Inspection on 27/08/09 for Blake Court

This inspection was carried out on 27th August 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Blake Court 05/09/08

Blake Court 06/09/06

Blake Court 03/01/06

Blake Court 22/09/05

Blake Court 07/02/05

Blake Court 03/12/04

Similar services:

Ashlong House

Spring Lane Care Home

Avenues (The) (Neave Crescent)

Barrington Lodge Nursing Home

Beacon House Nursing Home

St Mary`s Convent & Nursing Home

1-3 Frederick Gardens

The Royal Star and Garter Home

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report CARE HOME ADULTS 18-65 Blake Court Flat 5 5a Barrow Road Waddon Croydon Surrey CR0 4EZ Lead Inspector Lee Willis Key Unannounced Inspection 27th August & 2 September 2009 09:45 nd Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Blake Court Address 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) Flat 5 5a Barrow Road Waddon Croydon Surrey CR0 4EZ 020 8688 2682 F/P 020 8688 2682 www.scope.org.uk SCOPE vacant Care Home 6 Category(ies) of Physical disability (6) registration, with number of places Blake Court DS0000025756.V377312.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 (CRH - 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 8 Date of last inspection 5th September 2008 Brief Description of the Service: Blake Court offers accommodation and personal support for up to six generally middle age or older adults with Cerebral Palsy and associated physical disabilities. All the occupants who live at Blake Court can choice to have their own self-contained flat or cohabitate. The flats are owned by Croydon Churchs Housing Association, but are managed and staffed by the registered charity Scope. The services former registered manager, Laura Baker, resigned in July 2009 having been on long term sick leave since August 2008. In the past 12 months Scope have relied on various temporary management arrangements to run Blake Court in the absence of a permanent manager. We therefore welcome the appointment of a new permanent manager by the name of Dan Lipscombe who starts at the end of September 2009. The new manager and his Team Coordinator (i.e. Deputy manager) will also be responsible for the day-to-day running of another Scope service in Croydon, which is similar in size and nature. Located in the heart of a housing estate in Waddon the service is relatively close to South Croydon with its wide variety of community facilities. The service is also close to a number of good bus and rail links with good connections to central Croydon and the surrounding areas. Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 5 All the occupants flats are situated on the ground floor of a residential apartment block and each have there own separate entrances. Each flat has a large open plan lounge/kitchen area, separate bedroom, and en-suite toilet and bathing facilities. The flats have also been suitably adapted to meet the individually assessed needs and wishes of the occupants to maximise independence. All the flats are wheelchair accessible. There is a separate office located within the apartment block, which has its own kitchen, toilet and shower facilities, and sleep-in rooms for staff. All the occupants are provided with copies of the homes Statement of Purpose and Guide. In the financial year ending April 2009 Scope were charging between £39,000-£59,000 per placement per annum for facilities and services provided. Blake Court DS0000025756.V377312.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 we have judged this service as having some strengths, but also areas of particular weakness, especially with regards to a lack of continuity in the way Blake Court has been managed in the past year. We therefore now rate Blake Court as a 1 star ADEQUATE performing service, which represents deterioration in the overall standard of care provided since its last key Inspection carried out a year ago. We spent 6 hours at the service spread over two days. During these two separate site visits we met four occupants, the acting Team Coordinator, two permanent support workers, and a two temporary agency/Bank staff. The remainder of the inspection was spent in the office looking at various records and documents, including the care plans for all four of the occupants we met during this inspection. Eight of our ‘have your say’ surveys we send to the service to be distributed to various stakeholders were returned to us. The occupants, some with support from their, and staff completed four surveys each. The services Regional Manager also completed and returned our Annual Quality Assurance Assessment (AQAA) when we asked for it. This self-assessment document told us what Scope think they do well, what has improved since the services last inspection, and what Scope could do better. Finally, an expert by experience, who is a person who has a shared experience of using care services, joined us on the morning of the first day of this inspection. The expert by experience spoke to four occupants at length who he interviewed peoples own flats. The expert helps us get a better picture of what it is like to live in a care service and key parts of this report are based on what the expert by experience told us. We used a lot of the evidence he provided us with to support the judgments we made about the services overall performance. What the service does well: The expert by experience wrote in their report that – ‘he felt the people interviewed were generally happy with the quality of support they are provided by Blake Court’s staff. Typical comments both the expert by experience and we received from occupants included – ‘I have my own bedroom, my own living room come kitchen - that’s partly why I like it here’, ‘one or two staff are great… I like them because nothing is a problem.’ We would also agree with the expert by experiences findings that the service is good at promoting the occupants right to make informed choices and maintain Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 7 their independent living skills whenever this is practicable. For example, a number of the occupants told the expert by experience that staff are always actively encouraging and supporting them to take greater control of their lives by enabling them to buy their own food and clothes. Some of the more positive feedback we received from occupants about Blake Court included – ‘I like to be independent, and I can be more independent here than I was in my previous placement’ and ‘I can choose what I am going to eat and I can go shopping with the care staff to get my food’. Finally, the atmosphere within the service remained very friendly and relaxed Throughout the course of this two day site visit. What has improved since the last inspection? What they could do better: As will be mentioned throughout this report the long term absence of a permanent manager in charge of the day to day running of Blake Court has been the single biggest issue which has contributed to the service being down graded to an ‘adequate’ one star performing one. This is despite the ‘best’ efforts of Scope to ensure Blake Court continued to be run on an interim basis by some of their more experienced existing managers and acting locum managers on short term contracts. However, with the service experiencing four different temporary management set ups in the space of only nine months it was somewhat inevitable that this continued lack of continuity would have an adverse affect on service delivery, and occupant and staff morale. We believe the appointment of a suitably experienced and competent permanent manager marks a turning point for Blake Court, although there is clearly a lot for them to do to restore the occupants and staffs confidence in the service – See all the new and outstanding Requirements identified during this inspection listed below (all twelve of the services good practice Recommendations are listed at the back of this report): The services Statement of Purpose and Guide must be kept under constant review and where appropriate revised to reflect any changes in provision. This will ensure all occupants and their representatives have all the information they require to make an informed decision about whether or not to Blake Court is right for them. Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 8 After consulting with the occupants and/or their representatives the service must develop a care plan format that is far more consistent, person centred and easier to use and read than before. This will ensure occupants and staff can access all the information they require to know about how the service intends to meet individual’s unique personal, social and health care needs and wishes. All the occupants must have up to date health care action plans that contain detailed information about the outcome of all the appointments they have with health care professionals. This will ensure anyone authorised to inspect the record can determine whether or not occupants health care needs are being suitably met and monitored. All the occupants who are willing and capable of looking after their own medication must be provided with a lockable space in their self contained flats and risk management strategies developed setting out how staff are to support and monitor this good practice measure. This will ensure occupants receive the correct levels of medication and are kept safe from avoidable harm. All staff that work in the service must receive up to date infection control training. The services staffing arrangements must be reviewed and ways to make them more flexible considered in order they more accurately reflect the occupants personal, social, and health care wishes. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Blake Court DS0000025756.V377312.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 Blake Court DS0000025756.V377312.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using 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 information given to occupants and their representatives about the services and facilities provided by Blake Court are not always being kept up to date. This must be done to ensure stakeholders have access to all the information they require to make an informed decision about whether or not the place is right for them. The service has good arrangements in place to enable prospective occupants and their representatives to find out about what Blake Court has to offer them through planned visits and a thorough needs assessment process. EVIDENCE: The acting Team Coordinator showed us a copy of the services Statement of Purpose and Guide on request. The document was recently reviewed in May 2009, but had not been revised recently to reflect all the changes that have occurred within the service in the past year. The documents should include Scopes new management structure and the qualifications of new and existing staff. Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 11 All the occupants who completed our surveys told us they had been asked if they wanted to move to Blake Court before doing so and had received enough information to help them decide if it was right place for them. The Team Coordinator confirmed the service was now fully occupied following the recent admission of a new occupant. The Team Coordinator and a permanent member of staff spoken with at length both demonstrated a good understanding of what constituted best practice regarding assessing the suitability of new placements. All the staff met told us a number of visits were arranged by the service for the prospective new occupant to meet their peers and staff, view their flat, and stay overnight. The individuals care plan from their previous placement was produced on request. All the staff met demonstrated a relatively good understanding of the new occupant’s needs and wishes, including their food and drink preferences, and cultural heritage. Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using 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. Care plan formats currently used by the service are not particularly occupant ‘friendly’, and could be made far more person centred. This will enable the occupants and staff to access all the up to date information they require to meet people’s unique needs and wishes. The services arrangements for consulting the occupants and ensuring they have sufficient opportunities to participate in the day to day running of their home are rather variable at present and should be reviewed to make them more transparent and consistent. Sufficiently robust systems are in place to ensure the occupants are able to take responsible risks and to live their lives as independently as possible. Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 13 EVIDENCE: We received a very mixed reaction from both occupants and staff about the current care plan format. Two-thirds of the occupants who returned our surveys felt the service ‘usually’ met their needs, while the rest said this was only ‘sometimes’ the case. We received a similar response from staff with twothirds informing us they were ‘usually’ given all the information they required to meet the occupants in their care plans, while a few said this was never the case. Typical comments made by staff we met included –‘care plans need to be made more person centred’, ‘some care plans are too big, which makes it difficult to access all the information you need’, and ‘we seem to use lots of different care plan formats here.’ We examined four care plans in depth which were all written in various styles and not particularly easy to read. The new manager needs to review the various care plan formats the service currently uses and revise them to make them far more person centred, easier to read, and uniform. We also agree with the comments made the services Team Coordinator that ensuring all staff receive training in person centred care planning would be one way of improving the services approach to developing care plans. We therefore recommend Scope arranges this training for its staff. A permanent support worker confirmed the service continued to operate a keyworker system and that everyone who currently resides at Blake Court had a designated keyworker. Two occupants spoke with at length told us they got on extremely well with their keyworkers who did a good job in the main. All the occupants met also told us it was custom and practice for one to one meetings with your keyworker to be held every month. However, only a few of the care plans looked at in depth contained up to date records regarding the outcome of recently held keyworker meetings. A member of staff told us – ‘they did not have enough time to record the minutes of all the meetings they regularly arranged with the individual they keyworked.’ We recommended the new manager reviews these recording arrangements. The majority of the occupants we met told us they felt the service should be better at keeping them informed about what was going on at Blake Court. Typical comments included – ‘I wish Scope communicated with me better’, and ‘you don’t always get enough information about what’s going on here… no ones told me that Laura (services registered manager) had left.’ One occupant told us they use to have meetings with their peers on a regular basis, but this now only happens very occasionally. The Team Coordinator produced the minutes of the last two occupants meetings which showed us only two had been held in the past 12 months. We recommend all the services arrangements for consulting the occupants and ensuring they participate in all aspects of life in their home are reviewed by the new manager. Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 14 A comprehensive set of risk assessments were included in all the care plans being case tracked, which covered various aspects of these individuals’ personal, social, and health care needs. It was evident from the comments made by staff met that they were committed to supporting the occupants to take more responsible risks and to do more for themselves. The expert by experience wrote in their report – ‘occupants valued highly the independence they felt they had at Blake Court and compared it favourably to their previous living arrangements in 50 person residential unit, hostel and a smaller self contained unit. They all felt they had a high level of choice and control over their lives on a day-to-day basis in relation to for example buying food of choice, clothes personal items’. Blake Court DS0000025756.V377312.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): This is what people staying in this care home experience: People using 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 opportunities the occupants have to engage in stimulating and meaningful community based social activities which reflect their interests has improved since the last inspection, but current staffing arrangements are not ‘flexible’ enough to satisfy all the occupants social needs and wishes. Meals are varied, well balanced, and highly nutritional ensuring the varying dietary needs and tastes of the occupants are well catered for. Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 16 EVIDENCE: We noted a home tutor visit the service to give one occupant computer lessons, which was identified in their care plan as a regular pre-planned activity. As recommended in the services last report records maintained by staff of all the community based social, recreational, and leisure activities the occupants have the chance to participate in each day indicate that progress has been made to improve the social lives of the occupants. All the occupants met told they regularly attended a local day centre, went to church, and had been on holiday in the past year. Furthermore, all the occupants who returned our surveys told us they could usually do what they want to do during the day, evening, and at the weekend. These positive comments made about recent improvements to activities notwithstanding a number of the occupants and staff spoken with expressed some concerns that there was not always enough staff on duty at the right time to accommodate all the occupants social needs and wishes. The expert by experience also wrote in their report – ‘two occupants met felt they could access leisure and community opportunities if they wanted to pursue them but this required giving staff considerable notice due to persistent understaffing. One occupant told the expert by experience – ‘when it comes to shopping I need someone with me - which can be difficult in terms of having the staff available. The perception that there are not staff on duty at the right times to meet the occupants social needs has been a recurring theme throughout this inspection and will be examined in greater depth in outcome No# 7 – STAFFING. All the feedback we received from the occupants about the meals staff helped them to prepare was very positive. All the occupants we met told us they regularly go food shopping with staff and always choose what they are going to eat at mealtimes. Blake Court DS0000025756.V377312.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using 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. In the main suitably robust arrangements are in place to ensure the occupants physical and emotional health care needs are met, although the way staff record the outcomes of the appointments occupants with various health care professionals. The service also has some good policies and procedures regarding medication handling practices, but it needs to significantly improve how it supports the occupants to look after their own medication in order to keep them safe from avoidable harm. Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 18 EVIDENCE: Moving and transferring assessments were included in all four care plans examined in depth. All the staff met demonstrated a good understanding of what was expected of them regarding the safe moving and transferring of the occupants and how to use the services hoists correctly. Training records also revealed that sufficient numbers of staff had recently attended a moving and handling course. All the occupants and staff spoken with about the reliability of the services moving and handling equipment told us this was no longer an issue since all the hoists and overhead tracking devices were checked and replaced as required by suitably qualified professionals in May 2009.However, we do agree with the comments made by the expert by experience that the providers need to start thinking about how they are going to start replacing all the services moving and transferring equipment, which everyone we spoke with believed was well over ten years old. All the occupants met told us staff always support them to attend appointments with various health care professionals. We found evidence in one care plan that a referral had recently been made to a speech therapist and new guidelines developed based on this professional advice regarding how to minimize the risk of choking. AQAA states lots of advice and input is constantly being sought from various community health care specialists to meet the changing health care needs of the occupants. However, staff record keeping regarding the outcome of all the appointments the occupants attended with health care professionals were rather variable. The new manager needs to review the way staff monitor and record occupants access to health. Most staff who returned our surveys told us the training they had received gave them enough knowledge about health care and medication handling practises. We found documentary evidence that showed us sufficient numbers of staff had recently received training in the safe handling of medication in a residential care setting. The AQAA states the service does not hold any Schedule 2 Controlled Drugs or as required ‘PRN’ medication on behalf of any of the occupants. No recording errors where staff had failed to sign and date for any medicines they had handled were found on any of the medication administration record sheets we sampled at random. The Team Coordinator told us the services medication monitoring arrangements had recently been improved to minimise the risk of errors occurring, which involved staff coming on duty checking all the medicines handled by staff from the previous shift during the handover period. Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 19 It was also positively noted that where the occupants are willing and capable of looking after their own medication they are actively encouraged to do so. However, the Team Coordinator confirmed that there had been a number of incidents in the past year where ‘unwanted’ medication was found unaccounted for in an occupant’s medication cabinet. No risk assessments regarding how staff were expected to support and monitor the good practice of enabling the occupants to self administer their own medication could be produced by the Team Coordinator on request. The Team Coordinator also told us that for reasons unknown to them some lockable medication cabinets removed from occupant’s flats during a refit that took place well over a year ago had not been returned. The service needs to review the way it supports the occupants to look after their own medication as a matter of urgency. Blake Court DS0000025756.V377312.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using 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 services arrangements for dealing with concerns and complaints are sufficiently robust and understood by staff to ensure people who use the service feel listened too and safe. Allegations of abuse are always taken seriously by Scope and all the disclosures made in the past year have been dealt with in a very open, prompt and professional manner. EVIDENCE: Two-thirds of the occupants who returned our surveys told us they knew how and who to speak to if they were unhappy with the service and wanted to make a complaint. The expert by experience wrote in their report that a number of the occupants had used Scopes complaints procedure in the past 12 months and were satisfied with the responses they received. The services complaints record showed us that these complaints had all been taken seriously by the provider and fully investigated. Most occupants we met also told us staff ‘usually’ responded appropriately when they raised a concern. Similarly, most staff told us they knew what to do if someone raised a concern about the service. Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 21 The Team Coordinator and a permanent member of staff we met both demonstrated a good understanding of what constituted abuse and who they needed to notify without delay if they suspected and/or witnessed it. As required in the services last report documentary evidence was produced on request that showed us sufficient numbers of staff had recently up dated their safeguarding training. One member of staff told us they had recently completed their safeguarding training through an E-learning course they had completed on the services computer. In the past year the service has made an ‘unusually’ high number of referrals to the local authority about alleged incidents of abuse involving the occupants at Blake Court. In each instance the temporary locum manager who was in charge of the service at the time followed the correct procedures in line with local safeguarding protocols and notified all the relevant external agencies without delay. All were fully investigated and the majority were unsubstantiated, although a number of good practice recommendations about the conduct of the former registered manager and the moving and handling techniques of staff were made. As a result of the sheer volume of safeguarding referrals made to the Local Authority in the past year the Council is holding serious concerns meetings about the service, which are currently on going. No embargo has ever been placed on local authorities not to continue placing with this service. The Team Coordinator told us on going issues regarding the possible financial abuse of an occupant were still on going, but was confident the matter was being dealt with by all the relevant professionals. Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using 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 self contained flats are decorated and furnished to a satisfactory standard ensuring the occupants live in a personalised and relatively comfortable environment. The services arrangements for controlling infection are sufficiently robust to ensure the occupants live in a very clean and safe environment, although staff training in this area needs to be improved. Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 23 EVIDENCE: The two self contained flats we were invited to view with the permission of occupants who had lived at Blake Court for sometime were both found to be very personalised and decorated to a relatively good standard. However, the flat occupied by the services most recent admission was rather sparse in comparison. The occupant and the Team Coordinator told us this would be rectified as soon as the rest of this individual’s personal belongings and furniture were delivered from their previous address. We will closely monitor progress made by the service to make this flat more homely. As recommended in the services last report all the occupants met told CCHA, the Housing Association responsible for the maintenance of the building, have got better at repairing things more promptly. The expert by experience wrote in their report – ‘occupants were generally happy with the support they received around accessing and maintaining equipment.’ However, despite these improvements a number of occupants still mentioned some difficulties they were having with certain items such as an air pressure mattress and a leaky toilet not being repaired as soon as they would have hoped. All the flats viewed were kept clean and fresh. 100 of the occupants who returned are surveys told us their flats were usually kept fresh and clean. Each flat has its own washing machine, which is capable of cleaning laundry at appropriate temperatures in line with infection control standards. The Team Coordinator told us that insufficient numbers of the current staff team have up dated their infection control training, which will need to be rectified as soon as practicable. Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using 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. Staffing continues to be maintained at the minimum level to ensure the occupants are kept safe. However, the service still needs to review current staffing levels to make them far more flexible and responsive to occupant’s needs and wishes. In the main most staff are suitably trained to meet the needs of the occupants, although there remains room for further improvement in this area to ensure all staff have the relevant knowledge and skills to carry out their duties effectively, including the Team Coordinator. The services arrangements for recruiting new staff are sufficiently robust to minimise the risk of employing people who are not fit to work with vulnerable adults. However, the way in which the service enables the occupants who are willing to participate in the process of recruiting new staff needs to be revisited. Occupant’s views should be taken into account when employing new staff. Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 25 EVIDENCE: On the first day of this inspection two support workers, including a permanent and a temporary agency member of staff were both on duty. All the occupants and staff met told us there were usually two members of staff employed to cover each shift, and that ‘sometimes’ a third person would work at peak periods of activity. The previous months duty rosters revealed the service very rarely arranged for ‘extra’ staff to cover peak periods of activity. Staff met told us that the services manager and Team Coordinator between them ensure three to four times a week an additional third member of staff is always available on site. However, the Team Coordinator conceded that you spent most of your time as an ‘additional’ member of staff in the office doing administrative work and not providing direct hands on support. We received a very mixed reaction from occupants and staff about current staffing levels at Blake Court. While everyone agreed a minimum of two staff on duty during the day and at night was sufficient to keep everyone safe, everyone agreed the duty rosters needed to be made more flexible and responsive to the occupant’s needs and wishes. Typical written and verbal comments we received from the occupants and staff included – ‘the service would be better if we had more staff’, ‘it makes me frustrated when I don’t get to go out because there is not enough staff on duty to take me’, and ‘there’s not always enough staff on duty to respond to the occupants requests to go out’. Scope acknowledge how frustrated the occupants are about this issue and they told us they are trying to get the placing authorities to give them additional funding for more staffing, but the current economic climate makes it difficult to get any increases in fees. Another issue that is related to staffing levels was also brought to the attention of the expert by experience and myself during this inspection. One occupant told us they frequently waited over 20 minutes for staff to respond to them activating their call bell alarm. We observed this individual activated their call bell alarm at 12.45 on the second day of this inspection and staff responded 25 minutes later. We agree with the comments made by this occupant that it is reasonable to expect staff to take a maximum of 15 minutes to respond to a call bell. Occupants also told the expert by experience that ‘staffing levels were having an adverse affect on response times by staff to the bleep/intercom system’, ‘there are often severe delays in staff attending to meet occupants needs’, and ‘In the mornings it could be 20 minutes wait for staff to respond to my bleep’. The expert by experience wrote in their report that an occupant had told them that - ‘sometimes staff would knock on the door and quickly walk in before I’ve even said yes or no. And I would say to them I haven’t said - come in.’ Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 26 During the second day of this inspection we heard a member of staff knock on the door of a flat and observed them enter before waiting for permission to do so from the occupant. We recommend staff are reminded about their support worker responsibilities to respect the occupant’s privacy and dignity. All the agency staff met demonstrated a good understanding of the occupant’s needs and their support worker responsibilities. As required in the services last report agency staff met told us they had completed a comprehensive induction before being allowed to commence working at the home. This induction covered fire, health and safety, occupant’s needs, and care plans. It was evident from August’s staff duty rosters that the service is still heavily reliant on temporary staff with approximately a third of all shifts covered in this period by up to seven Bank and/or agency workers. A number of the occupants met told us they were concerned that so many different temporary staff who were being used on a regular basis who were not so familiar with their needs, wishes, and the services daily routines. The new manager should be mindful of this issue. All the staff met told us their employer had carried out satisfaction preemployment checks in the form of Criminal Record Bureau (CRB) and references before they started work at Blake Court. The services AQAA also states that all the people who have started work in the home in the past 12 months have satisfactory pre-employment checks carried out on them. One occupant told the expert by experience and us that they were no longer involved in the recruitment of new staff, despite expressing a wish to remain involved. The Team Coordinator acknowledged the service had let this good practice measure ‘slip’ in the last year. We recommend the new manager reintroduces it. Most of the written and verbal feedback we received from occupants and staff about the training staff received was in the main quite positive. The Team Coordinator produced documentary evidence on request that showed us sufficient numbers of the services permanent staff team had received up to date training in fire safety, moving and transferring, first aid, food hygiene, health and safety, safeguarding adults, and medication. Most people we spoken with believed staff had the right skills and experience to support the occupants, although most acknowledged there was always room for improvement in this area. Some of the typical comments made by staff included – ‘they need to train us more’, and ‘the service would be better if we got more training. The services AQAA told us that contrary to National Minimum Standards less than half of Blake Courts permanent staff team have achieved an National Vocational Qualification in care (level 2 or above). We recommend the new Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 27 manager establishes a time specific action plan to address this training shortfall. Furthermore, more staff should also receive specialist training in working with adults with learning disabilities, continence promotion, Mental Capacity, and complaints resolution. Blake Court DS0000025756.V377312.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using 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. Neither the occupants nor staff at Blake Court currently benefit from living and/or working in a service that has been consistently well run for the past few years. The high turnover of different temporary managers has adversely affected service delivery, and occupant and staff morale. The supervision and support care staff who work at the service receive has improved in the past six months, although there remains considerable room for further improvement in this area. Scope have established some good internal systems for monitoring the quality of care its services provide, although this service could do more to publish the results of any stakeholder satisfaction surveys it ascertains. The services health and safety arrangements are sufficiently robust to keep the occupants safe. Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 29 EVIDENCE: All the written and verbal feedback we received from occupants and staff about the way Blake Court has been managed in the past few years was in the main very negative. Typical comments included – ‘give us a manager on a permanent basis rather than temporary’, ‘the service would do better if we had a permanent manager and Team Coordinator’, ‘managers need to communicate better with staff… what they want us to do is always changing as different managers work differently’, and ‘managers need to know their job – this would help staff.’ The acting Team Coordinator confirmed his appointment to this senior position had never been made permanent and nor had he received any formalised training in his new managerial role, despite this being recommended in the services last report. It was also evident from the comments made by the acting Team Coordinator that it remains unclear what his new managerial role and responsibilities are. We recommend for the second consecutive time Scope clarify once and for all what the role, responsibilities are of a Team Coordinator, and what training, and support they can expect to receive. All the aforementioned negative comments made above notwithstanding it was positively noted that Scope recently appointed a new permanent manager as required in their last report. The new manager starts this September, is suitably qualified, and has a wealth of experience running residential care services for vulnerable adults. It is hoped this permanent appointment will mark a turning point for the service. All the staff we met told us that as recommended in the services last report they were now having one to one supervision sessions with senior staff, although it was still not at least once every two months as ‘best practice’ dictates. Staff also told us although a staff meetings had been arranged by the services last temporary manager the Team Coordinator could only produce the minutes for one held in June 2009. Minutes suggested the previous meeting was last held over six months ago in November 2008. The new manager needs to continue improving the frequency at which staff meetings are held. Copies of inspection reports carried out by managers of other Scope services on a monthly basis were produced on request. The contents of these reports revealed these internal audits had been very thorough and had covered the views of the occupants and staff about how the service was run and any complaints made about its operation. The Team Coordinator told the occupants are invited to complete satisfaction surveys about the service they receive at least once a year, but conceded that the results had not being published for any interested parties to view. We recommend the new manager address this quality assurance matter. Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 30 Documentary evidence was produced on request that showed us there had been no breaches of fire safety regulations as identified at the services last inspection. The services fire safety records revealed that in line with recommended good fire safety practice staff were testing the fire alarm system on a weekly basis and participating in fire drills at least once every six months. AQAA tells us that the premises: - electrical circuits; portable electrical appliances; hoists; fire detection and alarms; fire fighting equipment; emergency lighting; call bell alarms system; and water heating system – have all been serviced or tested as recommended by the manufacturer or other regulatory body. The team coordinator also produced a copy of a certificate that showed us a suitably qualified engineer had tested the services gas appliances inn the past twelve months. Blake Court DS0000025756.V377312.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 3 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 X 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 1 X 3 X X 3 X Version 5.2 Page 32 Blake Court DS0000025756.V377312.R01.S.doc Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 6 Requirement The services Statement of Purpose and Guide must be kept under constant review and where appropriate revised to reflect any changes in provision. This will ensure all occupants and their representatives have all the information they require to make an informed decision about whether or not to Blake Court is right for them. 2. AS6 15 After consulting with the occupants and/or their representatives the service must develop a care plan format that is far more consistent, person centred and easier to use and read than before. This will ensure occupants and staff can access all the information they require to know about how the service intends to meet individual’s unique personal, social and health care needs and wishes. 01/01/10 Timescale for action 01/11/09 Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 33 3. YA19 17 All the occupants must have up to date health care action plans that contain detailed information about the outcome of all the appointments they have with health care professionals. This will ensure anyone authorized to inspect the record can determine whether or not occupants health care needs are being suitably met and monitored. 01/11/09 4. YA20 13 All the occupants who are willing and capable of looking after their own medication must be provided with a lockable space in their self contained flat and risk management strategies developed setting out how staff are to support and monitor the practice. This will ensure occupants receive the correct levels of medication and are kept safe from avoidable harm. 01/11/09 5. YA30 13 All staff that work in the service must receive up to date infection control training. The services staffing arrangements must be reviewed and ways to make them more flexible considered in order they more accurately reflect the occupants personal, social, and health care wishes. This issue was identified at the time of the services last inspection and has not been addressed within the previously agreed timescale for action (i.e. 01/11/08). 01/01/10 6. YA33 18 01/01/10 Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 34 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 YA6 Good Practice Recommendations Person centred care planning training should be provided for all staff that work at the service. This will ensure all staff have the necessary knowledge and skills to meet the needs and wishes of all the occupants in a person centred way. The way in which keyworkers record the outcome of monthly one to one meetings they have with the people they keywork should be reviewed as current arrangements are very inconsistent and variable. The way in which the service ascertains the views of the occupants needs to be reviewed further to enable people to have an even greater say in how their home is run. We recommend the service may wish to consider consulting the occupants about the possibility of reintroducing regular peer group meetings. The way in which the service responds to routine maintenance issues in occupant’s flats should be reviewed further. This will ensure occupants live in flats that suit their needs, lifestyles, and expectations. The practice of staff knocking on the doors of flats and entering before receiving permission from the occupant to do so should cease immediately. Staff should be reminded about their duty of care to respect the privacy and dignity of occupants at all times. More permanent staff should be recruited so the service is not so reliant on temporary Bank and agency staff. This will ensure the occupants receive continuity of support from people who are familiar with their needs, wishes and daily routines. DS0000025756.V377312.R01.S.doc Version 5.2 Page 35 2. YA7 3. YA7 4. YA24 5. YA35 6. YA35 Blake Court 7. YA34 The way in which the service involves the occupants in the recruitment of new staff should be reviewed. Occupants who wish to participate in the process should have the opportunity to do so and have their views taken in account when employing new staff. The manager should establish a time specific action plan setting out how the service intends to ensure all its permanent staff team achieve a National Vocational Qualification in care. Sufficient numbers of the current staff team should receive specialist training in working with adults with learning disabilities, continence needs, as well increase their understanding of Scopes complaints resolution procedures and the Mental Capacity Act. All staff appointed Team Coordinators should be appropriately trained in their new managerial role and responsibilities. This will ensure they have all the necessary knowledge and skills to perform their new duties effectively, especially during the manager’s absence. This good practice recommendation was identified in the services last report and has not been implemented. We also recommend Scope appoint a permanent Team Coordinator; clarify what their roles and responsibilities are, especially on the absence of the services manager; and confirm whether or not Speakers and Blake Courts should have one Team Coordinator each. 8. YA35 9. YA35 10. YA37 11. YA37 Although the way in which the service supervises and supports its staff team has improved in the past year this still needs to be reviewed again to ensure staff have sufficient opportunities to attend group and one to one meetings with their peers and senior staff. The results of all the satisfaction surveys completed by the services major stakeholders should be published. This will make the service more open and transparent and enable occupants to know their views about how to improve their home are taken seriously. 12. YA39 Blake Court DS0000025756.V377312.R01.S.doc Version 5.2 Page 36 Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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