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Please note that the information on this website is now out of date.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 23/02/07 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 23rd February 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

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

At previous inspections the service users have commented upon the positive care that they received at the home. At this inspection, when one service users was asked how they had settled in, stated `they made me feel welcome.` Evidence suggested that service users are involved in making decisions on a day-to-day basis. These include when to go and what personal processions they wanted to buy for themselves.

What has improved since the last inspection?

It was positive to note that action had been taken regarding the immediate requirement that had been made in October 2006. The requirement related to the home obtaining information about service users prior to an admission. Prior to admission of a new service user, the home obtained a copy of the Care Programme Approach written by an appropriate external body. This was an extensive document, which outlined all the appropriate care needs of the individual.

What the care home could do better:

There is an ongoing issue regarding staffing levels within the home. At the point of registration, Mrs Coker confirmed that there would be two members of staff on duty at all times. Since that time, there has only been one member of staff on duty at any one time. At the previous inspection on the 25th October 2006, an immediate requirement was made regarding the staffing levels. The requirement stated that a second member of staff be on call and available at short notice. In addition that the home employs a second worker at their busiest times. The home still does not employ a second worker There are a number of issues, which arise from this situation.Firstly, that a number of service users have on more than one occasion referred to having to do out, either when they did not want to, or, were too ill to. This is clearly a restriction on freedom of choice. Secondly, the home is reliant on very few staff that work in isolation. It appears that the manager and one other staff member work in excess of 100 hours per week. This excessive number of hours could compromise the safety and well being of the service users. There was an incident in 2005, when a service user pulled a knife on the manager and the police had to be called. Thirdly, the Commission would query the level of independence training that can effectively be offered to service users if there is only one member of staff on duty at any one time. There is also an issue regarding training of staff within the home; there is little evidence that any appropriate training has been offered. The Care Standards Act 2000 state that staff should have an individual training and development profile, and at least 5 days training (pro rota). This is clearly not the case in this situation. In addition the Care Standards Act 2000 states that staff must have the knowledge and experience of specific conditions of service users to enable them to work effectively.

CARE HOME ADULTS 18-65 Better Care Residential home 211 Brighton Road Purley Surrey CR8 4HF Lead Inspector Ms Rin Saimbi Key Unannounced Inspection 23rd February 2007 09:50 Better Care Residential home DS0000055368.V330542.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 Better Care Residential home DS0000055368.V330542.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. Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Better Care Residential home Address 211 Brighton Road Purley Surrey CR8 4HF 020 8763 9796 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.V330542.R01.S.doc Version 5.2 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. 2nd June 2006 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. The costs of a placement per week for the year 2006/07 are £500. Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s third inspection for the year 2006/07. This was an unannounced key inspection which started at 9.50 am and was terminated at 1pm. Two inspectors were involved with the inspection. The previous inspections were on the 2nd June, which was also a key inspection, and the 25th October, which was a smaller inspection known as a random inspection covering a limited area of regulation. Following the inspection in October, two immediate requirements were made. One relating to information obtained prior to service users coming into the home, the second to staffing levels. The Commission have conducted three inspections reflecting their level of concern about the home. In addition, there has been an office based meeting with the proprietor/manager on the 5.7.06, the purpose of which was for the Commission to express concerns about the home and the service that it provides to its service users. The process of this inspection, involved discussions with the manager, a limited tour of the building, looking through documentation at the home, which, related to service users and staff. There was only a brief opportunity to speak to service users directly, as one of them went out soon after our arrival and another went to Westways. As the two service users left the premises before the inspectors had the opportunity to ask permission to enter their bedrooms, the inspectors chose not to go into their bedrooms. Bettercare is a small unit; Mrs Agnes Coker is the proprietor of the home; the manager; and one of the main members of staff working approximately 100 hours per week in the home. Mrs Coker was the only member of staff spoken to during this inspection. Therefore for the purposes of this report, the inspector has chosen to use the terminology of ‘the manager’, rather than to try and differentiate the roles undertaken by the one person. The inspectors were able to give some feedback to the manager on the day of the inspection; however, this was curtailed because of the manager’s conduct. What the service does well: Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 6 At previous inspections the service users have commented upon the positive care that they received at the home. At this inspection, when one service users was asked how they had settled in, stated ‘they made me feel welcome.’ Evidence suggested that service users are involved in making decisions on a day-to-day basis. These include when to go and what personal processions they wanted to buy for themselves. What has improved since the last inspection? What they could do better: There is an ongoing issue regarding staffing levels within the home. At the point of registration, Mrs Coker confirmed that there would be two members of staff on duty at all times. Since that time, there has only been one member of staff on duty at any one time. At the previous inspection on the 25th October 2006, an immediate requirement was made regarding the staffing levels. The requirement stated that a second member of staff be on call and available at short notice. In addition that the home employs a second worker at their busiest times. The home still does not employ a second worker There are a number of issues, which arise from this situation. Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 7 Firstly, that a number of service users have on more than one occasion referred to having to do out, either when they did not want to, or, were too ill to. This is clearly a restriction on freedom of choice. Secondly, the home is reliant on very few staff that work in isolation. It appears that the manager and one other staff member work in excess of 100 hours per week. This excessive number of hours could compromise the safety and well being of the service users. There was an incident in 2005, when a service user pulled a knife on the manager and the police had to be called. Thirdly, the Commission would query the level of independence training that can effectively be offered to service users if there is only one member of staff on duty at any one time. There is also an issue regarding training of staff within the home; there is little evidence that any appropriate training has been offered. The Care Standards Act 2000 state that staff should have an individual training and development profile, and at least 5 days training (pro rota). This is clearly not the case in this situation. In addition the Care Standards Act 2000 states that staff must have the knowledge and experience of specific conditions of service users to enable them to work effectively. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Better Care Residential home DS0000055368.V330542.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 Better Care Residential home DS0000055368.V330542.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): 2,4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In addition, there have been two previous inspections to the home on 2nd June 2006 and 25th October 2006, when many of these issues were discussed. Prior to admission of a new service user, the home obtained a copy of the Care Programme Approach written by an appropriate external body. This was an extensive document, which outlined all the appropriate care needs of the individual. A contract was available, however, it failed to give the basic terms and conditions for service users. The contract was not in a format appropriate to the service users needs. EVIDENCE: At the last inspection in October 2006, an immediate requirement was made regarding the information obtained prior to any new service user being admitted to the home. The requirement effectively stated that no new service user must be admitted to the home without a full psychiatric history, and a full assessment obtained by the manager stating the service users needs. Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 10 Since the last inspection, one new service user has been admitted to the home. Documentation was checked relating to this service user. On file was a Care Programme Approach (CPA) obtained from South London and Maudsley Hospital. This was a comprehensive document, which outlined the service users history including their mental health status, significant mental health history and a twenty-point summary of their needs in relation to all aspects of their care. This was a thorough document provided by an external professional body, which gave a clear focus of the work required. Given this document, the immediate requirement was deemed to have been met and therefore withdrawn. There was evidence that the prospective new service user did have the opportunity to visit the home prior to the admission. However, it was not clear from the evidence presented the process of the introductory visits. The contract for this service user was checked. It not contain all the areas specified in Care Standards Act 2000, standard 5.2. Namely it was not signed, did not include fees, room allocation or details of referring authority. The contract contained some rather unusual clauses, which could be deemed to be unfair. These included for example, an extra charge for the use of the ‘attractive garden’ and for ‘special diets’. Within this information no details could be found which related to Bettercare’s own insurance, rather it is stated that service users must have their own insurance. Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. In addition, there have been two previous inspections to the home on 2nd June 2006 and 25th October 2006, when many of these issues were discussed The Care Programme Approach had been translated by the home into a care plan. The care plan was inadequate for its purpose in that it did not state the rehabilitation that would be offered and how these services will meet the current and changing needs of the service user. The lack of an appropriate and meaningful care plan could potentially put service users and staff at significant risk. EVIDENCE: The care plan for new service user was viewed. As previously stated the home did have a comprehensive CPA, which highlighted the history of the service user and a twenty-list plan of goals. Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 12 Listed within the history were details of verbal and threatening behaviour, including an incident, which required four staff to handle an aggressive outburst; erratic compliance with medication; and being sexually disinhibited. The home had devised its own care plan, which comprised of three areas of work. All three related to the service users aggression, with the plan to keep the service user ‘occupied and happy’. Within the care plans there was no evidence of guidance on how to deal with challenging behaviour, no reference or training regarding restraint or any contingency plans if there was an emergency. Risk assessments were in place, but there was no reference to the risks identified in the C.P.A, which related to relapse, suicide and health. The lack of an appropriate and meaningful care plan could potentially put service users and staff at significant risk. There was an attempt to discuss the C.P.A provided and how this had been translated into the care plan, which the inspectors considered inadequate. The inspectors were unable to discuss because of the manager’s conduct. In relation to individual needs and choice, previous inspections have identified that service users can take some limited control of their lives on a day-to-day basis. On the day of inspection, it was noted that service users come and go at will. In addition, the inspector observed the manager assisting one of the service users in preparing their own lunch. Better Care Residential home DS0000055368.V330542.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): 11,12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. In addition, there have been two previous inspections to the home on 2nd June 2006 and 25th October 2006, when many of these issues were discussed. In general, service users within the home are encouraged to 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. Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 14 Mrs Coker assertion is that service users are very independent. She informed the inspectors that ‘ the law had changed’ and that she would only offer a service for a maximum of nine months. The Commission are unaware of this change as stated by Mrs Coker, nor has the registration of the home changed. There was some discussion that if service users are so independent that she may want to consider becoming supported living accommodation and therefore no longer have to register with the Commission. Service users appear to have good community links; on the day of inspection one of the service users was preparing lunch for her and another of the service users; one was at Westways attending a medical appointment; the fourth was out. At previous inspections service users have spoken about the activities that they have attended including college courses. There have also been holidays and trips arranged over the summer period. These have included all four of the service users going to Broadstairs in Kent for a four-day trip over the summer period. There are also shopping trips to Sutton and Crystal Palace. Service users were able to confirm previously that friends and family were welcome to visit whenever they wished, and that there was also more formal invites such as the Christmas party. On the day of the inspection, one of the service users was preparing lunch for herself and for one other service user. The manager, Mrs Coker, was observed assisting in the meal preparation. Mrs Coker encouraged the service user by informing her step by step of what she needed to do, observing her actions and giving information regarding hygiene. The service user prepared potato salad, burger, sausages and lettuce and cucumber and tomato salad. Given that the meal was for two service users who were both obese, it is unclear what discussions the manager had regarding nutrition with the service users. The inspector accepts that it is difficult for the manager to balance the needs and wishes of service users with that of a healthy diet. However, the Commission require that the home is able to produce evidence that nutritional issues are discussed with service users on an ongoing basis. There was evidence that the home do monitor the weight of service users on a regular basis. Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 15 Service users are able to move freely around the kitchen and help themselves to drinks and snacks. Better Care Residential home DS0000055368.V330542.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): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In addition, there have been two previous inspections to the home on 2nd June 2006 and 25th October 2006, when many of these issues were discussed 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 manager needs to be mindful of service users privacy at all times and ensure that in future it is not compromised. 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. Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 17 The manager was observed knocking on service users doors before entering. Service users have previously stated that they receive their mail unopened; There is a communal telephone available in the hallway, in addition if service users have a private call then the home will let service users use the portable handset, which can be taken, into their bedrooms. On the day of the inspection, there was an issue regarding a service users privacy and dignity not being maintained. It is not appropriate within this report to discuss the specifics without further compromising the service user privacy albeit to say that the inspector withdrew herself from the situation. The manager needs to be mindful at all times of what is being said, and who can hear such conversations. With this in mind, privacy must be maintained and not compromised in the future. A requirement has made in this regard. 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. 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 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. Medication is stored away in a metal cupboard, which is locked. The Medication Administration Records (MAR) were checked and no errors were found. Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. . In addition, there have been two previous inspections to the home on 2nd June 2006 and 25th October 2006, when many of these issues were discussed Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a complaints policy in place, which should ensure that service users feel that they are listened to by the home. The home has acquired some policies and procedures regarding vulnerable adults, however, the extent of knowledge within the staff group and the levels of training remain of concern, and it does not ensure that service users would not be protected from abuse. EVIDENCE: The home has a complaints policy in place; it has been adapted from another home and is adequate for the purposes. Neither the home nor the Commission have received any complaints from service users or any other interested parties. It was not possible at this inspection to ascertain the view of service users with regards to their feelings about the home. At previous inspections, service Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 19 users have stated that if they had any issues or complaints about the service then they would talk to their care managers in the first instance. The home has again acquired some policies and procedures regarding vulnerable adults. However, the staff’s level of understanding regarding these procedures has not been tested at this inspection. The manager has stated that she and another member of staff have both undertaken training regarding vulnerable adults. With the other member of staff have undertaken training in September 2005. However, this could not be verified at that time, nor has it been since then with a certificate of attendance. Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26 and 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. In addition, there have been two previous inspections to the home on 2nd June 2006 and 25th October 2006, when many of these issues were discussed 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 and meets the service users needs The premises could be more comfortable and homely, as there are areas of clutter and untidiness. 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 Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 21 garden. The second floor comprises of a further three bedrooms, bathroom and small office. 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. 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. Not all the bedrooms were seen at this inspection, as the service users were not available to give their permission; the ones that were seen were relatively clean. Each bedroom has a lockable door and only the service user and the manager have a key. At the inspection dated 2nd June 2006, it was noted that one of the service users did not have a lockable space in their bedroom. The manager stated at this inspection that the service user now did not want a lockable space, however, this could not be confirmed by the inspector and will therefore remain as a requirement until such time that it can. There has been an ongoing issue regarding clutter within the home. This detracts from the home having a comfortable and homely atmosphere, but also more importantly raises issues from a health and safety point of view. The areas of clutter will be addressed in the management section of this report as they relate specifically to fire safety. Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34 and 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. In addition, there have been two previous inspections to the home on 2nd June 2006 and 25th October 2006, when many of these issues were discussed Insufficient staffing levels and the lack of staff training does compromise service users safety, independence and freedom of choice. EVIDENCE: There remains an ongoing issue between the Commission and the manager/proprietor of the home regarding the levels of staffing. Prior to registration Mrs Coker confirmed that two members of staff would be on duty at all times. Since that time, there has only been one member of staff on duty at any one time. Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 23 At the previous inspection on the 25th October 2006, an immediate requirement was made regarding the staffing levels. Namely that the Commission would agree to one member of staff being on duty at certain times, as long as conditions were met. The conditions were that there was a staffing rota with a named person on call, and that person could arrive at the premises at short notice. In addition, that at the busiest times of the day, as identified by Mrs Coker, that there would be a second worker on duty. Mrs Coker informed the inspectors that she had met the first two conditions. However, she does not consider it necessary to employ a second worker to be on duty, as the service users are so independent. A number of issues regarding this have been raised with Mrs Coker on a number of occasions. Firstly, that a number of service users have on more than one occasion referred to having to do out, either when they did not want to, or, were too ill to. This was because Mrs Coker did not feel that she could leave service users without any staff on the premises. So therefore, when she went out shopping everyone had to accompany her. This is clearly a restriction on freedom of choice. Mrs Coker has denied that this has happened. She states instead, that it is part of the service users independence training. The Commission will be seeking legal advice regarding this issue. Secondly, the home is reliant on very few staff that work in isolation. It appears that the proprietor/manager and one other staff member work in excess of 100 hours per week. A third member of staff works twelve hours per week and a fourth member of staff has been employed. Whilst both full time members of staff have signed the exception to the European working time directive, the fact remains that the excessive number of hours could compromise the safety and well being of the service users. The inspector was informed of an incident when a service user became disruptive and violent and pulled a knife on a member of staff. The police were called and the service user removed, the member of staff incurred a minor injury and was treated the next morning. This again emphasis’ the need to have contingency plans in place should an emergency arise, A requirement therefore remains that the home must provide a written submission to the Commission outlining what contingencies plans are in place for any emergency and how the home will ensure that there is no service users restriction of choice. Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 24 Thirdly, the Commission would query the level of independence training that can effectively be offered to service users if there is only one member of staff on duty at any one time. There is an issue regarding training of staff within the home; there is little evidence that any appropriate training has been offered. One member of staff at the previous inspection stated that she has done vulnerable adults training although there was no evidence of this. Mrs Coker informed the inspectors that this member of staff had also completed other training, once again however, there was no evidence of this. One member of staff had completed two weeks training as a health care assistant/nursing auxiliary, and the certificate was available for inspection. However, this course was completed prior to being employed in the home. The course was directly relevant to working with the service users in this home. The Care Standards Act 2000 state that staff should have an individual training and development profile, and at least 5 days training (pro rota). This is clearly not the case in this situation. In addition the Care Standards Act 2000 states that staff must have the knowledge and experience of specific conditions of service users to enable them to work effectively. This particular member of staff does not appear to have any training specifically regarding mental health, nor has she received any training since being employed at the home. The new member of staffs file was checked. It contained an application form; enhanced Criminal Records Beaux check dated the 7.3.06; passport identification; two references and a record of a supervision held on the 1.12.06. It was noted that the references were on a printed format, but had no space for an official stamp. Mrs Coker was also advised that to make telephone contact with the referee to confirm the information that was given. Mrs Coker stated that she did do this, however, it was suggested that a record of the conversation be made perhaps on the reference itself. The staff file did contain a job description. However, it did not reflect the service user group, instead referring to ‘keeping Zimmer frames and wheelchairs clean’. A requirement has therefore been made that Mrs Coker must provide all staff with an appropriate job description. Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. . In addition, there have been two previous inspections to the home on 2nd June 2006 and 25th October 2006, when many of these issues were discussed Although management of the home ensures the day-to-day running of the home, the quality of the care that service users receive could be compromised by the lapses in administration. EVIDENCE: The manager, Mrs Coker is in the process of completing her NVQ Level 4, she informed the inspectors that she is due to finish in mid March 2007. This will remain a requirement until evidence is provided that it has been completed. Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 26 In regard to health, safety and welfare of the service users, a number of issues were identified during a tour of the building. Fire doors are still being propped open. This has been a requirement since 1.12.05 and is of concern that it continues to be the practice within the home. In addition, it was noted that the kitchen back door has a dead lock. This is not suitable as the back door could be used as a means of escape in an emergency. From the garden to the side of the building, there is an alleyway, which leads to the front of the building. It was obstructed on the day of the inspection with a large number of furniture items. These were according to Mrs Coker unwanted items waiting to be disposed of. The fact remains however; they constitute an obstruction, particular if there was a fire. Requirements have therefore been made that the items of furniture are removed and that the lock on the back door is replaced with something more suitable. In the hallway, there is a three-piece suite. Mrs Coker informed the inspectors that she was asked to place it there by registration so that service users have another space available to meet in if they wish to be away from the lounge. The fire department has visited the home and has not commented upon it. However, it was the view of the inspectors that it could constitute a fire risk. Therefore, the inspectors have agreed to contact the Fire Department to seek further clarification regarding the issue. However, until such time as confirmation is received from the fire department, a requirement is made that the suite must be removed. A valid Certificate of Employers Liability was available; there was a record of weekly fire testes, the last one being completed on the 18.2.07 and fire equipment was checked on the 25.10.06; there was a domestic electrical certificate dated the 4.1.03 which was valid for five years. The Portable Appliance Testing was last carried out on the 9.5.05 and therefore was out of date. A requirement was made in this regard. Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 27 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 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 2 33 1 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 2 X X 2 X 2 X Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 28 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 YA5 Regulation 5(1)(b) Requirement The contract must contain all the elements required by the Care Standards Act 2000, standard 5.2 The contract is in a format that is appropriate to each service user’s needs and does not contain any elements that could be deemed as unfair, such as use of the ‘attractive garden’ and ‘special diets’ being considered as extras. The care plan covers all aspects of personal and social support and health care needs Risk assessments are carried out prior to an admission and action is taken to minimise risks and hazards Nutritional needs are assessed and regularly reviewed including risk factors associated obesity. Written evidence is supplied with covers these areas Service users privacy and dignity must be maintained by the manager The home must submit evidence that vulnerable adults training DS0000055368.V330542.R01.S.doc Timescale for action 23/04/07 2 YA5 12(1)(a) 23/04/07 3 4 YA6 YA9 15(1) 12(1)(a) 23/03/07 23/03/07 5 YA17 12(1)(a) 23/03/07 6 7 YA18 YA23 12(4)(a) 19(5)(b) 23/02/07 23/03/07 Better Care Residential home Version 5.2 Page 29 8 9 YA24 YA26 23(2)(d) 23(2)(m) 10 YA31 18(4) 11 12 YA32 YA33 18(c)(i) 18(1)(a) has been completed by all its staff within the last three years Clutter is removed from the home With regard to a lockable space, the home must provide evidence that the service user has refused the item. All staff must be provided with an appropriate job description which reflects the work actually undertaken 50 of care staff achieve NVQ 2 by the revised deadline of 2007 There is a second worker on duty at the busiest times of the day Outstanding requirement from 22/06/05 Staff must receive training in order to fulfil the needs of the service users, in particular the field of mental health Outstanding requirement from 01/12/05 The manager must provide evidence once her NVQ 4 has been completed Outstanding requirement from 22/06/05 The home must obtain a fax machine The home must have written polices and procedures that comply with relevant legislation, and that these policies and procedures are relevant to the service users within the home Portable appliance testing must be completed as it expired on the 9.05.06 The home must adhere at all legislation relating to fire safety. This includes a) The removal of the dead- 23/02/07 23/03/07 23/03/07 23/05/07 23/02/07 13 YA35 18(1)(a) 23/02/07 14 YA37 9(2)(b)(i) 23/03/07 15 16 YA37 YA40 16(2)(ii) 12(1)(a) 23/04/07 23/05/07 17 18 YA42 YA42 12(1)(a) 23(4)(b) 23/02/07 23/02/07 Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 30 lock on the kitchen door b) Clutter removed from the side of the house, which is a means of escape c) The removal of the furniture in the hallway d) Fire doors must not be wedged open 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 YA34 Good Practice Recommendations When appointing new staff, the manager should contact the referee to verify the information given, and record this information. Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Better Care Residential home DS0000055368.V330542.R01.S.doc Version 5.2 Page 32 - 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!