Inspection on 21/01/08 for Beech Lodge

This inspection was carried out on 21st January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beech Lodge 01/07/08

Beech Lodge 13/08/07

Beech Lodge 05/03/07

Beech Lodge 27/07/06

Beech Lodge 01/08/05

Beech Lodge 12/04/05

Beech Lodge 13/12/04

Beech Lodge 22/04/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Beech Lodge Beech Lodge 95 Thorkhill Road Thames Ditton Surrey KT7 0UW Lead Inspector Jo Griffiths Unannounced Inspection 21st January 2008 10:30 DS0000013564.V353257.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 DS0000013564.V353257.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. DS0000013564.V353257.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech Lodge Address Beech Lodge 95 Thorkhill Road Thames Ditton Surrey KT7 0UW 020 8398 5584 Telephone number Fax number Email address Registered provider Web address Name of registered registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Kathleen Jeetoo Mr Y Jeetoo vacant post Care Home 9 Category(ies) of Learning disability (9) registration, with number of places DS0000013564.V353257.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The bedroom accommodation on the first floor may be used by fully ambulant persons only The age/age range of the persons to be accommodated will be: 18-65 years 13th August 2007 Date of last inspection Brief Description of the Service: Beech Lodge is a detached property set in a residential road. There are three single bedrooms on the ground floor plus an open plan lounge/dining room, a kitchen, shower room, toilet and a laundry room. The property has been extended recently to provide a new room to the back of the building on the ground floor. It has not yet been decided how this room will be used. On the first floor there are six bedrooms, a staff sleep-in room and a small office. There are separate toilets for staff and residents, and a bathroom. The home provides care and accommodation to adults with learning disabilities. Support can be provided for personal care, daily living skills and activities. The fees vary from £808 to £ £1770 per week depending on the needs of the person. DS0000013564.V353257.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The home is registered for nine people with learning disabilities. There were seven people living at the home at the time of the inspection. The inspector visited the service on 21st January 2007 between 10.30am and 4.00pm. The Manager of the home was present during the inspection and there were two staff on duty. The inspector spoke with four of the people that live in the home to get their views of the support they receive. Some of the records and documents in the home were inspected and two staff members were spoken with. This is the 2nd key inspection of this service in the current inspection year. The registered provider completed the Annual Quality Assurance Assessment (AQQA), required by the commission, before the previous inspection. What the service does well: What has improved since the last inspection? What they could do better: One person was admitted to the home last year without having their needs properly assessed. They continue to live at the home but their needs in a number of areas are not being met. This includes not being able to use the bathrooms, toilets and dining room in the home due to mobility difficulties. As DS0000013564.V353257.R01.S.doc Version 5.2 Page 6 the home has no improved in this area enforcement action will now be considered by CSCI. The registered person must make sure that the practice for moving people with mobility difficulties is safe. Equipment must be provided if assessed as necessary. Risk assessments have not been completed for all risks to service user. As this improvement has not been made since the inspection in August 2007 enforcement action will now be considered by CSCI. People’s care plans must reflect their actual care needs and where two staff are required for a person this must be provided through the rota. People must be able to choose a carer of the same gender if they wish for personal care. Records must be kept to show that people’s health needs are being met and that they are being provided with a nutritious diet. There are not enough staff on duty to meet the needs of everyone in the home, including at night and for going out. Care plans do not meet people’s needs at night. As improvement in these areas have not been made enforcement action will now be considered by CSCI. Staff training and recruitment files must be kept up to date in the home to show that checks are made before staff are employed and that staff are competent to do their jobs. This is to keep people in the home safe. People in the home must be safeguarded from harm, abuse and neglect. They must be listened to if they have any complaints and records of complaints must be kept. The complaints procedure must inform people how to contact the Commission. Some improvements need to be made to ensure the environment is comfortable for people to live in. This includes making sure people have all the furniture they need, ensuring they can access all areas of the home and ensuring that they have appropriate flooring in their rooms. Two immediate requirements were made in relation to safeguarding adults and choice of carer for personal care. Prior to the draft report being sent to the home the Registered Provider responded acknowledging the points and informing the Commission of the action that will be taken. Some improvements that were required following the inspection in August 2007 have not been made. Enforcement action will now be considered by CSCI. 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 DS0000013564.V353257.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000013564.V353257.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 DS0000013564.V353257.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): Standards 2 and 3 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Prospective service users do not always have an assessment of their needs before they are offered a place in the home. Therefore they cannot be confident that the service will be able to meet their needs when they move in. EVIDENCE: One service user moved to the home last year from another home owned by the registered provider. An assessment of the persons needs was not completed at that time as it was felt by the registered provider that they had sufficient information about the individual. However, it was not identified before the person moved to the home that they would not be able to access any bathroom facilities due to mobility difficulties. Consequently the person has not been able to have a bath or shower since moving to the home in May 2007. Had a proper assessment been completed this issue would have been identified and the registered provider would have been able to inform the individual that their personal care needs could not be fully met in the home. The person in question was spoken with and said that they felt their needs were not being met and that they were unhappy at the home. A requirement was made at the inspection in August 2007 that this person’s placement be DS0000013564.V353257.R01.S.doc Version 5.2 Page 10 urgently reviewed as it is not meeting their needs. A review meeting was held but as a new placement has not yet been found the person continues to remain in the home with unmet needs. Enforcement action will now be considered by CSCI. Since the last inspection of the service, assessments have been updated for all service users that are already living in the home and these are kept on the care plan files. The service is meeting the assessed care needs of the individuals using the service, with the exception of the person described above. DS0000013564.V353257.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): Standards 6, 7, 8 and 9 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The care plans do not always meet the needs of the service users and are not always reflective of actual practice. The care plans do not include service users preferences for how they will receive their care. Some service users are supported to make decisions in their daily lives, but one service user is severely restricted in decision making due to mobility issues and the layout of the home. People’s preferences about their care are not always listened to. Service users are consulted on some aspects of the running of the home. Service users are supported to take some reasonable risks as part of an independent lifestyle, but some areas of risk have not been assessed and minimised. DS0000013564.V353257.R01.S.doc Version 5.2 Page 12 EVIDENCE: Each service users has a care plan that describes how their needs will be met. The care plans for two of the people living in the home were inspected in detail. The care plans describe how some of the person’s needs are to be met by the support staff. One persons care plan did not provide adequate detail for how their personal care needs would be met, especially considering that they are not able to access any bathrooms in the home due to mobility difficulties. One care plan did not appropriately meet the needs of the person at night. Some of the information in the care plans is not being followed in practice. For example, it states that one person must have two carers to support them in their wheelchair when going out. In practice staff said that they sometimes go out alone with the person as it is not possible for two staff to be available. Some staff said they are not able to manage alone and therefore the person is not able to go out as planned. This has been reported in further detailed under the lifestyle section of this report. Whilst the care plans do identify any specific cultural or religious requirements they do not include individuals preferences regarding how they receive their personal care. For example, if they request male or female carers for intimate personal care. Where they are able to people have signed to agree their own care plans. One persons care plan showed that they had been involved in writing it. The staff and Manager had an awareness of person centred planning. There was some evidence of care being provided in a person centred way, for example people being consulted on their activities and being supported to get a job. However, there were examples where the care was not person centred, including people not being able to choose the gender of their carer and a person not having their personal care needs met. Training for the staff in person centred planning and providing person centred support may be of benefit to further their understanding in this area. There was no risk assessment completed for a person who goes out to the town without staff support and there was no risk assessment for service users using the iron. Some risk assessments were in place but had not been reviewed. At the previous key inspection in August 2007 a requirement was made to ensure that risk assessments were reviewed to ensure that each assessed risk has a clear action plan in place to manage the risk. Evidence found during the inspection confirmed that this requirement had not been met. Enforcement action will now be considered by CSCI. The Manager has introduced service users meetings and the minutes of these for January 2008 were seen. This is an opportunity for service users to discuss the menus, their activities and general issues about the running of the home. DS0000013564.V353257.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Generally service users are supported to participate in the activities that they choose and that match their interests. Most service users are supported to access services and facilities in their local community. One service users needs in this area are not being met. Service users are not supported through their care plans to develop and maintain relationships and their needs regarding sexuality and relationships have not been acknowledged in the care plan. Service users enjoy their meals and are supported to make choices around their meals. DS0000013564.V353257.R01.S.doc Version 5.2 Page 14 EVIDENCE: Most of the service users living at the home attend day centres during the week where they participate in a range of activities. Four people were out at day centres at the time of the inspection. When they returned two were asked if they were happy with their activities and they confirmed they were. Other service users have an activity planner that they have been involved in drawing up. This includes activities at home and within the local community. During the inspection two service users were seen to be helping with chores at home including ironing and cooking. One person went out to the town in the afternoon and the other was watching TV. The third service user that was at the home at the time of the inspection stated that they spent most of their time in their armchair in their room as they were unable to get around the house due to mobility difficulties. The activity planner for this person showed the activities for most days to be reading magazines and watching TV. There were three planned outings per week on the planner, but the service user said these do not take place consistently as there are not enough staff to do so. The care plan shows that two staff are required to support this person to go out in their wheelchair. The rota shows that there are only two staff on duty per shift so this is not possible to achieve with other service users to support during the day. The staff said that some staff members are able to manage going out alone, but others are not. Staff must follow the care plan with regard to safe practice for supporting people in wheelchairs and the care plan must accurately reflect care practice. The daily records in the care plan evidenced that the person’s activity planner is not being consistently followed. People said they felt their religious and cultural needs were being met. The care plan for one person stated that certain religious magazines would be provided and these were seen in the person’s bedroom. The daily records showed some people being supported to attend church. There was evidence in the care plans of people’s religious needs with regard to their diet being met. The care plans do not acknowledge or address people’s needs and preferences with regard to sexuality and relationships. The staff have not received training in equality and diversity. This may support staff to better understand how to provide a service that respects people’s diverse needs. One service user requested, through a recent survey carried out by the Manager, a key to the front door. The registered provider must ensure keys are provided to all service users. DS0000013564.V353257.R01.S.doc Version 5.2 Page 15 Service users spoken with said they have a choice of meals and that they are happy with the food. They said that they are supported to prepare the meals and this was observed to take place during the inspection. Weekly meetings are held to plan the menu and all service users have a choice of meals for that week. Everyone said they could choose something different if they want to on the day. People were seen to be offered choices of foods during the inspection. Service users do not participate in the food shopping for the home. Whilst records are kept of the planned menu for each day records are not kept of what each individual has. This is particularly important for people that are being monitored by a dietician. One service user eats in their bedroom as they are not able to get to the dining room due to mobility difficulties. DS0000013564.V353257.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. Not all service users receive their personal care in the way that they would prefer. Not all service users have their health needs met. People would benefit from all staff being trained to give medication. EVIDENCE: The Manager stated that all staff in the home are trained to give medication, however certificates to evidence the training and their competence were not available for all staff in the home. None of the service users currently living in the home manage their own medication, although the Manager stated that a risk assessment would be completed if they expressed a wish to do so. The medication is stored securely in the home and records were seen to be maintained appropriately. Where medications are prescribed as ‘PRN’ or ‘as required’ there is no guidance for staff to help them make a judgement as to when to give these. One person’s medication is prescribed to be given ‘as DS0000013564.V353257.R01.S.doc Version 5.2 Page 17 required’ for agitation. On speaking to the Manager and staff it was clear that there are different interpretations as to when this should be given. Some people had health action plans on their care plan files, but these had been completed some years ago and not updated. Through inspecting two of the service users care plans it was evident that one person’s health needs were being addressed and met. The keyworker for the service user was able to describe the action that had been taken to support the person to make an informed decision about their healthcare. One person had the involvement of a dietician to help them with a weight loss diet. There were no records of the person’s intake of diet and their weight had not been monitored or recorded since February 2007. It was therefore unclear if this persons health needs in this respect were being met. The person is at high risk of pressure sores due to being generally confirmed to an armchair during the day. The layout of the home does not maximise the persons independence with regard to maintaining their mobility. The care plans do not take into account people’s preferences about the way they receive their personal care. One person said they do not like to be supported with intimate personal care by male care staff. The care plans records show occasions where the person has been very distressed by having to receive care from a male carer. The rota shows regular occasions where only male staff are on duty, including at night. The Manager said that a female carer is used from another home to cover on these occasions but there was no recorded evidence of this. The service user said that a female carer has come over on some occasions but not often and when she does the service user has to wait some time for her to arrive. An immediate requirement was made to address this issue. An immediate requirement feedback sheet was left with the Manager. The staff spoken with expressed concerns about the moving and handling practice in the home. Staff said that they were aware that they were using poor moving and handling techniques but that they were unable to move the service user in any other way. There is a hoist in the home, but staff say it is not used and is unsuitable for the service user. There are no records of any physiotherapy or Occupational Therapist assessment for safe moving of service users. Staff said they have reported their concerns to the owners of the home but are concerned that safe practice has still not been agreed. The care plans do not adequately meet the needs of the service users at night. One person’s plan states that the person is to use a bell to call staff at night, if required, but the person told the inspector that they do not wish to disturb staff when they are sleeping. The care plans state that the person will be incontinent early in the morning, but the service user said staff are not available until 8am. Staff said that the person has their commode near to the bed so that they can use it in the night, but the plan also states elsewhere that DS0000013564.V353257.R01.S.doc Version 5.2 Page 18 two staff are required to support the person to mobilise from bed to commode and there is only one person on duty at night. At the last inspection in August 2007 a requirement was made that care plans be reviewed to ensure that all service users care needs during the night are properly recorded, with clear action plans as to how those needs can be met. Evidence showed that this requirement has not been met. Enforcement action will now be considered by CSCI. DS0000013564.V353257.R01.S.doc Version 5.2 Page 19 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): Standards 22 and 23 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Service users know how to make a complaint, but do not always feel they will be listened to. Service users are at risk of verbal abuse in the home and one service user is at risk of neglect. EVIDENCE: The home has received one complaint since the last inspection of the service. This was recorded in the complaints book. The Manager described the action that had been taken to investigate and resolve the complaint, but no records of this were held in the home. There is a complaints procedure on the notice board. This does not give the reader accurate contact details for the Commission should they wish to raise issues of concern. This was a requirement that was made at the last inspection and has not been met. Service users spoken with said that they knew they could raise any complaints with the Manager and staff, but not all service users felt that any action would be taken. The home has a Safeguarding adults and whistle blowing policy in place and there were certificates in the home to evidence that three staff members had received training. The Manager stated that all staff had received training, DS0000013564.V353257.R01.S.doc Version 5.2 Page 20 including himself, but that certificates were not currently available in the home. Both staff members and service users commented that there were sometimes incidents of verbal abuse from one service user to others in the home. The service users said this can be upsetting and the staff said that they were very concerned about it and had reported it to the owners. The care records and monthly keyworker reports showed that the incidents had been recorded as problem and discussed with the service user concerned. None of the incidents had been reported under local Safeguarding adult’s procedures. Service users continue to be at risk of verbal abuse in the home. One service user, as described in other sections of this report, is not receiving adequate personal care or the personal care they would like to receive due to not being able to access bathroom facilities. They are also at risk of pressure sores from having to remain in their armchair in their room during the day as they are unable to mobilise around the home. The service user does not have their personal care needs met through the night as waking night staff are not available. An immediate requirement was made at the inspection to ensure people are safeguarded from abuse, harm and neglect. An immediate requirement feedback sheet was left with the Manager. DS0000013564.V353257.R01.S.doc Version 5.2 Page 21 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): Standards 24, 25, 26, 27, 28, 29, 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Service users live in a safe environment, but would benefit from attention to furnishing in bedrooms to ensure it is a comfortable environment. People’s bedrooms meet their needs. The bathrooms and shared spaces in the home do not meet the needs of all service users. Appropriate adaptations have not been made or equipment provided to maximise service users independence. Not all areas of the home are clean and well maintained and the laundry flooring poses a risk of cross infection in the home. DS0000013564.V353257.R01.S.doc Version 5.2 Page 22 EVIDENCE: Service users all have their own bedrooms fitted with a washbasin. At the inspection in April 2007 it was noted that two of the bedroom sinks were heavily stained and a requirement was made to address this. It was noted in the text of the report of August 2007 that this had still not been addressed. The issue had still not been resolved at this inspection and therefore a requirement has been made. In one persons room there have been previous issues with unpleasant odours in the carpet. A requirement was made at the inspection in April 07 to resolve this. At the inspection in August 2007 it was found that a piece of lino had been fitted over a section of the carpet in the middle of the room. This had resolved the issue of the unpleasant odour but had been completed in a way that does not maintain the dignity or comfort of the service user. This lino fitted to the person’s room does not provide a pleasant environment for the service user and did not promote the persons dignity. It also presents a risk of trips and falls to the service user and staff. The service user complained to the inspector about the lino. A requirement has been made to resolve this issue appropriately. Most service users said they were happy with their bedrooms and said that they felt they met their needs. One person commented that they like to have their door open as they have to spend most of their time in their room and sometimes feel isolated. The registered provider must find a way to meet this person’s request without breaching fire regulations. None of the bedrooms had bedside lights. The registered provider must ensure that all service users are offered the furniture listed in the National Minimum Standards. Some of the bedding and pillows in service users rooms appeared to be very thin. There is a lounge and dining room on the ground floor for service users to use, although people that use wheelchairs are not able to access the dining room as there is a step down. There has been an extension to the ground floor, but this is not yet in use as the registered provider is waiting for heating to be fitted. The Commission were informed at the previous inspection that this would be used as additional communal space for service users, however, the Manager stated that it may now be used as office space. There is a bathroom on the first floor and a shower room on the ground floor. As described in previous sections of this report the bathroom facilities do not meet the needs of one person in the home. There is a laundry room on the ground floor. The flooring requires attention to ensure it is appropriately sealed and therefore not an infection and hygiene risk. DS0000013564.V353257.R01.S.doc Version 5.2 Page 23 One person in the home uses a wheelchair and requires staff support to mobilise. Staff expressed concerns about poor moving and handling techniques, a lack of appropriate equipment and a lack of assessment from a qualified person regarding moving the person. The rotas do not allow sufficient numbers of staff to meet the mobility needs of the person according to their care plan, particularly at night. The person that has mobility difficulties is not able to access any of the bathrooms in the home and no adaptations have been made to meet their needs. DS0000013564.V353257.R01.S.doc Version 5.2 Page 24 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): Standards 32, 33, 34, 35, 36 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Service users do not benefit from sufficient numbers of staff to meet their needs. Most of the staff that support service users are NVQ qualified, but have not undertaken the core training they need to effectively and safely support service users. Service users benefit from a supervised team of staff. Recruitment procedures could not be assessed to safeguard service users as they were not available in the home. EVIDENCE: Rotas show that there are two staff on duty during the day and one staff on a ‘sleep in’ duty at night. According to the staff rota there are occasions where there are only male carers on duty. Feedback from service users confirmed that they are not always able to have their personal care needs met by a carer DS0000013564.V353257.R01.S.doc Version 5.2 Page 25 of the same gender. At the last inspection in August 2007 a requirement was made that night staff be employed to meet the needs of the person who requires support to manage their continence during the night. Evidence gathered at this inspection showed that this requirement had not been met. The registered provider told CSCI, following the August 2007 inspection, that night staff were in place. At this inspection it was found that only ‘sleep in’ staff are on duty at night and on many occasions these are male staff. This does not adequately meet the needs of the people using the service. Enforcement action will now be considered by CSCI. One person’s care plan states that they require two carers to help them to mobilise and to push their wheelchair when they go out. There are not sufficient numbers of staff on duty to allow this to happen and consequently the person’s needs are not being met. The training records were not available in the home for all staff members and therefore it was not possible to evidence that staff had completed the training they need to safely support people. Of the records that were available it was clear that staff had completed the necessary training. Training records must be available for all staff, including any ‘bank’ staff used. The staff in the home have not completed training in Equality and Diversity. Service users would benefit from staff having a greater understanding of how to meet the diverse needs of service users in a person centred way. Three of the care staff have completed their NVQ award and the Manager stated that one had begun the award. The Manager has completed the Registered Managers Award and is awaiting certification. Staff recruitment files are not held in the home and therefore it was not possible to inspect this standard on this occasion. The registered provider must ensure that evidence of robust recruitment of employees is held in the home. The new Manager has begun supervising staff and plans to carry this out monthly. Records are kept of staff supervision sessions. DS0000013564.V353257.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Service users do not benefit from a well run home and do not have their views about the way their care is delivered taken into account. The health, welfare and safety of service users are not consistently promoted by the service. EVIDENCE: There is a new Manager of the home. The registered provider and Manager have failed to ensure that the personal care needs of all service users are met in the home. Whilst formal systems have been introduced for seeking service users views, such as surveys and meetings, there is clear evidence in previous sections of this report that people’s views are not being listened to and their DS0000013564.V353257.R01.S.doc Version 5.2 Page 27 needs not met. For example, people cannot always have a carer of the same gender and do not always have the numbers of staff on duty that they require to meet their needs. The registered provider has not made the appropriate adaptations to the building to ensure that all service users can access the facilities they need for everyday living. The home is not run in a way that respects the dignity of all the people that live there. Staff report that poor moving and handling techniques are being used and rotas do not allow for care plans to be followed with regard to supporting people to mobilise. Incidents of verbal abuse in the home have not been reported and dealt with effectively to ensure the protection of service users. Risk assessments have not been completed for all activities that service users undertake to ensure they can maximise their independence in the safest possible way. There is a risk of trips and falls due to poor fitting if lino over the carpet in one person’s bedroom. The Manager reported that there had been a regulation 26 visit to the home by a management consultant. The report for this visit had not been received by the Manager. DS0000013564.V353257.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 1 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 1 25 2 26 2 27 1 28 2 29 1 30 2 STAFFING Standard No Score 31 X 32 3 33 1 34 1 35 1 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 2 1 X LIFESTYLES Standard No Score 11 X 12 2 13 1 14 X 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 X 1 X 1 X X 1 X DS0000013564.V353257.R01.S.doc Version 5.2 Page 29 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 YA39 Regulation 24 Requirement The quality assurance system must be fully implemented in the home. Service users and other stakeholder’s views must be sought. Partially met, formal systems have been implemented but service users views about their care are not always being listened to. 2. YA39 26 Regulation 26 visits must be undertaken at the home and subsequent reports must be available for inspection. Not fully met, records of visits not available. 3. YA12 16(2)(n) Activity plans agreed with service users must be followed consistently. Records must be maintained in sufficient 29/02/08 29/02/08 Timescale for action 29/02/08 4. YA17 17(2) Schedule 4(13) 29/02/08 DS0000013564.V353257.R01.S.doc Version 5.2 Page 30 detail to be able to assess that service users dietary intake meets their nutritional requirements. Also service users who require a specialist weight loss plan must have their weight monitored in their care plan to evidence their health needs are being met. 5. YA18 12(4)(a) Service users wishes with regard to the receiving personal care from a person of the same gender must be respected. An immediate requirement was made and an immediate requirements sheet left with the Manager of the home. 6. YA20 13(2) Staff must be trained to administer medication and evidence of the training must be held in the home. The complaints procedure must inform service users how to contact CSCI if they need to. Service users concerns, issues and complaints must be listened to and action taken to resolve them. Records must be maintained of action taken in respect of all complaints. 8. YA23 13(6) The registered person must ensure that service users are safeguarded DS0000013564.V353257.R01.S.doc 21/01/08 29/02/08 7. YA22 22 12(3) 29/02/08 21/01/08 Version 5.2 Page 31 from harm, abuse and neglect. An immediate requirement was made and an immediate requirements sheet left with the Manager of the home. 9. YA24 23(2)(d) The registered person 29/02/08 must ensure that sinks in service users are clean and hygienic and pleasant for service users use. The lino over the carpet 29/02/08 in one person’s room must be removed in order to maintain the dignity of the service user and remove risks of trips and falls. All areas and facilities in the home must be accessible to service users and appropriate to their needs. The laundry room floor must be repaired or replaced to avoid the risk of poor hygiene and infection in the home. Appropriate equipment must be available for service users to maximise their independence. Sufficient numbers of trained and qualified staff must be on duty to meet the needs of the service users, take into account their preferences about their care and to ensure DS0000013564.V353257.R01.S.doc 10. YA24 12(4)(a) 11. YA24 23(2)(a) 29/02/08 12. YA30 13(3) 31/03/08 13. YA29 23(2)(n) 29/02/08 14. YA33 18(1)(a) 29/02/08 Version 5.2 Page 32 they can access the community. 15. YA35 18(1)(c)(i) Evidence of staff training must be held in the home. Evidence of recruitment procedures that safeguard service users must be held in the home. The registered person must ensure that safe moving and handling practice is employed in the home. 29/02/08 16. YA34 19(1) 29/02/08 17. YA42 13(5) 29/02/08 DS0000013564.V353257.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA7 YA15 YA20 YA25 Good Practice Recommendations It is recommended that staff undertake training in Person centred planning and equality and diversity. It is recommended that service users needs with regard to personal relationships be supported through the care plan. It is recommended that guidance for when “as required” medication should be given be written for staff to follow. It is recommended that a self release door box be fitted to the bedroom door of the person that wishes to have their door open at night. It is recommended that the provision of furniture and furnishings in service users bedrooms be reviewed to ensure they meet the recommended standards. It is recommended that all service users be offered a key to the front door of the home. 5 YA26 6 YA16 DS0000013564.V353257.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000013564.V353257.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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