Inspection on 17/04/07 for Bridlington House

This inspection was carried out on 17th April 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bridlington House 06/10/09

Bridlington House 28/07/09

Bridlington House 08/04/09

Bridlington House 07/04/08

Bridlington House 08/10/07

Bridlington House 20/06/06

Similar services:

Whiteley House

Tyndale Avenue

2-10 Norfolk Road

Bennfield House Nursing Home

Eastfield Residential Home

Sign Health

Springwood

Fairburn Mews

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

CARE HOME ADULTS 18-65 Bridlington House 4 Bridlington Avenue Hull East Yorkshire HU2 0DU Lead Inspector Angela Sizer Unannounced Inspection 17 & 18th April 2007 11:30 th DS0000064654.V336456.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 DS0000064654.V336456.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. DS0000064654.V336456.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bridlington House Address 4 Bridlington Avenue Hull East Yorkshire HU2 0DU 01689 847 360 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Akintola Oladapo Dasaolu Position Vacant Care Home 22 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (22) of places DS0000064654.V336456.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION 1. Bridlington House to provide personal care for one named service user and one additional service user who have reached 65 years of age. Refer to Application Number V33154. Date of last inspection 20th June 2006 Brief Description of the Service: Bridlington House is a care home providing accommodation and personal care for 22 persons who have enduring mental health problems. The category for older people is to make sure that individuals can continue to have Bridlington House as their permanent home as they approach and pass the age of 65. The care home is privately owned by an individual. The building is a detached property and it is situated within walking distance of the City Centre, shops, and local community centres, churches other places of interest are also nearby. The home has 6 single and 8 double rooms; four of the single rooms and two double rooms have en-suite facilities. The home has four bathrooms, one assisted and 12 communal toilets. There are two lounges and a dining room. There is a garden to the rear and a small parking area to the front of the property. The weekly fees are currently £273.00 - information supplied by the manager during the inspection visit on 17.04.07. The registered provider stated that all residents are given a service user guide and this contains the last inspection report. The registered provider also stated that prospective residents are offered a copy of the home’s statement of purpose and service user guide. DS0000064654.V336456.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection and took place over two days and took a total of 10 hours. Prior to the visit surveys were posted out to; 21 residents and 3 were returned, none of relative surveys were returned, 1 staff member returned their survey and 2 of the health and social care professionals surveys were returned. The pre-inspection questionnaire was not completed or returned to the CSCI. The majority of the residents were spoken to throughout the day regarding the care they receive and what it is like to live in the home, some of their comments have been included in this report. Three residents’ care records were tracked during the site visit and 3 staff personnel files were looked at. Two of the staff were spoken to find out what it was like working in the home and what training, management and support was offered to them. A tour of the premises was undertaken and a number of records were looked at to ensure that the correct maintenance has been undertaken. The previous requirements were discussed with the manager and it was identified that the majority remain unmet. A discussion occurred regarding how the residents are supported to follow their religion of choice and practise their faith and how the home meets diverse needs of individuals. The manager was given feedback at the end of the first visit. An official letter was issued with regard to the recruitment procedure. The records indicated that some staff had started working in the home prior to the Criminal Records Bureau disclosures being received. This practise is unsafe and could put residents at risk. The inspector would like to thank the residents, manager and staff for welcoming her into the home and contributing to the content of this report. What the service does well: The home has a welcoming atmosphere; staff are friendly and greet any visitors. Residents commented about staff being “staff are great”, “all of the staff are very kind”. Staff were observed interacting with several residents DS0000064654.V336456.R01.S.doc Version 5.2 Page 6 throughout the inspection and this was carried out in a professional and caring manner. Comments received from healthcare professionals about the care offered included; “when faced with difficult situations they know to contact the appropriate services”, “the staff are very caring and supportive to both residents and visiting professionals”, “provide a safe secure environment, good supportive staff”, “staff are very helpful”. The menu is varied; healthy and nutritious, meals are well presented and plentiful. Residents’ comments included; “the food is very good”, “the cooks ask us what we like”. What has improved since the last inspection? What they could do better: There has been minimal progress in relation to meeting the outstanding requirements, all but two remain unmet and during this visit several more were identified. Care plans, risk assessment and other documentation had been partly updated, but there was no consistency and staff were confused about what was the most up to date or current paperwork to use. The environment has deteriorated, several areas were in poor condition and there were offensive smells present throughout the home. Other areas of concern where dirty towels and flannels left out in communal areas and the staff having limited knowledge about infection control procedures. None of the staff have undertaken infection control training recently. DS0000064654.V336456.R01.S.doc Version 5.2 Page 7 The recruitment procedure is not currently safe and could put residents at risk from abuse. The home is currently employing staff without having the correct paperwork in place, this includes not having appropriate references, identification and Criminal Records Bureau checks. An official letter was issued during the inspection visit stating that staff must not work in the home until the appropriate checks have been received, it also stated that the registered provider must respond immediately. From discussion with both staff and residents it became apparent during the inspection visit that the staffing numbers were insufficient to meet the needs of the residents. Some comments included; “the staffing levels are not good, we are struggling”, “there are not enough staff here”, “I don’t think there are enough staff on duty”. The home has training plan for 2007, but there was no evidence on individual staff members files that this had been implemented. When spoken to the manager was unclear about what training was planned or if the staff had completed any. The staff group have not received any training in relation to equality and diversity and this would promote empowerment for the residents. The registered provider stated that all new staff will undertake induction and foundation training that meets Skills for Care specification, but there was no evidence of this in any of the staff files looked at. Supervision records were looked at and staff were spoken to, it was confirmed that supervision is not occurring on a regular basis. Therefore unsupervised staff are supporting residents and the care practice is not being sufficiently monitored. The quality assurance system has deteriorated since the inspection and there was no written evidence that surveys had been undertaken. The system requires further development to ensure that all stakeholders’ views are listened to and consultation occurs. The health and safety of the residents is not always maintained; the fire risk assessment has not been updated, the water system has not been checked recently. DS0000064654.V336456.R01.S.doc Version 5.2 Page 8 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. DS0000064654.V336456.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 DS0000064654.V336456.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): 2,4 & 5 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use this service have their needs fully assessed before they are admitted into the home. EVIDENCE: As stated in the previous inspection report residents are usually admitted with a full community care assessment and care plan, in addition the home undertakes its own assessment, evidence confirming this were seen on care files. Three residents files were looked at during the inspection visit, this was to make sure that the home finds out what residents’ needs are and to ensure that the home can meet their needs. The home undertakes it’s own assessment and the manager informed the inspector that a pre-assessment visit where possible would always take place. Evidence was seen on individual’s files that their needs had been fully assessed. The manager explained that residents’ religious and cultural needs are also discussed and support offered when required. One person attends church on a DS0000064654.V336456.R01.S.doc Version 5.2 Page 11 regular basis and issues regarding wishes after death were noted on individual case files. From speaking to a resident who had recently arrived at the home it was clear that they had had the opportunity to visit the home, spend time with other residents, enjoy a meal etc before making a decision to move to Bridlington House. Some comments included, “I visited the home before I decided whether to come and live here”, “I came to have a look around and decide if I liked it”, “I came to have a look around and meet the other people here, everyone made me welcome”. All residents’ files looked at included a contract of statement of terms and conditions, these detailed what services are included in the contract price, what is not included, when the fees are due, room to be occupied, termination or breach of contract. DS0000064654.V336456.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 & 10 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service do have a care plan and risk assessment, but these are brief and do not give full information, therefore residents needs may not be met in full and potentially risk may not be managed in a way that would ensure the residents are safe. EVIDENCE: Three residents files were looked at confirming that they had a care plan in place, but these are very basic and not specific about what intervention is required by staff. From speaking to several of the residents it was confirmed that they have some knowledge about what is written in their individual care plan. Most of the residents spoken to could also confirm whom their key DS0000064654.V336456.R01.S.doc Version 5.2 Page 13 worker was. The manager explained that she had been developing the care plans; unfortunately there was no evidence to confirm that this had been implemented. Two staff members were spoken to about the care offered and the residents’ needs. Both staff members could describe in detail what needs individual residents had and were clear about what support they required, but acknowledged that this wasn’t always recorded in the care plans and it may be a problem for casual or temporary staff who do not have sufficient knowledge about the specific needs of residents. Comments from staff included; “the care plans have been changed, but I am not sure that this is a better way than before”, “I am not involved at all in developing the care plan and I do not attend the reviews for the residents who I am key worker for, the manager does all of that”. During the last inspection visit training was been offered to staff members in relation to care planning and the aim of the day was to develop a person centred care plan for each resident, but it would appear that these skills are not currently being used as the manager is undertaking the task herself. Several of the residents were spoken to throughout the inspection visit and commented; “the staff are good, I know who my key worker is and we have a chat sometimes”, “all of the staff are very kind”. Staff were observed during the visit to interact with residents and offer care in a caring and empathic way. This means that residents can be confident that they will get the support from people who show respect. Residents are encouraged to be independent and tasks form part of their care plan, for example some residents assist with the shopping for the home and when spoken to confirm that they felt this was positive for them. One person said, “I go to the shops with the staff and buy the food for the home, I enjoy it and feel that I am being helpful”. Other residents spoken to stated that they could get up and retire to bed when they choose to and that they are able to make choices about everyday life within the home. One resident said, “I chose the colours in my bedroom and I am very pleased with it”. Risk assessments remain the same as detailed in the last inspection, these do not fully cover all areas and mainly focus upon risk and relapse of mental health, other areas require developing including the risk of falls, mobility, physical or environmental risks. Both care plans and risk assessments do not included information about who does what and when. Residents when spoken to confirm that staff respect their privacy, comments included; “staff call me by the name I prefer and they are polite”, “most of the staff treat me very well”, “the staff are great”. From speaking to approximately 10 residents the majority felt that they were listened to and if there have been any issues the staff or manager have dealt with these in an appropriate way. One resident said, “I have requested a single DS0000064654.V336456.R01.S.doc Version 5.2 Page 14 room and I am on the list”, when this was discussed with the new manager it was confirmed that this had been recorded and she intends to maintain a list of residents who wish to move to a single room. Other comments included; “I like living here, I can’t complain”, “I go out everyday to the Marina”. The home ensures that information held about service users is secure. Staff spoken to fully understood the need to maintain confidentiality and they were able to give clear examples of how this would be achieved. DS0000064654.V336456.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): 12,13,14,15,16 & 17 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who live in the home receive some activities, further development would take into account the social/recreational needs of all residents, as this would ensure inclusion for those with more diverse needs. EVIDENCE: Prior to the inspection visit-taking place questionnaires were sent out to all of the residents. Three were returned and stated that although some activities are offered within the home, these are not on a regular basis. During the inspection several of the residents were spoken to about the range of activities and outings, it was confirmed that since the last inspection visit the activities have continued to occur on a sporadic basis. A discussion was held with the manager and she stated, “there has been some progress with regard to DS0000064654.V336456.R01.S.doc Version 5.2 Page 16 activities, but staff often arrange something and the residents do not wish to join in”. During the inspection visit other residents were also spoken to about the level of activities and some comments included; “we play bingo sometimes and have quizzes”. It was also observed that some of the more able residents go out independently on a regular basis. One resident commented, “I go out everyday to the Marina I like going there”. Other residents who either have physical problems or their mental health prevents them from going out alone, tend to remain in the home during the day and due to the current staffing levels there is insufficient time to spend on a 1-1 basis with those residents. Other residents informed the inspector that they go to local community centres and day centres that run groups that enable the residents to partake in events occurring in the community. During the visit staff were observed interacting with residents and this was carried out in an appropriate manner. All staff spoke to the residents showing respect and called them by the name they prefer. Staff spoken to could describe clearly the principles of good care and how they should treat the residents, “with respect, how I would want to be treated by others, respect their privacy and maintain dignity when offering personal care”. Visitors are welcomed into the home and there are several quiet areas that residents can meet with their visitors in private. Some comments from residents included; “when my brother comes to see me he is always offered a cup of tea”, “the staff always leave me alone when I have a visitor”. There was evidence to suggest that day trips or outings are also offered to the residents, again this is for the more able or independent residents and often people with more severe or diverse needs are not included. It was confirmed by speaking to the residents that they have a key to their own room and that staff refer to them by the name they prefer. There was written evidence in place identifying if there was a particular risk to a resident holding his or her own key. The home offers a varied menu, but this is not displayed for the residents. The cook explained that she consults all of the residents during the morning to inform them of what is on offer for lunch. During the inspection visit the residents who were spoken to only had positive comments about the food stating, “the food is very good”, “the cooks ask us what we like”. There were no negative comments on the visit to the home. Lunch was observed and consisted of toad in the hole or liver with mashed potato, green beans, carrots and gravy followed by fruit with cream. The main meal of the day is served at lunchtime with a lighter option for tea. From speaking to the residents it was confirmed that if there is something that they do not like on the menu then they can have an alternative, “the cooks talk to us everyday about what we DS0000064654.V336456.R01.S.doc Version 5.2 Page 17 are having”, evidence of this was recorded in the residents meetings. Breakfast and supper are also offered, there are set times for drinks (hot), staff explained that cold drinks are available throughout the day. Residents confirmed that they find it acceptable to have drinks at set times. From speaking to the cook it was clear that residents are consulted about what they like and this is incorporated within the menu. DS0000064654.V336456.R01.S.doc Version 5.2 Page 18 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 poor outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service receive a good level of personal and healthcare support that ensures their needs are met. People are not fully protected by the medication procedure. EVIDENCE: Three residents were spoken to with regard to their personal and healthcare support, all of them stating that they felt their needs were fully met. Some comments included; “staff always listen and help me if I have a problem”, “I am going to the doctors today, but a staff member will come with me to help me” “I see my CPN and Psychiatrist every few weeks, the manager reminds me when someone is coming”. From speaking to three staff members it was also clear that they had a good understanding of what individual needs were and who required support to attend GP’s etc. Also staff talked about “treating residents’ with respect”, knocking before going into a room, prompting personal hygiene in a sensitive way. Staff were observed offering care and DS0000064654.V336456.R01.S.doc Version 5.2 Page 19 support to several residents and this was undertaken in a caring and empathic way. Residents confirmed that they see healthcare professionals including their GP, Community Psychiatric Nurse, District Nurse and Psychiatrist on a regular basis; this was also confirmed from reading the case files. Residents spoken to stated, “the staff come with me to see my doctor or psychiatrist”, “if I am not well the staff will ring the doctor and they come and see me”. Throughout the inspection visit residents were observed to be individual in the way that they dressed and residents’ bedrooms were personal to them. From speaking to the residents it was evident that the home promotes their independence and encourages residents to go out for walks or to local day centres in order to integrate into the community. One person said, “I get up and go to bed when I want to and I can have a bath whenever I choose to as well”. Due to the staffing levels residents do not have the option of stating who they would prefer to assist them with personal care. The medication procedure was inspected and overall remains the same as stated in the previous inspection report. Several errors in recording were noted. There were numerous gaps on the Medication Administration Records and no explanation could be given. Some medication had been signed as given and when the stock was checked discrepancies were found. Some carried forward medication had not been transferred onto the new Medication Administration Record and therefore the stock control was incorrect. On two records it was noticed that medication had been refused for a period of more than seven days and given that this medication was an anti-psychotic drug it could be dangerous for the resident to stop it instantly. The home’s staff had not reported this to the general practitioner. None of the current residents are self-medicating, but the home has a self-medicating risk assessment in place. The home does not have a homely remedies policy. From speaking to staff and it was clear that they had undertaken the Local Authority and Primary Care Trust medication training. There was written evidence confirming that the medication training had been completed. The manager stated that, “I cannot understand why there are so many mistakes when all of the staff have undertaken the training”. Currently there is no system that would monitor and review how the medication is given. The medication is stored in a locked medication trolley that is secured to the wall when not in use, this is kept in the dining room and there is no temperature monitoring in place. Currently none of the residents receive controlled drugs, but in the event that they did the home does not have a controlled drugs cabinet or register and from speaking to staff it was clear that they had little understanding about how these medicines should be administered and recorded. DS0000064654.V336456.R01.S.doc Version 5.2 Page 20 DS0000064654.V336456.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service experience poor outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service are informed about the complaints procedure and are able to express their concerns in an open culture. People who use the service are not always protected from possible harm or abuse, as the home continues to employ staff without the appropriate vetting taking place prior to them starting work. EVIDENCE: There has been one complaint since the last inspection visit on 21.06.06, the home has a complaints procedure in place and residents are given a copy of the service user guide which details how to make a complaint and who to, the Commission for Social Care Inspection address and telephone number are also included. From speaking to several residents it was clear that they understood what to do if they did have a complaint or concern. One person stated, “I would tell the staff or the manager, they always sort the problem out”, “I would see the manager or carers as I have done in the past”. The majority of the staff group have now undertaken Protection of Vulnerable Adults training and the remainder will undertake this when a space becomes available at the Social Services Training Department. It was clear from speaking to three staff members all varying in experience that they DS0000064654.V336456.R01.S.doc Version 5.2 Page 22 understood the term ‘abuse’ and what constituted this. There was one incident where a resident stated that she had been verbally and physically assaulted by a member of staff, this resulted in a safeguarding referral being made to the local Care Management Team. Whilst this was been look into the home took appropriate action and has recorded the events, the member of staff was suspended and subsequently dismissed once the Local Authority had concluded it’s investigation. During the inspection some of the financial records held in regard of residents were looked at, all of these were found to be in order and accurate. Residents also confirmed that they could “get their money whenever it was needed”. A recommendation has been adhered to and there are two staff signatures for all transactions. Since the last inspection four of the staff have undertaking some training in relation to challenging behaviour, this was a recommendation from that report and will remain outstanding until all staff have completed it. During the last inspection visit an official letter was issued with regard to the home not undertaking appropriate employment and Criminal Records Bureau checks before employment commenced. Following that inspection the registered provider confirmed that this requirement would be adhered to. During this inspection it was found that the home has not adhered to the recruitment procedure and has continue to employ both permanent or voluntary staff prior to the references and Criminal Records Bureau check being in place. Again an official letter was issued stating that the home must not employ any person either permanent or voluntary without the appropriate vetting being in place nor must they have any contact with the residents. DS0000064654.V336456.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People who use the service experience poor outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in an adequately maintained environment; several areas are in need of updating and renewal. The infection control procedures and lack of training for staff place people who live in the home at risk of infection or cross contamination. EVIDENCE: A tour of the premises was undertaken and overall the general environment is adequate. Some areas requirement improvement and some carpets will require replacement in the near future. The majority of bedrooms are personalised and homely, from speaking to several residents it was clear that they were happy living in the home. Since the last inspection the registered provider has purchased two sets of garden patio sets and also a BBQ. One DS0000064654.V336456.R01.S.doc Version 5.2 Page 24 staff member said, “since we have had the BBQ we have enjoyed a couple of meals outside”. The main lounge has been decorated and there is a new TV and digital box in place. Some of the chairs are torn and in poor condition. The main hallway and entrance to the annex has been decorated, but the carpet is in poor condition, old and worn in parts. The carpet in bedroom 5 was worn. Several residents were spoken to in their bedrooms and their views gained about the environment; “I like my room”, “I have got my own things in here, I have recently got a new telly”. It was also confirmed that staff always knock before they come in. One survey from a healthcare professional stated; “the only area of concern is that some residents have to share bedrooms”. Offensive smells were detected in several areas including the main hallway in the annex and several of the bedrooms. In some of the residents’ bedrooms and communal bathrooms the towels and face cloths were dirty and stained. There was no soap in several toilets/bathrooms. Razors had been left out in the bathrooms, not only is this dangerous there is also a risk of cross infection. Several of the staff were spoken to about the general cleanliness and infection control and it became apparent that none of the staff had undertaken any recent training in relation to infection control. Some comments from residents included; “sometimes there is a smell, there doesn’t seem to be many staff now”, “usually it is clean and fresh, but recently it hasn’t been”. Staff members stated; “we currently do not have a domestic and the cook is covering two afternoons per week”, “we often have to undertake the cleaning duties as well as the care support”. This was also confirmed when speaking to the manager. The water temperatures were taken and the downstairs bathroom was distributing at 47.1 degrees centigrade, the other outlets were distributing within the guidelines. The home has one assisted bathroom, which is situated on the ground floor; no evidence was seen confirming that the bath chair had been serviced. Both the baths and the flooring in the first floor bathrooms were in poor condition. The Fire Officer visited the home in November 2006 and confirmed that the home was maintaining its fire equipment and procedures accordingly. The fire risk assessment has not been updated or reviewed since the new regulations came into being. It was confirmed that fire training is offered to staff on an annual basis. DS0000064654.V336456.R01.S.doc Version 5.2 Page 25 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): 33,34,35 & 36 People who use the service experience poor outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People receive support from staff that have not been properly vetted and therefore the protection and safety of the residents is put at risk. The home’s staffing hours do not ensure that all of the residents’ needs are fully met. People are supported by staff that do not receive appropriate training in relation to maintaining health and safety. EVIDENCE: During the site inspection four staff files were looked at, 3 of the 4 included an application form with reference details, three files had two references in place and one didn’t have any. Some of the references sought did not include the last employer and where acquaintances or work colleagues. Two out of the four files had a current up to date Criminal Records Bureau check, another person had brought their Criminal Records Bureau from a previous employer. The home had also employed an administration person and a volunteer, there were no checks in place for them, nor was there any records in relation to DS0000064654.V336456.R01.S.doc Version 5.2 Page 26 identity, application form or references. This practice is dangerous and put the residents at risk of abuse from staff that have not been checked out properly prior to being employed. There was little in the way of evidence of identity for each staff member, some had copies of their passports. One staff member who had a different nationality did not have any paperwork in relation to working in this country. An official letter was issued during the inspection visit detailing regulations have been breached and stating that the registered provider must respond immediately. The home has a small staffing team of eight care workers; in addition there are three senior care staff and the manager. The pre-inspection questionnaire was not returned before the visit and therefore there was no information available prior to the visit. From discussion with both staff and residents it became apparent during the inspection visit that the staffing numbers were insufficient to meet the needs of the residents. Some comments included; “the staffing levels are not good, we are struggling”, “there are not enough staff here”, “I don’t think there are enough staff on duty”. The home has two care staff on duty at all times, the manager is in addition to this. The care staff in addition to providing the care for residents also undertakes cooking and cleaning duties, the home currently does not employ specific staff for domestic duties. The cook is covering the domestic duties for two half days per week and for a home this size is proving insufficient. It was also evident from speaking to residents that they do not feel sufficient activities are offered either within or outside of the home. Staff confirmed, “we do not have enough time to spend doing activities”, “I used to be able to go out with residents, but recently we have not been able to do this”. The home currently offers 336 care hours per week and the recommended amount based on 20 low level need residents is 410.09. The home has some people who have either medium or high level needs and therefore the expected amount of care hours would increase accordingly. The home has training plan for 2007, but there was no evidence on individual staff members files that this had been implemented. When spoken to the manager was unclear about what training was planned or if the staff had completed any. During the last inspection it was identified that there were still some areas requiring development in particular specific training for challenging behaviour or difficult to hep residents, epilepsy, alcohol related illnesses. Staff confirmed that the training had improved last year, but appears to have lapsed again. “I haven’t been on any training since last year and I know some of my mandatory courses are out of date”. Supervision records were looked at and staff were spoken to, it was confirmed that supervision is not occurring on a regular basis. Some comments included, “I haven’t had supervision since the new manager started in September 2006”, “I don’t think I have had any supervision”. Staff did confirm that they could go to the manager for advice on an informal basis. DS0000064654.V336456.R01.S.doc Version 5.2 Page 27 Staff were observed interacting with the residents throughout the visit, this was done in a sensitive and caring way, speaking to residents with respect and courtesy. Residents stated, “staff are great,” “sometimes they are busy and you have to wait”. Some comments received from other professionals included; “Possibly respond to individuals needs when in crisis, possibly giving them more understanding, support and listen to them”, “the staff are very caring and supportive to both residents and visiting professionals”, “provide a safe secure environment, good supportive staff”, “staff are very helpful”. DS0000064654.V336456.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 People who use the service experience poor outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People using the service are not safeguarded; weak management, poor staffing levels and supervision affect the overall care offered. The health and safety of the residents is not always ensured, as training in key areas is not always undertaken. EVIDENCE: There has been a new manager in post since September 2006 and an application for the registered manager was received by CSCI in March 2007, this application remains ongoing. There has been little improvement and in DS0000064654.V336456.R01.S.doc Version 5.2 Page 29 some areas deterioration since the manager has been in post. All but two of the requirements made during the last inspection remain unmet. The manager herself has a BSC in Social Work and is currently working towards achieving the Registered Manager’s Award and is aiming to complete by the end of June 2007. She has had previous experience working in care homes and domiciliary care offering support to people with physical and mental health problems. She has had no previous experience in relation to the managing of a care home. The manager stated; “the registered provider keeps in regular contact over the phone and visits quite often, around two visits a month”. The manager also explained that the registered provider makes decisions without consulting her. Recently he brought a voluntary member of staff to offer support with the maintenance and domestic duties, unfortunately none of the appropriate checks had been undertaken either before duties commenced or subsequently. An official letter was issued during the inspection to make sure that no residents come into contact with any person working either permanently or on a voluntary in the home who do not have an up to date Criminal Records Bureau check, this also stated that the registered provider must respond immediately. The quality assurance system has deteriorated since the inspection and there was no written evidence that surveys had been undertaken. The system requires further development to ensure that all stakeholders are contacted for their views and an annual report produced explaining what the shortfalls are and what if any corrective action is needed. The fire officer visited the home in November 2006 and stated that the home’s fire safety procedures were satisfactory. The fire risk assessment has not been reviewed since March 2006 and as the new fire regulations came into effect in September 2006 this was an area that required addressing. Equality and diversity is promoted to some extent within the home. The residents have a range of diverse needs including mental health issues, depression, schizophrenia, anxiety disorders, alcohol and drug related issues. Several of the staff group are also from ethnic minorities giving breadth and experience to the staff group as a whole. The staff group have not received any training in relation to equality and diversity and this would promote empowerment for the residents. The health and safety of the residents is not always ensured. The water system had not recently been tested for Legionella and the bath hoist had not been serviced in the past twelve months. The staff has undertaken most of the mandatory training courses, none of the staff have undertaken infection control training and from speaking to three staff members it was apparent that they had limited knowledge in areas such as cross infection or contamination. DS0000064654.V336456.R01.S.doc Version 5.2 Page 30 All other maintenance certificates were in order and up to date. The manager stated that the registered provider is undertaking regulation 26 visits, but there was nothing in writing to confirm this. The registered provider stated that all new staff will undertake induction and foundation training that meets Skills for Care specification, but there was no evidence of this in any of the staff files looked at. DS0000064654.V336456.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 X 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 X 33 1 34 1 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 x 2 X 1 X X 1 X DS0000064654.V336456.R01.S.doc Version 5.2 Page 32 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 YA6 Regulation 14, 17 Requirement All people using the service must have an up to date, detailed care plan. This will ensure that they receive person centred support that meets their needs. (Previous timescale 1.6.06 and 21.11.06 - not met) All people using the service must have risk identified and a clear, descriptive plan in place that covers all areas in relation to individual residents and the environment. As this will ensure that risk is being managed and supported where appropriate. (Previous timescale 1.6.06 and 21.11.06 - not met) People who use the service must receive their medication in a safe way, records must be completed accurately and medication in stock must match the documentation. There is no system for refusal of DS0000064654.V336456.R01.S.doc Timescale for action 17/07/07 2. YA9 14, 17 17/07/07 4. YA20 13 17/07/07 Version 5.2 Page 33 medication and when to contact a medical professional for advice. (Previous timescale 1.3.06 and 21.11.06 - not met) 5. YA23 12,13,17,19 People who use the service must receive support from staff that have been appropriately vetted before commencing work in the home. (See standard 34) 23 Several areas in the environment require attention and renewal; people who use the service do not live in a wellmaintained and safe home. 23 People live in a home that has offensive smells and staff have not received training in relation to infection control, therefore people live in a home that is not clean or hygienic. 12,13,18,19 People who use the service must be supported by sufficient numbers of staff that ensures their needs are fully met. 17,19 People who use the service must be supported by staff who have been properly recruited and the current guidance in respect of staff commencing employment and obtain all the following information prior to them commencing work must be followed; -Two written references -A current CRB check (Previous timescale 21.6.06 – not met) 18 Staff training and development programme includes specialist subjects around mental health problems, challenging behaviour or difficult to help residents and all other mandatory training including DS0000064654.V336456.R01.S.doc 18/04/07 6. YA24 17/07/07 7. YA30 17/07/07 8. YA33 17/07/07 9. YA34 18/04/07 10. YA35 17/07/07 Version 5.2 Page 34 infection control must be undertaken to ensure that people using the service are supported by a well-trained staff group who can ensure their health and safety. (Previous timescale 1.6.06 & 21.11.06 - not met) 11. YA35 17,18 Staff must undertake the appropriate induction and foundation training that meets the Skills for Care standard and written evidence of this must be kept. This will ensure that a properly trained and skilled staff group supports people who use the service. Staff must be appropriately supported and receive regular supervision as this would ensure that people using the service receive care from staff who are properly supervised and monitored. The manager must obtain NVQ Level 4 in Management to ensure that a person who is adequately qualified runs the home. The quality assurance and quality monitoring system must seek the views of all stakeholders including people who use the service, staff, relatives and other professionals as this will measure success in achieving the aims, objectives and statement of purpose of the home and highlight areas requiring improvement. (Previous timescale 1.06.06 & 21.11.06 - not met) The registered provider must maintain records of visits to the DS0000064654.V336456.R01.S.doc 17/07/07 12. YA36 17,18 17/07/07 13. YA37 9 17/07/07 14. YA39 17, 24, 26 17/07/07 15. YA41 17,26 17/07/07 Version 5.2 Page 35 16. YA42 16,23 home in accordance with regulation 26. This will ensure that the Commission can monitor the progress made. The water system must be checked for Legionella and all equipment including the bath hoist requires servicing with records kept. This will ensure that people using the service live in a safe environment and that their health and well-being are maintained. (Previous timescale 21.11.06 – not met) The home must have an up to date fire risk assessment that has been approved by the Fire Department, this will ensure that people who use the service live in a home that is safe. 17/07/07 17. YA42 17,23 17/07/07 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 YA23 Good Practice Recommendations People who use the service should be supported by a welltrained staff group, staff should the have the opportunity to attend training around challenging behaviour and breakaway techniques as this would enhance their skills in dealing with difficult situations. The bathroom water temperatures should be monitored and distribute at or close to 43 degrees centigrade as possible and this would ensure that people using this service live in a safe environment. 2. YA24 DS0000064654.V336456.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 DS0000064654.V336456.R01.S.doc Version 5.2 Page 37 - 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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