CARE HOME ADULTS 18-65
Augusta Close (5 & 6) Parnwell, Peterborough PE1 5NJ Lead Inspector
Lesley Richardson Announced Inspection 28th September 2005 1:15 Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 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 Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 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. Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Augusta Close (5 & 6) Address Parnwell, Peterborough PE1 5NJ 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) 01733 890889 Mr Alan Atchison Mrs Deborah Evans Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd February 2005 Brief Description of the Service: Augusta Close consists of 2 properties, situated on a residential estate on the north eastern edge of Peterborough. Both houses are two-storey, detached properties in the same road. They are owned by Mr Alan Atchison and provide care and support for up to 9 people with learning disability. 5 Augusta Close has 4 bedrooms and 6 Augusta Close has 5 bedrooms, both houses have a lounge/dining room, kitchen, bathrooms with shower and toilet and a separate toilet. The houses share access to a large back garden with patio and lawn. The houses are within walking distance of local shops, pubs, a post-office and public transport. Peterborough city centre is about 5 miles away and is easily accessed by public transport. Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 6½ hours and was carried out as an announced inspection on 28th September 2005 and 4th October 2005. The inspection took place over two days because it was not possible to look at everything on the first day. It was the first inspection of this home for the 2005-2006 year. Four hours were spent examining records and documents and two and a half hours were spent with service users and staff. A tour of the building was also undertaken during this time. The manager was present during the inspection. Six people who were living at the home and three of the staff on duty were spoken to during the inspection. Not all service users wished to express their views. Information given in a survey completed by service users and a questionnaire completed by the manager before the inspection were also used in the report. What the service does well: What has improved since the last inspection?
The home has made improvements in four of the six areas they were asked to improve at the last inspection. The manager said policies and procedures they were asked to amend and produce have been done. As these are for the complaints procedure and the protection from abuse policy this makes sure service users are protected and are able to tell someone at the home if they are not happy with something. Service users confirmed this and also said action is taken if they raise concerns with members of staff. Some improvements have been made regarding information that is needed before a person can start working and new staff members files contained nearly everything required. Similarly, improvements have been made on keeping records of checks that have been done to make sure people who live at the home are safe. Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 6 What they could do better:
There is much for the home to do to improve the standard of living for people at the home. Plans are written to let staff members know the best way to care for someone and these should be looked at every 6 months, at the least, to make sure that the information is still correct and relevant. However, the home only reviews these plans once a year and bases new plans or changes on a review done by social services. People who live at the home do not look at the plans or have the chance to agree with what is written in them, although they do have this opportunity with the social services reviews. The home should change these practices to make sure people who live there are able to comment about the care they get and any changes that are needed are made when they occur. People who live at the home have little opportunity to comment formally about how the home is run, although they said they would like to be more involved with decision made about the home. There is no survey conducted by the home to find out the views of people who live there, people who represent them or other people who come into contact with the home on a professional basis. This needs to change so that people living at the home have a say and a choice in how they would like to live. Some of the people who responded to a survey sent by the Commission for Social Care Inspection indicated they didn’t always feel safe at the home, that sometimes they were not well cared for and their privacy was not always respected. Although these views were held by about a third of the people living at the home, none of them was willing to talk to the inspector about them. The information has been passed on to the manager so she can address the issues. Half of the staff work force has NVQ qualifications in care, but the home does not provide additional training that would allow staff to meet the specific needs of service users better. Required health and safety training is given when new staff start working at the home, and this is updated. Staff members must be given proper training to look after people properly and if they are no allowed to do this, it puts service users at risk. Medication training and protection from abuse training are two areas where there are serious shortfalls and this must be addressed. The environment of the home needs improvement. There is no programme of maintenance, which means things are repaired or replaced only after they are unable to be used. Staff members said that although conservatories have been put on to the back of both houses and bathrooms in both houses have been partially refurbished, other areas still need work. Noticed in this inspection is plasterwork in both houses that is cracked and peeling, absent lights and light shades, lounge seating in one house that cannot be used as the springs have gone, and a kitchen cupboard that has become stand alone after being attached to the wall and poses a significant risk if it falls. It is Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 7 recommended that the home also start a programme of maintenance and records when areas or equipment becomes defective. The recruitment and vetting of new staff members is concerning, as although new staff members files contain most of the information required, there is still not information about what people do between jobs. Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (PoVA) checks are also required for all staff. The home was told they had to obtain a CRB check for an employee during the last inspection, which they did. However, this was a copy of a certificate from another employer and was already a number of years old. CRB disclosures are not transferable and the home has been told it must apply for a CRB check for this individual. A recently recruited staff member started working at the home, and was placed in sole charge of the home, before a CRB or PoVA check was applied for. This places service users at enormous risk and the home has been told it must not do this again. Staff morale is low and staff members receive little in the way of support and supervision. This must be changed if there is to be improvement in the running of the home. Staff members must receive supervision, which gives them the support to be able to care for people living at the home, and reduces the risk to people living at the home of mistakes occurring. Not all the checks that must be kept to make sure people at the home are safe and free from danger are being kept. The home was told they had to improve this during the last inspection, and some improvements have been made, but there are still some areas in which checks are not done, such as portable appliance testing. A fire safety officer was asked to visit the home after the inspection to assess if there was a breach in fire safety regulations; the home has to make sure people who live there are able to get out of all external doors easily in the event of a fire. 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. Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 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 Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 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): 2 and 4 Pre-admission assessments of prospective service users and pre-admission visits by service users ensure the home is able to meet service users needs and enables informed choice. EVIDENCE: Service users are referred to the home by the Learning Disability teams within council social service departments, who provide a detailed assessment about that service user, or the service user’s family may contact them privately. An assessment is only undertaken by the home if the prospective service user is referred privately. Prospective service users are encouraged to visit the home for tea visits, day visits and overnight stays so the home is able to fully assess their needs. They are then able to decide if they would like to stay at the home, which is on a temporary basis for the first month and becomes a permanent arrangement following a review and the service user’s agreement. The home has had one service user come to live at the home since the last inspection. An assessment of care needs and information about how best to meet those needs was seen on this service users file. The service user said she visited the home before living there, but as she already had friends living at the home she knew she wanted to live there and did not need as many visits as some other people may need. A similar arrangement is available to Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 10 service users leaving the home, especially for those going to more independent living. Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 8 Limited progress has been made on improving arrangements to ensure that the personal and health care needs of service users are identified and met. These shortfalls have a potential to place service users at risk. EVIDENCE: Care plans are written from the information obtained in the pre-admission assessments and during the period immediately following admission to the home. If a service user enters the home from another care home, care plans from the previous home are used initially. This ensures continuity of care, allows the service user to settle in with as few changes as possible, and enables care staff to assess any changes in that service users needs. Three service user care plans were seen and gave basic information about how identified needs were to be met. A review of service users’ needs should be undertaken every 6 months, however the home only reviews plans annually when social service reviews of care placements are conducted. Service users files confirmed the home writes a reviewed plan of care following the social services review. The service user entering the home most recently had a review of her care needs after one month at the home but had not had another after 6 months. Care plans
Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 12 should be reviewed 6 monthly or more frequently if needed to identify any changed care needs. Waiting for a social services review means the home is not being proactive in ensuring all service user needs are being met. Files seen showed service users agreement to social services reviews had been obtained, but their involvement with the home’s care plan drawn up from information obtained during the social services review was not evident. The home’s review of care needs was neither written in the first person, as in ‘by the service user’, or showing the service user had read and agreed the identified needs and plan of how to meet those needs. Of the six people who responded to the Commission for Social Care Inspection survey, all said they would like to be more involved in decisions made in the home. One person who lives at the home said she would like to live in supported living but did not want to move away from Augusta Close. The manager was made aware of the results of the survey. Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, and 14 Social activities provide stimulation and opportunities for community links for people living in the home. EVIDENCE: Service users are able to identify activities that enhance their personal development during annual reviews of care needs. One service user said he had achieved a certificate in first aid last year and this year is working on another project. Another service user’s file shows an individual learning plan for Tai Chi, and gave details of how and where this is to take place. Service users said they are able to attend social events in Peterborough for people with learning disabilities and regularly go out to a local social club. All people living at the home attend day service programmes or are in paid employment during the day. A short holiday in Blackpool was attended by all but one of the service users in the week between the two parts of this inspection. Service users said they had a great time and tried to do as much as they could whilst there, but did not go on the beach as the weather was too wet. Everyone responding to the Commission for Social Care Inspection survey said suitable activities were arranged at or by the home.
Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 14 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 The systems for staff training to ensure safe administration of medication are inadequate and potentially place service users at risk. EVIDENCE: Six people living at the home returned a survey to the Commission for Social Care Inspection. Of these people, between one third and a half of them felt they were not always well cared for and their privacy was not always respected. However, during the inspection service users said they get as much help as they need from staff members. One element of an anonymous complaint received by the Commission for Social Care Inspection stated a service user was unable to fully complete personal hygiene tasks, as there were often only male carers available. This service user’s care plan identified a need for prompting and encouragement with personal care rather than assistance. This issue was discussed with the manager who felt the service user chose not to complete her personal hygiene, rather than not being able to because assistance was not available from a female staff member. The service user did not wish to comment specifically about the issue. Service user files showed access to a range of healthcare professionals; service users make and attend appointments by themselves, or staff assist them with this.
Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 15 Medication is kept in a lockable filing cabinet in the staff room, which is locked when staff members are not present in the room. The manager said new staff members are given medication training by her before being able to administer medication to service users. This is the only training staff members receive on medication and is not enough to ensure service user safety. An appropriately trained professional, such as a registered nurse or pharmacist, must give medication training to all staff members with this responsibility. Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 16 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 The home has a complaints system with evidence that service users feel their views would be listened to and acted upon. EVIDENCE: The manager said the home has received no complaints since January 2004. However, this was found not to be the case. Issues raised by service users on a daily basis are dealt with immediately to reduce the risk of escalation. The Commission for Social Care Inspection has received one anonymous complaint and elements of this have been looked at during the inspection. Of the nine elements identified, four have been substantiated, two were partially substantiated, but there was not enough information to investigate fully the other three elements of the complaint. Requirements and recommendations have been made concerning some of the substantiated elements of the complaint. Service users said they would be able to speak to a staff member if they were unhappy with something at the home, one service user said she does mention things and when she does her concern is usually resolved. The complaints procedure has been changed to show current contact details for the local CSCI office. The manager said she receives reports of regulation 26 visits from the provider in approximately a 6 month batch, although there are reports for each month. In one notice dated 18th April 2005 a complaint from a service user about staff members refusing to use their own vehicles to transport service users was noted. The action for this was that the manager would speak to the service user and staff member(s) to resolve the issue. However, the manager said she did not receive a copy of the regulation 26 notice until 23rd September 2005. Although the home keeps a complaint log, this complaint had not been registered in the log.
Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 17 Staff members are given a copy of local Adult Protection guidelines, which they are encouraged to read. Information supplied to the Commission of Social Care Inspection stated the home has a policy for adult protection and prevention of abuse. The manager gives additional training and the home has a video for staff members to watch. However, staff are not sent on recommended free training provided by the Adult Protection Team. Although service users said, during the inspection, they felt safe at the home, one third of those returning survey’s to the Commission for Social Care Inspection said they sometimes didn’t feel safe at the home. A half of respondents to the survey said staff did not always treat them well, although they did not say in what way this occurred when they spoke to the inspector. These issues were drawn to the manager’s attention. Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 18 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 and 30 Improvements have been made to the home, although there are a number of matters that put service users at risk of harm and do not provide safe or comfortable surroundings in which to live. EVIDENCE: The home has undergone some renovation work in recent weeks, which enhances communal areas for service users. Décor is domestic and service users have some input into how each house is decorated and furniture that is bought. Despite new conservatories attached to each house, and new tiling and baths in the upstairs bathrooms, there were a number of areas in both houses that need work to maintain the health and safety of service users. • The sink surround in the first floor bathroom in No. 5 is chipped and peeling, and this requires repair or replacement. Although the first floor bathrooms in both houses had new baths and tiling, the old flooring and sinks have not been replaced. It is recommended that older areas of the bathrooms are replaced to ensure problems do not re-occur. • Plaster and paint work in both houses requires attention as it is stained, cracked and crumbling in a number of areas: lower floor toilet ceiling in no. 5, next to landing light switch in no. 6, kitchen ceiling in no. 6.
Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 19 • • • Lighting in no. 6 needs attention to ensure the safety of service users. A glass pane in the dining room light shade is missing and needs to be replaced. The first floor landing light had neither a light shade nor light bulb in place, although the manager said this has been replaced since the first date of the inspection. The seating on 2 items of lounge furniture in no. 6 was broken and did not enable service users to comfortably sit on them. These require repair or replacement to provide adequate seating for all service users. The kitchen areas in both houses are functional, although dated. The lino flooring in no. 5 has recently been replaced, although there are already tears where white goods have been moved back in to position. A cupboard to the right of the oven in no. 6 had come away from the wall and was free standing, which places service users in danger if it were to fall. Each house has a washing machine and washing line in the garden. Service users said washing is usually hung on clothes airers or draped over radiators if the weather is wet or too cold to dry outside. This is inappropriate and it is recommended therefore that the home obtain a tumble dryer for those service users that may need to wash bedding or personal items frequently. The houses were clean, tidy and free from offensive odours. However, there is no programme of routine maintenance and work on the houses appears to be done on a haphazard basis. A programme of routine maintenance should be started to ensure the home is kept in a good state of repair internally and externally. Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 20 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, 35 and 36 Vetting and recruitment practices do not ensure that all appropriate checks are being carried out, leaving service users at risk. Staff training opportunities are insufficient to meet the needs of service users. EVIDENCE: The home does not have a budget for staff training purposes. Mandatory training is given during the induction programme for new staff members. The manager said staff members ask about the possibility of attending service user specific training and this is passed on to the provider. However, as funding is not forthcoming, training opportunities are usually missed. The manager said she gives staff members medication training before they work alone with service users, but training is not sourced by an appropriate healthcare professional, such as a pharmacist or registered nurse. Information supplied in the pre-inspection questionnaire states 50 of staff at the home have an NVQ qualification in care at level 2 or above. The manager said staff morale was very low, partly due to poor support from the provider, partly due to a reduction in the staff team over the summer months. One staff member said the home had poor support from the provider and she felt that a number of issues that were continually not addressed made it more difficult for staff to care for people who live at the home. A staff rota supplied to the Commission for Social Care Inspection for four weeks in the
Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 21 month of September shows the manager is relied on heavily to provide direct care. The manager said staffing shifts were one staff member from 8am-2pm, two staff members from 2pm-8pm and 1 sleeping night staff member during the week. At weekends staffing shifts were one staff member from 8am10am, two staff members from 10am-5pm and one staff member from 5pm to 8am the next day. The rota supplied shows staff shifts covering the hours of 8am to 11pm each day but does not show which staff member covers the sleeping night shift. A staff member said the staff member working the 4pm to 11pm would normally also be on the rota for an 8am to 9pm shift the next, and it would be this staff member who would work the sleeping night shift. Rotas demonstrate that some staff are working excessive hours. Should service users require the assistance of staff members during the night, this would mean some staff potentially being on waking duty for 29 hours. This places staff members and service users at risk; a recommendation has been made that home reviews shift patterns to reduce this risk. Although the rota is written in pen, identification of staff is by first name only and there is nothing to indicate staff roles, i.e. manager or senior carer. This should be changed to ensure an audit trail. European working time directives, which allows staff to work over 48 hours per week, were not in the staff files seen during the inspection. The staff files of the two most recently employed staff members were seen and contained all the information and checks required to ensure service users safety. However, one staff member had started working at the home before the Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (PoVA) checks had been returned. This person was also the only staff member on duty at times, which places service users at enormous risk. Staff may not work in the home unsupervised without at least the return of a clear PoVA first check. Employment histories in both new staff members application forms were in months and years only. Gaps in employment history, even if only for 2 months, must be explored and a written statement signed by the applicant. The file of a long standing employee who did not have a CRB check at the last inspection was looked at to check compliance with a requirement made then. A CRB check that had been obtained by another employer in 2002 was in the staff member’s file. Portability of CRB checks has not been permitted since 26th July 2004 and therefore this check is not valid. An immediate requirement notice was issued on 28th September 2005 for an enhanced CRB and PoVA check to be applied for within 7 days. During the second part of the inspection on 4th October 2005 the registered provider was informed of the immediate requirement issued 6 days previously. A letter has since been received from the registered provider advising of the action to be taken to resolve this issue. The manager said staff members do not receive supervision at all. Although she has had training for this, she said she feels unable to give supervision, as she does not receive supervision or support from the owner of the home. Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 22 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): 38, 39 and 42 The systems for service user consultation are poor with no evidence that service user views are sought and acted upon within the home. Safety of all service users at night cannot be guaranteed and places them at risk. EVIDENCE: The manager said she has resigned from the position, although this has not been confirmed in writing to the Commission for Social Care Inspection. There is evidence that the management of the home is not effective in ensuring staff have adequate support and training, and in ensuring people who live at the home are consulted on how the home is run. A staff rota supplied to the Commission for Social Care Inspection shows the manager is used as a member of the staff team and does not have adequate time to complete a managerial role. The manager said the home has not conducted a quality assurance survey or gathered service users views about the home outside a review of care needs forum. Views of service users’ relatives or representatives are listened to at Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 23 the time of representation but do not form part of a survey and the home does not actively seek others views. Service users at no. 6 Augusta Close said they would be able to exit the house via the rear conservatory door, which is locked with a key at night. The sleeping night staff member locks the front door of the property and removes the key; service users are not able to exit the house from this door at night. The house telephone accepts incoming calls only and as the intercom system at the top of the stairs does not work, the home must install a system that ensures service users are able to alert staff at all times without the need to leave the building. This poses a considerable risk to service users in the event of fire and the opinion of the Fire Safety Officer was sought. The recommendation from the Chief Fire Officer is that all doors forming part of an emergency route should be readily operable and available when the premises (both houses) are occupied. Checks required to ensure the health and safety of service users are completed. The manager said that although mixer valves have been placed on hot water taps to prevent hot water above 43oc, periodic checks have been carried out as recommended during the last inspection. The hot water was found to be up to 61oc, and the manager has taken steps to prevent this occurring again. The manager said fridge temperatures were being taken and that one fridge was regularly running at 10oc. A new fridge has been requested. However, other checks, such as Portable Appliance Testing (PAT) is not completed at all. A previous requirement made regarding the need for all checks ensuring the health and safety of service users must be completed and documented has not been met. Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 24 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X 3 X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X 2 X X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X X 2 X X 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 2 1 1 1 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Augusta Close (5 & 6) Score 2 3 2 X Standard No 37 38 39 40 41 42 43 Score X 2 1 X X 2 X DS0000015142.V250862.R01.S.doc Version 5.0 Page 25 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 YA8 Regulation 24(1), (3) Requirement The registered person must establish and maintain a system for reviewing and improving the quality of care at the home. The system must provide for consultation with service users and their representatives. The registered person must make suitable arrangements to ensure that the care home is conducted in a manner that respects the privacy and dignity of service users, with due regard to the sex of service users. The registered person must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The registered person must make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The registered person must provide adequate furniture
DS0000015142.V250862.R01.S.doc Timescale for action 15/11/05 2 YA18 12(4)(a), (b) 05/11/05 3 YA20 13(2) 30/11/05 4 YA23 13(6) 15/11/05 5 YA24 16(2)(c) 15/11/05 Augusta Close (5 & 6) Version 5.0 Page 26 6 YA24 7 YA24 8 YA32 9 YA34 10 YA34 11 YA36 suitable to the needs of service users. 23(2)(b), The registered person must (d) ensure that the premises are kept in a good state of repair externally and internally. All parts of the home must be kept clean and reasonably decorated. 23(2)(p) The registered person must ensure lighting suitable for service users is provided in all parts of the care home. 18(1)(c)(i), The registered person must (ii) ensure that persons employed at the care home receive training appropriate to the work they are to perform and suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. 19 The registered person must not employ a person to work at the care home unless he has obtained the information and documents specified in paragraphs 1 to 9 of Schedule 2. Staff files must contain an appropriate and satisfactory CRB disclosure and PoVA check. (31st March 2005 timeframe from previous requirement not met.) 19 The registered person must not employ a person to work at the care home unless he has obtained the information and documents specified in paragraphs 1 to 9 of Schedule 2. Staff files must contain all the records detailed in Schedule 2 of the Care Homes Regulations 2001, and amendments 2004. (31st March 2005 timeframe from previous inspection not met.) 18(2)(a) The registered person must
DS0000015142.V250862.R01.S.doc 30/11/05 05/11/05 30/11/05 28/09/05 05/11/05 15/11/05
Page 27 Augusta Close (5 & 6) Version 5.0 12 YA36 18(2)(b)(i) 13 YA39 24(1)(a), (b), (3) 14 YA42 13(4)(a), (c) ensure that persons working at the home are appropriately supervised. The registered person must ensure that for the duration of a new worker’s induction training a member of staff, who is appropriately qualified and experienced, is appointed to supervise the new worker. The registered person must establish and maintain a system for reviewing and improving the quality of care provided at the care home. The system referred to must provide for consultation with service users and their representatives. The registered person must ensure that all parts of the home to which service users have access are free from hazards to their safety. Unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. All checks required to be kept to ensure the health and safety of service users and staff must be completed and documented. (31st March 2005 timescale from previous inspection not met.) 05/11/05 30/11/05 15/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA24 Good Practice Recommendations Service users care plans should be reviewed on a 6 monthly, or more frequent, basis. The home should complete a routine maintenance
DS0000015142.V250862.R01.S.doc Version 5.0 Page 28 Augusta Close (5 & 6) 3 4 YA27 YA30 5 YA33 6 YA38 assessment and programme to ensure it is in a good state of repair internally and externally. Older areas of bathrooms should be replaced to ensure problems do not re-occur. The home should install a tumble dryer in each house to ensure clothing and bed linen is dry and not leave service users at risk if garments are draped over radiators or airers in communal areas. Staff shift patterns should be reviewed to ensure staff members do not work excessively long hours. Staffing rotas should clearly identify staff members’ full names and roles within the home. The manager should review the management approach to create an open, positive and inclusive atmosphere. Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 29 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE 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 Augusta Close (5 & 6) DS0000015142.V250862.R01.S.doc Version 5.0 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
