Inspection on 12/12/07 for Buxton House

This inspection was carried out on 12th December 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Buxton House 22/04/08

Buxton House 31/05/07

Buxton House 05/07/06

Buxton House 24/11/05

Buxton House 15/08/05

Buxton House 23/03/05

Buxton House 11/11/04

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

CARE HOME ADULTS 18-65 Buxton House 50 Barrow Road Streatham London SW16 5PG Lead Inspector Mary Magee Unannounced Inspection 12th & 21 December 2007 09:30 st Buxton House DS0000041799.V353823.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 Buxton House DS0000041799.V353823.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. Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Buxton House Address 50 Barrow Road Streatham London SW16 5PG 020 8769 9667 0208 769 9667 janet-yeboah@uku.co.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) Buxton Healthcare Ltd vacant Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th August 2007 Brief Description of the Service: Buxton House is a small registered care home. It operates from an end of terrace house on a residential road in Streatham, Southwest London. It was first registered in July 2004. It provides care and support for six people that experience mental health related conditions. There are six single bedrooms laid out over three floors, a lounge, dining room/kitchen and a conservatory. It is a short distance away from public transport facilities and the local shopping area. The home charges range from £650 to £1050 per week. Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was undertaken over two days. A pharmacy inspector examined the medication procedures. During the inspection discussions took place with the registered provider and four members of staff. Three residents met with the inspector and provided a view of the service from a resident’s perspective. A tour of the premises was conducted, all the communal areas and one bedroom were viewed. A selection of records was examined, these included personnel files for residents and staff. Case tracking was used to evaluate the service provision from the referral and pre admission process to current delivery of support. One health professional met with the inspector and gave her views of the service. A completed Quality Assurance questionnaire was completed by the registered provider and supplied to CSCI. The findings from all the above sources including discussions with staff and residents are used as evidence to inform judgements. What the service does well: What has improved since the last inspection? The service has improved vetting procedures. Following continued shortfalls in recruitment procedures at previous inspections the problems have been addressed, recruitment and vetting procedures are more thorough. Pre admission assessments are completed before an offer of a placement is made to any prospective resident. Record keeping is improving with all information of a confidential nature stored securely. Care planning shows signs of improvement, it is more person centred with detailed information recorded of care and support needs. The allocation of key workers that take responsibility for monitoring and responding to the physical and emotional needs of residents results in better outcomes for residents. Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 6 Individual’s needs are reviewed regularly and support plans tailored to reflect changing needs. Staff morale is better; there is good teamwork that ensures the welfare of the resident is paramount. What they could do better: 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. Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 7 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 Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 8 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 3 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. No resident is admitted to the home unless their needs are fully assessed first, and the home is confident that it can fully meet these needs. Contracts are in place and issued to all residents. EVIDENCE: The home admitted one new resident in recent months. A full needs assessment was completed prior to offering him a place at the home. The admission process was staggered with trail visits so that he could familiarise himself with the home and meet with residents. Essential pre admission information was received from mental health professionals. This included personal history, psychiatrist’s report, and details of prescribed medication. The manager visited the prospective resident and undertook a full needs assessment. The information recorded was very detailed and gave a good indication of the support and assistance that he required. The risks associated with the person’s mental health condition were recorded too. There are improvements to be found in how residents are supported. Three of those spoken to are finding that the home provides a stable and secure environment, they have staff present for twenty four hours that monitor their well being, also there is always a member of staff present that can help them through a crisis. The home is more relaxed and homely, this is feature that residents appreciate. Some residents have previous experiences of long-term Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 9 hospitalisation, they like the supportive environment provided and feel valued as people. Copies of contracts were seen for the new resident. According to the registered provider all residents were issued with contracts. According to information supplied the service user’s guide has been revised since the last inspection (key). Yet more changes have taken place since then in management, the guide should be revised to reflect changes to management. A recommendation is made. The new resident has settled well at the home. He told of receiving all the necessary information and coming to the home for a trail periods. He is happy that he is living at a home that is homely and pleasant. Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 10 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 8 9 10. Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The care and support arrangements including risk management in place for residents are good and ensure that they are provided with consistency and stability. Residents have autonomy, their views are respected, and they hold their own meetings to discuss issues that matter to them. Residents can feel assured that confidential information is stored appropriately. EVIDENCE: I examined the written care plans for two residents. One of these was admitted in recent months. The care plans are improved since the last key inspection. According to residents they participate directly in developing individual care plans. They are based on needs assessment now contain good detail of all the support required. Information is also included on risks that the resident may present either to himself or to others. Details are recorded on management of these risks. Residents are enabled to take reasonable risks and receive the appropriate support to do so. Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 11 Allocated key workers work with residents to plan activities, welfare and health are discussed as well as their progress. The outcome of key working sessions are written and held alongside written support plans, this information is used to inform reviews. Daily records are also maintained of the events of the day, these indicate how a resident is progressing both during the day and night, and help inform other mental health professionals. Two of the key workers were spoken to individually. They demonstrated a good knowledge of the residents’ needs, spoke of the progress and indicated how they monitor and evaluate residents’ progress. They demonstrate that they are quick to recognise any changes and how they respond to these. For some residents they are subject to discharge conditions restrictions are imposed, these are managed appropriately. An occupational therapist from the mental health team was present at the home. Her findings are that staff are good at promoting and encouraging residents to participate or access the community. Staff are sensitive to the individual needs. They recognise the importance of residents feeling included in society and work together with them to establish confidence and self esteem. According to records and information received from staff the care and support needs of residents are reviewed regularly. There was a copy of the recent CPA review. From reading review records there is evidence that the home is helping to achieve positive outcomes for residents. Examples are to be seen of residents frequenting local shops alone; these individuals initially found great difficulty in accessing any facilities areas independently. Some difficulties discussed by residents at a previous inspection are no longer an issue. The atmosphere is more relaxed and friendly and residents feel they have more ownership. They feel their views are respected and that staff consults them if staff meetings are planned that require the use of the conservatory area. Residents hold their own meetings every week and minutes are maintained of these. Residents have confidence in how confidential information is stored and managed. Residents’ files are stored securely. Only staff with passwords may access the information stored on the computer. Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 12 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. Residents enjoy living in a relaxed and flexible environment, it contributes to their overall state of well-being. Staff provide encouragement and support that takes into account individuality, capacities and strengths. Residents find that they are involved in choosing on the meals they like, they assist with purchasing and preparing the meals. EVIDENCE: Residents receive appropriate support and encouragement to engage and participate in activities both in the home and in the community. Staff are knowledgeable on facilities available in the community. Records were seen of evidence of good communication between mental health services, day activities and the home. Contributions from all others involved in supporting residents are received and contribute to reviews/CPA meetings. A new resident has quickly settled in a day service for four days a week. He enjoys it; this is reflected in a good attendance record. There is a flexible and relaxed approach, “staff are good at recognising when a resident needs more gentle persuasion to engage” was the comment received from a mental health professional. The majority of residents participate in Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 13 activities in the community. All residents are fully involved in planning a programme of weekly activities with the key worker. The majority of those activities are in the community. For some residents the capacity to engage and progression in doing so are recognised and activity plans are tailored accordingly. There are signs of progress for residents, it is evident that for some individuals accessing the local community was difficult but these have been overcome through patience and confidence building. Setbacks are acknowledged and responded to appropriately. Staff are good at encouraging and promoting the personal development of residents. They recognise and respond, acknowledging each individual’s capacity and barrier to progress. Residents do not become negative as a result of setbacks in development. Staff encourage and support, working at a pace to that considers individual feelings and capacities. The home helps residents build and maintain family relationships. Examples were seen of preparations for residents to go to family homes for the festive period. Residents choose when to be alone or in company, although residents are encouraged to use the communal facilities and not spend too much time alone in their bedrooms. Residents take responsibility for some household task that promotes independent living skills. They take turns to cook the daily supper. Some residents enjoy using their skills, for others it is training and development in learning new skills. Rules on smoking and use of illegal substances are included in the contract. Residents choose the menus in their weekly meetings. With a different resident taking the lead on cooking the main meal daily meals are altered to accommodate any last minute changes that residents may express. The food available residents find satisfactory, “some days I like the meals better than others” was the comment from a resident. All three spoken to agree that there is sufficient nourishing appetising food available. Meals according to menus and residents take into account cultural preferences and dietary needs. A homely dining room located by the kitchen is used for sharing meals. A separate fridge is available for residents to store any additional food that they like. Some residents experience issues with overweight due to medication and the food consumed, all residents are weighed regularly and changes are monitored. According to records seen and from conversations with staff delays are encountered in accessing dieticians. It is recommended that staff promote more healthy eating by introducing information and guidance to residence. Residents are empowered, they manage their own finances and collect all their own benefits. Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 14 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 21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents find that both emotional and physical health care needs are promoted. Staff recognise early changes and take necessary action to respond appropriately to these indicators. The medication procedures are improving but shortfalls are hindering progress. EVIDENCE: Residents are able to self-care, however the amount of support and encouragement required varies according to individuals. Staff are keen to promote self worth and self esteem and recognize the importance of encouraging residents to take an interest in their appearance. The physical and psychological needs of individuals are monitored, recorded and reported to relevant health professionals as the need arises. Residents are registered with local GP practice. Records are maintained of all consultations. There are also records held of appointments with psychologists, psychiatrist and community psychiatric nurses. Staff generally are knowledgeable and respond promptly to changes noticed. For one resident a chart was recommended by healthcare professionals from the mental health team. The resident records his psychological state and any Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 15 early warning signs that may affect his behavior. Care staff support him to manage this appropriately. The indications are that it is working successfully. The resident feels confident in the service, he finds that his worker works well with enabling him to manage his condition. Key worker sessions record the state of well being, some records are too brief and lack detail. It is recommended that key worker records are more detailed and give a fuller picture on individual progress. The pharmacy inspector examined the medication procedures. The following report is a result of her findings. Two requirements were made on medication at the last inspection and the quality in this area was rated as poor. At this inspection, medication administration records from October to December were inspected, together with records of receipts and return, and medication storage and stocks. An improvement was seen in some areas, all residents are receiving their medication regularly, no errors have been made, and the home is supporting one resident well to manage his medication, however the requirements have not been fully met. 7 YA20 13 (2) the registered person must ensure that appropriate arrangements are in place for safely receiving, administering and storing medication. Medication profiles to be in place for all residents. Regular audits must be completed of all medication held, this to identify any shortfalls. 30/06/07 This has not been fully met as although audits are now being done, and the audit reports from September 2007 and December 2007 were available for inspection, there are issues with the recording of received and returned medication, and a discrepancy in the number of tablets for one resident was picked up. This indicates that these audits are not effective. A recommendation from the September 2007 audit that staff receive medication refresher training has not been actioned. Medication profiles are in process but have not been completed. 8 YA20 13 (2) the registered person must ensure that medication policies and procedures are reviewed. The review must take into account how medication is managed when supplied by the mental health pharmacist. The outcome of the review must be reflected in revised safe medication procedures. 30/07/07 This has not been met, as although the Registered Provider advised that the medication policy has been updated, a copy was not available at the home for Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 16 inspection. It is necessary for the medication policy to be available at the home at all times for use by staff. Areas for improvement: A risk assessment is needed for the resident who is managing his own medication and this must be reviewed regularly to ensure his safety and ongoing compliance. Medicines transcribed onto medication administration records must be checked by a second staff member and countersigned to ensure accuracy. Amendments to the dose or frequency of prescribed medicines on medication records must be dated and initialed for trace ability. The recording of receipts is not clear, as medication administration records state none for some medicines although these are in stock. Medicines must be reconciled at the end of each month and unwanted medicines returned regularly. Records of returns must include the date of return and signatures of staff and pharmacy to provide a complete audit trail. Medication audits must include a check on the quantities of medicines in stock compared to medication records to highlight any errors in administration. Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 17 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 good, This judgement has been made using available evidence including a visit to this service. Residents have the opportunity to put forward their views and feel comfortable in raising any concerns they have. Residents are protected and safeguarded by staff that are familiar with the appropriate policies and procedures that safeguard vulnerable adults from abuse or neglect. EVIDENCE: There are improvements in how the home responds to individual complaints raised. Residents have more autonomy and feel comfortable at raising issues. Residents’ meetings are held independently without staff presence, residents feel comfortable meeting as a group and putting forward their views and suggestions. A suggestion box has also been introduced so that residents can raise issues anonymously. Minor complaints were recorded in the complaints book. It was recognised that these were responded to and addressed appropriately. All three residents spoken to are confident in the complaints procedure. In the AQAA it was identified that the home plans to adapt the complaints format and make it more concise in an easy read format. Staff received training in safeguarding people from abuse or neglect. The safeguarding adults coordinator provided this. Staff spoken to appeared knowledgeable on safeguarding adult’s protocols. Appropriate action was taken recently when an incident occurred at the home notifications were made to relevant bodies, and full investigations undertaken as required. As a result of improved recruitment procedures residents are safeguarded by the vetting procedures Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 18 Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 19 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 25 30 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Residents benefit from living in an environment that is clean comfortable and homely. Communal space is supplements individual bedroom space and enables residents to engage and socialise. EVIDENCE: The home is pleasant and clean. It is attractively decorated. A lounge, a conservatory and dining room supplement the resident’s individual space. All the communal areas are comfortable and pleasantly decorated. There are adequate numbers of appropriately located bathroom and toilet facilities. Residents also have a pleasant garden to the rear, also a terraced roof on the first floor. For residents that smoke there is a garden room at the end of the garden. One bedroom was viewed during a tour of the premises. It had been made very homely with numerous personal possessions on display. The kitchen is sited off the dining room. In it are two fridges and a freezer, one fridge is used by residents to store additional perishable items that they purchases. Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 20 A leak has reoccurred from the terraced patio on the first floor. As a result the kitchen wall underneath encountered damage including dampness to the outside wall. The leak according to the registered owner is now repaired, the kitchen wall is drying out before it is repainted. This detracts from the kitchen and will need to be attended to. A requirement is stated. Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 21 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. Residents are safeguarded by more thorough recruitment procedures. A wide range of skills and experiences and competencies is to be found among the staff team, the lack of a training and development programme restricts staff development and their ability to progress the service. EVIDENCE: It was evident that staff morale has improved since the last key inspection, also that staff are more professional in their approach and work well as a team. Residents too are complimentary on staff support and feel secure in the knowledge that staff are dedicated in their roles. Staff are kind and demonstrate empathy to residents, always encouraging and supporting residents to overcome any setbacks. An occupational therapist commented, “ They are good at maintaining the right balance and recognise the individual’s capacity”. Appropriate staffing levels are available, suitable numbers of experienced and trained staff are present on the staff team. The home has improved recruitment procedures. The recruitment files for five care staff were examined on a random visit to the service in August 2007, Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 22 appropriate documentation was available to evidence that vetting procedures were thorough. This was done to check on compliance with a Statutory Enforcement Notice issued in June 2007. The files for the other care staff were examined at the previous inspection and found to be satisfactory. No further care staff have been recruited since then other than one domestic staff member. The file for this member of staff contained all the necessary documentation. According to information supplied on the AQQA document over 50 of support workers have achieved NVQ level 2 or equivalent. One support worker is currently completing this programme. Two members of staff are qualified as an RMN. The presence of qualified nurses has enhanced the staff team. The certification was not available for one of these nurses. The registered person should ensure that copies of the certification in relation to staff qualifications is sought for staff members and held on the staff files. Support staff have received a variety of training from many external sources, this includes information on mental health conditions, challenging behaviour, health and safety. The training received by staff has developed their skills and knowledge. Internally the home has not made appropriate provision to invest in staff development. It has not examined fully and identified the training needs of staff. Nurses though qualified in the mental health field need further training and development opportunities. The previous registered manager (no longer employed) delivered training on appropriate subjects to support staff on a regular basis. Records of some supervisions indicate that training needs are recognised and discussed, there is no evidence that this is further explored or responded to. Although the training delivered to staff relates to the conditions and management of the user group a full profile of staff training needs has not been developed, neither is there a staff training and development programme. The individual staff records held are not reflecting all the training delivered, there is no separate record or training matrix available to explore if all staff attend the training. The range of skills among the staff team is very varied, they range from qualified mental health nurses, a qualified social worker to part time support workers. A senior member of staff is always available and on duty to lead on the service. Despite improvements in training and the employment of more suitably qualified and experienced staff, the requirement set in previous inspections in relation to training and development is not fully met. It was noted that the majority of staff have not received training in food hygiene; all staff support residents with food preparation and need this training. The evidence of staff training supplied during the inspection was not sufficient to confirm that the home is making appropriate arrangements to train and develop staff, or fully equip them for their roles. Consideration will be given to Enforcement action if this requirement is not responded to within the new timescales set. A requirement set in previous inspection is restated. Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 23 A new member of staff employed in recent months has valuable experience of working with this client group. He works as a key worker for one resident. From discussions with residents it as found that he has developed an effective professional relationship with the resident. He told of receiving an induction in the first months of employment. The registered owner produced a copy of the induction workbook, it was not possible to evaluate if this is meeting Skills for Care Sector training. The information and training in the induction does not include appropriate management of health and safety aspects of the service. There is no foundation programme, a requirement stated in previous inspection report is not fully met, the requirement is restated. There is evidence that more regular one to one supervision is provided, there are also regular staff meetings held. Staff spoke of feeling supported and appreciating the supervision sessions. According to records seen the supervision is provided by staff that are supportive, however they may not be always be trained in supporting and supervising staff. A requirement is stated it is important that one to one is the appropriate team leader that has the training and the skills necessary for the role provides supervision. Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 24 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. Despite improvements in staff morale there is a lack of effective leadership due to the absence of an experienced manager. The home is recognising the importance of having a quality assurance system in place to develop the service. The first steps taken towards this development include the introduction of user feedback questionnaires to help monitor and evaluate the service. EVIDENCE: There are clear signs of improvement in staff morale, and the environment too is more relaxed and friendly. Residents have confidence in the service as staff now work together as a team. Staff too are more open in expressing their views, the standard of record keeping is improving. Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 25 The home has no registered manager since October 2007; signs are that it lacks effective leadership. In the interim period the deputy manager has had management responsibilities until a new manager is recruited. This is not satisfactory. Issues relating to management and that include training, supervision are not managed appropriately, no progress has been achieved in training and development. A requirement is stated. The home has made progress in establishing a monitoring system to evaluate the service. The home has introduced quality assurance questionnaires; these are for residents and staff and mental health professionals. A selection of completed questionnaires was viewed. No indication was given of how this information is collated and used to analyse outcomes or to inform development plans. More work needs to be done so that the a development plan may devised for the home that measure the success in achieving the aims and objectives, also to reflect the aims and outcomes for residents. The requirement stated in the previous inspection report is restated so that this is fully met. According to the records received on the completed on the Annual Quality Assurance Assessment all essential equipment is serviced and maintained. Fire drills and the testing of fire fighting equipment takes place. Temperatures of fridges and freezers are monitored regularly. A fire officer completed an inspection visit in April 2007. According to fire officers report received by the inspector the arrangements were found satisfactory at the time of the visit. The premises are clean and hygienic and the building and contents are in good state of repair. The other utilities that include gas and electric according to records checked in May 2007 are maintained and serviced at appropriate intervals. The health and safety management of the service needs to be incorporated into the induction training, also the mandatory training must include food hygiene. These are referred to in staff training. Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 26 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 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 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 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 N/A 2 X 2 X X 2 2 Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 27 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 YA20 Regulation 13 (2) Requirement The registered person must ensure that appropriate arrangements are in place for safely receiving, administering and storing medication. Medication profiles to be in place for all residents. Regular audits must be completed of all medication held, this to identify any shortfalls. (Unmet in previous timescale of 30/09/07) The registered person must ensure that medication policies and procedures are reviewed. The review must take into account how medication is managed when supplied by the mental health pharmacist. The outcome of the review must be reflected in revised safe medication procedures. (Unmet in previous timescale of 30/09/07). Timescale for action 30/01/08 2 YA20 13 (2) 30/01/08 3 YA24 23 (2) b The registered person must 20/02/08 ensure that the damp area of the kitchen wall is attended to and repainted. DS0000041799.V353823.R01.S.doc Version 5.2 Page 28 Buxton House 4 YA35 YA42 18 (1) (a) & (c) The registered person must ensure that staff training needs are assessed and that a training and development programme is put in place to respond to these needs. A dedicated budget to be allocated for this project. (Not fully met in timescale of 30/09/07) 29/02/08 5 YA35 YA42 18 (1) (c) (i) The registered person must ensure that an Induction and Foundation programme is developed and implemented for staff. This programme to meet Skills for Care workforce targets. All newly employed staff must complete this programme. (Not fully met in previous timescales of 30/08/07) The registered person must ensure the appropriate team leaders are allocated the duties of supervising staff, and that they have the training and the skills necessary for this role of supervision. The registered person must ensure that a suitably experienced and qualified person is appointed to manage the home. The registered person must ensure that an effective quality assurance system is developed and implemented at the home based on reviewing and improving the standard of service provided. The registered person must supply CSCI with a copy of the DS0000041799.V353823.R01.S.doc 29/02/08 6 YA36 18 (2) 29/02/08 7 YA37 8, 9 30/03/08 8 YA39 24 (1) a & b 29/02/08 9 YA43 25 (2) a b cd 14/02/08 Buxton House Version 5.2 Page 29 business and financial plan for the home for evaluation. 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 YA1 YA17 YA19 YA21 Good Practice Recommendations The registered person should ensure that the service users guide is kept updated to reflect changes to staffing. The registered should ensure that healthy eating is promoted, and more emphasis is placed on educating residents and staff on suitable alternatives. The registered person should ensure that that key worker records are more detailed and give a fuller picture on individual progress and state of well being. The registered person should continue to work with residents around recording information about their wishes with regard to illness and death. The registered person should update the complaints book to include information about what actions are taken to respond to complaints received. The registered person should ensure that copies of qualifications that include certification are sought and held on the staff files. 5 YA22 6 YA32 Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Buxton House DS0000041799.V353823.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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