Inspection on 05/09/08 for Blake Court

This inspection was carried out on 5th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Blake Court 27/08/09

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 19/12/2008.

CARE HOME ADULTS 18-65 Blake Court Flat 5 5a Barrow Road Waddon Croydon Surrey CR0 4EZ Lead Inspector Lee Willis Unannounced Inspection 5 September & 10 October 2008 12.00 th th O Blake Court DS0000025756.V372795.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 Blake Court DS0000025756.V372795.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. Blake Court DS0000025756.V372795.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 Position vacant Care Home 6 Category(ies) of Physical disability (6) registration, with number of places Blake Court DS0000025756.V372795.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 6th September 2006 Brief Description of the Service: Blake Court offers accommodation and personal support for up to six adults with Cerebral Palsy and associated physical disabilities. The five self-contained flats that make up Blake Court are owned by Croydon Churchs Housing Association, but are managed and staffed by the registered charity - SCOPE. Laura Baker, who is currently on long-term sick leave, was appointed the services acting manager in August 2007. Laura Baker is also responsible for running another service in the area, which is also managed by Scope. Located in the heart of a housing estate in Waddon the service is relatively close a wide variety of good leisure and community facilities. The service is also close to a number of good bus and rail links with excellent connections to Croydon and the surrounding areas. 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 and maximise their 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. Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 5 All the occupants are provided with copies of the homes Statement of Purpose and Guide. The Scope currently charges between £39,000-£59,000 a year for each placement for facilities and services provided. Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 2 stars. This means the people who use this service experience good quality outcomes. From all the available evidence we gathered during the inspection process it was clear the service has more strengths than areas of weakness. We spent four and a half hours at the service. During the visit we spoke at length to all four of the occupants who currently reside at Blake Court, the new temporary acting manager (Michael Stone), the team leader (deputy manager), and three other support workers who were all on duty at the time of this site visit. We received eight ‘have your say’ comment cards about the service, of which three were completed by the occupants, one by a relative, and the rest by members of staff. Various records and documents, including the care plans for two people whose care we had chosen to case track, were all examined in depth. The remainder of this site visit was spent touring the premises. We also received the services Annual Quality Assurance Assessment, which tells us what the manager thinks they are doing well at Blake Court, and what they could do better. What the service does well: What has improved since the last inspection? Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 7 The general consensus of opinion expressed by all the occupants and staff met during this visit was that the new acting manager was very approachable and had done a lot to improve the service in a very short period of time. The new managers open approach to running the service has clearly had a positive affect on the morale of both the occupants and staffs, which had been adversely affected by the uncertainty surrounding the permanent managers long term sick leave. All the requirements identified at the services last inspection report have been met (see below): Care plans are now being reviewed at more regular intervals (i.e. at least biannually) and up dated accordingly to reflect individual occupants changing needs and wishes. The new acting manager acknowledges that there is still some way to go to ensure all staff receive at least one formal supervision session with their line manager every two months, although it was clear that some progress had been made to reintroduce this good practice measure. As required in the services last inspection staffs training needs have been appraised in the past 12 months. All staff spoken with told us the new manager is very approachable and is available at Blake Court at least once a week for face-to-face meetings. Other areas of practice that have improved since the service was last inspected include, the reintroduction of occupants monthly meetings by the new acting manager, and the redecoration of all the flats. What they could do better: All the positive comments made above notwithstanding their remains a number of areas of practice where further improvement is required in order to enhance the lives of the occupants, as well as keep them safe: All staff that work at Blake Court must up date their safeguarding training. This will ensure they have all the knowledge and skills to recognise, and report abuse and keep the occupants safe. Staffing levels should be reviewed and made more flexible to ensure there are always sufficient numbers of staff on duty to meet the personal, social and health needs of the occupants. This will ensure the occupants receive the correct levels of staff supervision and support to meet their needs. When temporary agency and/or bank staff complete their induction before commencing work at the service the outcome of this training must be clearly recorded. This will enable anyone authorised to inspect these records to determine whether or not temporary staff are suitably competent to meet the needs of the occupants. Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 8 We require further written clarification regarding the arrangements Scope have put in place for the day-to-day running of the care home during the permanent managers absence to, including more details about the temporary acting managers qualifications and experience. This will enable us to determine the suitability of these interim arrangements. All staff that work at Blake Court must be involved in at least one fire drill every six months and where possible occupants should also participate. The outcome of any drill carried out in the home must be clearly recorded. This should include, the date it was carried out, the names of everyone involved, and what action (if any) was taken to remedy any defects/problems found. This will ensure the safety of the occupants, their guests, and staff. An Immediate Requirement Notice was issued at the time of this inspection for this major fire safety breach to be rectified within 24 hours. 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. Blake Court DS0000025756.V372795.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.V372795.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 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Occupants have all the information they need to make an informed decision about whether or not the service is right for them. The needs, strengths, and wishes of all prospective new occupants are fully assessed prior to their admission so the individual, their representatives, and the provider can be sure (so far as reasonably practicable) the placement is suitable. EVIDENCE: Occupants asked about the services Guide told us they had been provided with a copy, which they kept in their flats. Two occupants met went onto say they were fully aware how much Scope charged them for facilities and services provided. Staff spoken with confirmed the service has not received any new referrals since the last inspection. Consequently, one flat remains unoccupied. Several occupants told us that Scope has a good track record of keeping them informed about new referrals and in the past had ‘always’ asked their opinion Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 11 about the ‘suitability’ of any prospective new admission. All four of the occupants have lived together, albeit in their own self contained flats, for many years now and seem to get on reasonably well. Blake Court DS0000025756.V372795.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Improvements made to the way the service develops care plans ensures these documents are more person centred thus reflecting what is important to the individual occupant, what their capabilities are, and what support they need to achieve their personal goals. The services arrangements for assessing, managing and reviewing risk are sufficiently robust to ensure the occupants are kept safe, while their rights to make informed choices and live their life’s as independently as reasonably practicable are not restricted unnecessarily. Occupants are able to make decisions about they live their life’s, although there remains considerable room to improve the services arrangements for ascertaining occupant’s views about how their home is run. This will enable the occupants to have more opportunities to get involved in the day-to-day running of their home. Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 13 EVIDENCE: We looked at the care plans for the two occupants we had selected to case track the care they were provided. As required in the homes previous report improvements had been made to the way the service develops care plans. Care plans examined in depth had been made far more person centred. Both plans set out in far more detail what support these individuals required to ensure their personal, social, and health care needs were meet, and what their strengths, wishes, and aspirations were. Furthermore, both plans had been reviewed in the past six months and up dated accordingly to reflect any changes in provision. The review process had also involved all the relevant people, including the occupant, their keyworker, and their care manager. Two occupants spoken with at length told us they each had a keyworker, whom they liked. Two members of staff informally interviewed were both very clear about their keyworker roles and responsibilities. All the occupants asked about the decision making process at Blake Court told us they did not feel they were as involved as they use to be. Two occupants told us they use to enjoy attending occupants meetings, which they found useful forums for having their say about how Blake Court was run. Several members of staff confirmed occupants meetings were not being held as often as they use to be. The services new ‘interim’ manager told us he believed group meetings were a good way of ascertaining occupants views about their home and ensuring they had every opportunity to become actively involved in its day-to-day running. We recommend occupants meeting be reinstated as soon as reasonably practicable. Care plans examined in depth contained a comprehensive set of assessments and associated management strategies to minimise identified risks and hazards. These risk assessments covered every aspect of these occupants’ lifes. It was evident from the comments made by the interim manager that he is committed to ensuring the occupants are actively encouraged and supported to take ‘responsible’ risks as part of a structured programme to promote independent living where practicable. Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, & 17 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. The occupants have sufficient opportunity to engage in various in-house leisure and recreational activities that reflect their interests. However, current staffing arrangements are not ‘flexible’ enough to satisfy some of the occupants wishes to purse more meaningful social activities in the wider community. 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.V372795.R01.S.doc Version 5.2 Page 15 EVIDENCE: On arrival all four of the occupants were at home. One occupant met told us they were getting ready to have a siesta, which they had every afternoon. Staff spoken to about this were aware of this routine and clearly respected this individuals wishes. Entries made in several occupants daily notes revealed the occupants do have opportunities to engage in various social activities in the wider community. However, we concur with comments made by all the occupants and staff on duty at the time of this site that this is an area of practice that the service could significantly improve. Most of the occupants and staff spoken with believed staff shortages meant there was not always sufficient numbers of staff on duty to support all the occupants’ social wishes, specifically those that involved accessing the wider community. We our aware of a recent incident when contrary to Scopes own staffing level procedures one member of staff was allowed to escort four occupants on a community based trip. The providers are currently investigating this matter and we have been told that appropriate action will be taken to minimise the risk of a similar breach reoccurring in the future. All staffing related concerns are discussed in greater depth in the section of this report entitled - ‘STAFFING’. It was evident from comments made by all the occupants and a number of staff on duty at the time that the service continues to operate an open visitors policy without restrictions. There is a visitor’s book keep in the office, which any one who visits Blake Court is expected to sign and date on their arrival. One occupant told us their relatives are allowed to visit them in their flat whenever they like. All the occupants met told us they had been provided with keys to their flats. One occupant also told us staff often helped them cook their meals. The food and drink preferences of the occupants are included in the newly introduced care plan format. One occupant told us they “liked all the food staff helped them to make.” As staff support the occupants to prepare their meals in their own flats the service does not maintain planned menus, although staff do keep accurate records of all the food and drink consumed by the occupants. Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 16 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 good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Suitably robust arrangements are in place to ensure the occupant receive personal support in the way they prefer and require, and that there unique physical and emotional health care needs are continually recognised and met. Policies and procedures for handling medication are in the main sufficiently robust to keep the occupants safe. EVIDENCE: All the occupants told us staff always listened to what they had to say about what clothes they bought and wore. The new care plan format set out in detail individual’s unique health care needs and the staff support they required to meet them. Both care plans being case tracked contained up to date manual handling risk assessments that accurately reflected the individuals physical needs, strengths, and moving and transferring preferences. It was positively noted that prompt action had been Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 17 taken by one occupants keyworker, the team leader, and interim manager to seek urgent medical advice from the relevant health care professionals about one individuals changing health needs. All the occupants met told us staff always took their health care concerns seriously and would always seek professional’s advice from the relevant health care professionals as and when required. The services accident and incident books showed no ‘significant’ events involving the occupants had occurred since Blake Court was last inspected. No one has sustained any ‘major’ injuries or been admitted to hospital in an emergency during this period. The interim manager and team leader both demonstrated a good understanding of what constituted a ‘significant’ incident and which external agency’s, including the CSCI, should be notified without delay about the occurrence of such an event. No recording errors were noted on medication administration records sampled at random. These (MAR) sheets accurately reflected current stocks of medication held by the service on behalf of those occupants who were unwilling and/or able to manage their own medication. Stocks of medicines are securely stored in a locked metal cabinet kept in the office. Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 18 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 good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. The services arrangements for dealing with complaints are relatively clear and understood by the occupants and staff. Consequently, occupants are confident any concerns they may have about the operation of the service will always be taken seriously and acted upon in a timely manner. Furthermore, the services safeguarding arrangements are sufficiently robust to protect the occupants from avoidable harm and/or abuse, although they are still being placed at unnecessary risk of because insufficient numbers of staff have not up dated their safeguarding adults training recently. EVIDENCE: Inspected the services complaints log, which contained no new entries since the last inspection. All the occupants met told us staff were good listeners and ‘always’ took their complaints seriously. One occupant told us “although they were not always satisfied with the action taken by Scope in response to things they were no happy about they did always look into the matter”. Another occupant told us “would talk to their keyworker if they were unhappy with anything at their home”. Everybody met told us they had been given a copy of Scopes complaints procedures. The new acting manager, team leader, and the two other members of staff on duty at the time of this visit all demonstrated a good understanding of what Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 19 constituted abuse and which external bodies should be notified without delay if they suspected or witnessed the occupants being harmed, abused and/or neglected. In the past twelve months four allegations of abuse involving the occupants of Blake Court have been disclosed. In each instance staff working for Scope have reported the allegations of abuse to all the relevant external bodies, including the local authorities safeguarding team, the CSCI, and the appropriate funding authority, in line with local safeguarding protocols. Furthermore, it is custom and practice for Scope to suspend staff accused of abuse as a neutral move while the matter is looked into in accordance with recommended good safeguarding procedures. The outcome of the services two most recent allegations of abuse are pending while the referrals are fully investigated under the local authorities safeguarding protocols. Other allegations made in the past year relate to potential financial and physical abuse. The service is commended for notifying all the relevant external agencies without delay about these matters. Appropriate action has been taken by Scope in response to the findings of the aforementioned investigation to minimise the risks of similar incidents reoccurring in the future. No staff have been referred to the Protection of Vulnerable Adults (POVA) for possible inclusion on their register for people deemed ‘unfit’ to work with vulnerable adults. This provider has clearly demonstrated its takes all disclosures of abuse seriously, from whatever source they may come, and will always take appropriate action to deal with it in a timely fashion. However, the staff files inspected in respect of all those on duty at the time of this visit revealed their safeguarding vulnerable adults training had expired and was in need of up dating. The acting manager told us an action plan had already been drawn up for this training shortfall to be rectified. Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 28, 29 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Improvements made to the interior décor of all the self-contained flats ensures the occupants live in a far more homely and comfortable environment. The open plan layout and the specialist physical disability equipment provided in all the flats ensures it suits the occupant’s needs who are able to maximise their independence. EVIDENCE: In the main most of the occupants met told us they were happy with their flats. Typical comments included, “I got to choose the colour my flat was painted” and “I like my flat, I’ve lived here a long time – I’m at home here”. Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 21 One occupant who invited us to view their flat told us they were unhappy that it took the housing association so long to deal with a lot of important maintenance issues they brought to their attention. During a tour of this individuals flat they pointed out a damaged chest of drawers, a dripping tap on the wash hand basin in the bathroom, and a broken seal around the front door. The occupant confirmed they had reported all these matters sometime ago and was still awaiting a response. The two other flats viewed were both maintained to a relatively good standard and had been kept clean. All the flats viewed had recently been redecorated to a relatively high standard. Overall, we saw the service provides the occupants with a relatively pleasant and comfortable place to live. Furthermore, furnishings and fittings remain domestic in appearance and all the adjustable work surfaces, lowered light switches, and long cords on call bells to enable the occupants to access this equipment and maximise their independence. All the flats are open plan and very wheelchair accessible. Overhead tracking equipment is also available in all the flats making moving and transferring tasks easier for the occupants and staff. It was positively noted that as recommended in the services previous report the rotten wooden window and doorframes in the office have been replaced with new PVC ones. Each flat has its own washing machine, which is capable of cleaning laundry at appropriate temperatures in line with infection control standards. During this visit a number of staff were observed wearing latex gloves prior to providing personal care. Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 People who use the service experience adequate quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. The occupants are kept safe because in the main the service employs enough suitably competent and experienced staff to meet their needs and wishes most of the time. However, there is room to improve the way the service plans the duty rosters to make them more responsive to the social needs and wishes of the occupants. Furthermore, despite recent improvements in the services arrangements for enabling staff to attend meetings and receive one-to-one supervision sessions with their managers these opportunities remain too few and far between. The occupants should be supported by a staff team, which is well supervised and is continually up dating its existing knowledge and skills. Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 23 EVIDENCE: On arrival it was noted that three members of staff were on duty. Duty rosters sampled at random confirmed that there is always at least two members of staff on duty at all times during the day, with an additional third employed to cover ‘peak’ periods of activity. Two members of staff continue to sleep-in at night. The new acting manager confirmed that following a recent recruitment drive the service now only has one staff vacancy. Staffing numbers and the services flexible approach to planning the duty rosters, in theory should ensure there are always enough suitably trained permanent staff on duty at all times to meet the personal, social and health care needs and wishes of the occupants. However, all the occupants met told us they were ‘unhappy’ that there was not ‘always’ enough staff on duty to support them when they wanted to go out and pursue their social interests in the wider community. Several told us too many agency staff had been used recently to cover ‘long term’ staff sickness. Finally, one occupant told us, “because of these staff shortages I can’t always go out when I want”. We our also aware of a recent incident when one member of staff was allowed to support four occupants to a social event in the wider community, contrary to Scopes own staffing level protocols and best practice. All four support staff, including the team leader, who were informally interviewed in private about this matter confirmed the service had used a lot of agency staff in recent months to cover staff sickness, which included the manager, who had been on sick leave for some considerable time. Everybody met told us they believed this situation had adversely affected the ‘morale’ of both occupants and staff at Blake Court. The new temporary manager acknowledged that the service had become a bit of a ‘rudderless ship’ in recent months in the absence of the permanent manager and that this had indeed adversely affected staff and occupants moral. One member of staff told us they “didn’t like the feeling of being in ‘limbo’ and not knowing who was in charge of Blake Court.” Nonetheless, we agree with the new acting managers comments that a thorough review of the way the service plans is duty rosters and deploys its staff team should significantly improve the current staffing ‘crisis’. All the negative comments made above notwithstanding it was positively noted that all the staff on duty during the visit were observed interacting with the occupants in a very caring and respectful manner. Typical comments made by several of the occupants included, “I like most of the staff who work here”, “I know who my keyworker is and I can speak to them if I’m unhappy”, and “the new manager is very nice”. The acting manager confirmed that no new members of staff had been employed since the service was last inspected, although as previously Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 24 mentioned Scope were in the middle of a recruitment drive to fill all staff vacancies. The team leader told us all new members of staff receive a thorough induction before being allowed to commence supporting occupants unsupervised at Blake Court. As required in the homes previous report records of the inductions undertaken by all permanent members of staff were made available on request, although the team leader was unable to produce inductions completed by agency staff. The team leader assured us that all agency staff receive a structured induction before being allowed to commence working at the service, despite the lack of documentary evidence available. However, in light of the fact that an unusually high number of temporary agency staff have been used by this service in recent months this recording shortfall needs to be rectified as soon as reasonably practical. The acting manager was able to produce a matrix that outlined all the current staffs teams training needs and strengths. The document revealed very few gaps in staffs knowledge and skills. It was positively noted that over 50 of the current staff team have either achieved a National Vocational Qualification in care - level 2 and above – or were enrolled on a suitable course. It also showed that sufficient numbers of staff had also received up to date training in, fire safety, moving and handling, first aid, basic food hygiene, and health and safety. The team leader demonstrated a relatively good understanding of his new responsibilities as the person who was in charge of Blake Court in the manager’s absence. However, he did acknowledge that the last few months had be difficult with the manager off sick and that he had not received any specific training from Scope regarding his new managerial role and responsibilities. We therefore recommend all Scopes new team leaders receive additional support and training to enable them to have a better understanding of their new role. As required in the services previous report all the staff inspected in respect of the staff on duty at the time of this visit had each recently received an annual work appraisal from their line manager. Records contained in all four of the staff files selected revealed these individuals had received at least one formal supervision session with a manager representing Scope in the past year, in addition to their annual appraisal. The new acting manager and team leader both acknowledged that despite recent improvements in the frequency of staff supervision current arrangements remained woefully inadequate. Furthermore, the team leader confirmed that despite the services last staff meeting being held in August 2008 this had been the first one arranged at Blake Court since January 2007. The new acting manager told us he was aware of this shortfall and would be arranging staff meetings to be held on a monthly basis from now on. We feel staff morale would benefit from more opportunities for staff to meet in groups and/or on a one to one basis with their line managers to discuss any concerns they may have. Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 & 42 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. The ‘temporary’ appointment of a suitably competent and experienced acting manager to oversee the day-to-day running of the service during the absence of the permanent manager has significantly improved the morale of both the occupants and staff. Occupants and staff are repeating the benefit of living and working in a service, which is being well run. In general the occupants believe their opinions are central to how the service develops because on the whole there are good quality assurance and monitoring systems in place. However, the health and welfare of the occupants, their guests, and staff have been placed at significant risk of harm because the services fire evacuation procedures are woefully inadequate. Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 26 EVIDENCE: Michael Stone was appointed Blake Courts new acting manager in October 2008. He has taken over from Laura Baker, albeit temporary, while she remains on long-term sick leave. As mentioned throughout this report all the occupants and staff spoken with during this site visit expressed concern about Laura’s continued absence and felt this was having an adverse affect on the morale of all the people that live and work at Blake Court. We agree that the continued absence of the manager was beginning to affect morale at Blake Court and therefore we welcome the appointment, albeit it temporarily, of the new acting manager. The acting manager told us while he continues to be responsible for the dayto-day management of both Blake and Speakers Courts, he will relinquish his duties as manager of a Scope day centre for adults with physical disabilities. During this site visit Michael Stone demonstrated a good understanding of his interim managerial role and responsibilities. He was also able to describe a clear vision for the service, as well as sound understanding and application of ‘best practice’. Typical comments made by the occupants and staff about the appointment of the new acting manager were extremely favourably. One occupant told us, “Michael is very approachable”, another said, “I like the new manager, you can talk to him – he always listens”. Staff met told us, “Its great to have a manager on site again who you can talk to when you need too” and “Michaels made such a difference since his arrival”. The acting manager has agreed to send us written clarification about what exactly the arrangements are for running both Blake and Speaker Courts during Laura’s absence. We also need to determine Michaels ‘fitness’ to run a residential care home for adults with physical disabilities and will need to confirm what qualifications and experience he has. Blake Court has an effective quality assurance system that uses our annual quality assurance assessment, monthly visits by managers of other Scope establishments, and occupants forums and surveys to find out what they do well and how they might improve the service it offers. As previously mentioned in this report the acting manager acknowledges that the services arrangements for ascertaining the views of the occupants is an of quality assurance area which its needs to improved (See recommendation No 1). According to the services annual quality assurance assessment a large proportion of its policies and procedures have not been reviewed for well over three years and therefore have not been up dated accordingly to reflect changes in ‘best’ practice and related legislation. We recommended all Scopes policies and procedures are reviewed. Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 27 Fire records showed the services fire alarm system continues to be tested on a weekly basis by staff. The team leader told us he believed the last time a fire drill was carried out at Blake Court was over nine months ago. No record of the outcome of this drill and who participated could be produced on request. Fire records revealed the last drill was carried out over 20 months ago in February 2007. This failure to carry out fire drills at regular intervals (i.e. at least once every six months) and to record the outcome of these tests is a major breach of the care homes regulations and good fire safety practice. The occupants and staff have been placed at unnecessary risk of harm and consequently we issued an immediate requirement notice for this major health and safety shortfall to be rectified within 24 hours. Up to date Certificate of worthiness were made available on request to show that suitably qualified engineers had checked the services gas installations, fire alarm system and extinguishers, moving and handling equipment, and portable electrical appliances in the past twelve months. Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 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 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 2 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 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 3 X 1 X Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 29 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 YA23 Regulation 13(6) & 18(1) Requirement All staff that work at Blake Court must up date their safeguarding training. This will ensure they have all the knowledge and skills to recognise, and report abuse and keep the occupants safe (so far as reasonably practical). Staffing levels should be reviewed and made more flexible to ensure there are always sufficient numbers of staff on duty to meet the personal, social and health needs of the occupants. This will ensure the occupants receive the correct levels of staff supervision and support to meet their needs. When temporary agency and/or bank staff complete their induction before commencing work at the service the outcome of this training must be clearly recorded. This will enable anyone authorised to inspect DS0000025756.V372795.R01.S.doc Timescale for action 01/01/09 2. YA33 18(1)(a) 01/11/08 3. YA35 17(2), Sch 4.6(g) 01/11/08 Blake Court Version 5.2 Page 30 these records to determine whether or not temporary staff are suitably competent to meet the needs of the occupants. 4. YA37 38(2)(c) (d) When a new temporary acting manager is appointed we (the Commission) must be notified in writing about what arrangements the providers have made for the day to day running of the care home during the permanent managers absence, as well as the qualifications of the person who is now responsible for managing the home. This will enable us to determine the suitability of these interim arrangements. 23(4)(e) & 17(2), Sch 4.14 All staff that work at Blake Court must be involved in at least one fire drill every six months and where possible occupants should also participate. The outcome of any drill carried out in the home must be clearly recorded. This should include, the date it was carried out, the names of everyone involved, and what action (if any) was taken to remedy any defects/problems found. This will ensure the safety of the occupants, their guests, and staff. An Immediate Requirement Notice was issued at the time of this inspection for this major fire safety breach to be rectified within 24 hours. 01/11/08 5. YA42 11/10/08 Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 31 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 YA7 Good Practice Recommendations The way in which the service ascertains the views of the occupants should be reviewed. The occupants should have far more opportunities to get involved in making decisions about how their home is run. The way in which the service enables the occupants to engage in community-based activities should be reviewed. Current arrangements are limiting people’s rights to make informed choices about the type of social activities they purse in the wider community (See also Requirement No 2). The way in which the service responds to routine maintenance issues in occupant’s flats should be reviewed. This will ensure occupants live in flats that suit their needs, lifestyles, and expectations. All staff appointed team leaders 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. The way in which the service supervises and offers the staff team support, either through group meetings and/or formal one-to-one sessions, should be reviewed. This will ensure the occupants receive support from staff who have far more opportunities to express their views and up date their existing knowledge and skills. The way in which the service up dates its policies and procedures should be reviewed to ensure they accurately reflect current ‘best’ practice. Staff should also have access to up-to-date copies of all the homes policies and procedures and be able to produce them on request. This will ensure the rights and best interests of the occupants are safeguarded by the homes policies and procedures. 2. YA13 3. YA24 4. YA35 5. YA36 6. YA40 Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Blake Court DS0000025756.V372795.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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