Inspection on 21/01/08 for Bromley Road, 22a

This inspection was carried out on 21st January 2008.

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

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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bromley Road, 22a 16/08/07

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 21st January 2008 10:00 DS0000025612.V358120.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 DS0000025612.V358120.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. DS0000025612.V358120.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 Mrs Donna Esther Brodie-Brown 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) DS0000025612.V358120.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 16th August 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. DS0000025612.V358120.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced inspection that took place over one day. Since the last inspection a manager had been appointed. They had been in post since the 1st November 2007 and had worked at the home previously as the registered manager and so was familiar with the home and the service users. They were present for the inspection. The inspection also involved speaking to four service users, two of which were case tracked. None of the staff were spoken to on this occasion. Other inspection methods included inspection of care records and a partial tour of the building. This was the home’s second key inspection, the previous one having been carried out in August 2007 a result of which the home was given a quality rating of poor. The purpose of this inspection was to monitor the progress of the home towards meeting requirements and assessing if improvements had been made. The inspection identified there had been some improvement with five of the previous requirements having been met. Only two new requirements were specified at this inspection. However, three previous requirements had not been met and five have repeatedly not been met which could lead to enforcement action being taken. What the service does well: Service users spoken to were generally happy living at the home and with the support they receive from staff. One service user commented that they were happy with staff whilst another said they felt better when they spoke to staff about things. Service users are supported to make their own decisions and staff provides 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 and relationships. 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. Service users receive personal support flexibly and in the way they prefer from staff. DS0000025612.V358120.R01.S.doc Version 5.2 Page 6 The home is well maintained and provides a safe, clean and homely environment. What has improved since the last inspection? What they could do better: 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 also 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 still need to be reviewed and updated to reflect any changes where appropriate. 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. Improvements are required in the way allegations and incidents relating to adult abuse are handled with adult protection procedures being more rigorously adhered to. The way service users’ finances are managed by the home needs to be reviewed with local authorities that have supported individual service users to move into the home to ensure the arrangements in place are satisfactory and more formal arrangements for the management of their finances are not necessary. 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. The home still needs to improve quality assurance systems used to ensure that effective self -monitoring is undertaken and the home is run in the best interests of the service users. DS0000025612.V358120.R01.S.doc Version 5.2 Page 7 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. DS0000025612.V358120.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 DS0000025612.V358120.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 good This judgement has been made using available evidence including a visit to this service. Service users had access to a service user guide that provided them with all information they needed about the home. The needs of service users were fully assessed prior to moving 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 to include all the information required by regulation had been outstanding for the last four inspections. At the last inspection the service user guide had been revised. This was in an accessible format for service users with pictures and simple language being used and was found to include most of the required information but it had not addressed how individual plans were drawn up with service users and arrangements for how these were reviewed. However, prior to this inspection taking place a service user guide was sent to CSCI that had included this information meeting the stated requirement. There was also evidence within service users’ personal files that were looked at where a form had been signed by individual service users where appropriate to acknowledge that they had received a copy of the service user guide and a staff member had gone through this with them to check their understanding of its content. DS0000025612.V358120.R01.S.doc Version 5.2 Page 10 A new service user was admitted to the home in September 2007. There was evidence within the personal file that the home had obtained a full needs assessment from the referrer. There was also evidence the home had carried out its own assessment to ensure that the individual needs of the service user could be met. In addition, a six- week review of the placement with the placing authority had been held to check how it was going. The report of this indicated that it was going well. Four 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 a previous recommendation to change it to make it easier for service users to understand had not been addressed (See Recommendations). DS0000025612.V358120.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 adequate. This judgement has been made using available evidence including a visit to this service. Not all service users had a care plan in place and not all the plans had been reviewed to ensure changing needs and personal goals were addressed. Service users had been supported when required to make decisions about their lives. Service users had been supported to take risks as part of an independent lifestyle but effective risk assessments and management plans were still not in place for all service users to support this. EVIDENCE: Previous inspections have identified that care plans needed updating and had not been all been reviewed six monthly as required by National Minimum Standards (NMS) to ensure that service users’ changing needs and personal goals were addressed. Also, not all service users’ needs in particular their personal and social support needs had been detailed in sufficient detail. At this inspection four service users’ care plans were looked at. Two of the service users had care plans that were up to date. One of the plans had been written using the old format that was not accessible to service users. It had addressed some personal and social support needs whilst their health care needs had DS0000025612.V358120.R01.S.doc Version 5.2 Page 12 been detailed separately in a Health Action Plan (For further details see Standard 19). The other care plan had been drawn up in a more accessible format that had been written in simple language in the first person to make it easier for service users to understand. Pictures were also to be used although these had yet to be included. The plan was very comprehensive and covered all the individual service users’ personal, social and health care support needs. The manager reported that they were in the process of updating all the care plans using this format and had so far completed two others that were briefly looked at. This would address the previous recommendation that there should be plans in place that used a more person – centred approach. Due to the manager undertaking this process the other care plan looked at was still waiting to be reviewed and updated into the new format. Yet, concerns were raised as it was identified that the service user that had been admitted into the home approximately four months prior to the inspection whose file was looked at, that a care plan had not been drawn up with them since their admission. There were guidelines in place completed in relation to where they had been living previously but the details of these were not all still relevant. Key worker sessions had been held monthly so progress and that some of their needs had been addressed could be identified from these. However, it is essential following admission of a service user to the home that a care plan based on the assessment of need obtained from referrers and also the home’s own assessment is drawn up as soon as possible to ensure the individuals’ needs are fully addressed and progress of these can be effectively monitored (See Requirements). There was evidence that service users had been assisted when necessary to make decisions about their lives through key work sessions and notes of individual meetings held with service users, for example there was evidence in relation to one of the service users that they had been supported to look at ways and to decide how to manage their finances more efficiently. 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. Service users had been involved in setting the agenda for these meetings and individual service users had had an input in writing the minutes of the meetings. However, a previous recommendation to obtain information about independent advocacy services and make this accessible to service users had still to be addressed (See Recommendations). It had been identified at previous inspections that risk assessments that detailed all identified risk behaviours presented by service users and included measures to minimise those risks had not been adequately completed nor had they been reviewed and updated as required. At this inspection the manager reported how they were in the process of reviewing all risk assessments for service users living at the home. It was evident there had been improvements in this area with updated risk assessments with effective control measures DS0000025612.V358120.R01.S.doc Version 5.2 Page 13 specified having being drawn up for some service users. However, for other service users this was still to be addressed (See Requirements). DS0000025612.V358120.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 have appropriate relationships. The daily routines of the home were 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, nutritious and sufficiently 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. A weekly timetable of activities had also been drawn up for each service user. Inside the home one service user spoken to said that they played ‘games n’ stuff like Deal, No Deal’ with staff and that the home had purchased a new karaoke machine that they use. Outside the home records showed that service users DS0000025612.V358120.R01.S.doc Version 5.2 Page 15 were involved in a range of activities, for example one service user was attending college to do maths, English and computers, regularly attended a social club, went swimming, bowling and to bingo. Another service user had attended classes at a local education centre to do cookery, creative art and health and fitness. The service users who were both case tracked confirmed this. It was evident from records seen and also service users spoken to stated that they regularly go out within the local community, for example to go shopping, to eat at restaurants, cafes and to go to the cinema and attend church. Also, service users are supported to use public transport with two service users travelling independently. On the 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 and to have personal relationships. Relatives are able to visit the home when they would like and some of the service users spend 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. The routines of the home and the house rules do aim to promote independence. Service users, supported and encouraged 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. Some of the service users have a key to their room although others have chosen not to. Furthermore, staff interaction with service users was seen to be warm and respectful. Service users spoken to confirmed that staff do respect their privacy and knock before entering their rooms. 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 and the home had made attempts to vary the dishes for individual service users after it had been noted at the last inspection that there had been some repetition of meals. DS0000025612.V358120.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 &20 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 to ensure all service users’ health care needs were addressed had still not been updated. Staff had consistently adhered to the home’s medication policy and procedures to protect service users. EVIDENCE: The home operates a key worker system to ensure that there is consistency of support provided to service users. Service users spoken to were aware of who their key workers were and there was evidence that monthly key worker sessions had been held with service users. Service users also reported that they were satisfied with the support they had received from staff. At the last inspection it was identified that the Health Action Plans (HAP) that had been drawn up and which were aimed at detailing service users’ physical and emotional health care needs had not been reviewed and updated. Also, action to be taken to address individual service users’ health care needs specified within the plans had not always been followed, for example for one service user it had been specified they should be weighed fortnightly but this had been done monthly instead. Furthermore, although information contained DS0000025612.V358120.R01.S.doc Version 5.2 Page 17 within personal files indicated that there had been liaison with some health professionals such as GPs, psychologists and psychiatrists, it was evident that service users had not had any recent contact with primary health care services such as chiropodists, dentists and opticians. At this inspection as mentioned in respect to Standard 6 the manager was is in the process of updating service users care plans and this also included health action plans but not all had been completed. Of the four personal files that were checked, one had a health plan that had been updated. There was more evidence that appointments had been arranged for service users to see dentists, opticians and chiropodists and there was liaison with a range of other health professionals. An annual health record had been included in personal files to monitor health appointments and staff had recorded the outcome of the appointments. However, in respect to service users’ weight although it had been specified these should be done monthly records indicated this had not been carried out since September. For one service user who was case tracked it was noted that they had consistently lost weight and information within their personal records mentioned problems with their appetite and that they were not eating properly. Therefore this would have needed closer monitoring (See Requirements). In respect to medication an outstanding requirement that all staff needed to receive medication training was identified as met at this inspection. There was evidence within staff files that training had been provided by a pharmacist from Lewisham Primary Care Trust that covered the following areas; the legal framework of medication administration, the need for accurate recording, the importance of supporting service users to take medication and awareness of those medications commonly prescribed for people with learning disabilities and mental health problems. The home has a blister pack system in place and a small sample of medication records were checked that were accurate. All medication that was not in a blister pack had been audited on a daily basis to ensure stocks of medication corresponded with medication administered. None of the service users self- administered their own medication although the manager reported that measures were being taken to support one of the service users who had self -medicated previously to re- introduce them to taking responsibility for their own medication. This had been stopped for a period of time after tablets were found in their room, which they were supposed to have taken. DS0000025612.V358120.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 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 made aware of their rights to make a complaint. Service users have not fully been protected from abuse as a result of adult protection procedures not always having been followed by management although the majority of staff have now completed training in this area. EVIDENCE: The home had included information about the home’s complaints procedure in simple language and using pictures in the updated service user guide a copy of which had been issued to all service users and staff had gone through this with individual service users to ensure they understood its content. The manager also reported how a laminated copy of the home’s complaint policy was to be placed in each service user’s room to make this as accessible to them as possible. Service users’ spoken to did not have any complaints about the home and those case tracked stated that they would speak to their key worker if they had any concerns. Concerns and complaints were addressed monthly as part of key worker sessions with service users. No complaints formal or informal had been logged since the last inspection. Also, as mentioned in respect to Standard 7 a previous recommendation to obtain information about advocacy still needed to be addressed. It is also advised this information is included in the complaints policy (See Recommendations). Subject to a previous requirement that had been outstanding for the past three inspections that all staff should complete training in adult protection to increase their awareness around the different types of abuse and action to take if abuse was identified or suspected, this was identified as met at this DS0000025612.V358120.R01.S.doc Version 5.2 Page 19 inspection. Evidence was provided to CSCI shortly after the inspection that all staff had either attended a course provided by Lewisham Partnership or were due to attend. However, at the last inspection concerns were identified in respect to three adult protection issues that had occurred in which adult protection procedures had not been correctly followed by the responsible individual for the home. They had to take responsibility for the concerns due to the fact that one of the issues related to the manager who was in post at the time who was identified as having financially abused two of the service users living at the home. Although the matter was investigated and the manager was dismissed it was only reported to the police following advice from the local authority. This should have been done immediately. In respect to the other two issues, one that involved an allegation made by a service user that another service user had touched them inappropriately and the other where an ex – employee alleged another ex-employee had acted inappropriately towards a service user neither was reported either to CSCI or the local authority. Following the last inspection CSCI consulted with the local authority and the home was instructed to contact the local authority to report these matters albeit retrospectively. The home was informed by the local authority of action to be taken to address these matters. However, at this inspection it was identified the home had not fully followed all the instructions provided by the local authority. This again raised concerns about the level of understanding and awareness of those responsible for managing and running the home, specifically the responsible individual of their responsibilities in relation to adult protection and it was evident that they would benefit from attending training specifically for managers. In terms of the present manager they were not in post at the time these allegations were made and although they demonstrated an understanding of adult protection and some awareness of their responsibilities it was evident they would also benefit from attending training. There had not been any adult protection investigations required to be undertaken in relation to the home since the last inspection (See Requirements). In respect to service user finances, at the last inspection the home’s systems for managing these were identified as generally being robust. Accurate records and receipts detailing all transactions that had been signed by staff had been maintained and there was evidence that checks of the finances had been carried out three times daily at every handover, which had been noted on each individual balance sheet. Furthermore, it was reported that the responsible individual carried out random checks regularly. However, a requirement was specified as it was noted that the records kept by the manager and deputy managers who have access to a cashbox in which larger amounts of money for service users were kept and used to top up their personal allowances had not been accurately maintained. When money was transferred this transaction had to be signed for by two managers and this had not been done consistently. However, at this inspection this was identified as having been addressed. In addition, it was noted that this cashbox contained substantial amounts of money up to £500 for individual service users but it was recognised this was DS0000025612.V358120.R01.S.doc Version 5.2 Page 20 not appropriate and this was not identified as a problem at this inspection. However, due to the incident where two service users were financially abused concerns were raised at the last inspection about the appropriateness of some individual service users having responsibility for withdrawing money from their savings accounts to give to the home to manage on their behalf when they did not have capacity to fully understand their actions and the implications. A requirement was specified that this should be discussed with the placing authority of each service user to discuss the suitability of this present arrangement or whether it was considered formal financial representation was required. At this inspection, it was identified that there had been limited progress in this area. The responsible individual reported that the home was reviewing its guidelines regarding managing service users’ finances for consultation with placing authorities, which would be carried out when annual reviews took place with service users. However, this needs to be addressed as matter of priority (See Requirements). DS0000025612.V358120.R01.S.doc Version 5.2 Page 21 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 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, 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. The home was clean and hygienic on the day of the inspection and free from offensive odours. The home has appropriate laundry facilities that are sited away from the preparation of food. DS0000025612.V358120.R01.S.doc Version 5.2 Page 22 DS0000025612.V358120.R01.S.doc Version 5.2 Page 23 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): 32,34,35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was supporting staff to achieve a relevant qualification. Recruitment practices of the home had protected service users. A training plan had still not been drawn up to identify all staffs’ training needs although some action had been taken to ensure mandatory topics were completed by staff. Staff had still received regular supervision. EVIDENCE: At the last inspection it was identified that the home had not achieved the 50 target specified within National Minimum Standards (NMS) that staff should have completed a relevant qualification. Yet, it was reported that six staff had been registered to start the National Vocational Qualification (NVQ) Level 2. At this inspection it was reported that these staff had commenced the NVQ supported by the home. As a result of these staff working towards the qualification and including those staff that had already achieved one, this meant the home had now met the required 50 target. In relation to recruitment, the last inspection identified that the home’s practice had not completely protected service users by ensuring all documents required by regulation had been obtained prior to allowing staff to commence DS0000025612.V358120.R01.S.doc Version 5.2 Page 24 working in the home such as two references and appropriate identification documents. Also, gaps in employment had not been addressed. At this inspection four staff files were checked, three of which belonged to staff that had commenced working at the home since the last inspection was held. These included evidence that all necessary checks and documents had been acquired. In addition, in respect to a previous recommendation that at least two people should interview applicants in line with equal opportunities and records of this should be included in staff files, there was evidence of this having been undertaken for one of the staff that had been newly recruited but not within the other staff files checked. It is advised the home continues to take measures to ensure this is addressed as part of good recruitment practice (See Recommendations). In respect to a previous requirement that the home must ensure that a training plan is drawn up that identifies all the training needs of individual staff including training to be completed in mandatory topics such as manual handling, food hygiene, first aid amongst others as well as other specific training to meet the joint and collective needs of service users, this had not been fully addressed at this inspection. Yet, the timescale to achieve this requirement had not fully exceeded at the time the inspection was held. Although staff files that were looked at did include individual training records these had not all been fully completed to be able to identify exactly what training staff had undertaken. However, shortly after the inspection some evidence was provided to the Commission for Social Care Inspection (CSCI) that some staff had completed training in food hygiene, first aid and fire safety and in respect to specific training staff had undertaken a three- day course in ‘Working with People with Learning Disabilities’ provided by Lewisham Partnership. However, a training plan that fully outlines the training needs of individual staff had still to be completed. Furthermore, at the last inspection although newly recruited staff spoken to stated they had undertaken an induction programme organised by the home, there was no evidence within staff files to confirm this and the content of the programme. At this inspection evidence of induction for those staff that had been recruited since the last inspection was still not available. There was no documentation of completion of an induction programme included in their individual files. Following the inspection details of the programme used to induct staff was sent to CSCI. However, completion of this by individual staff needs to be evidenced. Also, at present the induction used by the home does not meet with Skills for Care specifications. The responsible individual for the home did report this was to be introduced but did not give a timescale for when this would be put in place (See Requirements). At the last inspection it was evident from records that staff had not received regular supervision to ensure they would receive at least six supervision sessions a year as specified within National Minimum Standards (NMS). At this inspection it was also evident that staff had not received regular supervision since the last inspection although since the appointment of the manager in DS0000025612.V358120.R01.S.doc Version 5.2 Page 25 November 2007 supervision for staff had begun to be carried out (See Requirements). DS0000025612.V358120.R01.S.doc Version 5.2 Page 26 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 adequate. This judgement has been made using available evidence including a visit to this service. In general the home is being managed effectively. Although the home does do some self- monitoring to maintain standards some areas still need to be improved. Overall, the health and safety of staff and service users is promoted and protected although the fire system should be serviced more regularly. EVIDENCE: As mentioned in the summary of the report the manager had been in post since November 2007. They had worked previously at the home as registered manager for five years before resigning in 2006 and have a lot of valuable experience working with individuals with a learning disability and mental health problems. The manager reported that they were hoping to start studying for the Registered Manager’s Award, NVQ Level 4 although did not have a date in place. They were also in the process of completing their application for registration, which they were hoping to submit to CSCI shortly. It has been evident in previous inspections that the home has experienced difficulties in DS0000025612.V358120.R01.S.doc Version 5.2 Page 27 making progress towards meeting requirements due to the instability of the management of the home and the manager now in post had a lot to address. However, it was noted from the rota that they were only working three days on a 9-5 basis where they were surplus to staff on duty whilst the other two days they were required to work either an early or late shift. This was discussed with the manager and responsible individual in terms of the manager having sufficient time to ensure that they were able to carry out all their responsibilities to ensure the effective day–to-day management of the home with this arrangement in place. It was reported by the responsible individual that it had been decided that the manager should have a hands-on approach with staff and be as accessible as possible. Although it is acknowledged this may be necessary due to the lack of management input and leadership experienced within the home over approximately the past eighteen months it is recommended that this arrangement be kept under review and to gain feedback from the manager to monitor progress and identify any problems (See Recommendations). At the last inspection although there was evidence that the home had drawn up customer satisfaction surveys that were issued to service users, the results of these had not been compiled in a report and this made available to those that had partaken and other interested parties including CSCI. A development plan based on the results of the surveys that outlined outcomes for service users had also not been drawn up and surveys had not been issued to professionals and relatives to gather their views of the service. This had still not been addressed at this inspection. The manager reported another survey would need to be carried out for 2008 although in terms of making improvements in relation to the way the home gains feedback in relation to self -monitoring it was reported that a Quality Action group was to be set up to include service user, relative and staff representation and this was due to start in the next month or two. Other quality assurance systems used by the home have included monthly provider visits with the reports of these visits having been regularly sent to CSCI and medication audits. In addition, the Annual Quality Assurance Assessment (AQAA) sent to the home by CSCI prior to the first key inspection in August 2007 requesting information on how National Minimum Standards have been met by the home and where and how improvements could be made to improve outcomes for service users, this was completed to a satisfactory standard (See Requirements). There was evidence that the health and safety of service users and staff had generally been promoted and protected, for example there were up to date maintenance certificates for gas safety, portable electrical appliances (PAT) and electrical wiring. There was also evidence that monthly health and safety checks had been carried out of the whole home including looking at fire safety. In respect to maintaining fire equipment this was generally up to date with fire extinguishers looked at in December 2007 although the fire alarm system was last serviced in February 2007 and this needs to be done more regularly. Fire DS0000025612.V358120.R01.S.doc Version 5.2 Page 28 drills had been carried out regularly. Water temperatures to prevent the risk of scalding had been recorded (See Requirements). . DS0000025612.V358120.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 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 3 X 3 X 2 X X 2 X DS0000025612.V358120.R01.S.doc Version 5.2 Page 30 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 YA6 Regulation 15(1) & (2) Requirement 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 timescales of 31/07/06 & 28/02/07 not met. Timescale of 31/05/07 &31/01/08 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. (Previous timescale of 31/01/08 partially met) The registered provider must ensure that a care plan based DS0000025612.V358120.R01.S.doc Timescale for action 30/06/08 2. YA6 12(1)(a) 30/06/08 3. YA6 15(1) 30/06/08 Version 5.2 Page 31 4. YA9 13(4)(b) & (c) 5. YA19 12(1)(a) 6. YA23 13(6) on the needs assessment obtained from the referrer as well as the home’s own assessment should be drawn up as soon as possible after their admission so that their individual needs are fully addressed and can be effectively monitored. The registered provider must 30/06/08 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 &31/01/08 partially met). Continued non-compliance with this requirement will lead to enforcement action being taken. 30/06/08 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. (Previous timescales of 31/01/08 partially met) The registered provider must 30/06/08 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 DS0000025612.V358120.R01.S.doc Version 5.2 Page 32 7. YA23 13(6) 8. YA23 13(6) 9. YA35 18 (1)(a) & (c) 10. YA35 18(1)(c) effectively and appropriately. (Previous timescale of 31/01/08 not met) The registered provider must ensure that those responsible for the management of the home specifically the responsible individual and the manager undertake training on adult protection to increase their understanding and awareness of their responsibilities in respect to this area. 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. (Previous timescale of 31/01/08 not met) 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 partially met. Timescale of 30/04/08 not exceeded at time of inspection but partially met). 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 DS0000025612.V358120.R01.S.doc 30/06/08 30/06/08 30/04/08 30/06/08 Version 5.2 Page 33 11. YA36 12. YA39 13. YA42 to staff is kept within staffs’ files and that the induction meets with ‘Skills for Care’ specifications. (Previous timescale of 31/01/08 not met) 18 (2) The registered provider must 30/06/08 ensure that all staff receives regular supervision (Previous timescales of 31/07/06,28/02/07, 31/05/07 &31/01/08 not met). Continued non-compliance with this requirement will lead to enforcement action being taken. 24 The registered person must 31/08/08 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 & 31/01/08 partially met) Continued non-compliance with this requirement will lead to enforcement action being taken. 23(4)(c)(iv) The registered provider must 30/06/08 ensure that all health & safety issues are addressed specifically that the fire alarm system is serviced at regular and appropriate intervals. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. DS0000025612.V358120.R01.S.doc Version 5.2 Page 34 No. 1. 2. Refer to Standard YA5 YA7 YA20 YA34 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 that information about independent advocacy services is obtained and made accessible to service users and is also included in the home’s complaints policy. 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 and kept within the relevant staff file. The registered provider should try to keep the present management arrangements specifically the manager’s hours of working under review to monitor their effectiveness and to assess if any problems arise for the day-to-day management of the home. 3. 4. YA37 DS0000025612.V358120.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Sidcup Area Office River House 1 Maidstone Road Sidcup London 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 DS0000025612.V358120.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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