Inspection on 26/06/07 for Darwell House

This inspection was carried out on 26th June 2007.

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 21 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 24/10/06

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 26th June 2007 09:40 Darwell House DS0000021117.V339351.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.V339351.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.V339351.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 darwell@evesleighcaregroup.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Evesleigh (Kent) Limited Vacant Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Darwell House DS0000021117.V339351.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. 22nd February 2007 Date of last inspection Brief Description of the Service: Darwell House is registered for fifteen adults with a learning disability. The home is a large, two story, detached property. There is 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 £2000 per week. Extras charged 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. Darwell House DS0000021117.V339351.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 by two inspectors on June 26, 2007 between 09.40 am and 3.40 pm. The focus of this key inspection was to review progress since a random inspection carried out on February 22nd 2007. The random inspection followed the last key inspection of October 24, 2006, when a number of breaches of regulation were identified. This current report should be read in conjunction with the October 2006 report. The Commission also met with the providers of the service on March 13, 2007 to discuss the poor outcomes and safety concerns which were evidenced in the February 2007 inspection report and which has been a repeated feature of previous inspections and in significant and ongoing adult protection activity by social services and the police. At this meeting the provider outlined their plans for improving outcomes for residents. This visit focused on the key breaches of regulation and failures to meet national minimum standards that had been identified in the last inspection, such as the purpose of the home, compatibility of the resident group, how care is planned and delivered, residents’ lifestyles, quality of the staffing, and how the home is managed in the interests of residents. During this inspection process, some relatives have returned the Commission’s survey cards and a number of social workers and other professionals have been spoken with as part of adult protection investigations since the last visit. The inspectors spoke with, or observed four current residents and looked at care records, along with medication arrangements. Communal areas were toured. Meal arrangements were examined. This visit and report took into account the recently completed Annual Quality Assurance Assessment by the home and other reports linked to how the service measures quality and outcomes for residents. Whilst some improvements were noted, there are still some breaches of regulation and failure to meet national minimum standards. Some safety concerns persist. It is evident that the service does not yet provide a service with a clear purpose based around a more positive future for residents. What the service does well: The home provides spacious, pleasant and secure grounds, which allow residents the freedom to spend time outside independently. The home is kept clean. Residents enjoy the opportunities afforded by horticulture projects and the care of farm animals, which are kept on the site. Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 6 The provider advises that 97.5 of staff have achieved or are working towards an NVQ Level 2 in care. What has improved since the last inspection? What they could do better: Many of the weakness found on previous inspections remain. Whilst outcomes in some areas are improved for some residents there are still some poor outcomes and some risks for residents that relate to how the service is managed and shortfalls in care planning. It is also evident that the current care provision prevents residents from achieving their full potential. The home is still unclear about what type of service it can provide and which residents fit into this. This lack of a clear purpose means that the service lacks direction for staff and residents. This is preventing residents from being assured about a positive future based on achieving their aspirations. This lack of clarity impacts on the effectiveness of any staff training based on residents’ needs. The management and staff in the home still lack some expertise with this group of residents, which limits expectations. Care planning for individuals is not person centred and lacks goal planning based on what is important to individual residents. Care planning lacks sufficient input from external professional specialists and other people important to individual residents. Some recent re writing of care plans has created further confusion and potential safety concerns. Guidelines within care plans are not clear about how to manage challenging incidents which puts people at risk. The organisation has employed a consultant to address the need for a clearer care planning system. Residents lack some choice because staff lack understanding of their needs and preferences. Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 7 Although activities on offer meet a number of residents’ needs their overall range lacks diversity, and there is evidence that residents are not assured of routines and activities that meet their needs and give them control and a sense of predictability. This may be linked to the inadequate care plans. Residents would benefit from being supported by people who communicate in a manner they can understand and help them make their own decisions. The recent high turnover of acting managers continues and the home is still without a registered manager to demonstrate commitment to the long term future of the service, which needs stabilising. Quality assurance practices do not sufficiently focus on what matters to residents. The organisation’s reports and checks on the home, although improved, are not highlighting the issues and effectively acting upon those which the inspectors regularly find. Some of these reports such as the Annual Quality Assurance Assessment completed by the acting manager are overly positive, inaccurate in part and as a consequence prevent the service from moving forward. The service needs to improve its ability to identify what quality care looks like in order to realistically measure where the service is now in order to move positively forward. It is noted that the provider is taking active steps to address these shortcomings. 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.V339351.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 Darwell House DS0000021117.V339351.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): 1, 2, & 3. Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. Current and prospective residents and purchasers of care cannot be confident that the available information about the service is an accurate reflection of what is provided. Therefore appropriate admissions and compatibility of residents cannot be assured. EVIDENCE: The home’s service user guide, which also contains the statement of purpose, was found to be clearly on display. This document describes the range of needs that are covered as “Global learning disability which may be mild, moderate or severe” along with a generalised admissions policy. This does not support appropriate admissions or assure compatibility. A requirement has been made in this report that the home must produce a suitable statement of purpose. The directors of the service indicated in a discussion during the inspection that they were still discussing the future purpose of the home. It was positively noted that a recent reduction to 5 men was benefiting residents, and that the service has been more proactive about resolving Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 10 incompatibility issues since the last inspection. It was evident that the atmosphere in the home had improved, with more space for residents. The lack of clarity around whom the home is for and its purpose make measuring the success of the home for individuals difficult. The lack of regular reviews of residents makes it difficult for the home to demonstrate that they are meeting assessed needs. Copies of assessments recently carried out by the home were sent to the Commission shortly before the inspection visit [June 7, 2007]. These did not include any outcome focus, and it was evident that they were carried out by staff and managers in the home with no or little involvement of advocates or social services. Some were just completed by staff. It was evident that diversity areas such as activities lacked a breadth of information. There is evidence that input from external specialists and professionals is not always actively facilitated. For example, a planned training event aimed at helping the home to meet assessed needs and develop an improved and shared understanding of how to meet needs and understand autism and communication needs was cancelled twice because of staff not being available. Darwell House DS0000021117.V339351.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, & 9. Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. Care plans lack clarity, expertise, and aspirational goals, and put residents at potential risk. The service has been reviewing these for some time. Residents’ rights would be better supported with the provision of effective independent advocacy to support their rights. EVIDENCE: Previous inspections identified shortfalls in the quality of care plans, and the organisation has appointed a consultant to review their care planning process. This work is currently in hand. Care plans of four of the five residents were viewed as part of the inspection process. Information was less easy to find than on the previous visits, because separate files had been created for the front line plan and for supporting information not intended for regular use. It was evident that some information Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 12 from the supporting information folder needs to be in the daily care plan. The supporting information file did not contain all historical information relating to residents as seen on previous visits. There was no evidence that new care plans had been risk assessed. For example, a resident with high needs has a new goal of “to bathe independently……to be left independently in bath 5-10 minutes.” It was not clear if this was safe as there was no attached risk assessment. It was not clear if this plan is in use, or not, and there was no stated agreement from anyone. The inspectors reviewed a care plan for one resident. This contained hand written notes of a review meeting in May 2007, which involved the resident’s care manager and his sister along with another home manager. Some goals were established such as gym and discussion about whom the resident might want to live with along with a goal of using public transport. However none of this information was found to be translated into action points or aspirational goals within his current care plan. This plan states “depressed in morning with current goals of computing and cooking”. The last monthly report of April 2007 was found to lack detail. Another care plan had not been reviewed since March 2007. The report lacked detail. For example, activities were listed simply as the Daily Activity Programme (DAP), and made no mention of any progress. In response to a pre-inspection survey of residents’ families one set of relatives expressed concern that they had not been invited to a care review despite always attending others and felt less involved due to the number of management and staff changes. A care plan for a resident for whom specialist support from the local disability team, speech and language clinical psychology professionals had been sought showed that two recent appointments had to be cancelled due to service related problems. This care plan showed no recent evidence of any review. Behavioural management guidelines were found to be weak and lacked specialised input. For example, one resident who is described as having behavioural problems did not have a clear action plan to resolve this, other than mentioning head massage and sensory room. The plan states that if self injurious behaviour lasts for more than 20 minutes then a certain medication is given. This contradicts another part of the care plan and medication records that show that the psychiatrist had stopped this named medication until further notice from March 13 2007. This plan was found to have communication guidance written in February 2006 although there was no evidence of how this was being monitored. A follow up meeting to develop guidelines for staff on how to communicate with this resident did not happen in April 2007 as planned Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 13 due to a lack of staff management commitment, as evidenced in a letter received by health professions. Goal planning was found to lack aspirational goals or relevance to residents and was not person centred. Residents are not always supported in making decisions about their individual needs and choices. Although the home displays information about advocacy services, inspectors reviewed a monthly report that stated that a resident had declined new medication with a subsequent statement that “the GP “helped him to say yes” This resident has capacity and there was no record of any independent advocacy being accessed or fuller details of the decision making process. Similarly a file showed how antidepressant medication was increased over the phone based on staff giving verbal reports on the residents behaviour with no evidence of appropriate consultation. It is positively noted that some of the information in care plans is fuller in relation to pen pictures and routines and that more reference is made to domestic goals in the daily reports, which are fuller. Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 14 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 Adequate. This judgement has been made using available evidence including a visit to this service. Residents are generally benefiting from those activities in place, although the range of activities is relatively basic, and do not promote aspirational goals. Residents are not always assured of predictable routines, and they have limited control over activities. The provision of food supplies has improved and is now well managed. Residents have choices, and portions are generous. EVIDENCE: The inspectors purposely arrived at 9.40 am to observe activity plans for the day. Each resident was found to be undertaking activities which were in line with their written activities schedules, although these lacked specific detail. One resident described his whole week of activities to the inspectors and Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 15 expressed satisfaction with this. This person is clearly experiencing improved outcomes and has benefited from other residents moving on from the service. One resident not in the home on the day of the inspection was found to have an active and varied week based on records looked at for the week before the inspection. Improvements to the home’s assessment of residents’ needs and care planning based on aspirational goals should produce some improvements if these become action plans. Daily diaries did show that all residents go out most days and are offered choices. There was recorded evidence that activities for residents were sometimes interrupted by a need for staff to attend to other residents’ needs, although it was evident that this is occurring less frequently. For the reasons stated above the inspectors were unable to evidence whether all residents had routines of their own choosing which they had control of and which met their preferences and needs. For several residents lack of clear routines can be a trigger for challenging behaviour. There was little evidence of any educational based activities for some residents and the service are asked to review such activity programmes. Since the last key inspection of October 2006 a number of relatives and Social Services care managers have raised concerns about opportunities for mental stimulation and activities. These concerns have reduced due to decisions made for these residents to move to more appropriate services. The availability of food was found to be much improved allowing much more choice to residents. The home was found to be well stocked with a range of fresh food. The home have improved how they manage the needs of one particular resident who is fully involved in menu and food shopping planning for his own individual diet. Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, & 20. Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. Residents do not benefit from proactive health care with some confusion in management, staff practice, and care plans. The service continues to have difficulty responding positively to support from professional specialists. Medication arrangements are satisfactory with the exception of decision making based on putting residents in control. EVIDENCE: One resident who has recently moved was the subject of adult protections since the last inspection. This resident had earlier indicated that some of her irritable behaviour and assaults on others was due to foot pain. This health condition progressed to a point that once staff finally took action, the toe ulcerated requiring a period of hospitalisation and her toe was subsequently amputated. Whilst it is recognised that the ulceration was caused by the Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 17 resident scratching her toe, social services identified that the lack of proactive health care may have contributed to this outcome. The health needs of one resident who self injures were put at risk when specialist training that was planned for staff to manage this resident’s behaviour was cancelled twice because of staff capacity problems. Some health professionals spoken with before the visit or who supplied a survey card indicated how their inputs are not followed through due to issues in the staff and management. This has made them less keen on offering support. One described staff as continuing, “to lack knowledge of both the resident and their particular problem”. Medications storage and records were examined and found to be satisfactory with administration sheets appropriately signed. One resident whose medication record shows that he no longer has PRN medication since March had contradictory care plan that stated he should have it if he self injures for 20 minutes. It was not clear due to shortfalls in behavioural management guidelines what the approach is. Records showed that the medication for two residents had been changed with a lack of independent advocacy and in one case with the residents initially saying no to the GP. In another case this had been done over the phone with just handwritten notes, which just states that the staff member discussed the resident’s behaviour over the last 3 weeks and no information to show what process had been followed and what these behaviours were. Care managers have indicated to the Commission concerns about how the home makes health decisions without consulting with them or following previous agreements. Continuity of health care has been also been affected by constant changes of management. One resident who is assessed as needing to being weighed regularly [at least monthly] was found to have last been weighed in February 2007. Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, & 23. Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. Residents would be better protected if management followed a correct complaints process The service continues to have difficulty working effectively with external agencies to the detriment of residents. Whilst there has been progress in addressing some compatibility issues, the running of the service still which lacks specific focus and therefore still places people at potential risk of harm. EVIDENCE: There have been a significant number of referrals to the safeguarding vulnerable adults team since the last key inspection involving a number of residents. Incidents have included residents being assaulted by others and instances of staff not following risk assessments. Some referrals were linked to the home’s response to health issues, incompatibility of residents, and staff and management having difficulty coping with complex needs and situations. The home has not always reported safeguarding vulnerable adults incidents as required, and has not yet established effective working relationships with external agencies to provide the expertise that the home lack Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 19 It has continued to be the case since the last key inspection that action plans agreed as part of safeguarding vulnerable adult investigations are not fully followed by the home. The complaints file was looked at during the inspection. This file starts from the beginning of 2007 so it was not possible to see if any complaints had been made between last key inspection of October and December 2006. The home’s Annual Quality Assurance Assessment stated that there had been one complaint over the last year. This contradicted the complaints file that showed two complaints at different times in January. A figure of one was entered for this month, which had been entered over a tippexed out entry. One complaint concerned side effects linked to medication for a resident. The other complaint concerned the behaviour of another resident. Records indicated that the provider had not addressed these issues in a timely manner. Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, & 30. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a comfortable, spacious, well appointed clean, and refurbished home which meets their needs and preferences. EVIDENCE: Darwell House is a two storey, detached property situated alongside its sister home, in ten acres of ground in Maynards Green. Accommodation for up to fifteen residents is provided in single room accommodation that has been personally decorated and furnished to reflect individual tastes and personalities. By the time of this inspection the number of residents accommodated had reduced to five. All residents were found to be based on the ground floor. All residents spoken with were happy with recent changes and have personalised their rooms. Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 21 The home was found to be clean and tidy throughout, all toilets and bathrooms had appropriate hand drying facilities. Dining rooms had a homely modern feel in keeping with the home and lounges. The kitchen was found to be unlocked with staff available to supervise residents, which is now giving them more independence with the kitchen, better suited to current residents needs. One resident indicated that he now had his own key to his room. Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35, & 36 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are now meeting residents’ needs. Staff lack some of the necessary skills due to shortfalls in training although all have a good basic range of qualifications. EVIDENCE: This inspectors found that the number of staff employed had decreased in line with the reduction in the number of residents. Staffing currently consists of 4 staff on each shift for the 5 current residents. During the visit one resident was at his parents’ home. The current weeks’ rota was found to be accurate. The rotas were found to be fine and showed reasonable staffing levels. Staff indicated that staffing might be reviewed due to a resident recently moving out. Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 23 Staff were found to be positive and calm about their work and each had particular residents they were supporting. During the inspection, it was noted that one staff member failed to knock on the door when coming into a closed room where inspectors were talking with residents. She made continued attempts to talk with one resident about a non urgent matter, which disrupted the meeting, and did not afford the residents due dignity and respect. The staff team was observed to work well together and communicated in a sensitive manner with residents. Staff files containing supervision and recruitment information, were not inspected on this occasion. The manager has confirmed in the home’s Annual Quality Assurance Assessment and previous Regulation 26 monthly reports that staff files include supervision and recruitment information. These were not inspected. It was evident that staff require more training to support them to meet needs as identified by the inspectors, Social Services, and the home itself as evidenced in the homes own referrals to specialists. The area manager via Regulation 26 reports and the home’s Annual Quality Assurance Assessment confirmed that over 97.5 of staff have achieved or are working towards a National Vocational Qualification in Care. Training has been an area previously identified by the CSCI as requiring attention and whilst some programmes have been implemented over the last year, staff do not have all of the skills to meet some of the complex needs of the people they are supporting. In particular, they have not received training in communication and autism. The home is required to send the Commission a copy of the current and future training plan to show how it will fully meet assessed needs in line with any necessary revision to the aims of the Statement of Purpose. On most recent inspections recruitment checks were found to have been carried out. The homes monthly Regulation 26 reports indicated that all CRBs are in place and other checks for existing staff. No new staff have been recruited for some time with a number of staff being supported to leave due to reduction in residents numbers. Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, & 42. Quality in this outcome area is Poor This judgement has been made using available evidence including a visit to this service. Residents do not benefit from effective management which is responsive to their needs and preferences and which gives the home a clear direction. Despite some improvements residents do not benefit from a robust system of quality assurance, which is clear about what constitutes quality care. EVIDENCE: This inspection visit found that the home was under its fourth manager in the last year with each of the last four inspections being overseen by a different manager. This lack of stability has affected outcomes and has undermined the confidence of relatives and Social Services in the home, which currently lacks Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 25 focus and direction. On a positive note the directors identified that the home needs someone to give it direction and have identified a new manager who will start soon. It is noted that the home has supported improved lifestyles for some residents with further work still needed. Recent Regulation 26 monthly reports by the organisation have improved, and now provide greater focus on the actual quality of care and how this is measured, and include action plans. However, th most recent report lacked direct or detailed reference to outstanding requirements and residents experiences. The Commission received a comprehensive improvement plan in June although it lacks specificity in relation to where the service is at in terms of compliance with outstanding requirements. The plan also made statements such as care planning is being carried out with all stakeholders and specialists, which was not found to be the case at the tme of the inspection. In June 2007 the Commission received the home’s Annual Quality Assurance Assessment completed by the area/acting manager. This was found to be overly positive and inaccurate in places, and did not reflect the number of breaches of regulation that remain. It made a number of statements which have been challenged by the findings of this inspection such as: that the service has a clear Statement of Purpose and a robust admissions process is in place, that all aspects are going well i.e. activities of which there is wide range. It states that staff provide good health care which is not the view of outside professionals. Such statements about the quality of care and staffing are not triangulated by evidence from Social services and this inspection. The AQAA claims that aspirations can be met and are documented in care plans. Factual inaccuracies are also present for example it states one complaint made over the last year up until June. Inspectors found two in the complaints file for January 2007, which is where the new file begins. The managing director has recently confirmed that although there is a business plan, no Annual Development plan for 2007 based on residents’ and stakeholders’ views and aspirations has yet been developed due to other priorities, such as managing incompatible residents out of the service. The service was advised that this would be a good opportunity to carry out this survey in order to now focus the service and involve all necessary people. During the inspection, records relating to residents were found to be securely stored. Daily records were found to be improved with no spacing between entries which is an improvement following the proven case since the last key inspection. Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 26 The home’s Annual Quality Assurance Assessment confirmed that all staff continue to attend health and safety training and that all equipment in the home has current safety certification. Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 2 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 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 3 33 3 34 3 35 2 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 1 12 3 13 3 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 X 1 X 1 X X 2 X Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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 October 24, 2006. 2 YA1 4[1][c] Schedule 18 That the Registered person must ensure that a clear admissions criteria and policy is developed. That this DS0000021117.V339351.R01.S.doc Timescale for action 26/09/07 26/09/07 Darwell House Version 5.2 Page 29 admissions criterion is consistent with the specific intended purpose of the home as described in the statement of purpose. That this admissions policy is sent to the commission within the timescale indicated. Requirement of the last 3 inspections. Requirement first made October 24, 2006. 3 YA3 14[1] That the Registered person must demonstrate that it is meeting the assessed needs of service users with a record of action taken. That this assessment involves all relevant persons and informs the care plan. That this reassessment is linked to a clear Statement of Purpose That the Registered person must ensure that the homes care planning system is carried out by suitable people and shows how Behavioural needs are identified and backed up with comprehensive management strategies. Requirement of the last 5 inspections. Requirement first made 28/10/05 5 YA6 15[1][2] That the Registered person must ensure that care plans are complete, clear, and are reviewed which involves all relevant persons and specialists. That the Registered person must ensure that care plans DS0000021117.V339351.R01.S.doc 26/09/07 4 YA6 15[1][2] 26/09/07 26/09/07 6 YA6 12 26/09/07 Darwell House Version 5.2 Page 30 7 YA7 12[3] are aspirational, indicate the level of capacity and have goals relevant to the individual with a plan of how these will be carried out. That the plan shows how any agreed actions will be carried out. That the Registered Person must make arrangements for independent advocacy for service users. That these arrangements are shown to meet needs. That where a Service User is undecided about medication changes that they receive independent advocacy. Requirement of the last 3 inspections. Requirement first made October 24th 2006. 26/09/07 8 YA9 13(4) That the Registered person must ensure that Risk assessments are developed to include all activities and the controls in place to manage the risk. That risk assessments are followed in practice with any action to increase independence based on risk assessment. Requirement of the last 6 inspections. Requirement first made 01/07/05 26/09/07 9 YA11 12 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 these goals are linked to daily life and activity programmes. DS0000021117.V339351.R01.S.doc 26/09/07 Darwell House Version 5.2 Page 31 Requirement of the last 5 inspections. Requirement first made 28/10/05. 10 YA16 12[4][a] That the Registered person must ensure that Service Users are supported to have clear and preferred routines which they have control of and which are followed in practice. 26/09/07 11 YA18 12 12 YA19 13 YA19 14 YA22 That the Registered person must ensure that Service Users are supported to receive a continuity of care from relevant health professionals. 12 That the Registered person must ensure that staff have a competent knowledge of Service Users and know how to respond to health issues, assist them to attend the relevant medical services and ensure that the Service User is correctly supported. 12 That the Registered person must ensure that Service User’s health is closely monitored and potential problems and complications identified at an early stage. 17[2]Schedule That the Registered person 4.11 must ensure that the complaints procedure is followed correctly and fulfils it purpose with the file used to record complaints about the service. That Service Users are supported correctly in this respect. 12 That the Registered person must ensure that Service Users are protected from psychological abuse. DS0000021117.V339351.R01.S.doc 26/09/07 26/09/07 26/09/07 26/09/07 15 YA23 26/08/07 Darwell House Version 5.2 Page 32 16 YA35 18 [c][1] That the Registered person must ensure that a full investigation takes place in to an incident of Service User distress identified during the inspection and detail all actions taken to prevent its reoccurrence and to support/protect the Service User concerned. That the home ensures that all staff receives suitable training in communication techniques with adults with learning disabilities and help service users develop their own appropriate communication aids. That support offered by relevant specialists from the local authority is utilised. Requirement of the last 5 inspections. Requirement first made 28/10/05 26/09/07 17 YA35 18[c][1] 18. YA37 CSA 2000Section 111&22 That the Registered person 26/09/07 must ensure that a training programme is developed based on the aims of the home as stated in any revision to the homes Statement of Purpose and which, is made relevant to the person centred needs of those Service Users accommodated. That the Registered person 26/08/09 must confirm the permanent arrangements for managing the home. That a completed Managers application to be registered is received by the Commission by the date shown. That the Registered Person must ensure that the home is conducted so as to make DS0000021117.V339351.R01.S.doc 19 YA37 12[1][a] 26/09/07 Darwell House Version 5.2 Page 33 proper provision for the welfare of service users. Requirement of the last 2 inspections. Requirement first made February 22, 2007 20 YA39 24 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. Requirement of the last 3 inspections. Requirement first made October 24, 2006 21 YA39 24 That the Registered person must establish an effective quality assurance and monitoring system based on service user and stakeholder views. That an Annual development plan is produced based on any survey of all stakeholder views and which shows future goals for the service relevant to Service Users and their supporters. That the quality assurance system shows continuous improvement as is also linked to individual service user care planning goals. Requirement of the last 4 inspections. Requirement first made November 9, 2005 Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 34 26/09/07 26/09/07 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 YA12 Good Practice Recommendations That the Registered person undertakes a consultation with all service users to assess how the current programme of activities can be widened to fully meet preferred, diverse, and varied needs. 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. 2. YA20 Darwell House DS0000021117.V339351.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Darwell House DS0000021117.V339351.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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