Inspection on 19/03/07 for Bede`s View

This inspection was carried out on 19th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 27 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bede`s View 26/08/08

Bede`s View 20/09/07

Bede`s View 10/05/06

Bede`s View 11/02/06

Bede`s View 22/08/05

Bede`s View 01/03/05

Bede`s View 01/07/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

CARE HOME ADULTS 18-65 Bede`s View St Bede`s Close Wasdale Avenue Wivern Road Kingston upon Hull East Yorkshire HU9 4HZ Lead Inspector Christina Bettison and Bev Hill Unannounced Inspection 19th March 2007 09:30 DS0000041450.V333133.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000041450.V333133.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000041450.V333133.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bede`s View 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) St Bede`s Close Wasdale Avenue Wivern Road Kingston upon Hull East Yorkshire HU9 4HZ 01482 788078 01482 788098 shiela.carmichael@hullcc.gov.uk Kingston upon Hull City Council Position Vacant Care Home 11 Category(ies) of Learning disability (11), Physical disability (11) registration, with number of places DS0000041450.V333133.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th May 2006 Brief Description of the Service: Bede’s View is a purpose built establishment, managed by Hull City Council Social Services Department and provides accommodation for eleven service users who have a learning disability. Accommodation is in single rooms although none of these are en-suite. The home consists of two bungalows each having its own kitchen and dining room/lounge area. A secure garden area is available for service users to utilise. The home has parking facilities. A variety of aids and adaptations are available to meet the needs of service users with mobility problems. The home is located to the east of Hull within a residential area. Shops are close by and several buses travel to the city centre. All bedrooms are for single occupancy. Weekly fees are: £886.00. Additional charges are made for the following: newspapers/magazines and sweets, hairdressing, chiropody and transport for social activities. Information on the service is made available to current service users via the statement of purpose, service user guide and inspection report. DS0000041450.V333133.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a key inspection and the unannounced site visit took place over 1 day on 19th March 2007. The visit was undertaken by two Inspectors – the lead inspector Tina Bettison assisted by a second inspector Bev Hill. One professional survey, 1 relatives survey and four staff surveys were returned. During the visit the inspectors spoke to the senior care officers on duty and staff, to find out how the home was run and if the people who lived there were receiving the right care to meet their needs. The service users that live at Bedes View have complicated needs and are not able to tell the inspector of their views therefore during this visit an observational tool (SOFI) was used to help to form a view whether service users needs are met or not. In addition to this comments from relatives and staff have been used. The inspectors looked around the home and looked at records. Information received by the CSCI since the previous inspection was also considered in forming a judgement. Prior to the visit the inspector referred to complaints received and notifications sent to the Commission for Social Care Inspection, the event history for the home over the past year and the completed pre- inspection questionnaire. The CSCI have concerns about the standard of care and management at the home. The visit lasted 7 1/2 hours. What the service does well: Service users and their relatives are provided with information that is easy to read so that they know what to expect from the home. All service users have a single room that is nicely personalised to their own taste, providing them with a private area to their liking where they can spend private time or receive visitors. Relatives are very involved in the home and are made to feel welcome, making sure that family can keep in contact. A good recruitment policy is in place so that service users are protected from harm. DS0000041450.V333133.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home needs to be managed better so that all of the things that need to get better do. Assessments need to include all up to date information to give a clear picture of what service users needs are so that appropriate care and support can be provided. Where service users present behaviour that may be a risk to themselves or others, a plan must be in place and updated regularly so that risks can be reduced and service users protected from harm. Service users plans and risk assessments and behaviour management plans must state clearly the care that needs to be provided by staff and they must be looked at and changed when needed to make sure that service users get the care they need when they need it. Service users need to be helped to try out new activities and be supported to regularly attend activities that are planned both in house and in the community. Service users health needs must be written in the plan and action taken to meet them. Service users medicines must be looked after well and staff must assist service users to take their medicines safely. When service users have medicines that are taken “when needed” the instructions for staff need to be clear when and why they can help service users to take it. DS0000041450.V333133.R01.S.doc Version 5.2 Page 7 Medication must be handled appropriately, service users must receive their medication when they need it and accurate records must be kept, if this does not happen service users may placed at risk of harm. There needs to be enough staff in the home so that the staff can meet the needs of service users and carry out all of their duties safely. The senior care staff must be given enough time to carry out their duties properly so that service users needs can be met. Meals need to be provided that are nutritious, varied and well balanced and take into account service users health needs and likes and dislikes. Staff must be provided with special training, e.g. how to deal with behaviour that may harm service users or staff and to help them to meet the special needs of the service users. Staff need to be given time with their manager to discuss their practice, training and support. The manager must make sure that staff meet the complicated health needs of service users and special health advice is followed. A system that helps to improve the standards in the home must be started to make sure that everyone is asked about the running of the home and improvements are made. The manager needs to make sure that the houses are safe for the service users to live in by making sure that the gas, electrics and water have been checked out by a qualified person. 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. DS0000041450.V333133.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000041450.V333133.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Service users needs are assessed, however not in full and consideration is not being given as to whether the home is sufficiently resourced to meet their needs. EVIDENCE: There have been no new admissions to the home since the previous inspection. However the Local Authority have undertaken re assessments of all service users in order to clarify if the home is able to meet their complex needs and is adequately resourced. Each service user has their own individual care file. At the random inspection carried out in August 2006 all 11 care files and the assessments were examined. All 11 service users are assessed as critical by the local authority and all have multiple disabilities, complex health needs, communication deficits, significant sensory impairment and some present behaviour that can be difficult to manage and pose a risk to themselves and others. DS0000041450.V333133.R01.S.doc Version 5.2 Page 10 Most of the service users are identified as needing 2;1 support for all personal care tasks and assistance with moving around the home and out in the community. Service users and their representatives are provided with the information they need to make an informed choice about where they live. DS0000041450.V333133.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Service users needs are met on an informal basis by inadequate numbers of staff, the quality of the service user plans and risk assessments are very basic. These shortfalls have the potential to place people at risk and mean that service users assessed needs are not met. EVIDENCE: Since the previous key inspection in May 2006 and the random inspection in August 2006 there has been only minimal improvements to the service user plans. All service users have a care file, which has been tidied up since previous inspections however they still do not reflect the full range of needs and do not DS0000041450.V333133.R01.S.doc Version 5.2 Page 12 ensure that all aspects of health, personal and social care needs are identified and planned for. Three care files were examined as part of the inspection process. The service user plans did not include everything that is detailed in the local authority assessment/care plan and did not detail accurately what staff need to do to meet all of service users needs. In one care file examined there was a very basic service user plan, that did not cover all identified needs and all of the risk assessments had not been reviewed for well over a year. Areas of health need had not been detailed either in the form of a service user plan or health action plan and there was no evidence of outcomes or monitoring of health needs. This is detailed further in the health section of this report. Where service user display behaviours that can be difficult to manage and specific techniques or methods of communication are needed in order to minimise the risks there were behaviour management strategies completed by the health authority however in one care file examined there was a management plan completed by the staff in the home that directly contradicted the nursing plan completed by the community nurse. E.g. the nursing crisis management plan gave clear instruction to staff to respond to the service users periods of agitation and self injurious behaviour by using diversion techniques and increasing staff engagement with the service user, where as the homes crisis management plan instructs staff to use “planned ignoring” techniques. This will leave the staff group confused as to which approach to use and the service user and others not having their needs met and not being protected from harm. In another care file examined again there was a very basic service user plan, that did not cover all identified needs and all of the risk assessments had not been reviewed for well over a year. Areas of health need had not been detailed either in the form of a service user plan or health action plan and there was no evidence of outcomes or monitoring of health needs again this is detailed further in the health section of this report. One service user who is identified in their assessment as needing one to one support is not receiving this as the additional staff are part of the homes staffing provision. In the third care file examined although it contained lots of information the service users plan itself was disjointed and sections were found throughout the care file. This means that care staff would have to plough through the whole file instead of having a cohesive plan that covered all assessed needs easy to locate and read. Some of the service user plans, for example those for dressing and undressing did not detail how independence, privacy and dignity DS0000041450.V333133.R01.S.doc Version 5.2 Page 13 were to be maintained and they did not detail sufficiently the tasks staff needed to complete. Some plans were information sheets with tick boxes for the level of support the service user required in particular areas, for example, dressing, toileting, mobility, sleeping, communication, eating and drinking and medication. However these too did not have clear tasks for staff. Some parts of the service users plan were called, ‘management plans’ and these mainly covered health related issues such as epilepsy management and bowel management. In this particular file there were three separate plans for the management of epilepsy, two of which were not in use. This would be confusing for staff and could result in the service user not receiving the care and support they needed. Similarly there were two separate management plans for pain control, one of which was also not in use. Plans no longer in use need to be removed from the working care file to avoid confusion. Plans were not always signed and dated by the person formulating them and they were not evaluated effectively. Risk assessments covered a range of activities but were not followed through to care plans. Some needs identified in assessments or reviews were not followed through to the care plan stage. For example nutritional needs, weight monitoring and continence management. None of the service user plans were signed and dated to evidence either the service users or their representative’s agreements. Discussion with staff suggested that service users basic care needs were being met even though there was a lack of clear plans and guidance. This approach is dependent on staff memory and good verbal communication systems. Service users are at risk of not having their care needs met if these informal systems break down. Although the manager had been undertaking some review and monitoring of the care files, this process has failed to be effective and areas for improvement have not been identified and therefore standards have not been raised. These issues have been raised at previous inspections and a requirement made for the service users plans to be well completed, maintained and reviewed on a regular basis, the manager must take action to meet this. A member of staff commented “on taking up my job at Bedes View I have seen a lot of trust from service user for staff built on a daily basis. Service user appear more confident with all aspects of their daily living skills. Service users DS0000041450.V333133.R01.S.doc Version 5.2 Page 14 are accessing more professional agencies regarding their well being. The daily routines appear less institutional, service users are able to make their own choices rather than staff choosing” DS0000041450.V333133.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Insufficient staff and a limited range of activities within the home and community mean the service users do not have the opportunity to participate in stimulating and motivating activities that meet their individual needs, wants and aspirations. Service users are not provided with a well-balanced, varied and nutritious diet. EVIDENCE: Service users are not being provided with a sufficient range of activities, both in-house and within the community. One service user is assessed as requiring one to one support from staff but in the morning the inspectors observed that this did not happen, discussion with DS0000041450.V333133.R01.S.doc Version 5.2 Page 16 two members of staff indicated that the time is not spent specifically with the individual but shared out with other service users. In the three care files examined, each service user had an activities programme however a large proportion of the activities carried out are outings in the local community or to the local shops or in house activities. In one care file examined the activities programme identified; • Ice hockey games; - the records indicated that he had never been • Swimming - records stated “30/6/06 went swimming and really enjoyed himself” and “16/9/06 appeared happy”, although this appeared to be a positive experience for this service user he has only been twice • Pub – he went once on 29/9/06 • Bowling – he went 10 times since March 2006 • Cinema- he went 8 times since March 2006 • Out on the mini bus – he went 16 times since March 2006. For another service user the plan identifies;• Bowling- the records indicated that he has never been • Pub- he hasn’t been since November 2006 • Cinema- he has been 4 times since October 2006 • Community farm- he went once on 7/9/06. An entry in a FACS review held severely restricted as he is unable and “ staff have difficulty pushing not appear to have been resolved taking place. on 15/6/06 stated “…………..activities are to access the mini bus due to no tail lift” …………for long distances”. This issue does as there are severely restricted activities A professional commented “Concerns around staffing levels in order to initiate fully a full package of care. Individuals would benefit from more 1;1 interaction and stimulation and to be able to get out much more. A more substantial recreation and leisure regime may lesson the incidences of behavioural distress. Staff portray that they cannot fulfil all that is expected of them” Discussion with staff and records indicated that family and friends are able to visit the home and can use any of the communal facilities or the service users bedroom. There is no restriction on visiting times. Staff assist service user to maintain contact via mail and telephone. The majority of service users use non-verbal or extremely limited verbal communication to express their choices and wishes and promote their independence. Any restrictions are not documented within their service user plan. DS0000041450.V333133.R01.S.doc Version 5.2 Page 17 Discussion with staff indicated that there is no choice at mealtimes although they have a good understanding of individual service users likes and dislikes and provide an alternative if there is something on the menu they do not like. The care staff currently do all of the cooking and are now ordering their provisions via the council. Staff spoken to say that they try to prepare home cooked food but due to staffing numbers are not always able to. The home are still purchasing a large amount of prepared/frozen food due to the fact that care staff do not have the time to prepare from scratch. The fridge, and freezer temperatures are being taken on a daily basis. The freezers contained large quantities of food items such as chicken nuggets, frozen chips, pizzas, chicken in batter and frozen fish. Some fresh produce was seen and included fruit and vegetables. The lunch on the day of inspection was tinned ravioli and the evening meal on the day of inspection was Chicken Kiev. In one care file examined the service user has recently been diagnosed with insulin dependant diabetes, the service users plan for diet and nutrition only referred to “low sugar diet”, and there was no more detail than this and no reference to his diabetes in the health action plan. The likes/dislikes page stated, “likes most food”. The staffing structure, menu’s and provisions need to be reviewed to ensure that service users are provided with a well-balanced, varied and nutritious diet. This was a requirement of previous inspections and the home must take action to ensure that the diet provided is adequate. The current service users are very dependent and present behaviours that may pose a risk to themselves and others. The current staffing structure is inadequate to meet the complex needs of service users and does not allow for activities and meaningful interactions. This has not improved since previous inspections. DS0000041450.V333133.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18.19 and 20 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Service user’s health, personal and social care needs are not being fully met. These shortfalls have the potential to place residents at risk. EVIDENCE: Service users plans and behaviour management guidelines continue to be very basic, there does not appear to have been any significant improvement since previous inspections, although this was raised as an area for improvement with the manager at previous inspections. There has been some health screening undertaken by the community nurse and although health action plans were available they were very basic and did not cover all of the service users health needs. There was evidence that staff consult with health professionals i.e. dietician, community nurses, psychology etc, but the recording was very poor and although dates had been recorded when service users had visited the opticians, dentist, GP etc the records did DS0000041450.V333133.R01.S.doc Version 5.2 Page 19 not evidence outcomes for service users in respect of meeting their health needs. E.g. in one care file the records indicated that the service user had visited the GP and had bloods taken but it did not indicate why and there was no follow up. They also stated that the district nurse was visiting to “change dressings” but again no records to identify for what reason and if there had been any improvements in the condition. It was identified in their health screening that the same service user needs positional change in their Kirton chair to alleviate any risk of pressure sores however there was no indication of this in the service user plan, no health action, no risk assessment and no recording and staff were not observed to undertake this. In one care file examined the service user has recently been diagnosed with insulin dependant diabetes, the service users plan for diet and nutrition only referred to “low sugar diet”, and there was no more detail than this and no reference to his diabetes in the health action plan. The likes/dislikes page stated, “likes most food”. For another service user the consultant psychologist had requested “blood pressure to be taken and urine to be tested every two weeks and pulse to be taken every day”, this had not been identified in the service users plan, nor in the health action plan and there were no records to evidence that this was taking place. It was noted in a LA review on 19/1/06 that the consultant psychiatrist recommended that a service users should take regular exercise, however there was no evidence that this was taking place. A professional commented in a survey “Further support with developing health action plans and person centred planning would help” Where service user display behaviours that can be difficult to manage and specific techniques or methods of communication are needed in order to minimise the risks there were behaviour management strategies completed by the health authority however in one care file examined there was a management plan completed by the staff in the home that directly contradicted the nursing plan completed by the community nurse. E.g. the nursing crisis management plan gave clear instruction to staff to respond to the service users periods of agitation and self injurious behaviour by using diversion techniques and increasing staff engagement with the service user, where as the homes crisis management plan instructs staff to use “planned ignoring” techniques. This will leave the staff group confused as to which approach to use and the service user and others not having their needs met and not being protected from harm. DS0000041450.V333133.R01.S.doc Version 5.2 Page 20 In general the medication was well managed and one of the senior care officers had overall responsibility for its management. The home stored medication securely. Pharmacy support was from a local branch of Lloyds the Chemist and they had only recently had a visit to check practice. Appropriate temperature recordings were made of the medication cupboard and fridge. The home maintained records for each service user that included information sheets detailing GP, any medication allergies, photos, current medication and any management plans in place. All staff had either completed modular medication training or were progressing through the course. Training consisted of workbooks and questionnaires. Senior staff confirmed all but very new care staff had completed epilepsy management training, which included the administration of rectal diazepam. All medication was signed into the home and there were no missed signatures on the medication administration records observed. Stock control was managed and medication was returned to the pharmacy when no longer in use. Medication was audited monthly by senior staff. There were some areas of medication management that needed addressing: ♦ Temazepam medication was prescribed for one service user for administration prior to dental appointments. It was stored and recorded as a controlled drug, however when examined the controlled drugs register had not been completed appropriately. There was confusion surrounding the date of administration and a missed signature. The administration date did not match the date on the MAR sheet. Staff did not record a running total so this could not be matched with the amount of medication remaining in the home. Staff entered Temazepam medication that was received into the home in the controlled drugs book but this was recorded as the total amount of milligrams rather than the number of tablets received. This could lead to confusion. ♦ Staff did not always transcribe medication onto the MAR sheet with the full manufacturers instructions, for example Paracetamol medication. ♦ The home required an up to date British National Formulary or similar to provide information to staff. ♦ Staff advised that one service user had their medication placed covertly in food or on top of food. The inspectors could not see evidence that a decision regarding this had been taken during a multidisciplinary best interest meeting. Staff assured the inspectors that a meeting must have taken place. Evidence must be forwarded to CSCI regarding this issue. DS0000041450.V333133.R01.S.doc Version 5.2 Page 21 In one of the care files examined there was evidence in the care file that the service user was being administered medication that was, ‘unlicensed’. The senior staff could not immediately locate evidence of the ‘best interest’ meeting that would have taken place prior to the start of the medication. This needs to be located and forwarded to CSCI. A professional commented in a survey “Recent error in recording of medication and concern around misinterpretation in use of PRN medication” The medication practices have been identified during previous inspection visits and a requirement was made requiring the systems to improve, although there had been improvements in the recording of medication administered, PRN protocols are still not being updated when medications change. DS0000041450.V333133.R01.S.doc Version 5.2 Page 22 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure and policies and procedures for safeguarding adults however due to the unsatisfactory staffing arrangements, poor service user plans, poor attention to health needs and outcomes means that service users are not safeguarded from harm whilst in the care home. EVIDENCE: The home has a complaints procedure and policies and procedures for safeguarding adults, whistle blowing, aggression, physical intervention and restraint and management of service users money and financial affairs. There had been one complaint/concern recorded since the previous inspections regarding a signature discrepancy on the MAR sheet. There was no evidence on file of the outcome of this investigation. The manager and all staff have had Protection Of Vulnerable Adults (POVA) training however the unsatisfactory staffing arrangements, poor service user plans, poor attention to health needs and outcomes mean that service users are not protected from harm whilst in the care home. DS0000041450.V333133.R01.S.doc Version 5.2 Page 23 One of the service users presents difficult behaviour and the CSCI have been notified of several incidents of assaults on other service users and selfinjurious behaviour. None of this information had been included in the recent re assessment undertaken by the LA and the behaviour management guidelines are still unclear as to how staff are managing this behaviour. The location of the home, the service being provided in two separate bungalows, assaults on service users from other service users and the lack staff and senior care cover give cause for serious concerns. (These areas are explained further in environment and staffing.) The management and staff need to assess the compatibility of the service users living together and need to ensure that service users live in a safe environment and are protected from verbal and physical abuse and do not feel frightened and intimidated by other service users in the home. DS0000041450.V333133.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28 and 30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The environment provides service users with homely and comfortable surroundings in which to live, however the lack of attention to maintenance issues compromises their safety. EVIDENCE: Bede’s View is a purpose built unit providing accommodation in two bungalows. All service users have a single room that is nicely personalised to their own taste, providing them with a private area to their liking where they can spend private time or receive visitors. Since the previous inspections all of the bedrooms have been decorated and some personal items purchased to make them more individualised and homely. DS0000041450.V333133.R01.S.doc Version 5.2 Page 25 Service users have access to a secured garden area. To the front of the premises the grounds are fenced, however service users privacy and dignity would be enhanced by the addition of hedging or conifer type shrubs. The main gate to the grounds is kept locked to ensure the safety of the service users and an intercom system has been fitted. The lounges and communal areas are functional, and since the previous inspections some pictures and decorative items have been purchased to make it more homely. Both bungalows had some plaster off the walls and the paintwork needed touching up in places. A plan of maintenance and renewal still needs to be developed. These were requirements of the last inspection and action must be taken to ensure this requirement is met. There is only one small office for the manager and staff to use. This covers both bungalows and is not sufficient for the needs of the home. There is no other private space for staff and managers to conduct meetings or supervisions. If they need to discuss things in private with relatives or visiting professionals there is nowhere for this to happen. Discussion with two members of staff indicate that staff supervision and meetings have to take place in the conservatory, which is part of the service users home/communal space this is not acceptable and does not ensure confidentiality and privacy is maintained. The manager has being given the task of completing a quarterly health and safety audit and the office is one of the areas that has been identified. The timescale for this is set as ongoing. There needs to be a timescale for action to be identified. This was identified at previous inspections and action must be taken to meet this. The home only has a limited number of cleaning hours and the cleaning staff work hard to try and ensure the home is clean and odour free. The current cleaning hours do not allow any time for areas to be deep cleaned and the provider should review the hours to ensure that they are sufficient. This was a requirement of the previous inspection and there is no evidence that any work has been done to meet this requirement. A number of maintenance certificates were either out of date or could not be located this is detailed further in the conduct and management section of this report. DS0000041450.V333133.R01.S.doc Version 5.2 Page 26 DS0000041450.V333133.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35 and 36 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The current staffing arrangements are not sufficient to meet the needs of the service users and both mandatory and specialised training must be provided. Staff are not adequately supervised and supported leading to poor care practices. EVIDENCE: During the course of this site visit one of the inspectors undertook an observation on the Willow bungalow using a tool developed specifically for use during inspection activity. The inspector was aware that their presence in the lounge may have affected the way staff members interacted with service users. The lounge/dining area was small and it was difficult to ‘blend in’ to the surroundings. An observation of five service users wellbeing and interaction with staff was conducted over a two-hour period in one of the lounges. One service user left the lounge for most of the observation. It was noted that when staff approached service users or were approached by them the interaction was DS0000041450.V333133.R01.S.doc Version 5.2 Page 28 warm, caring and friendly. However the interaction was noted to be fleeting as the staff members were very busy and instead of three staff members permanently supporting six service users, one senior care staff member was absent for a large portion of the time. When they were present they were completing management tasks and full attention to the service users was not possible. For the most part service users showed signs of wellbeing, were alert, interested in surroundings and engaging with staff. However it was noticed that one service user, on two occasions, showed overt signs of distress and self harm when another service user entered their vicinity, they got up and went to the staff member in the lounge who on both occasions asked if they wanted music on and returned with them to the conservatory. The one staff member in the lounge missed both incidents of distress but responded positively to the service user when engaged by them. The inspector was unsure if this was the response the service user was asking for. On two occasions a second service user displayed agitation and self-harm whilst sat next to staff, one incident went unnoticed whilst another was commented on by staff saying, ‘you don’t want to do that’. This particular service user had two different behaviour management guidelines on his care file that contradicted each other; E.g. the nursing crisis management plan gave clear instruction to staff to respond to the service users periods of agitation and self injurious behaviour by using diversion techniques and increasing staff engagement with the service user, where as the homes crisis management plan instructs staff to use “planned ignoring” techniques so it is not clear how staff are expected to manage this behaviour and protect the service user from harm. There were two episodes of staff members using a pace of language that the service users would not understand but on the whole they spoke to service users appropriately. However due to limited staffing numbers conversation at times consisted of brief questions to check if they were ok and not prolonged conversation or interaction. One service user tended to engage more with staff and it was noted they received the most one to one attention. Another service user was supported for a short time in a table activity. Another service user spent most of the twohour observation outdoors but when they entered the building they engaged with staff and were responded to positively. Staff were attentive and observant with one service user when they noticed what they thought were signs of an impending seizure and they took appropriate action. This confirms that although the staff team are generally caring and mean well, the current service users are very dependent and present behaviours that may DS0000041450.V333133.R01.S.doc Version 5.2 Page 29 pose a risk to themselves and others and the current staffing structure is inadequate to meet the complex needs of service users and does not allow for activities, meaningful interactions and the protection of service users. This has not improved since previous inspections. A professional commented in a survey “Generally staff make an effort to take on advise and information, I feel this is dependent on individuals sometimes I need to check and persist on particular tasks identified. Staff appear willing to try to make the effort to take on board information. Staff would benefit from training in • Medication • Bowel care • Interaction and communication Carers try to accommodate different needs of individuals but appear restricted by staffing levels” All four staff commented that the home/service users would benefit from more staff. One commented, “I feel this team are hard workers but do need to be supported in a way which can only have an even better affect towards the service user. We realise as a team that there is a lot of scope for improvements but time and pairs of hands are a key factor. I am really pleased in the improvement and confidence in each service user. One of the service users is identified in their assessment as needing 1;1 staff support from 8.00 am to 10.00pm however this is not being provided. The majority of the other 10 service users are identified as needing 2;1 support for all personal care tasks, when this is provided it will inevitably mean that other service users are left unsupported, this is unsafe practice and does not safeguard the health, safety and welfare of the service users. The staff although motivated to improve the standards in the home all feel the current deployment of senior staff and low numbers of care staff is preventing the home from moving forward in meeting requirements and needs to be addressed urgently. Senior care officers spoken to informed the inspectors that they felt very frustrated as they knew there was a lot of work to be done to bring the home up to standard however as they are part of the care staff hours are not able to dedicate any time to paperwork as service users presenting needs come first. There is no time allocated to senior staff to complete the necessary paperwork associated with the senior care role. This has an impact on medication, supervision, care planning and health and safety. There is only one senior care staff on duty after the manager goes off shift and on weekends. The senior DS0000041450.V333133.R01.S.doc Version 5.2 Page 30 care staff cover the management of the two bungalows but are also part of the care staffing calculation of one bungalow. If the care staff in one bungalow are having a difficulty or a staff member calls in sick the senior care staff has to undertake responsibility for this therefore reducing the number of care hours provided to the service users. On the day of inspection it was noted that on arrival in the Rowan bungalow that two care staff were attending to personal care of a service user in their bedroom leaving one care staff to assist three service users in the lounge. She was trying to assist them to have breakfast but as they all need assistance to eat two of them were having to wait, at 10.00 one service user was still in his nightwear. The member of staff also had to answer the door buzzer, deal with visitors and see to a food order that was being delivered, as a result of this service users were left unattended to and under stimulated. This was not the fault of the member of staff who was trying her best in very difficult circumstances. In addition to this, as the registered manager was on annual leave the senior care officer on duty had to leave the bungalow he was working in to attend to the inspectors. This meant that as one member of staff was out for a walk with one of the service users this left one care staff with 4 service users. If one of these service users needed assistance with personal care or had a seizure it would have left the remaining service users unsupervised. This is clearly unacceptable and unsafe practice. The senior care officer, as well as dealing with the inspectors, had to resolve a query with the food order that had been delivered, deal with telephone calls and issues raised by staff. Through no fault of his own he appeared at times to look stressed and did not manage to get away at the end of the day until at least ¾ hour after he should have gone. This does not ensure the health; safety and welfare of staff working in the home and in turn will not ensure that service users receive a high quality service. Although there have been three care staff transfer from another service to fill some vacancies, there is a senior care officer on suspension, another has taken up a temporary post elsewhere within the LA, one senior care officer has just returned form maternity leave and another is on a temporary contract covering for one senior care officer and another care staff is acting up as a senior care officer covering a post. This is an unstable position and does not ensure consistency and continuity of staff to meet the complex needs of service users. The support and supervision of staff continues to be of serious concern and needs to improve to ensure that staff receive the support and guidance they need to carry out their jobs to a high standard. It is vital given the complex needs and dependency of the service users in the home. DS0000041450.V333133.R01.S.doc Version 5.2 Page 31 Staff records examined evidenced that although the quality of supervision had improved in some areas, it is not being provided in sufficient quantity to ensure staff are adequately supported. Five staff files were examined, one staff had had 3 sessions since June 2006, anther 4 sessions since February 2006, another 3 sessions since May 2006, another 3 since April 2006 and another 6 since February 2006. Only two of these staff have had an achievement and development interview in the last year. The majority of staff are not up to date with their mandatory training and very little service specific training had been provided. Staff informed the inspector that due to the Hull City Council budget position they have been informed that only mandatory training is being provided currently. A training plan was not available; the home does however have 50 of staff qualified to NVQ level 2. The registered person was requested at previous inspections to review the staffing structure and care staff hours provided in the home to ensure that they can meet the complex needs of the service users. The CSCI have completed a staffing calculation for the LA and the inspector was informed that this is now with senior managers awaiting a decision. However this situation has gone on for far too long and the CSCI have serious concerns about the standards of management, staffing numbers and deployment and therefore the standards of care and protection of service users at the home. DS0000041450.V333133.R01.S.doc Version 5.2 Page 32 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The management and conduct of the home is unsatisfactory and does not demonstrate that it is acting in the best interests of the service users that live there. EVIDENCE: Progress in raising the standards of care and management in the home has been slow. This is attributed in part to the slow decision making structures within the local authority that leads to an inability to make changes at a local level that will ensure more positive outcomes for service users. DS0000041450.V333133.R01.S.doc Version 5.2 Page 33 In addition to this the restrictions of the current staffing structure and number of care hours provided within the home mean that although the staff are willing they do not have the time within the shift to undertake all of the duties required to ensure that service users complex personal, health and safety needs are met. Staff have meetings with the managers on a regular basis and everyone is encouraged to join in with discussions and voice their opinions. The acting manager is not yet registered with the CSCI. The registered manager does not ensure safe working practices as the majority of staff are not up to date with mandatory training. Not all regular maintenance checks are carried out;• • • • • • • • • • • • Fire risk assessment- completed on 23/12/03 and the fire officer recommended that it be updated, this has not been done. Fire drills- the last one undertaken on 1/3/07 Fire equipment checks- last done on 27/3/06 and the alarm on 25/1/07 Emergency lighting- last done on 1/3/07 Gas safety- certificate valid until 31/7/06 no subsequent certificate Electrical hard wiring- dated 20/2/02 for 5 years not updated PAT – no record although he arrived on the day of inspection to complete the test Call bell system- checked by SCO on a weekly basis Hoists- done on 5/3/07 Baths- done on 5/3/07 (although one of the baths not lifting up) Water temperatures- completed by SCO weekly Legionella – no certificate or evidence of test or risk assessment. All accidents and injuries or communicable diseases are reported and recorded. The home does not regularly review aspects of their performance through a programme of self-review via a quality assurance system and this needs to be addressed. Although some service users and relatives had been asked to complete questionnaires, only two relatives had responded and it is doubtful as to whether a questionnaire is an appropriate way in which to ascertain service user satisfaction. There did not appear to be any review of the responses and no action plan prepared following this consultation and no other QA activity had taken place. DS0000041450.V333133.R01.S.doc Version 5.2 Page 34 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 3 26 x 27 3 28 2 29 x 30 2 STAFFING Standard No Score 31 1 32 2 33 1 34 3 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 x 1 x LIFESTYLES Standard No Score 11 1 12 1 13 1 14 1 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 x 1 x 1 x x 2 x DS0000041450.V333133.R01.S.doc Version 5.2 Page 35 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 YA2 Regulation 14 (1 and 2) Requirement The registered person must ensure that service users needs are assessed in full and that the service is sufficiently resourced so that all of their needs can be met and service users protected from harm. The registered person must ensure that issues of compatibility between service users are adequately assessed and are taken into account. The registered person must ensure that service user plans are developed and agreed with service users and must detail the action to be taken by staff to meet all of their personal, health and welfare needs. (Timescale of 1/11/05 and 31/08/06 not met) The registered person must ensure that where service users display behaviours that are difficult to manage or there are any limitations or restrictions on facilities, choice or human rights to prevent self harm or abuse or harm to others that this is DS0000041450.V333133.R01.S.doc Timescale for action 30/06/07 2 YA2 14 (1 and 2) 30/06/07 3. YA6 15 (1 and 2) 17 18/05/07 4. YA7 13 (6) 18/05/07 Version 5.2 Page 36 5 YA8 12 (2) 6. YA9 13,17 agreed by a multi agency meeting and documented appropriately. (Timescale of 31/08/06 not met) The registered person must ensure that where decisions relating to service users are made by others in their “best Interests” that this clearly documented and why. The registered person must ensure that there are individual and generic risk assessments available that are maintained and reviewed at least annually. (Timescale of 1/5/06 and 31/08/06 not met) The registered person must ensure that service users are given opportunities to develop their independence skills and meet their spiritual needs. The Registered person must ensure that service users are able to take part in valued and fulfilling activities that meet their diverse needs. (Timescale of 1/6/05, 1/5/06 and 31/08/06 not met) The registered person must ensure that service users are enabled to access a wide range of activities in the community and that there cultural needs are recognized and met. (timescale of 31/08/06 not met) The Registered person must ensure that activities are provided and access to the community is promoted that meets the diverse needs of the service users and meet their assessed needs. (Timescale of 1/6/05, 1/5/06 and 31/08/06 not met) 30/06/07 18/05/07 7 YA11 16 (2 m and n) 30/06/07 8 YA12 16 (2 m and n) 18/05/07 9. YA13 16 (2 m and n) 30/06/07 10. YA14 16 (2 m and n) 18/05/07 DS0000041450.V333133.R01.S.doc Version 5.2 Page 37 11 YA17 16 (2i) The registered person must 18/05/07 ensure that service users receive a nutritious, varied and balanced diet that is attractively presented and meets their health needs. (Timescale of 1/10/05, 30/06/06 and 31/08/06 not met.) The registered person must 18/05/07 ensure that service users are provided with sensitive and flexible staff support to maximise their privacy, dignity independence and control. (Timescale of 30/06/06 and 31/08/06 not met) The registered person must 30/06/07 ensure that service users complex health needs are met by the provision of health screening; health action plans and access to health professionals and records of outcomes are maintained. (Timescale of 31/08/06 not met) The registered person must 18/05/07 ensure that medications are stored appropriately and administered to service users as per the instructions, records maintained and that staff are appropriately trained and competent to undertake this task. (Timescale of 10/5/05 and 14/10/05 and 31/08/06 not met) The registered person must 30/06/07 ensure that the complaints procedure is followed and service users and their advocates are listened to and acted upon appropriately and that a record of all investigations and outcomes is maintained. (Timescale of 30/06/06 and 31/08/06 not met) 12. YA18 18 13. YA19 13 14. YA20 13 (2) 15. YA22 22 DS0000041450.V333133.R01.S.doc Version 5.2 Page 38 16. YA23 13 (6) 17. YA24 16,23 18. YA24 16,23 19 YA31 18 (1a) 19. YA32 18 (1a and c) 20. YA33 18 (1a) 21. YA33 18 (1a) The registered person must ensure that service users are protected from harm by the provision of trained, competent staff in sufficient numbers and service users plans and guidelines are prepared and followed. (Timescale of 31/08/06 not met) The registered person must ensure that the home is safe and has a planned maintenance and renewal programme for the fabric and decoration of the building with records kept. (Timescale of 1/6/06 and 31/12/06 not met) The registered person must ensure that there is a meeting room/office fit for purpose that is private and separate to the resident’s communal space. (Timescale of 1/6/06 and 31/12/06 not met) The registered person must ensure that enough staff re provided in the home to ensure that staff are able undertake all of the tasks associated with their role and within their job description. The registered person must ensure that staff have the skills and competencies to meet the needs of service users. (Timescale of 31/08/07 not met) The registered person must ensure that the current staffing levels and structure are reviewed and are sufficient to meet the needs of the service users. (Timescale of 31/1/04 and 31/10/05 and 31/08/06 not met) The registered person must ensure that cleaning staff are employed in sufficient numbers to enable the home to be cleaned thoroughly. DS0000041450.V333133.R01.S.doc 30/06/07 30/06/07 30/06/07 30/06/07 30/06/07 18/05/07 18/05/07 Version 5.2 Page 39 22 YA35 18 (1c) 23. YA36 17 (6 f) 18 ( 2) 24. YA37 9 25. YA39 17,24,26 26 YA42 23 (Timescale of 31/3/06 and 30/06/06 and 31/08/06 not met) The registered person must ensure that all staff are provided with service specific training in how to meet the complex needs of the service users. The registered person must ensure that staff receive the support and supervision required and must include all of the areas specified in 36.4 of this standard. (Timescale of 1/9/03 and 31/08/06 not met) The registered person must ensure that the home is managed effectively. Policies and procedures are implemented and that compliance with the care standards act, regulations and other legal requirements are adhered to. (Timescale of 31/08/06 not met) The registered person must ensure that the home fully implements a quality assurance system. (Timescale of 1/7/05, 1/5/06 and 31/12/06 not met) The registered person must ensure that the home is safe and that certificates are obtained and evidence is maintained for the following;• Gas safety • Electrical hard wiring • Fire risk assessment • Legionella • PAT 30/06/07 18/05/07 30/06/07 30/06/07 30/06/07 DS0000041450.V333133.R01.S.doc Version 5.2 Page 40 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000041450.V333133.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 DS0000041450.V333133.R01.S.doc Version 5.2 Page 42 - 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!