Inspection on 16/08/07 for Bromley Road, 22a

This inspection was carried out on 16th August 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bromley Road, 22a 21/01/08

Bromley Road, 22a 12/07/06

Bromley Road, 22a 18/01/06

Bromley Road, 22a 20/05/05

Bromley Road, 22a 16/12/04

Bromley Road, 22a 27/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Townley Road, 2-3

Chatsworth Care - Tudor Lodge

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

CARE HOME ADULTS 18-65 Bromley Road, 22a Catford London SE6 2PT Lead Inspector Ornella Cavuoto Unannounced Inspection 16 /17th August 2007 09:30 th Bromley Road, 22a DS0000025612.V341786.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 Bromley Road, 22a DS0000025612.V341786.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. Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bromley Road, 22a Address Catford London SE6 2PT 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) 0208 6906681 020 8314 0300 Mpower Limited Care Home 11 Category(ies) of Learning disability (0), Learning disability over registration, with number 65 years of age (0), Mental disorder, excluding of places learning disability or dementia (0), Mental Disorder, excluding learning disability or dementia - over 65 years of age (0) Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. This home is registered for 6 persons of whom 6 can have a learning disability, 1 can have a learning disability and be over 65 years 6 can have a mental disorder and 1 can have a mental disorder and be over 65 years Two of the service users maybe over the age of 65 years. Date of last inspection 19th February 2007 Brief Description of the Service: 22 Bromley Road is a care home for women and men with mild to moderate learning disabilities, who might also have other support needs, such as certain mental health needs or physical impairments. The overall aim is that of providing care and to empower service users to make informed decisions, leading to fulfilling experiences. The philosophy is that of enabling ordinary living as members of the community, with equal rights and access to employment, training, recreation, housing, health and social services. 22 Bromley Road aims to achieve this by ensuring that the service is based on a thorough assessment of needs and delivered in collaboration with external agencies. Recruitment and training is targeted to enable staff to advance the rights of service users to privacy, dignity, independence, security, civil rights, and choice. The provider is an organisation named: Mpower Ltd represented by one of its directors. The day-to-day running of the home is delegated to a care manager. The premises are a large detached house. It is set back from a busy main road and has a large garden. Recent building work extended the house to provide eleven single bedrooms, 3 with en-suite facilities and to make part of the premises suitable for people using wheelchairs. At the time this inspection was held there were eight service users living at the home. One service user had moved on to live more independently in supported housing accommodation. Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over two days. The home has had ongoing problems with the management of the home. At this inspection one of the deputy managers who was recruited May 2007 was acting up as manager following the dismissal of the home manager recruited in April 2007. The acting manager and the responsible individual for the home, who is one of the directors of Mpower Ltd, were both present for the inspection. The inspection also involved talking to three service users and three of the support workers. Care records were looked and a tour of the building was undertaken. The inspection found that eight of the previous requirements had been met and although some progress had been made in respect to other previous requirements this was limited. A number of the previous requirements have been repeated over the past three inspections and it is evident that progress in these areas has been hindered due to the home experiencing an ongoing period of instability in respect to the management of the home. This needs attention. Also, action needs to be taken to address repeated requirements, as continued non-compliance will result in enforcement action being taken. Eight new requirements have been specified as a result of this inspection. What the service does well: Service users are generally well cared for and supported by staff. One service user said regarding the home, “I just like it here”. Service users are supported to make their own decisions and staff provide them with information as required to assist them in this. Staff support service users to take part in a range of activities and to be a part of the local community and make good use of local facilities such as shops, pubs, restaurants, leisure centres. Family links are maintained with service users regularly spending weekends with their families. Also service users are supported to maintain friendships inside and outside the home. Generally service users are encouraged to be as independent as possible and take responsibility for their own personal care and to take part in house hold tasks. Service users receive healthy and nutritious meals that they are involved in choosing ensuring they get to eat the foods they like. Those service users with culturally specific needs are also met although the home needs to ensure that their diet is sufficiently varied. The home is well maintained and provides a safe, clean and homely environment. Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Although some improvements had been made in respect to the service user guide some information still had to be added to ensure it met with regulation and the standards. Improvements were still needed in respect to service user plans that they should be regularly reviewed and updated at least six monthly to reflect any changing needs. There needs to be more detail included in service users’ care plans in respect to their personal and social support needs. Risk assessments need to be more comprehensive and measures to reduce risks more clearly specified. Risk assessments also should be regularly reviewed and updated to reflect any changes. The home needs to ensure that the Health Action Plans (HAP) that outline all service users’ health care needs and measures to be taken to address these are updated on a regular basis to ensure that all health care needs are met. Staff still need to receive training around medication that meets with National Minimum Standards (NMS). Although some measures have been taken some staff still need to undertake training around adult protection. Improvements are also required in the way allegations and incidents relating to adult abuse are handled with adult protection procedures being more rigorously adhered to. Improvements are required in the way service users’ finances are managed by the home. Staff need to be supported to complete the NVQ Level 2 in care qualification. An annual training plan still needs to be drawn up with staffs’ individual training needs in respect to mandatory training and more specific training to meet the individual needs of service users being assessed. The home needs to ensure that a record of the induction programme provided to newly appointed staff is kept and that it meets with ‘Skills for Care’ specifications. Staff still need to receive supervision on a regular basis. Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 7 When recruiting staff all necessary checks and documents need to be obtained prior to allowing staff to begin working within the home. The home needs to take measures to ensure the home is effectively managed. Despite some action being taken by the home improvements are still required to develop a formal and effective quality assurance system to ensure that effective self -monitoring is undertaken and the home is run in the best interests of the service user. 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. Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 &5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had updated the service user guide and made this accessible to individuals living at the home although some information was still to be added. A full needs assessment had been obtained for the service user that had most recently moved into the home. Terms and conditions had been issued to service users. EVIDENCE: A previous requirement that the service user guide needed to be updated had been outstanding for two previous inspections and had still not been addressed at the random inspection held in February 2007 although the date for compliance had not fully exceeded at that time. At this inspection, there was evidence that the service user guide had been updated. A booklet had been put together that was in an accessible format with simple language, photographs and pictures being used. Overall, the service user guide did include all the required information although how individual plans are drawn up with service users and arrangements for how these are reviewed had not been specified. This needs to be added. It was reported that the new document had been drawn up with the involvement of service users. A copy of the updated service user guide had been placed on the notice board in the dining room making it accessible to all service users (See Requirements). Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 10 A new service user was admitted to the home in November 2006. There was evidence within the personal file that the home had obtained a full needs assessment and a detailed hospital discharge summary from the referrer. There was also evidence the home can carried out its own assessment and a pre- admission meeting had been held for the service user’s needs to be discussed. At the last random inspection although it was found the home had in place a statement of terms and conditions that met with regulation and the relevant standard, this had only been issued to one service user and had not been signed. At this inspection, it was identified that for those service users whose personal files were looked at, these all contained a statement of terms and conditions and they had been signed either by the service users themselves or a relative on their behalf. However, the document is not in an accessible format and it is advised that this is addressed to make it easier for service users to understand (See Recommendations). Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7& 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All service users had a care plan in place but not all had been reviewed and changing needs and personal goals had not always been clearly addressed. Service users have been supported when required to make decisions about their lives. Risk assessments in place did not all address risks presented by service users and measures to reduce risks were not always clearly specified. EVIDENCE: Previous inspections had identified that care plans needed updating and had not been reviewed six monthly as required by National Minimum Standards (NMS). At this inspection four service users’ care plans were looked at. Overall, the care plans did cover personal and social support needs and some health care needs although in addition to the care plans all service users had a Health Action Plan (HAP) that aimed to look at individual health care needs in detail (For further details see Standard 19). The care plans had also addressed specialist requirements and aggressive and self- harming behaviour. However, areas of the care plans needed to be more detailed particularly in respect to Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 12 personal and social support needs, for example for one service user their needs in respect to their cultural background had not been addressed. For two of the service users there was additional information in place that covered areas of personal and social support in detail and there were also guidelines to support staff with addressing different areas of service users’ needs such as communication and behaviour found to be challenging but most of this information was not dated to be able to identify if it would still be relevant to the service user. One set of guidelines that was dated had been drawn up in 1998 and there was no indication if these had since been reviewed. Although two of the care plans had been reviewed, no changes had been made to the content of the care plans despite there being evidence from other information contained in their personal files that changes had taken place in respect to their care, for example for one service user who often experiences periods of confusion new guidelines had been introduced to support the service user and staff with how to manage this more effectively. Yet, this had not been reflected in their care plan. For another service user who presents with complex and challenging needs their care plan had not been reviewed and updated despite a number of changes having been introduced to manage their care, for example, due to inappropriate behaviour towards female staff it was decided only male staff should support the service user with personal care but this had not been addressed in either their care plan or a risk assessment. Subject to a previous recommendation that key work sessions should be held monthly and that staff and where appropriate service users sign the forms this had been met (See Requirements). At the random inspection held in February 2007 there was evidence that the home had obtained support plans that were person –centred and in a simple format accessible to service users. In addition, to the care plans on service users’ files these were to be completed with service users. At this inspection although one or two of the plans did contain information it was evident that these had not been completed using a person – centred approach and that staff needed training and guidance around how to complete the support plans with service users (See Recommendations). There was evidence that service users had been assisted when necessary to make decisions about their lives through key work sessions, for example there was evidence that service users had been supported to look at courses and activities they wanted to sign up for that would be of particular interest to them. In addition, minutes of service user meetings indicated that service users were involved in decisions to be made in relation to the running of the home and that their views had been listened to. However, it was identified that there was no information available to service users about independent advocacy services and it is advised this is addressed to support service users (See Recommendations). At the last two inspections it had been identified that updated risk assessments covering identified risks and hazards for service users had not been completed. Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 13 At this inspection although risk assessments were in place and the form being used was very comprehensive identified risks were not always clearly set out and control measures to reduce the risks had not always been clearly specified. In addition, the forms were not all dated to be able to identify when reviews of the risk assessments should be completed. Furthermore, at the last random inspection held in February 2007 concerns were raised as for one of the service users who presents with complex and challenging needs a risk assessment had not been drawn up since they were admitted to the home in November 2006. At this inspection, although a risk assessment was in place it did not address all the identified risks comprehensively and control measures had not been clearly specified. In addition, there was evidence within the service user’s personal file of concerns identified by a health care professional involved in the service user’s care that the home was not effectively managing the risks presented by the service user. As a result, at this inspection an immediate requirement was issued specifying the home needed to complete a comprehensive risk assessment for the service user with clear control measures detailing action to be taken by staff to reduce and manage these risks. This was addressed by the home within the timescale specified. However, this is an area that needs to be more effectively addressed by the home (See Requirements). Bromley Road, 22a DS0000025612.V341786.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have been supported to partake in meaningful and fulfilling activities and to actively participate in the local community. Service users have been supported to maintain links with family and to develop appropriate relationships inside and outside the home. The daily routines of the home are aimed at promoting service users’ independence and staff have respected their rights. Service users have been involved in menu planning and generally the meals cooked have been healthy and nutritious although for those with culturally specific needs meals need to be more varied. EVIDENCE: There was evidence within personal files from key worker notes and the individual daily monitoring books that service users have been supported by the home to participate in activities inside and outside of the home. Service users spoken to confirmed they had been involved in activities. A weekly timetable of activities had also been drawn up for each service user. Inside the Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 15 home service users spoken to said they had been involved in cookery sessions, to play board games; one service user stated “Staff play games with us” and to exercise, for example by playing football in the garden. Other activities included on the weekly timetable in place included aromatherapy sessions and for one service user that has sensory equipment in their room they have a weekly sensory session. Outside the home, some of the service users had recently attended a summer scheme at a local activity centre that service users mentioned they had enjoyed. They have also had opportunities to go bowling, which took place during the inspection, one service user regularly attends the gym and another attends a local day centre where they are involved in a range of different activities. In addition, the home has organised for service users to enrol to do a range of classes at local centres that they have been involved in choosing. These are due to begin in September 2007 and include cookery, computer, pottery, music woodwork, dance, health and fitness amongst others. Service users spoken to stated that they regularly go out within the local community, for example to use the shops, to go out and eat at restaurants and cafes, to play bingo and attend the hairdressers. On one day the inspection was held some service users went out to the local pub and they stated they would often go there. Service users have been supported to maintain contact with family members. There was evidence of relatives being invited to and having attended house meetings and regularly visiting the home as well as service users spending weekends at home with their family. One service user has been in a long -term relationship and this continues to be supported by the staff team. There was also evidence within individual care plans where it has been identified that support is needed for service users to socialise with others to be able to develop relationships. The routines of the home and the house rules do aim to promote independence. Service users, supported by staff, are involved in household tasks such as cleaning and tidying their rooms, which was observed during the inspection. There is freedom of movement and individual choice. Service users were able to choose how they spent their time whether to spend time alone in their rooms or to be in the company of others. One service user has a key to their room although others have chosen not to. Furthermore, staff interaction with service users was seen to be warm and respectful. However, at the last key inspection held in July 2006 service users spoken to reported that staff did not always knock before entering their rooms or wait for permission to enter. This was again reported as a problem by service users at the random inspection held in February 2007 and whilst the inspector was sat talking with a service user in their room, a staff member walked in with their evening meal without knocking on the door. Yet, at this inspection service users spoken to stated that staff did respect their privacy and always knocked before entering their rooms. Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 16 In respect to meals it was reported that a menu is drawn up for the week in which service users are consulted. Service users also help with the weekly shop. This was confirmed by one of the service users spoken to. The menus were inspected and these did indicate that meals provided were generally healthy and nutritious. Service users spoken to also stated they liked the food and got to eat what they like. For individuals with culturally specific needs these had been met by the home although it was identified from the daily monitoring sheets that there was a lot of repetition of foods with one service user being given the same meal up to four times in one week. This was also identified as an issue at the last key inspection held in July 2006 although at the random inspection held in February 2007 there had been an improvement in this area. It was reported that the meals that had been provided were what the service user prefers to eat and relatives would bring food prepared from home that would often consist of the same meal. However, it is advised that this is discussed with the family and more variation of meals are provided whilst still ensuring their cultural tastes are met (See Recommendations). Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 &20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have been flexibly supported with personal care. Records indicated that not all the health care needs of service users had been met. Generally, staff had adhered to medication policies and procedures to protect service users but staff have yet to receive an adequate level of training in respect to medication. EVIDENCE: The home operates a key worker system to ensure that there is consistency of support provided to service users. Service users reported they were satisfied with the personal support they receive from staff and confirmed they are encouraged to do as much for themselves as possible, for example two of the service users spoken to confirmed they choose their own clothes. All service users were observed as being dressed appropriately and of neat appearance. In respect to health care needs, all service users had Health Action Plan (HAP) in place that aimed to detail all service users’ physical and emotional health care needs and measures to be taken to address these. However, although dates for reviews of the plans had been specified these had not been Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 18 completed. Consequently the information within the plans had not been updated to indicate whether needs had been met. In addition, where the plans had specified action should be taken to address individual service users’ needs this had not been done; for example for one service user it was included in their health action plan that they should be weighed fortnightly but this had been done monthly instead. There was some evidence within personal files such as from key worker notes and other information contained within the files that some areas in relation to service users’ physical and emotional health needs had been met including involvement of health professionals such as the GP, psychologist, community psychiatric nurse (CPN), and that service users had been supported to attend their scheduled appointments with the mental health team to see the consultant psychiatrist. Yet, apart from one service user where it was identified that they had seen a chiropodist and that another service user had been to the dentist, overall there was no information available that indicated these or other service users’ had had any recent contact with primary health care services such as opticians, dentists and chiropodists. This needs to be addressed. Furthermore, despite a form for professional visits being included within one of the service user’s file this had not been completed. However, it is advised that where service users have contact with health professionals or attend appointments these are recorded on a separate form within the file making this information more accessible and the progress made in relation to the areas identified in the HAP easier to monitor (See Requirements & Recommendations). A sample of medication records were checked and these were all found to be accurate. The home has a blister pack system in place but all medication not in the blister packs had been checked daily to ensure stocks corresponded with medication administered. Records had also been maintained for medication being checked in and out when service users had gone on social leave and fridge temperatures for cold storage of medication and room temperatures where medication was stored had been checked and recorded and were both were within the recommended ranges. In respect to a previous requirement that all staff should receive medication training this had been partially met. At the last key inspection held in July 2006 there was evidence that staff had completed module one of a medication course that provided basic administration training provided by Lewisham Partnership but they were all due to attend module two. However, at the random inspection held in February 2007, it was reported that medication training would be provided in house by one of the directors who is a qualified nurse and NVQ Assessor. At this inspection, it was found the home had recruited a number of new staff and staff files checked apart from one for those staff who were newly recruited did include evidence that they had received an induction in medication. However, staff still need to receive more formal accredited medication training as specified within the NMS (See Requirements). Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints had been logged and dealt with appropriately and service users have been provided with opportunities to raise their concerns. Service users are not presently being fully protected from abuse, as adult protection procedures have not been adhered to and not all staff have received training in this area. EVIDENCE: Subject to a previous requirement that the home needed to ensure all complaints both informal and formal were logged and appropriately investigated and responded to, this had been met at this inspection. The complaints log maintained by the home was checked and two complaints had been recorded; one was an informal complaint from a service user about a comment that emerged to be a misunderstanding. The other complaint was a formal complaint from relatives of one of the service users living at the home concerned that they did not have enough activities in place and also that some of their support needs were not being adequately met by the staff at the home. Both complaints had been appropriately addressed. None of the service users spoken to raised any concerns or complaints about the home. It was noted that complaints are addressed as part of key work sessions with service users giving them a regular opportunity to raise any concerns. However, as mentioned in respect to Standard 7 the home does need to obtain some information about independent advocacy support and make this accessible to service users. Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 20 Subject to a previous requirement that all staff must complete adult protection training this had been partially met although the timescale for compliance had not been fully exceeded at the time the inspection was held. It was reported that POVA (Protection of Vulnerable Adults Training) had been organised for staff and this had been accessed through Lewisham Partnership. Two of the support workers spoken to, confirmed that they had undertaken this training and there was some evidence other staff had completed this training but for some staff that it was reported had attended the course there was no evidence available to confirm this (See Requirements). In respect to adult protection issues there have been two incidents that have had to be reported to social services under adult protection procedures since the last inspection. The first incident was the result of the last random inspection held in February 2007 in which a service user made a number of allegations about staff, two of whom had since left the employment of the home; that they had been hit, pushed to the floor and their personal property had been broken amongst others. At the time the allegations were made, two of the directors stated that the service user often suffers from periods of confusion at which times they have been known to make allegations against service users and staff. Although there was some evidence within the service user’s personal file to confirm this, it was considered that due to the gravity of the allegations the placing and host authority should be informed. This was done by the inspector immediately following the inspection. At this inspection it was identified that the home had not been required to carry out a full investigation. It was reported that an independent advocate had been brought in by the home to talk to the service user about the allegations and they identified no concerns but there was no evidence of this. Despite the advocate stating they would send a report this was not done and the home did not follow this up. The placing authority only recently carried out a placement review almost five months after the allegations were initially made and were reported. This found everything to be satisfactory and the allegations were cited within the report of the review as ‘overruled’. The second incident reported to social services under adult protection procedures involved the manager of the home whom it was identified had stolen money from the personal accounts of two of the service users living at the home. The manager who admitted to committing the theft on being questioned by the directors of the home was immediately dismissed and although the matter was reported to social services, concerns were raised with CSCI that action had not been taken by the home to report the incident to the police straight away. This was only done following advice from social services. It was reported at this inspection that the manager had left the country but would be arrested straight away on their return by police and charged for the offence. A referral for the manager’s name to be included on the Protection of Vulnerable Adults (POVA) list to alert other agencies of their unsuitability to work with vulnerable people had been completed by the home. However, also at this inspection two further adult protection concerns were identified, neither Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 21 of which CSCI had been informed and no action had been taken to report these to social services. One of the concerns involved an allegation made by a service user that another service user had touched them inappropriately and the other involved allegations made by an ex-employee that another exemployee had behaved inappropriately towards service users. Both matters were reported to social services after intervention from CSCI. However, the lack of action taken by the home in respect to these concerns and also that there had been failings in respect to the other adult protection matters; that the home had not secured the report from the advocate and had not immediately contacted the police raises serious concerns about the level of understanding and awareness of those responsible for managing the home about adult protection procedures. Action needs to be taken to address this to ensure that procedures are accurately followed to safeguard the service users living in the home (See Requirements). In respect to service users’ finances, for the two service users whose money was stolen alternative ways of managing their money was being looked into, for example for one of them a relative had decided to apply for court of protection whilst for the other service user the responsible individual was talking to the family to look at options in which they would take responsibility for the management of their finances, for example it was reported that one option being discussed was that the responsible individual would become a trustee of their account. However, this was not considered to be a suitable arrangement. In relation to the system used by the home to manage other service users’ finances it was identified that some changes and improvements were required. At present the home takes responsibility for safekeeping service users’ savings books and for managing their personal allowances. The home has a cash box in which larger amounts of money for service users withdrawn from their savings are kept and to which only the acting manager and the deputy manager have access. This is locked and kept in a locked cupboard. Money is used from this cash box to top up service users’ personal allowances, which are kept in a separate cash tin. When monies are removed from the cash box to top up the personal allowances both the acting manager and the deputy manager are required to sign for this but it was noted that this had not been done consistently. In addition, the cash box contained substantial amounts of money up to £500 for individual service users. It was reported that this had been recognised as not being appropriate and that the amounts of money kept for service users within the home were to be considerably reduced and limited to a specific amount. This will be checked at the next inspection. In respect to service users’ personal allowances the home had maintained accurate records and receipts detailing all transactions that had been signed by staff. The allowances are checked three times daily at every hand over which is noted on each individual balance sheet. In addition, the responsible individual carries out random checks on all the finances. A sample of service users’ finances were checked and these were all found to be in order. However, concerns were raised about the appropriateness of service users’ having responsibility for withdrawing money from their savings accounts to give to the Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 22 home to manage on their behalf when they did not have capacity to fully understand their actions and the implications. This clearly makes them vulnerable to abuse albeit that the home has effective systems in place for managing finances. This needs to be addressed with the placing authority of each service user living at the home to discuss with them the suitability of this arrangement and whether more formal arrangements to manage their finances should be put in place (See Requirements). Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26 &30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a homely and comfortable environment that is well maintained. Service users’ bedrooms meet their needs with all the required furniture and fittings. The home was clean and hygienic. EVIDENCE: The home is a large spacious detached house that is set back from a busy main road. It is suitable for it’s stated purpose and was extended to provide eleven single bedrooms, 3 with en-suite facilities and to make part of the premises suitable for people using wheelchairs. The home has ample of communal space with a large well -maintained garden that is accessible by a ramp. Overall, the home is decorated and furnished to a high standard and is well maintained. Since the last inspection the home had recruited a maintenance person to ensure the upkeep of the home. Service users bedrooms are all large and spacious include all the required furniture and fittings and were all personalised. Subject to a previous Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 24 requirement that the chest of draws for one service user needed to be repaired this had been done. The home was clean and hygienic on both days that the inspection was held and free from offensive odours. The home has appropriate laundry facilities that are sited away from the preparation of food. Bromley Road, 22a DS0000025612.V341786.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): 32, 33,34 35 &36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had not met the required target that 50 of staff team need to be qualified but measures have been taken to support staff to achieve a relevant qualification. There were sufficient staff working at the home to support service users. The home’s recruitment practices have not fully protected service users. A training plan had still not been drawn up to fully identify training needs of staff and there was a lack of evidence that staff had received an induction that meets with NMS. Staff had not received regular supervision. EVIDENCE: At the random inspection it was reported that 46 of support staff had completed a National Vocational Qualification (NVQ). At this inspection it was identified that three of the bank staff working at the home had completed a NVQ and one of the support workers had a qualification of a higher level than NVQ. Other staff working at the home did not have a relevant qualification although it was reported that six of the support workers were due to start the NVQ Level 2 supported by the home. Completion by staff would ensure the home meets the required target as specified within NMS that 50 of staff should be suitably qualified (See Requirements). Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 26 It was evident through observation and also by inspection of the home’s rota that there were sufficient staff working at the home to ensure the needs of the service users were met. Three support staff are on duty during the morning, afternoon and evening shifts and two waking staff are on during the night. In respect to recruitment seven staff files were checked that belonged to staff that had been employed to work in the home since the last inspection. Although all the files contained an up to date Enhanced Criminal Bureau (ECRB) check, it was found that for one staff member only one reference had been obtained, for two staff there were gaps in their employment and there was no evidence that these had been discussed with the staff members in question and the gaps accounted for. Also, in one of the files appropriate identification could not be identified. Furthermore, evidence indicated that one person only had interviewed staff, as there was only one written record of the interview on file. In line with equal opportunities at least two people should interview applicants and both should record the process to ensure it was carried out fairly and without discrimination (See Requirements & Recommendations). At the previous two inspections it had been identified that the home had not drawn up a training plan to identify all the training needs of staff and that staff had gaps in mandatory training topics such as infection control, food hygiene, first aid amongst others. At this inspection a training plan had still not been drawn up despite the home having recruited a number of new staff. There was some evidence within staff files that included individual training forms that had listed that some staff had completed some mandatory training in areas including first aid, food hygiene and fire safety although there were no certificates in place for these courses and it was unclear if these had been completed in-house or externally via Lewisham Partnership. Also, not all staff had completed training in these areas. Some staff files included certificates of training such as food hygiene that they had completed prior to being employed by the home, which were still valid. However, all gaps in mandatory training need to be identified and accredited training for staff organised. There was no evidence that any specific training had been completed by staff although some staff had attended a three day ‘Introduction to Working with People with Learning Disabilities’ course provided by Lewisham Partnership. Concerns were raised during the inspection as it was identified that not all staff felt confident about addressing the behaviour of one of the service users that could be very challenging and it was evident that specific training was required. In respect to induction staff spoken to did confirm they had been inducted. One staff member reported that they had received a four day induction in which they had no contact with service users and they were given training in fire safety and first aid, became familiar with individual care plans and service users’ needs and also policies and procedures. However, there was no evidence included in staff files that the induction had been completed, what had been Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 27 involved or that Requirements). it met with Skills for Care specifications (See It was evident from staff files that staff had not been in receipt of regular supervision since the last inspection and although the acting manager had begun to organise supervision with staff they would not have received sufficient sessions for the year as specified within NMS (See Requirements). Bromley Road, 22a DS0000025612.V341786.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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There has been ongoing instability in respect to the management of the home, which has had an overall negative impact on the running of the home. Some measures had been taken to complete surveys as part of self- monitoring but improvements are still needed in this area. The health, safety and welfare of service users have been protected and promoted. EVIDENCE: The home has been without stable management since the registered manager resigned in April 2006 following a long period of sickness. Since this time the home has recruited two managers, one that was employed in October 2006 left after only a few weeks in post whilst the other manager as mentioned in respect to Standard 23 was dismissed after only being in post for approximately two months. Neither manager underwent the process to become registered. Since the manager’s post became vacant the deputy manager who Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 29 was recruited at approximately the same time as the manager of the home has been acting up in the position since June 16th 2007. The deputy manager does have relevant experience having worked with people with learning disabilities. Also, they had just completed the NVQ Level 3 and reported that they were intending to commence the NVQ Level 4, Registered Managers Award (RMA) in due course. However, it was evident that they had limited management experience and would need to receive a lot of support initially. The home also has a second deputy manager who has acted up as manager previously. They have worked at the home for many years and are very familiar with the service users. In discussing the management situation of the home with the responsible individual they were not clear as to whether or not the deputy manager would be permanently recruited to the post and put forward for registration. Yet, given the instability the service has experienced and it was evident from the inspection that the home has found it difficult to progress in areas without a manager in post that measures need to be taken to ensure the effective management of the home (See Requirements). At the random inspection held in February 2007 there was evidence that the home had drawn up customer satisfaction surveys but these were still to be issued to service users, relatives or professionals. At this inspection, some evidence was seen that these had been completed with service users but there was no evidence of surveys issued to relatives and professionals and the results of the surveys had not been compiled in a report and made available to those that had partaken as well as to the CSCI. A development plan based on the results of the surveys that outlined outcomes for service users had also not been drawn up. In respect to monthly provider visits as part of quality assurance these had been regularly carried out and copies of the reports had been sent to the CSCI (See Requirements). In respect to health and safety all the areas identified at the last inspection that required attention had been addressed at this inspection; the home had a detailed fire risk assessment in place, monthly health and safety checks of the building had also been completed. Water temperatures had been checked and recorded and prior to the inspection taking place an up to date electrical wiring certificate had been sent to the CSCI. In respect to fire drills this was not checked at this inspection and will be carried over to the next inspection. All other areas relating to the health and safety of the home were found to be satisfactory. Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 X 3 3 4 X 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 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 1 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 2 2 X 1 X 2 X X 3 X Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5 Requirement The registered provider must ensure each service user is provided with a service users guide to the home. The information to be up to date and to include all that is required by the relevant standards and regulations. (Previous timescales of 01/08/05, 31/05/06& 28/02/07 not met. Timescale of 30/04/07 partially met). Continued non-compliance with this requirement will lead to enforcement action being taken. The registered provider must ensure that service user plans are regularly updated and reviewed at least six monthly. Also that individual plans are signed by service users, their relatives or a representative where appropriate to evidence their involvement in the planning of their care and goals that are identified with them. (Previous timescale of 31/07/06 & 28/02/07 not met. Timescale of 31/05/07 DS0000025612.V341786.R01.S.doc Timescale for action 30/11/07 2. YA6 15(1) & (2) 31/01/08 Bromley Road, 22a Version 5.2 Page 32 3. YA6 12(1)(a) 4. YA9 13(4)(b) & (c) 5. YA19 12(1)(a) 6. YA20 13 (2) partially met). Continued non-compliance with this requirement will lead to enforcement action being taken. The registered provider must ensure that the personal and social support needs are addressed in detail within all service users’ care plans to ensure their needs in these areas can be fully met. The registered provider must ensure that all service users have a comprehensive risk assessment in place that is reviewed and updated on a regular basis. Also that when service users are undertaking activities such going on holiday risk assessments are completed to ensure their safety and well being. (Previous timescale of 31/07/06 & 28/02/07 not met. Timescale of 31/05/07 partially met). Continued non-compliance with this requirement will lead to enforcement action being taken. The registered provider must ensure that all the health care needs of service users are fully addressed by keeping the information contained within the health action plans updated and action to be taken in respect to service user’s health care needs specified within the plans is fully implemented by staff. The registered provider must ensure all staff that administer or handle medication have formal training in medication use, control and administration. (Previous timescale of 01/08/05 partially met. DS0000025612.V341786.R01.S.doc 31/01/08 31/01/08 31/01/08 30/04/08 Bromley Road, 22a Version 5.2 Page 33 7. YA23 13(6) 8. YA23 13(6) 9. YA23 13(6) 10. YA23 13(6) Timescale of 31/07/06 not met. Timescale of 28/02/07 partially met). Continued non-compliance with this requirement will lead to enforcement action being taken. The registered provider must ensure that all staff receives training in adult protection. (Previous timescale of 31/07/06 partially met & timescale of 28/02/07 not met. Timescale of 31/08/07 not fully exceeded at time of inspection but had been partially met). Continued non-compliance with this requirement will lead to enforcement action being taken. The registered provider must ensure that where matters arise related to adult abuse or allegations are made about abuse that measures must be taken in line with adult protection procedures so that the issues are dealt with effectively and appropriately. The registered provider must ensure that measures are taken to review the present financial arrangements in place for service users with the relevant placing authorities to establish that the present arrangements are adequate to fully safeguard service users from potential financial abuse. The registered provider must ensure that all procedures in respect to the handling of service users’ finances are adhered to, specifically that two managers sign when money is transferred to top up service users’ personal allowances. DS0000025612.V341786.R01.S.doc 30/04/08 31/01/08 31/01/08 31/01/08 Bromley Road, 22a Version 5.2 Page 34 11 YA32 18 (1) (c) 12. YA34 19 & Sched 2 13. YA35 18 (1)(a) & (c) 14. YA35 18(1)(c) The registered provider must ensure that all staff are supported to achieve the NVQ Level 2/3 qualification to ensure the home meets the required target of 50 of staff being qualified. (Previous timescale of 31/10/06 & 30/04/07 not met. Timescale of 01/12/07 not exceeded) New date for compliance set. Continued non-compliance with this requirement will lead to enforcement action being taken. The registered provider must ensure that all documents and information as required by regulation are obtained prior to allowing staff to commence working in the home. The registered provider must ensure that an annual training plan is drawn up and that all staffs’ individual training needs are assessed including those for mandatory training and specific training to ensure that the individual and collective needs of service users are met. (Previous timescale of 31/07/06 not met. Timescale of 31/08/07 not fully exceeded at time of inspection but was partially met. New date for compliance set). Continued non-compliance with this requirement will lead to enforcement action being taken. The registered provider must ensure that a record of the induction programme provided to staff is kept within staffs’ files and that the induction meets with ‘Skills for Care’ DS0000025612.V341786.R01.S.doc 30/04/08 31/01/08 30/04/08 31/01/08 Bromley Road, 22a Version 5.2 Page 35 specifications. 15. YA36 18 (2) The registered provider must ensure that all staff receive regular supervision (Previous timescales of 31/07/06,28/02/07 & 31/05/07 not met). Continued non-compliance with this requirement will lead to enforcement action being taken. The registered provider must ensure that suitable arrangements are made for the effective management of the home. The registered person must ensure that the quality assurance systems for the home are developed. An effective system where service users ‘ views underpin all self-monitoring, reviews and development of the home. (Previous timescales of 1/10/05 & 31/10/06 not met. Timescale of 30/04/07 partially met) Continued non-compliance with this requirement will lead to enforcement action being taken. The registered provider must ensure that all health & safety issues are addressed including: - Fire drills are regularly carried out. (This is not a repeated requirement. Not checked at this inspection. New date for compliance set). 31/01/08 16. YA37 8(1) 31/01/08 17. YA39 24 31/01/08 18. YA42 23(4)(e) 30/11/07 Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 36 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA5 YA6 Good Practice Recommendations The registered provider should try to draw up an accessible format for the statement of terms and conditions so that it easier to understand for service users. The registered provider should try to ensure the ‘support plans’ that are in an accessible format are completed with service users and that staff receive training on how these should be completed using a person -centred approach. The registered provider should try to ensure that information about independent advocacy services is obtained and made accessible to service users. The registered provider should try to ensure that those service users living at the home with culturally specific needs in respect to food receive a varied diet. The registered provider should try to ensure that two people are always present when prospective staff are interviewed and a record of the process is recorded by both interviewers. 3. 4. 5. YA7 YA17 YA34 Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Bromley Road, 22a DS0000025612.V341786.R01.S.doc Version 5.2 Page 38 - 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. 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