Inspection on 03/05/06 for Self Unlimited

This inspection was carried out on 3rd May 2006.

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

Other inspections for this house

Self Unlimited 21/09/07

Self Unlimited 31/01/05

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 CARE Edenbridge 1 Phillippines Close Off Hever Road Edenbridge Kent TN8 5GN Lead Inspector Ruth Burnham Key Unannounced Inspection 3rd May 2006 09:30 CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and 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. CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service CARE Edenbridge Address 1 Phillippines Close Off Hever Road Edenbridge Kent TN8 5GN 01732 782700 01732 782701 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) www.care-ltd.co.uk CARE (Cottage and Rural Enterprises Ltd) Mrs Jennifer Ann Wilders Care Home 34 Category(ies) of Learning disability (34) registration, with number of places CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 5 Service Users may also have a Physical Disability Care of one Service User is restricted to one person whose date of birth is 31/08/1932 31st January 2005 Date of last inspection Brief Description of the Service: Care Edenbridge is a home which provides accommodation for 34 people with learning disabilities. The accommodation is purpose built and residential accommodation is divided into 4 units and comprises of 3 separate houses and a bungalow, there is also an administration block with kitchen and dining room for day services, for which there are a variety of workshops on site. There is also another building, which is divided into flats and is currently used for temporary staff accommodation. The establishment is owned by a national organisation, which has establishments throughout the country that provide care and day services for people with learning difficulties. Residents work during the week either at the day centre, or in external employment. Training is provided and service users work towards gaining qualifications relevant to their abilities and chosen activities. The home employs care staff who work a rota that includes members of staff working in each unit at night, on sleep in or waking duty in the houses according to need. Other staff are available on call at night on the site. In addition to the care staff, there is administrative and management support in the separate office accommodation. CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Staff and service users moved into this home from their former accommodation at Ide Hill approximately 6 months ago, this was the second inspection at the new home, it was unannounced and was carried out by one inspector who was at the home from 09:00 to 16:30 during which time the registered manager, the new service manager, the training officer, 2 unit managers, 4 members of staff and 6 service users were spoken to. Two of the houses and the bungalow were visited and a number of records were examined. What the service does well: What has improved since the last inspection? What they could do better: Care plans must be up to date and address all the needs of residents, independence must be promoted respecting the right of service users to make decisions. Residents should not be locked out of communal areas of the home or their own rooms and access to food should be freely available at all times unless individual care needs override this for specific residents, blanket policies must not be used. Unnecessary risks to the health and safety of service users must be identified and so far as possible eliminated by the provision of up to date risk management guidance to staff as part of the care plan. The confidentiality of residents must be protected in that personal records should not be left in view in an open office, suitable locking mechanisms shall be used to enable all service users to open the front doors and their bedroom doors CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 6 wherever possible and furniture must be suitable for residents use. The registered person shall ensure that any complaint is fully investigated and appropriate records maintained in line with the regulation. The gardens must be finished and landscaped appropriately. Sufficient numbers of staff should be on duty to maintain satisfactory standards of hygiene. Staff must have an adequate understanding and ability to communicate in English to enable them to successfully undertake training and to communicate effectively with one another and with service users and where service users have identified need for support at night, waking night staff should be on duty. The provider must ensure that requirements are being actioned and effective management is in place 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. CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 No judgement has been made on this standard EVIDENCE: Since moving into the new home no new service users have been admitted. CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14, and 33 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 - 10 The quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The needs of people who live in the home are not always being met and, for some, inadequate care planning, recording and risk management is placing them at risk, limiting independence and restricting choice. Confidentiality is not always being maintained. EVIDENCE: There is a risk that the needs of people who live in the home may not be met in that care plans are still not being updated to reflect changing needs. The quality of care planning still varied considerably between houses, a sample of care plans were examined in one of the houses and the bungalow. It was not possible to determine if care plans examined in the house were being CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 10 generated from care management reviews as these were not available, however it was clear that the outcome for people who live in the home was reducing rather than promoting their independence, food had been removed from cupboards, fridges and the freezer and many doors in the home were being locked by staff routinely, these actions were being taken in order to manage the behaviour of one of the residents to the detriment of all the other people who live in the house. The registered manager and newly appointed service manager were unaware that this action had been taken and agreed to ensure that food will be replaced for easy access by residents and that the practice of staff locking doors unless specifically requested to do so by residents will cease. In a different house a service user was unhappy with the colour of his room, which he had not chosen, he said that he had been told that it would be too expensive to redecorate despite the fact that his neighbour in the house had had her bedroom redecorated in similar circumstances. The mangers said that they were unaware of this situation. The majority of daily records seen did not reflect the content of care plans and poor risk assessments, which conflicted with information in the care plan were placing people who live in the home at serious risk if staff were to follow the guidance which had been recorded. For example a generic risk assessment in one service users file stated that this particular resident would never try to have a bath without staff supervision whereas his care plan clearly stated that he always had a bath by himself although it had been agreed that he should be supervised. In another care plan staff were being told to prompt an older resident with mobility difficulties and poor eyesight to carry her laundry bin to the laundry, if staff who didnt know this resident followed the recorded guidance, injury could result from their actions. Thankfully staff spoken to did know these service users and were caring for them appropriately by ignoring inappropriate guidance. It was clear that care plans seen were out of date with the exception of a care plan seen in the bungalow, which again demonstrated a much better understanding of the purpose and process and included up to date risk assessments where needs had changed. There is still risk of harm to service users where risk assessments are not being used as part of the working care plan, are generic rather being drawn up on an individual basis and are not being updated in light of incidents, accidents or changing needs, this was of particular concern where adult protection procedures had been called into play. People who live in the home who were seen and spoken with during the inspection said they were generally happy to be living in the home. Individual house meetings and a general committee meeting with representatives of people who live in the home who are elected by their peers have been set up, an advocacy group for residents and day service users has also been set up. People who live in the home cannot always be confident that their personal information will be available only to authorised and appropriate people as office doors are being wedged open, even when there are no staff in the room. CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11 - 17 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The quality of life for people who live in the home is enhance through the wide variety of work, social and educational opportunities available to them. CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 12 People who live in the home enjoy meals and mealtimes however their choice and independence in this area has been severely restricted in one of the houses, access through front doors is difficult for some residents. EVIDENCE: People who live in the home users are supported to choose and participate in a variety of activities. The majority spend the working week either in the day services on site or in paid employment in the wider community many also take up further education opportunities wherever possible, those spoken to said that they enjoyed the work they were doing and had chosen it for themselves. Day services include catering, laundry services, gardening and a variety of crafts. Residents benefit from the support of a Bursar to manage their financial affairs including benefits and funding. Quality assurance systems are in place in this area to ensure that , where the home acts on behalf of service users, all transactions are recorded, receipts are kept and regular audits take place. People who live in the home are being encouraged to integrate into community life by providing information and access to community facilities and events. Transport is available where necessary to pursue their own chosen lifestyle and leisure activities, holidays are chosen individually by residents, some choose group holidays, others prefer a more individual option. Residents spoken to were enjoying living in Edenbridge where they are now close to local amenities such as shops, the library, pubs etc and do not always have to rely on staff to take them out. Family and friends are welcomed and may be involved in daily routines and activities with the service users agreement, visitors are welcomed and may be seen in private. The privacy of people who live in the home is respected, staff enter bedrooms with permission and normally with the occupant. Suitable locking devices are offered which can be locked from both sides to enable service users to protect their personal space and possessions, not all residents can operate these and there are still problems with the difficult locking mechanism on the front doors of the houses for many of the people who live there. Staff interaction with residents was observed during the inspection and was warm and respectful, they are able to choose when to be alone or in company and when not to join in an activity. Residents have unrestricted access to their own houses and grounds and visitors have access subject to individual and collective consent. People who live in the home are encouraged to take responsibility for household tasks in order to promote increased independence and develop life skills.There was a wide variety of health choices available at lunchtime for people who live in the home, they are able to choose to have lunch in the day centre cafeteria or in their own houses. The manager said that work is being done to promote healthy eating and the chef is suitably qualified. Residents plan menus, shop and are involved in the preparation of meals other than those taken in the daycentre and records are kept of food provided, those CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 13 spoken to enjoyed the food in the home. It is unfortunate that the removal of food in one of the houses severely restricts independence and choice for the people who live there and spoils what would otherwise be a very positive report for these outcomes. CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 - 21 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home benefit from flexible and sensitive personal support, they are protected and their health is promoted. EVIDENCE: People who live in the home benefit from sensitive and flexible personal support from staff which takes account of their personal preferences and respects their privacy and dignity. Routines are generally flexible and relevant Concerns noted at the precious inspection about managing the health care needs of people who live in the home had been addressed through providing a health action plan for all residents to minimise risk where specific health care needs have been identified. Additional specialist support is accessed where CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 15 required and the health action plans are being used to promote their health and monitor for any problems which may occur. Wherever possible people who live in the home are supported to administer their own medication with appropriate risk assessment, individual secure storage facilities have been provided in resident’s bedrooms and people who live in the home are protected by ensuring that all staff who handle medication have received appropriate training. People who live in the home can be secure in the commitment of the staff and management to provide care until death wherever this is possible and the needs of residents can continue to be met in the home. CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The majority of People who live in the home felt listened although poor communication between staff and management means that appropriate action to address concerns is not always taken. People who live in the home are protected from abuse. EVIDENCE: There is a clear complaints procedure which is availble to service users in an accessible format however there are still instances where people who live in the home have voiced concerns which have not been followed up using the procedure, for example where the resident had complained about the colour of his room, no record of the complaint had been made and no action taken. This demonstrated a breakdown in communication between the managers of individual houses and the registered manager who was unaware of the problem and said that the room would have been redecorated immediately had this been reported. The complaints log does however indicate that the outcomes in this area have improved and examples were seen of good recording, investigation and follow up. At least 2 of the service users have expressed their concern about the violent behviour of another resident towards staff and one of these residents has been supported to make a formal complaint using the complaints procedure which the management are now CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 17 investigating. Some discussion took place about the management of this situation and how the home can minimise the negative impact on residents who share accommodation with this service user, specialist advice and input is being sought and guidance and risk assessments are in place to protect staff and residents from physical harm, the management are also aware of the emotional impact the situation is having on residents and are continuing to monitor this . People who live in the home are protected form risk of harm through sound recruitment procedures which include checks on all staff prior to appointment through the criminal records bureau, two written references are also taken up prior to appointment. Where staff move from overseas checks are carried out in their country of origin. CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 - 30_ The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality of life for people living in the new home continues to be greatly enhanced by the excellent accommodation, although failure to finish the gardens, ensure the suitability of locks and some furniture is detracting from the homeliness and accessibility of some areas of the environment. Poor hygeine standards may place some service users at risk. CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 19 EVIDENCE: The quality of life for people living in the new home continues to be greatly enhanced by the excellent accommodation, There are 4 separate residential units – 3 houses and a bungalow, which have been designed to meet residents’ needs in a homely way. There is ample communal space with separate areas for dining and a choice of lounges in each unit, the accommodation is bright, cheerful, airy and clean with good kitchen and laundry facilities. Teething problems with drainage and heating have been addressed to ensure that people who live in the home are comfortable, it was noted during the last inspection that not all residents are able to open the front doors easily as the fittings are difficult for them to manipulate, this is still the case. It was disappointing to see that gardens have still not been turfed or landscaped so residents are unable to enjoy access to them now the better weather is here. The units are well furnished and equipped although tables and chairs in first floor snack kitchens are unsuitable because of their exaggerated height, this was mentioned in the previous report and was again discussed with the manager during this site visit who agreed to replace these tables and chairs with more appropriate furnishings in consultation with the people who live in the home so they can enjoy using these facilities. It was of further concern that the occupant of one bedroom who had mobility and sight difficulties was unable to reach the alarm cord when in bed, further risk was being created by the practice of stacking suitcases on top of the wardrobe. The bungalow has been designed for ease of access for people with physical disabilities or dementia and suitable easy chairs have now been provided for the bedrooms as agreed prior to registration. Residents may be at risk of harm where it was noted that not all areas were being maintained to a satisfactory standard of hygiene, specifically in one of the houses where the microwave had not been cleaned effectively and bathrooms were also not being adequately cleaned to minimise risk of infection. Care staff who are responsible for these areas had no cleaning schedule to work to and were engaged in other areas more related to the care needs of residents. CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 - 35 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home benefit from the commitment of staff and the good relationships between staff and themselves, however they are disadvantaged by difficulties with communication and insufficient numbers of staff on duty at night or to carry out ancillary tasks. EVIDENCE: People who live in the home benefit from the support of staff who understand their roles and responsibilities, they have clear job descriptions and they get to know and develop relationships with the people they support. Interaction CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 21 observed throughout the inspection between staff and service users was warm and respectful, all staff are provided with the General Social Care Council code of conduct. Not all the houses have waking night staff It was clear that waking night staff should be employed if the needs of service users, particularly in one house where not all service users sleep through the night and there is continual disturbance and some degree of risk. Cleaning staff are not employed, care staff are expected to carry out these tasks. There is clearly risk to residents where adequate standards of hygiene are not being maintained and it did not appear that there had been any analysis of how much time was needing to be spent on cleaning to enable managers to accurately assess the numbers of staff needed in each house. The manager said that the successful recruitment of new staff, many of whom are local, will mean that people who live in the home will no longer be disadvantaged by the previous difficulties when the service had to use agency staff to make up the shortfall and there was a shortage of staff who drive, it is now a requirement for new staff to drive which will ensure that activities in future should not have to be cancelled. The recruitment of local staff should also improve the communication difficulties which residents have experienced with staff whose first language is not English, residents again commented on their difficulty in understanding and being understood by some staff. Staff records were examined which showed that people who live in the home are being protected through sound recruitment procedures including taking up two written references prior to appointment and obtaining current Criminal Records Bureau checks. People who live in the home benefit from the provider’s training and development plan and dedicated training budget and also from the enthusiasm and dedication of the training officer. All staff have structured induction training within 6 weeks and foundation training within 6 months, they receive equal opportunities training including disability and racial issues and have an individual training and development assessment and at least 5 training days each year. Additional training in care planning has been put in place and more is planned which will improve the quality of care provided to residents. CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home have been disadvantaged by ineffective and changing management and poor communication between levels of management. CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 23 EVIDENCE: There is now a new service manager in post who demonstrates an understanding of the changes which need to be made to empower people who live in the home through the support of staff and managers who understand the importance of promoting independence and good risk management. The current, temporary registered manager has been unable to focus adequately on the residential home as her other responibilities take her away from this area and the residential services manager has gone on maternity leave. It was evident throughout the inspection that communication between various management levels has been poor in that measures which the manager had taken to meet previous requirements which had been delegated to unit managers were not always being implemented and ineffective monitoring meant that this was not being picked up. The new service manager is already meeting with staff and other managers to implement change in line with the last inspection report and has recognised that some degree of cultural shift must take place if service users are to be empowered to take as much control of their own lives as they are able. Minutes of meetings which were examined during the inspection showed that at least one serious shortfall noted during the inspection were due to failure to implement an explicit instruction of the new manager. It will clearly take time before residents begin to benefit from new initiatives. Since the last inspection a new quality assurance system has been implemented which the manager said will produce a report in line with the regulations by November. People who live in the home are protected from harm through the support of staff who have been trained in safe working practices including infection control, moving and handling, first aid, fire safety and basic food hygeine. Safety certificates are available for all installations and equipment. CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 24 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 4 28 2 29 3 30 2 STAFFING Standard No Score 31 3 32 2 33 2 34 3 35 3 36 x CONDUCT AND MANAGEMENT Standard No Score 37 1 38 x 39 2 40 x 41 x 42 3 43 x 1 1 3 1 2 LIFESTYLES Standard No Score 11 3 12 4 13 3 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 CARE Edenbridge Score 3 3 3 3 DS0000064927.V292623.R01.S.doc Version 5.1 Page 25 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 YA6 Regulation 14 &15 Requirement The registered person shall ensure that the assessment of the service users needs is - (a) kept under review; and(b) revised at any time when it is necessary to do so having regard to any change of circumstances. The registered person shall, after consultation with the service user, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met, make it available to the service user, keep it under review and revise it after consultation. Specifically care plans must be up to date and include all the needs of residents Action still needs to be taken to achieve compliance with this requirement. Previous timescale 31/03/06 2. YA7 12 (2) The registered person shall so far as is practicable enable DS0000064927.V292623.R01.S.doc Timescale for action 30/06/06 30/06/06 CARE Edenbridge Version 5.1 Page 26 3. YA9 13(4)(b) 4 YA10 17(1) service users to make decision with respect to the care they are to receive and their health and welfare. Specifically independence should be promoted respecting the right of service users to make decisions. Residents should not be locked out of communal areas of the home or their own rooms and access to food should be freely available at all times unless individual care needs override this for specific residents, blanket policies must not be used. Action still needs to be taken to achieve compliance with this requirement. Previous timescale for action - 31/03/06 Unnecessary risks to the health and safety of service users must be identified and so far as possible eliminated by the provision of up to date risk management guidance to staff as part of the care plan. Action still needs to be taken to achieve compliance with this requirement. Previous timescale for action - 31/03/06 The registered person shall - (a) maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user; (b) ensure that the record referred to in sub-paragraph (a) is kept securely in the care home. Specifically medication or other personal records should not be left in view in an open 30/06/06 30/06/06 CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 27 office 5 YA16 16 The registered person shall 30/06/06 having regard to the number and needs of the service users ensure that - (a) the physical design and layout of the premises to be used as the care home meet the needs of the service users; (c) provide in rooms occupied by service users adequate furniture, bedding and other furnishings, including curtains and floor coverings, and equipment suitable to the needs of service users and screens where necessary; in that suitable locking mechanisms shall be used to enable all service users to open the front doors and their bedroom doors wherever possible. Furniture must be suitable for residents use, i.e not of exaggerated height. 30/06/06 The registered person shall having regard to the size of the care home and the number and needs of service users - i) provide, in adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared and available at such time as may reasonably be required by service users; Blanket policies must not restrict access to food The registered person shall 30/06/06 ensure that any complaint is fully investigated and appropriate records maintained in line with the regulation. Whilst improvements have been made more action still needs to be taken to achieve full compliance with this DS0000064927.V292623.R01.S.doc Version 5.1 Page 28 6 YA17 16 7. YA22 22 CARE Edenbridge 8 YA28 23 requirement. Previous timescale for action - 31/03/06 The registered person shall 30/06/06 having regard to the number and needs of the service users ensure that - (o) external grounds which are suitable for, and safe for use by, service users are provided and appropriately maintained; The gardens must be finished and landscaped appropriately. The registered person shall having regard to the size of the care home and the number and needs of service users - (j) after consultation with the environmental health authority, make suitable arrangements for maintaining satisfactory standards of hygiene in the care home; Specifically microwaves and bathroom furnishings must be kept clean. The registered person shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users, specifically staff must have an adequate understanding and ability to communicate in English to enable them to successfully undertake training and to communicate effectively with one another and with service users. More action still needs to be taken to achieve full compliance with this requirement. DS0000064927.V292623.R01.S.doc 9 YA30 16 30/06/06 10. YA32 18(1)(a) 30/06/06 CARE Edenbridge Version 5.1 Page 29 11. YA33 13(4) & (5) Previous timescale for action - 31/03/06 The registered person shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users, specifically where service users have identified need for support at night, waking night staff should be on duty. Sufficient numbers of staff should be on duty to maintain satisfactory standards of hygiene. 30/06/06 12 YA37 26 13 YA39 24 Where the registered provider is 30/06/06 an organisation or partnership, the care home shall be visited in accordance with this regulation. The person carrying out the visit shall - interview, with their consent and in private, such of the service users and their representatives and persons working at the care home as appears necessary in order to form an opinion of the standard of care provided in the care home; (b) inspect the premises of the care home, its record of events and records of any complaints; specifically to ensure that requirements are being actioned and effective management is in place The registered person shall 30/11/06 establish and maintain a system for - (a) reviewing at appropriate intervals; and (b) improving, the quality of care provided at the care home, The registered person shall supply to the Commission a report in respect of any review of quality DS0000064927.V292623.R01.S.doc Version 5.1 Page 30 CARE Edenbridge conducted by him and make a copy of the report available to service users. The system shall provide for consultation with service users and their representatives. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. CARE Edenbridge DS0000064927.V292623.R01.S.doc Version 5.1 Page 32 - 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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