Inspection on 30/01/08 for Castle-Ford

This inspection was carried out on 30th January 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 27 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Castle-Ford 29/07/08

Castle-Ford 07/11/06

Castle-Ford 30/11/05

Castle-Ford 09/06/05

Castle-Ford 07/12/04

Castle-Ford 06/07/04

Castle-Ford 22/01/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

CARE HOME ADULTS 18-65 Castle-Ford 46-48 Princes Avenue Withernsea East Riding Of Yorks HU19 2JA Lead Inspector Christina Bettison Key Unannounced Inspection 30th January 2008 09:30 Castle-Ford DS0000019657.V357614.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 Castle-Ford DS0000019657.V357614.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. Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castle-Ford Address 46-48 Princes Avenue Withernsea East Riding Of Yorks HU19 2JA 01964 613164 01964 612412 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) Mr John Frederick Wright Christine Wright, Mr Mark Anthony Wright, Duncan Joseph Wright Mr Mark Anthony Wright Care Home 18 Category(ies) of Learning disability (18) registration, with number of places Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th November 2006 Brief Description of the Service: Castle-Ford is a privately owned registered home catering for the needs of 18 people who have a learning disability. It is located in the seaside town of Withernsea and is within walking distance of the local shops and public transport. The home consists of three terraced properties converted into one building. There is a reasonably private garden and adjacent car parking. Accommodation consists of several lounges, an activities area, a sensory room, 4 double rooms and 10 single rooms none of which have en-suite facilities. There is no stair lift or hoist in the home, people who have mobility problems are situated on the ground floor and have access to bathroom and toilet facilities on the ground floor also. The home does not provide nursing care. The fees charged are £338.50 per week. An additional charge is made for newspapers/magazines, hairdressing, chiropody, and sweets. Information on the service is made available to people via the statement of purpose, service user guide and inspection report. Castle-Ford DS0000019657.V357614.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 no star. This means that the people who use this service experience poor quality outcomes. The site visit took place over 1 day in January 2008. Surveys were posted out prior to inspection; six were returned from staff, nine were returned from relatives and twelve returned from people who stay in the home. During the visit we spoke to the manager, staff, and some of the people who live in the home. We spent time observing interactions between staff and the people who live in the home to find out how the home was run and if the people who lived there were cared for properly. We looked around the home and looked at some records. Information received by us over the last twelve months was considered in forming a judgement. As part of this visit we referred to notifications sent to the Commission for Social Care Inspection, the event history for the home over the past year and the completed pre- inspection questionnaire. The site visit was led by Regulation Inspector Mrs. T. Bettison, the visit lasted seven and a half hours. What the service does well: Most of the people have lived in the home for a number of years and have been cared for by some of the same staff. Relatives told us; “All of the staff have good communication with myself, we have a good relationship and I feel my daughter and other residents are cared for” “The home provides unique care and attention for each and every resident in a family atmosphere” “The staff are the most helpful and caring people I know. The residents are all well looked after and cared for and given every support they need” The home is warm and comfortable and those people who could talk to us and completed questionnaires said they were very happy living there. Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 6 Those people who are more able are helped and encouraged to maintain their independence. Relatives told us: “They have given my brother the freedom he likes in the day time to do his own thing” The people who live in the home told us; “It’s good food, got good fellow residents, good staff and management” What has improved since the last inspection? What they could do better: Each person living in the home needs to have a full assessment completed by someone qualified to do this, then detailed plans need to be prepared so that staff know what peoples needs are and are able to meet them. Plans must be reviewed at least every 6 months. People need to be given more opportunities to develop their independence. The people who live in the home told us; “It would be nice to help around the home more. For example help in the kitchen, washing pots etc” Where people are at risk of harm or display behaviour that is difficult for staff to manage, plans must clearly state how this will be reduced. Peoples religious and cultural needs and activities and interests will need to be included in the plans. There also needs to be plans to identify and say how peoples health needs will be met and when professional advice is given this must be followed by staff. All of the people that live in the home must have the opportunity to take part in activities and facilities in the community that meets their individual needs, wants and interests. The rules for the administration of medication must be updated to include selfadministration and homely remedies and staff must be assessed as competent to administer medication. Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 7 Staff will need induction; basic training and extra training to help them understand what is expected of them and recommendations for professional people must be followed. Staff told us; “We could do to go on more courses and I think the staff would benefit from a challenging behaviour course and a full first aid course” The home needs to have a plan for training. The policies and procedures (rules) for medication need to be updated and when people have medicines that are taken “when needed” the instructions for staff need to be clear when and why they can help them to take it. There needs to be enough staff in the home so that the staff can meet the needs of people and carry out all of their duties safely and to make sure that the people that live in the home are helped to attend activities and spend time in the community. Staff told us; “We have 2 members of staff to care for 18 residents, cook meals, do laundry, clean bedrooms, escort residents to day centres and appointments and fit in activity sessions. Some residents get left because we have no time for them” “There is too much work for only two people on shift” “If we got more funding this would mean we could have more staff to take the service users out every day of the week. Several staff told us: “We need extra staff on days and a full time cook” The home needs to have a plan for maintenance, decoration and ongoing repair with timescales that are kept to. A system to check the quality of the service provided needs to be in place and be effective and this must include regular visits form the owner. 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. Castle-Ford DS0000019657.V357614.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 Castle-Ford DS0000019657.V357614.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 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples needs are not assessed in full by qualified person and consideration is not being given as whether the home is sufficiently resourced to meet all of their needs. EVIDENCE: Three care files were examined as part of the visit and only one of them included a copy of the care management assessment or the homes own assessment. We were informed that the manager has requested that the local authority re assess all of the people that live in the home as a number of them are getting older, their needs have changed and they are becoming more dependent and needing more staff support. Consideration has not been given as to whether the home is sufficiently resourced to meet everyone’s needs, there are only two care staff on duty for up to 18 people some who are getting very dependant and peoples individual needs are not being met. (See staffing section and individual needs and choices section of this report) Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 10 In the care files examined there were very basic plans, basic risk assessments and no health action plans. None of this was sufficient to give staff a clear understanding of how to deliver care and meet peoples individual complex needs. Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples needs are met on an informal basis by inadequate numbers of staff, the quality of the plans and risk assessments are very basic. These shortfalls have the potential to place people at risk and mean that people’s needs are not met. EVIDENCE: All of the people in the home have two care files, one an archive file and the other an active daily file. Both files are individual to the person to maintain their privacy, dignity and respect. Three care files were examined as part of the inspection process. Only one of them contained a care management assessment or the homes own assessment. Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 12 The plans for people did not include enough detail, they did not reflect the full range of needs and do not ensure that all aspects of health, personal and social care needs are identified and planned for and did not detail accurately what staff need to do to meet peoples needs. In one care file examined although there was a local authority assessment on file not all of their needs had been transferred into a plan of care. The plan of care included very basic information and did not cover all areas of need, there were basic plans for health care, finance, personal care, diet/nutrition and communication however there was no mention of needs relating to medication, personal social and emotional development, culture and faith needs and friends or family contact. The local authority assessment stated that this person likes boats and used to go to work with his dad (who worked with boats) but there was no mention of this in the care plan and no evidence that this interest was being maintained. This person has problems with their weight and both the LA assessment and the dietician recommended a low fat diet and regular daily exercise (a walk locally) however there was no evidence of this in the plan of care and no evidence that this need was being met, on the contrary the persons weight had increased recently. There were some risk assessments on file for areas such as; - cleanliness of room, sun exposure, mobility, bathing/showering and risk of abuse however the LA assessment mentioned “needs supervision when crossing the roads” and epilepsy however there was no risk assessments to cover these areas. A LA “Fairer access to care” review had been carried out on 16/7/07 and an internal review 16/8/07 but none since. In another care file examined, there was no assessment and a very basic plan that did not cover all identified needs and poor quality risk assessments completed. Information on file stated that this person has autism and liked strict regimes in his lifestyle and suffers with asthma. They can on occasions exhibit behaviours that be difficult for staff to manage and has very particular likes and dislikes relating to food and drink. The plan only contained a section for personal care which was very basic and did not give any indication of what tasks this person might be able to manage themselves and what tasks they would need support for and what form this should take. There was a section on diet and nutrition but no mention of their likes/dislikes and there was no evidence of plans for medication, finance, personal social and emotional development, culture and faith needs and friends or family contact or communication. There was a basic plan for health but this only mentioned Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 13 their asthma and the medication prescribed but no PRN protocols in place as when the medication can be administered and how much. There was a basic behaviour management plan in place that told staff to look for “triggers” but no detail as to what the triggers where, however there was a behaviour monitoring chart in place. A LA “Fairer access to care” review had been carried out on 6/6/07 but none since. In the third care file examined again there was no LA assessment and the plan of care was very basic. The LA care plan stated that this person enjoys football, rugby, cinema, gardening, visiting family and watching the TV, it also mentions that this person can on occasions suffer from a low mood. The plan only contained a section on personal care. None of the above had been included in the plan of care and there was no evidence that their individual diverse needs were being met. It stated that this person had problems with their thyroid and needed regular blood tests however the last recorded check was 9/9/07 and there was no outcome of this noted. This person is also seeing a specialist for a painful hip, they had been for an X-ray on 2/10/07 but again there were no records of an outcome or follow up for this. A LA “Fairer access to care” review had been carried out on 3/6/07 and an internal review on 16/1/07 but none since. Health screening had not been undertaken for anyone living in the home therefore health needs had not been sufficiently detailed in plans and there has been no input from the health authority/community team learning disability in the development of health screening or health action plans and there was minimal evidence of outcomes of monitoring of health needs. Monthly monitoring was taking place but this appeared to be very repetitive in its content and did not cover important issues like health needs and medical appointments. There were also no protocols in place for the administration of medication on a PRN basis. There were serious omissions in all the care files examined, poor quality plans that did not detail all needs and did not include areas of cultural and religious needs, diet and nutrition, communication needs, mobility issues, poor quality risk assessments, poor quality behaviour management guidelines and they did not include administration of medication PRN, no systematic monitoring of incidents of presenting behaviour and no health action plans. Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 14 On the whole the people who live in the home appeared relaxed and comfortable in their surroundings. For those people who were able to verbally communicate it was observed that the staff members interacted on a regular basis with them. Overall speaking to people in an appropriate way that promoted inclusion. Observations and comments received from staff, relatives, professionals and the people who use the service suggested that peoples basic care needs were being met even though there was a lack of clear plans and guidance and inadequate staffing numbers. This approach is dependent on staff memory and good verbal communication systems. People are at risk of not having their care needs met if these informal systems break down. Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 15 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 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People that live in the home that are more dependant have limited opportunity to maintain and develop their skills and participate in stimulating and motivating activities that meet their individual needs, wants and aspirations. EVIDENCE: People that live in the home that are independent lead an active lifestyle, walking to the shops, visiting friends and relatives and attending day services, colleges and adult education classes. However there are a number of people living in the home that are more dependent and require staff support to either go out or undertake an activity in house. Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 16 For one person the LA care plan stated that this person enjoys football, rugby, cinema, gardening, visiting family and watching the TV, none of these needs were being met. For another person the local authority assessment stated that this person likes boats and used to go to work with his dad (who worked with boats) but there was no mention of this in the care plan and no evidence that this interest was being maintained. This person has problems with being overweight and the both the LA assessment and the dietician recommended a low fat diet and regular daily exercise (a walk locally) however there was no evidence of this in the plan of care and no evidence that this need was being met, on the contrary the persons weight had increased recently. There was little supporting documentation to evidence that peoples individual diverse needs and wants had been identified, planned for and therefore met. Discussion with staff and records indicated that family and friends are able to visit the home and can use any of the communal facilities or peoples bedrooms. There is no restriction on visiting times. The majority of people have limited verbal communication to express their choices and wishes and promote their independence. Any restrictions are not documented within their plan. The care staff currently do all of the shopping and cooking. We were told that the staff try to promote a healthy eating menu however there were no records available to evidence this. In addition to this the store cupboard consisted of mostly supermarket “value” range of products. The manager is required to review the food provided in the home and ensure that it is of good quality, nutritional and well balanced and meets the needs and wants of the people who live in the home. The diet and nutritional needs of people needs to be detailed in their plan and include their likes and dislikes. Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 People who use the service experience poor outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. Peoples health and personal care needs are not being fully identified, planned and met. These shortfalls have the potential to place people at risk. EVIDENCE: Health screening had not been undertaken for anyone living in the home therefore health needs had not been sufficiently detailed in plans and there has been no input from the health authority/community team learning disability in the development of health screening or health action plans and there was minimal evidence of outcomes of monitoring of health needs. Monthly monitoring was taking place but this appeared to be very repetitive in its content and did not cover important issues like health needs and medical appointments. For one person who has problems with their weight, both the LA assessment and the dietician recommended a low fat diet and regular daily exercise (a Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 18 walk locally) however there was no evidence of this in the plan of care and no evidence that this need was being met, on the contrary the persons weight had increased recently. For another person there was a basic plan for health but this only mentioned their asthma and the medication prescribed but no PRN protocols in place as when the medication can be administered and how much. And in another file it stated that this person had problems with their thyroid and needed regular blood tests however the last recorded check was 9/9/07 and there was no outcome of this noted and this person is also seeing a specialist for a painful hip they had been for an X-ray on 2/10/07 but again there were no records of an outcome or follow up for this. Files evidenced some appointments with specialists; - dietician, optician, chiropody and some consultants however this was patchy and reactive and there were serious omissions in the identification, planning, meeting of health needs and very poor recording to evidence that all health needs had been met. None of the files contained any evidence that people were seeing a dentist. The home has polices and procedures supplied by Mulberry house and the medication training is provide by them also. This did not include a selfadministration policy and a homely remedies policy. The people who live in the home are not given the opportunity to self medicate. The senior staff had completed administration of medication training this includes a workbook and test that is sent off to Mulberry House for verification. However there was no evidence on staff files that their competency had been assessed. In general the medication appeared to be managed satisfactorily. The home stored medication securely. The home did not have any controlled drugs in the home at the time of the visit, however they were advised to obtain a controlled drugs register and cabinet should it be needed in the future. We were concerned that the medication cabinet was sited in the kitchen store cupboard, which may at times rise above 25 degrees, the temperature inside the medication cabinet should be checked and monitored on a daily basis. All medication was signed into the home and there were no missed signatures on the medication administration records observed. Stock control was managed and medication in the blister packs was returned to the pharmacy when no longer in use. Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 19 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 People who use the service experience adequate outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a complaints system and people who live in the home are given opportunities to raise concerns however due to the unsatisfactory staffing arrangements, poor plans and lack of training people are not fully protected from harm whilst in the care home. EVIDENCE: The home has a complaints procedure and policies and procedures for safeguarding adults. Meetings are held regularly for the people who live in the home and records are kept. The meetings are used to enable people to make suggestions as to the running of the home and raise issues and dissatisfaction and get them resolved. There had been no complaints to the home since the previous inspection, For people who present behaviour that may pose a risk to themselves and others robust behaviour management strategies were not in place and not all staff have received training in how to manage people in times of distress and high anxiety. There had been no safeguarding adults referrals since the previous inspection. Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 20 There were records to evidence that some staff had received training in the Protection Of Vulnerable Adults (POVA) but not all and we were informed that the people who live in the home had also watched a DVD on how to protect themselves and raise issues. However the unsatisfactory staffing arrangements, poor quality and lack of assessments and plans, poor attention to health needs and outcomes means that people are not fully protected from harm whilst in the care home. (These areas are explained further in individual needs and choices management and staffing) and give cause for concern. Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 21 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 People who use the service experience adequate outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The environment provides people with safe, warm and comfortable surroundings in which to live, however areas of the houses are in need of repair and redecoration. EVIDENCE: Castle-Ford is a privately owned registered home located in the seaside town of Withernsea and is within walking distance of the local shops and public transport. The home consists of three terraced properties converted into one building. There is a reasonably private garden and adjacent car parking. The home has several lounges, an activities area, a sensory room, 4 double rooms and 10 single rooms none of which have en-suite facilities. There is no stair lift or hoist in the home, people who have mobility problems are situated Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 22 on the ground floor and have access to bathroom and toilet facilities on the ground floor also. The home has been maintained and provides a safe environment for people to live. Overall the décor is satisfactory however the home in places looks tired and dated and in need of redecoration. Peoples bedrooms were personalised with photographs, pictures and personal belongings. They also have the opportunity to bring their own furnishings into the home if they wish. On the day of the visit the home was clean tidy and tidy, all equipment for laundering of clothes is provided and there is adequate outside space, although this could do with landscaping and the planting of plants and shrubs to make a more pleasant area for people to use in the summer. The manager is required to submit a maintenance and renewal plan to CSCI to identify timescales for the redecoration of the home. Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35, 36 People who use the service experience poor outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The current staffing arrangements are not sufficient to meet the needs of the people living in the home and mandatory and specialised training is unsatisfactory placing people at risk. EVIDENCE: We were informed that the home has 11 full time care staff and the registered manager works supernumerary. The rota evidenced that there are 2 care workers allocated per day shift to attend the needs of 18 people. During a Monday to Friday an additional member of staff comes in to undertake cleaning and prepare lunch, for two hours per day however they do not attend to personal care needs and this support is not available on a weekend. Staff have the responsibility of cleaning some areas of the home, the preparation, cooking and serving and cleaning up after 2 meals per day, Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 24 supporting people to attend appointments, activities, undertake shopping and gardening and in addition to this attend to the care needs of the people that live in the home. This is clearly inadequate numbers of staff. Information received by the manager in the completed Annual Quality Assurance Assessment dated 21/9/07 indicated that the home provided 266 care staff hours and 98 other support hours (not personal care) and 35 other staff hours. A staffing calculation was completed by the inspector based on 6 people with high level need, 9 medium level need and 3 low level needs and this resulted in the need for 745.32 care staff hours per week needed. The registered person must undertake a review of the people in the home re their assessed needs, and undertake a review of staff hours provided to ensure that there are enough staff in the home to meet peoples care needs and diverse needs in relation to maintaining and promoting independence and provision of activities. On the whole the people who live in the home appeared relaxed and comfortable in their surroundings. For those people who were able to verbally communicate it was observed that the staff members interacted on a regular basis with them. Overall speaking to people in an appropriate way that promoted inclusion. Four staff files and the training records were examined in the course of the inspection, one of these being a new starter. All had completed application forms and had two written satisfactory references and all had CRB clearances prior to commencing employment. There was no evidence that the new staff had commenced induction. There was also no evidence of probationary interviews being carried out for new staff. The manager must ensure that new staff are given basic induction into the home on commencement and commence formal induction that is completed within 6 weeks of commencing employment. Most of the training provided is by using videos and workbooks provided by Mulberry house however we were informed that funding has been achieved to access other training and some will be provided by the local authority and other care providers. We were told that mandatory training courses are booked in and are hoped to be completed by March 2008. Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 25 The long serving staff had completed some training however a lot of it was dated 2004/2005 and had not been updated since and the new member of staff had nor completed any mandatory training other that fire safety. Some staff had completed the safe handling of medication training, however there was no evidence of an assessment of competence undertaken. The home did not have a training plan however we were informed that 10 staff had completed the NVQ level 2 or above. The people that live in the home have presenting needs in communication deficits, autism, sensory impairments and some present behaviour that may pose a risk to themselves or others, although we were told that staff had completed training in this there was no evidence on staff files. Staff records examined evidenced that supervision has been provided sufficiently however staff had not received appraisal interviews. The registered person is required to prepare a training plan and ensure that all staff are up to date with mandatory training and service specific training is provided in autism, effective communication skills, managing behaviour that may pose a risk to themselves or others, diabetes, age related conditions, medication training that includes a competency assessment, equality and diversity, the mental capacity act, values and attitudes and effective recording. Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 26 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 People who use the service experience poor outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The management and conduct of the home is unsatisfactory and does not ensure that people’s needs are met and they are protected from the risk of harm. EVIDENCE: The Annual Quality Assurance Assessment document was completed by the manager and submitted to CSCI prior to the inspection taking place. CSCI are concerned that the content of the AQAA did not correspond with the findings on the day of inspection. Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 27 The AQAA stated, “All service users have a CCA and care plan from care management”. Only one of the files examined contained a CCA. Also it stated “all service users have a service user plan which identifies strengths, needs and achievable goals” as detailed in this report this was not the case in practice. These are just some examples. The registered manager of the service has a number of years experience in the care profession and in the field of learning disabilities. It was a requirement of the previous inspection that he complete the NVQ level 4 and registered managers, however this has not yet been achieved and remains an outstanding recommendation. The manager is registered with the CSCI. The low staffing numbers, lack of detailed plans and guidelines, poor attention to providing both mandatory and service specific training, and the lack of evidence that risk is being managed effectively does not ensure that people are being protected from harm. The restrictions of the current staffing structure and number of care hours provided within the home mean that although the staff are willing and caring they do not have the time within the shift to undertake all of the duties required to ensure that peoples complex personal, health and safety needs are met. As part of the inspection all maintenance records were examined;• • • • • • • • • • • Fire risk assessment- completed Fire drills- undertake monthly. Fire extinguisher- 6/8/07 Emergency lighting and fire alarm- weekly internally Gas safety- checked on 8/2/07 Electrical hard wiring- dated 2/6/07 valid for 1 year only PAT –March 2007 Water temperatures- weekly Legionella – not done but system purchased and implemented Wheelchairs- not checked Call bell system- weekly internally will be Since the previous inspection the home have only notified the CSCI of one incident (power failure) and no others. The registered manager is required to ensure that all incidents that affect the health, safety and well-being of the people that live in the home under regulation 37 are notified to the CSCI. Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 28 The home has a QA system, which includes regular audits and consultation with stakeholders however this process has failed to be effective in highlighting areas of concern and taking action to address them. Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 29 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 1 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 3 STAFFING Standard No Score 31 x 32 1 33 2 34 x 35 1 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 x 2 x LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 x 16 x 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 x 1 x 2 x x 2 x Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14 Requirement Timescale for action 30/04/08 2 YA6 15 and 17 3 YA6 15 and 17 4 YA7 13 (6 and 7) The registered person must ensure that the manager obtains a copy of care management assessment/or undertakes a full assessment. This will help the service understand peoples needs and determine if they have the skills and resources to meet them. The registered person must 30/04/08 ensure that plans are developed and agreed with people using the service and must detail the action to be taken by staff to meet their personal, health and welfare needs. The registered person must 30/04/08 ensure that people are reviewed at least 6 monthly and plans are updated to reflect changing needs so that their needs are met. The registered person must 30/04/08 ensure that where people display behaviours that are difficult to manage or there are any limitations or restrictions on facilities, choice or human rights to prevent self harm or abuse or harm to others that this is DS0000019657.V357614.R01.S.doc Version 5.2 Castle-Ford Page 31 5 YA9 13 and 17 6 YA11 16 (3) 7 YA12 YA13 YA14 16 (2 m and n) 8 YA17 16 (2 i) 9 YA18 13 (b) 10 YA19 13 11 YA20 13 and 15 agreed by a multi agency meeting and documented appropriately so that people are protected from harm. The registered person must ensure that there are individual and generic risk assessments available that are maintained and reviewed so that people are protected from harm. The registered person must ensure that peoples religious and cultural needs are identified planned for and met. The Registered person must ensure that activities are identified, planned for and provided that meet the diverse needs of the people who use the service and meet their assessed needs. These must be incorporated into the plan. The registered person must review the provision of food in the home and consult with relatives, staff and the people who live there to ensure that the food provided is nutritional, tasty and well balanced. The registered person must ensure that recommendations from professional therapist are adhered to at all times to ensure peoples safety and their needs being met. The registered person must ensure that peoples complex health needs are met by the provision of health screening, health action plans and access to health professionals. The registered person must ensure that where medications are administered PRN that guidelines for administration are written up and followed by staff so that staff know when and how much can be given. DS0000019657.V357614.R01.S.doc 30/04/08 30/04/08 30/04/08 28/02/08 31/01/08 30/04/08 31/01/08 Castle-Ford Version 5.2 Page 32 12 YA20 13 and 15 13 YA20 13 and 15 14 YA23 13 (2 6) 15 YA24 23 16 YA32 18 17 YA32 18 The registered person must review and amend the medication polices and policies to ensure they include selfadministration and homely remedies policies and that staff adhere to all policies and policies so that people are kept safe. The registered person must ensure that all staff that need it have received training in the management of medication and that they are assessed as competent so that people are kept safe The registered person must ensure that all staff receive training in safeguarding adults and that all requirements are met to ensure that people are protected from harm. The registered person must provide a maintenance and renewal plan with timescales for the redecoration of the home; the timescales must be adhered to so that the home is comfortable for the people that live there. The registered person must ensure that all new staff are registered on and complete induction to common induction standards within 6 weeks of appointment and a basic induction on commencement in post so that staff are competent to meet peoples needs. The registered person must ensure that staff receives specialised training in meeting the complex needs of people with a learning disability;• Autism • Communication skills • How to deal with people that present with difficult behaviour DS0000019657.V357614.R01.S.doc 28/02/08 28/02/08 28/02/08 28/02/08 31/01/08 30/04/08 Castle-Ford Version 5.2 Page 33 • • Equality and diversity Medication including competency checks. 18 YA33 18 19 YA35 18 20 YA37 8 21 YA37 37 22 YA39 24 23 YA42 23 so that staff are competent to meet peoples needs. The registered person must ensure that the home has an effective staff team with sufficient numbers and skills to support peoples assessed needs at all times. Staffing levels must be regularly reviewed to reflect changing needs. The registered person must ensure that a training needs assessment is carried out and training plan developed so that staff are competent to meet peoples needs. The registered person must ensure that the home is managed effectively. Policies and procedures are implemented and that compliance with the care standards act, regulations and other legal requirements are adhered to so that staff are competent to meet peoples needs. The registered manager must ensure that all incidents that affect the health, safety and well-being of the people that live in the home under regulation 37 are notified to the CSCI. The registered person must ensure that an effective quality monitoring system is in place based on audits and checks and takes into account views of stakeholders and the people who use the service and action is taken to address areas identified for improvement. The registered person must ensure that the home is safe and that there is evidence that the DS0000019657.V357614.R01.S.doc 28/02/08 28/02/08 31/01/08 31/01/08 30/04/08 28/02/08 Castle-Ford Version 5.2 Page 34 following have been serviced and maintained;• Legionella – 24 YA42 18 The registered person must ensure that all staff are up to date with their mandatory training so that staff are competent to meet peoples needs. The registered person must undertake regular visits to the care home and prepare a written report which is sent to CSCI to ensure that the owners are monitoring the standard of care and quality of service being provided. 28/02/08 25 YA42 26 31/01/08 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 YA37 Good Practice Recommendations The registered person should provide confirmation that he has commenced the Registered Manager’s Award and has the intention of commencing a National Vocational Qualification at level 4 in care. This is an outstanding recommendation from previous inspections. The registered person should obtain a controlled drugs cabinet and register. The registered person should introduce a monitoring system and take advice from the pharmacist to ensure that the temperature inside the medication cabinet is kept below 25 degrees. 2 3 YA20 YA20 Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Castle-Ford DS0000019657.V357614.R01.S.doc Version 5.2 Page 36 - 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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