Inspection on 20/01/06 for Dimensions 49 Chichester Court

This inspection was carried out on 20th January 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dimensions 49 Chichester Court 07/05/08

Dimensions 49 Chichester Court 06/12/06

Similar services:

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Ashlong House

Norbury Crescent (30)

Edenvale

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

CARE HOME ADULTS 18-65 49 Chichester Court 49 Chichester Court Stanmore Middlesex HA7 1DX Lead Inspector Clive Heidrich Unannounced Inspection 20th January 2006 07:25 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 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 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 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. 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 49 Chichester Court Address 49 Chichester Court Stanmore Middlesex HA7 1DX 020 8905 0068 020 8343 8876 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.pentahact.org.uk PentaHact Care Home 7 Category(ies) of Learning disability (7) registration, with number of places 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th July 2005 Brief Description of the Service: 49 Chichester Court is the largest of four houses in a purpose-built complex previously managed by Hillstream Care but now by Pentahact following a merger during the late summer of 2004. The building is maintained by the Metropolitan Housing Association. The home provides long-term care and accommodation for up to seven adults with learning, physical and sensory disabilities. There were two vacancies at the time of the inspection. All service users have their own bedrooms. Bedrooms are on the ground and first floors. There is a spacious lounge, two dining areas, and a large garden to the rear. The building is fully wheelchair accessible downstairs, and has an adapted bathroom there. Access to the first floor is by stairs only. The home is quite close to shops, leisure facilities and local transport. It shares a mini-bus with the other three houses in the same complex. Unrestricted parking is available on the road leading to the house. 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place across a dry morning in January. It finished at 3:50p.m. Its focus was both on compliance with previous requirements, and on assessing the core standards that were not inspected during the July 2005 inspection. The inspector met with all five service users, all of whom have significant verbal communication difficulties but from whom attempts were made to understand gestures and body language. The inspector also discussed aspects of the service with the three staff working at the start of the visit, and with the deputy managers who arrived in the early afternoon. Additionally, care practices were observed throughout the day, most of the environment was checked on, and a number of records were sampled. The manager was not present at the inspection as she was on leave. Reference to ‘management’ in this report refers to one or both of the assistant managers. All of the service users went out to their day services during the morning. One returned home at lunchtime as expected, and most had returned by the end of the visit. The inspector thanks all involved in the home for the patience and helpfulness during the inspection. What the service does well: The service aims to meet the individual needs of five people living in the home, all of whom have wide variety of complex needs. Improvements noted at the last inspection, in terms of staff support to service users being more hands-on, involving, empowering, have been consolidated. Staff have received most training specific to the service users’ needs. There is good accessing of specialist health services such as dieticians and speech therapists in support of the individual needs of service users. Service users are protected by good standards of medication procedures and practices in the home. The home has a permanent and experienced manager who continues to show good leadership skills in support of service users and staff. A service development plan has been set-up and communicated to staff. Clear goals for the service have been set-up and are being monitored. 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The ongoing lack of a suitable bath for service users who reside downstairs was left on an immediate requirement form with one of the assistant managers at the end of the inspection. The issue was confirmed by letter to the organisation the next working day. Prompt and suitable responses have since been received from Pentahact management, and a target date for installing a new adapted bath has been agreed. There are a few other requirements that are outstanding from the last inspection. These include about ensuring that fire doors are not propped open unless through a suitable device that releases when the fire alarm goes off. Other such requirements include about ensuring that service users’ care plans continue to be suitably updated, that there be suitable evidence of organised skills development work for service users, and that the manager apply for registration with the CSCI. 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 7 A few new issues were identified through the auditing of records. The manager must ensure that service users are supported to attend planned visits to places of worship, and that standard health checks for such things as dental care and chiropody are up-to-date. Whilst there are generally good standards of training for staff, there was little evidence of training in autism despite this being a trait of some service users. Plans are in place to address this. Finally, some further issues of maintenance were identified in areas that have not yet benefited from recent redecoration. 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. 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 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 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 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 and 2. There have been no service users admitted into the home since the last inspection. Guides about the service are not yet updated to reflect the current provider organisation and manager, although this is planned for. EVIDENCE: Management noted during the visit that there are two vacancies in the home. The vacancies are governed by the funding authority, Brent, with whom there is a block contact in place. Whilst there have been discussions to fill the vacancies, there has been no progression to the stage of assessing the needs of any potential users of the service since the last inspection. The organisation’s admissions policy was provided. The procedure was seen to be focus on meeting prospective service users’ needs and facilitating their control over the process of deciding whether the service could meet their needs. Management noted that plans for reviewing and updating the statement of purpose and the service user guide have been postponed but will shortly be addressed. The current version refers to the previous service provider and registered manager. 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Service users can make decisions about their lives with appropriate staff support as needed. Where their decisions involve significant hazards, these hazards are considered and appropriate actions taken so as to minimise risks. There is good progress with developing service user plans that reflect individual and personal needs and goals. Progress in these areas is however still needed for some service users. EVIDENCE: The inspector observed staff offering choices to service users such as with the foods available at breakfast. Where the communication from a service user was more difficult to understand, staff offered various support options until they found one that the service user accepted. Staff overall enabled good standards of participation and choice for service users where needed. Some service user communication profiles have been developed. These clarify what specific gestures from each service user appear to mean. Other profiles remain to be developed, a process which must be completed. 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 11 The individual plans of service users varied between those that had just been re-developed using a new system and those that were out-of-date and did not reflect current practice. The new system focuses predominantly on planning with respect to O’Brien’s five accomplishments and to the likes and dislikes of the service user. The outcomes of this should enable positive lifestyle developments for service users. There was additionally good use of photos and pictures in these new documents. The process needs to be completed, goals set up where not yet in place, and evidence of goal progression captured so as to adjust or achieve the goals. A sample of individual service users’ risk assessments found the assessments to have all been reviewed and updated since the last inspection. They now matched the care practices and philosophy of the home. The assessments matched needs, clarified the actions necessary to minimise risks, and included more-recent updates in response to incidents. 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 12 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, 14, 15 and 16. Service users generally receive good support to access and be part of the local community. They take part in appropriate activities. The effort now being put into providing trips away, based on service users’ wishes and needs, enables standard 14 about appropriate leisure activities to be judged as exceeded. Service users are supported to maintain and develop appropriate relationships. Their rights and responsibilities are well respected in the home and community. Efforts in this respect, particularly in terms of staff development, enables this standard also to be judged as exceeded. Service users have opportunities for personal development. However, there remains little written evidence about how this is being planned and developed, which must be addressed. EVIDENCE: The inspector observed one service user safely attending to their breakfast without the need for support. Others had support through prompting, enabling choices, and where needed, staff undertaking parts of the task for the service user. It was evident that the breakfast process was something that service 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 13 users are encouraged to be involved in, and in which their independence is encouraged. Other observations confirmed that this staff value and encourage the service users’ development of achievable skills. Daily records and service user files lacked evidence of skills development. This is an outstanding requirement that is repeated in this report. There were however some newly-developed plans in this respect in for some service users. Management noted that the better recording of daily records was one area in which improvements are planned, which should then help to track the progression of the development of key skills for each service user. Checks of a sample of service users’ daily records across the previous six weeks found little evidence of church attendance. Staff feedback, and individual activity programs, found that it is planned for some service users to attend church with staff support. The manager must ensure that these plans are carried out consistently. All service users attend day care services currently, all being transported via community transport services. Staff capably supported all service users, with one exception, to be ready for transport on time. Staff noted that, for the one service user who was not quite ready, the service user had been more tired this morning than usual and so was supported to get up a little later than usual. This was communicated to the day service, as was appropriate. Staff commented that the service users went to the Pentahact Christmas party on the other side of London. Most service users bought suits for this occasion, as reflected in some very attractive framed photos now on display in the lounge. There was very good feedback from staff about the holidays and short-breaks happening for service users. A few short holidays have successfully taken place in England for a few service users since the last inspection. Records and feedback showed that holidays abroad are being planned for most service users this summer, including one to the West Indies to meet up with family. Shorter breaks, such as to Manchester for a football match, were also due to happen. Staff clearly explained how each break links to the service users’ needs and goals. The effort now being put into this aspect of service users’ community presence and participation is impressive. Staff feedback informed the inspector that the balloons up on the walls of the dining room were from a party to celebrate the birthday of one of the service users recently. Records and staff feedback showed that service users keep good contact with family and friends’ where appropriate, such as with visits, at clubs and on trips out. There was awareness amongst staff of trying to develop friendships through the care-planning goal process. 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 14 There is now a photo-roster just inside the office for service users to be clear on who is working each day. Staff reported that three of the current service users get involved in replacing photos each evening. Each service user has a photo-labelled key to their bedroom. Observations and staff feedback during the visit found that service users are supported to lock their bedrooms when not using them, and that they are responsible for keeping the rooms clean. Checks of a couple of bedrooms found no concerns with the standard of cleanliness. Staff fedback that service users were involved in the recent redecorations of the home. Some service users went out to choose blinds for the lounge, whilst all the service users were involved in the consideration of carpet samples. One service user has been supported to purchase a vibro-chair since the last inspection. It was in the lounge during the visit. Staff explained that it has been very successful, but has been broken down in recent weeks. A letter of complaint was being planned in terms of lack of service under the guarantee. . 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Service users receive appropriate personal support except for in respect of the downstairs bath that remains out of use. Service users’ specific health needs are generally well-addressed. However improvements are needed with ensuring that routine health checks are kept up to date. Service users are protected by good standards of medication procedures and practices in the home. EVIDENCE: Service users were seen to be reasonably dressed throughout the inspection. Staff feedback to the inspector included about encouraging service users to wear clothing is weather-appropriate. There remains an inability for service users on the ground floor to have baths. This is discussed further under standards 24-30, but standard 18 cannot be considered met until all service users can have baths again. There was good written evidence of the service acquiring specific external professional support in relation to individual service users’ health needs. This includes support from a dietician, a speech therapist, and an occupational 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 16 therapist. There were clear guidelines in place as a consequence of such support, and staff showed good knowledge of the contents of the guidelines. Monitoring charts about service users’ specific health were generally being filled in by staff, and actions were reported to be being taken as a consequence of the charts. Staff additionally reported that further training was being planned after gaps were identified in the knowledge of the team in respect of some service users’ health issues. Inspection of routine health checks raised no concerns for appropriate appointments with GPs, but there was insufficient recorded evidence of chiropodist, dentist, and optician involvement overall. This was based on analysing the well-presented health files of four service users. For instance, one service user’s dental appointment from 2005 had been cancelled with no apparent follow-up. The manager must ensure that an audit of service user’s needs in respect of these services is undertaken, and that actions are taken where needed. The inspector observed part of the process of staff offering service users their medication. Tablets are dispensed by two staff, and then offered respectfully to the service user by one of the staff. Both staff signed the administration sheet. The medication cupboard was seen to be tidy and secure, and there was no excess stock being stored in the home. There was a medication procedure for the home that included updates in respect of the advice from the CSCI pharmacy inspector’s recent inspection report. Records about service users included a general trend towards medication reduction through appropriate professional involvement. General standards of medication are judged as thorough. There were some medication bottles that did not have dates of opening recorded on them. There is a risk of such medication ceasing to be fully effective a period after the bottle is first opened, hence it is recommended to record the date of first opening, and then of disposing of the bottle after the given time period. That period is at maximum six months, but can be shorter for specific medications. At the time of the inspection, one service user who undertakes regular blood tests with support had not been able to since the previous evening due to a broken component of the testing kit. Staff arranged to rectify this via a local pharmacist during the inspection. A spare kit be considered, to minimise risks associated with not being able to undertake prescribed checks. Daily stock-check forms were now in place for key tablet medicines. This is in response to a medication error that was appropriately reported to the CSCI following the last inspection. 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Work is ongoing to ensure that service users’ views are listened to and acted on. Some progress has been made in this respect. Service users are protected from abuse, neglect and self-harm. EVIDENCE: A complaint procedure with added pictures was sent to the inspector following the last inspection report. In the inspectors opinion it would not significantly assist a service user from this home to complain, due to the high levels of communication support needed amongst the service users. The manager had however written to parents and representatives of service users since the last inspection to remind them of the complaints procedure. Management noted that they are about to trial a system of acquiring expressions of dissatisfaction amongst service users, and that they are searching for other means of acquiring this information. The complaints folder was viewed. It contained reference, since the last inspection, to two issues that were judged as verbally-received complaints, from a neighbour and a relative. Written responses were seen to be constructive. It is recommended that each issue within the complaints file be clearly recorded about, in terms of what the issue was, what actions were taken, and what the outcome was. The revised ‘protection from abuse’ policy was sent to the inspector following the last inspection. The revisions, including about the procedure with which to report allegations or concerns, are judged as suitable. 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 18 There was now individual guidance for working with each service user who presents challenging behaviour. The guidance incorporates the positive values of the ongoing training that staff are receiving, and works to achieve consistency and positive outcomes. Discussions with staff and management established that the guidance generally supports service users effectively, and that there has been some decrease in challenging behaviours. Observations also supported this. Further work in this area is planned for. The accident and incident records were checked through. Entries in this were seen to be thorough. The manager signs off each entry to include about whether there is any follow-up action necessary. 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. Significant improvements have been made since the last inspection to service users’ communal living areas and bedrooms. These areas are now homely, comfortable, and suitable to service users’ needs. The home is also kept clean and hygienic. There remain improvements needed to facilities for bathing for some service users. Some other specialist equipment must also be acquired, to enable greater independence and safety of service users. There are also some maintenance issues that must be addressed to uphold suitable standards of homeliness within corridors and toilets. EVIDENCE: There has been significant refurbishment of the home since the last inspection. This was most evident in the lounge, which has been repainted, had new flooring installed, new sofas purchased, and has generally been completely altered and improved on. The dining area was seen to have new flooring. It had also been repainted. One service user’s bedroom was seen to have clearly been repainted, and staff reported that most bedrooms had had this redecoration. The flooring in two rooms was also seen to have been replaced and hence improved on. This all represents major improvements in the décor and comfort of the home for service users, which is impressive. 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 20 There was a recent incident of a leak from an upstairs bathroom into the ceiling of the downstairs hallway. Management were clear that the leak had now been rectified, but that there was some minor redecoration work now needed. This includes on the walls and carpet outside the bathroom as paint had flaked and the carpet had become partially stained. The ceiling light and light-holder in the hallway, near the kitchen, must also be replaced, as the gap in the ceiling is unsightly and potentially hazardous. The adapted bath downstairs has not been available for service users’ use for a number of months. It was not available for use at the last inspection, of July 2005. Requirements were made in the last inspection report about this. Feedback from staff on this visit found that the two service users who live downstairs have not been able to use the bath for this period. They have used the shower area instead, but their preferred choice would be the bath, and there are issues with the fragility of the skin of one service user in respect of the shower. The manager has kept the inspector informed about the progress made in acquiring a replacement bath. An occupational therapists report was recently received by the home, and has consequently been passed onto the organisation in charge of maintenance in the home. However, the service users living downstairs could not access a bath at the time of the inspection. It was consequently required, by immediate action letter, for Pentahact to supply the CSCI with a written plan of when a new downstairs bath, that meets both the needs of both service users and also health and safety standards, would be installed and made available for use. At the time of drafting this report, a plan had been set up in this respect. It is additionally necessary to action the other recommendations of the occupational therapist’s report. This includes the issue of setting up further doors in the home to be held open by a fire-release-device so as to both enable some service users to move around more independently and to uphold fire safety standards. Some doors continued to be propped open on this visit, contrary to advice from the fire authority. There are some other minor requirements from the last inspection report that remain in need of addressing, according to observations during this inspection. They are listed in full at the back of this report, but are in summary to do with retiling in a toilet, and suitable cleanliness of the office floor. There were no other concerns seen with cleanliness and infection control. Finally, the flooring between the hallway and the kitchen must have a slat installed, to cover the gap between the two floors. 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 21 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): 32, 33, 34 and 35. Service users are supported by a very competent and effective staff team. The staff team are close to achieving a suitable ratio of qualifications overall. Staff have received most appropriate training, and shortfalls in this respect have been planned for. Recruitment practices mostly protect service users, but some shortfalls with paperwork must be addressed. EVIDENCE: Staff worked appropriately to support and interact with service users. Staff were for instance heard to greet service users warmly, and they were seen to knock on service users’ bedroom doors before entry. Staff were also seen to take the time to chat and interact with service users whilst they were waiting for the transport to arrive, and were seen to respond to service users’ specific needs. The overall focus was suitably service user orientated. Records and feedback established that three staff have NVQs in care, whilst at least three others are undertaking an NVQ course. This is seen as sufficient progress towards suitable qualifications of the team as a whole. There has been a small turnover of staff since the last inspection that has been matched by new starters. There has also been the appointment of two 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 22 assistant managers in that time period, which has had a clear positive effect on the running of the home as well as reducing agency staffing numbers. Staffing levels had been reviewed and justified in writing by the manager, as previously required. Checks of the last two weeks’ roster found that levels of at least three staff working on each shift were almost always upheld. The review noted that a fourth person would be rostered to work at weekends to support with service users’ activities. In conjunction with the requirement under standard 11 about the lack of church attendance for service users, it is recommended that this fourth shift at the weekend always be rostered for. Checks of the files of three staff were made. The files of a fourth were not available as the worker had only recently started work in the home. The files were on this occasion well-organised. Suitable checks of references and identification had taken place. Employment start dates were unclear in all cases, which must be addressed. Criminal Record Bureau (CRB) checks were available and suitable in two of the four cases. This must be improved upon. CRB checks were in place for agency staff. From an analysis of the training records of five staff, the key courses that staff need to attend relative to service users’ needs are in autism and in challenging behaviour. Some staff have attended the latter, but none the former. The majority of staff have attended other relevant courses such as emergency 1st aid, epilepsy, and protection from abuse. There was a clear list of training courses planned for staff, and so it should just be necessary for this to be followed through. 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 and 42. Service users benefit from a home where the management ethos of being very client-centred has made significant improvements in how the staff team work with service users. The manager’s experience and qualifications support this. Pentahact have made suitable efforts to enable service users and their representatives to influence how the home and the organisation operate. Minor improvements are needed to ensure that record-keeping processes in the home are in the best interests of service users. Service users benefit from a good standard of health and safety provision. EVIDENCE: The manager has been in charge of the home for about a year. She has experience of running homes for people with learning disabilities. She has the Registered Managers Award, and is currently undertaking an appropriate course in care, to meet the training standard expected of managers. It remains for her to apply for registration with the CSCI. 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 24 Observations during the visit, and feedback from staff, found that the team is striving hard to work together and place service users at the forefront of their work. The inspector was impressed with the communication between staff working at the start of the visit. Handovers between shifts were seen to take place, and a number of records are used by staff to confirm that they have undertaken required duties whilst working. There were also good standards of information being recorded about within the communication book. There have been ongoing team training days for all staff, to help to clarify and discuss the values that staff are expected to work with. There was also a team roles statement in the office which staff said had been drawn up during these meetings and to which they work towards. The management approach of the home is overall judged as exceeding the National Minimum Standard. Management noted that a service review took place in October 2005. It involved an independent person from within Pentahact auditing the views of service users where possible, staff, family and friends, and involved professionals. A review report from this was due to be produced. The organisation have additionally sent the CSCI their 5-year strategic plan for 2005-2010 General checks of recording procedures found that information is much more presentable and easily-accessible than at the last inspection. An audit of three service users’ daily records showed that improvements are needed in ensuring that entries are made for each shift, as there were a small number of gaps. It was also discussed with management about changing the recording system to better enable key information to be captured, for which plans were evident. It was found, from checks of the incident file, that there were three incidents since the last inspection that ought to have been notified to the CSCI, including about the leak from the bathroom and about a medication error. It is noted that the home does ordinarily supply the CSCI with appropriate notifications, and that their forms include prompts to remind about this process. The manager must ensure that every appropriate incident is notified. Fire extinguishers, the fire alarm system, and the emergency lighting system were seen to have been professionally checked within suitable timescales. Internal fire checks and drills were seen to be up-to-date. Suitable professional checks were in place in respect of portable electrical appliances, the hoists in the home, and against legionella in the water systems. 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 3 3 X 4 X 5 X 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 3 27 2 28 3 29 1 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 4 15 3 16 4 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 2 4 3 X 2 3 X 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 6 Requirement The statement of purpose and the service user guide must be reviewed and updated to reflect the change of provider organisation and manager. Timescale of 1/12/05 not met. Each service users individual plan must capture all of their needs and explain how these will be addressed. Standard 2.3 provides guidance on areas of consideration for this. Timescales of 1/3/05 and 1/10/05 partially met. There needs to be clear written guidance to staff about the communications used by each service user. Timescale of 1/10/05 partially met. There must be suitable evidence that service users are supported with maintaining or developing skills. Timescales of 1/12/04 and 1/3/05 partially met. DS0000062735.V279938.R01.S.doc Timescale for action 01/04/06 2 YA6 15 01/10/05 3 YA6 12(5), 17(1)s3 p3(l) 01/04/06 4 YA11 14, 15 01/03/05 49 Chichester Court Version 5.1 Page 27 5 YA11 16(3) 6 YA18 12, 23(2)(j) The manager must ensure that plans for individual service users to attend their chosen places of worship are carried out consistently. The manager must ensure that all service users are enabled to have regular baths if that is their preferred choice. Previous timescale of 1/9/05 not met. The manager must ensure that an audit of service user’s needs in respect of dental, opticians’, and chiropody services is undertaken, and that actions are taken where needed. Consideration must be given to how service users can communicate complaints and about how effectively this is addressed. 01/04/06 01/04/06 7 YA19 13(1)(b) 01/04/06 8 YA22 22(2) 01/05/06 9 YA24 23(2)(b, d) 10 YA24 23(2)(d) 11 YA24 23(4) Timescale of 1/12/05 partially addressed. 01/04/06 Redecoration work following a leak from an upstairs bathroom is needed. This includes: • on the walls outside the bathroom due to flaking paint, • cleaning of the stain on the carpet just outside the bathroom, • that the ceiling light and lightholder in the hallway, near the kitchen, must be replaced. The flooring between the hallway 01/04/06 and the kitchen must have a slat installed, to cover the gap between the two floors. Fire doors must not be propped 11/08/04 open unless with the approval of the LFEPA (fire authority). Previous timescales of 11/8/04 not met. DS0000062735.V279938.R01.S.doc Version 5.1 Page 28 49 Chichester Court 12 YA24 23(2)(b) The downstairs toilet needs retiling in the areas where four tiles were removed to gain plumbing access. Previous timescale of 1/11/05 not met. The office carpet must be kept permanently clean, by professional input to remove ingrained stains if necessary. This is because some service users regularly use the office. Previous timescale of 1/9/05 partially met. Pentahact must supply the CSCI with a written plan of when a new downstairs bath, that meets both the needs of service users and also health and safety standards, would be installed and made available for use. Completed. It is necessary for a replacement adapted bath, that meets service users needs, to be urgently acquired for the downstairs bathroom. Previous timescale of 15/9/05 not met. Actions from the occupational therapists’ report must be addressed. The manager must ensure that, in respect of information held about staff in the home: • The information about new staff is available immediately; • Criminal Record Bureau disclosures are in place for all staff; • Start dates for working in the home are clear for all staff. 01/04/06 13 YA24 23(2)(d) 01/04/06 14 YA27 10(1), 23(2)(c), (n) 26/01/06 15 YA29 12, 23(2)(c), (n) 01/04/06 16 17 YA29 YA34 13(1b), 23(2)(a, n) 17(2, 3) 01/05/06 01/05/06 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 29 18 YA35 18(1)(c) 19 YA37 10(3), CSA s11, 12 The manager must ensure that, 01/07/06 as per training plans, all staff will have received training in both autism and challenging behaviours. The manager must ensure that 15/03/06 she applies for registration with the CSCI. Previous timescale of 1/9/05 not met. Improvements are needed for service users’ daily records to ensure that key information is recorded about for each shift. The manager must ensure that every appropriate incident is notified to the CSCI, as this was found not to always be the case. 20 YA41 17(1)(a) s3 pt 3 37 01/04/06 21 YA41 01/03/06 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 2 3 Refer to Standard YA6 YA20 YA20 Good Practice Recommendations Evidence of service users’ individual goal progressions should be captured so as to help adjust or achieve the goals. A record of the date of opening any liquid medications should be kept. It is recommended that a spare blood testing kit be considered for one service user, to minimise risks associated with not being able to undertake prescribed checks due to faulty equipment. It is recommended that each complaint within the complaints file be clearly summarised, in terms of what the issue was, what actions were taken, and what the outcome was. In conjunction with the requirement under standard 11 about the lack of recent church attendance for service users, it is recommended that a fourth shift at the weekend, that coincides with church services, always be rostered for. DS0000062735.V279938.R01.S.doc Version 5.1 Page 30 4 YA22 5 YA33 49 Chichester Court Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 49 Chichester Court DS0000062735.V279938.R01.S.doc Version 5.1 Page 31 - 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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