Inspection on 17/04/08 for Alexandra House

This inspection was carried out on 17th April 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Alexandra House 09/10/08

Alexandra House 26/09/06

Alexandra House 28/12/05

Alexandra House 14/06/05

Alexandra House 15/12/04

Alexandra House 22/07/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Alexandra House Alexandra House 31 Pollards Oak Road Hurst Green Oxted Surrey RH8 0JL Lead Inspector Jo Griffiths Unannounced Inspection 17th April 2008 10:30 X10029.doc Version 1.40 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 Alexandra House DS0000013549.V362522.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 Older People and 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. Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra House Address 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) Alexandra House 31 Pollards Oak Road Hurst Green Oxted Surrey RH8 0JL 01883 380739 Mrs Myrna Noorbaccus Mr Mike Noorbaccus Mrs Myrna Noorbaccus Mr Mike Noorbaccus Care Home 5 Category(ies) of Learning disability (3), Learning disability over registration, with number 65 years of age (2) of places Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The number of persons for whom residential accommodation and personal care is provided at any one time shall not exceed FIVE (5). The age/age range of the persons to be accommodated will be: 3 PEOPLE UP TO 64 YEARS & 2 OVER 65 Date of last inspection Brief Description of the Service: Alexandra House is registered with the Commission for Social Care Inspection to provide accommodation and care to five adults with a learning disability. The property is located in a residential area in Oxted in Surrey and is close to public amenities. Accommodation is on two floors and comprises of a kitchen, dining room, lounge, laundry area, bathrooms, toilets, one shared bedroom with an en-suite bathroom and three single bedrooms. One bedroom and bathroom is on the ground floor and is accessible to wheelchair users. The home has a front and rear garden. Private parking is available. The range of fees charged by the home is £700 - £1600 per week. Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was a key inspection of Alexandra House. The inspector, Jo Griffiths, visited the home on 17th April 2008 between 10.30am and 4.30pm. The home is owned and managed by Mr and Mrs Noorbaccus. Mr Noorbaccus, was at the home during the inspection visit. There were four people living in the home and they were at home during part of the inspection. There were three care staff on duty. The inspector spoke with the Manager and the deputy Manager, who was not on duty, but was in the home. It was not possible to speak with all the people living in the home due to limited verbal communication skills, but observations were made of the support they received in the home and the interactions they had with the staff. Some of the staff on duty were not able to give feedback on the service they provide as they do not speak English as a first language. Prior to the inspection the registered provider completed and returned the Annual Quality Assurance Assessment (AQAA) that is required by the Commission. Relatives of the people that live there and some staff completed surveys about the home. Some of the records and documents kept for the running of the home were inspected. What the service does well: What has improved since the last inspection? What they could do better: Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 6 The ‘Service User Guide’ needs to give people clear information about the fees that are charged and what the fees cover. Any additional costs for services need to be stated and everyone should be issued with a contract for their care and accommodation. The care plans should be written in a way that involves the person and takes account of their views about their health and their care. Individuals must have access to their own plans. The plans must be read, understood and followed by all the staff that work in the home to ensure people’s needs are met. The Manager must ensure that all the staff are able to communicate effectively with the people that live in the home. People’s right to privacy in their bedrooms must be respected and they should be supported with their personal care needs in a person centred way rather than following set routines in the home. People should be supported to make their own decisions about their lives and their futures through person centred planning and staff would benefit from training in this area to help them in providing this support. People should have the opportunity to use mainstream community health services, where possible, rather than have all their health appointments on a home visit basis. The care plans could be further expanded to include the support people need to have meaningful personal relationships and to increase their opportunities for meeting new people in the community. People may benefit from a review of the range of activities available to ensure they can lead varied and interesting lifestyles. People that use the service need to be given clear information about how to make a complaint and how this will be managed. They should be provided with up to date contact details for CSCI and the local authority. The registered person must ensure that the people that live in the home are safeguarded from harm and abuse. A policy for safeguarding people needs to be developed and this should include a whistle blowing policy. The staff must be trained and able to understand and follow the safeguarding policies. The staff recruitment procedures must be reviewed to ensure that evidence of robust and safe systems is held in the home. The required checks of new employees must be made before they start work. The registered person must maintain records of the training undertaken by all staff in the home. Arrangements must be made to ensure that staff that do not speak English are supported to undertake the training they need and an induction to the service. All staff must be able to read and understand the policies and procedures of the care home. The people that live in the home would benefit from more staff members completing their NVQ award. Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 7 The Managers must ensure that the rotas accurately reflect the staff on duty, including the management cover of the home. The Managers must ensure they are available to be contacted by CSCI or Care managers during their rota’d working hours. The Managers of the home must be able to demonstrate how they keep up to date with relevant legislation and good practice guidance, for example, Valuing People, to ensure people using the service benefit from the best support. A quality assurance system needs to be formalised that includes the views of the people that use the service and other stakeholders. A report of the quality review of the home needs to be produced and made available to people that live there and CSCI. The registered person must ensure that individuals are accurately invoiced each month for items that have been purchased on their behalf. There should be no balance owed to individuals by the care home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2 and 3 People that use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are not provided with all the information they need about the service and the costs of the service before they move in. They do not have a contract with the care home for the service provided. People have an assessment of their needs to ensure they can be met before they move to the home. EVIDENCE: Standard 6 is not applicable for this service. Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 10 The home has a Statement of Purpose and a Service User Guide to give prospective service users information about the services the care home provides. Both documents require amending to ensure that they give clear information about the home’s complaints procedure and the contact details for CSCI need to be updated. The base fee scale that is charged by the care home is included in the Service User Guide. The Manager stated that additional charges are made for transport, holiday accommodation and eating out. Information about these additional charges, how the charges will be made and who is responsible for them has not been included in the Service User Guide. Each person currently living in the home had an assessment of their needs by their funding authority before they moved to the home. None of the people living in the home has a contract with the registered provider for their care and accommodation. A contract needs to be drawn up for each person outlining what will be included in the fee, who is responsible for paying the fee and the terms and conditions of the person’s residence at the care home. Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 People that use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Individuals do not have their needs fully met in a person centred way. People have not been effectively involved in their plans and some staff have not read the plans. People’s have their health needs met and are supported to manage their medication safely. Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 12 People are not always treated in a way that respects their privacy and dignity. People have not been consulted about their preferences regarding their personal care when formulating their care plan. EVIDENCE: The home has introduced a computerised care plan system for older people since the last inspection of the home. Each person has their own care plan on the computer and a copy is kept in their bedroom. Two of these were inspected. The care plans provide some information about how to support people with their personal care needs, but they do not reflect that people have been consulted about their preferences regarding their care. The care plans cover all areas of health need and give some information about meeting the person’s social needs. It was not clear that people had been involved in writing their care plan and the plans have not been produced in a way that is accessible to the person that it is for. The care plans are not person centred and are focused on medical needs, describing the person’s needs as the ‘problem’. Some of the plans state that people will be toileted during the ‘toileting rounds’ during the day, this does not identify individual needs or meet them in a dignified way. In addition to the care plans each person had an ‘Essential lifestyle plan’. These had been completed by staff and were not in a format that the person themselves could understand. Therefore people have no ownership of their ‘essential lifestyle plans’ meaning that they cannot be considered person centred. The registered provider said that he had attended some training in Person centred planning, but the plans that were in place did not reflect an understanding of effective person centred planning. None of the staff team have completed any training in Person centred planning. The Manager was aware of the ‘Valuing People’ white paper, but the staff on duty had not heard of this document. Given that this is a key Government document in terms of learning disabilities it would benefit the people in the home if staff were to be introduced to it and the principles of person centred working incorporated in the home. The care plans showed that people have their health and personal care appointments at home, including home visits from the Dentist, optician and hairdresser. The Manager said that the service users prefer this and that it can be difficult for them to access mainstream services as the general public find it hard to accept people with learning disabilities. People should be encouraged to use community services where possible and discrimination against people with learning disabilities must be challenged. Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 13 Each person has a health action plan. These have been completed on the computer by staff. It would benefit individuals if they were involved in their health action plan to help them understand and manage their own health needs. There were clear records of the involvement of healthcare professionals and people’s current health needs were being addressed. One person has the involvement of a speech and language therapist who is supporting the staff to design a photo activity board for the person. This is positive for the individual, as it will help them to communicate their wishes regarding their lifestyle. Risk assessments had been completed as part of the care plans for each person. These adequately addressed and minimised risks to individuals, including the risk of falls and fire. Some of the staff team do not speak English and the Manager said there have been difficulties in communicating with them. The Manager confirmed that not all the staff access the care plans on the computer or write the daily care plan notes due to their difficulties with understanding the English language. The people in the home are at risk of inadequate or inappropriate care if the staff are not able to read the care plans or follow instructions regarding people’s support. Some of the staff team are unable to communicate effectively with the people in the home due to language barriers. None of the current residents administer their own medication. All medicines are stored by the home and administered by trained staff. The storage of medicines was seen to be secure and appropriate. Accurate records are kept of the medicines that are administered. When the inspector arrived at the home one person was asleep in the bed of another person that lives at the home. The Manager stated that it was because the person was waiting for a visit from the district nurse for a blood test and that the staff had been unable to get the person up the stairs, as they were unstable on their feet. The Manager did say that the person whose bedroom it was had been asked if it was ok, but also acknowledged that the situation was not appropriate. The registered person must ensure individuals private space is respected and that people are not expected to give their permission for another person to use their bed. Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 People that use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are supported to do the activities they enjoy. They would benefit from being supported to make more use of their local community facilities and services, in line with ‘Valuing people’. People are supported to maintain contact with their family, but would benefit from being supported with their needs regarding their sexuality and personal relationships. Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 15 People in the home are supported to make some decisions in their daily lives, but would benefit from effective use of person centred planning to support them to make wider decisions and take control of their lives. The residents of the home enjoy a varied and balanced diet with a choice of meals each day. EVIDENCE: People have an activity planner as part of their care plan based on their known likes and dislikes. This includes some outings each week and going out for drives and walks. One person uses a day centre once a week and one person has a 1-1 cookery session at home. No one attends college or further education and no one is employed or looking for work. The daily records for each person showed that they regularly go out for activities, although the range of activities could be expanded as a high number of the activities were recorded in the daily records as a ‘drive out’. During the inspection people spent the morning at home doing puzzles and looking at books. All four people went out with staff for a drive in the afternoon. People do not use mainstream community facilities for their health and personal care needs. Financial receipts show that people regularly enjoy coffee and tea out and that they go out for a meal approx once a week. As reported above, ‘essential lifestyle planning’ documents have been completed by staff for each person but they have not fully involved the person themselves. Person centred planning has not yet been effectively used to help people make decisions about their lives and their futures. People in the home do attend ‘service users meetings’ once per month and this is an opportunity for them to have a say about their care and the service they are receiving. The home has a policy on sexuality, but this requires updating to reflect consent issues and the Mental Capacity Act 2005. The policy should also refer to individuals right to confidentiality regarding their sexuality and personal relationships. People’s needs in this area have not been identified or addressed through their care plan. People in the home are supported to stay in contact with their family members and visits from family members are welcomed. People’s religious needs have been included in the care plan and the Manager said that people could be supported to go to church if they wish. There is a four-week menu in the home that has been approved by a dietician. The Manager said this is based on the known likes and dislikes of the people that live there and that there is always an alternative meal if they do not want what is on the menu. Records are kept of the meals provided. Service users were asked if they liked the food and they said ‘yes’. Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 People that use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are not provided with the information and support they need in order to make a complaint if they need to. People in the home are at some risk of abuse and harm due to a lack of adequate policies and procedures to safeguard them. EVIDENCE: People that use the service do not have access to a full complaints procedure for the home. The Statement of Purpose and Service User Guide do not instruct people how to make a complaint or the timescales for responding to any complaints. There has been one complaint received by the home from a Care Manager in relation to the service provided for one particular individual. The owner of the home is liaising with the funding authority regarding the response to this complaint. The Manager and deputy manager said that most people that live in the home would find it hard to communicate any complaint they have to the service provider. None of the people in the home have an independent advocate and Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 17 only two people are in contact with their family members. Some of the care staff team are not able to speak English and this makes communicating with the people that use the service difficult. A copy of the Surrey Multi Agency Adult Protection policy was in the home, but the care home does not have its own Safeguarding adults policy. This needs to be developed to ensure that staff understand what constitutes abuse, how people are to be safeguarded and how to report any allegations of abuse. The staff on duty at the time of the inspection were asked about their understanding of abuse and what they would do if they suspected abuse was taking place. Unfortunately the one staff member was not able to speak any English and the other had very limited English. When asked the questions about abuse and safeguarding people one staff member was not able to respond to the questions at all and the other did not appear to understand what was being asked and responded by saying that they help people to wash and dress and do anything they need to do for them. None of the recently employed staff have undertaken any training in Safeguarding adults. The Manager said that the induction of the new staff was proving challenging due to their lack of English language skills and that currently they would not be able to read any of the policies, procedures or care plans in the home. This puts people in the home at risk of potential abuse and harm as staff are not able to follow procedures for supporting them safely and safeguarding them. The recruitment records for the staff employed in the home were limited and in some cases for newer members of staff there were no records held in the home. Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 23 and 26. People that use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a safe, clean and hygienic home. They have their own bedrooms, but privacy of their personal space is not always respected. People have access to comfortable communal facilities and sufficient bathroom facilities that meet their needs. Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 19 EVIDENCE: The home has a lounge, dining room, kitchen, laundry and three bathrooms for use by the people that live there. Three of the bedrooms are single and one room is a shared room, although there is currently only one resident in this room. The owner plans to divide the shared bedroom into two single rooms before moving anyone else into the home and is advised to refer to the National Minimum Standards for guidance on the required room dimensions and facilities. Multiple occupancy in bedrooms is not considered to be good practice in care homes for younger adults and should only be provided in exceptional circumstances where the individual makes an informed choice that they wish to share a room. There is no screening for privacy in the shared bedroom and therefore it is not appropriate to use this as a shared bedroom at this time. As described earlier in this report the privacy of one person’s bedroom was not respected as another service user had been allowed to temporarily use the bed. The bathroom facilities meet people’s needs. Everyone has a hand wash basin in their room and there is an option of either bath or shower in one of the shared bathrooms. The home was clean and maintained to an adequate standard. There is a large rear garden for use in the summer with tables and chairs. Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 People that use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. People in the home are not supported by sufficient numbers of trained staff to meet their needs. People in the home are not safeguarded by the homes procedures for recruiting new staff. EVIDENCE: Since the last inspection of the care home new care staff have been recruited from overseas using an employment agency. The recruitment records for four of these new staff were reviewed and it was found that in two cases there were no records available in the home. The Manager said that the documentation for these staff was still with the external agency that had introduced the staff Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 21 members to the home. For the other two staff members it was found that some of the required recruitment checks had been made and evidence of these checks were found on the files. However, one person did not have a current work permit allowing them to work in the UK or a Criminal Records Bureau check. The other file had two references but these did not match the employment history given by the person on their application form. The registered Manager told us that the other information for these staff was held in the other care home. The registered provider told us in the Annual Quality Assurance Questionnaire (AQAA) that there had been difficulties with the induction and training of the new staff as they are not able to speak any English. He is trying to arrange for training in English language skills for them but in the meantime this means a high number of the care staff team are working without any training or understanding of the policies and procedures of the home. The Manager must make arrangements to ensure that the people in the home are supported by trained staff whilst the new staff are trained and fully inducted to the service. During the inspection observations were made of the support that was given by the staff to the people that live in the home. Whilst they demonstrated a caring approach the staff were not able to effectively communicate with people due to their lack of English skills. The Manager confirmed that the staff on duty had not received any training or been able to read the individuals’ care plans. Some training records and certificates were available in the home, but there were a number of staff with no training records. Many of the certificates are displayed on the walls around the home, which could be considered rather invasive on the feel of the service users home. The provider should review the training files to ensure there is a clear training record and evidence of training courses attended for all staff members held in the home. Some staff members have completed the NVQ award but people in the home would benefit from new staff undertaking the qualification once they have completed their induction. Both the registered Manager’s and the deputy Manager have been trained to provide training courses to junior staff members. There were no records to evidence how they are keeping themselves up to date in the subject areas in order to effectively teach others. Records of the training courses and updates attended by the Manager and deputy should also be held in the home. The Manager has issued all staff with a copy of the General Social Care Council (GSCC) code of conduct and a copy is held in the home. The rotas for a 2 week period were reviewed. These did not accurately reflect the staff on duty on that day. It is also recommended that the rotas be made clearer with regard to which of the registered providers homes the staff are Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 22 working in. This will allow the Manager to monitor the hours that are worked by the staff across the two homes. Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, and 38 People that use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 24 People do not benefit from a home that is managed in their best interests to ensure their needs are fully met. Individuals’ financial interests are safeguarded, but information needs to be provided to people about any additional charges that will be made to them. The health, safety and welfare of service users are not promoted due to being supported by staff that are not trained to meet their needs or able to follow the policies of the home due to language barriers. EVIDENCE: There are two registered Manager’s/Owners of the home and they state that they each work 15 hours in the service per week. There have been concerns received from other professionals about the lack of availability of the Manager’s in the home. CSCI have made a number of attempts to contact the Manager’s of the home by telephone since the last inspection, but have been told by staff that they are not in the home. The Manager’s have since told the Commission that this is due to them instructing staff to say they are not there to avoid sales calls. The registered Manager’s must ensure that they are available to speak to CSCI or Care Manager’s when they are rota’d on duty to enable effective joint working for the benefit of the people that use the service. The rotas were inspected and showed that the Manager who was supposed to be on duty was not. However, the other Manager was in the home, but was not included on the rota. The Manager’s must ensure that the rota accurately reflects the management cover of the care home. Both the Manager’s have the Registered Manager’s Award and the NVQ level 4 in care. The Manager on duty said that they had both completed other training courses since the last inspection, but there were no records available in the home to evidence this as they are held in the other care home owned by the registered providers. The Manager’s of the home have not ensured that people’s needs are being met by trained and competent staff. They have not ensured that people are safeguarded in the home and that the staff that support them understand how to protect people and the policies for reporting any allegations of abuse. The home does not have the appropriate records to evidence that staff have been recruited following safe practices or that staff are appropriately trained. The Manager said that a new development plan for the service was being worked on. There were no records of any quality review of the home and the Manager was advised that a report of the quality review of the service must be produced and supplied to CSCI and stakeholders. There has been no recent formal consultation with service users or their relatives to gather their views of the service as part of any quality monitoring, although it was noted that Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 25 service meetings have been held at regular intervals. A requirement was made at the last inspection and this will remain in the report, as further work is needed to ensure there is evidence of a quality assurance system in the home that takes account of service users views. Whilst the Manager on duty was aware of the ‘Valuing People’ White Paper the principles of this have not been incorporated into the service in an effective way. As described earlier in this report, effective consultation has not taken place with people about their care plans and person centred planning has not been used in a way that gives people control of their lives. Leading an ordinary life and accessing community services has not been fully promoted in the home. The registered Manager’s must ensure they keep up to date with the latest good practice guidance with regard to learning disabilities to ensure that the people that use the service are supported to live as independently as possible. People in the home have their own personal bank accounts. The provider pays for all activities, clothing and personal items for the service users and keeps receipts. The service users are then invoiced monthly to cover these costs. The invoices are made up for a round figure and this therefore means that at the end of the month the service user may have overpaid or underpaid the provider in respect of purchases made for that month. The provider should review the financial system to ensure that the amounts balance accurately at the end of each month. Some of the charges that are made to service users are for fuel for the house vehicle and for holiday costs. The receipts have been divided by the number of service users and people have been charged accordingly. The registered person must ensure that additional charges made to service users are made clear in the Service User Guide and in individuals contracts. Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 1 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 ENVIRONMENT Standard No Score 19 3 20 3 21 3 22 X 23 2 24 X 25 X 26 3 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No Score 31 1 32 X 33 1 34 X 35 2 36 X 37 X 38 1 Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation Requirement Timescale for action 16/06/08 5(1)(bb)(e) The registered person must 4(1)(c) ensure that the Service User Guide includes details of any charges that will be made to the service user that are additional to the stated fee. The Statement of Purpose and Service User Guide must include a summary of the complaints procedure for the home. 2. OP2 5(1)(c) The registered person must 16/06/08 ensure all service users are provided with a standard form of contract (terms and conditions) for the provision of services and facilities in the care home. The registered person must ensure that care plans are produced in a format that is accessible to service users. The provider must demonstrate that service users have been consulted about and involved in their plans. The registered person must 16/06/08 3. OP7 15(1)(2) Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 28 ensure that service users needs are met through the care plan and that staff are able to access and follow the plans. 4. OP8 13(1) The registered person must ensure that service users have the opportunity to access mainstream primary health care services in their local community, including GP, dentist and optician. The registered person must ensure that the privacy and dignity of service users is respected in terms of their personal space and meeting their individual needs. The registered person must ensure that service users are provided with a copy of the complaints procedure for the home that includes the timescales for investigating complaints. The complaints procedure must be supplied to service users in a format that is appropriate to their communication needs. The registered person must ensure that service users are safeguarded from harm and abuse. The registered person must ensure that the skill mix of staff is appropriate to the needs of the service users at all times and that staff are able to communicate with service users in their first language. The registered person must ensure that the information and DS0000013549.V362522.R01.S.doc 16/06/08 5. OP10 12(4)(a) 16/06/08 6. OP16 22 16/06/08 7. OP18 13(6) 16/06/08 8. OP27 18(1)(a) 16/06/08 9. OP29 19(1)(b) schedule 1 16/06/08 Alexandra House Version 5.2 Page 29 documents referred to in Schedule 1 of the Care Homes Regulations 2001 are obtained and held in the care home in respect of all persons employed in the home. 10. OP30 18(1)(c) The registered person must ensure that staff undertake the training required to effectively carry out their roles and that evidence of their training be held in the home. The registered person must develop a system for reviewing the quality of the service provided in the care home. The provider must, as part of this process, consult service users, relatives and other stakeholders to obtain feedback about the home to ensure it is run in the best interest of service users. This requirement has not been fully met by the timescale set (20/01/07) The provider must ensure that this is fully met by the new timescale. 12. OP35 13(6) The registered person must ensure that the financial systems for accounting for service users money is clear and accurate and that service users do not make overpayments to the registered person for services. 16/06/08 16/06/08 11. OP33 24(1)(2) 16/06/08 Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 30 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 OP8 Good Practice Recommendations That service users be supported to be involved in developing their health action plans and managing their own health. That the range of activities available to people be reviewed to ensure they have a variety of activities that meet their needs and interests. That the policy on sexuality be reviewed and that people’s needs regarding their sexuality and personal relationships be acknowledged within their care plan. That person centred planning be used effectively to help people plan their own lives and the support they need to achieve their goals in life. That the person centred plans be developed with people in a format they can access and take ownership of. That staff be trained in Person centred planning. 5. OP23 That the shared bedroom not be used unless appropriate screening is provided and the registered person can demonstrate that both service users have made a clear informed decision to share a room. That 50 of the staff complete the NVQ award. That the registered Manager’s are able to demonstrate that they are keeping up to date with relevant legislation and good practice guidance in relation to people with learning disabilities. That the registered Manager’s ensure the rota’s accurately reflect the management cover of the home and that the Manager’s are contactable by the Commission and Care Manager’s when on duty. 2. OP12 3. OP13 4. OP14 6. 7. OP28 OP31 Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Alexandra House DS0000013549.V362522.R01.S.doc Version 5.2 Page 32 - 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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