Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 01/12/05 for Better Care Residential home

Also see our care home review for Better Care Residential home for more information

This inspection was carried out on 1st December 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users within the home all feel well cared for; a questionnaire was sent out to the service users and relatives prior to the inspection taking place. Three of the four service users responded, and in general they were positive about issues of care. One service user stated on the day of the inspection that she `felt quite safe at the home`. Four relatives responded to the questionnaire and again they were positive, highlighting in particular the friendliness of the staff and the warmth by which they were welcomed. Service users spoken to at the time of the inspection all felt that they were generally involved in making decisions on a day to day basis, the examples given were what to eat, what toiletries they wanted to buy for themselves.

What has improved since the last inspection?

The home has focused on the appropriate completion of documentation relating to service users. The previous inspection identified three types of risk assessments in operation within the home, some of which was duplication of information or had a clinical perspective. The risk assessments have now been streamlined so that they focus more appropriately on the service users. In addition, information relating to service users within the care plan was not found to be pertinent or up to date. Whilst recognizing that the home needs still to improve in the area of care plans, the information held was generally more relevant to the needs of the service users.

What the care home could do better:

Whilst recognising that the home has only been registered for a short time, there are issues that the home must address with urgency which remain outstanding from previous inspections. Firstly, there are outstanding checks yet to be undertaken on the homes staff, these include PoVA checks. Secondly, the home does not have its own policies and procedures regarding vulnerable adults, nor has it acquired a copy of Croydon`s policies and procedures. One member of staff had attended a course regarding vulnerable adults, although there was no evidence that they had. The combination of these two factors is of concern to the Commission given that they relate specifically to the protection of vulnerable service users. In addition to this, there is an issue regarding the staffing of the home. Registration was only granted on the basis that two members of staff were on duty at all times. The previous inspection again raised this as an issue as only one member of staff was on duty at any one time. The agreement had been that the Commission would consider a review of these staffing levels at less busy times once they had received documentation from the proprietor that service users were in appropriate work or education. This documentation has not been forthcoming, and there is in fact further evidence that the lack of staffing is compromising the well being of the service users. One service users stated that she `had to go out when she did not necessarily want to, as there was only one member of staff on duty and that service users could not be left in the home unattended.` This is a restriction on freedom of choice and must be addressed.Staff are also working long hours, and on occasions 100 hours per week. One member of staff works from 8 pm on a Friday to 8 am on a Monday, making this 60 consecutive hours without a break. Whilst the members of staff have signed the European working time directive, it is of concern that the level of hours worked over an extended period could compromise the quality of care given to service users. The manager has stated that there are contingency plans for emergencies such as sickness, however, these need to be stated clearly in writing to the Commission.

CARE HOME ADULTS 18-65 Better Care Residential home 211 Brighton Road Purley Surrey CR8 4HF Lead Inspector Ms Rin Saimbi Announced Inspection 1st December 2005 09:30 Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Better Care Residential home Address 211 Brighton Road Purley Surrey CR8 4HF 020 8664 9745 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) Mrs Agnes Harriette Lucinda Coker Mrs Agnes Harriette Lucinda Coker Care Home 4 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4) of places Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The undersized bedroom will be used as a communal space, with the existing dining room becoming a bedroom. The French windows out of the upstairs bedroom will be permanently locked with ventilation being provided by other means. 22nd June 2005 Date of last inspection Brief Description of the Service: Bettercare is a registered care home for up to four female service users who have mental health difficulties. The homes aim is to provide rehabilitation and support to enable service users to develop skills for independent living. The home itself is a large Victorian property situated on a busy road near Purley. The home is close to local shops and has good transport links via buses and trains. The home is a converted residential property and from the outside appears to be no different from any of the other properties on the road. The homes accommodation is over two floors; the ground floor has a communal lounge/dining room, it is also been used as a temporary office with a filing cabinet, there is a kitchen, bedroom and toilet. The first floor has a further three bedrooms, bathroom and a storage area. To the rear of the property there is a garden with a small patio and lawned area; to the front of the building there is driveway, which could accommodate several cars. Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s second inspection for the year 2005/06, it was an announced inspection. The inspection itself started at 9.30 and lasted approximately six hours. The inspection took the form of discussions with three of the four service users, the manager and one member of staff. In addition, there was a tour of the building and looking through documentation, which related to service users and staff. The inspection, in the main, focused on the previous requirements and recommendations, which were made at the last inspection in June 2005. An oversight by the inspector resulted in the requirements and recommendations appearing in the main body of the report, but not in the concluding section, which gives timescales for action for the requirements. It would therefore be unfair to penalise the home in the scoring of the outcomes for not meeting the target dates. However, there remains within the scoring of outcomes some major shortfalls within the home which must be addressed for with. What the service does well: Service users within the home all feel well cared for; a questionnaire was sent out to the service users and relatives prior to the inspection taking place. Three of the four service users responded, and in general they were positive about issues of care. One service user stated on the day of the inspection that she ‘felt quite safe at the home’. Four relatives responded to the questionnaire and again they were positive, highlighting in particular the friendliness of the staff and the warmth by which they were welcomed. Service users spoken to at the time of the inspection all felt that they were generally involved in making decisions on a day to day basis, the examples given were what to eat, what toiletries they wanted to buy for themselves. Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Whilst recognising that the home has only been registered for a short time, there are issues that the home must address with urgency which remain outstanding from previous inspections. Firstly, there are outstanding checks yet to be undertaken on the homes staff, these include PoVA checks. Secondly, the home does not have its own policies and procedures regarding vulnerable adults, nor has it acquired a copy of Croydon’s policies and procedures. One member of staff had attended a course regarding vulnerable adults, although there was no evidence that they had. The combination of these two factors is of concern to the Commission given that they relate specifically to the protection of vulnerable service users. In addition to this, there is an issue regarding the staffing of the home. Registration was only granted on the basis that two members of staff were on duty at all times. The previous inspection again raised this as an issue as only one member of staff was on duty at any one time. The agreement had been that the Commission would consider a review of these staffing levels at less busy times once they had received documentation from the proprietor that service users were in appropriate work or education. This documentation has not been forthcoming, and there is in fact further evidence that the lack of staffing is compromising the well being of the service users. One service users stated that she ‘had to go out when she did not necessarily want to, as there was only one member of staff on duty and that service users could not be left in the home unattended.’ This is a restriction on freedom of choice and must be addressed. Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 7 Staff are also working long hours, and on occasions 100 hours per week. One member of staff works from 8 pm on a Friday to 8 am on a Monday, making this 60 consecutive hours without a break. Whilst the members of staff have signed the European working time directive, it is of concern that the level of hours worked over an extended period could compromise the quality of care given to service users. The manager has stated that there are contingency plans for emergencies such as sickness, however, these need to be stated clearly in writing to the Commission. 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. Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The home has gathered information regarding service users, generally this information was pertinent to ensure their care needs are met. EVIDENCE: Service users spoken to at the time of the inspection did not necessarily feel that they had a choice regarding their placement, although they did feel that the placement was meeting their needs Pre-admission assessment information was available for service users with current identified problems and service users psychiatric history. Information from this assessment process was then at the initial stages translated into the care plan, which was completed in conjunction with the service users themselves. A previous requirement had been made that all prospective service users must have all areas of need and risk identified prior to admission to enable the home to make decisions about the ability of the home to meet needs. As no new service users have been admitted to the home since the last inspection it is not possible to access this area fully. Therefore this requirement remains. Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8 and 9 In general the quality of information held about service users is pertinent and appropriate and should enable staff to assist them were possible to be independent. EVIDENCE: Service users themselves felt that they could take control of their lives on a day-to-day basis and that they were supported in doing this by the homes staff. Although there was scope for much further involvement of service users in identifying their changing needs, aspirations and goals, are currently being overlooked. The service users within the home all had a written care plan. It was noted that there had been an improvement regarding documentation for service users. Risk assessments were in place. Documents viewed, were all reviewed on a regular basis by the manager of the home. The care plans did include appropriate interventions, however they were not always as accurate and up to date as they should be. In one example, a care plan dated 14.6.04 detailed that one particular service user had counselling on Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 11 a weekly basis. This care plan was reviewed on a regular basis. In trying to ascertain when sessions took place, the manager stated that they had not taken place for over a year, as they had been withdrawn. Although there was evidence that recent care plans were reviewed on a monthly basis. This was completed by the manager, and did not involve the service users. The manager stated that at the point of the initial care plans, they were completed with service users and that service users received a copy of them. Since that time the manager acknowledged that she reviewed them herself with no reference to the service users. Service users themselves were unable to confirm what were on their care plans, none remembered receiving the documentation relating to the initial care plans. Two requirements have therefore been made regarding care plans. Firstly, that they should be kept up to date and changes are recorded accordingly. Secondly, that the care plans must be completed with the service users on a regularly basis in order to ensure that they reflect the changing needs, aspirations and goals of the service users; and that if the service users is in agreement with the care plan that they should sign accordingly. If they are not in agreement with the care plan, this should also be recorded. Service users are encouraged to make decisions about their daily lives ranging from what to eat, to having control over their own finances. Some restrictions have been placed on service users for example one person does not have a key to the front door; the reason for this is documented in the care plan. Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,13,14,15,16 and 17 In general, service users within the home live ordinary and meaningful lives. Their lifestyle aspirations vary according to their interests and there is some opportunity for personal development and independence training. EVIDENCE: The homes stated aim is provide rehabilitation and support to enable service users to develop skills for independent living. Service users appear to have good community links; they spoke of attending church, going to the shops, local library and hairdressers. In addition, they attend activities, which benefit them educationally for example one service user attended regular art classes; or to improve their employment skills via Status Employment. There were also holidays and trips arranged; three of the service users went to Broadstairs in Kent for a five-day trip and one to Dover; there have also been two-day trips to France, Eastbourne and occasional days into central London. Service users all said that they enjoyed their holiday and outings. Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 13 A recommendation is made that they home should retain a folder of activities undertaken by service users, and that photographs should be taken as a reminder of the occasion. Service users were able to confirm that friends and family were welcome to visit whenever they wished, and that there was also more formal invites such as the Christmas party. With regard to meals and meal times, service users spoke positively about the food. The service users decide upon a menu and then will assist in the shopping and preparation of the food. The home is able to cater for one service a user who is vegetarian; and another is of African origin and enjoys certain foods, she is also Muslim and therefore has dietary requirements on the basis of religion. During the period of the inspection, no meals were seen being prepared by the service users; although menus were available and seemed to contain a variety of fresh foods and convenience foods. Fresh fruit is available and service users are able to help themselves to drinks and snacks. Service users nutritional needs are assessed and their weight monitored, on a regular basis, if required. One service user is clinically obese and therefore her weight is monitored and the home are trying to educate her regarding the most appropriate foods to eat; another is thin and needs encouragement to eat foodstuffs that will assist her in putting weight on. Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,20 and 21 Service users are encouraged to take as much responsibility as possible for their own health and personal care needs. This is crucial for the service users who have been discharged from hospitals and are in the process of moving towards independence and autonomy. EVIDENCE: Service users are generally given opportunity to maximise choice; in general they manage and hold their own money. Service users are able to choose their own clothes, toiletries, make their own hairdressing appointments. Service users are encouraged to maintain their own health appointments, this is seen as essential by the home as part of a process towards independence and autonomy; staff will accompany service users only if necessary. The home does keep a record of all appointments that they are informed of; documentation in relation to this was viewed for two of the service users. The home will give service users a ‘gentle’ reminder if appointments are forth coming or need to be made. Service users have absolute choice about which health professionals they wish to register with, NHS healthcare is local and can be accessed easily. The home Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 15 monitors service users mental health and will make referrals if it becomes appropriate. A multi-disciplinary team review and monitor medication at a day centre. All service users attend the centre unaccompanied, at which time they are given two weeks prescribed medication. This, the manager explained was to encourage independence and responsibility. The manager then hand transcribes the medication information from the container onto the Medication administration sheet. The previous inspection identified two requirements with regard to medication. Firstly, that staff must appropriately record the Medication Administration Records. In regard to this inspection, omissions were still found in the Medication Administration Records; these omissions all relate to the previous evening. Whilst acknowledging that this was a genuine oversight, it is not acceptable, and therefore a requirement in this regard remains. The second requirement from the last inspection refers to the manager not changing prescriptions without the agreement and knowledge of the General Practitioner. No evidence of this practice was found on this occasion and therefore this requirement is withdrawn Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 There is a complaints policy in place, which should ensure that service users feel that they are listened to. The lack of policies, procedures and staff training is potentially putting service users at risk. EVIDENCE: The home has a complaints policy in place, however it does not cover all the elements required by the standards, namely the timescales; a requirement has therefore been made in this regard. Neither the home nor the Commission have received any complaints from service users or any other interested parties. Service users in general felt that their views were listened to, although all service users stated that if they had an issue regarding their care they would raise it with their care managers in the first instance. The home has not yet acquired Croydon’s policy and procedures regarding vulnerable adults; nor does the home have its own policy and procedures. The manager stated that she has not undertaken any training in this area. One member of staff had undertaken training independently of the home in September this year. However, this could not be verified by a certificate of attendance, nor were the responses to questions asked about vulnerable adults in absolute line with the procedures. This combination of factors is of concern to the Commission and must be addressed for with. Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29 and 30 Although there is some improvement to develop storage, there is still clutter within the home which is not conducive to providing a comfortable and homely environment for the service users. EVIDENCE: The home is located on a busy residential road on the outskirts of Purley. The accommodation is over two floors; on the ground floor there is a large lounge/dining room, one bedroom, and a large kitchen with access to the garden. The second floor comprises of a further three bedrooms, bathroom and storage room. Each of the service users has their own bedrooms, which are equipped with a bed, wardrobe, chest of drawers and wash hand basin. It is the responsibility of the service users themselves to tidy their own bedrooms as part of their programme towards independence. The manager acknowledged that on many occasions she would clean and tidy service users bedrooms, as they will not complete the task themselves. All bedrooms were clean and relatively tidy. Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 18 The home is equipped with domestic style furniture and benefits from certain areas having recently been painted. There are sufficient communal areas, which can be accessed by service users freely. All service users have their own bedrooms, which have a lockable door and only they and the manager have key. However, on the day of inspection one bedroom did not have a serviceable lock and the key could not be turned, therefore the bedroom could not be locked. This is an outstanding requirement from the previous inspection and needs to be addressed for with. It was also noted that not all service users had a lockable drawer in their bedroom, a requirement is therefore made in this regard. One of the service users does not have her own key to the front door; the reasons for this were documented in the care plan, and appear to be a legitimate reason for the lose of independence. A previous requirement that the home should be more homely, comfortable and safe, that is to say that the clutter from the home should be removed, has been to some extent been achieved and therefore this requirement has been withdrawn. A condition of registration of the home is that the French doors that lead from one of the bedrooms must be locked at all times, and that ventilation should be provided by other means. At the previous inspection was in the summer, the French doors were found open in direct contravention of the condition of the registration. In discussions with the builder used by the home, it appears that the French doors must be opened from time to time, as they are aluminium and liable to cause rising damp if not. It has therefore been agreed with the manager that the doors can be opened intermittently but briefly, and whilst the manager is in the room. Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35 and 36 The insufficient staffing levels and lack of staff training could compromise service users safety, independence and freedom of choice. EVIDENCE: . Staff at the home do not currently have sufficient training or experience in the field of mental health, and this needs to be addressed. It was noteworthy that all the service users spoke positively about their relationship and contact with the staff team. However, the home is reliant on very few staff that work in isolation. It is difficult to see how the aims of the home to provide living skills towards independence can be achieved in this situation. Freedom of choice is compromised, and there is concern that sufficient contingencies are not in place should there be an emergency The staff team is very small, there are two individuals who work the majority of the week, plus one person who works the equivalent of full time. The duty rota indicated that there was only one member of staff on duty at any one time. Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 20 Registration was granted on the basis that two members of staff were on duty at all times; the previous inspection raised this as an issue. The agreement had been that the Commission would consider a review of these staffing levels at less busy times once they had received documentation from the proprietor that service users were in appropriate work or education. This documentation has not been forthcoming, and there is in fact further evidence that the lack of staffing is compromising the well being of the service users. One service users stated that she ‘had to go out when she did not want to, as there was only one member of staff on duty and that service users could not be left in the home unattended.’ This is a restriction on freedom of choice and must be addressed. Staff are also working long hours, and on occasions 100 hours per week. One member of staff works from 8 pm on a Friday to 8 am on a Monday, making this 60 consecutive hours without a break. Whilst the members of staff have signed the European working time directive, it is of concern that the level of hours worked over an extended period could compromise the quality of care given to service users. The manager has stated that there are contingency plans for emergencies such as sickness; however, this needs to be stated clearly in writing to the Commission. A requirement has therefore been made that the staffing levels must be reviewed. Written submissions must be made to the Commission outlining activities that are regularly undertaken by service users and when; highlighting what contingencies plans are in place and how the home will ensure that there is no service users restriction of choice Since the previous inspection, some work had been undertaken by the home in relation to staff files. The documentation including job descriptions, application forms was in place; Criminal Records Beaux checks had been completed, or there was evidence that they had been applied for. However, there were some omissions, which relate to the previous inspection; namely POVA checks were still to be undertaken. The home must ensure the safety and well being of service users and to the end they must complete all checks prior to commencement of employment. Staff have undertaken some training since the previous inspection, namely fire training and first aid. One member of staff had stated that she had recently completed a vulnerable adults training course independently of the home, however there was no evidence of this. Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 21 No member of staff has completed any training specifically regarding mental health; therefore a requirement has been made in this regard. Staff do receive supervision and support in order to carry out their tasks; supervision occurs on a regular basis and is recorded and signed by both parties. A previous requirement that supervision must be recorded is therefore withdrawn. Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Although the management of the home ensures the effective day-to-day running of the home, the quality of service users care could be compromised by the lack of management acumen. EVIDENCE: The manager is responsible for the qualifications and training requirements of themselves and of staff, thereby ensuring the effective day-to-day running of the home. The registered manager of the home and has a qualification in nursing, although not in the field of psychiatry. She states that she has completed NVQ level 4, but it has yet to be verified. Quality assurance and monitoring systems appear to be in place. Service users have a regular residents meeting, the minutes of which were available for inspection purposes. The manager stated feedback about the service is actively sort and will be responded to. Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 23 In regard to health, safety and welfare of the service users, the home must ensure that all fire doors are kept closed and not propped open, as they were downstairs. A requirement has been made in this regard. Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 2 X X X Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 X 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 1 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Better Care Residential home Score 3 X 2 X Standard No 37 38 39 40 41 42 43 Score 2 X 3 X X 2 X DS0000055368.V264205.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 2 Regulation 14(1)(a) & (b) Requirement Potential new service users must have their needs fully assessed prior to admission. Outstanding requirement which can only be accessed when a new service user is placed at the home Care plans must be reviewed regularly and must contain accurate information Care plans must be developed and reviewed with service users involvement Medication Administration Records must be kept up to date Outstanding requirement from 22/06/05 The complaints policy must include all the elements required under the regulations including timescales The home must obtain local policies and procedures regarding vulnerable adults, and in line with these develop their own policies and procedures Outstanding requirement Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 26 Timescale for action 01/06/06 2 3 4 6 6 20 15(2)(b) 15(2)(c) 17(3)(a) 01/02/06 01/02/06 01/12/05 5 22 22 01/02/06 6 23 12(1)(a) 01/02/06 from 22/06/05 7 26 23(2)(c) The home must ensure that service users have a serviceable bedroom lock 01/12/05 8 9 26 33 23(2)(m) 18(1)(a) Outstanding requirement from 22/06/05 The home must ensure that 01/01/06 service users all have a lockable space within their bedrooms The home must provide a written 01/02/06 submission regarding staffing levels, outlining the activities that service users attend on a regular basis, contingency plans if there is a emergency and an assurance that service users freedom of choice is not compromised Outstanding requirement from 22/06/05 All staff must have the required checks prior to commencement of employment, in particular PoVA Outstanding requirement from 22/06/05 The manager must complete her NVQ Level 4 Outstanding requirement from 22.6.05 Fire doors must be kept closed Staff must receive training in order to fulfil the needs of the service users, in particular mental health 10 34 18(1)(a) 01/01/06 11 37 9(2)(b)(i) 01/04/06 12 13 42 35 23(4)(a) 18(1)(a) 01/12/05 01/04/06 Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard 14 Good Practice Recommendations The should keep an activities folder containing photographs of all outings and event Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Better Care Residential home DS0000055368.V264205.R01.S.doc Version 5.0 Page 29 - 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!