Inspection on 08/01/08 for Bevan House

This inspection was carried out on 8th January 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bevan House 14/03/07

Bevan House 24/04/06

Bevan House 12/09/05

Bevan House 15/11/04

Bevan House 28/07/04

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 Bevan House 104-106 Coldharbour Road Croydon Surrey CR0 4DW Lead Inspector Lee Willis & James 0’Hara Key Unannounced Inspection 8th January 2008 09:30 Bevan House DS0000025865.V349034.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 Bevan House DS0000025865.V349034.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. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bevan House Address 104-106 Coldharbour Road Croydon Surrey CR0 4DW 020 8726 7811 020 8686 0135 unicornprojects@hotmail.com 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) Mr Maharajah Madhewoo Premnath Radhakissoon Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories 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: 6 14th March 2007 Date of last inspection Brief Description of the Service: Bevan House is a privately run service that was extended in 2007 and is now capable of accommodating up to six adults with learning disabilities. The service is currently home to two young men who have both lived at Bevan house (formerly Coldharbour Road) for several years. Mr Madhewoo continues to be the proprietor and is now the temporary acting manager of the home once again following the departure of the registered manager Mr Radhakisson on 11th Jan’08. Mr Radhakisson has been in operational day-to-day control of the home since Feb’07. The extended property now comprises of two attached terrace houses that are situated on a quiet residential street in a housing estate in Waddon. The home is within easy walking distance of wide variety of local shops, cafes, restaurants, take-always, pubs, and banks, and is also very close to several main line bus routes and a local train station with good links to central Croydon. The home now consists of six single occupancy bedrooms spread over two floors. All three of the new bedrooms located in the neighbouring house (106 Coldharbour Road) have their own en-suite toilet and shower facilities. Communal areas include a main lounge; separate dinning area, ground floor bathroom, two communal toilets, kitchen, laundry room, office, and new workshop facility. The garden at the rear is mainly lawn and there is able space for parking vehicles at the front of the property. People who use the service have been provided with copies of the homes Statement of Purpose and Guide. The service currently charges between £1,100 and £1,450 a week for each placement. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 5 Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. From all the available evidence gathered during the inspection process the Commission for Social Care Inspection (CSCI) has judged the service as having some strength’s, but also a number of areas of weakness that have place the people who use the service at risk. For this reason the home as been judged as being poor. We spent six hours in the home and spoke to the two people who currently live there, whose personal files we examined in some depth. We also met the registered manager and one other member of staff. We looked at records and documents, including care plans, the home’s Statement of Purpose, and User Guide. The remainder of this site visit was spent touring the premises. We received five ‘have your say’ comment cards about the home. The people who use the service, with help from their keyworkers, completed two surveys, while the manager and two members of his staff team completed the rest. We have still not received the homes Annual Quality Assurance Assessment (AQAA), which tells us how the service makes sure of good outcomes for the people who use it and what future develop plans it intends to implement. See Requirement No.11 at the end of this report. What the service does well: What has improved since the last inspection? Since the arrival of Mr Radhakisson (now the former manager) the number of incidents where the staff have deemed it necessary to administer psychotropic ‘as required’ (PRN) medication has been significantly reduced. It was evident from comments made by the manager and medication administration records sampled at random that this type of medication is only ever used as a ‘last Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 7 resort’ when all other measures have failed. Staff have access to PRN guidelines and demonstrated they understood their role and responsibilities regarding the appropriate use of PRN medication. One of the out houses located at the rear of the property has recently been converted into a workshop for people who use the service to do woodwork in their leisure time. The atmosphere in the home during the course of this unannounced site visit remained very relaxed and congenial throughout. As previously mentioned in this report the excellent rapport the now former manager had with the people who used the service gave the place a very homely and relaxed feel. What they could do better: The positive comments made above notwithstanding there have been some on going issues regarding the homes admissions procedures and recruitment of new staff practices that we have serious concerns about: Firstly, a Statutory Requirement Notice was on the home in 2007 because the registered provider had failed to ensure that reasonable notice of their intention to terminate a person’s placement was given to the individual’s next of kin and the relevant placing authority. The Commission is very conscious that the home currently has four vacancies and will continue to closely monitor how the new manager deals with any new referrals. Secondly, the service has a poor recruitment procedure with shortfalls in recording and process being evident. Staff are appointed and start working without two written references being obtained or verification sought about the reasons why they ceased to work with vulnerable adults in their previous employment. The Commission will monitor closely the way the home recruits new staff as current arrangements have placed the people who use the service at unnecessary risk of harm or abuse. Other issues identified during this inspection included: People who use the service are not able to achieve their full potential because there is not enough emphasis placed on supporting individuals to maintain and develop their independent living skills. There is scope to improve this by involving all staff in delivering this care and making sure established routines are reviewed to take account peoples potential to become more independent. Similarly, people who wish to look after their own medication should have far greater opportunities to do so within an appropriate risk framework. The home needs to improve the way is plans and monitors healthcare appointments and checks up people who use the service have with various medical professionals as current arrangements are rather variable and ad hoc. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 8 The homes complaints procedure is not made available in other formats as needed for individuals and therefore fails to give clear information about who to complain to, how to complain or what happens after a complaint is made. The use of one half of a pair of curtains that clearly do not have enough gather to stretch across bedrooms windrows they are currently hung from in the new extension need to be replaced before these rooms are occupied. There are potential risks to the people who use the service such as unsafe showerhead fittings, locks that cannot be opened from the outside in an emergency, and excessively hot water. There is also a potential risk of infection spreading in the home because there is no wash hand basin prominently sited in the laundry room. The home needs to carry out a thorough fire safety risk assessment of the building to comply with good fire safety guidance. Finally, the homes fire book should contain the names of all the staff who participate in fire drills conducted in the home at regular intervals. 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. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 9 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 Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 10 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 and 3. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service do not have all the information they require to make an informed decision about whether the service is right for them. The homes current arrangements for charging service users for the facilities and services provided are not very open or transparent and will need to improved to enable people to make more informed decisions about whether or not they are getting value for money. People who may wish to use the service cannot be confident that their needs can be met as the home has failed to make sure that people’s needs are assessed by a suitably qualified or suitably trained person prior to admitting them to the home. EVIDENCE: Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 11 “I like living here”, and “I have been given a book about the home” were some of the typical comments made by one person who lives at Bevan House. In completed surveys, both the people who use the service wrote they had received enough information about the home before moving in order to decide if it was the right place for them. We saw that a Statement of Purpose and Guide were available, which tells people what the service offers and what its aims and objectives are. The Guide is available in a relatively ‘easy to read’ format, which is illustrated with a wide variety of coloured pictures, symbols, and photographs. One person who uses the service told us they had been given a new copy of the homes Guide, which they kept in their bedroom. The random inspection on the 23rd of May 2007 Mr Radhakissoon told us that he had not reviewed the Service Users Guide since being appointed, but was currently working to develop a new Guide that would take account of the amendments made to the Care Homes Regulations (2001) in 2006. At this inspection the manager told us he had now reviewed the Guide (October 2007) and up dated it accordingly to reflect all the recent changes as recommended in the homes last two inspection reports. However, despite the recent review further amendments are required to ensure it contains all the relevant information about staff qualifications, and what fees are payable for facilities and services provided. Following an assessment carried out by the registered provider Mr Madhewoo and Mr Radhakissoon a new person moved into the home on the 31st of March 2007. However as a result of a discussion between Mr Radhakissoon and Mr Venkaya the acting manager of 16 Campden Road (another of the registered providers care homes) a decision was taken to terminate the new admissions accommodation at 104 Cold harbour Road (Bevan Road) and transfer them to 16 Campden Road. This individual’s accommodation was terminated on 6th April 2007, despite the placing authority, Greenwich Social Services Learning Disabilities Team, advising Mr. Venkaya to wait for a formal review to be held before taking any further action. A Statutory Requirement Notice was served on the home for this breach of Regulation 40(1) & 40(2) of the Care Homes Regulations (2001). The Statutory Requirement Notice required that the registered provider 1. Ensure that reasonable notice is given to the person who appears to be the service users next of kin, when terminating the arrangements for the accommodation of a service user. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 12 2. Ensure that reasonable notice of the intention to terminate arrangements for a service user’s accommodation is given, to a local authority where arrangements for the provision of accommodation, nursing or personal care to the service user at the care home, have been made by that authority. 3. Ensure that if it is impracticable for you to comply with Regulation 40(1)(a)(b) and (C), to as soon as it is practicable provide to the Commission a statement as to the circumstances that made it impracticable for you to comply with the requirement. No new residents have moved into the home since the last inspection. However the Commission will continue to monitor how the home admits new residents. Mr Radhakissoon told us he had received two new referrals from Local Authorities about placing people at the home in recent months. However both were outside the categories for which the home is registered so the home manager turned them both down on the grounds that the service was unable to meet their assessed needs. Mr Radhakissoon said that the two current residents care manager’s had made enquiries about possible placements at the home, but no referrals had been made. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Both residents have person centred plans with detailed information on their needs and personal goals. Both residents have individual risk assessments and risk management strategies in place so that they can participate in activities in the home and in the community in a safe manner. EVIDENCE: Mr Radhakissoon told us that both residents care managers had visited the home and reviewed their placements. One resident’s personal file was inspected at random. The file included a missing persons profile, a recent photograph, details of his next of kin and his General Practitioner, a person centred plan 08/10/07, the person centred plan Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 14 included sections such as my likes, my dislikes, a relationship circle, personal care, finance and social and spiritual needs. The resident had his risk assessments reviewed and updated on the 8th and 10th of October 2007. The resident had his care plan/placement reviewed on the 27/11/07. Mr Radhakissoon produced evidence that residents meetings took place in November and December 2007. He told us that residents meetings take place every month. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 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. A good range of activities within the home and community mean the service users have various opportunities to participate in stimulating and motivating activities. People who use the service are also actively encouraged to participate in household chores to enable them to maintain and develop their independent living skills, although there is scope to improve this by making sure there is a full social care plan for each person. The home has excellent arrangements in place to enable service users families to continue their involvement in there loved ones lives. Dietary needs and preferences are well catered ensuring the people who use the service are provided with daily variation, choice, and nutritionally wellbalanced meals. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 16 EVIDENCE: On arrival at the home one person who uses the service had already gone out while the other person was waiting for their transport to turn up to take them to a local day centre. Some of the comments made by the one person who was at the home included “there’s always something going on”, “staff sometimes take me to McDonalds”, and “I like going to the day centre”. Mr Radhakissoon produced a weekly activities chart for the other person who uses the service. The chart indicated that they attend the Unicorn day centre on a regular basis, and are actively encouraged by staff to prepare some of their meals, wash up, and clean their bedroom. There is a good range of activities on offer, including trips out to the local cinema, bowling alley, fast food restaurants, and shopping centres. A selection of games, puzzles, and books were found stacked on shelving in the main lounge and dining area during a tour of the premises. One person who uses the service is interested in woodwork and they told us they liked making things in the shed, which was recently converted into a workshop. A number of carpentry tools were found in the shed/garage at the back of the garden during a tour of the external grounds. One person who uses the service told us staff help them to clean their bedroom and make cups of tea. However, the manager acknowledged that the people who use the service were not reaching their full potential and more could be done to provide them with the right opportunities to maintain and develop independent living skills. Both the care plans viewed contained very limited information to help staff deliver programmes for promoting independent living. It is recommended that the staff team discuss this area further with the people who use the service and their representatives, and decide what additional information should be recorded in care plans to help promote greater independent living. Both residents have regular contact with their families. One resident told us that his Auntie visited him at Christmas and New Year, the homes visitors book indicates that his Auntie visits him on a regular basis. The other resident’s mother contacts him by phone and sends parcels with personal items to him in the post. Food menus were examined and found to be appropriate. Mr Radhakissoon produced a four week rolling menu, however he told us that the residents do not always wish to eat what is planned on that day. If the residents choose differents options then these are recorded as well. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, & 20 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. The home has suitable arrangements in place to ensure the people who use the service receive personal support in the way they prefer and require. However, a lack of planning and monitoring of health care appointments people who use the service have with various medical professionals is placing them at risk. In the main policies and procedures for handling medication are sufficiently robust to keep the people who use the service safe, although more should be done to actively enough and support people to self administer their own medicines. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 18 EVIDENCE: Typical comments on both the surveys completed by people who use the service with the help of their keyworkers included ”I relax in the evening”, “ I can do what I want at the weekends”, and “I chose the clothes I wear each day”. Both the people who currently reside at Bevan House were appropriately dressed for the season in relatively well-maintained clothes. The manager told us a relative of one person who uses the service buys their clothes for them. This arrangements is clearly restricting this individuals right to make informed decisions about the clothes they wear and should be reviewed with all the relevant parties, including the person who uses the service, their relative, and professional representatives (See good practice Recommendation No.2). In the main records sampled at random contained good quality information regarding the health care needs of the people who use the service. It was evident from one care plan that the individual it referred to had received regular input from a variety of different health care professionals in the past 12 months, including a GP, community-based nurses, a dentist, and chiropodist. However, the other care plan revealed this individual had only seen an optician in the same period of time. The way the home supports the people who use the service to manage their healthcare is variable and needs to be reviewed as a matter of urgency. It was suggested to the manager that he should encourage the people who use the service to attend a local well man clinic on a regular basis. Staff maintain detailed records of all the accidents and incidents involving the people who use the service. These records showed that two accidents had occurred since May 2007, which had both been appropriately dealt with by staff on duty at the time. Only ‘minor’ injuries were sustained as a result and there have been no unplanned admissions to hospital in the last 12 months. It was recommended at a previous inspection that the ‘registered manager develop a system for recording returns of medication’. Documentary evidence was produced on request to show this good practice recommendation has been implemented. Medication Administration Record (MAR) charts for both residents were inspected for the current month and no recording errors were noted. A sample of the medication in stock was counted and compared to the quantities on the MAR charts, these were accurate, indicating medication is being given as prescribed and there is no mishandling. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 19 Medication stocks are kept relatively secure in a locked filing cabinet located in a small office in the main lounge area. As the home has recently doubled in size and therefore has the potential to accommodate four new people we recommend the service obtain a more ‘suitable’ metal cabinet for the sole purpose of storing medication more securely. The manager told us none of the people who currently use the service self medicate, although he felt one individual might be capable of looking after their own medicines if they received the right support. We recommend it be discussed with the relevant individual and their representatives in order to clarify this person’s views on the matter. If they are willing to self administer their medication the decision must be risk assessed, suitable arrangements put in place for their medication to be securely stored in their bedroom, appropriate records kept, and suitable monitoring arrangements established. Progress on this matter will be assessed at the homes next inspection. The manager told us the service does not currently hold any Controlled Drugs, but ‘as required’ (PRN) medication is administered from time to time. Detailed protocols for the use of PRN were produced on request and the manager was very clear when and how to administer this type of medication. The manager told us he would only administer PRN medication as a ‘last resort’ when all other methods to deescalate an incident that challenged the service had failed. Medication administration records confirmed that PRN medication had only been used on very few occasions in 2007, which compared very favourably to previous years when it had been administered more frequently. Documentary evidence in the form of certificates of attendance were produced on request to show that sufficient numbers of the homes staff team had been suitably trained to handle medication on behalf of the people who used the service. The manager demonstrated a good basic knowledge of how medicines are used, and how to recognise and deal with problems. The home does not have a copy of the Royal Pharmaceutical Society of Great Britain’s guidance on best practice regarding handling medication in a residential care setting. We recommend the service obtain the most up to date version of this guide for referencing purposes. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 20 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 and allegations of abuse are sufficiently robust to ensure the people who use the service feel listened to and safe. However, information about the complaints procedure is not available in ‘easy’ to read formats, therefore not everyone who lives at the home may know how to complain if they are dissatisfied with the care they receive. The homes recruitment practices are inconsistent and unsafe. Consequently, the people who use the service are being placed at unnecessary risk of harm or abuse from staff who maybe ‘unfit’ to work with vulnerable adults. EVIDENCE: The service has a book for recording complaints. Mr Radhakissoon told us that there have been no complaints made to the home by the residents, staff or by any other persons since the last inspection. The manager told us he welcomes ‘constructive criticism’ and would always follow up any concerns/complaints made. The homes complaints policy is conspicuously displayed on a wall in the entrance hall. The manager and another member of staff both conceded the current policy was rather ‘wordy’ and not that ‘easy’ to read or understand. The home should look at making sure that the complaints procedure is Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 21 available in different formats that can be understood by the people who use the service. None of the people currently residing at Bevan House have been subject to a safeguarding adults referral in the past year. The manager demonstrated a good understanding of the local authorities vulnerable adult protection protocols and was fully aware which external agencies he would need to notify without delay if abuse was witnessed or suspended in the home. Mr Radhakissoon told us that one member of staff had started work at the home since the last inspection. He told us that he interviewed her alone at Unicorn House in September 2007; he asked her a number of questions however did not keep a record of her answers or the interview. He told us that none of the residents were involved at any point in the recruitment or selection process. Mr Radhakissoon produced this person’s personnel file. The file included a Criminal Record Check, copy of her passport, application form, proof of identification, and one reference (as previously mentioned). The recruitment policies for Bevan House need to be reviewed in order to be adjudged to comply with it being an equal opportunities employer as identified in a CSCI publication Safe and Sound. Checking the suitability of new care staff in regulated social care services. A recommendation has been made in respect of the below points (See good practice recommendation No.7); Advertise vacancies widely and in a manner that ensures equal opportunities to all prospective candidates. Develop a standard interview template. Keep evidence of short-listing and those invited for an interview. It is good practice to keep evidence of decision making even where there are a small number of applicants. Ensure that two or more senior members of staff are present at interviews to reduce bias. Record answers given by the candidate to questions. Records showed the homes most recently employed member of staff commenced working at Bevan House on the 12/11/07 before essential recruitment checks were carried out on them. Mr Radhakissoon admitted to having only obtained one written reference in respect of this new member of staff and told us he had “decided to take a risk” and start them before receiving a second written reference from their previous employer. Mr Radhakissoon also told us that he had telephoned this person’s previous employer to enquire about the whereabouts of their reference after he had interviewed them and allowed them to commence working at the home. It was at this point Mr Radhakissoon discovered this person had failed to pass their Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 22 probationary period of employment, which had involved supporting vulnerable adults. The one reference the manager had obtained was written on company headed paper and there were no concerns about its authenticity. The manager told us he would always follow up references if he ever had any concerns about authenticity, as recommended in the homes last inspection report. However, the one written reference the manager had obtained from the new member of staffs previous to last employer, where they had worked with vulnerable adults for the past four years, was less than favourable about their work related performance. Given the rather limited and less than ‘flattering’ information the manager had received in respect of his latest recruit it was therefore surprising to learn that Mr Radhakissoon had made no attempt to obtain any written verification from this individuals last two employers regarding the reasons why they had ceased to work for them in their role as a support worker. Mr Radhakissoon told us that he terminated this person’s employment on the 23/12/07 because they had failed to supply him with two written references. This person name was not included on any of the staff duty rosters compiled since Christmas 2007. The manager acknowledged that he should have never allowed this person to commence working at the home before obtaining a second written reference and confirming why they had ceased to work with vulnerable adults in their previous two places of employment. When asked if he had written to her explaining why her employment was terminated he told us that he hadn’t yet but was planning to do so. We have on-going issues about the homes recruitment practices and have issued a Warning letter reminding the provider about their statutory obligations under the Care Homes Regulations to obtain two written references in respect of all person working at the home and to verify why a member of staff who has previously been employed to support vulnerable adults ceased to work in that position. The Commission will consider taking enforcement action against the service if a similar breach of the Regulations occurs in future. Mr Radhakissoon told us that one person who uses the service has their own bank account, which they manage. The relative of another person who uses the service is their appointee; she holds their bank account and looks after their financial affairs. They have a small amount of personal spending money held in the home. Records show they have access to their money on a daily basis, which is topped up by their relative on a regular basis as and when required. Mr Radhakissoon showed us a bank account statement for July – October 2007. The statement indicated that this individuals benefits are paid into their account. We recommend the home keeps copies of bank account statements on file. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28 & 30 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. The overall décor, furnishings, and fittings in the home are of ‘reasonable’ quality, which means the people using the service, live in a relatively homely and comfortable environment. The homes new shower facilities are placing the people who use the service at risk of harm and will need to be looked at as a matter of urgency to minimise the likelihood of scalding. The homes laundry facilities are inadequate and will need to be improved to control infection. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 24 EVIDENCE: Since the last inspection the Commission agreed the homes application to register the adjoining building at 106 Coldharbour Road. Since then the registered person has changed the name of the home (104 Coldharbour Road) to Bevan House. Bevan house is now registered with the Commission to provide personal care and accommodation for up to six people with learning disabilities. The home has a fax machine, but the manager told us it was currently out of order. Two out of three of the new bedrooms, which remain vacant, were viewed during a tour of the premises. Both were decorated to a reasonable standard and contained the vast majority of furniture and fittings required by National Minimum Standards for bedrooms. However, it was noted one half of a pair of curtains had been used to cover the windows in the new bedrooms. These single curtains did not have enough gather to stretch the full width of the windows and were therefore not fit for their intended purpose. The outstanding requirement set at the last inspection regarding bathroom/toilet doors being fitted with more suitable locks that can be overridden by staff from the outside in the event of an emergency has been met. However, since May 2007 ensuite shower and toilet facilities have been added to three new bedrooms in the 106 Coldharbour Road part of the home, which will also need these locks replaced with more suitable devices. The manager told us all the homes new shower units had been fitted with thermostatic mixer valves that prevented hot water temperatures exceeding a safe 43 degrees Celsius. At 11.30am it was noted that the temperature of hot water emanating from the new shower facility in bedroom No.5 was a safe 43 degrees Celsius, although the damaged seal on the showerhead forced most of the water to spray in completely the wrong direction. The manager agreed to repair the faulty shower before the bedroom is occupied. The temperature of hot water emanating from another new shower unit in bedroom No.6 was found to be an unsafe 48 degrees Celsius. The risk this might present a prospective occupant of this bedroom needs to be assessed prior to them moving in. A dirty plastic shade covering a fluorescent light in the main lounge needs to be cleaned and the home should consider replacing it with a more suitable light fitting that is more domestic in appearance. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 25 In the past year a building located in the rear garden has been converted into a workshop for people who use the service to do carpentry in their leisure time. The lopsided dry brick barbeque in the rear garden, the disused CCTV equipment, and screen in the main lounge, and a trap door cut into the stairwell ceiling in 106 Coldharbour all look unsafe and/or surplus to requirements. The risk they present the people who use the service, their guests, and staff will need to be assessed and appropriate action to taken as required. The home was clean throughout and no offensive odours were detected during a brief tour of the premises. The homes washing machine, which is located in a separate building in the rear garden, is capable of cleaning laundry at appropriate temperatures. However, the carpet on the laundry room floor is not readily cleanable and there is no hand washing facilities prominently sited in this area contrary to infection control standards. We also recommend suitable safety measures are established as the laundry room can only be accessed by going outside. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 26 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, 35 & 36 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. Overall, sufficient numbers of very experienced and competent staff are employed on a daily basis to support the needs, activities, and aspirations of the people who live at the home. However, the staff duty roster needs to be improved to accurately reflect who actually works at the home. EVIDENCE: We saw staff were caring and observing them speaking to the people who used the service in a very polite and respectful manner throughout the course of this site visit. As stated previously in this report, it was clear from the comments made by staff that they see meeting the social and emotional needs of the people who use the service as an important part of their role as carers. The home operates a keyworker system and one person who uses the service told us they knew who their designated keyworker was and that they “got on really well with them”. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 27 Due to the major shortfalls identified in respect of the homes recruitment practices during this inspection all the evidence and subsequent judgment made about how this has adversely affected outcomes for the people who use the service is included under Protection – See National Minimum Standard No.23. Mr Radhakissoon produced staff training records. The record indicated that all staff had attended appropriate training however some needed refresher training in some areas. Mr Radhakissoon told us that all staff training was up to date but that the training records had not been amended. It was agreed that these records would be examined in more depth at the homes next inspection. Mr Radhakissoon showed us the following weeks staff duty rota, which included the name of a new member of staff, when asked Mr Radhakissoon told us that he didn’t know this person and had never met them. He told us that he was a member of staff from the Turrets, another care home owned by Mr Madhewoo. The manager told us he had not received any information about the new member of staff and didn’t know if all the essential recruitment checks had been obtained in respect of this individual. When asked if this new member of staff was going to have to be given a full induction before being allowed to work unaccompanied in the home Mr Radhakissoon told us arrangements had been made for the individual to visit Bevan House tomorrow to commence their induction programme. This individual was not included on the staff duty roster for the week and therefore the rota did not accurately reflect who would actually be working in the home each day. It was recommended at the last key inspection that staff appraisal be related to the needs of the residents, the objectives of the home and the training and development needs of the member of staff. Mr Radhakissoon produced two staff appraisals on request. The one appraisal that was examined in depth identified the member of staffs training needs in relation to supporting a resident with autism, keyworking and promoting independence. Mr Radhakissoon produced evidence that the staff team received training on autism in May 2007. Mr Radhakissoon was also able to produce evidence to show all his current staff team have been ‘appropriately’ supervised at regular intervals since the home was last inspected. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had confidence in the former manager because the service was well run when he was in operational day-to-day control of the home. Some progress has been made to ensure the views of the people who use the service and their representatives are taken into account when the service monitors its own performance, although they is still room for improvement in this area. For instance, the home has failed to provide us with its annual quality assurance assessment, which makes the task of determining whether or not the service is achieving its stated aims and objectives difficult to assess. In the main the welfare of people using the service, their guest, and staff are safeguarded because the homes health and safety sufficiently robust However, some of the homes fire safety measures will need to be reviewed as a matter of urgency to improve them. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 29 EVIDENCE: The manager has considerable knowledge and experience of helping to run residential care homes for adults with learning disabilities. Comments from people who use the service included “very approachable” and “always helps me when I need it”. However, Mr Radhakissoon told us that he was leaving at the end of the week and that he did not know who would be responsible for running the home thereafter, but assumed it would be the proprietor (Mr Madhewoo) as an interim measure. The proprietor has subsequently confirmed in writing that Mr Radhakisson ceased to be the manager of Bevan House on 11th January 2008 and that in the interim he (Mr Madhewoo) would be in operational day to day control of the home until a new manager was appointed. Mr Radhakissoon produced evidence that residents meetings took place in November and December 2007. He told us that residents meetings take place every month. We also saw lots of good examples of staff taking their time to answer the questions of the people who used the service, and keeping people up to date with changes to travel arrangement and activity schedules. We have still not received the homes annual quality assurance assessment (AQAA), which was due to be sent to us by 8/01/08. The manager told us he had posted the completed AQAA on 7/01/08. The manager was reminded about how important this document is to the inspection process, which tells us about how the home ensures good outcomes for the people using the service, and if any future developments are being planned. It was recommended in the homes last inspection report that the registered manager follow guidance given in Standard 39 of the National Minimum Standards when developing a quality monitoring system. Mr Radhakissoon showed us completed residents comment forms for September 2007. He told us that he had also sent comment forms to the residents relatives, care managers, and other health care professionals involved at the home. He told us that he would use any feedback, positive or negative, to improve the service for the residents. Progress made by the homes new manager to publish the results of various stakeholder surveys the former manager told us he had already distributed will be assessed at the homes next inspection. Mr Radhakissoon produced Regulation 26 reports on request for unannounced visits of the service by the proprietors in June, July, August, September, October, and November 2007; he told us that he was awaiting the report for December 2007. The manager told us he had not carried out a fire risk assessment for the building. We recommend the manager should contact the local fire authority to Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 30 seek their advice about carrying this risk assessment. The homes fire records revealed that the 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 good fire safety guidelines. The manager told us all the homes current staff team had participated in at least one fire drill in the second half of 2007, but had not recorded all their names in the fire log book. Fire doors tested at random on the ground all closed flush into their frames when released. Mr Radhakissoon produced evidence that smoke detectors are checked on a weekly basis. Up to date Certificates of worthiness were made available on request to show that suitably qualified engineers had checked the homes gas (Landlords) installations, fire alarms, fire extinguishers, and portable electrical appliances. During a tour of the kitchen it was noted that all items of food were correctly stored in line with basic food hygiene standards. A set of multi-coloured chopping boards was also found for the safe preparation of food. Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 31 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 1 3 1 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 3 25 X 26 2 27 1 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 3 2 X X 2 X Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 32 No 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 YA1 Regulation 4(1)(c), Schedule 1.2 & 5(1)(a) & (bb) Requirement People who use the service and their representatives must be supplied with a more detailed Guide that contains up to date information about the relevant qualifications held by staff, and the range of fees they will be charged for facilities and services provided. This will make the service more transparent and ensure the people who use the service have all the information they require to decide if the home can meet their needs and whether or not they are getting value for money. People who use the service must be actively encouraged and supported (as far as practicable) to attend appointments and check ups with healthcare professionals (e.g. GP’s, dentists, chiropodists) at regular intervals or as required (See Recommendation No.3). This will ensure all the people who use the service have their health care needs met. DS0000025865.V349034.R01.S.doc Timescale for action 08/02/08 2. YA19 12(1)(a) & 13(1)(b) 08/03/08 Bevan House Version 5.2 Page 33 3. YA22 22(2) The people who use the service and their representatives should have access to easier to read versions of the homes complaints procedures. This will ensure people who use the service and their representatives know how to make their views known about the homes operation if they are dissatisfied and what they can expect in response. Two written references, including (where applicable) a reference relating to a new member of staffs last period of employment, which involved work with vulnerable adults must be obtained in respect of all person that work at the home. This will ensure the safety of the people who use the service. Due to the persistent failure of the service to meet this serious breach we have issued a Warning letter to ensure future compliance. Where a new member of staff person has previously worked in a position, which involved contact with vulnerable adults, written verification of the reason why they ceased to work in that position must be obtained. This will ensure the safety of the people who use the service. 08/02/08 4. YA23 19 Schedule 2.3 08/01/08 5. YA23 19 Schedule 2.4 08/01/08 6. YA26 12(4)(a) Curtains hung in bedrooms must & 16(2)(c) be sufficiently large enough to cover the full width of the window they are intended to cover. This will ensure the privacy of the people who use the service are respected 08/02/08 Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 34 7. YA27 13(4) All the deadlocks fitted to ensuite 01/03/08 shower and toilet doors in the newly registered bedrooms must be replaced with more suitable devices that can be overridden by staff from the outside in the event of an emergency. This will ensure the safety of the people who use the service. Shower units in the home must be assessed for the risk they present the people who might use the service in future and what action is to be taken to minimise the likelihood of scalding. This will ensure the safety of the people who use the service. 08/02/08 8. YA27 13(4) 9. YA27 23(2)(c) All the homes shower facilities 08/02/08 must be kept in good working order. This will ensure the people who use the service have their personal hygiene needs met. The dry brick barbeque in the rear garden, the disused CCTV equipment in the main lounge, and the trap door on the stair well ceiling in the new extension must be assessed for the risk these features present the people who use the service and the action to be taken to minimise any identified risk. This will ensure the safety of the people who use the service, their guests, and staff. Hand washing facilities must be prominently sited in the laundry room and the carpet replaced with more suitable flooring that is readily cleanable. This will minimise the risk of infection spreading in the home. DS0000025865.V349034.R01.S.doc 10. YA28 13(4) 08/02/08 11. YA30 13(3) & 23(2)(j) 01/03/08 Bevan House Version 5.2 Page 35 12. YA33 17(2), Schedule 4.7 The staff duty roster must accurately reflect who actually works at the home. This will make the service more transparent and ensure the safety of the people who use it. 08/02/08 13. YA39 24 The service must fill in an Annual 08/02/08 Quality Assurance Assessment and provide us with a copy when we ask you for one within the prescribed timescale for action. This will enable us to make more informed judgements about the service, especially within regards to how it ensures good outcomes for the people using it. 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. 01/03/08 14. YA42 23(4)(a) Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 36 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 It is recommended that the Service Users Guide be reviewed in line with the amended regulations. This recommendation has been carried over from the homes last two inspections as it has only been partially implemented (See Requirement No1). The way in which the service supports people who use it to maintain and develop their independent living skills should be reviewed, as current arrangements do not actively promote personal development and growth. For instance, the practice of restricting what clothes a person who uses the service buys needs be reviewed, as this limits peoples choice and independence. The way in which the health care needs of the people who use the service are met should be reviewed and the home should give serious consideration to making ‘better’ use of local well man clinics. The people who work at the home should have access to the latest version of the Royal Pharmaceutical guidance on handling medication safely in a residential care setting. This will ensure they have all the information they require to handle medication safely in the home in order to protect the people who use the service from harm. People who use the service (so far as practicable) should be able to manage their own medication within an appropriate risk framework to promote their independence. The way in which the medication of the people who use the service is stored should be reviewed. The way in which the service recruits people to work at the home should be reviewed to make these arrangements more transparent and too promote equal opportunities. This will minimise the risk of the people who use the DS0000025865.V349034.R01.S.doc Version 5.2 Page 37 2. YA11 3. YA19 4. YA20 5. YA20 6. 7. YA20 YA23 Bevan House service being placed at unnecessary risk of harm or abuse from staff who are ‘unfit’ to work with vulnerable adults. 8. YA23 The way the service manages the money of people who live at the home should be reviewed to make it more open and transparent. The homes damaged fax machine should be maintained in good working order. This will enable the people who use the service and staff to communicate more effectively with others. The home should consider replacing fluorescent ceiling lights with more suitable fittings that are more domestic in style. As the homes laundry facilities can only be accessed by going outside, the risk this presents the people who use the service and staff must be assessed and appropriate action taken to minimise any identified risks. This will ensure the safety of the people who use the service and staff. People who use the service and other major stakeholders, including their relatives, care managers, and the CSCI, should all be able to view the results of any satisfaction surveys/questionnaires carried out by the home. This will ensure the views of the people who use the service underpin all self-monitoring and development by the home. The way in which the service records the outcome of fire drills should be reviewed to include more detailed information about staff and residents who have participated in a fire practice. This will ensure the safety of the people who use the service and staff. 9. YA24 10. YA28 11. YA30 12. YA39 13. YA42 Bevan House DS0000025865.V349034.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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