Inspection on 08/01/08 for Beulah Road (55)

This inspection was carried out on 8th January 2008.

CSCI found this care home to be providing an Poor 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 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beulah Road (55) 03/03/09

Beulah Road (55) 20/05/08

Beulah Road (55) 11/07/07

Beulah Road (55) 24/11/06

Beulah Road (55) 31/10/05

Beulah Road (55) 01/12/04

Beulah Road (55) 06/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Beulah Road (55) 55 Beulah Road Thornton Heath Croydon Surrey CR7 8JH Lead Inspector Lee Willis Key Unannounced Inspection 18 & 23rd January 2008 10:45 th Beulah Road (55) DS0000028139.V355433.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 Beulah Road (55) DS0000028139.V355433.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. Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beulah Road (55) Address 55 Beulah Road Thornton Heath Croydon Surrey CR7 8JH 020 8653 6377 T/F 020 8653 6377 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) www.caremanagementgroup.com Care Management Group Ltd (trading as CMG Homes Ltd) Iye Fornah Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning Disability - Code LD The maximum number of service users who can be accommodated is: 7 11th July 2007 Date of last inspection Brief Description of the Service: 55 Beulah Road is owned by CMG a specialist provider of care for adults with learning disabilities and challenging behaviour. The service provides accommodation and personal support for up to seven generally younger males. Iye Fornah has been in operational day-to-day control of the home since being appointed manager in July 2006. Located on a suburban street close to the centre of Thornton Heath the home is within easy walking distance of a wide variety of local shops, cafes, pubs, and banks. The home is also very close to numerous bus stops and a local mainline train station with excellent links to central Croydon and the surrounding areas. The main house comprises of six single occupancy bedrooms, a large open plan lounge/ dinning area, a designated smoking room, separate kitchen, office, and laundry room. There is also a one bedroom self-contained flat situated in the rear garden that has its own cooking and en-suite bathroom facilities. The garden at the rear of the property is well maintained and includes a new decking area. People who use the service have all been provided with copies of up dated versions of the homes Guide and a contract that sets out people’s terms and conditions of occupancy. Fees currently charged for facilities and services provided currently ranges from £1,418.93 to £1,850 per week. Beulah Road (55) DS0000028139.V355433.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 0 star. This means the people who use this service experience poor quality outcomes. From all the available evidence we gathered during this services second key (main) Inspection since 1st April 2007 the Commission for Social Care Inspection (CSCI) has judged the home as having a number of strengths as well as areas of particular weakness that will require urgent improvement through an action plan. The Commission will closely monitor this selfimprovement plan. We spent six hours at Beulah Road spread over two site visits. During these visits we spoke with three people who use the service, the registered manager, two support workers, and a care manager who was attending a an urgent review meeting being held at the home in respect of their ‘client’. We also looked at records and documents, including the care plans for three people who live at the home and the Users Guide. The remainder of this site visit was spent touring the premises. As part of the inspection process the manager completed and returned an Annual Quality Assurance Assessment (AQAA) to tell us about this service, how it makes sure of good outcomes for the people using it, and any future developments that are being planned. What the service does well: What has improved since the last inspection? Since the home was last inspected CMG have introduced a new admissions tool. The tool has been designed to ensure that the needs of all the people who already use the service are assessed and the affect any new admissions could have on existing group dynamics within the home is carried out prior to anyone moving in. The manager still needs to familiarise herself with the new tool and receive training in how best to apply it. Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 6 Opportunities for people who use the service to engage in more meaningful and stimulating indoor activities has improved in the last 6 months, although their remains considerable scope to improve the quality of community based activities. It was positively noted that additional staff are now employed at the weekends in order to address this issue. However, there are still far too many drives to non-specific destinations happening on a regular basis. Frequency of staff meeting has improved in the past year, which are now held on a monthly basis and well attended by staff. Service user meetings are also being held at regular intervals. It was positively noted that the use of ‘as required’ medication has been significantly reduced in the last year and more dignified approaches were being used to manage peoples challenging behaviour. The manager and her staff team are commended for ensuring ‘as required’ medication is only used as a ‘last resort’ when all other de-escalation techniques have failed in line with universally recognised good practice. What they could do better: All the positive comments made above notwithstanding their remains a number of significant areas of practice that the provider must take urgent action to rectify and improve the lives of the people who use the service, as well as keep them safe. Overall, the home has not been particularly well managed of late and consequently many of its aims and objectives are not being achieved: The home must ensure all the people using the service have care plans that are more person centred which emphasis individual’s unique strengths, personal goals, and the actual support they require to achieve their aims. The service has a poor track record of complying with this outstanding requirement, despite it being identified at previous inspections. Risk management plans are in place for all the people who use the service, but these need to be reviewed on a more regular basis and up dated accordingly to reflect any changes in people’s needs and/or circumstances. This will ensure staff have all the information they require to keep the people who use the service safe. The way in which the service manages and records all informal concerns as well as formal complaints about it operation must be reviewed, including what action (if any) is taken in response to them. This will ensure the way the home deals with complaints is made more transparent and will enable stakeholders to have more confidence in the system. At present not all stakeholders feel confident their concerns will be taken seriously by the home. Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 7 All staff that work in the home must refresh their protection of vulnerable adults and basic food hygiene training. This will ensure the people who use the service are kept safe. Staff must be appropriately supervised and their overall standard of performance appraised at more frequent intervals. This is essential to the people who use the service receive support from suitably competent staff. The way in which the provider communicates with external agencies (e.g. CSCI and placing authorities) and keeps them informed about the occurrence of significant incidents involving the people who use the service needs to be significantly improved. The dangerous practice of wedging fire resistant doors open must cease and the providers should consider alternative ways of keeping the kitchen door ajar to enable the people who use the service to access this area. This will ensure the safety of the people who use the service, their guests, and staff. A warning letter has been issued reminding the providers of their fire safety responsibilities. The building must be assessed for the fire risk it presents to the people that use and work at the service and action taken to minimise any identified hazards or risks. This will ensure the safety of the people who use the service. This is an outstanding fire safety matter identified at the homes last inspection. All staff that regularly works nights in the home must be involved in at least one fire drill every three months or receive fire safety instructions in that time. (Day staff must do the same at least once every six months). This will ensure the safety of the people using the service. Radiators assessed as posing a risk to the people who use the service must be covered as soon as practicable. 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. Beulah Road (55) DS0000028139.V355433.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 Beulah Road (55) DS0000028139.V355433.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): 1&2 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have good information about the home in order to make an informed decision about whether the service is right for them. People’s needs are fully assessed prior to admission so the individual, their representatives, and the home can be sure the placement is appropriate for them. However, the way in which the provider assesses and consults with other people who already use the service about the compatibility of new admissions needs to be significantly improved. EVIDENCE: The manager told us the homes Statement of Purpose and Guide was in the process of being up dated at CMG’s central offices to reflect all the changes that had occurred at Beulah Road in the past 12 months, including a statement regarding the views of the people who use the service. This good practice recommendation was made at the homes last inspection and is repeated in this report. Progress to meet implement it will be assessed at the homes next inspection. Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 10 The home currently has no vacancies having accepted a new referral since it was last inspected. The individual is non-verbal and appears to have similar strengths and needs as two others already residing at the home. However, there now seems to be two very distinct groups of people currently using the service who appear to have very different strengths, personal goals, and needs. The manager told us she was very conscious that there were compatibility issues between various people who lived at the home. Consequently, arrangements had been made for the providers new Director of care to review all the homes placements using CMG’s new compatibility assessment tool. The manager told us the new tool placed a greater emphasis on the unique needs and personal goals of the existing service user group therefore minimising the risk of placements for new referrals breaking down because of the adverse affect the move had on existing group dynamics. The new manager is not familiar with the CMG’s new compatibility assessment tool and will need to be trained in its application. The manager told us she would always expect to visit a prospective service user in their home and be fully involved in the assessment process and work closely with CMG’s own centralised admissions team. Furthermore, Iye told us she would always invite a prospective new service user and their representatives to visit the home, meet the other service users, and staff before any decisions about moving in on a trial period of residency was made. Beulah Road (55) DS0000028139.V355433.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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Limited progress has been made to ensure care plans are more person centred and accurately reflect what is important to the individual, what their capabilities are, and what support they need to achieve their personal aspirations. However, there is someway to go to ensure the unique strengths, needs, and personal goals of all the people who use the service are reflected in their care plan. Some progress has also been made by the manager to review all the risk management plans that are already in place for people who use the service. Consequently, the people who use the service are much better protected by the recently updated risk management strategies that are now in place, although there remains scope for improvement in this area. Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 12 EVIDENCE: We looked at the care plans for two people living at the home. The manager told us that she and her staff team had only recently attended CMG’s training on developing person centred care plans and therefore the task of up dating all seven care plans for the people who used the service remained a work in progress. We consider this outstanding requirement to be partially met and a new timescale for appropriate action to be taken to address this shortfall will be made for a second and final time. Failure to resolve this on going issue within the new prescribed timescale for action will result in the Commission considering taking enforcement action to ensure future compliance. One member of staff met told us they had received training in person centred care planning and were confident the new approach would enable them to deliver the support the people who used the service required. As previously mentioned in this report the manager was fully aware of the importance of capturing good information about people before they move in. The care plan viewed for the homes most recent admission had clearly been generated from information obtained during the admissions process, and included detailed information about the person’s background, strengths, likes and dislikes, personal goals, as well as needs. In response to one individual changing needs it was positively noted that an urgent review meeting involving all the relevant professionals had been arranged to take place to look at the suitability of their placement. Since the home was last inspected the providers have introduced a new tool for keyworkers to record each month the ‘success and achievements’ of the people they regularly support. The new tool has been designed to help keyworkers remain focus on peoples unique goals and what they hope to achieve from their placement, an area the providers acknowledge they could do better at. We recommended the manager introduce the new tool as soon as reasonably practicable. In the past 6 months there have been a number of significant incidents involving the people who use the service. The manager told us risk management strategies that were already in place to help staff deal with incidents of challenging behaviour were in the process of being up dated to reflect changes in need. Some progress has been made by the manager to resolve this matter and she is confident the task will be complete by the end of February 2008. Beulah Road (55) DS0000028139.V355433.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, 14, 16 & 17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are actively encouraged to pursue a wide variety of stimulating social activities in their own home, although there remains considerable scope to improve the quality of the community based activities, especially at the weekends. This will ensure they have far greater opportunities to live more meaningful and fulfilling social lives. Dietary needs and preferences are well catered ensuring the people who use the service are provided with daily variation and choice, although there is scope to improve the nutritional balance of the meals provided. This will ensure people who use the service have more opportunities for healthier eating. Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 14 EVIDENCE: Two people spoken with at length who live at the home told us they led active social lives. During the two site visits most of the people who used the service either went out with staff for a ‘drive’ or attended various sessions at local day centres. The new books for recording all the social and educational activities people who use the service engage in each day were being appropriately maintained by staff. These records revealed that the service continued to be good at supporting people who used the service engage in prearranged activities in the wider community during weekdays. However, there remains limited opportunities for people who use the service to engage in meaningful activities in the evenings and at the weekend, despite additional staff being employed to cover late shits on Saturdays and Sundays. Records of activities continue to make reference to people who use the service going for lots of ‘drives’ to unspecified destinations or just watching television. The manager told us there remains considerable room for improvement with regards community based activities the people who use the service have the chance to participate in, especially at the weekends. The requirement made at the homes last inspection regarding community-based activities is considered partially met and progress made to comply with it in full will be assessed at the homes next inspection. Two people who use the service were observed making a hot drink and staff on duty at the time were observed actively encouraging these individuals to develop their independent living skills and do things for themselves. During a tour of the premises a bedroom door on the first floor was found locked. A member of staff told us this was to prevent another person who used the service entering this bedroom without the permission of the individual who occupied it. Staff told us the individual concerned was able to effectively communicate to them when they wanted their bedroom door to be unlocked. The practice is unnecessarily restrictive and needs to be reviewed with all the relevant people concerned and a risk management plan established. Typical comments made by people who use the service about the meals provided included, “it’s the best thing about living here”, “I get to eat Jamaican food”, and “staff sometimes help me make my dinner”. Two people who use the service told us staff often make Caribbean style food, such as Jamaican stew and plantain. One person told us it was good that some staff knew how to cook Caribbean style food, which was their favourite food. The manager told us she planned to look at new ways of actively providing the people who used the service with healthier meal options. Beulah Road (55) DS0000028139.V355433.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): 19 & 20 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitably robust arrangements are in place to ensure the people who use the service receive personal support in the way they prefer and require, and that their unique physical and emotional health care needs are continually recognised and met. Furthermore, people who use the service are kept safe by the homes sufficiently robust medication practises that are in place, although there is scope for the home to improve the way its supports people who use the service to take greater control of their own medication. Current arrangements limit choice. Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 16 EVIDENCE: Detailed care planning in the form of health action plans are in place to meet peoples’ health needs. Three action plans sampled at random contained detailed infiramtion regarding the support these individuals required to ensure their health care needs were met and the outcomes of appointments they had attended with various health care professionals, including GP’s, community based nurses, dentists, opticians, and chiropodists. No recording errors were noted on medication administration records (MAR) sheets sampled at random. These records reflected current medication stocks held by the home on service users behalves, which were securely stored in a locked metal cabinet in the office. The manager told us that with the right support she believed a number of the people who use the service could self medicate if they wished. We recommend the views of these people about the possibility of having greater control over their medication is ascertained and based on the outcome of these discussions the risks involved are thoroughly assessed and suitable risk management strategies developed as needed. Positively noted that the use of ‘as required’ medication had been significantly reduced by the home in the last 12 months and more dignified approaches were being used more often than not to manage behaviours that challenged the service. The manager and her staff team are commended for ensuring as required medication is only ever used as a last resort when all other methods have failed in line with universally recognised good challenging behaviour guidance. Beulah Road (55) DS0000028139.V355433.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 & 23 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes arrangements for dealing with complaints are not sufficiently robust and understood by the management to ensure major stakeholders always feel their concerns will be taken seriously and acted upon. Gaps in staffs recognising, preventing and reporting abuse training means the people who use the service are not always supported by suitably qualified and/or competent staff. Consequently the people who use the service are being placed at risk of harm and/or abuse. Furthermore, people who use the service are also placed at risk because the manager does not always keep the relevant professionals informed about the occurrence of significant incidents in the home. This lack of openness and transparency means that relevant professionals do not always have the correct information to ensure people who use the service are kept safe. Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 18 EVIDENCE: The home maintains a record of any concerns and/or complaints it receives. The record contained detailed information about the nature of complaints made, but not what action had been taken in response. The manager also told us that with the benefit of hindsight she should have recorded concerns raised by a member of staff about medication practices in 2007, which later resurfaced at a staff disciplinary hearing. The manager was reminded that she had a duty of care to record all informal concerns, as well as complaints, and to always keep a copy of any action taken in response. Typical comments made by the people who use the service about the ability of staff to listen included “I can talk to my keyworker if I am unhappy”, and “staff listen to me, but never do anything about it”. Throughout the course of this inspection the manager was observed taking her time to deal with one individuals queries. Records of ‘significant’ incidents and accidents involving the people who use the service was produced on request and showed that a dozen or so of these events had occurred in the home since it was last inspected. Our database showed that a number of these incidents, which had occurred during the summer months (2007), had not been reported to us contrary to the Care Home Regulations (2001). One of these incidents involved staff using physical intervention techniques to deescalate a potentially dangerous situation and should have been reported to the Commission without delay. Nonetheless, this point notwithstanding it was also noted that significant progress had been made by the home in the last quarter of 2007 to improve its reporting of such events. Staff met demonstrated a relatively good understanding of what constituted a ‘significant’ incident and which external agencies they needed to notify without delay. The manager told us she had learnt from her previous mistakes and would now notify the Commission about the occurrence of significant incidents in the home. It was agreed that if the manager had any doubts about the significance of an incident she should remind her staff team to report it anyway. We will continue to closely monitor progress made by the home to meet its incident reporting responsibilities. Since the home was last inspected in July 2007 a number of adult protection case conferences have been convened by the Local Authority to follow up concerns raised about inappropriate behaviour occurring between people who use the service. This has raised issues about the suitability of some of the placements and it was agreed at the subsequent professionals meeting that the provider should lead the investigation into this matter. Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 19 The manager demonstrated a good understanding of the Local Authorities reporting abuse protocols and was able to produce a copy on request. The home has copies of the Department of Health ‘no secrets’ and CMG’s own whistle blowing policy for staff to follow if they witness or suspect abuse. A training matrix showed that all the homes current staff team had recently received refresher training in CMG’s own British Institute for Learning Disability (BILD) approved Dignified Management of Conflict (DIGMA). However, the matrix also revealed that a third of the homes staff needed to up date their recognising, preventing and reporting abuse training. One staff spoken with was clear whom they needed to notify if they witnessed or suspected abuse in the home. The balances recorded on the financial sheets sampled at random for two people using the service matched the amounts being held by the home on their behalves. Receipts are also kept of all purchases made on service users behalves and money is individually stored in a secure place. A whole new range of new financial checks and balances have been introduced since the home was last inspected to minimise risks associated with the financial abuse of people who use CMG services. Measures included financial audits being carried out by two staff at each shift handover and during monthly Regulation 26 visits carried out by CMG’s Regional managers. The manager demonstrated a good understanding of these new financial monitoring arrangements and told us she has already attended CMG’s own training on managing services users monies. Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The good condition of the décor, fixtures, and fittings in the home means the people who use the service live in a relatively homely and comfortable environment. The homes arrangements for controlling infection are sufficiently robust to ensure the people who use the service also live in a very clean and safe environment. EVIDENCE: People spoken to were happy with the environment. Typical comments included “I like my bedroom” and “I helped decorate my room”. On arrival we noted that the maintenance team was there dealing with a small scale flood that had occurred in the homes basement. This matter was dealt Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 21 with by the time of the next site visit to the home. We saw the home generally provides the people who use the service with a relatively pleasant and comfortable place to live. Furnishings and fittings remain domestic in appearance and are relatively well maintained. The main lounge remains the most popular venue for people who use the service to congregate when they are not in their bedrooms. The manager told us all the homes radiators have been risk assessed and it has been agreed that they should be covered to protect the people who use the service. The manager is confident they will all be covered by March 2008. Progress made on this matter will be assessed at the homes next inspection. Records are appropriately maintained of hot water temperature taken at regular intervals. The temperature of hot water emanating from the shower unit located on the first floor was noted to be a safe 39 degrees Celsius when tested at 11.20am. The manager told us she had discussed the idea of converting the smoking room into a sensory area with the homes only resident smoker. The outcome of the meeting is recorded and it appears they are satisfied with the plan providing they are supplied with a suitable outdoor shelter to smoke under. The manager told us money has already been set-aside in the homes new budget for the sensory room and outdoor smoking shelter to go ahead. Progress made on both these matters will be assessed at the homes next inspection. Only three chairs were set up around the dinning room table, which was insufficient to ensure all the people who used the service could sit down together at meal times. The manager told us several chairs had been damaged in recent weeks and new replacement chairs had already been ordered. In the interim chairs are brought in from the office to ensure people who use the service and staff can still sit together at mealtimes. The home was very clean and hygienic on both days we visited. The manager demonstrated a good understanding of the homes arrangements for controlling infection in the home. In line with environmental health guidelines the homes laundry room is located in an area where food is prepared, eaten, or stored. The laundry room contains a wash hand basin, plentiful stocks of latex gloves and plastic aprons, and the walls and floor are readily cleanable. Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient numbers of staff are employed on a daily basis to support the people who use the service. However, inadequate supervision of staff with infrequent individual sessions and gaps in their training means the people who use the service are not always supported by suitably qualified and/or competent staff. The homes recruitment procedures are sufficiently robust to minimise the risk of service users being harmed by people who are ‘unfit’ to work with vulnerable adults. EVIDENCE: As previously mentioned throughout this report we saw that staff on duty at the time of this inspection were always polite and courteous to the people who use the service. Having arrived in the morning we noted that four staff including the manager were all on duty. The manager told us this ratio of staff was sufficient to meet the needs of the people who used the service. Staffing levels matched those identified on the duty roster for the day and it was Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 23 positively noted that a required at the homes last inspection staffing levels had been increased on weekend late shifts to meet the social needs of the people who used the service. Staff training records revealed that 50 of the homes current staff team had achieved a National Vocational Qualification in care in line with National Minimum Standards and that a further 33 were on target to achieve this award by the end of the year. In order to continue to drive improvement we recommend the home establishes a time specific action plan setting out how it proposes to ensure 100 of its workforce are NVQ trained. The manager told us that no new members of staff have been employed to work at the home since it was last inspected. The manager demonstrated a good understanding of the checks that needed to be carried out on new staff and the importance of asking appropriate questions at face-to-face interviews. Staff training records revealed that sufficient numbers had received medication handling, first aid, and health and safety training. However, an unacceptable number of gaps in staff’s mandatory knowledge and skills were noted in respect of basic food hygiene. Furthermore, insufficient numbers of staff have not attended infection control, person centred care planning, and supporting people with epilepsy and autism training. In light of these gaps the manager and the new Director of care have agreed to work together to identify what the current staffs teams areas of particular weakness are and what additional workshops they would benefit from attending. Progress made by CMG to resolve gaps in training will be assessed in more depth at the homes next inspection. Three staff files inspected at random revealed that between them that had only received three supervisions with a senior member of staff in the last ten months, thus falling well short of the minimum required by the provider and National Minimum Standards (i.e. At least one session every two months). Furthermore, none of the staff have had their overall standard of performance appraised in the past twelve months. The manager told us both herself and her deputy manager were suitably qualified to supervise their colleagues and was unable to give a creditable reason for the lack of staff supervision and appraisal. This major shortfall needs to be rectified as a matter of urgency. Beulah Road (55) DS0000028139.V355433.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, 38, 39 & 42 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are not living in a particularly well run home at present. The homes arrangements for supervising staff and reporting incidents need to be significantly improved. People know that their opinions are central to how the home develops and reviews their practice because there are good quality assurance systems in place. People using the service are being put at risk of harm because staff are ignoring too many basic safety practices, including ones related to fire safety and basis food hygiene. Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager is suitably qualified to run a residential care service for adults with learning disabilities and challenging behaviour, but as previously mentioned in this report Iye and her deputy have failed to ensure the aims and objectives of the service are always achieved. For example training, development and supervision of staff is very inconsistent. This lack of supervision and appraisal also means the content and philosophy of the homes Statement of Purpose is not being routinely discussed with staff. Furthermore, feedback received from other professional’s regard the managers leaderships style suggests communication is not always as open as it should be regarding significant events in their ‘clients’ lives. The home lacks any real purpose and direction at the moment. However, these comments notwithstanding the manager did tell us that she was receiving a lot more additional support from the homes Regional manager and the new Director of care, and was confident she could get the service back on track. Furthermore, minutes were produced on request to show that staff meetings were being held on a monthly basis and residents one approximately once a quarter. All these meetings were well attended and the manager is evidently committed to ensuring they are held more frequently than they had in the past. Topics covered included the needs of the people who use the service and worker roles and responsibilities. The quality assurance systems CMG have introduced in recent years cover every aspects of life in the home and use the views of major stakeholders to monitor how successful or not the home has been regards achieving its stated goals. An annual quality assurance report for 2007 was produced on request, which contained a lot of feedback from the people who used the service about the standard of care they received at the home. Documentary evidence in the form of Regulation 26 reports showed monthly inspections continue to be carried out by CMG’s regional managers. In addition to these reports members of CMG’s relatively new quality assurance team also undertake quarterly quality monitoring assessments. All the reports referred to above were found to be extremely thorough, although the providers could do better at following up issues identified as a result of their quality monitoring visits. The manager told us she had still not up dated the fire risk assessment for the building because she had not received the right training from CMG. The timescale for action to be taken to address this major breach of fire safety Regulations will be extended for a second and final time. Failure to resolve it in a timely fashion will result in the Commission considering taking enforcement action to ensure future compliance. Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 26 Fire records revealed that the homes fire alarm system continues to be tested on a weekly basis and that two fire drills had been carried out in the past six months in line with the London Fire and Emergency Planning Authorities good fire safety guidance. However, on closer inspection of these fire records it was noted that not all the homes staff had participated in at least one of the fire drills carried out in the second half of 2007. Night staff should participate in at least one fire drill every quarter or alternatively have their fire safety awareness up dated through one to one supervisions or group meetings every three months or so. During a tour of the home on the morning of the first day it was noted that a brown paper bag was being inappropriately used to wedge open the fire resistant kitchen door. The offending wedge was immediately removed on request at time of the inspection and the providers were formally reminded g about their duty of care to ensure fire resident doors are never wedged open preventing them from closing automatically into their frames when the fire alarm is activated. An up to date Certificate of worthiness was made available on request to show that a suitably qualified engineer had checked the homes water heating systems for traces of legionella in the past twelve months. During a tour of the kitchen it was noted several items of food had been taken out of their original packaging and placed in containers that were not labelled or dated contrary to basic food hygiene standards. Furthermore, a tin of condensed milk was found in the fridge. This product once opened should have been decanted into a more suitable container to minimise the risk of aluminium poisoning. Overall, far too many examples were found at this inspection where staff had clearly ignored basic safe practices and cut corners so that their jobs were made easier. Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 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 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 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 X 12 3 13 X 14 2 15 X 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 X 1 2 3 X X 1 X Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 28 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 YA2 Regulation 9(2)(b)(i) & 18(1) Requirement All staff, including the manager, who will be expected to use CMG’s new compatibility assessment tool must be trained in its use. This will ensure all the people who use the service are kept safe. All the people using the service must have more person centred care plans. This will ensure that they receive person centred support that meets their unique personal needs and goals. Previous timescale for action of 1st November 2007 partially met. Risk management plans in place for all the people who use the service must be reviewed on a regular basis and up dated accordingly to reflect any changes in need. This will ensure staff have all the information they require to keep the people who use the service safe. DS0000028139.V355433.R01.S.doc Timescale for action 01/03/08 2. YA6 15(1) 01/04/08 3. YA9 14(2) 01/03/08 Beulah Road (55) Version 5.2 Page 29 4. YA14 01/05/08 16(2)(m) (n) People who use the service must be supported (as far as reasonably practicable) to attend a wide variety of social, leisure, and recreational activities of their choice at the weekends and in the evenings. Previous timescale for action of 1st August 2007 partially met. 17(1)(a) Sch 3.3(q) The practice of restricting when a person who uses the service can access their bedroom must be reviewed. Any decisions that limits peoples freedom of movement and choice must be based on an assessment of risk and include the views of relevant professionals and the person who uses the service. This will ensure they receive the person centred care that meets their needs. The way in which the service manages and records all informal concerns as well as formal complaints about it operation (from whatever source they come) must be reviewed, including what action (if any) is taken in response. This will ensure the home is more transparent and enable stakeholders to know their concerns are taken seriously. The way in which the home notifies the Commission about the occurrence of ‘significant’ incidents and or events involving people who use the service must be reviewed. This is to ensure the way staff deal with such incidents is DS0000028139.V355433.R01.S.doc 5. YA16 01/03/08 6. YA22 17(2) Sch 4.11 23/01/08 7. YA23 37(1) 23/01/08 Beulah Road (55) Version 5.2 Page 30 made more open and transparent. 8. YA23 13(6) & 18(1) All staff that work in the home must be appropriately trained to recognise, prevent and report abuse. This will ensure the people who use the service are kept safe. Radiators within the home must be assessed for the risk they present to the people that use the service and action taken to minimise any identified risk. Previous timescale for action of 15th August 2007 partially met. All staff that prepare meals in the home must receive basic food hygiene training. This will ensure the safety of the people using the service. All the people who work at the home must be appropriately supervised at regular intervals (i.e. at least once every 2 months). This will ensure suitably competent staff supports the people who use the service. The building must be assessed for the fire risk it presents to the people that use and work at the service and action taken to minimise any identified hazards or risks. This will ensure the safety of the people who use the service. Previous timescale for action of 1st August 2007 not met. All staff that regularly works nights in the home must be DS0000028139.V355433.R01.S.doc 01/04/08 9. YA24 13(4)(a) 01/03/08 10. YA35 18(1) 01/05/08 11. YA36 17(2), Sch 4.6(f) & 18(2) 23/03/08 12. YA42 23(4)(a) 01/03/08 13. YA42 23(4)(e) 23/02/08 Beulah Road (55) Version 5.2 Page 31 involved in at least one fire drill every three months or receive fire safety instructions in that time. (Day staff must do the same at least once every six months). This will ensure the safety of the people using the service. 14. YA42 23(4)(c)(i) The dangerous practice of wedging fire resistant doors open must never be permitted to happen again and the providers should consider alternative ways of keeping the kitchen door ajar to enable the people who use the service to access this area. This will ensure the safety of the people who use the service, their guests, and staff. A warning letter has been issued reminding the providers of their fire safety responsibilities. 18/01/08 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 YA1 Good Practice Recommendations The homes Statement of purpose/Guide should be revised to include stakeholder’s views about the quality of the care provided. This recommendation was made at the homes last key inspection, but has not been implemented. The way in which keyworkers monitor and record the success and achievements of the people who use the service should be reviewed and the providers new monthly template introduced as soon as reasonably practical. 2. YA7 Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 32 3. YA17 The home should be more proactive when it comes to encouraging service users to eat healthier meals by seeking the seeking the advice of dietician and training staff in preparing more nutritionally balanced meals. People using the service should be able to manage their own medication if they wish in order to promote their choice and independence providing all the risks associated with the activity are thoroughly assessed and managed. People who choose to smoke should be provided with suitable shelter, which meets the new smoking legislation and enables them to smoke in more comfort outside. This will ensure peoples social needs are met. People who use the service should be able to access a sensory room. This will ensure that they receive person centred support that meets their social needs. The service should consider establishing a time specific action plan setting out how it intends to ensure 100 of its staff team hold an NVQ in care. This will ensure the home continues to drive improvement and the people who use the service are supported by suitably qualified staff. The homes training matrix used to identify the staffs teams knowledge and skills strengths and weaknesses should be kept up to date to reflect any changes. In addition, all staff should receive an annual appraisal of their work performance that includes a thorough assessment of gaps in their knowledge and skills. This will help the manager plan staff development programmes and ensure her staff team are suitably qualified and competent to meet the needs of the people who use the service. More of the homes staff team should receive training with regard implementing the providers new person centred care plans and supporting people diagnosed with epilepsy and autism to ensure the needs of all the people who use the service are met. This recommendation was made at the homes last key inspection, but has not been implemented. The way the home is currently managed should be reviewed to make it more effective. This will ensure the needs of the people who use the service are met. 4. YA20 5. YA28 6. YA28 7. YA32 8. YA35 9. YA35 10. YA37 Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beulah Road (55) DS0000028139.V355433.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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