Inspection on 24/10/06 for Darwell House

This inspection was carried out on 24th October 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 27 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Darwell House 22/12/08

Darwell House 04/01/08

Darwell House 26/06/07

Darwell House 07/06/06

Darwell House 28/10/05

Darwell House 23/04/05

Darwell House 29/11/04

Darwell House 26/05/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Darwell House Grange Court Maynards Green East Sussex TN21 0DJ Lead Inspector Jason Denny Key Unannounced Inspection 24th October 2006 09:15 Darwell House DS0000021117.V315529.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 Darwell House DS0000021117.V315529.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. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Darwell House Address Grange Court Maynards Green East Sussex TN21 0DJ 01435 866468 01435 867519 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) Evesleigh (Kent) Limited Mrs Jacqueline Head Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum service users to be accommodated is fifteen (15). Service users will be aged between eighteen (18) and sixty-five (65) years on admission. Service users will have learning disability as their assessed primary need. 7th June 2006 Date of last inspection Brief Description of the Service: Darwell House is registered for fifteen younger adults with a learning disability. The home is a large, two storey, detached property which has been divided into two smaller units. One unit provides seven single bedrooms and the other has eight. Each unit has a large amount of communal space, separate kitchen and dining facilities and sufficient bathrooms and toilets. The service stands alongside its sister home [Springmeadow], in several acres of ground in Maynards Green, near to Heathfield town, with shops and public transport links. Some of the land is utilised by service users for sport, allotments and gardens. Information on the current range of fees charged is normally within the home’s statement of purpose/service user guide with fees described as approximately ranging from around £995 to £2500 per week. Extras changed for are for personal items Inspection reports are not routinely sent out to families and advocates after each publication although a copy is kept on display in the reception area of the home and can be obtained via the manager. Minster Pathways took over the service since from July 1, 2005 on behalf of the new purchasers of Opus Living Ltd. The company name of Opus changed to Evesleigh [Kent ltd] in April 2006 with the current ownership remaining unchanged since July 1st, 2005. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced key Inspection, which included a visit to the home which took place between 9.15am and 4 pm on October 25, 2006. The overall conclusion of this inspection is that Six [of the eight] outcome areas is Poor, and in urgent need of improvement. One outcome area is Good, and One area Adequate [ok]. This inspection focused on the key areas such as the compatibility of the Resident group and who the home intends to provides care for in the future, how care is planned and delivered, activities and lifestyles, staffing ,how the home is managed and how concerns are dealt with. During this inspection process, a number of relatives and social workers have been spoken with, or completed questionnaires sent to them. Five Residents were focused on, all of whom have struggled to have their needs met. Some diversity and equality areas were explored in relation to what opportunities are provided. The inspectors spoke with, and observed 11 of the 14 Residents and looked at care records, how residents raise views along with medication arrangements. Discussions with management looked at the future purpose of the home and progress plans. The inspector toured all communal areas of the home. Meal arrangements were examined, complaints recording, along with how the service measures and improves quality. Two inspectors carried out the inspection visit due to concerns about the performance of the home and a inability over a number of years to admit people whose needs it can meet, and so that two inspectors could see the same evidence. An additional visit by the same two Inspectors and their manager to meet with senior management took place on August 30th 2006, to discuss the main concerns of the last key inspection of June 7th, 2006 of which this report should be read in conjunction with. Since the last inspection there have been a number of adult protection investigations based on those reported by the home. Two of these investigations involving social services, the home, and the Commission found that the service was again failing to provide enough staff, provide good leadership and management to staff, protect residents by good risk assessment and respond correctly to incidents. Linked to some of these concerns has been a complaint by a relative, investigated by social services, which indicated issues with unsafe staffing levels. Another incident raised a concern about how the home supports residents with adjustments to medication. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 6 This inspection visit found a number of incidents, which have occurred in the home since the last inspection, which had not been reported. A number of adult protection investigations were therefore triggered by this inspection with socials services identifying a number of repeated poor practices. What the service does well: What has improved since the last inspection? What they could do better: This inspection repeats the key weaknesses of the previous inspection and many of the issues, which have persisted for several years. In addition there are some new concerns, which indicate poor management and evidence of misleading the Commission and social services. In light of this increasingly worrying situation the Commission is now taking formal action. The home will be issued with a Statutory Notice within the month of November 2006 with a short timescale to show improvement. As reported at the last inspection the home needs more resources such as staff and focus more on what matters for Residents. Staff, residents, relatives, and Social Services all identify that the lack of staff is affecting choices and outcomes for Residents. There is still overall a lack of regular, structured and fulfilling activity programmes, which allows sufficient individual choice, meets needs and expectations, and allows for good skill development. The lack of routine and predictability is clearly detrimental to Residents. Those activities, which do take place for some, tend to be in the morning due to the lack of staff at other times. The lack of drivers as well as staff is affecting this, along with some Residents activity schedules not being followed due to resources, and their higher level of need. It is again not clear why the home continues to accommodate residents where it is struggling to meet their diverse [different] needs. A clear purpose and admissions criteria is needed to protect existing and future Residents. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 7 It is still not clear what the purpose is off both units of Darwell with a number of Residents incompatible and some clearly unhappy with life in the home, with one again asking to move out. Staff training, and management supervision needs to improve to ensure staff have the necessary skills to meet the specialist needs of the people they are expected to support, along with carrying out what is indicated in residents care -plans. Staff although caring, need to improve their communication with, and their understanding of resident’s needs. Resident’s goals need to be personal to them. The organisation needs to improve their quality assurance practices so they focus on what matters for Residents, and respond to their comments. Surveys should include most people involved in the life of Residents and indicate what actions are being taken. Reports produced need to accurately reflect the information received. It is concerning that the organisation’s reports and checks on the home are not highlighting the issues and effectively acting upon those, which the inspectors regularly find. Residents lack an independent voice that can speak up for them. The last Inspection report indicated some hope that the service manager would make the necessary improvements. This inspection found confusion about management arrangements with the registered manager in a part time role with the service manager also managing the home and making decisions, The registered manager was not available during the inspection with it not clear who had been responsible for certain decisions. A deterioration was found in the leadership and direction being given to the home. Staff morale was poor as observed by the inspectors and commented upon by visitors, and some seniors lack the necessary skills and understanding of Resident’s needs. The inspector’s found evidence of incidents that had occurred but which were not being reported, with disagreements about what actually happened. A number of different adult protection investigations within 2 weeks of the inspection visit indicated a number of issues, which need to be addressed by the home to show that Residents are being protected and that there is open, and accurate recording. Previously all staff and managers have been open and regularly reported incidents. Therefore it is now difficult to get an accurate picture of what is happening in the home. Where incidents have been reported since the last inspection [up until early August 2006], this has involved management adding to what staff had earlier stated, with the effect of making these incidents look less serious. The home was also found to be maintaining a staff rota, which was misleading about the real picture of staffing shortages, the actual rota worked was discovered showing the real shortfalls. Some staff indicated they were aware of these practices and did not agree with them. The homes ability to assess Residents is concerning due to them stating that everyone has been reassessed with no plans to take any action despite incompatibility issues and a Resident’s written and verbal unhappiness in the home. A resident who has recently been moved in is causing some difficulties and has insufficient staffing support. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 8 The home needs to ensure that Residents rights are protected such as in relation to their personal property and being in involved in how the home is run. Of those social workers spoken with three have indicated that they plan to move Residents, and during the inspection another Resident confirmed she would shortly be moving during early November 2006. 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. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 9 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 Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, & 5. Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. The information available to current and prospective service users [Residents] does not reflect the services offered by the home, although contracts are improved. The home statement of purpose and admissions criteria is confused and needs to improve in order to avoid further inappropriate admissions, incompatibility issues, and communicate a clear sense of direction for the home. The home needs to demonstrate that it can effectively and independently determine what service users are appropriate for the home. EVIDENCE: The current Statement of Purpose looked at and which was sent to the commission in August 2006 does not provide an accurate reflection of the services provided at the home or give specific guidance on what type of future person would be suited to the home to fill current vacancies. The service has not clearly indicated what the purpose of each unit [Claret and Skye] of the home is for, and how they will deal with current incompatibility issues. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 11 When Opus Living Ltd was purchased by new owners on 01 July 2005, they agreed with the CSCI to review current placements and to define what services would be provided by this home. The Inspectors were therefore confused to be told by the service manager during the inspection that reassessments had been carried out on all service users [Residents] with the service not planning to move anyone out of Darwell. This is confusing as the organisation have been told in previous meetings such as August 30, 2006 that until a group of compatible Service Users occurs in each unit then outcomes are difficult to improve and people cannot develop to their full potential. One new Service User had moved in from a home on the same site[September 28, 2006] which was confirmed to be causing new difficulties with existing service users [Residents] with this person regularly going into service user bedrooms uninvited, [as confirmed by a relative , social services discussions with staff, and records and incident report including diary entries after the Inspection,] and allegedly assaulting a current resident. It was also evident that the home had not adjusted staffing levels to support this move or fully involved other Residents [Service Users] in the process. Another service user had moved floors within the same home. A service user who indicated at the last inspection they did not want to live in the home repeated the same statement with the service manager present, this was also supported in a recent survey questionnaire they had filled in and held in the home. The service manager informed the service user that she would take action. The care manager confirmed that he was approached and a meeting took place shortly after the inspection. The inspectors were concerned that it took their visit to move this situation forward. The service manager also confirmed that she has been asked by the Responsible Individual as confirmed in a recent [September 28, 2006] section 26 monthly report to market the homes vacancies even though the service has not yet developed a clear and agreed Statement of Purpose. Following the last inspection the Commission received an updated service user guide and a statement of Purpose dated June 1, 2006. Overall some parts of these documents especially the range of needs met and admissions criteria were still confused. The commission then received a further Statement of Purpose and service user guide in August 2006. This document was helpfully split to draw a distinction between both units. The service user [Resident] guide was also written in a more user-friendly way for service users [Residents]. The home was re-described as being for people with special needs, which did not fit with the current service users. A meeting took place with the organisation on August 30, 2006 to discuss the Statement of Purpose and the importance of getting this right to ensure a compatible home where all individuals are not restricted by living with others who are incompatible with a staff team and service linked to the homes purpose. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 12 The same incompatibility issues [as highlighted in detail in previous reports], affects how the service can meet individually assessed needs and improve outcomes. Some staff spoken with indicated some of these incompatibility issues and how they affect risk and the running of the home. Some other staff made positive comments about how certain service users were progressing although this did not match with written records, observations, and discussions with some of these service users. One staff member speaking in agreement with another whilst commenting on the difficulties staff face with incompatible needs stated “ This is not care, this is containment”. A range of written evidence such as daily reports, discussions with some care managers and relatives and observations noted in other parts of this report supported this statement particularly in relation to less able service users. The home was again asked to reassess all current service users to ensure a compatible home in line with a clear Statement of Purpose. The inspector spoke to a number of care managers as part of the inspection process three of whom indicated that they are looking for a new placement/home, and another that they were reviewing the placement due to ongoing concerns. During the inspection a service user described in the last report as being an inappropriately placed after the new organisation took over. Made positive comments about a new home, which their care manager [Social Services ] has organised for the person to move into during early November 2006. The contract in place between the home and service users now includes all required information. Such as what services are included within the fees and any conditions that would apply in the event of the contract being terminated by either party. Most care plans looked in showed the fees, which are charged, but not all. The service manager was verbally asked to address this. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 13 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, &,9,. Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. The care-planning system has improved although Service users would be better protected if care plans were followed in practice. The rights of service users and their ability to influence how care is given would be better supported by the availability of independent advocacy The safety of service users would be improved if risk assessments and behavioural supports were thorough and followed in practice. EVIDENCE: Four care plans were viewed as part of the inspection process. Care plans have developed since the last inspection although in many respects they are not followed in practice especially in relation to the written routines, as was observed during the inspection and seen in records. Daily records often contained little detail or comments about what type of trips occurred and made little reference to care-plans or goals. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 14 Care plans provide a basic level of information about the service user. At this stage, specific needs and behaviours are not always backed up with comprehensive care guidance and behaviour management strategies. This was also highlighted by some staff who are critical that when a particular service user assaults another the managers advise that they are taken out with 2 staff sometimes for their favourite meal. The service manager explained that these incidents had occurred when the person was due to go out for a meal anyway. Either way it was acknowledged in discussion that there was some confusion with staff about the reasons behind approaches. These decisions were found in written records although they were not supported by clear written and agreed behavioural strategy for incidents when the person attacks others. Staff indicated the impact this has on other service users and commented on the inherent incompatibility issues, which make behaviours difficult to manage. Some adult protections since the last Inspection indicated that activities were either not risk assessed or that existing guidelines were not followed in practice, sometimes due to staffing levels or lack of staff awareness. Care plans identify goals for individual service users, which are then monitored as part of the ongoing review process. At the last inspection it was identified that the goals were fairly basic and it was required that these be reviewed in respect of service user development. It was disappointing that this had not been addressed. All Care-plan’s looked at had the same goals of tidying rooms, loading and unloading washing machines, making a drink. A detailed conversation with a newer service user at the last Inspection indicated that these goals had no meaning or value to the person. When the service manager was asked about why service users did not have aspirational or individual goals she stated that service users are “free to choose to have the same goals”. Furthermore, the process of reviewing and recording changes to the care plans and goals needs expanding. Monthly reports looked at were either not filled in or contained 1-2 lines. Some made no reference to incidents, which had occurred that month. The home are again advised to make independent advocacy available to service users so they can speak to someone outside of the home. Comments being made to inspectors by service users are not always acted upon by the home. One service user indicated discomfort into signing a contract he is not happy with, where independent advocacy might have helped this. Staff conformed along with records, that the confiscation of his Play-station as means of encouraging him to go out is making him upset. The home has a range of risk assessments in place. Some further work in this area is again required to ensure the risks associated with all activities are considered. Since the last inspection adult protection investigations have indicated insufficient risks assessing. During this Inspection some trips out where found not be subject to written risk assessments such as one outing which took place where 2 staff supported 4 diverse service users one of whom needs 1:1 and has a history of absconding as confirmed by staff. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 15 It was further concerning that the managers in a meeting within 2 weeks of the inspection visit confirmed that following an incident in August, that this person is assessed to need 2:1 staffing when in the community, an assessment not followed in practice as observed on the Inspection visit. Another service user who needs 2:1 staffing in the community was due to go on a planned trip with two staff and another service user. Records showed how risk assessments are regularly ignored sometimes as staff indicated to get people out even where there is insufficient staff, or due to staff not being aware of what the risk assessment is as was evidenced during this inspection in respect of two different planned trips. An adult protection meting on August 10,2006 found that a risk assessment was not known by staff despite having been written and which was later found. Memos and other communications from both managers connected with the home were critical of staff for continually ignoring risk assessments such as supervision of one service user at mealtimes where the risk assessment states two staff with managers requesting at least I staff person. This supported other linked evidence such as staff discussions which indicated confusion about what management expected of staff, want staff thought was necessary, and what was written in care-plans. One Service User informed the inspector of concerns about a recent change of key workers. It was evident through staff discussions and confirmation from the service user that the reason had not been explained to him. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 16 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): 11,12,13,15,16, & 17. Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. Service users will benefit from a structured programme of fulfilling activities, which meet their preferred and individual needs. Too many service users are unoccupied for long periods or have their plans regularly changed, and those activities, which are provided, often lack purpose. Meal arrangements are poor, based on financial resources, choice and supervision. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 17 EVIDENCE: Despite being a requirement of the last four inspections that activity programmes were revised, it was again observed at this inspection that service users lack a fulfilling timetable of activities. It was identified that activities are still occurring on an ad hoc basis, as opposed to being scheduled and planned in advance. Activities were found to be affected by staffing levels and availability of drivers. This has also led to staff taking risks by wanting to take out service users with not enough staff. On at least one[reported] occasion this has led to violent incidents between two service users. Due to limited goal planning it was not possible to see how activities are linked to personal development. One relative indicated that although overall trips out are slightly more frequent they still find that a particular service user who was active before moving into the service spends most of their time in the home. They also explained how certain activities which the service stated they would provide have not occurred with the service user having to wait until they are collected by their parents to access these opportunities and go on annual holidays. They explained how staffing levels ,lack of drivers, and lack of knowledge of the service user caused by staff turnover, affects opportunities. On the day of the inspection a senior member of staff in one unit stated in earshot of the inspector , “the inspectors are here lets get as many out as possible”. This meant that one service user’s planned morning trip was cancelled until the afternoon as this person needs two of the four staff on duty for the six service users in that unit. When the senior was questioned she stated that this decision was made because of the weather although the weather was observed to be the same throughout the day. This left the person and another in the home as was the case on the last inspection. The senior also stated that she did not think this would affect the service user as she had not been told of the original plan. The inspector advised that service users should have ownership of their plans and that there should be predictable routines. The service user’s parents confirmed that the service user is upset by changes to plans and has an understanding of days of the week. The other person spent the inspection wandering around the home as was the case on the last visit. Service users were found to have activity schedules on display which at times were different from the ones in the care-plans and which as confirmed by written records are not consistently followed in practice. A service user and a staff member in two different unit expressed surprise at being told what activities would be taking place as they were different to what had been planned. Daily records looked at often did not record the purpose or type of trip out so it was difficult to gauge if people were learning new skills apart from those whom go to college. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 18 On the morning of the inspection most service users went out shopping and one to work in a shop. After lunchtime most service users spent the rest of the afternoon in the home. Staff indicated that afternoon activities and trips are especially difficult as there are less staff and not always a driver. In one unit there are typically 3 staff in the afternoon and one of the 7 service users now needs 2 staff to go out. The diverse needs of some service users were not being met. A service user with very limited information about his interests on file was still found not to be supported to do fishing despite this being a stated interest. Another service user again stated as had at the last inspection that he used to go to church every Sunday since a particular staff member left the home. It was not evident in records if any regular church activity has been organised and given staffing levels difficult to see how this could take place. One service user informed the inspector that they were “bored”. The availability of food stocks and budgets for staff has not previously been reported as a problem. On this Inspection staff indicated that they now have to ask for a daily budget for food with petty cash in one unit lower than £3 as evidenced to one of the inspectors. Records and discussions with staff indicated that the lack of food stored in the home reduced alternatives and ability to follow weekly menus. Staff indicated in one unit, and showed in records, that on the previous evening someone had to rush out to get sausages so that an evening meal was possible. There was no evidence that service users went without food but that options such as fresh fruit and alternatives were strictly limited. This urgent situation was discussed with the service manager who stated that she was not aware of the situation and will investigate promptly. One service user who can have incidents linked to food choice now has daily and weekly meetings to discuss their menu as confirmed by staff. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19, & 20. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Health needs are responded too although more thought is needed for personal care support. Changes to Medication needs to be properly agreed and based on the best interests of Residents. Storage and security is good. EVIDENCE: Medication was inspected at the last inspection June 7, 2006 this included storage, recording and dispensing, with all aspects found to be good. Careplans and daily records showed how those service users focused on, are supported to have their basic health needs addressed including medication reviews. Following an adult protection investigation since the last Inspection the medication storage for one unit has moved upstairs to the same floor to avoid further incidents of service users not being supervised correctly when staff go and prepare medication before meals. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 20 A care manager has expressed concern to the home[although this was not recorded within the care-plan despite a review.] and the Commission following an instance where the home were involved in increasing one service user’ medication which had been agreed to be reduced. The home took this decision following one minor incident without consulting with all necessary people apart from the GP and psychologist. The care manager has since been able to resolve this with the home and give them guidance and remind them of the previous agreement, which has now resulted in the same service user coming off medication which is so far proving beneficial. The home are therefore advised that in future medication is not used as an unnecessary control such as\in response to one reported minor incident, and only where it is in the interests of the service user. Record showed basic health needs being monitored and one relative remarked that personal care for a service user has improved where before staff would not always assist with hair washing due to perceptions about service user choice. The Inspectors were concerned and discussed and showed the service manager an instance where one service user was in their room with 3 used incontinent pads on the floor. The service manager was unable to explain any effective safeguards in place to support the service user in respect of this area of care. The service manager was advised to work with the service user and the staff team to agree a better way forward. One relative indicated how the turnover of staff meant that staff found it more difficult spotting when a service user was sick, due to lack of knowledge of individual traits. They indicated how on recently collecting the service user they discovered an ear infection and the person pale in colour. 16 days following the inspection a senior staff person reported to the Commission that they found medication which had been signed for and not given to a particular service user[found on top of a cooker in the kitchen] . It was reported that this error had not affected the service user in any way. Medication arrangements will be looked at in more detail at the next inspection. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, & 23. Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. The home needs to ensure that it maintains a clear record of complaints and concerns. Service users need to have their views regularly recorded and acted upon. Adult protection reporting is poor and lacks transparency Service users need to be protected from psychological abuse such as having their property inappropriately confiscated. EVIDENCE: The Inspector found on this inspection that the complaints files was now available for inspection and easy to find. The complaints file recorded some concerns from service users over the last year. The complaints file was incomplete in that for instance a complaint from a relative about staffing levels and home visits, which was investigated by social services and involved the home was not in the complaints file although it related to the welfare of service users. The inspector was confused in that the correspondence relating to this complaint was in the service users file. The inspector was only aware of the complaint, as socials services had contacted them to clarifying some information from the home, which had lacked transparency and was misleading. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 22 Of more serious concern was the discovery in one unit that at least two possibly three incidents described by staff when questioned about information elsewhere and the homes communication book which relates to incidents in the home, had not been reported to the Commission or social services. It was also evident that some staff were more open than others in discussing these incidents. Some Staff explained the new lack of openness as due to how the organisation responds to incidents. What was clear was that incidents were not being sent to the Commission and social services ,and shortly after the inspection this process resumed as had been the case prior to April 2006. Due to all the issues involved it was not possible to be clear whether these incident reports now being received reflected what had occurred. The use of the communication book was found to be confusing with some staff indicating what type of incidents had occurred with other simply stating “see incident report”. In some cases the book was not used at all when there were incidents. In one case the service users daily book did not record what the incident was. None of these incidents reports could be found which staff said was confusing as some of them had not had opportunity to read one or had previously read them. It was explained and confirmed by the service manager that incident reports go straight to the manager, although staff have a copy for the incident file and care-plan folder. The home were advised that incidents need to be reported without delay even if that means staff sending the reports such as at weekends. The service manager was asked to immediately report both dated incidents, which were confirmed by 4 different staff one occurring two days before the inspection and another 12 days. Both incidents concerned assaults by oneservice users on two different people. The service managers recollection and description of the incident which occurred on 12/10/06 differed from what staff told inspectors and differed again in what was written in a very brief report which was received and which did not confirm to how such incidents be reported. It was evident to inspectors that significant assaults had occurred which were not reflected in the reports eventually sent. The home were advised that all staff on duty especially the person In charge should produce written statements which might reduce any risk of staff talking to other staff about aspects not covered in written statements. The home was advised to return to open reporting and adult protection guidance. For instance when social services confirmed to the inspector that the home had reported one of these incidents following the inspection the service manager needed reminding that all incidents of assault need reporting without the home filtering out what they consider significant. It was also noticeable that staff’s description of one assault involving someone being kicked on the floor varied greatly from what the service manager stated. In light of this it was not possible to fully establish what the real picture is regarding incidents. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 23 Following the inspection a relative indicated to the inspector in a phone call an assault on a service user as evidenced in chest bruising found on their daughter on a weekend visit which staff had confirmed in two phone calls led from an one incident which had taken place 3 days before the inspection. The Inspector on hearing this news 6 days following the inspection asked the home to report these incidents. This was then discussed with the registered manager who had returned from leave and expressed confusion as to why this and other incidents are not being reported. The incident reports which the service and registered manager sent following the inspection were quite different from what had been reported during the inspection and by a relative. These reports read as descriptions of less serious incidents although the lateness of there reporting questioned their reliability as to what actually happened. Also the reports lack information and completeness. The organisation are asked to investigate all incidents since the last inspection and account for discrepancies in descriptions and explain why there has been a change in reporting along with reminding staff how they can report directly to the Commission and social services to avoid management being blamed for non-reporting. Some other evidence sent by the home such as daily report logs for one service user showed evidence of information being added to after the initial entry for that part of the day. This read as information being added to once the management were made aware that there was concern that an incident had not been reported. There was also an issue with gaps between entries making manipulation possible. The organisation stated after the inspection and during adult protection investigations whilst this report is being completed that they are conducting an investigation in to all of these matters. At the time of writing this report 3 weeks following the inspection date further incidents which occurred before the inspection visit which were unreported, some including assault on service users are now being reported. Staff in one unit informed the inspectors that a particular service user’s play station is confiscated at certain times to prompt the person to go out, whilst openly admitting that this person gets angry and upset. The inspector found a poorly written and brief contract to confirm these arrangements although the care manager or an independent advocate had not signed it. The service user confirmed in discussions their unhappiness with this decision. The inspectors were confused as to the need for this restriction as the service user had gone out that morning despite being seen with his play-station that day. The service manager was advised that a proper process needs to be followed in respect of upholding peoples human rights and that more thought needs to go into underlying issues before confiscating people’s personal possessions. The inspectors were also concerned about the lack of knowledge some staff had in relation to this service user with some stating that he was much happier and socialises well with everyone, when records, discussions, and observations with the service user confirmed otherwise. Misleading information from some staff and managers was also identified by Social Services following the inspection Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 24 relating to the frequency by which a service user goes in to other people’s bedrooms uninvited. The protection of service users interests will further improve once all staff have the skills to understand non-verbal communication methods, once all service users have structure to the day, and when the service develops a clear statement of purpose and admissions criteria to ensure a more compatible group of service users in each unit. A new member of staff with a background in autism showed examples where staff have needed guidance to understand the purpose behind some challenging behaviour of service users. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 25 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, & 30. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Service users benefit from home that is clean, comfortable, well-maintained, and mostly well equipped. EVIDENCE: The environment was not looked at in detail due to other concerns and due to it being inspected as recently as June 7, 2006 during the last key Inspection. The evidence from that inspection is repeated below. Darwell House is an adapted two storey, detached property situated alongside its sister home, in ten acres of ground in Maynards Green. The home is divided into two self-contained units. Accommodation for fifteen service users is provided in single room accommodation that has been personally decorated and furnished to reflect individual tastes and personalities. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 26 The home was found to be clean and tidy throughout, all toilets and bathrooms had appropriate hand-drying facilities. All bedrooms looked at were modernly equipped and most recently decorated. One bedroom lacked chairs for visitors or the service user’s own convenience. The service user indicated that they would like chairs in their room. All service users spoken with indicated overall satisfaction with their room’s which was based around their preferences. Dining rooms had a homely feel in keeping with the home and lounges. The home is currently looking at the feasibility of the commercial type kitchen in the unit of the home intended for more independent service users. The gas powered kitchen and its layout creates some risks for those wishing to develop further independence. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, & 36 Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. The quality of staff is variable with them not deployed in sufficient numbers, which is affecting outcomes for service users. A transparent rota needs to be maintained in the home. Service users would be better supported if staff had the skills to meet their specialist needs. EVIDENCE: Since the last Inspection the home has continued to operate without enough staff to meet needs. The service is supplying misleading information in one unit as to how many staff actually work on each shift. The inspectors found two rotas -the one, which staff actually work which staff have been told to put in pencil, and a master rota, which indicated more staff on shift. Some staff stated “this is the rota for CSCI” the one manager’s want the inspectors to see”. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 28 It was concerning that from looking back on weeks before the inspection that the master rota had staff ticked as working when the actual worked rota showed differences and staff going sick and not being replaced. Two care managers from social service also confirmed a similar situation where on a visit they verified with the service manager that shifts had run short sometimes less than 3, only for the Responsible Individual[at a Social Services adult protection meeting August 10, 2006] to present another rota to claim that staffing levels had really been higher. On shifts as recently as October 16, 2006 the rota worked showed 3 staff on the morning when this should have been at least 4, with no-one replacing the staff who had gone sick. It is concerning that the master rota was found to be ticked to attempt to show that all 4 staff worked as planned. It was also concerning to find a memo to remind staff not to change the rota worked even though they are asked to write this in pencil making manipulation at a future point easier. The inspector saw a third rota, which no-one could account for and which was discounted. One Service User in one unit needs 2:1 staff when going out in the community one of these planned days is a Tuesdays, but on the rotas looked at there was no examples of the required 5 staff on duty the only days this occurred was occasional Fridays and Thursdays but no regular pattern or on a weekly basis s judging by the master rota which shows more staff working than the actual worker worked filled in by staff when they work the shift. The Inspectors with the homes permission made photocopies of these rotas. A service user due to have foot-spa on 19/10/06 went out instead with no details of what this trip was about. It was evident from going through her daily records that her activity schedules are often not followed such as on 08/08/06 and 17/10/06 there was no trip out despite this being scheduled, for example. The 1:1 Hours daily sheet was often found blank such as 16-17 October 2006 despite the service user being in the home. For one service user there daily activity schedule on the wall of the staff office was different to the one in her careplan, with her daily records showing further deviations. Even this false rota showed some shifts planed where not enough staff were entered, one example was 22/10/06 on a late shift when there should have been at least 4 staff [or 5 if planned outside activity for a particular Service User] on the master rota there was just 3 staff for the 6 Service Users[in the home at the time] on the late shift a shortfall of at least 1. On shifts as recently as October 16, 2006 the rota worked showed 3 staff on the morning when this should have been at least 4 It was also the case that the management of the home and staff were unclear how many staff they needed. At a recent adult protection in August 2006 the home were informed that 5 staff were needed and funded for when one particular service user goes out with her 2:1 staffing which she is funded for. On the day of the Inspection 4 staff were on duty and rota showed that it Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 29 rarely gets above this. On one weekend there were just 3 staff on shift for 6 service users in one unit. It is positively noted that at least half of the time there are now 4 staff on shift where as at the last Inspection the home generally had 3.In the other unit the rota and staff indicated that most afternoons there are only 3 staff where 4 staff would assist with activities and supervising of service users. Since the end of September 2006 a new service user has been added to his unit without any increase in staffing which is especially concerning as this person needs 1:1 staffing when out although after the inspection during an investigation Social Services and the Commission were told this person needs 2 staff when out and also wanders around the home at night and into others rooms when there is just one night staff. Social Services in a meeting on November 7, 2006 along with the Commission expressed concern why night staffing was not higher especially as the Service User is new to the home In both units there were issues with having enough drivers and covering existing shifts with a small staff team where there continues to be a high turnover of staff. If shifts run short and no existing staff can be brought in the shift runs short as agency have not been used since 2005 and is not an option as confirmed by the service manager and in previous memos looked at. Relatives and care managers from social services described staff as “nice and caring” but whose effectiveness is affected by resources. Two relatives indicated confusion about how the home relies on them taking their service users home [due to staffing levels] one every weekend and the other fortnightly when both the service users are funded every day of the year, with one being 1:1 staffing during day time hours. One relative indicated how they were told [verified by social services investigation] by the home that variations to home visits had to be agreed in advance due to rota planning which relied on this person going home every week-end. One relative indicated how staffing levels are still variable which concerned them in relation to the supervision of service users. The home does attempt to repay back some of the unused 1:1 hours by providing 2:1 support for trips out although it was evident on the inspection day, looking at records, and speaking with the care manager that these hours are often used for other service users. On weekend day 21/10/06 a service user spent the whole day with no structured activity, in the home, watching TV, as seen in daily records. This service user did not leave the grounds during that week-end with the only structured activity provided a football session on Sunday 22/10/06 in the garden. Since the last inspection the home and organisation have given assurances and shown in the pre-inspection questionnaire completed, that all new employees provide a full employment history and that satisfactory references and a Protection of Vulnerable Persons Register check is carried out before staff can start in the home with them only working unsupervised and alone with service Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 30 users once the CRB comes back. The registered individual has been asked by CSCI in a separate meeting to confirm that appropriate references were carried out on two particular members of the organisation who had worked in the same previous organisation. A new member of staff indicated that she was pleased with her induction, which included shadowing into all aspects of the job along with a written workbook, although she has no named supervisor. Training has been an area previously identified as requiring attention and whilst some programmes have been implemented over the past few months, staff do not have the full range of skills to meet some of the complex needs of the people they are supporting. In particular, it has been identified that staff need to undertake communication training as a matter of priority. It was also evident from some staff discussions that the particular needs of some service users was not fully understood partly due to training .for instance some staff did not understand the importance of predictable routines for people with severe autism. The inspectors were concerned to hear service users regularly being referred to as “mate, sweetheart, and darling”[with some service user all three names]. This was reflected back to the service manager who stated that she had never heard service users being called these names. Some staff also used controlling language and gave instructions such as “you do not need the telly on, go to your room and tidy it, then have a shave” without always explaining the reason behind them. The manager indicated that autism training was planned but was reminded that any training has to be effective with staff more closely supervised. It was evident from observation and records that there is a current lack of consistency with the staff team and that morale is lower than on previous visits, an observation supported by other visitors to the home whom spoke with the inspector. It was also evident that staff had developed their own ways of working where they disagreed with management instructions such as the insistence that the same staff member works with the same person throughout the shift. Some staff indicated that they openly rotate the staff in order to avoid staff getting too tired. The Inspectors positively noted the recruitment of a very skilled and experienced member of staff who identified how the home could improve. It was therefore disappointing to hear that shortly after the inspection visit that this person had chosen to resign. It was identified that in one unit there has been steady turnover of staff. The service manager stated that approximately 10-15 of staff have the basic National Vocational Qualification in care at level 2 and that much work is needed to meet the Government target of 50 . The service manager and recent section 26 reports indicate that staff are receiving written supervision at least monthly. It was not clear how this improvement was improving outcomes for service users given the lack of purpose and direction of the home. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 31 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, & 42. Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. Service users and staff require improved management and professional leadership in order to improve outcomes and ensure that plans are acted upon. The management of the home and overseeing organisation need to create a positive, transparent, open and inclusive atmosphere and ensure that all practices are appropriate. The home needs a thorough system of quality assurance based on what matters to service users, and which is in touch with what is happening The home needs to show that service users are protected from unnecessary risks and that actions are taken including clear paperwork evidence. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 32 EVIDENCE: The Registered person/provider was advised to write to the Commission to confirm the current arrangements for managing the home due to confusion expressed by staff and some issues about responsibility such as reporting incidents. The service manager explained that the registered manager is part time and building up their hours and has to be careful with what they take on. A number of unprofessional memos and communication were found in the staff room from both managers-one from the registered manager read “I have just received a rollicking “[from her senior management] because of you”. Some memos from the service manager made reference to staff not following her previous guidance. The inspector for the home was mentioned in staff team minutes 11/10/2006 with the manager quoted as stating that [the named inspector] “ has certain issues with Grange Court and has been in touch with several care managers [Social Services]”. The inspectors also noted that some staff were less open and helpful towards the inspectors than on previous visits which had found a more open staff team willing to discuss incidents A number of staff described both managers, as lacking time to discuss issues other staff spoken with made no comments about management. The inspectors saw evidence of a home, which was being poorly managed and lacking leadership and direction. It was evident that the service is struggling to meet existing requirements and responding to the needs of service users. The continuous delay in producing an appropriate Statement of Purpose is especially concerning along with how the home assesses the suitability of service users. The service manager needed prompting from the inspectors to inform one service user who openly stated that they did not to live in the home, what action would be taken in response to their wishes. The inspector requires job descriptions for both of these managers along with the Responsible/-Registered individual who oversees the home to determine who is making the decisions to ensure all areas are clear and accounted for. For instance it is not clear who is making the decision or not to report incidents and who should be reporting them from the home. During the Inspection, the fourth change of area manager over the last year, was announced which made it more difficult to assess who was getting to grips with the service’s shortfalls. The home has a number of systems in place to gain feedback from representatives and monitor the services provided by the home. It is however, required that the effectiveness of these systems are again reviewed to ensure that the right level of feedback is being obtained and appropriately responded to in light of a number of service users and relatives indicating to the inspectors areas for improvement. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 33 It is evident that the organisation which oversees the home are not providing enough support and guidance and accurately reflecting the views of people in their reports. A Survey result report sent to CSCI and received September 25, 2006 by the Responsible Individual made the following remark in relation to service users-“ “There are no very negative areas…we are delighted with these results and feel that this reinforces the fact that service users are very happy with all aspects of their lives at Darwell” this report failed to mention some of the actual survey answers which the inspectors found on their visit such as one that answered No- to liking the home and their room. [May 2006] the report mentions that 4 care managers were sent survey cards when there are 14 connected with the home and after a comment where questioned the amount of activities, states “we are delighted with these results” The report indicates some negative comments from staff and some negative from a relative but does not elaborate on these. Whilst it is acknowledged that a survey has now taken place it lacks comprehensiveness, proportionality, accuracy, and action plans to act on comments. Section 26 monthly reports of inspections of the home by the organisation are now being sent to the Commission on a monthly and timely basis These reports still need to be more comprehensive and make reference to the views of Residents and staff in relation to the overall quality of care being provided. Some attempt should be made to measure the quality of care to those who lack verbal skills to express this. It is evident from visits by the Inspectors that issues are not being picked up on in these reports. These reports such as the last one carried out by the Responsible Individual on September 28, 2006 did not pick up on the fact that a number of incidents had not been reported to the Commission or issues with daily logs, incomplete records, staff shortages, and activity schedules not been followed An audit sent to the Commission dated September 26 of the home by the quality assurance manager and existing service manager had the key sections relating to staffing and management, blank. Despite being requested in a letter accompanying the recent published inspection report the home was found to have not have developed an Improvement Plan or shared with service users its commitment to improve the service and how this will be achieved. The home were given a month to send the commission this plan. During the inspection, a variety of records were inspected and found to have gaps especially in relation to incident reports of serous incidents which were not found or in the correct files. It was also evident that different staff were following different systems in relation to record keeping which transparency and information sharing more difficult to measure. The current way daily logs are written with gaps between entries makes it possible for further information to be added as was found with one adult protection investigation which led out of this inspection. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 34 An Immediate requirement was made in relation to unreported incidents as mentioned in Complaints and Protection section of this report standard 23. A further unreported incident was disclosed by a relative after the inspection. This incident had occurred several days before the inspection visit. In light of these concerns about non-reporting the organisation are asked to carry out a audit of all incidents since the last inspection and send the Commission and Social services any further adult protection alerts for investigation. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 35 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 1 2 2 3 1 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 1 34 3 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 1 X LIFESTYLES Standard No Score 11 1 12 1 13 3 14 1 15 X 16 1 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 1 1 1 X 1 1 X Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 36 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 YA1 Regulation 4&5 Requirement That the Registered person must ensure that the home introduce an appropriate Statement of Purpose [for each unit where appropriate] that clarifies the intended service user group it aims to provide services to. That this document accurately and clearly describes the needs of current services users [Residents] with this linked to future intended service users to ensure compatibility. That copy of the Statement of Purpose within the service user guide is sent as one document to the Commission by the date shown. Requirement of the last 3 Inspections. Requirement first made 28/10/05 That the Registered person must ensure that a clear admissions criteria and policy is developed. That this admissions criterion is consistent with the specific intended purpose of the home as described in the statement DS0000021117.V315529.R01.S.doc Timescale for action 07/01/07 2 YA1 4[1][c] Schedule 1:8 07/01/07 Darwell House Version 5.2 Page 37 3 YA2 12[1] 4 YA3 14[1] 5. YA6 15 6 YA7 12[3] 7. YA9 13(4) of purpose. That this admissions policy is sent to the commission within the timescale indicated. That the Registered person must ensure that all service users are re-assessed to ascertain the suitability of the home to meet their particular needs. That the outcome of these reassessments are sent to the Commission by the date shown. That the Registered person must ensure that the home meets the assessed needs of service users with a record of action taken. That a particular service user identified for reassessment at the last Inspection has their current views recorded with appropriate action taken. That the Registered person must ensure that the homes care planning system is carried out in practice. Behavioural needs should be identified and backed up with comprehensive management strategies. Requirement of the last 2 Inspections. Requirement first made 28/10/05 That the Registered Person must make arrangements for independent advocacy for service users. That these arrangements are shown to meet needs. That the Registered person must ensure that Risk assessments are developed to include all activities and how the controls in place manage the risk. That risk assessments are followed in DS0000021117.V315529.R01.S.doc 07/01/07 07/01/07 07/01/07 07/01/07 24/01/07 Darwell House Version 5.2 Page 38 8. YA11 12 9. YA12 16(m)(n) 10 YA16 12[4][a] 11 YA17 16[2][I] practice Requirement of the last 3 Inspections. Requirement first made 01/07/05 That the Registered person must ensure that Meaningful and person centred goals are identified within care plans, which reflect their diverse needs and unique preferences for service users. That any achievements recorded and reviewed. Requirement of the last 3 Inspections. Requirement first made 28/10/05. That the Registered person must ensure that a consultation with all service users takes place to devise a programme of suitable and fulfilling activities, which meet preferred and diverse, needs. That these activities take place or current schedules are revised to ensure transparency. Requirement of the last 5 Inspections. Requirement first made 01/04/05 That the Registered person must ensure staff use service user’s preferred from of address which is recorded in the individual plan to ensure that the at home is conducted In a manner which respects the dignity of service users. That the Registered person must ensure that the home is sufficiently stocked with adequate quantities and suitable and varied food so that menus can be followed and that choices can be available, and that services users have portions to eat at reasonable times. That DS0000021117.V315529.R01.S.doc 24/01/07 07/01/07 24/11/06 24/11/06 Darwell House Version 5.2 Page 39 12 YA22 172Schedule 4.11 13 YA23 12 14. YA23 12, 13 & 37 15. YA32 181c sufficient provision of financial resources is provided to staff to ensure that this is possible. That there are sufficient quantities of fresh food available. That the Registered person must ensure that a full record of complaints and concerns is made to the home about the care of service users is maintained in the homes complaints file. That within the timescale indicated written complaints stored in care –plans are transferred to the complaint file to aid transparency. That the Registered person must ensure that service users personal property is not confiscated by the home unless there is a serious risk to welfare to the service user or others. That any restrictions are fully recorded and agreed by all relevant persons. That the home is conducted in manner, which shows an awareness of and upholds the rights of service users. That decisions which evidently affect the psychological wellbeing of service users are reviewed. That the Registered person must ensure that all staff and manager re familiarise themselves with adult protection policy and protection of vulnerable adults policies and procedure and ensure that all of the home practices are appropriate, consistent and transparent. That the Registered person must ensure that at least 50 of care staff achieve the DS0000021117.V315529.R01.S.doc 24/11/06 24/11/06 24/11/06 31/12/07 Darwell House Version 5.2 Page 40 16 YA33 17 17. YA33 181a 18. YA35 18 [c][1] 19. OP35 18[c][1] 20 YA37 12[5][a] National Vocational Qualification in Care, at level 2. Requirement of the last 3 Inspections. Requirement first made 28/10/05 That the Registered person must ensure that an accurate and transparent rota is maintained in the home of hours worked and planned shift cover. That the current system of maintaining two different rotas ceases. That the Registered person must ensure that all times there are experienced and qualified staff working in sufficient numbers to meet assessed needs such as activities Requirement of the last 3 Inspections. Requirement first made 28/10/05 That the home ensures that all staff receive suitable training in communication techniques with adults with learning disabilities and help service users develop their own appropriate communication aids. Requirement of the last 3 Inspections. Requirement first made 28/10/05 That the Registered person must ensure that all staff received appropriate training in autism with staff then supervised in the workplace in how they apply this training for the benefit of service users. That the Registered Person must in relation to the conduct of the home maintain professional relationships and communications with staff. DS0000021117.V315529.R01.S.doc 31/10/06 24/11/06 24/01/07 24/01/07 24/11/06 Darwell House Version 5.2 Page 41 21. YA37 38 22. YA39 26 23 YA39 24 24 YA39 24[a][1-3] That the Registered person/provider must send the Commission by the date shown the arrangements by for managing the home during the Registered manager’s current reduced hours. That job descriptions for the registered manager, the service manager, and the responsible/ Registered Individual demonstrating their various roles is included in this plan. That the Registered Provider must ensure that monthly section 26 shows sufficient evidence of Service users and staffs views, in order to arrive at an opinion as to the quality of the care. That sufficient numbers of service users and their advocates regardless of disability and diverse needs are included in these reports in relation to their care. That such a report indicates the identification of any issues and how they are being managed. Requirement of the last 2 inspections. Requirement first made 07/06/06 That the Registered person and organisation must review current quality assurance practices That any surveys and reports are sufficiently comprehensive, accurate, proportionate, and contain actions plans for improving the service. That the Registered person must ensure that an Improvement plan is developed as requested with the last published inspection DS0000021117.V315529.R01.S.doc 17/12/06 24/11/06 17/12/06 17/12/06 Darwell House Version 5.2 Page 42 25 YA41 17 26 YA42 37[1][e] 27 YA42 37[1][e] report. That this plan is also shared with service users. That this plan is sent to the Commission within the timescale indicated. That the Registered person must ensure that all records produced and maintained by the home are available for inspection and accessible. That all staff and managers follow a consistent method for alerting others about incidents affecting service users and ensure that records are stored appropriately. That daily records are recorded correctly with immediate affect. That the Registered person must ensure that any incidents, which affect the welfare of service users, are reported without unnecessary delay. That such incident reports as afar as possible accurate and complete Immediate requirement made on the day of inspection visit. That the Registered person must ensure that the organisation carries out an audit of all incidents, which have taken place since the last inspection affecting the welfare of service users. That all reports not reported to the Commission and social services as vulnerable adults alerts take place within the timescale indicated 24/11/06 24/10/06 17/12/06 Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 43 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA18 YA20 YA41 Good Practice Recommendations That a particular service users is given more support with the timely disposal of incontinent pads That any possible changes to medication of service users are carefully reviewed and involve independent advocates and at least the service user’s care manager. That records are written without gaps. Darwell House DS0000021117.V315529.R01.S.doc Version 5.2 Page 44 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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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