Inspection on 28/07/08 for Better Care Residential home

This inspection was carried out on 28th July 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 26 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Better Care Residential home 24/05/07

Better Care Residential home 23/02/07

Better Care Residential home 02/06/06

Better Care Residential home 01/12/05

Better Care Residential home 22/06/05

Better Care Residential home 30/03/05

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Better Care Residential home 211 Brighton Road Purley Surrey CR8 4HF Lead Inspector Michael Williams Key Unannounced Inspection 28th July 2008 09:30 Better Care Residential home DS0000055368.V368782.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.V368782.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.V368782.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.V368782.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 January 2008 Date of last inspection Brief Description of the Service: Mrs Coker is the individual owner and she calls this service ‘The Better Care Residential Home’; it is a registered care home for up to four female residents who have mental health difficulties. The home’s Insurance policy displayed in the entrance, although out of date, confirms these details and the person in charge did not advise us of any changes to the name or ownership of Better Care. The home’s aim is to provide support to enable female residents to develop skills for independent living. The home itself is a large, converted family home situated on the busy A23 road near Purley. The home is near local shops and has good transport links including buses and trains. The home’s accommodation is on two floors; the ground floor has a single communal lounge/dining room, a kitchen, a toilet a shower room, and one, single bedroom. The first floor has a further three single bedrooms, a bathroom and a small office and a room which the owner is using as a staff sleeping-in room but which conditions of registration require to be used as part of the residents’ communal space, such as a lounge. To the rear of the property there is a garden with a small paved area and a grassed area; to the front of the building there is driveway, which can accommodate several cars. Fees are £509 per week as at January 2008. The provider, Mrs Coker states ‘extras’ may be charged ‘by negotiation’ but has not specified what those additional charges will be. Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection started with a short site visit on 28th July 2008 and ended with a second visit on 30th July, when two inspectors, Mr Williams and Mr Lacey visited the service. In addition to this second visit, which latest approximately seven hours (a total of 14 inspector-hours), a number of questionnaires were distributed to interested parties including staff and residents. We received two replies, one from a resident the other from a member of staff. We toured the premises several times during the day and we checked a wide range of documentation, including residents’ files, staff records and various other records such as medication, the visitors’ book and fire safety checks. During the course of our visit we met with those residents who had agreed to speak to us and their helpful contributions to this inspection is acknowledged with thanks. In addition to the observations we made on 30th July we have also visited this care home on three other occasions in 2008. Our first visit this year was on 23rd January 2008; we then made a second visit on 4th February to follow up urgent safety problems identified in the first visit. We also issued a number of Notices requiring Mrs Coker to address serious breaches in the regulations that could lead to prosecution. Our visit to Better Care on 14th May confirmed that Mrs Coker had accepted the need for improvements and had started to address all the points we raised in our Notices. We also took account of correspondence, meetings and notifications relating to this service. What the service does well: What has improved since the last inspection? Mrs Coker has accepted, the need to improve a range of areas in her service including for example documents such as the Statement of Purpose and the old, and very misleading Residents’ Guide – which charged for use of the garden as an ‘extra’ facility; the kitchen also needed to be improved; fire safety matters were to be addressed. These and numerous other shortcomings Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 6 have during the course of 2008 been addressed by Mrs Coker and we acknowledge her efforts to improve her care home and her efforts to try and meet the National Minimum Standards. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1 and 2: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. We cannot assure residents that they will receive all the information they might expect before, or immediately after, deciding to live in Better Care, nor that the initial assessment information will be fully utilised to inform the home’s future care planning. EVIDENCE: In May 2008 we required Mrs Coker to ‘provide an accurate Statement of Purpose and Guide’. They have now been amended so as to include more sensible information but also we advised that it should be available in a format that can be given to residents and other people that may request a copy. This was not the case when we re-visited in July; the pages were still filed in plastic envelopes in a folder and it took some time for the person in charge to deduce which pages formed the Statement of Purpose and produce it for our perusal. It was a similar situation for the Resident Guide. This should have been much more readily available so as to be handed to the new resident upon arrival and to be available for inspection by the Commission or other interested parties such as care managers. These are important documents because they should give details of the service and the fees – which all residents are entitled to know about. It is also to be noted that these documents are in addition to any that might be supplied by the placing authority. Placing authorities are giving the home detailed assessment information but the home’s own assessment format is for elderly people not young mentally ill people. Areas of strength include the efforts to improve information but it is still not being delivered to residents as intended. This section, about choice, is assessed as adequate. Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 6, 7 and 9: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Resident cannot be assured that their changing needs, goals and risk-taking are reflected in suitable care plans. EVIDENCE: We checked a sample of residents’ case files to check if the improvement we noted in May had been sustained but this did not appear to be the case. The care plan we checked in detail was limited in range and in its guidance to staff and the resident for whom they are compiled. Contingency planning was weak and did not reflect the many potential risks identified in the information provided to the home by the placing authority. We identified about 12 areas where care planning, risk assessment and contingency planning might have been appropriate but Mrs Coker had written just three ‘care plans’ with no contingency planning in place. It is also disappointing to see that in the preparation of the home’s care plans even the resident’s name is not spelt consistently and correctly and it is not clear from the signature who has signed to agree the plans – but it is acknowledged the three care plans are signed and dated. Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 10 There is some evidence that residents are consulted about their aspirations or have made known their wishes and ideas; for example the home was provided with very detailed and practical information about a resident’s mental health needs (which the resident had previously helped the mental health team to compile prior to admission to Better Care). The purpose of this was to guide the care home in how best to support the resident and in particular how to support the resident if ‘early warning signs’ arise. Little of this information had been translated into care and contingency planning by Mrs Coker. Nevertheless, Better Care is a small and informal care home so residents have the opportunity to meet and talk to staff each day and this is often one-to-one, for example when preparing meals in the kitchen. Although the home has documentation in place to record personal information about each resident the admission and assessment forms in use are clearly designed for older people rather than younger adults with mental health problems. Questions in the form about sensory impairment and walking aids tend to confirm this. The home’s assessment forms do however include questions about basic information including matters of diversity such as gender, age, sexual orientation, race, religion or belief or disability. The home provides care for women only and the staff group is female but the home’s staff team appears not to reflect the racial and cultural background of the residents as indicated in Standards 18.7 and 31.4. Areas of strength include the acquisition by the home of detailed information compiled by professional agencies making a new placement; the home does give each resident plenty of opportunities to meet with staff both in small groups and individually to share their ideas about their care needs and expectations of the home. Matters that need improving include the need for the home to identify risks such as risks of mental health relapse and to make clear in their care planning what contingencies are in place and precisely how support will be offered at times of crisis. This section, about needs and choices, is assessed as adequate. Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 11 to 17: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. This home allows residents to participate in a range of community and leisure activities and to develop self-help skills so they can prepare for more independent living. EVIDENCE: Because this is a very small home each resident can lead a more individualised lifestyle; so for example, the bathroom is usually available for them to use at a time of their choosing; similarly the kitchen though small is big enough for each resident to prepare their meals individually if they choose. Residents are young and active people and they can all make use of the community; on the day of visit some were visiting a local recreation centre to use the gym’ and swimming pool. Others went shopping. It was evident that they are making good use of the community resources in the local area. Residents told us about their contact with family and friends and how staff in the home is supporting them to sustain these relationships in a positive way mindful of both their right to maintain these contacts but with due regard to risks to their mental health. Staff support residents to prepare meals, again mindful of the need for a healthy diet. This area of work seems to be reasonably well managed and is assessed as good. Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 12 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): NMS 18, 19 and 20: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Since the care planning by Better Care is so limited we cannot assure residents that their personal and healthcare needs can be fully met by this home. EVIDENCE: Residents have access to health care services in the community. The community mental health team takes the initiative in maintaining contact with their clients, because residents are entitled to ‘Aftercare’ within the meaning of the Mental Health Act, and the care home staff support residents to keep in touch with their team. Residents in Better Care do not require specialist aids and adaptations such as hoists and lifts but they do need access to facilities that will support their rehabilitation such as access to a domestic scale kitchen; a suitable laundry services or facilities; access to suitable washing and bathing facilities; freedom to maintain their own bedroom and so forth. Better Care can provide these facilities though not to a high standard as we report in the section about the environment. As we have identified in earlier sections of this report, the home’s own care plans, which should guide the actual delivery of care, are somewhat limited in scope and detail. Quite correctly the home has not recently admitted without first obtaining enough information about the resident to make a decision about whether or Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 13 not her needs can be met by the home, its staff and services. The home therefore has a detailed history and documentation listing identifiable risks to mental health and to safety. We identified in the information given to the home by the mental health team no less than 12 specific and readily identifiable areas that were indicative of issues that could arise in the future. Mrs Coker has devised just three and these are not particularly well documented, they are rather vague and without clear guidance and contingency planning. The use of phrases such as, “staff to monitor…” and “staff to prompt…” are examples of their lack of detail and clarity. The senior member of staff we spoke to thought more information could have been provided by the mental health team; but we concluded that a great deal of background information had already been sent to the home but was not being used to compile the home’s own action plans for the resident. There seems little point in asking for more information if what they already have is not being used to compile more effective plans of action. We checked medication information and record keeping and noted that it had improved from 2007 so that a record of incoming medication was in place and residents were not only being supported to administer their own medication with support and ‘monitoring’ but they were also being encouraged to keep a written record on a standard medicine chart. We do not see this as a requirement nor a statutory record and is not to be confused with the home’s obligations to keep a record of medicines received and administered but we see this is a positive step by the home to help residents to be careful about taking their medication consistently. Residents tell us that they are happy with the way that staff deliver their care and respect their dignity and rights, so, for example, they told us they had no complaints to make when we asked about the care and support they receive in this home. However, decisions on how personal care is delivered are not be consistently well recorded – where for example the home has been asked to monitor a specific issue of mental health on a daily basis (such as mood) this is not being recorded in the care plan as a plan of action and is not consistently recorded in the daily notes. The home would therefore have some difficulty in reporting to the mental health team an accurate picture about this issue over any specified period. Areas of strength include improvements to the handling of medication and the information that is available to the manager but matters requiring improvement the need to demonstrate that this information is being used to guide practice and meet identified needs. This section, about care, is assessed as adequate. Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 14 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): NMS 22 and 23: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The home now has in place a suitable complaints procedure and staff are aware of the safeguarding procedures so residents know they will be listened to if they have any concerns. EVIDENCE: The home seems to have an open culture that allows residents to express their views and concerns in a safe and understanding environment. The home appears to be run very informally and so residents seem free to voice their opinions and concerns. Since this is a very small service with just one owner/manager the lines of communication are very short indeed, within the home complaints and concerns can be raised with the owner, Mrs Coker. Thereafter residents would need to approach other support agencies such as Social Service Departments, Mental Health Teams or the Commission. Residents were not given a copy of the Residents’ guide that contains details of the complaint procedure so we cannot be certain that each resident including new residents are being given a written copy of the complaints procedure. This is an example of the sometimes poor quality of management of this home; having been prompted by requirements to prepare suitable documentation such as the Resident Guide, which should include a complaint procedure, this has not been follow through by Mrs Coker – so the document, containing important information the residents are entitled to be given, is not in a suitable form to give to residents, inspectors or anyone else. We cannot confirm whether or not in could be made available in other formats and languages if a resident or other party requested it. Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 15 We interviewed staff about ‘safeguarding’ matters, that is, the procedures for reporting suspicions or allegations of abuse and we are satisfied that the staff know they must protect residents from harm and report untoward incidents. They also know about ‘whistle-blowing’ - reporting to external agencies any such problems. We understand from other inspections we have made that restraint is not used in this home. Areas of strength include the accessibility of the owner/manager if residents have concerns. Matters requiring improvement include the need to make sure each resident has upon admission written information about the matters raised in this section. This section, about complaints and protection, is assessed as adequate. Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 24, 27, 28, 30: People using this service experience poor quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents say this is a nice, comfortable family sized home that they like living in. It is not however an entirely safe nor entirely clean and hygienic care home for residents. EVIDENCE: This care home although it has not long been registered is not well presented. The front drive is barren, without ornamentation or flowers and compares poorly with adjacent properties. What was built as a family home has been modified to meet fire safety standards, such as smoke detectors and fire doors. The home has a single lounge/dining room on the ground floor; four bedrooms; one on the ground floor and three on the first floor. None of the bedrooms have modern facilities such as an ensuite toilet or shower. The furniture is already looking old and worn, wardrobe backs coming loose; wardrobe doors not closing correctly; drawer handles missing, curtain hooks not in place; laminate edges on wash-cabinets peeled off. The first floor bathroom is particularly poorly presented and is not a welcoming room for residents who may wish to use this facility to relax and ‘unwind’ as their mental health team suggests. In this room the mirror is tarnished, the hotwater cylinder is in an unlocked cupboard; there are unguarded and possibly Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 17 used (shaving) razors, a dirty nailbrush and toothbrush in the cabinet; under the bath the panel is in poor condition with an unlocked cupboard containing cleaning chemicals. We also note that the radiator is unprotected and although it was not hot (in mid-summer) it may pose a hazard when it is in use. Similar radiator hazards were seen in bedrooms. Many care homes choose to put protective covers over radiators so as to reduce the likelihood of heat burns if resident come to rest against one. The ground floor shower room was also in a poor condition. The electrical circuits may have been faulty since the ventilator was not working and the shower was intermittently running water when we checked it, the overhead light was also flickering. We checked some of the windows and found they were not restricted, it could be opened to at least 30 centimetres and since the home has admitted a new resident it would have been wise to take precautions by fitting restrictors at this time. At the time of our arrival, a little before 10 am, we were told that the whole electrical system had shut just down. The fault was blamed on a faulty toaster and the landlord reset the electrical ‘trip’ restoring power to the home. We were advised that an electrician was called but he had not arrived by the time we finished our inspection at about 5 pm, so we cannot confirm that the electrical system in this home is without fault. The kitchen was not entirely clean throughout, the toaster for example was dirty and a wall appear to have suffered water damage and not made good. Once again the back door had been allowed to get very dirty. The new vinyl floor cover is already rucked and taped down in various places. Two freezer units are standing in the centre of the kitchen covered by clothes, rather unsightly and not easily cleanable surfaces in a kitchen area. The garden was unkempt; the grass needed cutting and it is a rather barren and poorly presented garden with little colour and shrubbery, there is rubbish stored behind the store-room. Again, not a welcoming area for residents to sit and relax in any comfort. The person in charge agreed various areas of the home needed ‘freshening up’. It is regrettable that staff are not alert to these various deficiencies and advocating on behalf of residents to get the home restored to a better standard throughout. The home has no visitor’s room and the first floor room that should have been allocated as communal space is not; the manager was advised she could ask for this condition in her registration to be removed rather than risk prosecution for failing to comply with a condition of registration – despite a commitment to do so the certificate remains unrevised and Mrs Coker was adamant when we raised the matter earlier in the year that no further communal space will be provided for residents. Areas of strength include the residents’ fondness for this little, homely service. Matters requiring improvement include a need to bring the whole home to an acceptable standard of safety, décor and refurbishment. This section about the premises is assessed as poor. Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 32, 33, 34, 35 and 36: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. On this occasion we can be a little more confident than on previous inspections that the home is reasonably staffed so residents know there are sometimes enough staff to support and protect them. EVIDENCE: Mrs Coker left the premises ‘for a private appointment’ without further explanation shortly after we arrived to begin an unannounced inspection. The person in charge was an experienced ex-nurse who worked with us very patiently and professionally during our visit over several hours and her hospitality is acknowledged. We also acknowledge that Mrs Coker has responded to our previous requirements to improve staffing to a safer level. Although the staff duty roster was very difficult to read because it had alterations, deletions and the use of correction fluid to change details we nevertheless conclude that since the arrival a of a third resident there have been two staff on duty each but not every day. For example when Mrs Coker left at 10:30 am on 30th July she was not replaced by another member of staff; leaving one person as carer and in charge of the home. The person in charge confirmed that since 21st July there were usually two members of staff on duty during the day and one at night. The roster does however seem to show gaps such as on 23rd, 24th, 26th and 27th July when only one member of staff is shown as being on duty. But we Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 19 understood the person in charge to advise us that that this reduction in staffing may have reflected times when a resident was on leave. Leaving only one member of staff on duty on 30th once again this tends to demonstrate that Mrs Coker makes progress in meeting requirements very reluctantly, slowly and does not maintain improvements consistently - by failing on this occasion to make alternative staff arrangements for her own absence when there is a new resident living in the home. The person in charge as long-term member of the small staff team advised us that she has received training in various aspects of her work including for example the protection of vulnerable adults. The training records though in disarray tend to show that staff have received training as required by the Commission including training in mental health. Staff have also had some supervision meetings, in one instance the records show that a member of staff had one meeting in January and another in May, indicating they are not receiving support at two-monthly intervals as they might expect. We checked a member of staff’s recruitment to confirm that the correct checks had been made and this appeared to be the case although once again the actual staff files are poorly set up and not indexed. Areas of strength include the increase in staffing numbers and matters requiring improvement include the need to sustain staffing levels, to ensure staff absences are correctly covered whether at short notice or planned absences; to improve staff support and to improve the staff files. This section, about staffing, is assessed as adequate. Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 20 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): NMS 39, 41 and 42: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. We cannot assure residents that this is always a well run service; nor can we assure them that policies, procedures, and records are maintained in their best interests; so we cannot say this is an entirely safe and well managed service. EVIDENCE: The owner/manager, Mrs Coker has advised us that she has passed her RMA (Registered Manager’s Award). She is registered with the Commission as the provider and as manager. Mrs Coker has received a series of not very positive reports from the Commission. She has given various commitments to work with the Commission to improve standards but despite these assurances Mrs Coker unresponsive attitude to the Commission’s regulation of her care home was noted in the her own documentation; never the less she has made some progress to meeting standards. On this occasion we find there have been improvements. Staffing levels have improved. Staff training has been put in place. Documents such as the Statement of Purpose and Residents’ Guide were amended to more accurately reflect the service. These and other Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 21 improvements do point to an effort on Mrs Coker’s part to improve services for residents and this is reflected in an overall improved rating from a ’poor’ service to an ‘adequate’, 1 star service. The Commission remains concerned that Mrs Coker seems unable to sustain improvement. The Residents’ Guide was updated but it was still not available for distribution; the care planning once again fails to reflect the wide range of risks and care needs identified for her in the information she was given at the time of the new admission; the environment has been allowed to deteriorate again; staffing levels have improved but there are gaps in the service; the home had insurance cover last year but we saw an out of date certificate on display in the entrance hall this year. Also in the entrance hall is the record of visitors, it is in place but very rarely required to be filled in by visitors to the home – for example a visitor called to check the main electrical unit but did not sign-in and was not asked to do so. In fact the record shows that only person, a pharmacist, has signed the record since the Commission’s inspectors last visited on 14th May 2008. Whilst we are aware that Mrs Coker hopes to move to alternate premises we are requiring to her report any likelihood of a lack of viability of Better Care in the next six months or at any stage thereafter. Mrs Coker’s records show that she has provided some supervision meetings for staff; but for one member of staff we saw evidence of only two sessions in 2008 when we would expect these one-to-one meetings every two months. This may reflect poor record keeping or insufficient supervisory meetings. Mrs Coker is aware of the need to promote safeguarding and has ensured staff did receive training in ‘the protection of vulnerable adults from abuse’ as we required. Residents are managing their own money. Those records we checked are not to a high standard. The record of visitors being one such example; staff records and residents’ files are not well catalogued; we found no errors in the medication charts we checked; other records are in place such as fire safety but again the risk assessment is rather unusual in that the ‘fire risk assessment’ is a somewhat cursory page of notes but this is repeatedly copied again and again each week; this is possibly an example of misunderstanding the purpose of the fire risk assessment and subsequent regular safety checks. Safety issues include the unrestricted windows; the poor storage of chemicals in the bathroom; the poor standards of hygiene in the kitchen. Areas of strength: Although there remain shortcomings in this service we do not overlook the fact that one resident has recently moved on and we are told she is now living in more independent living accommodation. Matters requiring improvement are listed throughout this report. This section, about management and administration is assessed as adequate. Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 22 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 2 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 1 28 2 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 2 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 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X X X 2 X 2 2 2 Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 1 YA1 6(a)&(b) 2 YA1 3 YA1 4 YA2 YA6 5 YA9 YA18 Statement of Purpose: the provider must provide a Statement of Purpose in a form that can be taken away; this is so that residents or inspectors may have a copy if they request one. 6(a)&(b) Service User Guide: the home must provide each resident with Guide so they have relevant information about the service. 5A(2) Fees: each resident must be provided with information about fees paid by or on their behalf. So residents know by no later than the day they are admitted to the home what fees are payable. 15(1)&(2) Care Plans must reflect those issues identified in the assessments provide in accordance with Standard 2.2 so that the resident knows their needs can be met. 15(1)&(2) Care Plans must make clear what risks have been identified through the assessment provided in accordance with Standard 2.2 and these must be reflected in the Care Plans so residents know risks associated with their health including mental health are fully appreciated and acted upon by the DS0000055368.V368782.R01.S.doc 30/09/08 30/09/08 30/09/08 30/09/08 30/09/08 Better Care Residential home Version 5.2 Page 24 home’s staff. 6 YA19 12(1)a,b Monitoring Mental Health: The home must demonstrate that it has in place a system for monitoring and recording information about residents’ mental health as required by their initial assessments so that the home can accurately identify and report any changes in condition. Complaints procedure: the home must provide each resident with written copy of the complaint procedure so they have clear guidance about how and to whom they may complain. Safety of the premises: the home must be maintain free from hazards such as unrestricted windows so as to reduce the risk of harm to residents. Bath and shower rooms must be maintained free of hazards such as electrical faults to reduce risk of harm to residents Bath and shower rooms must be maintained in a good state of repair and decoration for the comfort and safety of residents. Electrical Safety: The home must confirm that the electrical system is safe (following a break in supply on 30th July 2008) so that residents can be assured the system is no longer faulty. 30/09/08 7 YA22 22(5) 30/09/08 8 YA24 13(4) 30/09/08 9 YA27 23(2)b 30/09/08 10 YA27 23(2)b 30/09/09 11 YA24 23(2)b 30/09/08 12 YA30 23(2)d 13(3) Hygiene standards: The provider 30/09/08 has failed to maintain hygienic standards in the kitchen by failing to keep clean all areas of the kitchen including the area around the back door and items of equipment such as the toaster. Good hygiene standards are needed to safeguard residents from food contamination This requirement remains DS0000055368.V368782.R01.S.doc Version 5.2 Page 25 Better Care Residential home outstanding from 30/3/08 13 YA33 18 Staff numbers: the home must 30/09/08 demonstrate that it has staff on duty in sufficient numbers to meet residents’ needs and must maintain those numbers at all times by covering absences. Staff supervision. The provider is 30/09/08 failing to demonstrate that she is providing regular supervision for all her staff (the NMS guidance indicates that six time per year would meet this requirement). This means staff are not receiving the support, guidance and monitoring their roles requires. Regular supervision must be provided. This remains outstanding from 30/3/08. Staff supervision: staff must be 30/09/08 supervised at least six times each year and record of this maintained so staff and the resident they care for know they are being adequately supervised and supported. . Annual Quality Assurance 30/09/08 Assessment: The home must provide the Commission with an AQAA report within the specified timescale so that it can demonstrate how it will improve services to residents. Visitors record: The home must 30/09/08 maintain a record of all visitors to the home. This is so residents are protected manager knowing who has called into the home. This remains an outstanding requirement from 30/03/08 18 YA42 13(4)a Health & Safety: The home must 30/09/08 audit potential hazards in the home including chemical storage and take appropriate steps so as to minimise risks to residents. DS0000055368.V368782.R01.S.doc Version 5.2 Page 26 14 YA36 18(2)a 15 YA36 18(2)a 16 YA39 24 17 YA41 17 & Sch. 4:17 Better Care Residential home 19 YA42 13(4)a 20 YA42 21 YA43 22 YA39 23 YA39 24 YA43 Health & Safety: The home must audit potential hazards in the home including window safety and take appropriate steps so as to minimise risks to residents. 13(4)a Health & Safety: The home must audit potential hazards in the home including radiators and take appropriate steps so as to minimise risks to residents. 25(2)e Insurance: the home must demonstrate that it has current insurance cover for the home by putting on display an up to date certificate so residents know the home is adequately insured. The Commission request a copy of the insurance cover for this service. 25(1)&(2) Viability: The owners must provide and the Commission with confirmation Reg.13 that the service remains viable and Registrati must give six months notice if the on service is likely to cease being Regulatio viable. This is so the Commission is ns made aware of the home’s future sustainability in compliance with the Care Home Regulations and Regulation 13 of the Registration Regulations. 25(3) a b Financial Position: the owners must c provide a copy of the accounts including details of the running costs, including rent, mortgage, food, heating, salaries etc. So the Commission can evaluate the financial sanding of the home. 25(1) Business Plan: The home must provide the Commission with an annual business plan so the Commission can evaluate the business acumen of the provider. 30/09/08 30/09/08 30/09/08 30/09/08 30/09/08 30/09/08 Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA28 Good Practice Recommendations Shared space (lounges and dining rooms): It is recommended that Mrs Coker review the communal space she is providing and make application to have her registration conditions reviewed if she does not wish to adhere to current certificate. This recommendation is made so as to avoid Mrs Coker being in breach of conditions of her registration. Hygiene standards. It is recommended that Mrs Coker review the method of hand drying in kitchen toilets and bathrooms and uses an hygienic method of drying hands so as to reduce risks of cross contamination by using linen towels. NMS 42.2v. applies Staff files: It is recommended that all staff files be properly managed by being methodically filed and indexed so as to show that all necessary checks are made before recruitment are in place and that induction and training and in place. 2 YA42 3 YA18 Better Care Residential home DS0000055368.V368782.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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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