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Inspection on 24/05/07 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 24th May 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

People who use the service have commented on previous occasions and at this inspection about the support that they get from the manager. Comments have been made such as `very nice and friendly` and `we get help when we need it` Evidence suggested that service users are involved generally 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?

Some work has been completed on care plans, which are now marginally improved. However, this is very much a step in the right direction and there is still much work that needs to be completed. Requirements relating to care plans are still in situ.

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 a 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. Training must include vulnerable adults training, food hygiene, fire, first aid and manual handling. 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. That is to say, that staff must all have knowledge of mental health issues.

CARE HOME ADULTS 18-65 Better Care Residential home 211 Brighton Road Purley Surrey CR8 4HF Lead Inspector Ms Rin Saimbi Key Unannounced Inspection 24th May 2007 10:00 Better Care Residential home DS0000055368.V341173.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.V341173.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.V341173.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.V341173.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. 23rd February 2007 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, 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.V341173.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 first inspection for the year 2007/08. This was an unannounced key inspection which started at 10.00 am and was terminated by the inspectors at 12 noon. Two inspectors were involved with the inspection. During this time, the inspectors talked to people who use the service, the manager, had a tour of the building and looked through some documentation. Paperwork relating to two people who use the service was case-tracked. The manager was then invited into the Commissions office to present certain other documentation as part of the inspection process. The manager did not come into the office, but instead information was hand delivered. The Commission remain concerned about the people who use the service and therefore the home will be receiving more the usual number of inspections. All documentation received by the Commission regarding this home over the last year was also reviewed. As part of the inspection process, questionnaires are sent out to people who use the service, their family and friends and to other stakeholders. Only one relatives comment card was returned to the Commission, which was generally positive about the home. Following on from the previous inspection, the Commission requested that the fire department visit the premises as the manager disagreed with what the inspectors were requiring. London Fire and Emergency Planning Authority visited the home on the 30th March 2007 and identified seven areas of concern, which had to be remedied within two months. 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, regarding the documentation that was presented to the office, as the manager was not available no feedback could be given. Better Care Residential home DS0000055368.V341173.R01.S.doc Version 5.2 Page 6 What the service does well: 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 a 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. Better Care Residential home DS0000055368.V341173.R01.S.doc Version 5.2 Page 7 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. Training must include vulnerable adults training, food hygiene, fire, first aid and manual handling. 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. That is to say, that staff must all have knowledge of mental health issues. 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.V341173.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.V341173.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 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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. Contracts were available, however, there they did not give the basic terms and conditions for service users. The contract was not in a format appropriate to the service users needs. EVIDENCE: At a previous 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. At the last inspection in February 2007, one new service user has been admitted to the home. Documentation was checked relating to this service Better Care Residential home DS0000055368.V341173.R01.S.doc Version 5.2 Page 10 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. 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 particularly service users was viewed at the last inspection and consequently a requirement was made that it must 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. At this inspection the home provided a copy of a contract that it has with another service user and Croydon Social Services dated 16th June 2004. This document was appropriate and signed by the service user, the home’s manager and a representative from the Council. A second contract was provided by the home. It was a sample contract and therefore was not signed, did not have fees included although there was a space for them to be included at a later date. The contract is confusing as it lists its amenities and facilities to include occupational therapy, hairdressing and laundry service. None of which appear to be on offer to people who use this particularly service. In addition, service users are advised to make complaints to the sister in charge or Head of Nursing. This is home is not a nursing facility and therefore these posts are not in existence. A requirement remains therefore that a contract between the service users and the home must be in a format that is appropriate to each service users and does not contain any elements that are deemed to be unfair or do not exist. Better Care Residential home DS0000055368.V341173.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,&9 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The Care Programme Approach had been translated by the home into a care plan. The care plan was in general, adequate for its purpose, although it did need to be more comprehensive about certain areas of work. The lack of clarity of the care plan could potentially put service users and staff at significant risk. EVIDENCE: The home provided two care plans of people who use the service; the inspector as part of the case tracking process requested these. The care plan for the newest service user was viewed. This service user had a comprehensive Care Programme Approach (CPA), which listed a twenty-plan goal and a thorough history. Better Care Residential home DS0000055368.V341173.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. At the previous inspection the home had translated this twenty-plan goal to three separate issues, which related to keeping the service user ‘occupied and happy’. At this inspection, the care plans has been extended to include five goals. The care plans had been agreed by the service user who has signed each goal and it appears that the goals are reviewed on a regular basis. However, there was still 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. Instead the care plans are contradictory, one care plan refers to ‘if service user becomes violent take her to her room and give one to one session’ another states ‘if service user gets aggressive staff to leave her to cool down and explain to her about her behaviour’. This lack of clarity about what to do in an emergency situation could put people who use the service and staff at risk and therefore needs to be addressed. A requirement remains in this regard. Risk assessments were viewed at the previous inspection, but there was no reference to the risks identified in the C.P.A, which related to relapse, suicide and health. The second service user care plan was viewed. It contained a five-point goal, which focused on possible relapse, anger management, non-compliance of medication and self-harm. There was evidence that this plan was agreed with the service user and reviewed regularly. Better Care Residential home DS0000055368.V341173.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): 12,13,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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. Service users appear to have good community links; on the day of inspection one of the people who use the service was away, another was at Westways. One of the inspectors was able to talk to the two remaining service users. They were able to describe what they did in the community, this did include crafts at Better Care Residential home DS0000055368.V341173.R01.S.doc Version 5.2 Page 14 Westways, swimming, library, visiting family, shopping and one of the service users was signed up at the volunteer bureau although had not undertaken any activities as yet. Within the home they said that they watched television, read, cooked and that there was a cleaning rota. There had already been discussions within the home about summer holidays, and the service users thought that there was a possibility that they would go to France this year. Service users were able to confirm that friends and family were welcome to visit whenever they wished. Although there was some disappointment that Christmas had been just an ordinary day. People who use the service stated clearly that they knew that they were in the home to learn how to become more independent and take more responsibility for themselves. One described the staff as ‘very nice and friendly’; another said that they were always there to help. With regard to diet, a requirement was made at the previous inspection that nutritional needs must be assessed. The home was able to provide evidence that people who use the service and who are obese have their weight monitored on a regular basis. People who use the service confirmed that the staff talk to them about healthy food. On the day of inspection, it was observed that the manager gave a service user a meal, which consisted of sausage roll, potato salad and coleslaw at ten o’clock in the morning. The manager described this as lunch, whilst the service user described it as her breakfast. This raises two areas, which need to be addressed. Firstly, it is still unclear to the Commission to what extent nutritional needs are being met appropriately if this is a usual meal. Secondly, there is the issue of encouraging independence and maximising choice. Therefore two requirements have been made relating to the above incident. Better Care Residential home DS0000055368.V341173.R01.S.doc Version 5.2 Page 15 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): 18,19,20 & 21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are generally 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: People who use the service are generally given opportunity to maximise choice; in general they manage and hold their own money. People who use the service are able to choose their own clothes, toiletries, make their own hairdressing appointments. Service users themselves confirmed this. 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. Better Care Residential home DS0000055368.V341173.R01.S.doc Version 5.2 Page 16 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. It was noted that there was an empty Dossette pack on the dining room table. People who use the service confirmed that there is a practice within the home that each person’s medication is left in the Dossette pack on the dining room table. This is an unsafe practice, as it is not possible to determine who has taken the medication. A requirement has therefore been made in this regard. The home could within the realms of a risk management strategy consider people who use the service to self-administer their own medication. Better Care Residential home DS0000055368.V341173.R01.S.doc Version 5.2 Page 17 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. 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. However, the complaints policy within the home’s contract must be reviewed, as it refers to the sister in charge and the Head of Nursing, neither of which posts exist within the home. Neither the home nor the Commission have received any complaints from people who use the service or any other interested parties. In discussions with people who use the service there was a positive view of the service. One person said, ‘there is nothing I don’t like’. When asked what they would do if they had a problem or complaint, two people stated that they would talk to the manager or their care manager. Better Care Residential home DS0000055368.V341173.R01.S.doc Version 5.2 Page 18 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 having undertaken training in September 2005. However, this has not been verified and will remain as a requirement until such time that it can be. Better Care Residential home DS0000055368.V341173.R01.S.doc Version 5.2 Page 19 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): 24,26,28 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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 physical environment is not well maintained nor updated and therefore cannot be deemed as comfortable or homely. 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, staff sleeping in room and small office. Better Care Residential home DS0000055368.V341173.R01.S.doc Version 5.2 Page 20 The home is equipped with domestic style furniture and benefits from certain areas having recently been painted. 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. All the bedrooms were seen at this inspection, and 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, as well as raising health and safety issues. The hallway had a roll of lino, speaker boxes and various other items. The kitchen was of a poor standard of repair and decoration. Within the kitchen, the sink surround was damaged, the boiler cover was taped, and there was a chest freezer located some two feet away from the wall and into the kitchen floor space covered with a cloth. There were plenty of work surfaces in the kitchen, but the majority were covered with items, thereby making food preparation difficult for one of the service users trying to prepare vegetables. The age of the kitchen units, the décor and the clutter all gave the impression of being unclean and unhygienic. The bathroom décor was also in urgent need of updating. Better Care Residential home DS0000055368.V341173.R01.S.doc Version 5.2 Page 21 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): 31,33,34 and 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 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. 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. Better Care Residential home DS0000055368.V341173.R01.S.doc Version 5.2 Page 22 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 inspector that she had met the first two conditions. However, she does not consider it necessary to employ a second worker to be on duty. 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. Whilst both full time members of staff have signed the exception to the European working time directive, the fact remains that for several years two members of staff have continually worked an excessive number of hours. This could compromise the safety and well being of the service users, as well as the impact it will be having on the individual staff members. The inspector was informed of an incident in 2005, 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. 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. Better Care Residential home DS0000055368.V341173.R01.S.doc Version 5.2 Page 23 There is an issue regarding lack of 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. Mrs Coker has presented a letter from Continuing Education and Training Service stating that they cannot provide funding for training as two members of staff have already acquired the equivalent to NVQ level 2. However, this is not the issue that is being addressed. 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 should include vulnerable adults training, food hygiene, fire, first aid and manual handling. 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. Evidence from staff files indicated that 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. 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. Staff files have been checked on previous inspections and found to be satisfactory. No new members of staff have started at the home since these files have been inspected. A requirement was made at the previous inspection that all staff must have an appropriate job description. As the job description previously presented referred to ‘keeping Zimmer frames and wheelchairs clean’. No new job description has been presented and therefore this requirement remains. Better Care Residential home DS0000055368.V341173.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 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 continued lapses in administration. EVIDENCE: The manager, Mrs Coker is in the process of completing her NVQ Level 4, she initially informed the inspectors that she is due to finish in mid March 2007, however, this has been delayed to June 2007. This will remain a requirement until evidence is provided that it has been completed. Better Care Residential home DS0000055368.V341173.R01.S.doc Version 5.2 Page 25 The previous inspection identified a number of issues relating to fire safety. This became a contentious issue, as Mrs Coker was adamant that the Commission was wrong in its assertions. The Commission therefore wrote to the Fire Department requesting a visit. The Fire Department visited on 30th March 2007, and confirmed that the furniture in the hallway must conform to fire safety standards and therefore must be removed; the alleyway to the side of the building is a fire exit and as such must be kept clear; that fire doors must be kept closed. It was noted that on the day of the most recent inspection, there was still the practice of propping open some fire doors; Although Mrs Coker did close them on our arrival. This has been the practice since 1.12.05 and must cease for with. With regard to health, safety and welfare of the people who use the service, a number of further issues were identified during a tour of the building. Water temperatures were taken from the upstairs bathroom and some of the bedrooms. The temperature recorded was at least of 50*C. The temperature should be 43*C and therefore the temperature must be regulated to ensure that it is safe for people who use the service. The Portable Appliance Testing was completed on the 4.5.07 and therefore this requirement was withdrawn. Better Care Residential home DS0000055368.V341173.R01.S.doc Version 5.2 Page 26 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 3 29 X 30 2 STAFFING Standard No Score 31 2 32 X 33 1 34 3 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 2 1 X 3 X X 1 X Better Care Residential home DS0000055368.V341173.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA5 Regulation 12(1)(a) Requirement The contract is in a format that is appropriate to each service users needs and it only contains relevant information Outstanding requirement 23.2.07 Care plans must focus on procedures for service users who are likely to be aggressive and actions that could be taken in an emergency. Risk assessments must be present and identify hazards The daily routines must promote the service users independence Nutritional needs of service users must be met, and evidence provided that it is being met Outstanding requirement 23/02/07 Medication must not be left unattended The complaints policy stated in the contract must be removed The home must submit evidence that vulnerable adults training has been completed by all its staff within the last three years DS0000055368.V341173.R01.S.doc Timescale for action 24/07/07 2 YA6 15(1) 24/06/07 3 4 5 YA9 YA16 YA17 15(2)b 12(2) 12(1)a 24/06/07 24/05/07 24/06/07 6 7 8 YA21 YA22 YA23 12(1)a 5(1) 19(5)(b) 24/05/07 24/06/07 24/06/07 Better Care Residential home Version 5.2 Page 28 9 YA24 23(2)m Clutter from the home must be removed. Outstanding requirement 23/02/07 The bathroom and kitchen décor must be renewed The home must provide evidence that one of the service users has refused a lockable space All staff must have appropriate job descriptions which reflect the work that is undertaken 24/05/07 10 11 12 YA24 YA26 YA31 23(2)b 23(2) m 18(4) 24/08/07 24/06/07 24/06/07 13 YA33 18(1) a Outstanding requirement 23/02/07 There is a second worker on duty 24/05/07 at the busiest times of the day Outstanding requirement 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 01/12/05 Staff must all receive basic care training including. This must include vulnerable adults training, food hygiene, fire, first aid and manual handling. The manager must complete her NVQ Level 4 Outstanding requirement from 22/06/05 14 YA35 18(1) c 24/07/07 15 YA35 18(1) c 24/07/07 16. YA37 9(2)(b)(i) 24/06/07 17 YA42 23(4) Fire doors must not be propped open Outstanding requirement 01/12/05 Hot water temperatures must not exceed 43*C DS0000055368.V341173.R01.S.doc 24/05/07 18 YA42 23(1) 24/06/07 Page 29 Better Care Residential home Version 5.2 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Better Care Residential home DS0000055368.V341173.R01.S.doc Version 5.2 Page 30 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. 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