of the premises and managing safety. A further shortfall was found in the lack of support given to staff to ensure they are able to fulfil their role. The service have not been employing a good process for auditing their standards of practice and the outcomes for the residents using their services. 75 Hightown Road DS0000064991.V344359.R01.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. 75 Hightown Road DS0000064991.V344359.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 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,5, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The organisation has made changes to support the needs of individuals but there are further improvements necessary to ensure the service can support all the persons accommodated. EVIDENCE: The service has not admitted any new clients since the last inspection. The four clients met all had individual written statement or contract on their files. Discussions and records identified that one service user had recently been discharged from hospital had an assessment carried out with the input from multi agency professionals and the clients family to ensure that they could meet the needs of the individual. The service has improved their assessments by undertaking Essential Lifestyle Plans. The service has made changes to ensure the needs of individuals can be met. New flooring has been placed in one service users room to meet their 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 10 changing needs. A new bath has been assessed and installed giving the Service users a choice of bath or shower to maximise their independence. A new bed has been purchased to meet the changing needs of one Service use and staff state, every effort was made to ensure that the bed would still have a homely appearance. Concerns have been raised through out the report regarding the needs of service users not being recorded in care plans and assessments and for the inability of one service user to access all areas. 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9, Quality in this outcome area is Adequate Despite improvements having been made in the services assessment processes, there are still significant shortfalls in ensuring records are maintained regarding the needs of all individuals. EVIDENCE: The last audit found there was no records of service users being involved or consulted regarding the care plan content, therefore a requirement was made to ensure that care plans are reviewed regularly with service users involvement. The service annual quality assurance assessment (AQAA) stated that all service Users are involved in their care reviews, care planning and all events in the home which may effect them and that daily notes show the way that each individual Service User communicates their choices. 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 12 When auditing the records it was found that new care records were now in place but these were not hand signed by staff nor did they show the involvement of the service user. Entries seem to be undertaken by a number of staff but records do not always indicate by whom. Care plans were not reviewed regularly up until 17/07/07 and this was questioned during the visit with staff. Senior Staff said they hadn’t had time to check this had been done. It was also discussed with staff that the care records despite being changed are not easy to complete making it complicated for staff to access the relevant information. Records are repetitive and old records have not been removed/archived. Staff do not use the care plan records as working documents. Service user records are fragmented across a number of folders making it difficult to follow need assessments. One staff comment card stated, “Any change or update to the support or care of residents is notified to staff via team meetings as required or personally or communication book if urgent.” There was no mention that they would refer to the care plan. A discussion also took place with staff regarding how the care plans did not identify that they had been driven by the service users wishes, needs and preferences. When asking a member of staff about clients current health needs they were described to the inspector as , X has • • • • Diabetes Immobility and manual handling difficulties Incontinence Pressure sores x 2 Despite this there was no reference to wounds/pressure sores in the care plan (staff said they were putting sudo cream on them and covering with a dry dressing). The provider has subsequently stated that this resident did not have pressure sores and that medical advice had been sought from a medical professional and was recorded in the health action plan, which was not seen during the inspection. References to the other health needs were erratic, poorly described and planned for. 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 13 It was further noted that despite having these needs the accompanying risk assessments were not in place regarding these needs either. The staff confirmed there was no nutritional risk assessment in place and that weights for all clients had not been undertaken for some months. Records confirmed this. In other client records there were the necessary risk assessments in place and these had been updated and reviewed. One client did have a detailed manual handling risk assessment in place but another risk assessment was found to be out of date. One clients records indicated they enjoyed going to the pub, shopping for groceries, attending the women’s institute, going to the library, going to the day centre, having friends come and visit, a glass of baby sham, watching TV and DVDs, to see their family, to go to shows at the theatre and as she loved dogs, going to dog shows. Records were that today she had a friend over and yesterday she went to Tescos. Staff confirmed she went to a show to see ABBA and went for a drive yesterday to see the ponies. There was a good amount of detail regarding her preferences to her routine and staff did say improvements have been made to offering more choices and improving personal centred care planning . One care evaluation captured was, “X chose her clothes for the next day and when she would like to go to bed. . 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,14,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff have improved personal centred planning and the wishes and desires of individuals are respected in their every day lives. The staff have improved consultation but could further improve some aspects in relation to ensuring the residents have their nutritional needs assessed and recorded. Limitations to the freedom of residents to access all areas of their home externally need to be removed. EVIDENCE: Care records did note client attendance for college and other age peer and culturally appropriate activities. Records identified service users going for, 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 15 “a short push (in their wheelchair) along high town road” and, “yesterday a drive after dinner.” Other notes recorded, “x enjoying a shopping trip to buy groceries and shopping for personal clothing.” Recorded indoor activities noted in client records were, • • X was helped to tidy their room a bit X was supported to pack washing away and tidy her room and choose a DVD to watch. On the day of the visit a relative was seen arriving and picking up their son for a trip out and client records identified that they were being enrolled on courses for sensory cooking, story telling and sensory gardening as they had shown a preference to these pastimes. Preferences were also noted regarding what individuals like to eat with and how individuals choose preferences for cups and mugs. Improvements have been made in respect of meals and mealtimes. Discussion and records identified that service users choose their menu each week with the support of staff using prompts and their names are recorded next to the meal they chose. This was seen displayed in the kitchen. Mealtime preparation was observed and staff sat with residents during the mealtime supporting them. The use of aids was encouraged appropriately to promote dignity and independence. Throughout the mealtime conversation, dignity, respect and choices were respected and encouraged. Staff showed a calm and patient understanding of the needs of each individual and were very supportive. The only issues in respect of nutrition and health were the lack of monthly weights. These had not been completed on all residents since May and June of 2007.This was a concern when a comment in communication book was that one resident had put on a significant amount of weight. This has also not been incorporated in the respected client care records and care plan. Staff confirmed they do not undertake nutritional risk assessments. Despite this a lot of good practice was noted and these were 1. Food records completed. 2. High risk foods were probed before serving. 3. Menu and service user choice displayed. 4. Foods in fridge covered and dated. 5. Specialist cutlery available and discussion indicate an occupations therapist had been involved in providing aids. 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 16 Staff discussed how they planned to use the newly purchased week board to display a pictorial menu empowering resident choice. The manager must now look to how the service users nutritional needs and support will be assessed and planned for. One concern raised in a later section was all service users do not have unrestricted access to the home and grounds due to the lack of upkeep for the garden and issues around safety. 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff work hard to manage the needs of individuals but the systems they are using to assess and record needs and outcomes need to be reviewed and made effective. The care records and outcomes are not receiving constant audit and this is causing client files to be overly bulky, disorganised and unauditable. Staff are making attempts to ensure medication records are completed. The organisation needs to ensure the training staff receive for the safe administration of medication is to the level desired by the skills for care council. EVIDENCE: Care records were found on previous occasions to be out of date and not reflecting peoples needs. 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 18 Despite the introduction of new care processes by the organisation there are still significant omissions for the recording of the current healthcare needs of individuals. This has been discussed and noted in a previous section in respect of a lack of risk assessments for nutrition, weight loss management, specialist dietary requirements, and falls. Client records are fragmented and therefore difficult to audit. Staff are not clear on how they should record events and are using the communication book to record events and significant changes. Despite this the home staff have recognised when they are in need of specialist advice and support. One care manager commented that, “Following on from my assessment a referral was made for support from specisalist learning disability healthcare support. The service was struggling to provide care for an individual due to a recent hospital discharge .They were managing the service users needs very well but needed extra specialist support.I undertsand that the health team are now involved and the situation has eased.” Clients are having regular care management reviews. One stated, • • • X especially accustomed chair should be arriving soon .The chair offers support in all the right places and the correct height. A podiatrist has been found who will visits the home and x will be offered treatment every five weeks X is going to be supported to register at a dentist surgery in new Milton due to her current dentist having poor wheelchair access. The review also indicated how x was being supported socially and what activities they were participating in. Records indicate that staff discuss healthcare needs of residents. Areas noted and recorded on were the need for health checks, medication reviews, activity reviews, arrangement for any specialist therapies (Indian head massage), activity reviews, review of walking aids, podiatry needs and for doctors appointments. One compliment letter from a relative stated, “Thank you very much to you and all the staff for the wonderful care you give to X.” The client medication records audited have improved. The notes made by staff in the communication book would indicate staff have been auditing these. 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 19 Notes were written regarding omissions made in the records and actions to manage this. One area of concern was the quality of training provided to staff so that they were deemed competent to undertake medication administration. Discussion established that the manager, who does not hold any specialist qualification in medication, undertakes this training for staff. The training does not include the criteria set down by the skills for care for medication competence (learning sets). Further there were notes in the communication book, which said “I have spoken to x at the pharmacy regarding what to do when medication is not required. We are to write O.” This inter staff communication would indicate a lack of understanding in the recording of medication throughout the staff group at a basic level. Staff stated they receive their guidance from the local pharmacy. Staff confirmed they don’t use any guidance from the skills for care council on medication learning and that the manager responsible for giving the training has not received any specialist training to deem her competent and able to undertake this role. Care records did indicate that clients and or families had been consulted regarding the arrangements in case of death. 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 20 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 adequate This judgement has been made using available evidence including a visit to this service. Staff cannot improve practices, which may have been complained about if they do not have any knowledge of dissatisfactions, which may have been received by the service. The organisations has not ensured there is an audit trail to indicate they handle complaints in line with their policy and procedure. EVIDENCE: A recommendation made at last visit was that the complaints log should include details of the date when a complaint is made; who and the outcome took the date action, as this would provide an easy audit trail for the home to monitor complaints. The homes AQAA states there has been one complaint since the last visit, which was resolved within 28 days and one safe guarding investigation. The inspector was unable to audit the handling of complaints by the organisation as she was informed by staff that the details of the recent complaint was not held on the premises, that staff did not know the content of it and that there were no records to see. At the last inspection it was stated, 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 21 “We plan to have a complaints procedure which is an a audio/visual format to meet service user needs which is accessible to them at all times.” This has not been undertaken. In the AQAA received prior to this visit the organisation reported, “We need to improve the procedure in place to document any complaints received.” When a care worker was asked in their comment card, what would you do if you witnessed bad or inappropriate practice stated “blow the whistle and inform the manager immediately and fill in the necessary forms.” Records indicate that staff complete financial checks regularly to safe guard clients from financial abuse. 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is not a clear responsibility taken to ensure the service is kept suitable for it’s intended purpose as the outdoor space is not suited to the needs of all individuals. EVIDENCE: The homes grounds were not found to be suitable for its stated purpose when visited. It was not accessible to all service users, had not been maintained and was not safe to walk in and did not meet the needs of the individuals. One service user was observed crawling to the back door leading to the garden. A staff member assisted him up and led him outside to the side gate 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 23 and during this the client knocked his leg on one of the cut branches laying across the patio/path. This was amongst 15 bags of garden refuse and tree cuttings spreading across the walkway. The back garden was overgrown with weeds, had tools and implements left around and the patio was overgrown with weeds and very uneven. There was a broken greenhouse, and a broken TV in the garden and a full wheelbarrow and numerous garden cuttings lying around. It was also identified that one client was unable to access the garden because the path and patio were uneven and this individual had mobility disabilities. Internally one service user had no lock on his door and there were odours to one service users room downstairs and a number of light fittings, skirting and surfaces, which were overly dusty and dirty. The carpet was also not clean. The organisations policies and procedures are not up to date (see standard 40) Staff confirmed that the home does not have the department of health guidance regarding infection control and prevention of infection in care homes. Despite this the client individual rooms were nicely decorated and suited to needs and wishes. Staff had made stimulating areas around the home suited to the needs of one service user and since the last inspection a disabled bath has been installed in the downstairs bathroom. 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 24 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): 32,33,34,35,36, Quality in this outcome area is Adequate This judgement has been made using available evidence including a visit to this service. The senior staff in the home are not suitably equipped to undertake the role they are expected to do. Care staff are provided with a level of training they find prepares them to undertake their role. Staff and stakeholders are not satisfied with the staffing arrangements. The organisation needs to improve the Learning and development planning and supervision of senior staff. Setting objectives goals and recording the support needed, so to ensure the staff are skilled competent and feel confident in their roles they have been given. EVIDENCE: Staff records indicated staff are provided with standard mandatory training and that they felt satisfied with this. 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 25 Evidence identifying the failure by staff to record the needs of the residents in care plans, record keeping and a minimal knowledge in respect of medication administration would indicate staff would benefit from more specialist training and guidance. Staff reported they felt unsupported by senior managers outside of the home and that changes have been made but staff either haven’t had time to implement them, nor have they been given the training to support the changes. Staff reported they undertake roles they are not prepared for and outcomes are not audited or measured. Staff are not adequately consulted and supported by the organisation. Records showing that staff are provided with induction training, which meets the national minimum standards, and that 100 staff hold a safe food handling qualification unless the staff practices are monitored. There has been a previous issue regarding the homes staffing numbers. It was raised that Staff said that a minimum of two staff are on duty and that any one-to-one hours needed to support service users are covered by bank staff. The rotas showed that a minimum of two staff were on duty each day. This included the acting manager who said she has few hours a week to concentrate on the management aspects of the home. On this occasion the staffing levels were confirmed as the same. One relative said, “The only negative is inconsistent staffing / turnover.” The organisations own AQAA indicated that there is a high percentage of agency /pool or bank staff in use. However, the provider has stated that bank staff are specifically employed and undertake the same training as staff and this provides consistency. A comment made by the organisation in their assessment was, “ A barrier to the improvement of the care home was being short staffed.” One comment from a care manager was that, “the home may be struggling at the moment with staffing levels as they may be experiencing recruitment issues.” One care staff comment card identified in one comment, “Staffing levels do fluctuate brought up to strength by bank or relief.” The homes own internal audit indicated that there are less than 50 of staff employed that hold a qualification in care. However, the AQAA states that there are plans for at least two more staff to undertake NVQ training within the next 12 months. 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 26 Two newly recruited staff had their records audited. Both indicated they had received a probationary package. This included an in house induction day. Records were completed for days one to three and showed an induction to health and safety, the homes buddy system and a medication assessment. The learning plan also noted the records of statutory training for moving and handling, first aid, basic food hygiene, fire training and introduction to challenging behaviour. There were also Health and safety checklists but some were incomplete regarding fire instruction, infection control and care planning. One care worker comment card stated, “the team work really well together, always keeping the service users interests as a top priority.” Files of newly recruited staff identified that a thorough recruitment process had been undertaken and all checks had been completed prior to employment . Staff comment cards indicated that staff felt the training and induction covered everything they needed to know to do the job when they started by use of the induction training pack but mostly on the job training (shadow staff doing the job) which was considered comprehensive and in detail. One care staff commented “Specific training is undertaken to gain knowledge to help us do the job more effectively. “Support and supervision is on a regular basis with important issues dealt with as / if they arise. Annual reviews are carried out to guide performance and targets are set.” 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 27 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): 37,38,39,40,41,42, Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Despite changes in management staff there has been no improvement in management practices and service user outcomes. It has also failed to monitor the outcomes of the homes stated purpose and ensure that care practices are safe. A failure to audit the minimum standards has led to service users being placed at risk despite the hard work of staff and the good care and support being provided by them. EVIDENCE: 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 28 There has been a long history since 2005 of management changes however the service is aware of this. The AQAA identifies the need for the manager to obtain the Registered Managers Award and NVQ 4 and states that this will be started within the next 12 months. There is a new manager in position but she has recently resigned. The care staff report they feel really supported by the homes manager and said she had been working very hard to improve outcomes for residents. A care manager also stated that, “I was impressed by the positive attitude of the manager and the one member of staff I met who showed respect to service users.” Another stated, “I have only visited the home once to complete a care management assessment .The manager was very helpful and her knowledge of the service users needs was excellent.” Staff reported, , • I do feel the service is striving towards a much more person centred outlook We involve service users in all decisions regarding life and try as much as possible to implement any choices they have made. • I think the company CIC needs to invest more time and support in the managers. This includes service managers, who I feel are given too many houses to support and monitor. If in doubt support there is always someone to give assistance if needed. • They also said in their survey • The service excels in its main role for supporting people and is continually looking for ways to improve. At the last inspection a concern was raised that the manager was not always aware of where the paperwork was kept for the inspector to see. This was apparent again on this occasion. The manager and staff were finding it very difficult to find relevant policies and procedures and the homes quality assurance policy. Paperwork in general was poorly indexed and disorganised. One outstanding requirement from the last inspection was for the records required to be kept in the home to be up to date, accurate and available for 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 29 inspection. Again on this occasion the complaints records were not available and a number of care records had not been updated. The service assessment (AQAA) also identified that some policies and procedures are quite dated. These were noted as: • • • Pressure relief 1997. Manual handling 1995. Clinical waste 1999. The policy index also showed the infection control policy as 2004 and the fire risk assessment as 2001. Staff looked for updates within file and could not find them. The fire risk assessment record was devised in 2000 and had not appeared to be updated since the new legislation This was last reviewed by staff 31/01/07. At the last visit it was indicated that the provider had developed a quality assurance system, which the home are going to use to gain views and opinions from the people who use the service. It was stated by the acting manager that a questionnaire would be sent to service users and their families/representatives. The inspector read the homes quality assurance policy. It stated, “Each year the continuous improvement department will issue questionnaires to service users and their relatives representatives and analyse the responses and make reports available.” When asked staff including the ex manager and current manager did not know what the policy was where it was and said they didn’t have any knowledge of the policy being implemented. When talking to one of the service users relatives they confirmed they hadn’t received a questionnaire. It was further stated that the responsible individual for the organisation completes monthly-unannounced visits to the home as required carrying out a quality review of the service. A copy of these reports was available in the home. Regulation 26 visits undertaken did indicate some audit and action in respect of fire training and records, COSHH risk assessments, fridge and freezer checks and review of policies needing updating. Regulation 26 visit records do not indicate a thorough process of audit and monitoring or action planning in respect of findings against the minimum standard requirements. A number of concerns were also raised while making a visit to the service. As mentioned in the section on the environment, the garden was in a very poor state, inaccessible by all service users and unsafe to use. 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 30 When walking around the internal building numerous prescription creams were in communal bathrooms, there was a tube of sterident, and five spray cans of oust. These were all removed during the course of the visit and locked away as requested. The laundry door was also found to be wedged open by a device, which was not linked to the fire alarm. This concern was raised at the time and explained to staff. The last regulation 26 report undertaken indicates there are other issues raised in respect of fire safety. Staff could not evidence that a fire risk assessment had been undertaken in line with the changing legislation. 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 2 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 x 27 3 28 x 29 3 30 2 STAFFING Standard No Score 31 2 32 2 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 3 2 2 x LIFESTYLES Standard No Score 11 3 12 3 13 x 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 3 1 2 1 2 2 1 x 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 32 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(c, d) Requirement Care plans must include the support needs for service users, be reviewed regularly and be signed by the person undertaking the review and the service user and/or their representative, to demonstrate service users and staff are aware of service user needs. This has been raised again as the compliance date of 20/03/07 has not been met. Timescale for action 10/11/07 2. YA9 13.4(b, c) Care records must be organised and easily auditable and used as working documents. Risk assessments must be 10/11/07 updated and reviewed regularly, to show that risks have been identified and minimised, to ensure the safety of people living and working in the home. This has been raised again as the compliance date of 20/03/07 has not been met. The current healthcare needs of individuals must be reflected in their care plans with actions stated that clearly indicate that DS0000064991.V344359.R01.S.doc 3. YA19 12 10/11/07 75 Hightown Road Version 5.2 Page 33 these needs are reassessed and reviewed regularly. Assessments must be demonstrated for clients needing support with continence nutrition falls and mobility. 4. YA20 13(2) Training for care staff in medication meet with the guidance of content given by the skills for care council and delivered by someone competent to provide it. The organisation must ensure that there is an audit trail of complaints and any actions taken as a result to demonstrate that those people living at the home have their views listened to. The internal and external accommodation must be kept in a suitable state of tidiness and cleanliness so as to cause no harm. The garden must be tidied up and access ,paths and patio made safe and suitable for use by all the clients. The registered provider must appoint a skilled and experienced manager. There must be a process to monitor outcomes and actions taken to address any shortfalls Policies and procedures giving guidance to staff must be reviewed, updated and reflect relevant good practice. These include but are not exclusive to policies in respect of • Fire prevention and risk assessment, • Infection control, • Manual handling, • Nutrition, • Pressure relief and clinical waste. 10/11/07 5. YA22 22 10/11/07 6. YA24 23 10/11/07 7. 8. 9. YA37 YA39 YA40 8 9 24 12 10/11/07 10/11/07 12/10/07 75 Hightown Road DS0000064991.V344359.R01.S.doc Version 5.2 Page 34 10. YA41 17.1,3. Records required to be kept in the home must be up to date, accurate and available for inspection. This has been raised again as the compliance date of 20/03/07 has not been met. The organisation must address the following areas of concern identified in the body of the report • • • • The wedging open of the laundry door, which is a fire door. The uneven patio and path in the garden. The excessive rubbish in the garden and broken greenhouse. The poor storage of COSHH items. 10/11/07 11. YA42 12 10/11/07 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 YA42 Good Practice Recommendations To implement skills for care council learning sets in medication and infection control 75 Hightown Road DS0000064991.V344359.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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 75 Hightown Road DS0000064991.V344359.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. Re-publishing this information is in breach of the terms of use of that website. 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