Inspection on 31/05/07 for Buxton House

This inspection was carried out on 31st May 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 26 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 12/12/07

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 31st May& 4th June 2007 10:00 DS0000041799.V339829.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 DS0000041799.V339829.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. DS0000041799.V339829.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 Mrs Victoria Schandorf-Torto Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places DS0000041799.V339829.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th March 2007 Brief Description of the Service: Buxton House is a care home located in an end of terrace house on a residential road in Streatham, Southwest London. It was registered in July 2004 to provide care and accommodation for up to six people with mental health related issues. There are six 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 from £650 to £850 per week. This cost does not include toiletries or holidays but the home may pay a contribution to a holiday. DS0000041799.V339829.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 took place over two days. The inspection findings are based on information received from a number of sources. The acting manager and two support workers met with the inspector. Four residents also met with the inspector for a group discussion. A selection of personnel records for residents and staff were examined. The current care arrangements for two residents were case tracked. This included their views plus the view of care coordinators and support workers. A pre inspection questionnaire was completed prior to the inspection. Information from this record was also used as evidence in the report. The inspector spoke with three care coordinators to gain their views on how the needs of residents placed there are met. What the service does well: What has improved since the last inspection? What they could do better: The service has deteriorated. In many areas the home is delivering services to unacceptable standards. As result of these findings eighteen requirements have been stated. A number of requirements made are in respect of the shortfalls within the staff team. Staff are not receiving appropriate induction and training and they do not get adequate support and supervision. Due to the lack of provision for training and developing the workforce staff are unable to support residents to achieve the best outcome. A requirement in relation to staff recruitment has been stated at two previous random inspections. The home continues to employ staff without vetting them thoroughly. This failure is now the subject of a Statutory Enforcement Notice. The registered manager is currently suspended. In the absence of this manager the back up arrangements are inadequate and effective. The home lacks clear leadership and guidance. The environment is not inclusive and staff DS0000041799.V339829.R01.S.doc Version 5.2 Page 6 morale is poor. Communication within the staff team is not good, this needs to be addressed urgently. Due to the lack of a quality assurance system in place to monitor the service shortfalls have not been identified. Requirements set at previous inspections have not been responded to within timescales. A requirement is given regarding the development of an effective quality assurance system. There are unsafe procedures for managing and administering medication. Errors have occurred in the medicine administered to residents. 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. DS0000041799.V339829.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 DS0000041799.V339829.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): 2 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service is not fully meeting resident’s individual needs although visiting health care professionals view the home as being good at supporting residents. There have not been opportunities for the service to demonstrate improvement at fully assessing new residents before they move into the home. EVIDENCE: No new residents have been admitted since the last inspection. As a result it was not possible to evaluate if prospective residents are fully assessed before they are offered a place at the home. This requirement is restated as a result with increased timescales to demonstrate that it is achieved. The inspector met with four residents in a group setting for discussions. Generally they find stability at the home and feel they are well supported. They like the home and enjoy living there. They are not involved in development of policies and procedures. The environment is not as inclusive as it could be. Staffing changes have impacted on residents. The inspector did not explore this further as it was found that residents are concerned about the impact of the changes and appear concerned about the future. The views of three mental health care coordinators were gained. Their views were positive on the support given. “They always support residents to attend CPA meetings and any reviews that take place” was a comment from one coordinator. Staff generally follow care plans as agreed but there have been DS0000041799.V339829.R01.S.doc Version 5.2 Page 9 issues relating to medication”, another coordinator said “Errors have occurred in administering incorrect doses of prescribed medication which demonstrate that the home is not fully meeting the needs of residents. During the inspection further evidence was supplied demonstrating that the home is not fully meeting individual needs. The staff team has been depleted. The registered manager is not available for duty, vacant posts have not been recruited to. Residents find that they are not having key working sessions, no evidence was recorded to suggest otherwise. DS0000041799.V339829.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 adequate. This judgement has been made using available evidence including a visit to this service. The support is appropriate and given in response to individual needs. The written care plans are not sufficiently developed and are not person centred. As a result not all the essential information is recorded on how best each individual is supported. Confidentiality is not considered sensitively. EVIDENCE: Feedback from residents regarding the care and support delivered is that the service satisfies their needs. They find security in the home and appreciate having a staff team to support them. They have experienced frequent changes to staffing personnel. Some support workers they find are knowledgeable and demonstrate a commitment to improving their lives. This was also the view of care coordinators spoken to, some find individual members of staff to be knowledgeable but there are occasions when this is not always the case. The inspector spoke to three care coordinators in mental health teams. They spoke positively about residents’ experiences. They feel that generally staff follow the support plans agreed and that the placements are satisfactory. They find that residents receive assistance to make decisions about their lives as DS0000041799.V339829.R01.S.doc Version 5.2 Page 11 needed and enable residents to attend all appointments. Residents manage their own finances and collect all their own benefits. Some on return choose to ask staff to hold small sums of money for safekeeping. In the previous two random inspections in November 2006 and March 2007 requirements were made relating to how support plans are written. New plans have been developed by a support worker. The data had been compiled and inputted on the computer. On day two of the key inspection a relative of the registered provider was using the computer to print off these plans. The plans for two residents were examined. They are easier to follow, clear and concise. Some areas have insufficient information on the resident’s mental health needs. Examples include, lack of information on short and long term goals, the input from mental health team and a medication profile. Risk assessments supplied by professionals from the mental health team are kept on residents file. Alongside staff maintain a daily record of individuals’ progress. The daily diary is also used to communicate this information on handover. The inspector recognises that staff experience difficulty in engaging some residents when reviewing and developing the plans of care and support. This has caused some delays in recording all the necessary information. It is evident that there has been little input from residents on the new plans. The plans are not person centred. All the information from previous needs assessments, risk assessments undertaken by care coordinators and by the home staff needs to be reflected in appropriate care plans. Although there has been progress in care planning more time is needed to enable comprehensive person centred care plans be developed. The requirement is restated Staff are supportive and enable residents take risks as part of leading an independent lifestyle. For example, in recent months there was an incident in the community where a resident was a victim of crime. Reports received indicated that management had supported the resident well at this difficult time and involved the relevant authorities. Where necessary residents receive support to attend events and appointments in the community. The inspector met with four residents for a group discussion. Their experiences are positive of life there. One area that residents feel is not considered is their rights to use of communal areas. They find that occasions arise when the lounge is not available for their use. There is no consultation with service users, and their feelings are not considered regarding the non availability of the lounge when there is a staff meeting or training. Staff reported that residents are consulted when the communal area is needed for staff meetings. Consideration must be given to the feelings and wishes of residents. A requirement is stated. Personnel files were held in a locked cabinet. The IT system is also used to record information. The inspector observed that a person not employed at the DS0000041799.V339829.R01.S.doc Version 5.2 Page 12 home recorded confidential information on the computer for residents. She was printing up new care plans. Residents are concerned about confidential information and about who has access to it. They indicated that they feel insecure about sensitive information held on IT and on how it is managed. One spoke of a new computer and questioned what had happened to information held on previous computer. The acting manager was unable to confirm if all this information had been deleted. A requirement is stated regarding managing confidential information. DS0000041799.V339829.R01.S.doc Version 5.2 Page 13 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 benefit from living in a relaxed and flexible environment. The encouragement and support given by staff takes into account each individual’s needs. Residents are offered the choice of a diet that is healthy and what they enjoy. EVIDENCE: There is a flexible and relaxed approach at the home. Residents like this flexible approach and feel that support and encouragement is available for them but not enforced on them. Residents live individual and independent lives choosing to engage and participate as they wish. A number of the residents enjoy activities outside the home. Working or attending college or day centres or the gym. They also have a variety of leisure activities to choose from. Records seen on individual files and feedback from residents indicate that often the mental health conditions experienced reflects in the non attendance by DS0000041799.V339829.R01.S.doc Version 5.2 Page 14 individuals at some events. Sometimes residents find it difficult to be consistent in attendance at enrolled activities such as college. 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 feel helpless as a result of setbacks in development. Staff encourage and support, working at a pace to that considers individual feelings and capacities. Residents are encouraged and supported to maintain family relationships. Residents spoke of family visits and how staff enable them achieve this by preparing prescribed medication at the correct time to take for home stays. The local community is feely accessed by residents, all have received bus passes. Residents take responsibility for practical chores and find it therapeutic. Residents are issued with times for laundry. Should they not be able to undertake laundry chores at this times there have been occasions when residents have taken laundry out to laundries in the local precinct. More consideration is needed if residents are not able to use facilities at the allocated time. A recommendation is made. Residents have weekly meetings. They also discuss menus and plan what food they would like. Overall there is satisfaction with meals provided. The inspector saw evidence of how the home makes provision for and gives consideration to the cultural needs of individual needs. A number of residents choose to have additional meals in the evening and like to order take away meals. DS0000041799.V339829.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents find that staff have a flexible approach by supporting and promoting their self-esteem. However, the systems in place for monitoring the physical and emotional well being of residents are not effective and result in residents not receiving the best outcome. Residents are not protected by current medication procedures and as a result medication errors have occurred. EVIDENCE: From observations made from previous inspections it is evident that staff promote a sense of self-esteem and self worth. Residents are interested and take care of their appearance. Reports from mental health professionals indicated that staff are doing a good job of promotion of physical and mental health. They always make sure that residents attend CPA meetings on time. A member of staff is also always present for review meetings. However, one care coordinator remarked that he has experienced talking to a support worker who had little knowledge of mental health needs. DS0000041799.V339829.R01.S.doc Version 5.2 Page 16 During the inspection it was found that there has been some deterioration in how the physical and emotional needs of residents are monitored. The inspector found gaps in recording confirming this. Daily records are maintained for each resident but key working sessions are not being recorded. There was no evidence to suggest that residents in recent months have one to one sessions with a support worker to discuss their progress. Staff when spoken to said that they have not had the time to do key working sessions recently due to staff absenteeism and shortage of staff. Records held of weights recorded are sporadic and show inconsistency. A requirement is stated regarding monitoring health care. All residents are registered with a local GP. Many of the residents spoke of attending appointments independently. The most notable deterioration in the service has been in the administration of medication. One resident is currently undergoing changes to his prescribed medication. The placement team provide a member of staff daily to monitor the response to changes made to prescribed medication. The MAR sheet was examined to evaluate the procedures in place. Staff were knowledgeable on the changes and what to look out for, they had updated the MAR sheet. All medicine was signed as administered in accordance with instructions. Professionals within the mental health team review medication regularly at weekly monthly appointments, appropriate blood tests are undertaken too at this time. For some residents the medication dispensed is monitored and delivered by a representative from the mental health team. A number of errors have taken place in recent months with the medication administered. One of the contributory factors is the failure in medication procedures is due to the supply of medicine directly to the resident when an appointment is attended at the mental health unit. For one resident no written reports on medication changes were sent to the home. A report was received from the care coordinator about a resident that was administered the incorrect dosage of prescribed medication recently. Because the resident was issued his medication at the mental health unit the home was not been sent the relevant information in writing. The care coordinator felt that the home should have followed the instructions on the medication container. The care coordinator acknowledges that the full details of any changes in medication must be sent in writing to the home and not rely on instructions on medication box. A list of staff that are deemed as trained and competent in administering medication is held. Examples were seen of a qualified nurse employed as acting manager reminding a support worker on night duty that signatures must be in place for medication when it is administered. Several occasions had arisen when prescribed medication administered was not signed for at the correct time. Due to lack of management direction deterioration has taken place in the system for receiving and administering medication. It is not DS0000041799.V339829.R01.S.doc Version 5.2 Page 17 effective or safe and needs to be improved. Medication profiles are not written up for residents to indicate clearly the prescribed medication required. Staff spoke of difficulties experienced with MAR sheets, they are being typed by an external body and not handwritten by staff. Some of the experienced staff described the extra attention given to ensure procedures are followed. These staff appear vigilant and ensure that medication procedures are followed. Audits are not done of medication to highlight any areas of shortfalls. Shortfalls in medication procedures must be addressed. Two requirements are stated in relation to medication procedures at the home. DS0000041799.V339829.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents meet weekly to discuss issues and raise awareness of any concerns. However, the nature of the meetings can be developed as residents often present with insecurities and can find it difficult to raise issues when staff are present. Due to shortfalls in medication procedures and poor recruitment residents are not safeguarded from abuse, neglect or self harm. EVIDENCE: The complaints book was examined. A number of minor issues were raised by residents. There was indication on how these were responded to. A member of staff said that all views are welcomed and that minor issues raised are responded in person. Residents indicated that any concerns they raise are listened and responded to satisfactorily. From speaking with residents as a group they told of having residents meetings regularly and discussing issues but that a member of staff is always present at discussion. The inspector detected that this arrangement is not the most comfortable arrangement for residents. Some demonstrate that they are not so confident about speaking out and have insecurities about the placements if they do so as an individual. To overcome this it is recommended that residents should have the chance to meet as a group without staff recording who raises any points. Feedback could then be received back from the group to avoid any resident feeling victimised. There have been no allegations of abuse or neglect raised at the home. Evidence from residents, mental health team show no concerns about this. Staff present demonstrate a good knowledge of procedures to safeguard DS0000041799.V339829.R01.S.doc Version 5.2 Page 19 vulnerable people. Regular staff according to records supplied have received training on following safeguarding vulnerable adults. As a result of shortfalls in medication procedures residents are not fully safeguarded from neglect or self-harm. Recruitment procedures continue to be poor, this places vulnerable adults at risk. See requirements stated. DS0000041799.V339829.R01.S.doc Version 5.2 Page 20 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 28 30 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 home that is clean, comfortable and pleasant. Shared space is available that complements individual bedroom space. EVIDENCE: The home is pleasant and clean. It is attractively decorated. Improvements were found in how the stair carpet and wooden floor on the landings have been finished. A lounge, a conservatory and dining room supplement the resident’s individual space. The residents encounter problems as a result of staff using the conservatory. During these periods they are unable to use the lounge. Referred to in Standard 8. All the communal areas were comfortable and nicely decorated. 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 resident invited the inspector to view the bedroom. It had been made very homely with numerous personal possessions on display. All issues relating to the environment have been addressed. There are no outstanding repairs needed at the home. DS0000041799.V339829.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 33 34 35 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents do not benefit from the presence of a skilled staff team. There has been little investment in training and developing an effective staff team. Recruitment procedures continue to be poor and as a result residents are not safeguarded. EVIDENCE: Residents speak positively about some members of staff and find that they are good in the role, knowledgeable and skilful in managing mental health issues. Staff morale is low and there is a lack of leadership. Staff spoke of problems within the staff team. Due to the absence of a manager and recent staff changes they are not receiving the support and supervision they need in the last couple of months. Internal issues are not resolved through constructive meetings, the inspector found evidence in daily communication sheets that staff use these records to record grievances with each other. A requirement is stated. According to the completed pre inspection questionnaire supplied three new members of staff have started work at the home since the last random inspection on 14th March 2007. For two of the members of staff a CRB with Enhanced Disclosures were in place. Also available was confirmation of DS0000041799.V339829.R01.S.doc Version 5.2 Page 22 appropriate immigration status. A second reference was not available on the file held for one of the new members of staff. For the third member of staff the application form was not completed satisfactorily. According to the staff team there was confusion if this member of staff was employed directly or supplied by an agency. The record seen stated that he commenced work in May 2007. The inspector spoke briefly with him and he confirmed that he was employed by the home and had completed the application form. There were no references or confirmation of phone references, there was no CRB Enhanced Disclosure with POVA checks, no confirmation of immigration status. At the previous two random unannounced inspections on November 15th 2006 and March 14th 2007 there have been requirements stated regarding recruitment procedures. A requirement was stated in both random inspection reports that the registered person must ensure that any member of staff employed to work at the home is vetted thoroughly first. A meeting took place between the registered provider and the regulation manager and the inspector on May 18th 2007. At this meeting the registered provider provided CSCI with evidence on her plans to implement an effective and robust recruitment procedure. The evidence available on this key unannounced inspection is that the recruitment procedures are robust. A Statutory Enforcement Notice is served to the registered provider in relation to the recruitment procedures. The matter will be followed up by CSCI. Staff that have worked at the home and holding full time employment elsewhere were written to and asked for a declaration of hours contracted elsewhere. One night worker no longer works at the home because of this request. One support worker employed is currently completing the adaptation course in social work. A declaration is not available of the hours committed in the other role. The requirement stated regarding declaration of hours by staff in employment elsewhere is restated. Seven members of staff are employed. The inspector did not receive any evidence to suggest that home has insufficient numbers of staff on duty. Two members of staff are on duty during the day, with three on duty on some occasions. One support worker is available on waking nights from 9pm until 7am the following day. According to records seen this is appropriate for the current needs of residents. Appropriate staffing levels are maintained. However, there are occasions when regular staff members have worked long hours in an emergency. Examples of when this occurs were seen in the daily communication book. If a support worker is unable to attend work due to other commitments staff are willing to cover additional shifts on their days off. Support workers spoke of covering DS0000041799.V339829.R01.S.doc Version 5.2 Page 23 additional shifts in emergencies and how tiring it becomes due to the demands of the job. Seven staff members are employed, although many are part time staff. Recruitment is ongoing to overcome this difficulty. The inspector received evidence from the registered provider at a meeting held on May 18th 2007 that another qualified member of staff would start employment shortly. References had been sought but the work permit and CRB disclosure is being processed. The requirement regarding the staff team is repeated to consider the delays experienced in recruitment. The inspector received a general list of training delivered in the past twelve months. It did not indicate how staff are suitable, what training each one has received. The inspector received positive comments from two mental health care coordinators about the responsiveness of staff but they also reported that they have experienced speaking to inexperienced staff when visiting. It is evident that there are some members of staff that are trained and competent and who work hard to ensure that residents need are met. Other staff are less skilled and require assistance to develop their skills and knowledge. Three individual staff files were inspected. They did not contain proof of individuals’ skills. No certificates were present of qualifications, and neither is there a record kept of the training delivered to individuals. Members of staff (two) spoke of training attended, some are short courses organised by the mental health team. The registered manager prior, to suspension, had also given training to staff on conditions associated with mental health. As a result of poor record keeping and retention of information on courses participated in it was not possible to confirm how staff are trained and competent for the role. It is apparent that insufficient consideration is given to allocating financial resources to train and develop the staff team. There was no training and development programme available. Staff spoken to are not aware of any plan by the home to address training needs. A requirement stated in two previous inspection reports for November 15th and March 14th remain unmet. This requirement is restated. Some members of staff working at the home for the past year spoke of receiving an induction at the home. They said that in their recent experience they were not aware of a full induction programme for newly recruited staff. Staff members present confirmed that they had not seen newly recruited staff complete an induction programme. There was confusion as to whether the registered provider has some input in the induction and that they are not party to this. Nothing is recorded on the staff files of newly recruited staff to confirm that there is an induction programme, which meets the Skills for Care Sector target. A requirement is stated. DS0000041799.V339829.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 38 39 41 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service is deteriorating as a result of the lack clear lines of management. No emphasis is placed on evaluating how the service is performing. As a result the deterioration has not been recognised. Staff are not effectively supported or guided and poor working relationships are developing within the staff team. There is a lack of transparency in how the service operates. EVIDENCE: The home has been without a registered manager for the past two months. The registered manager is currently suspended. In the interim there has been ineffective leadership and direction. The service has deteriorated since the random inspection on March 14th 2007. Vulnerable residents are not benefiting from living in a well run home. Some residents expressed concern about their placements, as so many changes have taken place in the staff team. DS0000041799.V339829.R01.S.doc Version 5.2 Page 25 At a meeting with the registered provider on 18th May the inspector was informed that a decision would be taken within a week to resolve the management issue. It is now some three weeks later at the time of writing the report. No further information has been received about the management arrangements. At the random inspection on March 14th 2007 the environment and atmosphere was observed to be non-inclusive due to working relationships between the registered manager and the registered provider. Although the manager has been absent for the majority of the period since then the atmosphere has deteriorated further. It is not open and inclusive and indications from staff are that communication has broken down within the staff team. When the inspector arrived for the inspection the acting manager did not have the keys to the filing cabinet where staff files are held. On the second day of the inspection one of the support workers had a set of keys that enabled access to the cabinet. The acting manager said that he was not involved in consultation regarding new support plans that are under development by a support worker. Yet he has worked at the home for over twelve months and has a good knowledge of residents’ needs, also a qualified RMN. All of this evidence suggests an environment where there is a lack of transparency and where resident’s needs are not a priority. A requirement stated at the previous inspection has been restated in regard to how the home is managed. No evidence was supplied to indicate that the home is run in the best interests of residents. Although residents enjoy living at the home no regular evaluations of services have been done to determine how effective the service is in meeting the aims and objectives. The views of stakeholders are not gained to establish how the service is performing. There is no annual development plan for the home. Staff are unaware of any plan that may have been developed by the registered provider. The inspector has experienced that action is not progressed within timescales to implement requirements set in previous inspection reports. All of this evidence confirms that there is no effective quality assurance system in place for the home. A recommendation was made at the previous inspection about management working together to develop an effective quality assurance system. The home needs to make sure that an effective quality assurance system is developed. This is the subject of a requirement. Record keeping is poor. This particularly relates to the secure and safe storage of important and confidential information. Staff spoke of records going missing regularly and also of a number of staffing rosters that are used. The registered provider spoke to the inspector and reported that records have been mislaid or lost. It is evident from conversation with staff that the systems used are unreliable, they too find that important records such as those relating to service users have been mislaid or lost. At the time of this inspection records seen on residents files at previous inspections were absent. A resident raised his concern about record keeping and how confidentiality is protected. He is DS0000041799.V339829.R01.S.doc Version 5.2 Page 26 not comfortable with how management currently manage records. A requirement is stated. Confirmation was provided by the provider on the pre inspection questionnaire that the safety of the environment is promoted. Regular fire drills are conducted, weekly testing of fire alarms take place. Fire fighting equipment is serviced at appropriate intervals. 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 such as gas and electric as maintained and serviced at appropriate intervals. There was no evidence that staff induction includes health and safety training. A requirement about this is given. The home has current insurance liability certificate displayed. The concerns highlight shortfalls in human resource planning, the quality monitoring, the financial management and allocation of appropriate resources for training the staff team. The inspector requires that a copy of the business and financial plan for the home be forwarded to CSCI for evaluation. A requirement is stated. DS0000041799.V339829.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 2 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 3 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 2 2 1 X 2 2 2 DS0000041799.V339829.R01.S.doc Version 5.2 Page 28 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 YA2 Regulation 14 (1) a, b, c, d Requirement The registered person must ensure that only prospective residents that are fully assessed by a competent person are admitted to the home. The home must be satisfied that it can meet the assessed needs of prospective residents before admission. (As no new residents were admitted it was not possible to evaluate this, still within permitted timescales). The registered person must ensure that the home is conducted in a manner that promotes and makes proper provision for the health and welfare of residents. The registered person must ensure that the written care plans and records of reviews are developed and maintained. These to be person centred and to contain essential detail that includes the care and support needs including prescribed medication for residents. (Although there has been progress this requirement is not fully met within timescale of DS0000041799.V339829.R01.S.doc Timescale for action 30/06/07 2 YA3 YA19 YA20 12 (1) (2) (3) 30/07/07 3 YA6 YA3 15 (1) (2) 30/06/07 Version 5.2 Page 29 30/04/07) 4 YA8 12 (4) a 23 (2) e g The registered person must ensure that the dignity and wishes of residents are considered. Consultation must take place with residents regarding the use and non availability of communal areas when used for other purposes The registered person must ensure that information of a confidential natured is handled and stored in a manner that respects confidentiality and privacy. Confirmation must be provided that information is registered in accordance with Data Protection Act 1998. The registered person must ensure that effective systems are put in place to monitor and respond to the physical and emotional needs of residents. To include key working sessions. 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. 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. The registered person must ensure that the home reaches the target of 50 of care staff on or having completed training DS0000041799.V339829.R01.S.doc 30/07/07 5 YA10 17 (1) (b) 30/06/07 6 YA19 YA18 12 (1) a & b 30/06/07 7 YA20 13 (2) 30/06/07 8 YA20 13 (2) 30/07/07 9 YA32 18(c) 30/09/07 Version 5.2 Page 30 to NVQ level 2. (Not met in previous timescale of 30/05/07 due to change in staffing personnel, timescale extended to allow for new members of staff employed to enrol on this training). 10 YA33 18 (1) a & b The registered person must ensure that the home has an effective staff team available with sufficient numbers and complementary skills to support the assessed needs of residents. Appropriate numbers of staff needed to be available and cover on a temporary basis to avoid interrupting continuity of care to residents and to prevent regular staff members working excessively long hours. (Unmet in previous timescale of 30/05/07, recruitment is ongoing) The registered person must ensure that adequate documentation and recruitment checks are carried out before staff are allowed to work in the home. (Unmet in previous timescale of 30/11/06 and 30/04/07) This is the subject of a Statutory Enforcement Notice 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. 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 DS0000041799.V339829.R01.S.doc 30/08/07 11. YA34 YA23 19 (b) Schedule 2 13/07/07 12 YA35 YA42 18 (1) (c) (i) 30/08/07 13 YA35 18 (1) (a) & (c) 30/07/07 Version 5.2 Page 31 needs. A dedicated budget to be allocated for this project. (Unmet in timescale of 30/04/07) 14 YA36 18 (2) The registered person must ensure that staff receive regular support and supervision. In addition records must be held as evidence of this exercise. The registered provider must ensure that management arrangements make proper provision to promote an open, positive and inclusive environment. Confirmation must be sent to CSCI of management arrangements. (Unmet in previous timescale of 30/05/07) 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 ensure that record keeping improves. Records held must be stored safely and securely and confidentially. Records specified in Schedule 4 must be available at all times in the care home for inspection purposes. Records maintained must be retained for not less than three years. The registered person must update the statement of purpose and the service user’s guide to reflect changes to staff qualifications. The registered person must supply CSCI with a copy of the business and financial plan for the home for evaluation. 30/06/07 15 YA38 YA37 10 (1) 30/06/07 16 YA39 24 (1) a & b 30/08/07 17 YA41 17 (1) (2) (3) 30/06/07 18 YA1 5 01/08/07 19 YA43 25 (2) a b cd 14/08/07 DS0000041799.V339829.R01.S.doc Version 5.2 Page 32 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 5 Refer to Standard YA16 YA21 YA22 YA22 YA23 Good Practice Recommendations The registered person should ensure that more flexibility is allowed in using the facilities of the home, in particular the laundry. 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 ensure that residents are given the opportunity to meet as a group to discuss issues and then feedback the outcome. 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 obtain multi-agency guidelines with regard to the protection of vulnerable adults. DS0000041799.V339829.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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. 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