Inspection on 07/06/06 for Darwell House

This inspection was carried out on 7th June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 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 26/06/07

Darwell House 24/10/06

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 Unannounced Inspection 7th June 2006 09:40 Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V292901.R01.S.doc Version 5.1 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) Opus Living Mrs Jacqueline Head Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 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. 28th October 2005 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, in ten 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 range of fees charged is not within the homes current statement of purpose/service user guide but was confirmed in the preinspection questionnaire prior to the inspection with fees approximately ranging from around £1100 to £2000 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 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 who also purchased Evesleigh, remaining unchanged since July 1st, 2005. Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 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 9.40am and 4 pm on 7 June 06. This inspection focused on the key major 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, the environment and staffing of the home, along with 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, along with a meeting with the overseeing organisation in May 06. Two inspectors carried out the inspection visit due to concerns about the performance of the home in recent years, the inability of the home to admit people whose needs it can meet, and the overall lack of progress. A monitoring visit by the same two Inspectors took place on 15 March 06,to reassure the Commission that there were signs of improvement. This inspection showed signs of improvement despite concerns in most areas. One outcome area is Good, two Adequate [ok] and five areas are Poor, and in urgent need of improvement. Four Resident were focused on [two newest] all of whom have struggled to have their needs met. Some diversity and equality areas were explored in relation to lifestyles to test what opportunities are provided for Residents. The inspector’s spoke with, and observed 11 of the 13 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 staff training plans. The inspector toured all communal areas of the home along with bedrooms. Meal arrangements were examined, along with complaints recording, as well as quality improvement measures. What the service does well: What has improved since the last inspection? The managing organisation that own the home have recruited an experienced [service] manager who is based on site and oversees the home manager. It was evident that the new service manager who started in April 06 is getting to grips with the wide range of improvements, which are urgently needed so that the home can meet the needs of its residents. The new service manager outlined clear plans and showed good skills and a realistic assessment of the home ands where it needs to improve. The atmosphere in the home was found Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 6 to be positive and staff were seen to be more focused .The home is cleaner and well maintained, and all residents have clear contracts. The format for care-plans is now good and will be effective once the plans are completed and made more relevant to Residents. The home has more mini-bus drivers. Full recruitment checks are carried out on prospective new staff What they could do better: 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. Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 7 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.V292901.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, 4 & 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] is not accessible to all and does not reflect the services offered by the home, although contracts are improved. The home statement of purpose and admissions criteria is confused with people still being admitted whose needs are not clearly established and which are not being met, or who are compatible with others. Particular service users need reassessing, as the home is not meeting their needs. EVIDENCE: The Statement of Purpose does not provide an accurate reflection of the services provided at the home and needs further updating. 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. It is again required that this review is undertaken as a matter of priority with the home producing a Statement of Purpose that is specific and accurate about the services provided. The home has produced a Service User Guide in a format that is accessible to some service users but does not include photographs or assistance to those Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 9 with a severe learning disability. There was no evidence during the inspection that service users had there own copy of the guide in a format, which they could individually understand. This document needs to be updated to include all information required by the Standard. Greater attention needs to be given to making this document relevant to all service users. The guide lacks updated information on service user views. Clarity is needed about staffing arrangements given serous concerns and the fact that the previous guide as quoted to the Inspector by social services includes specific staffing ratios at a basic minimum of 7 staff to 15 service users excluding those funded 1:1,. The manager has agreed with social services that at least 4 staff to 6 service users in the Skye unit of the home is needed but this is not documented in the homes guide or statement of purpose it simply states staffing levels to meet assessed needs. Following the inspection the Commission received an updated service user guide for Claret unit [not Skye], and a statement of Purpose dated June 1, 2006. Overall some parts of these documents especially the range of need met and admissions criteria are still confused. This document still lacks specific information such as the range of fess charged. It was also concerning that there was no specific stated Purpose drawing a distinction between both the Skye and Claret unit’s, grouping these as one and using the broad term of admitting people with learning disabilities without being more specific in some parts of the documents. This is also important as both units have different facilities such as different type of kitchens with one unit having the potential for independent kitchen access. In another section of the Statement of Purpose service user accommodated are described as moderate to severe learning and physical disabilities? Yet during the inspection none were found with physical disabilities with some service users having a mild learning disability one of whom it was not possible to evidence whether they had any learning disability. The Statement of Purpose indicates elsewhere that the home can also admit those with mobility, hearing and visual impairment needs with without disclosing how it can meet these special needs. No evidence was provided during the inspection to show what expertise existed to meet such diverse needs, nor was anyone found with such needs? One of the five seniors quoted in the home’s Statement of Purpose were not found to be working in the home based on the training records supplied. A National Vocational Qualification trainer recently appointed was not named in the document. Photographs of staff is advised to assist service users to identify them. The admissions policy is a general company statement and is nonspecific to Darwell or the two units within it. The home as confirmed by staff and records, is struggling to meet the needs of the two most recently admitted Service Users. In one case this is due to the home lacking information on the persons needs due to shortfalls in the persons original assessment. The service user who is a teenager clearly confirmed confusion as to why he was living in the home which had no choice over, did not visit before moving in, and who does not relate to the older people living in Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 10 the home. The person spends most of day in their room with staff and records describing a interest in a computer game as being a problem. The service user also indicated as confirmed in records that staff do not understand their independent skills and high functioning ability. The person was found to have a mild learning disability, if any, in comparison to the range of learning disability by other people in the home. No social services care assessment was found in his care-plan. The manager agreed that he needs reassessing to provide more information on his needs. Shortly after the inspection the person’s new social worker confirmed that the home had now made contact in order to undertake a review. The only assessment on file was one done by a previous manager which lacked detail on the range of needs and how these would be met. The other service user was found to have a member of staff assigned at all times but was observed to need two staff at times which was affecting the meeting of other people’s needs. It was not clear from records, observations, activity plans whether the home was meeting the persons needs or whether the environment was suitable, with the other service users having less complex needs. It was also evident from observations, records, and talking with staff and the manager, that staffing skills and numbers is not matched to the needs and preferences of service users some of whom were subsequently left unoccupied throughout the inspection. 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. Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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 provided detailed guidance to staff as to how care should be delivered. Behaviour management strategies need to be more robust to ensure service users are supported appropriately. 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 the system of undertaking risk assessments involved input from all relevant stakeholders. EVIDENCE: Four care plans were viewed as part of the inspection process. It was again identified that care plans had not been significantly developed since the last inspection. Care plans provide a basic level of information about the service user. At this stage, specific needs and behaviours are not backed up with comprehensive care guidance and behaviour management strategies. Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 12 On a positive note the care-planning system has improved and is more logical to follow and once all information is entered in the plans will be more comprehensive. One care-plan of a newer service user was severely limited by there being little pre-assessment information, with most sections not filled in. 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. Most Care-plan’s looked at had the same goals of tidying rooms, loading and unloading washing machines. A detailed conversation with a newer service user indicated that these goals had no meaning or value to the person and that the person did not share the home’s main concern about room tidyness. It is concerning that in some cases service users are encouraged to clean their rooms in exchange for drinks and food Furthermore, the process of reviewing and recording changes to the care plans and goals needs expanding. It is not sufficient for staff to simply record “no change” month after month or repeat information from previous reviews. A number of service users have limited family contact or opportunity to develop relationships outside the home. A number of improvements which service users want as expressed to the inspectors and not to the home according to discussions with staff and records. The home are advised to make independent advocacy available to service users so they can speak to someone outside of the home. The home has a range of risk assessments in place in respect of varying aspects of service users’ lives. Some further work in this area is again required to ensure the risks associated with all activities are considered. Many of the risk assessments in place require additional information about the affect controls in place have on the level of risk. One service user was described as entering what is called a “Fantasy world” of a children’s storybook character with the potential for violence. No guidelines were found to be in place along with any explanation for this behaviour therefore putting others at risk. It was not clear from records whether these behaviours had actually occurred. One care-plan focused on motivating someone out of their room without offering any alternative of interest to the service user. The stated alternative was a garden project which the service user showed in records and staff decision, not to be interested in. Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. 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. Service users will benefit from a structured programme of fulfilling activities, which meet their preferred needs. Too many service users are unoccupied and those activities, which are provided, occur mainly in the morning. Meal arrangements have improved although some relatives remain concerned. EVIDENCE: Despite being a requirement of the last three 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. A group of 4 service users in one section [unit] of the home had two staff although one was allocated to one service user with the other staff person split between three who came and went from the dining room, all of whom have diverse needs. Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 14 This staff person was on occasion needed to support the other service user where one staff person is not always enough. The three service users were not found to be occupied or offered meaningful activities throughout the inspection between 9.40apm and 4pm, one spent most of the visit doing laps of the grounds. Of the thirteen service users four were found to have attended college in the morning and two went shopping. The manager identified that afternoon and evening activities are needed and are being looked at based on increased staffing and resources. Some service users spent the morning in their rooms with this attributed to motivational issues by some staff although it was also evident that staffing numbers were insufficient to support everyone to do activities. The diverse needs of some service users were not being met. A service user with very limited information about his interests on file was found not to be supported to do fishing despite this being a stated interest. Another service user stated that he used to go to church every Sunday since a particular staff member left the home. The manager confirmed that there was a problem with existing staff wanting to support him to go to church. The same person who was unoccupied during the afternoon and expressed a wish to go to the gym more. It was positively noted that the home has more minibus drivers, which is supporting service users to go out more. It was also evident that although staff lack knowledge of what some people want to do with limited records, they did present themselves as more motivated and concerned about activities. It was also evident that routines and activity programmes were receiving greater attention with it hoped that eventual positive outcomes will be reached for everyone. It was evident that this needed to be linked to better care-planning goal setting so that service users are supported to develop meaningful lifeskills The lunchtime meal in one unit was observed which was found to be flexible and well organised with a range of choices offered and prepared, with four different sitting organised at the convenience of service users. Relatives and some service users have expressed frustration that the kitchen in this unit is unsafe for those more independent service users who would like to cook. Since the last inspection a relative has withdrawn a service user due to concerning weight loss. Another relative expressed concern that a service users meal choice was not always being followed with the potential for an incident. No evidence was found to indicate that there are any current problems with meal arrangements. One relative expressed concern that the tradition of a service users being supported to send birthday cards to family and friends, had recently ceased. Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. 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. Service users need to receive personal support in the way they prefer with any restrictions based on a clear risk assessment. Medication arrangements are soundly managed along with all health checks with advice acted upon. EVIDENCE: One service user expressed concern that they were not allowed to have a bath independently despite claiming that they used to do this before moving in to the home. The person was also concerned why they had to bath everyday with staff present. The inspector found that there was no written risk assessment to explain these restrictions. There was medical advice in the care-plan, which indicates that regular bathing is necessary to support an existing condition. Medication was inspected including storage, recording and dispensing, with all aspects found to be good. Care-plans and daily records showed how those service users focused on, are well supported to have their basic health needs addressed including medication reviews. Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. 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 better managed. EVIDENCE: A complaint was received by the CSCI in September 2005 raising concerns in respect of poor care practices and management at the home. Following an investigation by the CSCI it was upheld that staff training/qualifications are currently inadequate and that aspects of care planning are insufficient. Other areas of the complaint were partially upheld and resulted in requirements being made in respect of the following areas; reviewing policies and procedures, improving fire safety, ensuring staff recruitment procedures are robust and reviewing the way transport arrangements are funded. The organisation was asked to submit an action plan detailing how he intends to meet the identified shortfalls. It is evident form other parts of this report that these areas are yet to be fully resolved. The homes pre-inspection questionnaire indicated that another complaint has been made to the home over the last year by staff regarding care practices. The manager was unable to locate a complaints file and made assurances that one would be in place as a matter of urgency and which will be made fully accessible to staff and service users in the home. The inspectors were concerned that a number of service users expressed views on how service Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 17 provision could improve especially in regard to how staff can support them and how activities could improve along with noise levels at night of other service users. These views were not found to have been recorded by the home in records examined with the new manager not having been made aware of the views, which the inspectors shared at the end of the inspection. Since the last inspection the home has improved how it reports adult protection alerts. There was also found to be a genuine decrease in adult protection issues based on incident records examined, which showed that all significant incidents have been reported to the Commission and social services. 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. Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, & 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. Security arrangements have been questioned by weekend visitors. EVIDENCE: 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. 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 Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 19 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. On arrival in the grounds of the home the inspectors were approached by staff to ascertain their identity. Visitors have indicated to the Commission that at week-ends where there are no admin staff and management, that staff are “thin” on the ground and that they walk straight in to the home where they have to find staff after being greeted by service users. The manager stated an immediate wish to review these security arrangements. Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, & 36. Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. Service users benefit from a more permanent team of staff, but these staff are not regularly supervised, supported, or deployed in sufficient numbers which is affecting outcomes for service users. Service users would be better supported if staff had the skills to meet their specialist needs. Recruitment procedures are now robust to protect service users. EVIDENCE: The home has worked hard to increase the number of permanent staff employed and reduce the previous heavy reliance on agency staff. At the beginning of the inspection the new service manager [current acting manager for the home] identified that there was not enough staff on each shift to meet needs or support activities and choice especially in the afternoon and evening. Staff confirmed this and in one unit [home spilt into two units] 3 service users had to occupy themselves with one staff member moving round the unit to offer limited supervision. The new manager showed evidence of trying to recruit further staff with interviews planned. A newer member of staff confirmed that they had just 1 supervision in 6 months of being employed and Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 21 that their induction did not include how to support a number of service users they have had to give personal care to, leading to some confusion. The new service manager confirmed these comments in records and indicated that a new comprehensive induction is being introduced which established staff will also cover in part. Some senior staff stated that they found supervising junior support staff as difficult resulting in this not occurring regularly. The service manager stated that senior staff are being more closely supervised and supported in order to fulfil their roles and responsibilities. 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 users once the CRB comes back. A number of staff training records were inspected and whilst there was evidence of some training having been provided, this was not sufficient as was the case at the last inspection. Training has been an area previously identified by the CSCI 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 but also due to a lack of care-planning information due to poor pre-assessments. The service manager identified and showed in a training programme that all staff is set to receive all necessary training and that the organisation now benefits from dedicated training personnel. Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, & 42 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Service users and staff benefit from experienced management with it hoped that this will now translate in to improved outcomes for all service users The home would benefit from a more robust system of quality assurance based on what matters to service users. Health and safety practices protect service users from harm. EVIDENCE: The organisation has recently created a new service manager post in order to support the mangers of the two homes [Darwell and Springmeadow] on the same site. This person started in April 06 and was found on the inspection to be managing the home due to the existing manager being on leave. The position of service manager was created to assist the home make quicker progress. The service manager communicated a clear sense of direction and Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 23 clear plans to improve the home over the next 3 months. The service manager was highly motivated, transparent, and clear about what needed urgent improvement and how this will be achieved. The Registered person/provider was advised to ensure that the Commission are informed in writing when the manager is absent from the home. That the arrangements for managing the home are sent to the Commission during the manager’s current absence from the home whilst convalescing. Some relatives also highlighted issues surrounding how the overall organisation communicates information with the home advised to improve communication links. 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 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. Section 26 monthly reports of inspections of the home by the organisation are not being sent to the Commission on a monthly or timely basis which is particularly important for a home not operating well in most areas. The last report to be received by the commission was on June 1, 2006 for an April visit. This report included the view of just one service user in relation to their sink. These reports 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. Subsequent discussions with the new area manager have indicated clear plans to address this in line with effective quality assurance. It is evident that quality assurance measures are focusing primarily on what the home looks like which is not always as important to service users, as activities and how staff support them During the inspection, a variety of records were viewed and found to be accurately maintained and up to date. Records showed that the building and equipment is well maintained to ensure safety along with comprehensiveness safety training for all staff such as first aid, food hygiene, and Moving and Handling, and health and safety. Fires safety practices were found to be good, based on information supplied to the inspectors and as seen on a tour of the building. Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. 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 1 3 1 4 1 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 2 12 1 13 2 14 X 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 2 2 1 X X 3 X Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 25 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5 Requirement That the Registered Person must ensure that the homes Service User Guide is updated, accurate, and includes the information required by the Standard. That the guide represents the views of service users and is reproduced in a form, which is accessible to each individual service user. That the guide is sent to the commission within the timescale indicated. Requirement of the last 2 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 criteria is consistent with the specific intended purpose of the home. That this admissions policy is sent to the commission within the timescale indicated. That the Registered person must ensure that the home introduce an appropriate Statement of Purpose that DS0000021117.V292901.R01.S.doc Timescale for action 07/08/06 2 YA1 4[1][c] Schedule 1:8 07/08/06 3. YA1 4 07/08/06 Darwell House Version 5.1 Page 26 4 YA2 12[1] 5 YA3 14[1] 6. YA6 15 7 YA7 12[3] clarifies the intended service user group it aims to provide services to. That copy of the Statement of Purpose within the service user guide is sent as one document to the Commission by the date shown. That this Statement of Purpose distinguishes between the two different units of the home [Skye and Claret with an individual stated purpose] Requirement of the last 2 Inspections. Requirement first made 28/10/05 That the Registered person must ensure that the two most recently admitted service users are re-assessed to ascertain the suitability of the home to meet their particular needs and gather more comprehensive information about their needs That the Registered person must ensure that the home meets the assessed needs of service users and ensure that comprehensive assessments are carried out with service users involved in the decision making before being accommodated, along with trial visits. That the Registered person must ensure that the homes care planning system effectively monitors service users’ health, welfare and social needs. Care plans should provide support guidelines which outline how care should be given. 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 DS0000021117.V292901.R01.S.doc 06/09/06 07/06/06 06/09/06 06/10/06 Page 27 Darwell House Version 5.1 8. YA9 9 YA11 10 YA12 11 YA18 12 YA22 13 YA22 must make appropriate arrangements for Independent advocacy with this offered to all service users. 13(4) That the Registered person must ensure that Risk assessments are developed to include all activities and how the controls in place manage the risk. Requirement of the last 3 Inspections. Requirement first made 01/07/05 12 That the Registered person must ensure that Meaningful goals are identified for service users and achievements recorded and reviewed. Requirement of the last 2 Inspections. Requirement first made 28/10/05 16(m)(n) 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. Requirement of the last 4 Inspections. Requirement first made 01/04/05 12 That the Registered person must ensure that as afar as possible service users receive personal care in the way in which they prefer. That any restriction on independence such as bathing is subject to continuous risk assessment and consultation. 17[2] That the Registered person Schedule must ensure that a record of 4.11 complaints and concerns is maintained in an identifiable file within the home available for inspection. 24[1][a][b] That the Registered person 22 & must ensure that an immediate DS0000021117.V292901.R01.S.doc 06/07/06 06/09/06 06/08/06 06/07/06 13/06/06 06/07/06 Darwell House Version 5.1 Page 28 17[2] Schedule 4.11 14 YA32 18[1][c] 15 YA33 18[1][a] 16 YA35 18(1) 17 YA35 18[c][1] 18 YA36 18[2] review takes place based on seeking service users views in order to make improvements such as to the range of preferred activities on offer, and how service users want to be supported. That any concerns or complaints from service users as part of this or any consultation are recorded and acted upon. That the Registered person must ensure that at least 50 of care staff achieve the National Vocational Qualification in Care, at level 2, as soon as possible. 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 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 2 Inspections. Requirement first made 28/10/05 That the Registered person must ensure that all staff receive effective and comprehensive induction and do not give personal care to service users until shown to do so. That all staff who have not done so, or completed National Vocational Qualifications, undertake Skills for Care induction packages. That the Registered person must ensure that all staff are supervised at regular intervals and at least six times yearly. DS0000021117.V292901.R01.S.doc 31/12/06 06/07/06 06/09/06 06/07/06 06/07/06 Darwell House Version 5.1 Page 29 19 YA37 38 20 YA39 24 That the Registered 06/07/06 person/provider must ensure that the Commission are informed when the manager is absent from the home. That the Commission are sent the arrangements by the date shown, for managing the home during the Registered manager’s current absence from the home whilst convalescing. That the Registered person 06/09/06 must ensure that To establish an effective quality assurance and monitoring system based on service user views That the results are published in the home’s guide. Requirement of the last 2 Inspections. Requirement first made 28/10/05 07/07/06 That the Registered Provider must ensure that monthly section 26 reports are sent to the Commission on a monthly and timely basis. That the report shows sufficient evidence of Service users experiences in order to arrive at a 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 reports are sent to the commission on a timely basis. 21 YA39 26 Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 30 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 YA15 YA26 YA38 Good Practice Recommendations That the home supports family links by supporting service users to write in recognition of special events That a particular service user is provided with chairs for his room. That communication is improved between the organisation and stakeholders such as relatives of service users. That this Includes the communication of inspection reports. That security is reviewed in response to week-end visitors concerns. 4 YA42 Darwell House DS0000021117.V292901.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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