Inspection on 26/05/06 for Bursted Houses

This inspection was carried out on 26th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bursted Houses 30/10/08

Bursted Houses 01/11/07

Bursted Houses 16/01/06

Bursted Houses 17/03/05

Bursted Houses 09/09/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Bursted Houses 227-235 Erith Road Bexleyheath Kent DA7 6HZ Lead Inspector Lorraine Pumford Key Unannounced Inspection 26th May 2006 10.00 Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 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 Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 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. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Bursted Houses Address 227-235 Erith Road Bexleyheath Kent DA7 6HZ 020 8331 5196 020 8331 5196 s.ashburn@mcch.org.uk 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) MCCH Society Limited Mrs Susan Ashburn Care Home 25 Category(ies) of Dementia (2), Learning disability (25), Learning registration, with number disability over 65 years of age (5) of places Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Maximum number of service users accommodated at any one time should not exceed 25, of which 5 may be over 65 years of age. 16th January 2006 Date of last inspection Brief Description of the Service: Bursted Houses is run by Maidstone Community Care Houses (MCCH) and offers accommodation for adult service users with a learning disability. It is made up of four self-contained properties, three of which are bungalows and one a house with stairs. These properties are laid out within a quiet cul-de-sac facing each other. Each house is staffed independently and caters for service users with differing needs. One house caters for service users with particularly challenging behaviour, another house is staffed to care for those service users who are older with greater physical care needs and require a quieter environment in which to live. The remaining two properties, one houses all men and the other accommodates both men and women with complex needs. The home has also recently varied its registration to include dementia and has developed a small unit to care for two service users. This has affected the amount of communal space in one of the homes. Each house has domestic style facilities, such as a kitchen, dining area, lounge, bathrooms and toilets. The management responsibility for Bursted Houses rests with the Registered Site Manager who has an office adjoining one of the houses on the site. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by two inspectors, who spent a total of 21 hours on site over a two day period. The inspectors spoke with the recently appointed manager who had been in post a week, five members of staff were interviewed in private and a number of staff were spoken with additionally during the course of the inspection, information they contributed has been incorporated into this report. The majority of service users accommodated have disabilities which impede their communication however, where possible, comments made by them have also been included. Family members were contacted for three service users and their comments have also been included. During the course of the inspection some documents and record specifically relating to the care of five service users were examined. A tour of the houses was also undertaken. Fees for the service provide are currently £1003.00 What the service does well: Risk assessments are in place that safeguard service users and promote their independence. Service users are freely able to access their own care plans. Staff were seen to promote service users choice and decision-making. Procedures are in place that protect service users finances. Service users are enabled to maintain contact with family and friends. The home operates a key worker system and staff clearly understand the additional responsibility of this role. The majority of staff were seen to assist service users in a calm unrushed manner, which respected service users privacy and dignity. It was evident that care staff provide support to service users to enable them to attain an individual and personal identity. Service users are provided with appropriate community health care support. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The Service User Guide and Homes Statement of Purpose need to be updated to reflect the change of manager in the home. The Statement of Purpose should cover the whole registered service; the current practise of one per house is misleading for people unfamiliar with Burstead Houses. A contract underlining both partys rights and responsibilities, including the fees charged must be provided to safeguard service users accommodated. The care plan format needs to be reviewed to provide clear guidance for staff on how to meet individual service users assessed needs. Information regarding service users must be stored appropriately to protect their confidentiality. A record of food provided to service users needs to be maintained to provide written evidence that all service users are provided with a varied nutritional diet. Records need to be maintained to provide evidence that service users are provided with appropriate leisure and social activities. There needs to be clear written policies and procedures regarding both parties responsible for the funding of service users holidays. A number of issues arose in relation to storage, recording and training of staff in relation to medication practises. Action needs to be taken to ensure service are provided with a safe, clean, and well maintained environment, particular action must be taken to ensure a safe hot water temperature. The responsible person needs to ensure they can provide evidence, that robust recruitment procedures are in place to protect service users in the home. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 7 There needs to be effective quality assurance mechanisms in place to monitor and develop the service provided to service users. 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. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 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 Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Records need to be updated to ensure that service users and other parties are provided with current, relevant information. Service users must be provided with a contract underlining the care and service provided and both parties rights and responsibilities. EVIDENCE: The manager stated there had been no change to the service user group since the CSCI inspection in January. The records pertaining to a service user admitted in October 2005 indicated that no action has been taken to address the requirements made in relation to this admission at the time of the previous inspection. Copies of the homes of Statement of Purpose and Service User Guide were examined, at the time of the inspection the manager had only been working in the home for a short period of time, and these documents need to be updated to reflect this change of management in the home. Service users still have not been provided with a contract detailing the fees, care and service provided or the terms and conditions of occupancy. This contract must be in place to safeguard the rights of service users Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 10 accommodated and to clearly establish both parties rights and responsibilities with regards the care and service provided. Following the inspection the Area manager was contacted, it was positive to hear that contracts are currently being prepared, photographs of the service users and accommodation will be included in the contract format, therefore making it more user friendly for the service users. Following the inspection a copy of the Statement of Purpose for House 233 was forwarded to the CSCI, although this document provided comprehensive information regarding the care and service provided in the house, it is misleading as the general information and description of the environment could lead the person reading the document to believe there is only one property on the site, when in fact 233 is one of a number of properties situated on the same site. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 Quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. Risk assessments are in place that safeguard service users and promote their independence. The care plan format needs to be reviewed to provide clear guidance for staff on how to meet individual service users assessed needs. EVIDENCE: A number of issues arose in relation to service user care plans examined. Files seen included an assessment of daily living; guidance on the resident’s needs in written and pictorial form and risk assessments. However, these were assessments only and this information should have been used to formulate detailed care plans, providing information for staff on action to be taken by them to meet the service users assessed need. Risk assessments were seen to be in place for all service user files, including moving and handling, use of transport and activities outside of the home etc. Staff stated that the MCCH care review process is for each persons care to be reviewed monthly, six monthly and annually at the time of their birthday, Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 12 however it was not possible to ascertain from records seen in house 233 or 235 that care plans along with risk assessments were being regularly reviewed according to these guidelines. Not all the information regarding the service users is collated in their personal file, for example service users weight was being recorded in an alternative book in house 235. Records in houses 227/229 were more up-to-date with evidence of monthly update by service users key workers. All care plans seen were bulky and contained information no longer current, for example information regarding service users GP appointments in 1997 to 1999. All care plans would benefit from archiving, which would enable staff to have easy access to relevant current information. The inconsistency of records maintained by staff in each house makes it difficult to effectively audit the systems operating in each home. The inspectors were pleased to see that service users have access to their care plans, a service user in house 233 was seen reading his care plan file, made available to him while a member of staff was writing up the days events. He looked through the file on his own and at his own pace, with a staff member available if he wanted to ask anything. In house 227 a service user was keen to show the inspector his own file and pointed out pictures of himself and his family and talked about seeing his family during the forthcoming holiday. Discussion took place with the manager regarding confidentiality and the current use of the staff communication books, in house 235 it had been left out in a communal area and could easily be picked up by a visitor to the home, this book contains information regarding a number of service users, this practice is time-consuming as staff are recording information twice in the communication book and then on the service user file. Information regarding a service users intimate care needs had been left on a bedside cabinet, staff stated this was to remind night staff to update information when necessary, discussion took place with the staff member regarding the need to ensure that service users privacy and dignity is upheld at all times by ensuring that confidential information is stored appropriately. Staff were seen to promote service users choice and decision-making by offering service users the opportunity to participate in in-house activities, choice of clothing and food being prepared for lunch. Records in relation to service users personal allowance were examined inhouse 227/229 and 231. Service users benefits are paid directly into individual named personal accounts. The team leaders responsible for the dayto-day management of service users finances are the named appointee responsible for withdrawing the money when necessary from building society Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 13 accounts, written evidence was seen that the manager sanctions the withdrawal. The team leader is the only person who holds the key to service users personal allowances, these are stored individually in named envelopes, the sample examined indicated that service users personal allowance tallied with the house records. Each house has a small float which care staff are able to access so that in the absence of the team leader service users still have access to money. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. It was apparent that staff endeavour to promote service users independence on a day-to-day basis. Records need to be maintained to evidence that residents are provided with relevant social and leisure activities and a varied nutritional diet. EVIDENCE: None of the current service user group are able to participate in employment or formal education. Service users were seen to participate in local community activities; service users from one house were on a shopping trip to Lakeside shopping centre service users were also seen to accompany staff on short trips to local shops to purchase milk etc. In house 231 a service user is supported to do gardening at the home. He showed the inspector plants he has grown and has been given a chair on the patio next to his plants and a small (plastic) greenhouse. The service user pays for the gardening items (seeds etc) himself, as it’s an activity specific to him rather than a general one that other service users participate in. Evidence of Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 15 his activities was recorded in a daily diary. A service user in 227/229 was seen to be assisted by staff to water the flowers recently planted in the front garden. On the first day of the inspection service users in house 231 were enjoying an impromptu singsong, which was being led by one of the service users relatives. Discussion took place with the staff and service users in house 235, one had spent a day in Greenwich accompanied by a member of staff and his advocate, this information was recorded in his daily diary, staff stated that service users in the house went out each Monday, however there was no further written evidence of other activities taking place on a regular basis, staff agreed to record this from now. From discussion with service users, staff and relatives it is apparent that service users are supported to maintain links with family and friends. Staff in house 227/229 stated that holidays for one service user were arranged in the general vicinity of his family home to enable him to spend time with his mother, from discussion with the service user and his mother it was apparent how important this opportunity is for both of them, she also stated how appreciative she was with regards to the efforts made by staff to ensure her son maintains regular telephone contact. Discussion took place with staff in relation to service users holidays, the Service User Guide for 233 states service users are supported to take a holiday each year to a place of their choice. This may be a short break or week away. Key workers will be available to provide support and guidance to enable service users to make decisions around their choice of holiday, and support with the arrangements, however there appeared to be general confusion regarding the financing of holidays, one member of staff stated that service users pay for their own holidays and for their supporting staff. Staff claim expenses (e.g. food) from MCCH. Staff spoken to in other houses were of the opinion that service users paid for their holiday themselves and for staff to accompany them if they had the money to do so, however MCCH would pay for service users to go on holiday if they did not have the financial means to pay for themselves. This issue needs to be addressed with written guidance clearly stating both parties rights and responsibilities in relation to the funding of holidays. It was clear from observations made and through discussions with staff that whenever possible, residents’ independence is promoted and encouraged. Generally service users were seen to have ready access to all communal areas and their bedrooms. Whenever possible service users are able to hold a key to their own bedroom, a service user in house 227/229 unlocked his room to show the inspector around his bedroom. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 16 Two service users spoken with said the food was good. One said he had enjoyed his lunch. Food stocks seen were reasonable. There was a menu on the kitchen wall in 231; staff stated they sometimes deviate from this menu. From discussion with staff in the majority of houses the current practice is to record in general food provided after mealtimes, staff confirmed that records were not specifically maintained when service users had an alternative meal from their peers. Discussion took place with staff regarding the need to maintain an accurate record of food provided to service users to evidence that everybody is receiving a varied nutritional diet. The record of food provided to service users in house 235 included information regarding the main course only, staff stated that service users were becoming increasingly less active due to increased age and staff were watching service users weight. The manager agreed to follow this issue up with staff to ensure that service users were seen by their GP or dietician to ascertain if it was necessary for service users to follow a specialist diet. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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 the service. Procedures for the storage and recording of medication and the lack of protocols relating to the administration of chlorpromazine do not protect service users and staff working in the home. Service users receive personal support from care staff working in the home and appropriate professional health care and support. EVIDENCE: The home operates a key worker system, staff spoken with were able to provide the inspector with a clear picture of the additional responsibilities this entails and the way in which they provide support to service users they are responsible for. Good interaction was seen between staff and service users in-house 235, 227 /229, staff assisted service users requiring assistance with personal care in a dignified manner which respected their dignity and privacy. In house 235 staff provided service users requiring assistance with eating in a calm unrushed manner. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 18 The inspector saw two support workers in 233 sitting together on the sofa and talking with each other (social conversation), not attempting to interact with the four service users who were in the lounge with them. The inspector was present for 10-15 minutes and the care staff were still talking to each other when he left. All staff (including bank and agency) should be aware of the appropriate attitudes and skills required to meet service users’ needs. All service users seen were wearing clean, age appropriate clothing, it was evident that care staff provide support to service users to enable them to attain an individual and personal identity. Service users care plans indicated that they visit the GP when necessary and receive regular routine health checkups, they access community health care professionals such as dentists and chiropodists and opticians as and when required. In addition service users have access to more specialised health care professionals when needed. A number of issues arose in relation to the training of staff, recording and storage of medication. In house 231 a number of issues arose with regards the medication of the service user tracked. Medication stored in the plastic tray displayed a photo, however it was not dated. A persons appearance can change with not only age but also if they develop a health problem so good practise would be to ensure that the photo is dated. There was no photo on MAR sheet, a member of staff stated this was waiting to be developed. There are no written protocol for ‘as required’ medication in relation to chlorpromazine. The team leader stated staff make judgements whether to administer based on their knowledge of the service users behaviour. This is an unsafe practice as staff members views may be subjective and therefore a protocol is required to ensure consistency with regards to administering this medication. This protocol should be formulated with the assistance of appropriate health care professionals. Although there was no evidence that chlorpromazine medication had been administered to this resident a large number remained in stock. The MAR sheet indicated a total of 42 tablets had been entered by a member of staff on 30/04/2006,this was in addition to the 42 tablets counted on the 30/03/06, leading to a total of 84 tablets, this means the home is overstocking medication which is a poor and potentially unsafe practise. Staff in house 233 could not locate the protocol to indicate when the medication should be administered for a service users prescribed diazepam as required. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 19 The team leader in house 227/229 discussed with the inspectors the current practice of recording on a separate sheet details of medication, which cannot be stored in a monitored dose system. It was agreed that as all the medication details were on the printed MAR sheet from the pharmacy, this duplication was not necessary as it increased the risk of an administration error. This practice was also found to be taking place in house 235, the team leader agreed to amend the practice in this house as well. At the time of the inspection the inspector found a bag containing medication in the hallway of 235, staff stated this was awaiting collection by the pharmacy; this matter was brought to the attention of the team leader who asked staff to return the bag to a locked cupboard housing medication until collected. A number of hand written entries had been made to the MAR sheets these had not been signed and dated by the staff responsible for updating the record, two members of staff should sign hand written entries to reduce the risk of error. Hand written entries to the MAR sheet indicated that a prescribed dose has been changed to PRN. staff stated that this has been amended following advice from the service users GP, however staff were unable to locate written evidence that this was the case. Care staff were advised to take the service users MAR sheet with them to the service users GP appointments, to enable the doctor to amend and sign this record. A record of staff signatures was being maintained, this enables persons inspecting the records to undertake an effective audit. The issue of training in relation to the administration of medication was discussed with the staff who were interviewed. All members of staff spoken with stated they had received training from MCCH in relation to medication procedures. Staff stated they were supervised by a senior member of staff, who would sign them off when they were considered competent to do the task. The inspectors could not locate any certificates of competence attained by staff in relation to formal medication training by an accredited trainer. The manager stated whilst he had only been in post for a week, he had already undertaken an audit of medication in some houses and that following this, a meeting with the team leaders was to take place that afternoon to discuss his findings and follow-up on action to be taken. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. 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. Documentation must be provided to substantiate that relevant adult protection training is in place to safe guard the wellbeing of service users. EVIDENCE: The shift leader in house 231 outlined what she would do if a service or relative raised a concern or complaint. She stated she would keep a record of the incident, deal with the matter if possible or involve the manager if she was unable to resolve the issue. At the time of this inspection there was evidence in the complaints log of one complaint made by a service user in house 227/229 to the team leader, this is still under investigation. Relatives spoken with stated they were pleased with the service provided and had never had need to complain to MCCH regarding any aspect of the care or service. The CSCI has received no complaints with regard the service since the last inspection in jannuary2006. Staff spoken with stated they understood the term whistle blowing and felt they could go to the manager if they had any particular concerns. The majority of staff interviewed were able to demonstrate an understanding of issues regarding adult protection and stated they had received training in relation to this, however it was not possible to evidence this as certificates could not be located. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 21 Staff spoken with who work with service users assessed as having challenging behaviour also have additional training to assist them with managing the service users aggression. A copy of the staff induction programme was seen this did not include any information regarding whistleblowing. Verbal feed back from staff indicates that adequate training and procedures are in place with regards adult protection and whistleblowing, however no written evidence to verify this could be produced by the home. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There has been some further progress made in the redecoration and refurbishment required. However, in some areas particularly 227/229 not all service users are provided with a safe, comfortable, well-decorated or well-furnished environment. EVIDENCE: The inspector was told of plans to extend the communal space in house 231 by adding a conservatory. This would enable the lone female service user in 231 to have a separate sitting area if she chose to. Staff did not know whether this plan was to be actioned. The conservatory could also offer space for service users to receive visitors privately, as other than their bedrooms, service users do not have a place to meet visitors in private. The outdoor space for 231 is a good size, with enough seating for service users. Staff should ensure there is adequate shade for service users during the summer, for example a temporary gazebo. Adequate facilities should be provided for staff to store personal belongings whilst on duty, staff either leave them in the offices available or in service users areas. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 23 There is no office in house 231 and staff write notes etc, either on the dining room table or on a drop-down desk housed in the activities cupboard sitting on a chair in the corridor. A chair in this position obstructs service users’ entry to a communal bathroom and some of the bedrooms. House 235 is also without an office, staff have to sit in the hallway or use the dining room table. Shower room in 231 is currently being refurbished, not yet completed and therefore not currently in use. There is an open sluice situated in the shower room, which appear to have been left in situ. The inspector was told by two staff members (separately) that the sluice is used for disposing of water after cleaning floors and for washing clothes. It is not clear why the sluice was not removed while the room was being refurbished. Its continued presence means that both infection control and service users enjoyment of the shower facility may be compromised. The laundry in house 233 has a washer with sluice cycle and a separate dryer. Service users’ clothes were appropriately labelled and there was a colourcoded system for storing laundry. Staff in house 235 stated the washing machine was currently out of action and they were sharing another houses facilities, however they were confident it would be repaired that afternoon. Since the last inspection action has been taken in house 235 to replace the carpets in the lounge, dining room and corridor. Service users bedrooms were individually personalised. Each service users has a lockable draw. Staff stated that service users were provided with appropriate beds and specialised equipment such as wheelchairs, hoists and safety rails to meet their needs. A number of issues arose in relation to the condition of houses 227/229. The team leader informed the inspectors that the fire door from the lounge to the foot of the stairs had been removed by staff as one of the service users continually removed the screws from the door hinges making the door very hazardous. The team leader stated that whilst she had completed a risk assessment in relation to this the fire officer had not been consulted. The team leader and manager agreed to take urgent action to replace the door and use tamperproof screws. This was completed during the course of the second day the inspectors were in the home. The team leader stated the hall carpet had been replaced in the main entrance, however a service user has already began to damage it. The manager stated that the boiler continues to be a problem and requires frequent remedial works to maintain hot water and heating, a recent visit made by a representative of MCCH to meet the requirements of Care Homes Regulation 26 highlighted the need for the boiler to be replaced, however the manager stated no further action has been taken. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 24 Service users are at risk of harm by the temperature of hot water in bathrooms of house 227/229. On the day of the inspection a test to bath hot water taps indicated the temperature to be 50° centigrade, this is of particular concern as the care plan for one service user accommodated highlights the need for him to run a bath for himself to relieve agitation. Action needs to be taken urgently to prevent the service users from harm. Both bathrooms and upstairs toilets are in need of redecoration, the toilets in particular are not only unsightly the state of the flooring and wall panelling means that it is not possible to effectively clean the area to minimise the risk of the spread of infection. Service users at home showed the inspector their bedrooms, as far as possible staff had assisted service users to personalise their bedrooms. One service user spoken with stated that he liked his bedroom and was quite happy in the home. The lounge and dining areas are comfortably and appropriately furnished to meet the current needs of the service user group. Discussion took place regarding the opaque plastic sheeting on the door and windows overlooking the rear garden which restricts visibility and light into the room, the team leader stated this had been done to protect the privacy of service users and staff at night as one of the service users accommodated removes any curtains hanging at the windows, the perimeter fence to this house backs on to a small concealed alley where local youths congregate, climb the fence and are abusive to service users and staff. Discussion took place with the team leader in relation to replacing the existing fence, a higher fence would not only improve the overall security of the premises, but also would improve the privacy of service users and staff. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The recruitment procedures are not robust enough to ensure service users are fully protected from harm. It is not possible to evidence that staff are appropriately trained to undertake all care practises required to be carried out. EVIDENCE: The manager stated he had spent his first week in the service attempting to sort out administration issues relating to staff records, the task was proving to be problematic as he found staff files lacked the necessary information, i.e. in some instances basic information such as a staff members date of birth was not recorded. A total of five staff files were examined, none of the files seen provided sufficient evidence that sound recruitment procedures are in place to protect service users. The manager stated CRB’s are held centrally by MCCH thus were not seen; neither new staff’s CRB’s nor existing staff’s CRB numbers were available in the home, the manager said he would ask MCCH to provide them so they would be available at future inspections. Information varied on staff files. There were two references on file for one member of staff recently employed; other files either had one, or none. Indication that action had been taken to check staff identity as part of the process also varied between each file seen. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 26 There was no evidence to confirm that staff had provided evidence they were medically fit to work with the service user group. Staff spoken with stated they had completed applications, which included the names of referees, and attended a formal interview. All staff stated they had a job description and a contract of employment. All staff spoken with stated they had commenced employment initially in a supernumerary status, working along side senior staff. Staff stated they had completed an induction programme and some issues arose in relation to the format currently used. Completed documents indicated the whole induction had been completed on the same day, this included manual handling, the record should not have been signed until the person has received training by a suitable qualified person who has assessed the member of staff as competent. It is not possible for any one to fully comprehend and understand every policy and procedure in one day. Action should be taken to prioritise the information to be covered over the initial weeks and months of the new employees induction period. The document should then be signed by the employee and supervisor as each area is assessed and the new member of staff is judged as capable of undertaking the task. A member of care staff spoken with stated she had been employed within the last six months, she said as part of her induction she had been given a work book relating to care practice which she was required to complete. Her manager would then sign off when she had completed the task to a satisfactory standard. The members staff did not have her book available and the manager did not have a blank copy for the inspectors to see on this occasion. Care staff interviewed said they had completed statutory training i.e. health and safety, though it was not possible to evidence this from records seen. Although one member of staff informed the inspector she had not received manual handling training or training in relation to a hoist being used in the home, she was still undertaking both tasks on a regular basis. A number of staff spoken with had undertaken NVQ 2 training and were planning to undertake level 3 in the near future. Copies of staff training certificates were located in a large cantilever file, these were in no particular order, the only way to find certificates relating to the staff sample would be to go through every certificate in the file, therefore on this Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 27 occasion it was not possible for the manager to provide evidence that suitably qualified staff are caring for service users in the home. There was no matrix regarding staff training for the forthcoming year, staff stated that generally they were notified by head office when courses had been arranged for them. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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. There is no effective system in place for reviewing or continuously improving the quality of care provided to ensure the needs of the residents are being met by the home. EVIDENCE: As previously stated at the time of this inspection, the manager had only been working in the home for a period of a week, prior to taking up this post he had worked in a number of health and social care settings. The manager needs to submit an application for him to be registered by the CSCI, as the person responsible for managing the home on a day-to-day basis. CSCI records indicate monitoring as required under Regulation 26 of the Care Homes Regulations 2001 does not take place on any regular basis, the manager has recently received a letter indicating MCCH have now appointed a new member to undertake this task. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 29 Discussion took place with the manager regarding the action required by him to meet the requirements of regulation 24 of the Care House Regulations 2001, he stated that he was aware of this requirement and was currently preparing a format to use for completing this task. The manager was not aware of any action taken by MCCH to ascertain the views of service users their advocates or other relevant stakeholders in relation to the quality of service they provide. A relative spoken with stated she could recall having received a questionnaire from MCCH to ascertain the views in relation to the service, during the course of this telephone conversation the relative reiterated that her family are very happy with the care and service her nephew receives in the home. Staff spoken with stated they had never seen a copy of the inspection report and were only told the negative points i.e. the thing they were getting wrong and action required by them to improve the service and were surprised that inspectors always endeavoured to highlight good practise as well. Sharing the report may in the long term improve staff job satisfaction and help them to work together towards improving the service. Health and safety documentation was seen. Some documentation requested by the inspector could not be found including the gas safety certificate, electrical installation certificate, water safety, portable appliance testing. The manager agreed to locate the appropriate documentation and provide these to the lead inspector. The manager agreed to provide the lead inspector with evidence that defects shown in the previous fire contractor’s reports have been rectified. These had not been provided at the time of writing this report. Bexley Council Environmental Health Department undertook a food safety inspections on 13/05/2005 in house 223 and 28/07/2005 in house 231 and 235. House 233 has a chest freezer in the hall that was not locked. The freezer’s position is reasonable and does not obstruct traffic in the hallway, a risk assessment should be completed in relation to the freezer, if this indicates a service users could climb into the freezer, consideration should be given to providing an appropriate lock. The assisted bath in 233 had a built-in electric over-bath hoist with a service sticker 17/03/2006. The hoist was tested and found to be working satisfactorily. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 30 Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 X 3 X 4 X 5 2 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 1 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 2 LIFESTYLES Standard No Score 11 x 12 N/A 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 x 2 X 2 X X 2 X Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 32 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA5 Regulation 4 Requirement The Registered Person must ensure that service users are provided with terms and conditions of the placement. This was a requirement raised on previous inspections and remains outstanding. The Registered Person must ensure that care plans are fully reflective of the individuals needs and reviewed on a regular basis. Maintain a record of the care homes charges to service users, including any extra amounts payable for additional services not covered by those charge, in this instance the arrangements for funding of service users holidays. Maintain a record of food provided for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of DS0000038151.V291163.R01.S.doc Timescale for action 01/08/06 2 YA6 15 01/07/06 3 YA14 17 sch4 8 30/09/06 4 YA17 17 sch4 13 30/06/06 Bursted Houses Version 5.1 Page 33 4 YA20 YA2813 any special diets prepared to individual service users. The Registered Person must ensure that there are safe systems in place for the storing administration and recording of prescribed medication. 30/06/06 5 YA28 6 YA30 7 YA24 23(1)(a)(i) The registered Person shall not 30/08/06 use premises for the purpose of care home unless the premises are suitable for the purpose of achieving aims and objectives, in this instance adequate day space for the service users accommodated and room for service users to meet visitors in private action plan required 23 Appropriate sluice facilities are 30/08/06 provided to meet the needs of the service users; sound practice is in place to reduce the risk of the spread of infection. Action plan required 23 The Registered Person must 30/08/06 ensure that there is adequate heating within the houses. The boiler in House 227-229 must either be replaced or repaired to ensure it provides efficient, effective and sufficient heating. This was a requirement raised on previous inspections and remains outstanding, action plan required 23(b)(d) The registered Person must in so far that the premises is to be used as a care home ensure that it is of sound construction and kept in a good state of repair externally and internally and all parts of the care home are kept clean and reasonably decorated in this instance in relation to the bathroom and toilets in 227/229 action plan required DS0000038151.V291163.R01.S.doc 8 YA24 30/08/06 Bursted Houses Version 5.1 Page 34 9 YA34 17 & 19 The Registered Person must ensure that adequate recruitment checks are carried out on new members of staff employed. This was a requirement raised on previous inspections and remains outstanding. The Registered Person must ensure that all new staff receive moving and handling training prior to commencing as part of the staff team. This was a requirement raised on previous inspections and remains outstanding The registered Person must ensure that persons employed to work in the care home receive training appropriate to the work they are to perform. In this instance providing evidence that staff have received training in relation to medication, manual handling, fire safety, whistleblowing, adult protection and health and safety. The recently appointed manager must apply to the CSCI to be registered. The Registered Person must investigate the implementation of a system for reviewing and improving the quality of care within the home. The system must include consultation with service users. The provider must undertake a monthly audit of the service and provide a copy of their findings to the CSCI The registered Person must ensure that all parts of the home which service users have access to are so far is reasonably practical free from hazards to DS0000038151.V291163.R01.S.doc 01/07/06 10 YA42 13 30/06/06 11 YA35 35 30/07/06 12 13 YA37 YA39 8 24 30/07/06 30/08/06 14 YA39 26 30/07/06 15 YA42 13(4)(a) 30/06/06 Bursted Houses Version 5.1 Page 35 their safety. In this instance by ensuring that hot water temperatures are safe 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 3 4 Refer to Standard YA10 YA28 YA24 YA35 Good Practice Recommendations Information regarding service users should be stored appropriately to maintain service users confidentiality. Provide staff with adequate facilities to store personal belongings whilst on duty. The addition of a higher perimeter fence would enable service users greater privacy and security. The staff induction programme is reviewed and presented in a format to prioritise information for staff, so it is easier to comprehend. Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 36 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 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 Bursted Houses DS0000038151.V291163.R01.S.doc Version 5.1 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!