Inspection on 22/06/05 for Better Care Residential home

This inspection was carried out on 22nd June 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Better Care Residential home 28/07/08

Better Care Residential home 24/05/07

Better Care Residential home 23/02/07

Better Care Residential home 02/06/06

Better Care Residential home 01/12/05

Better Care Residential home 30/03/05

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 Better Care Better Care Residential Home 211 Brighton Road, Purley Surrey CR8 4HF Lead Inspector Rin Saimbi Unannounced 22nd June 2005 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 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 Stationary 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 G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Better Care Residential home Address 211 Brighton Road, Purley, Surrey, CR8 4HF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8664 9745 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 G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The undersized bedroom will be used as a commual space, with the exisitng dining room becoming a bedroom 2. The French windows out of the upstairs bedroom will be permanently locked with ventilation being provided by other means Date of last inspection 30.3.05 Brief Description of the Service: Bettercare is a registered care home for upto 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, kitchen and one bedroom. The first floor has a further three bedrooms, bathroom and a storage space. 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 a driveway which could accommodate several cars. Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s first inspection for the year 2005/06, it was an unannounced inspection. The inspection itself started at 9.15 and lasted approximately three hours, two inspectors were involved for the duration of the inspection. The inspection took the form of discussions with the service users, all of who were met by the inspectors, and with the manager (as no other staff were on duty). In addition, there was a tour of the building and looking through documentation, which related to service users and staff. The inspection focused in the main on the previous requirements and recommendations, which were made at the last inspection in March 2005. The majority of the requirements made at that time were given a timescale of action for the end of May 2005. Mrs Coker the manager and proprietor of the home had a pre-arranged meeting with a service user and the professionals involved in her care, and therefore was not available for approximately the last forty minutes of the inspection. Feed-back about the inspection was given to Mrs Coker on an ongoing basis, although there was no opportunity to give formal feed-back at the end of the inspection. This was with Mrs Coker’s agreement. What the service does well: The manager of the home had positive interaction with the service users; they in turn spoke positively about the staff, saying that they felt well supported by them. Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: 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 G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 8 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 standard(s) 2 The home has information regarding service users. Service users themselves did not necessarily feel that they had a choice regarding their placement, although they some did feel that the placement was meeting their needs EVIDENCE: Pre-admission assessment information was available for service users with current identified problems and service users psychiatric history. 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. Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 9 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 standard(s) 6,7,8 and 9 In general the quality of information held about service users was pertinent and appropriate. It was not however, always up to date, extensive as it could be, accurate, or in a format that was readily accessible to service users should they wish to read the information held about themselves, or to staff working with service users. This is clearly of concern, as information obtained and held about service users defines the work that should be undertaken, whether the work is meeting the accessed needs. Service users are encouraged, and do participate in the running of the home which assists them in the process towards independent living. EVIDENCE: The service users within the home all had a written care plan. In general, these were reasonably well written, although they could be more expansive. The care plans did include appropriate interventions for example weekly counselling or one to one sessions with staff. However, the recording of such Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 10 visits or sessions was not consistent, and therefore it was not possible to be clear that they had occurred or not. Service users did have risk assessments on file; in fact three different formats were being used. The information being held on these separate documents was confusing and sometimes contradictory. Advice was given that the clinical based assessment should be withdrawn, and that the remaining two forms should be combined. This would therefore allow for a clearer, more comprehensive assessment to be put in place. The previous requirement regarding risk assessment has therefore been deemed to only be met partially. It was noted that the document entitled ‘Activities for Daily Living’ contained some appropriate and pertinent information. However, it did not necessarily fit the headings that were being used, 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. The home holds regular service users meetings, which are documented. This gives service users the opportunity to express their views and to participate in the daily running of the home. Service users confirmed that they felt that their views were listened to and acted upon. Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 11 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 standard(s) 11,12,14,15,16 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 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. With regard to appropriate daytime activities, the manager stated that along with other professionals, she was in the process of finding suitable educational opportunities for all the service users. One of the service users were able to confirm that this was the case. Another of the service users stated that she currently did not have enough to do during the day, and was often bored. Service users stated that there were trips away. Recently, three of the service users went to Broadstairs in Kent for a five-day trip; there have also been two day trips to France and occasional days into central London. Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 12 Service users were also able to confirm that friends and family were welcomed to the home, although one service users did state that visitors were infrequent. On the day of inspection, service users were engaged in routine activities, two had gone to the local shops, whilst a third was waiting for her review meeting with health professionals. During the period of the inspection, no meals were seen being prepared by the service users. Although service users stated that they were assisted in the preparation of meals. A menu was available for inspection, the manager stated that it was devised by the service users and did contain a range of food. Some of the foodstuffs stored in the fridge once opened were dated, in line with requirements made at the previous inspection. However, two meat products found in the fridge were well past there use-by date and therefore would be deemed a hazard to health and safety. The home must ensure that foods are properly rotated, and that they are stored appropriately. Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 13 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 standard(s) 18,19 and 20 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. The home needs to ensure however, that protocols are in place so that service users well being and safety are not endangered. EVIDENCE: Service users are generally given opportunity to maximise choice; they are able to choose their own clothes, although it was noted that one service users was correctly being steered towards changing her clothes for something cooler, as it was such a hot day. Another service users had just been shopping for her personal toiletries, and was then making a careful note of the money that she had spent so that she could budget what she had left for the week. All service users have their own bedrooms, which have a lockable door. However, on the day of inspection one service user was not able to lock her door, this had been the situation for a number of weeks and was likely to remain so for a further ten days. The manager commented that this particular service user did not object, and that the situation was in hand awaiting repairs. Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 14 The home must however ensure that all service users have working locks fitted to their bedroom doors. As previously stated 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 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 requirement that the home must have risk assessments in place regarding the collection of medication has now been completed, and therefore the requirement has been met. However, two new requirements have been made with regard to medication. Firstly, that staff must appropriately record the Medication administration records. Secondly, the manager must not change prescriptions without the agreement and knowledge of the service users manager. Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 15 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 standard(s) 22 and 23 There is a complaints policy in place, which will ensure that service users feel that they are listened to. The home does not have any policies and procedures in place regarding vulnerable adults and therefore the service users are potentially at risk. EVIDENCE: The home has a complaints policy in place. 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 and acted appropriately, although they were not always clear how they would make a complaint if they needed to. The manager stated that no member of staff has as yet completed any form of training relating to vulnerable adults. Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 16 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 standard(s) 24,25,26,27,28, and 29 The home is on a residential road and from the outside appears no different from the other properties. The home is accessible to community facilities and services. In general, the environment was cluttered which could lead to an unsafe home; this issue needs to be addressed. 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. The bedrooms were reasonably tidy, although some were in need of cleaning. It is acknowledged that this is the responsibility of the service users themselves as part of the service users programme towards to independence. Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 17 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. However, the home is cluttered and untidy. It was difficult for three people to sit around the dining table; the medication cupboard which is situated in the storage room could only be accessed with great care because of all the items on the floor; the lawn area in the garden was overgrown and therefore could not be used; the old sofa in the garden must be removed as it presents a fire hazard. The home must ensure that the environment for the service users is more homely, comfortable and safe. On the day of inspection, it was found that the French windows leading from the back bedroom were open. This is in direct contravention of one of the conditions of registration, and must not happen again. Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34,35 and 36 Service users spoke positively about their contact with staff. 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. Staff at the home do not currently have sufficient training or experience in the field of mental health, and this needs to be addressed. EVIDENCE: As only one member of staff, Mrs Coker the manager was available, it was not possible to access whether staff at the home were clear about their roles and responsibilities. It was noteworthy that all the service users spoke positively about their relationship and contact with the staff team. However, the duty rota indicated that there was only one member of staff on duty at any one time, and that two individual workers, one of which was the manager, generally covered the rota. Two other individuals’ names appear on the rota, and Mrs Coker was in the process of appointing an additional member of staff. However, as it stands the main two individual workers are working excessive hours, often exceeding over eighty hours per week, and sometimes Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 19 over 90 and 100 hours per week. This issue was raised at the previous inspection, and has yet to be addressed. In addition, other areas of concern have been raised particular if there was an emergency or the service users had to be accompanied to an appointment. Mrs Coker has stated that staff are always available should such a situation arise and that she has used staff in that capacity. Requirements have therefore been made that an on-call worker must be available and their name must appear on the duty rota. In addition, if staff have worked extra hours accompanying service users to appointments etc. then this must be recorded on the duty rota forthwith. Registration of this home was granted on the basis, and with the agreement of Mrs Coker, that at least two staff must be on duty at all times. This is clearly not happening and is not acceptable. The Commission has agreed that if Mrs Coker can produce evidence that service users are in appropriate work or education during the day then the staff levels will be reviewed. However, this does not necessarily mean that staffing levels will automatically be reduced. Until such time that the Commission receives this documentation, the home must ensure that at least two staff are on duty. 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. One file had only one reference, and 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 undergone very little training, one member of staff has undertaken an alcohol abuse training course. The manager needs to complete her NVQ level 4. With regard to supervision, the manager stated she does undertake supervision, although she has not kept any records of the meetings. It was not possible to ascertain from staff whether this was the case. A requirement has been made in this regard, that care staff must receive recorded supervision at least six times a year. Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 20 Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 42 The calibre of the manager is crucial to the running of the home; therefore it is vital that appropriate qualifications are completed, in order to ensure the smooth running of the home. EVIDENCE: Mrs Coker is the registered manager of the home and has a qualification in nursing, although not in the field of psychiatry. Mrs Coker has yet to complete her NVQ level 4, she stated that she has completed the course but it is yet to be verified. The manager undertakes monthly health and safety audits. Although the accuracy of the checks being undertaken could be questioned, as they were not being filled out accurately. In addition, there are no general risk assessments in place for the environment. Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 22 The home must also ensure that all cleaning products stored in the bathroom and toilet must be locked away in compliance with chemicals and other substances hazardous to health regulations. Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 x Standard No 11 12 13 14 15 16 17 3 2 x 3 3 3 2 Standard No 31 32 33 34 35 36 Score x x 1 1 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Better Care Score 2 3 1 x Standard No 37 38 39 40 41 42 43 Score 2 x x x x 2 x G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 24 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 Regulation Requirement Timescale for action 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 Good Practice Recommendations Better Care G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 25 Commission for Social Care Inspection CSCI 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 G53-G53 S55368 Bettercare V231120 090605 stage 0.doc Version 1.30 Page 26 - 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!