Inspection on 17/06/08 for Carr Bank House

This inspection was carried out on 17th June 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carr Bank House 12/01/10

Carr Bank House 08/12/09

Carr Bank House 22/10/09

Carr Bank House 30/06/09

Carr Bank House 05/07/07

Carr Bank House 11/06/06

Carr Bank House 31/10/05

Carr Bank House 03/07/05

Carr Bank House 18/08/04

Carr Bank House 01/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Carr Bank House 9-11 Heywood Street Bury Lancs BL9 7EB Lead Inspector Lucy Burgess Unannounced Inspection 17th & 23rd June 2008 10:00 Carr Bank House DS0000008422.V366349.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 Carr Bank House DS0000008422.V366349.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. Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carr Bank House Address 9-11 Heywood Street Bury Lancs BL9 7EB 0161 797 7130 0161 763 1747 jocarrbank@btconnect.com 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) Mrs Pauline Jones Mrs Jo-Ann Yvonne Simpson Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 14 service users, in the category of Adults with Mental Disorder (MD) under 65 years of age. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 5th July 2007 Date of last inspection Brief Description of the Service: Carr Bank House is a privately owned care home for 14 adults with mental health needs. Fees range from £365.00. However this may vary depending on the person’s level of assessed need. The home is located in a residential area, close to Bury town centre, within easy reach of buses and trams, shops, cafes, and other local amenities. The house consists of 2 adjoining properties that have been adapted to form a large house. There is a small garden at the front and a large enclosed garden at the side. There are 12 single rooms and one double. Three bedrooms also have en-suite facilities. There are 2 lounges, an activities room, and a dining room. Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Two inspectors carried out the visit to the home, which they did not know was going to take place. The inspection was carried out over 2 days lasting 9 hours. The second visit took place so that we could speak with the registered manager. During the first visit inspectors briefly spent time talking with people at the home as well as the deputy manager. We also spent sometime looking round the home to check that it was clean and well maintained as well as looking at records. As part of the inspection process the provider was asked to complete a selfassessment document (Annual Quality Assurance Assessment). This was late in being returned and a reminder letter was sent to the home. Surveys were also sent out to people living at the home, their relatives and staff asking for their comments. None were returned. Discussion and feedback was held with the registered manager during our second visit. What the service does well: Carr Bank is a large home that offers people roomy accommodation in a residential area close to Bury town centre. People living at the home enjoy a relaxed routine and have help and support where needed. Most of the people living at the home have done so for sometime and are very settled. Whilst there have been some changes in the staff team good relationships continue with people at the home. The home continues to be supported by the local mental health team. Staff have built up good working relationships with them so that the health and wellbeing of people is maintained. Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Care Plans need to be reviewed to reflect the current and changing needs of people so that staff know what support they need. Risk Assessments should be developed in all areas of concern. Information should provide staff with direction about how to minimise such risk so that people are safe. Accurate weight and diet records should be maintained to show what steps are being taken to make sure that the health and well-being of people is being monitored properly. Staff need to ensure that medication such as eye drops is dated on opening and disposed of as prescribed ensuring items are only used when safe to do so. Work needs to be undertaken to improve the standard of the environment so the people live in a clean, well-maintained home. The manager is to review the staff rotas so that staff are available to support people, encouraging them to take part in activities in and away from the home. This will enable people to increase their independence and skills. A staff training plan needs to be developed identifying the training needs of staff. This will ensure staff have the knowledge and skills required to meet the needs of people living at the home as well as ensuring their continued development. The manager must ensure that all relevant information and checks are carried out on new staff before they commence any work at the home. Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 7 Action needs to be taken to ensure that water temperatures are maintained at 43°C. A number of areas were identified within the fire officers report which required attention. The manager should ensure that these are complied with and that people are not placed at risk. Work identified on the gas safety and electric certificates needs to be addressed and confirmation sent to the CSCI to confirm the action taken. A copy of the recent fire alarm inspection report should be sent to the CSCI. Any incidents, which may affect the well-being of people, should be reported to the CSCI. 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. Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessments are carried out appropriately so that staff are able to meet the needs of person once they have been admitted to the home. EVIDENCE: Since the last inspection in July 2007 no further admissions have been made at the home. The last person placed at the home had moved from the sister home, Laburnum House. A system is in place for gathering information when people are referred to the home. This involves assessment information being requested from health and social care professionals as well as opportunities for the person to visit the home or have an overnight stay. This helps staff when making a decision about whether they are able to meet the person’s needs as well as enabling prospective residents to meet with staff and other people who live at the home. Through previous discussion with the manager it is acknowledged that this as an area of further development so that they have sufficient background information about the person’s mental health ensuring this does not leave others at risk. This became more apparent following a recent admission, which quickly broke down. Carr Bank House DS0000008422.V366349.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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans and risk assessments do not provide up to date information to show how to people were to be supported properly ensuring their health and well being is maintained. EVIDENCE: Information continues to be held for each of the people living at the home. Records include; a care plan, risk assessment, personal information, professional visits, CPA minutes and daily diaries. We looked at the files for 2 people where there had been recent changes in their physical health. On the first file the person had been losing weight. The district nurse and dietician have carried out assessments and supplements had been provided. Other issues had been identified with regards to them managing their own personal care. The care plan was looked at to see if these issues had been detailed on the plan along with guidance for staff in relation to the support Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 11 required. The plan stated that the persons dietary intake and weight were to be monitored. However we were advised that meals were no longer being recorded as the person had gained some weight. Weight records were also looked at but these too were poor. The manager must ensure that plans and assessments are reviewed and updated as needs changed and that information provides clear direction for staff about the support to be provided. There was no information on the plan with regards to staff monitoring the person’s personal hygiene although information had been recorded in key worker book at the request of the manager due to changes being noted. With regards to risk assessments these covered areas such as personal hygiene, exploitation, nutrition and diet and physical health. However the information had been copied directly from the care plan and did not clearly identify the particular areas of risk and how these were to be minimised. The second file had also not been updated to reflect the changing physical needs of the person, the recent GP and hospital appointments, which had taken place and further action being taken. The manager advised us during our second visit that this information had been added. Again the risk assessment was a copy of the care plan The manager must again ensure that information recorded on the plan is accurate and up to date reflecting the current needs of people at the home. Risk assessments should also detail areas of concern that have been identified and how these too are to be minimised ensuring people are supported safely. Consideration should also be given with regards to the type of language used. Signature sheets were in place for staff to sign to say that they have read the plan and understood the information. There is also key worker system in place. This was developed so that each person along with their key worker could discuss goals and aspirations and how these could be achieved. Information recorded varied in relation to detail and frequency. The manager said that these were working well however some people engaged more than others. Progress in this area will be looked at again during our next visit. Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People need more access to staff so that they can be supported in developing their daily living skills, opportunities to socialise within their community, in order to promote their independence. EVIDENCE: Routines within the home continue to be flexible with people following a lifestyle of their choosing both in and away from the home. People spend some of the time watching television, reading papers and relaxing, as well as more planned activities away from the home accessing the local and wider community. This was observed during our visit. Five people have joined a local centre where they are able to attend group sessions. At present only one person attends on a regular basis for relaxation classes. Others take part in activities such as going to the pub to watch darts, Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 13 going to the betting shop, bus rides to Ramsbottom, gardening club, computers, art classes, playing the guitar and shopping. An activity book is in place. Events are recorded when staff go out with people. Information seen showed that generally the same 3 people will go out with staff to the local shopping centre and market. As detailed further within the report the manager is going to review the staff rota so that more staff are available at the times when support is required. In doing this more opportunities may be available during the day to encourage people to be more active in and away from the home. For example; one person who previously had a job at a local pub has over a period of time become less active and at present prefers the company and support of staff when going out. In amending the rota this would provide more opportunities for them. The home has a large private garden. One person in particular enjoys the privacy of the garden and spends a lot of time relaxing there. Relationships with family and friends are also encouraged both in and away from the home. Visitors are welcome to visit Carr Bank at any time. Individuals are able to see visitors in private using the communal rooms or their bedrooms. One person regularly spends the weekend with their partner or alternatively they stay together at the home. Arrangements in relation to meals continue to be flexible. Two people are Jewish however do not follow a kosher diet. When requested items have been purchased from the kosher butchers. Another person has a vegetarian diet. Individual meals had been prepared and frozen for them. Fresh fruit and meat were available. Items being stored in the fridge, which had been opened had been dated and frozen meat items were being defrosted away from cooked food. The home has a large kitchen where meals are prepared and a second kitchen, which is used by people to make their own drinks and snacks when they choose. Action identified during our previous visit in relation to a fly screen for the large kitchen window had been addressed. As previously identified, where able people continue to be encouraged to develop and maintain their independent living skills. Some of the residents are involved with household tasks, including cooking, cleaning and laundry. Support is provided where required. Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the home liaises with relevant health care professionals they need to ensure that records for monitoring the well-being of people are maintained. This will ensure people receive the right support should their needs change. EVIDENCE: People living at the home are independent and able to manage their own personal care needs however where necessary staff would offer prompts or encouragement. The manager explained that with one person it was noted that their personal hygiene was not being addressed. Staff were therefore asked to monitor this and offer encouragement and support where necessary. Records continue to be made of all health appointments and any intervention required. Notes are recorded following GP and Consultant visits. Review notes in line with the CPA programme are also held on file. These include reviewing the needs of people as well as their current medication. The home continues to have good links with local mental health professionals that will offer advise and support where needed. One person continues to Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 15 receive outreach support, which involves 1-2-1 support to assist in developing life skills. The physical health of one person was being monitored due to weight loss over the last year. As already identified improvements are needed to the care plan and assessments. Further information needs be improved with regards to what monitoring takes place i.e. food intake and regular weight checks. From the information seen the persons weight had only been checked and recorded 4 times since September 2007 and did not appear to be accurate showing that on each occasion any weight loss or gain was 7 pounds. More attention should be made ensuring information is accurate and reflects the changing needs of people so that appropriate support and intervention can be provided if concerns continue. Whilst action had been taken in contacting the dietician and supplements being provided the manager must ensure that support and monitoring carried out by staff needs to be in place to ensure that the health and well being of the person is improving and that no further intervention is required. Another person had also been experiencing a change in their physical health. Prompt action had been taken with regards to the person visiting their GP and being referred to the hospital for further examination. The medication system was examined. Generally this was found to be in order and held safely. Records are made of all items brought into the home and returned to the supplying pharmacist. There is also a checklist for those items not provided with the dosette book. This ensures that stocks are correct at all times. Administration records were also up to date and had been signed by staff where necessary. A minor shortfall was noted in relation to eye drops, which had been prescribed for one person. It was unclear if these had been administered as records were not seen and the bottle had not been dated on opening. The manager is advised to date the bottle on opening and discard following completion of the course or as prescribed. We also found that there had been one medication error where staff had administered the wrong medication to someone. This had not been reported to in line with regulation 37. Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 16 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place with regards to responding to complaints and concerns. Whilst awareness training has been provided, staff have not received formal training in the local authority safeguarding procedure ensuring residents are fully protected. EVIDENCE: The home has an up to date complaints procedure, which provides details about how to contact CSCI. People living at the home appear to have an open rapport with staff and are aware of whom to speak with if they have any issues or concerns. Since our last visit we have been contacted by the manager about a concern, which had been brought to her attention by a member of the public. Appropriate action was taken to resolve the matter. No other issues have been raised at the home or directly with CSCI. Polices and procedures are held at the home with regards to adult protection. Whilst training has previously been completed in this area, this has not been in relation to the local authority procedure. This is available through the Bury Adult Care Training Partnership Group, which the home has applied to be a member. As part of the annual training programme the manager should make arrangements for staff to attend so that they are aware of their responsibilities should an allegation be made. Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 17 Suitable arrangements are in place with regards to the management of people’s personal allowances. At present only 3 people are supported with a budget plan. A record book is held for each person and clearly evidences the running total of money held and all outgoings. Records were signed by the individuals and a staff member. A check was carried out, money held balances with the records. All others are provided with personal allowances each week from the provider and manage it themselves. Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 18 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Improvements are needed to the environment so that people live in a home, which is clean and well maintained. EVIDENCE: Action identified during our previous visit with regards to replacing broken windows and a fly screen for the kitchen had been addressed. A new modern fire surround had also been fitted in the recreational area along with new ornaments, which had improved the appearance of the room. However issues in relation to damp on the gable end have not been resolved. Two bedrooms have been affected by this and have damp stained walls, which need to be addressed. During our first visit we spent some time looking round all the communal living areas, bathrooms, some bedrooms and the outside areas of the home. A number of areas required attention. These included: • Unfinished step at the back door and step from the front pavement into the front garden, both potentially a trip hazard Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 19 • • • • • • • The back yard was storing rubbish and needed weeding, this needs to be cleared The garden was over grown and unkempt with rubbish lying around, this too needed attention Upstairs bathrooms in poor condition, odour, soiled flooring, one had a broken tap Non-smoking lounge furniture was heavily stained and required cleaning The front smoking lounge needs to be identified as a smoking area. There was also damp to the chimney breast and the curtains needed to be re-hung In the downstairs shower room there was a strong odour and the carpet was soiled and sticky General appearance within the hallways was dirty with marked/soiled walls and chipped woodwork. The fire officer had also inspected the home. A number of issues were identified and detailed in a letter dated April 2008. The manager advised us that there was only one area outstanding. The manager has put in place a monitoring form, which was being completed on a weekly basis. These were being used to check that the action identified by the fire officer was being adhered to by staff. The records however had not been completed for 2 weeks and prior to that issues had still been arising with staff leaving items within the laundry area. From our observations we too found laundry piled at the side of the dryer and combustibles in the laundry area. There were also a number of items such as stepladders, a hoover and other materials being stored within the vestibule areas, preventing access to the fire alarm. During our second visit we discussed our findings with the manager. She acknowledged that work was required to the bathrooms and that this had been discussed with the provider. It had been agreed that these were to be completely refurbished. Arrangements were also being made for a gardener to address work required to the outside areas and that this would hopefully be on a monthly basis. She also provided us with a schedule of work planned for the next few months. However this does not cover all the areas identified during our visit. This should be expanded upon to incorporate all areas of the home so that a good standard of accommodation is provided for people at the home. Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 20 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 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient staff need to be provided at times when people need support so that their needs can be fully met. Further training and development is needed to ensure that people are supported by staff that have the knowledge and skills required for their role. EVIDENCE: Since our last visit to the home 2 staff had been recruited however have not continued to work at the home. We looked at their recruitment information, which had been gathered. The manager told us that the two staff had spent little or no time working at the home and that they had decided not to continue with their employment prior to the criminal record checks being completed. From the documents seen information had been gathered in relation to an application form, medical questionnaire, references and copies of identification. Shortfalls were found however these had not been followed up due to them leaving so soon. Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 21 The manager is reminded that staff files must evidence a full and detailed employment history, 2 written references, one being from the previous employer and a current POVAfirst check and/or criminal record check prior to the commencing of any work at the home. The staff rotas were looked at. Shifts are identified on the rota showing the hours allocated each day for domestic tasks, the carer responsible for meals and the carer providing support. In addition to this there are the management hours. Through the discussion with the deputy manager we were informed that some administration tasks are delegated within the team. The manager completes the care plans, risk assessments, rotas, supervisions as well as planning training. The deputy manager then takes care of the medication system and general day to issues. Another member of staff has the responsibility for monitoring issues in relation to health and safety. The manager has recently been covering some of the evening shifts due to staff shortages. Previously agency staff had been used however the manager was unhappy with the quality of staff and lack of continuity. The manager explained that she feels that the second member of staff provided in the evenings is not necessary and could be used more effectively during the day to support people when attending appointment or activities. The on-call support would then be provided to cover the evening and nightshift so that additional support/cover could be provided should an issue arise. When developing the rota the manager must ensure that sufficient staffing is provided throughout the day so that the needs/routines of people can be met. Rotas should be kept under review should the needs of people change or if there are any new admissions. Since our last visit in July 2007 there has not been any training provided for staff other than fire safety in February 2008. We looked at the training matrix for staff, which showed that training in mandatory courses had been completed in 2005 and 2006 and medication training in 2007. The manager is aware that some of these areas now need to be up dated. The manager advised us that the application and information required to join the Bury Training Partnership Group had recently been submitted. Once this is completed training opportunities for staff will be accessed through the group. The manager needs to develop a training programme for staff in relation to their training and development needs for the forthcoming year. A copy of this should be sent to CSCI. We also discussed training in relation to the specific needs of those people living at the home. The manger has spoken with a mental health professional known to the home that has advised them to develop a workbook covering general information about mental health. The content of the information would then be looked at before it is delivered to staff. Whilst this would not cover specific issues it would help to develop peoples understanding and awareness. Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 22 NVQ training is also provided. The majority of the team have either completed level 2 or above or are currently working towards the award. The manager has now completed the work for the registered managers award/NVQ 4. This has been submitted to the assessor for verifying. In relation to staff supervision and support the manager has held a meeting with staff where the effectiveness of the current system was discussed. Some staff felt that it was repetitive and not very productive. It was agreed by everyone that supervisions would be held on a 2 monthly basis. Sessions would be broken down to include 2 general discussions, 2 sessions on training and development, 1 observation where the manager would work along side the staff member and an unannounced visit to the home. Each of the meetings will be recorded and information held on file. Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Registered Manager must ensure that all work required within the home is addressed so that the people living there receive a quality service. EVIDENCE: At present the manager of the home is supporting the ‘sister’ home Laburnum House due to the registered manager there being on maternity leave. At present management hours are split between working at Carr Bank, visiting Laburnum House and working from home. Additional management support is provided at the home by the deputy manager who is available in the absence of the manager. The manager has recently completed her portfolio for the Registered Managers Award. This has been outstanding for sometime and has yet to be verified by Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 24 the external assessor. Once completed copies of the certificates should be forwarded to us. There was also some discussion about the future plans for the home. The manager said that they were considering the possibility of providing a rehabilitation service for people on a short-term basis, providing intensive support to help them move back into the community. Whilst it is acknowledged that the service needs to be kept under review consideration does need to be given to those people who live at the home on a long-term basis ensuring this does not impact on them. Consultation would need to be held with all parties before this took place. In relation to quality assurance the manager has completed an annual report. This explores a number of areas about the service provision and the improvements required. A plan of work has been identified in relation to the environment and staff training and development. Copies were provided. The provider has also undertaken the monthly monitoring visits in line with regulation 26. Reports have been completed and are held at the home. We looked at records held in relation to health and safety checks. The home had recently been inspected by the fire officer and a number of areas were identified which required attention. Whilst some things had been addressed others remained outstanding. Management daily checks have been put in place, which involve making checks to the laundry room, cleaning cupboard and smoking areas. This task has been delegated to a member of staff. Records showed that the last check was carried out on the 5 June however had not been continue as the staff member was on leave. It was noted that issues were still arising, as staff were not always following procedure. The manager must ensure that these are complied with and that staff are aware of their responsibilities in ensuring people are not placed at risk. The home has a record book for logging any accident or incidents. Information showed there had been 3 incidents since our last visit including a medication error and someone having to attend A&E. These incidents had not been reported to us in line with Regulation 37. Reports in relation to a previous incident involving someone no longer living at the home have also not been provided. The manager must ensure that we are advised of all incidents, which may affect the well being of people living at the home along with the action taken to ensure that they are safe and protected. Other records were looked at with regards to servicing. We were advised that the fire alarm and equipment had been serviced the week prior to our visit and that they were awaiting the certificate. A copy of this is to be provided. Up to date checks were in place for the small appliances, 5 year electrics and gas safety. Points of action were identified on both these reports. The manager is asked to formally respond to us advising us that these have been addressed. Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 25 Water temperature records were also looked at. Information stated that thermostatic valves had been fitted in December 2007 however readings were found to vary significantly between 19°C and 56°C. To ensure the safety and comfort of those living at the home the valves must be checked by someone qualified to do so ensuring temperatures are regulated and maintained at 43°C. There was also an up to date insurance certificate displayed in the manager’s office. Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 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 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 3 X X 2 X Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement Care plans need be reviewed on a regular basis ensuring information reflects the current and changing needs of residents and staff are clear about the support required. (Outstanding requirement 30.8.07) Risk assessment need to clearly identify the area of risk and the level of support required to minimise such risk so that people are safe. (Outstanding requirement 30.8.07) Accurate records must be maintained with regards to dietary needs and weight monitoring so that people are support fully ensuring their health and well being is maintained. Arrangement should be made for staff complete Safeguarding training in relation to the local authority procedure so that they are aware of the procedure to follow and people are protected. Timescale for action 30/09/08 2. YA9 13(4) 30/09/08 3. YA19 12(1) 30/08/08 4. YA23 18(1) 13(4) 30/09/08 Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 28 5. YA24 23(2) The standard of the environment needs to be improved so that people live in a comfortable well maintained home. The standards of hygiene within the home needs to be improved providing a clean environment and minimises the risk of cross infection. Staffing levels should be kept under review ensuring staff are provided in sufficient numbers at times which best meet the needs of people living at the home. All relevant information and checks needs to be in place before staff commence any work at the home ensuring people are not placed at risk. A programme of training needs to be developed for the forthcoming year so that staff receive all the necessary training relevant to their roles and responsibilities ensuring they are competent to carry out their role safely. That CSCI is informed that the identified work on the electric and gas safety certificates have been carried out to ensure the health and safety of service users. (Outstanding requirement 30.8.07) 30/09/08 6. YA30 13(3) 23(2)(d) 30/08/08 7. YA33 18(1)(a) 30/08/08 8. YA34 19 schedule 2 30/08/08 9. YA35 18(1)(c) (i) 30/09/08 10. YA42 23(2) 30/08/08 11. YA42 13(4) 23(2) Action needs to be taken to ensure that water temperatures are maintained at 43°C for the safety and comfort of people living at the home. 30/09/08 Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 29 12. YA42 37 Any incidents, which occur that may affect the well-being of people, must be reported to the CSCI in line with Regulation 37. The manager must ensure that compliance is made in relation to the fire officer’s report so that the home is safe. 30/09/08 13. YA42 23 30/08/09 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 Refer to Standard YA3 Good Practice Recommendations When admitting new people to the home a more detailed assessment needs to be made ensuring the home has sufficient background information about the person’s mental health needs ensuring this does not leave others at risk. Progress should be made with regards to the key worker system so that people are assisted in making decisions about their lives. The manager and staff need to explore with people living at the home opportunities to promote their personal development exploring activities of their choosing both in the home and the wider community. Staff should date medication such as eye drops on opening and ensure they are disposed of as stated. Once received copies of the manager’s certificates in relation to the NVQ 4/RMA should be forwarded to the CSCI. A copy of the recent fire alarm servicing certificate should be forwarded to the CSCI. 2 YA7 3 YA11 YA12 YA13 4 5 YA20 YA37 6 YA42 Carr Bank House DS0000008422.V366349.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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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