Inspection on 25/07/06 for 93 Ings Road

This inspection was carried out on 25th July 2006.

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 no outstanding requirements from the previous inspection report, but made 32 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

93 Ings Road 08/03/07

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 93 Ings Road 93 Ings Road 93 Ings Road Hull HU8 0LS Lead Inspector Christina Bettison Announced Inspection 25th July 2006 09:00 DS0000065523.V297178.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 DS0000065523.V297178.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. DS0000065523.V297178.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 93 Ings Road Address 93 Ings Road 93 Ings Road Hull HU8 0LS 01482 329226 01482 329337 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) Avocet Trust Position vacant Care Home 5 Category(ies) of Learning disability (5) registration, with number of places DS0000065523.V297178.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection NA Brief Description of the Service: The service at 93 Ings Rd is managed by Avocet Trust. It is one of a small number of similar services that Avocet provides. Avocet Trust is a registered charity. This service was a new registration in 2005. 93 Ings rd is a detached house registered to provide respite care for up to five service users. The home is situated on Ings Rd to the east of the city of Hull. The house consists of a hall, lounge, dining room, kitchen, small utility room, two bathrooms one upstairs and one downstairs and five single bedrooms all but one of these being upstairs. One of the upstairs bedrooms has an ensuite shower room. The house has a private garden to the rear of the property and there are plans to create a drive way to the front of the property. There are a variety of shops, pubs, GP surgeries and post office all within walking distance. Public transport to various parts of the city is easily accessible. Weekly fees range from £735 - £2587.94 per person per week. Additional charges are made for the following: newspapers/magazines, hairdressing, chiropody, transport for social activities and sweets. Information on the service is made available to current service users via the statement of purpose, service user guide and inspection report. DS0000065523.V297178.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an announced key inspection and took place over 1 day in July 2006. Relatives surveys were posted out of which 2 were returned; visiting professionals surveys of which 1 was returned and staff surveys of which 1 was returned. During the visit the inspector spoke to the manager and staff. The service users that stay at the respite service at Ings Rd have complicated needs and are not able to tell the inspector of their views therefore in this report comments from relatives, social workers and staff have been used to help to form a view whether service users needs are met or not. Observations of care practice were made to assess service user satisfaction. The inspector looked around the home and looked at some records. Information received by us since registration was considered in forming a judgement. Prior to the visit the inspector referred to notifications sent to the Commission for Social Care Inspection, the event history for the home since registration and the completed pre- inspection questionnaire. The site visit was led by Regulation Inspector Mrs. C. Bettison and the visit lasted eight hours. What the service does well: Avocet Trust provides accommodation and personal care support and is a good service for adults with a learning disability and other needs. The primary aim is to enable people to develop and maintain as much independence as possible, whilst helping them to be more confident and access community facilities. Service users and their relatives are given enough information about the home to enable than to make a choice about whether it will be suitable for them or not. The houses are located in the local community and are on a bus route making all leisure facilities and shops easy to get to. All service users are provided with a single room that meets their needs, in a house for no more than 5 people thereby providing them with a home and private areas to their liking where they can spend private time or receive visitors. DS0000065523.V297178.R01.S.doc Version 5.2 Page 6 Families are encouraged to be involved as much as they wish to and are made to feel welcome when visiting their relative. Service users are able to continue with all of their planned activities and are supported by the staff team to do so whilst staying at the home. Service users receive a healthy diet and their likes and dislikes are also taken into account. What has improved since the last inspection? What they could do better: Each person that stays at the home should have been assessed by a professional person and the home should have a copy of this assessment so that the staff know what their needs are, this has not happened for every service user so their needs may not be met. Each person living at the home should have a detailed individual plan, which guides staff on how their needs must be managed. Important information, e.g. health assessments, risk assessments and behaviour management plans which would help staff and improve the quality of care, is missing. As peoples needs change the plan should change and it should be regularly reviewed however this has not happened. This means that service users needs may not be met. The manager must make sure that staff meet the complicated health/dietary needs of service users and special advice is followed. Service users must be helped to identify and meet their health/dietary care needs. The manager must ensure that medication is handled appropriately, service users must receive their medication when they need it and accurate records must be kept, if this does not happen service users may placed at risk of harm. Each member of staff at the home should have a regular meeting with the manager to discuss the training they may need, support and other things. This has not been happening as often as it should. The home needs to have enough staff on duty every day to meet the needs of the service users that are in the home. DS0000065523.V297178.R01.S.doc Version 5.2 Page 7 The manager must make sure that the staff team have had all the training they need for them to be able to do their job properly and meet all of the service users needs. A quality monitoring system must be introduced to make sure that everyone is asked about the running of the home and improvements are made. At the time of the inspection the home had a new manager however he needs to be registered with the CSCI, in order to give service users and staff a sense of stability. The Commission for Social Care Inspection is concerned about the management and standards of care in the home. This home was only recently registered and there are a high number of requirements arising from this first inspection. 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. DS0000065523.V297178.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 DS0000065523.V297178.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are given enough information prior to their stay and their needs are assessed prior to admission, however the home is not obtaining a copy of this assessment therefore placing service users at risk and staff not being aware of their needs. EVIDENCE: The home has a statement of purpose and each service user has been given a service users guide and a statement of terms and conditions, all documents meet both the regulations and NMS. Two service users care files were examined as part of the inspection process. One of the relatives prior to the inspection had alerted the inspector to the fact that the home did not receive a copy of her sons community care assessment from the local authority prior to admission, this was confirmed on examination of the care file and discussion with the manager who stated that they have been trying to obtain a copy from the local authority (East Riding council) without success. DS0000065523.V297178.R01.S.doc Version 5.2 Page 10 This particular service users has complex needs and without full and detailed information the home will not be able to adequately meet his needs. The other file examined did contain the CCA and Care plan from the Local authority. The registered person must ensure that they receive a copy of the assessment prior to admission. There was evidence that potential customers of the service are admitted for overnight stays and trial stays to determine their suitability for the service. DS0000065523.V297178.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Service users needs are met on an informal basis by inadequate numbers of staff, the quality of the service user plans and risk assessments are very poor. These shortfalls have the potential to place people at risk and mean that service users assessed needs are not met. EVIDENCE: Some minimal information is available in care files however it does not reflect the full range of needs and does not ensure that all aspects of health, personal and social care needs are identified and planned for. Two care files were examined as part of the inspection process. The service user plans did not include everything that is detailed in the local authority assessment/care plan and did not detail accurately what staff need to do to meet service users needs. DS0000065523.V297178.R01.S.doc Version 5.2 Page 12 One care file examined was for a service user that has highly complex needs. The service user needs 24 hour supervision, has severe epilepsy, poor mobility, is artificially fed by a Percutaneous Endoscopic Gastromy (PEG) but can eat some foods, needs their temperature managed, has communication needs and some behaviours that can be difficult to manage, they need full support for personal hygiene and has a specially adapted bed and should have a physiotherapy programme. Although a pen picture highlighted these needs briefly, there were no detailed plans as to how staff should meet these needs. There was no moving and handling assessment on file and no strategies for dealing with behaviour that is difficult to manage. An epilepsy management plan is in place that staff understand and follow however the manager must ensure that where service users are fed by the use of a Percutaneous Endoscopic Gastromy site that a plan is prepared that identifies the tasks that are delegated by NHS staff and specifies that the responsibility of the PEG site remains with the community nurse and that the dietician reviews the nutritional requirements There were some risk assessments for trips and falls, use of bed side rails and medication and there was some monitoring and daily records being kept for food and fluid intake, sleeping patterns and seizure activity. There was an epilepsy management plan that had been developed by the community nurse. However from evidence found in the accident book and discussion with relatives it was evident that the risks in relation to trips and falls were not being adequately managed. This service user had not had a review. In the other care file examined again this service user had a high level of needs, limited verbal communication, totally dependant for all aspects of personal care, needs supervision for eating and drinking and needs staff support for all mobility (they have no road safety awareness). There was no detailed service user plan however a care review had taken place on 17/5/06. This particular service user had recently absconded from the house and been located at another care home in the vicinity. The registered person must ensure that service users are kept safe by ensuring an appropriate risk assessment is undertaken and that there are adequate numbers of staff to meet service users needs. Discussion with staff and relatives suggested that service users basic care needs were being met even though there were issues about numbers of staff (detailed further within the staffing section of this report) and there was a lack of clear plans and guidance. This approach is dependent on staff memory and good verbal communication systems. Service users are at risk of not having their care needs met and their health, safety and welfare is compromised if these informal systems break down. DS0000065523.V297178.R01.S.doc Version 5.2 Page 13 All records were maintained in accordance with the Data Protection Act and staff were clear about their responsibilities within this. DS0000065523.V297178.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,15,16,17 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. A wide range of activities within the home and community means that service users have the opportunity to participate in stimulating and motivating activities that meet their individual needs, wants and aspirations. EVIDENCE: There was evidence on care files examined that service users continue with their planned activities whilst staying at the home for respite care. Both service users care files examined contained an activity timetable that included leisure activities such as shopping, visits to the pub, snooker, pottery at the adult education centre, bowling, swimming, use of computers, visits to the park, days out, watching videos and TV and listening to music at home. Service users are able to access Avocets own day service whilst receiving respite care. DS0000065523.V297178.R01.S.doc Version 5.2 Page 15 One of the service users is still able to attend the 16 unit at the school she attends whilst receiving respite care. The house is situated in the local community and blends in well with its surroundings, the manager informed the inspector that they have no problems with the neighbours. The home has good links with families and they are made welcome at the home and are able to visit whenever they wish, however the very nature of the service (respite care) means that they do not take up this offer very often as they are taking a well earned break. From observation staff appeared to interact well with service users although they appeared to be rushed and a little stressed at times. All service user have a private bedroom where they can spend private time and they have unrestricted access to all areas of the house. The manager and staff promote a healthy eating menu but try to balance this with service users likes/dislikes and special treats on occasions. The menu plan is presented in a pictorial format for service users. Breakfast consists of a variety of cereals, toast, tea, coffee and juice. Lunch is a choice of sandwiches, soup, beans or egg on toast or omelette, jacket potatoes with a choice of fillings. Options on the menu for dinner included chicken, mince, pasta, fish, all served with fresh vegetables and the manager confirmed that there is always plenty of fresh fruit and yogurts available. Where service users are on special diets and/or need health interventions there must be a copy of the specialist guidance/assessment and a plan on the care file of how these needs must be managed. DS0000065523.V297178.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Service user’s health, personal and social care needs are not being fully met and medication is not being managed appropriately. These shortfalls have the potential to place service users at risk. EVIDENCE: Because of the nature of the service (respite care) the majority of the service users health needs are managed by their relatives when they are living at home. However the staff at the home will support service users to attend any appointments whilst staying at the home. One of the service users that was at the home on the day of inspection has complex health needs and has the ongoing support of the community nurse and the epilepsy nurse. An epilepsy management plan is in place that staff understand and follow however the manager must ensure that where service users are fed by the use of a Percutaneous Endoscopic Gastromy site that a plan is prepared that identifies the tasks that are delegated by NHS staff and specifies that the responsibility of the PEG site remains with the community nurse and that the dietician reviews the nutritional requirements. DS0000065523.V297178.R01.S.doc Version 5.2 Page 17 As the inspector arrived at the home the service user was not well and was having a severe seizure that required the administration of stesolid (rectal diazepam). The staff have received training to undertake this task however on this day it took two staff to meet the service users needs and provide the ongoing physical and emotional support required in times of distress. The staffing numbers in the home on this day where not adequate to meet the assessed needs of the service users at the home. (See staffing section of this report.) The management of the medication was assessed as part of this inspection; the inspector discussed the systems with the manager and examined the stocks of medication and recording tools. The inspector was informed that service users bring in their stock of medication with them on admission. The stock is booked in entered onto the stock control sheet and then transcribed by staff onto the medication administration sheets. The bottles and packets were clearly labelled. On examination it was apparent that on a couple of occasions there had been mistakes made in the transcribing. There was a stock of 10mg of Stesolid held however there was no record on the MAR sheet for the administration of 10mg of Stesolid. The registered person must ensure that medication administration instructions are accurately transcribed and that where possible two staff sign this to ensure it is correct. There was also a stock of Calogen emulsion that stated “must be disposed of 14 days after opening” however the bottle had been opened and no date entered to ensure that it is disposed of in a timely manner. Some medication was being stored in the fridge in the kitchen, this may lead to service users who have access to the fridge not realising it is medication and drinking it. If it is not feasible to obtain a fridge specifically for medication then the medication stored in the food fridge must be kept in a separate container within the fridge (ideally lockable) and clearly labelled medication and a risk assessment must be undertaken. Staff have not completed a medication training course that includes a competency check and this must be addressed. DS0000065523.V297178.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a complaints system and there had been no complaints since registration. All staff are aware of their responsibilities with respect to POVA however due to the insufficient numbers of staff, poor service user plans, and unsafe medication practices service users are not protected from harm whilst in the care home. EVIDENCE: Neither the home nor the CSCI had received any formal complaints about the home since registration. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of service users money and financial affairs. The manager and all staff have had Protection Of Vulnerable Adults (POVA) training. The staff on duty displayed a good understanding of the vulnerable adults procedure and they are confident about reporting any concerns and certain that any allegations would be followed up promptly, and the correct action to be taken however the insufficient numbers of staff, poor service user plans, and unsafe medication practices mean that service users are not protected from harm whilst in the care home. DS0000065523.V297178.R01.S.doc Version 5.2 Page 19 DS0000065523.V297178.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The environment provides surroundings in which to live. EVIDENCE: 93 Ings rd is a semi-detached house registered to provide respite care for up to five service users. The home is situated on Ings Rd to the east of the city of Hull. The house consists of a hall, lounge, dining room, kitchen, small utility room, two bathrooms one upstairs and one downstairs and five single bedrooms all but one of these being upstairs. One of the upstairs bedrooms has an ensuite shower room. The house has a private garden to the rear of the property and there are plans to create a drive way to the front of the property. On the day of inspection the house was found to be clean, tidy and provided a homely and comfortable environment for service users to stay. The house is DS0000065523.V297178.R01.S.doc Version 5.2 Page 21 service users with comfortable and safe large enough to accommodate five service users and provides plenty of communal space. All the required equipment was in place to meet service users needs. DS0000065523.V297178.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35 and 36 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The current staffing arrangements are not sufficient to meet the needs of the service users and further training must be provided. Staff are not adequately supervised which may lead to poor care practices. EVIDENCE: There are currently four service users that regularly use the service at 93 Ings Rd for respite care. One of the relatives stated in a comment card “The avocet trust provide an excellent standard of care for our son and maintain good levels of communication regarding his progress. We are delighted with the Avocet trust care for our son whilst he is in respite at Ings rd, Hull” However another relative had informed the inspector prior to inspection that she did not feel that there were enough staff provided at the home and staff members spoken to stated that it was very difficult at times to meet service user needs and manage the risks within the current staffing hours provided. DS0000065523.V297178.R01.S.doc Version 5.2 Page 23 On the day of inspection there were two service users at home and three staff, one of these being the manager, who is expected to work a proportion of his week as a carer, however it appeared on the rota he was working the whole of the week as a carer. One of the service users at home on the day of inspection is funded for 2;1 staffing 24 hours a day, 7 days a week. As the inspection was an announced inspection and the manager would have been expected to spend some of the day with the inspector this would have only left two staff for two service users, one of which should have had two staff to himself as per the funding arrangements. As the inspector arrived at the home the other service user was not well and was having a severe seizure that required the administration of stesolid (rectal diazepam). The staff have received training to undertake this task however on this day it took two staff to meet the service users needs and provide the ongoing physical and emotional support required at this time of distress. The manager then rang another staff member to come in and assist; however she was due to work the night shift, later that day. This meant that the other service user (who is funded for 2;1 staff) only had one member of staff with him for part of the morning. Although Avocet were providing the staffing as agreed with the placing authority the inspector concluded that the staffing numbers in the home on this day were not adequate to meet the assessed needs of the service users at the home and there was poor management of the staff rota, taking into account what was required for this particular day. The arrangements do not allow for staff to take adequate rest breaks away from service users. Following the inspection the inspector undertook a staffing calculation using the residential staffing forum tool and concluded that in the week commencing 24/7/06 there should have been 450.74 care hours per week for the two service users taking into account the additional 196 daytime hours and 70 waking night hours for the service user funded 2;1. Given the fact there was a planned inspection it would have been good practice for the manager to be supernumerary on this day. Accident records identified 9 accidents in relation to three different service users and relating to trips and falls. This could be due to lack of supervision from staff and/or the layout of the building. The manager must undertake an audit of these accidents and take remedial action to rectify any causes highlighted from the audit. In addition to this there had been a regulation 37 notification received by the CSCI that on 22/7/06 one of the service users had left the house unsupervised (this service user has no road safety skills and needs staff supervision 24 hours DS0000065523.V297178.R01.S.doc Version 5.2 Page 24 a day). The report stated that there were 3 staff on duty for two service users (one of these needing 2;1 staff). The staff were making preparations for a day out at the coast and one of the staff needed to use the telephone in the dining room, at this time the service user left the house unbeknown to staff. The service user was eventually located at another care home in the vicinity however she would have had to cross a busy main road to get there, she was eventually located and returned safely to the house. The managers followed all the necessary protocols on contacting the police and family, however this again highlights that the staffing numbers provided at the home are insufficient to meet the complex needs of the service users and ensure their safety. The inspector was informed that there had been some unrest within the staff group as when they were appointed to the home they were given to believe they would be working full time at the home. This did not happen and the staff have had to work at other homes within Avocet to make up their hours. This has meant that they have been unable to develop a good team spirit within the home. The grades of staff is also of concern as there can be occasions when one or two grade “A” staff (lower level) are working alone with service users with highly complex needs and some that exhibit behaviours that can be difficult to manage. The registered person must review the grades of staff working at the home and their levels of responsibility and accountabilities. The registered person must urgently review the staffing numbers provided at the home and because of the nature of the service this must be calculated on a daily basis and provided in accordance with the numbers and needs of the service users in the home on any given day. Staff recruitment records were examined and were all found to be in order. The manager did not have a training plan for the home and none of the staff had received an annual appraisal. A number of the staff had received appropriate training relevant to the job, however for one staff member there was no evidence of any training having been undertaken other that the care of the Percutaneous Endoscopic Gastromy (PEG) site. There was evidence that all staff other than the one mentioned previously had undertaken training in how to care for a Percutaneous Endoscopic Gastromy (PEG) site, how to administer rectal diazepam and had all received mandatory training. However the staff had not received any training in how to deal with behaviours that may be difficult to manage, training in medication that includes a competency check and for one new member of staff she had commenced her induction on 25/3/06 but this had yet to be completed and signed off. DS0000065523.V297178.R01.S.doc Version 5.2 Page 25 Information received by the CSCI prior to inspection indicated that 5 out of the 6 staff had NVQ level 2 however there were no certificates on staff files to confirm this. All staff had only received two or three supervision sessions since the home opened this does meet the requirement of six times per year and must be addressed. DS0000065523.V297178.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40,42,43 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The Commission for Social Care Inspection is concerned about the management and standards of care in the home. This home was only recently registered and there are a high number of requirements arising from this first inspection. EVIDENCE: DS0000065523.V297178.R01.S.doc Version 5.2 Page 27 The previous manager has returned to his post as manager of another service within Avocet. A new manager has been appointed to the home and had only been in post for a short while at the time of inspection, he has not yet submitted his application to become the registered manager of the home. He has a variety of skills, relevant qualifications and experience and has managed care homes in the past. The manager has additional management responsibility for the Domiciliary Care service as well as the respite service; he is expected to work part of his time as a carer. The registered person must review the way that the manager is deployed and the time that is available to him to raise the standards of care and management at the respite service and the Domiciliary care service. In addition to this the restrictions of the current staffing structure and number of care hours provided within the home mean that although the staff are willing they do not have the time within the shift to undertake all of the duties required to ensure that service users complex personal, health and safety needs are met As part of the inspection all health and safety and the maintenance certificates were examined, all were available and up to date. A systematic approach to quality assurance has yet to be implemented in the home. The inspector has been informed that all of the Policies and procedures have been updated and that it is Avocet’s intention to hold workshops to introduce the new procedures and ensure all understand them and work within them. Regulation 26 visits are undertaken by the trustees of Avocet Trust, the manager has commenced staff meetings and management meetings take place monthly. Consultation with stakeholders, service users and families need to take place to ensure everyone is given the opportunity to contribute to the running of the home. . DS0000065523.V297178.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 2 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 1 32 2 33 1 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 x 1 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 2 x 1 3 x 1 3 DS0000065523.V297178.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NA STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 YA3 2 YA6 YA23 YA3 YA6 YA19 15 Regulation 14 Requirement The registered person must ensure that service users are individually assessed and that a copy of this assessment is kept on file. The registered person must ensure that all service users have an individual plan that covers all aspects of personal, social and health needs. The registered person must ensure that where service users are fed by the use of a Percutaneous Endoscopic Gastromy site that a plan is prepared that identifies the tasks that are delegated by NHS staff and specifies that the responsibility of the PEG site remains with the community nurse and that the dietician reviews the nutritional requirements. The registered person must ensure that individual plans are reviewed at least 6 monthly and amended in light of changing needs. The registered person must DS0000065523.V297178.R01.S.doc Timescale for action 31/08/06 31/10/06 3 13 (1b) 30/09/06 4 YA6 YA23 15 31/12/06 5 YA9 13 (6) 30/09/06 Page 30 Version 5.2 YA23 6 YA7 YA23 13 (6) 7 YA17 YA19 13 (1a and b) 8 YA20 YA23 18 (c i) 9 YA20 YA23 18 (c I) ensure that risk assessments are in place for areas that pose a risk to service users and which must include up to date moving and handling assessments. The registered person must ensure that where service users display behaviours that are likely to cause harm to themselves and/or others, that a behaviour management plan is put in place that all staff understand and follow. The registered person must ensure that service users that need specialist diets are assessed by a speech and language therapist and/or a dietician and that there advice is followed. The registered person must ensure that medications are stored appropriately and instructions are transcribed accurately to ensure that medication is administered to service users correctly. The registered person must ensure that all staff responsible for administering medication have received training and have their competency assessed. The registered person must review the grades of staff working at the home and their levels of responsibility, accountabilities and deployment. The registered person must ensure that certificates for the achievement of NVQ level 2 are retained on staff files to evidence that the qualification is valid. The registered person must ensure that new staff complete LDAF induction. The registered person must urgently review the staffing DS0000065523.V297178.R01.S.doc 30/09/06 30/09/06 31/08/06 31/12/06 10 YA31 YA42 18 30/11/06 11 YA32 18 30/11/06 12 13 YA32 YA33 18 18 31/08/06 31/08/06 Page 31 Version 5.2 YA23 14 YA35 18 15 YA35 18 16 YA35 YA23 18 17 YA36 YA23 YA37 18 18 8 numbers provided at the home and because of the nature of the service this must be calculated on a daily basis and provided in accordance with the numbers and needs of the service users in the home on any given day. The registered person must ensure that a training plan is developed for the staff team in the home. The registered person must ensure that all staff are up to date with their mandatory training and that there is evidence of this on staff files. The registered person must ensure that all staff receive training in how to manage behaviour that may present a risk to service users, staff or others. The registered person must ensure that all staff receive formal supervision at least 6 times per year. The registered person must review the way the manager is deployed to ensure effective management of the respite service and the domiciliary care service. 31/10/06 31/08/06 31/10/06 31/12/06 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA39 Good Practice Recommendations The registered person must implement a quality assurance system within the home that ensures the views of service users and their families are taken into consideration. DS0000065523.V297178.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000065523.V297178.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!