Inspection on 27/11/08 for Davigdor Lodge Rest Home

This inspection was carried out on 27th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Davigdor Lodge Rest Home 27/11/07

Davigdor Lodge Rest Home 27/06/06

Davigdor Lodge Rest Home 03/02/06

Davigdor Lodge Rest Home 05/07/05

Davigdor Lodge Rest Home 15/02/05

Davigdor Lodge Rest Home 11/05/04

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The Springs Community

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Belle Vue Country House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Davigdor Lodge Rest Home 56-58 Tisbury Road Hove East Sussex BN3 3BB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jennie Williams     Date: 0 2 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Davigdor Lodge Rest Home 56-58 Tisbury Road Hove East Sussex BN3 3BB 01273726868 01273726868 e.hyslop1955@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Susan Lyn Dubeau Type of registration: Number of places registered: Mr G Rawat,Mrs B Rawat care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Service users should be aged between thirty five (35) and sixty-five (65) years on admission. Service users with a past or present mental health illness only to be accommodated. The maximum number of service users to be accommodated is twenty five (25). Date of last inspection Brief description of the care home Davigdor Lodge is a privately owned residential care home for up to 25 people who have a past or present mental health illness. The registered provider also part owns a further two registered care establishments within the East Sussex area and has owned Davigdor Lodge since 1992. Davigdor Lodge comprises of two homes that have been joined together and converted for its current use. The home is located in a residential area of Hove and is situated within walking distance of local amenities, sea front and bus routes into Brighton. Accommodation is presented across four levels, lower ground, ground, first and second floors. Residents accommodation consists of twentyCare Homes for Adults (18-65 years) Page 4 of 36 25 Over 65 0 Brief description of the care home five single bedrooms, of which four are provided with toilet and handbasin en suite facilities. There are seven bathrooms with toilet and bath facilities located throughout the home and a shower room. Residents must be able to mobilise independently to access areas not at ground level. The home is not suitable for wheelchairs. The dining area is located on the lower ground floor. There are two lounge rooms for residents to use and a conservatory is the designated smoking area. There is a garden at the rear of the home that residents have access to. Fees range from 403 pounds to 557 pounds per week. There are additional costs for chiropody, personal toiletries, newspapers/magazines and any cost incurred by the individual when they go out. This information was provided on the 27 November 2008. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: It should be noted that following recent CSCI consultation, it was identified that service users prefer to be called people who use services. It was confirmed that the home uses the term residents. For the purpose of this report, people who use the service will be referred to as residents. This unannounced site visit took place over two days for a total of nine hours. Evidence obtained at this site visit, previous information regarding this service and information that the CSCI have received since the last inspection forms this key inspection report. The last key inspection was undertaken on the 27 November 2007. An expert by experience accompanied the Inspector on the second day and spent three Care Homes for Adults (18-65 years) Page 6 of 36 and three quarters hours at the home. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The expert by experience spoke with residents and staff throughout the site visit. A care plan was viewed along with specific areas of care/goals in a further five resident files. Procedures and records for handling residents finances were viewed. Four staff files were inspected, along with training records. A tour of the environment was undertaken and some individual rooms were viewed. Medication procedures were inspected. The quality assurance system was discussed, some recent results viewed and complaint records were viewed/discussed. An annual quality assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. There were twenty-five residents residing at the home on the day of the site visits. What the care home does well: What has improved since the last inspection? What they could do better: The documentation in place for some people does not fully reflect the level of care provided and there is a risk that care may not be consistently provided. Clear and up to date information pertaining to individuals must be maintained to evidence that the home is meeting the needs and the personal goals of residents. Residents need to be empowered further and given more opportunities for personal development in line with what is advertised in their Statement of Purpose. An example being To enable each individual to function to his/her potential Clear and detailed risk assessments need to be in place and provide staff with guidance on how to reduce any identified risk. This will better promote the safety of residents and staff. Care Homes for Adults (18-65 years) Page 8 of 36 Robust medication procedures must be implemented and suitable arrangements be made for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home to safeguard residents and staff. The procedures for administering medication should be reviewed to ensure that holistic and person centred care is provided. The Registered Manager needs to undertake Safeguarding Adults training with the local authority to update herself with current procedures to ensure that any allegations of abuse are dealt with in line with local multidisciplinary procedures. Clear records need to be maintained in relation to residents finances to ensure they are safeguarded. The dining area could be made a more conducive environment in which residents eat their meals. Lighting in some areas of the home could also be improved. Robust recruitment must be followed to ensure residents are safeguarded. Management within and external to the home must undertake more robust quality monitoring to ensure they meet the homes aims and objectives. Regulation 26 reports must be provided to the Registered Manager on a monthly basis. It is required that the home undertakes a comprehensive environmental health risk assessment to ensure the home is free from hazards and action taken wherever needed. This includes, but not limited to, radiator guards, window restrictors, infection control procedures and prioritising work that needs to be undertaken as highlighted in previous fire risk assessments. This will better safeguard residents and ensure they live in a safe environment. Other shortfalls of which no requirement or recommendation has been made are highlighted throughout the report. The reader is advised to read the contents of the report to obtain a full picture of the service. This service has some strengths but areas of particular weakness. Management demonstrated a willingness to ensure compliance to address any risks to residents. This will be monitored by the Commission through an improvement plan. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home. There is a risk of residents being admitted to the home whose needs cannot be fully met. Evidence: The home has a Statement of Purpose and Service Users Guide that provides prospective residents with information about the service and facilities provided at the home. It was confirmed that the Service Users Guide advises people that a copy of the most recent CSCI inspection report is available. This information could not be found in the documents provided to the Inspector. No requirement or recommendation has been made in relation to this, however management must ensure this information is included. A copy of the most recent report was observed to be readily available near the entrance to the home. The AQAA identifies that all prospective residents are assessed prior to moving into the home. The home was unable to obtain information from one new resident due to a language barrier. The home used information from Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: social services and a visiting carer to base their assessment on whether they could meet the individuals needs. The last two admissions were arranged by the care matching team. Limited information was provided and the home is addressing this with the care matching team. It was reiterated to the Registered Manager that it is in the homes best interest to ensure that they undertake a comprehensive assessment themselves to ensure the needs and expectations of the prospective resident can be met. Prospective residents are encouraged to visit the home prior to moving in and the first four weeks are considered a trial period. Care Homes for Adults (18-65 years) Page 12 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The documentation in place for some people does not fully reflect the level of care provided and there is a risk that care may not be consistently provided. Residents are not always assisted to achieve their personal goals. Medication procedures do not safeguard residents and staff. Evidence: Care plans and goal setting are in place; however further work is required to be undertaken. On reading care plans, it was difficult to get a clear picture of individual preferences and routines. Shortfalls in the documentation were discussed with the Registered Manager and deputy manager. Staff demonstrate an understanding of some residents needs/goals, however all information is not being recorded. This was evident by some staff knowing some individuals goals that had been expressed to them, however other staff were not aware of this goal due to no information being recorded. There was some evidence to demonstrate that staff assist individuals to work towards their short-term and long-term goals, however this information was not Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: consistent between residents. This has not been reflected as an outstanding requirement, however management must ensure that information recorded is consistent. On speaking with residents, the expert by experience noted most residents did not know what was in their care plan or take any active part in the writing of the plan. From a discussion with the Registered Manager it seemed that the care plans were more for members of staff than for the residents. On viewing records, there was evidence that an individual had been involved in devising their initial care plan, however this was not dated and there was no evidence to identify that the individual was involved in any further reviews. Management confirmed that residents do not wish to sign the care plans. It was discussed that staff could always record that residents were involved however refused to sign. All documentation used for an individual needs to be named to ensure that information is not confused with other residents details/care planning. Staff must be reminded to write in pen and not to be using pencil to record information pertaining to individuals. Daily notes are not always recorded and did not always identify if short-term goals have been achieved or not. Staff use a daily communication book for sharing of information. Information about all residents is recorded on the same page. It was recommended that the home review the procedure for recording daily records about the well being of residents. Having all information about individuals on the one page does not help promote confidentiality if someone wishes to view any records about an individual. Daily records are a good source of evidence to show that care is being provided, as detailed in the care plan. Daily records when well written, help ensure a consistent approach and good quality of care for residents. It is in the homes interests to be able to show what they have done, along with providing the evidence on which to base the monthly review and to record that they are following the assessment of needs. Residents are generally able to choose their own daily routines, however on speaking with staff and residents and from views obtained by the expert by experience, it did not appear that residents are empowered enough within the home environment. Residents were observed to be able to make decisions for themselves throughout the day such as smoking, what to eat, if they wish to leave the home to visit the community etc. Further work is needed for risk assessments. It was confirmed that where a risk is identified, a more comprehensive risk assessment should be implemented. Risk assessments viewed did not provide guidance for staff on what action to take to Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: reduce the risk. These are regularly reviewed, along with care plans, however one risk assessment had been reviewed every month for four months and no staff member had identified the shortfall in the documentation. Staff need to ensure that information is read thoroughly and clear information is provided and that the reviews are not just task orientated. Care Homes for Adults (18-65 years) Page 15 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lifestyle is generally their own choice, however further work needs to be undertaken to empower residents and provide further opportunities for personal development. The environment and provision of meals needs to be improved. Evidence: Residents were observed throughout the day to be able to leave the house independently when they chose to. Residents need to be provided with more opportunity for personal development. This was evident when viewing the complaints records. A resident complained that they were sometimes late to attend a day centre due to staff not preparing the sandwiches in time for them to take. The Registered Manager confirmed this individual is capable to make their own sandwiches, however the action taken to resolve this was to reiterate to staff the importance of having the sandwiches made in time. The individual should be empowered and provided with the Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: equipment/food to take control of this themselves. There was one resident taking part in further education. This resident was taking a literacy course and basic IT skills. No one was participating in any occupation. Residents are able to go out into the community alone if they choose to and it is safe for them to do so. Some residents did attend a day centre, although one has recently closed and another is not being used by residents for fear of violence, which had taken place in the past. Four of the current residents attend a day centre. One resident expressed a wish to attend bingo but said she had no support to do so, whilst another resident informed the Inspector that they attended bingo on a regular basis. The AQAA identifies that three residents attend bingo regularly. On speaking with residents, the expert by experience felt there are not many residents who take part in mainstream activities. There are not many in-house activities except board games. The expert by experience was told that they did have an art therapist attending, but this proved to be too expensive for the number of residents who attended. On the day of the site visit, the expert by experience observed that there did not seem to be any activities except for the communal lounges with televisions and the smoking room. Most of the residents appeared to be bored. There were no other activities taking place during the visit. The Inspector was informed that some residents are hard to motivate and the AQAA identifies that part of plans for improvement in the next 12 months is to encourage under motivated residents to take a more active roll. It also identified that residents have been involved in buying more board games for them to enjoy. Staff do take the residents on occasional trips to France but these are not taken up by many residents. Residents have attended a holiday camp on Hayling Island. Many of the residents the expert by experience spoke to did not wish to go there again, although some had enjoyed it. The expert by experience spoke with residents regarding what they would like to do. One expressed the view that they would like to cook more. There is a small kitchenette for the use of residents but this does not have a cooker. Residents are able to use the main kitchen when the cook was not using it. Other wishes/goals expressed, which should be achievable, were shared with the Registered Manager and deputy manager and advised that these goals be reflected in care plans and assist individuals to achieve them. One person has the finances available to achieve one of their goals. For one resident, it was not known if they have the finance to achieve their goal, however this should be recorded and broken down to short term goals that may be needed to Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: achieve their long term goal, ie: budgeting, planning transport etc. One resident felt they are not getting any support to help them achieve an aspiration. They informed the expert by experience that a member of staff suggested they take an aircraft trip around Hove. Individual goals/aspirations should be respected by the staff. From speaking with residents, the expert by experience identified that there is a lack of activities within the home and lack of support for accessing activities in the wider community. Residents are able to form personal, family and sexual relationships inside and outside of the home environment as they wish. There was a sexual care plan in place for an individual in a new relationship. There are no restrictions for visiting, however people are encouraged not to visit between 11:00pm and 8:00am. The expert by experience arrived at the home just before lunch was served and joined the residents for lunch. This gave an opportunity to ask the residents about the food and also to experience the food herself. Her findings were as follows: The dining room was fairly small for 25 people. The room was dark and also seemed to be a bit of a passageway to other areas of the home. There was very little light coming into the room, as the windows were very small and high up. The tables were covered with patterned tablecloth. The meal consisted of jacket potato with a choice of fillings. The food was served by one of the key workers. The potatoes had been cooked in a microwave so the residents were served individually and were all eating at different times although they were all seated and waiting. Residents were asked for their choice of filling and this was served up by the staff. The potato I had was undercooked; it was poorly presented on the plate and was reminiscent of school dinners. There were no fresh vegetables served with the potato. Although the residents were given choice over the fillings, I would have thought that residents could maybe help themselves to fillings. Most of the residents I spoke to about food said it was adequate, but they did not have much choice in what was offered. One resident said that the cheapest food seemed to be purchased. Another resident said he had asked if they could have certain food but was told it was too expensive. There is no qualified cook at the home at present. Carers are currently undertaking these duties. It was confirmed that food/meals are discussed at resident meetings. Staff confirmed that residents are provided with a choice. No requirement has been made specifically in relation to food, however the home must address this issue as part of their own quality assurance system. The AQAA identifies that 100 per cent of permanent staff have received training in safe food handling. Care Homes for Adults (18-65 years) Page 18 of 36 Care Homes for Adults (18-65 years) Page 19 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents healthcare needs are monitored, however do not always receive personal support in the way they prefer. Residents and staff are not safeguarded by the medication procedures in place. Evidence: Care plans, as explained previously in the report, need to provide more detail and guidance to staff on residents needs to ensure they receive personal support in the way they prefer and require. There is a key worker system in place, however some residents thought that they did not get enough time with their dedicated key worker. One resident who had some help with personal care felt they were being hurried. Guidance and support is provided, where needed, regarding individuals personal hygiene. Short-term goals have been implemented about some issues of personal hygiene for individuals, however staff are not recording if these daily goals are being achieved and if not, what further action may be needed. On observation, it appeared that residents were able to choose their own clothes, Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: hairstyle, makeup and their appearance reflected their personalities. Information from the expert by experience identified several residents felt they were not shown any respect from the staff and one resident remarked that one member of staff greeted them with Hello kids. This offended this resident and others who did not wish to be treated like a child. Some residents attend a clinic for injections. If a resident is ill a Community Psychiatric Nurse (CPN) will attend the home. Records are kept of all multi disciplinary health professional visits. Residents are supported, when needed, to attend health appointments in the community. It was confirmed that specialist advice is sought from health professionals when needed eg: dietician, GP, district nurse. Residents are weighed regularly and the Registered Manager confirmed that dietetic advice is sought when needed. For those residents who may have some behavioural issues related to their mental health illness, there were no clear guidance of things that may trigger this behaviour or information for the staff on signs to look for or best practice on how to deal with behaviours. As required from the last inspection, the Registered Manager confirmed they have implemented a risk assessment in relation to diabetes. Information regarding diabetes is contained in an individuals file and staff have received in house training from the providers regarding this illness. No one at the home has received any external training relating to diabetes. Staff collectively do not have knowledge about diabetes, apart from the information that has been downloaded from the internet. It is recommended that professional training be accessed for staff to ensure they have a full understanding of how to best care for someone with diabetes and any emergencies that may result from this healthcare need. The deputy manager confirmed there are policies and procedures in place for all aspects of dealing with medications. These were not read. She has recently undertaken her own audit of medicines and shared her results with the Inspector. At the first site visit, management confirmed that they were discussing ways to improve this. There was evidence that medication procedures needs to be more robust to ensure residents are protected by the homes procedures. New Medication Administration Records (MAR) charts were in place and being used for the third day and there were already shortfalls in the documentation noted. Examples of this were: staff had not recorded why a medication had not been administered, medicines were noted not to be signed for and a handwritten prescription (by staff) Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: was noted not to be the same as the prescription printed on the box. The deputy manager will address the shortfalls with the relevant staff members. The home needs to obtain confirmation that the controlled drugs (CD) cabinet complies and is installed in compliance with current legislation. At the second site visit, the deputy manager confirmed that arrangements were being made with their supplying pharmacist to assess the CD cupboard. Staff were not accurately recording controlled drugs. Records and tablets left corresponded, however written records were not reflective of this, as staff had written incorrect information. A bottle of liquid temazepam had been smashed and the supplying pharmacist had supplied the home with a new bottle (100mls) plus an additional 40mls. There were no records at the home identifying that a bottle had smashed and no record of the amount or when the new supply was provided to the home. At the second site visit, the deputy manager confirmed that she has discussed this with their supplying pharmacist and were taking action to address this. Work has been done to improve the storage of medicines. There is now a cupboard where all medication is stored. It was confirmed that the supplying pharmacist undertakes an audit every three months. Administrating medicines to residents appears to be task orientated and not person centred. There is a shelf placed across the corridor outside of the medication storage area and residents come into the area individually at times medications are needed to be administered. Deputy manager confirmed there has been no negative feedback from residents regarding this procedure. Care Homes for Adults (18-65 years) Page 22 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Safeguarding Adults allegations and complaints are dealt with in a non-biased manner although residents do not always feel comfortable to raise concerns. Clearer records being maintained will further ensure residents personal allowances are safeguarded. Evidence: On speaking with the residents the expert by experience found they are frightened of making complaints and were concerned that I would report them to management if they made any complaints. They felt that their complaints would not be taken on board and so many of them did not do so. This was also related to familial relationships within the home where it was identified that management and some workers are related. There is a complaints procedure available at the home that people have access to. The AQAA identified there had been no complaints made in the last 12 months. On viewing records there had been nine complaints made. Records demonstrated that the service takes any concern seriously. These were not related to care provided within the service and related to the environment, about other residents or related to smoking. Action was taken to address all concerns expressed. In house Safeguarding Adults training is provided to staff from a training video. It was recommended that some staff attend external training with the local authority to share Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: information about local procedures with others. For two new staff, Safeguarding Adults training is being arranged in house for them. The Registered Manager and deputy manager undertook local Safeguarding Adults training with the local authority designed for managers a couple of years ago. It is required that they attend an update to learn about the changes in local procedures and about the different levels, as the Registered Manager confirmed that she was not familiar with these. There are procedures in place for the handling of residents finances. There is a corporate appointee for seven resident, others manage their own finances with or without support depending on needs and some are assisted by external services. Some residents informed the expert by experience that they felt that they did not have easy access to their money and one commented that they did not have free choice over what they spent their money on. Some facts provided to the expert by experience from a resident appeared muddled. When viewing records for the specific individuals who expressed concerns, the Inspector was unable to locate the information as incorrect names had been provided to the expert by experience. Receipts are kept of financial transaction, where possible, and residents sign when they receive their money. Records viewed and actual money counted were not always corresponding. Some errors noted were due to staff adding/subtracting incorrectly. One resident had 40 pounds extra than what the remaining balance showed. The Registered Manager was unclear about how errors had occurred as she confirmed that the money was checked the day before. Action must be taken to ensure clear records are maintained of residents finances. The AQAA identifies that there have been no incidents when restraint was used in the last 12 months. Control and restraint training is being arranged for all staff to attend. The Registered Manager confirmed that staff have had in house training on the mental capacity act from an easy guide information they downloaded from the internet. Further training is being arranged. The expert by experience noted several residents felt that they were discriminated in general in the community, felt socially isolated and felt the stigma of having mental health issues. There was no evidence that staff discriminated or harassed any residents. Care Homes for Adults (18-65 years) Page 24 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Work has been done and needs to continue to be undertaken to improve standards within the home, ensuring residents live in a comfortable environment. Evidence: The home is two houses joined together and is located in a residential area in Hove. Rooms are located over four floors and residents must be able to moblise independently to access areas above and below ground level. On touring the environment, individual rooms were seen to be personalised and reflect the individuals choice and character. The expert by experience viewed some areas of the environment and observed there is a conservatory which is the designated smoking area. The room is cold and uninviting. The chairs are very hard and uncomfortable. There were some rather dead looking plants. I spoke to the manager about this and she said that it was deliberate, and the area was deliberately made uncomfortable to encourage residents to cease smoking. I noticed that a member of staff was using the conservatory to smoke in. As this is the residents home and smoking is a personal choice I do not think this is a way to encourage non-smoking. There are no bath hoists at the home and residents must be able to access these with Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: minimal assistance. This is currently not a problem at present, as residents are generally independent and require minimal assistance. It was confirmed that the facilities provided at the home are taken into account when assessing prospective residents. Whilst residents are independent with mobility, discussions were had with the Registered Manager on how they would assist someone from the floor should they have a fall. It was confirmed that they would call an ambulance. Consideration needs to be made to having facilities provided to safely raise someone off the floor, particularly as some of the residents are becoming older. One section of the home appeared quite dark when the Registered Manager and Inspector went to view rooms on the top floor. It was getting late in the afternoon and the Registered Manager confirmed she had not noticed that the stairs were not well lit. A resident confirmed that it was always like that. The Registered Manager confirmed that she will assess this and take action if necessary. The Registered Manager confirmed that they have doubled the number of cleaning staff since the last inspection. Any areas that were noted to be in need of additional cleaning were informed to the Registered Manager who will ensure that this is addressed. An example was extractor fans. The AQAA identifies that three staff have received training in prevention and control of infection and is aware that providing staff with training in infection control is an area that they could do better. There is a cleaning checklist on all toilet facilities to ensure these areas are monitored. The staff toilet checklist identified that this was being cleaned monthly. The Registered Manager confirmed this is not correct, but staff must not be completing the monitoring forms. Management need to address the staff toilet area to ensure this promotes infection control, particularly as kitchen staff also use this area. The hand towel should be removed and the paper towels provided placed in a proper holder and not left on a shelf. The pedal bins needs to be placed where this can be used effectively. Bin lids should also be used in communal bathrooms to promote infection control. There were no offensive odours noted throughout the home, however some areas smelt of smoke from residents smoking. Management is trying to address this problem with the individuals involved, as smoking is not permitted in individual rooms. There are risk assessments in place for those residents who smoke in their rooms. Care Homes for Adults (18-65 years) Page 26 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are generally being met with the number of staff on duty. Residents are not safeguarded by the recruitment procedures in place. Evidence: On duty at the second site visit, there were three carers working in the morning, three carers in the afternoon, however one carer was also responsible for cooking duties. It was confirmed that two staff work at night. It was confirmed that generally staffing numbers are three carers working throughout daytime hours and two staff working at night. The information in the AQAA regarding staff was not provided as this information has been shared with Skills for Care. The Registered Manager was requested at the first site visit to access this information to have available for the Inspector at the second visit. This information was not available by the second day as the Registered Manager confirmed she did not have the time to do this. She was advised to follow the guidance provided on our website on how to access this information to provide to us. Ten care staff are employed at the home of which seven have National Vocation Qualification (NVQ) level 2 or above. Two of these care staff are currently doing NVQ Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: level 3 and one is undertaking NVQ level 4. Three other staff are currently undertaking NVQ level 2 studies. The AQAA identifies that what the service does well is to follow robust recruitment policies and procedures in order to protect residents. There was not evidence of this at the home. Four staff files viewed identified that two staff had commenced employment prior to a Protection of Vulnerable Adults (POVA) or full Criminal Record Bureau (CRB) check having been received. The Registered Manager confirmed that one staff member came to work to commence induction and was never left alone and the second staff member was a previous employee returning after two years. The home needs to ensure all recruitment checks are undertaken again for this individual. The home was advised that should they choose to keep this person working, they are responsible for them and a risk assessment needs to be in place to demonstrate why they continue to work this person. At the second site visit, it was confirmed that they have stopped this person from working whilst they undertake recruitment checks. Application forms could not be located for two staff members and only one reference could be located for another. For the staff that had no previous care experience, references had been obtained. No records were made by the home following interview to identify why they thought this person was suitable to employ. It was confirmed that new staff complete an in house induction and following advice from the previous report have commenced using Common Induction Standards as set by Skills for Care. Residents informed the expert by experience that staff sleep at night on the sofas. This information was passed to a registered provider and the Registered Manager for them to address as part of their quality monitoring. Care Homes for Adults (18-65 years) Page 28 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More robust quality monitoring within the service by management will assist in ensuring the home is well run and meetings it aims and objectives. Health and safety procedures need to be more robust to further safeguard residents health, safety and welfare. Evidence: The Registered Manager is registered with CSCI and confirmed that she and the deputy manager have completed an advanced management for care course. She confirmed that she keeps herself up to date from a business support service external to the home, using the Internet and has attended mental health training. When discussing shortfalls with management throughout the inspection, the Registered Manager and deputy manager found this dialogue useful, however management must ensure they are more pro active in keeping themselves up to date with changes within the care industry and best practice guidance. Surveys are given to residents twice a year to obtain their views and to identify if any Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: changes could be made to the running of the service. These results are read and issues identified are discussed with residents and staff. There is a suggestion box at the home that provides people with an opportunity to express their views anonymously at any time. Health professional surveys had been sent out in the past and the Registered Manager confirmed that she will be implementing these again twice a year. The AQAA identifies that this is already being done. Discussions were had with the Registered Manager on ways to analyse and display results, so all people with an interest in the home are made aware of any quality monitoring results. There is currently no method available for staff to provide feedback/suggestions anonymously. The Registered Manager confirmed that she will implement staff surveys to address this. Recent results had not been analysed as yet. On viewing some of the surveys, there was a mixture of positive and negative results. A registered provider was open and honest with the Inspector and confirmed that it was identified with a recent absence of the Registered Manager and deputy manager within the service, the running of the home nearly came to a stand still. He confirmed that he was aware of the shortfalls within the documentation and other areas identified at the site visit. He thought that an inspection by CSCI was due and instead of trying to change things in a short period of time prior to inspection, he would wait for the inspection to be undertaken. It was discussed that this in not the way to use the inspection process and it would have been in his best interest to have already started to implement his proposed changes. Regulation 26 reports were provided to the Registered Manager on the days between the Inspectors site visits. Whilst the Inspector appreciates the homes honesty, the registered provider was reminded that these reports are to be used effectively as a means for them to ensure the home is being run in the best interest of residents and that the homes aims and objectives are being met. A copy of these reports must be provided to the Registered Manager on a monthly basis so that action can be taken should any shortfalls be noted or to evidence that they are managing the service effectively. The AQAA identified that some policies and procedures were not in place. The Registered Manager will address this. The AQAA identifies that any equipment has been serviced or tested as recommended by the manufacturer or other regulatory body. It identified that gas appliances had not been checked since November 2006. It was confirmed that these had been checked/serviced in October 2008. Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: Radiators are unguarded and not of guaranteed low surface temperature. The home must undertake risk assessments for these and take action if identified as being needed, particularly as some residents are becoming older and may be at a higher risk of falls than when they were first admitted. Windows above ground level are not restricted. The Registered Manager confirmed risk assessments have been done for residents regarding these. This must be kept under review as needs change and new residents are admitted. The Registered Manager confirmed that there is a first aider on every shift. Residents have keys to the front door and their individual rooms. No records are kept of who is in or out of the home. Every handover staff do a checklist to see who is in or out. The Registered Manager said that residents did not want this in place as they have previously tried a method of signing in/out, however residents did not want to sign. The last report reflected that the manager confirmed that with the exception of the seals around fire doors in the house all other recommendations highlighted in the homes fire risk assessment had been addressed. It was confirmed at the last inspection in November 2007 that this work would be carried out next year but the timescale was not clear, however it was acknowledged that this work must be carried out as a priority. At this inspection, this work had not been completed. Again the Inspector was informed that this was to be completed next year. This must be done as a priority to ensure residents are safeguarded, particularly as there is a higher risk of a fire due to some residents smoking in areas that are not designated for smoking. A room viewed had burn holes in the bed clothing and the Registered Manager confirmed that staff are monitoring this. The Registered Manager confirmed that there are quality-monitoring systems in place at the home where the environment, individual rooms and documentation etc are spotchecked. This procedure needs to be reviewed, as management undertaking their own audits should identify shortfalls noted at this inspection. Robust systems must be in place to ensure, but not limited to, robust recruitment procedures are followed, quality monitoring is effective and clear audit trails are maintained of all medicines receieved into the home. An AQAA was completed as required, however discussions were had with the Registered Manager on how information could be expanded to provide more detailed evidence, ensure that all sections are completed and that all key standards are addressed. The brief summary was very brief. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 That clear and accurate information pertaining to individuals be maintained, up to date and all care provided and personal goals be accurately recorded. This is to evidence that the home is meeting the needs and personal goals of service users. 27/02/2009 2 9 13 That clear and detailed risk 27/02/2009 assessments be in place and provide guidance to staff on how to reduce any identified risk. This will better promote the safety of residents and staff. 3 11 12 That residents are 27/02/2009 empowered further and given more opportunities for self development. This will assist in promoting service users independence and fulfill services as Care Homes for Adults (18-65 years) Page 33 of 36 advertised in the Statement of Purpose. 4 20 13 That confirmation be obtained that the controlled drugs cabinet complies and is installed correctly. This is to ensure compliance with current legislation. 5 20 13 That robust medication procedures are followed and suitable arrangements be made for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This is to ensure service users and staff are safeguarded. 6 23 16 That accurate records be maintained of service users finances that the home holds for safekeeping. This is to ensure service users monies are safeguarded. 7 23 13 That the Registered Manager 31/03/2009 undertakes Safeguarding Adults training with the local authority to update herself with current procedures. This is to ensure that any allegations of abuse are dealt with in line with local multidisciplinary procedures. 8 34 18 That robust recruitment procedures are followed. 27/02/2009 27/02/2009 30/01/2009 31/03/2009 Care Homes for Adults (18-65 years) Page 34 of 36 This is to ensure service users are safeguarded. 9 42 13 That the home undertakes a comprehensive environmental risk assessment and to take action wherever needed. to minimise risk. Priority must be given to address shortfalls noted in previous fire risk assessments. This will ensure the home is free from hazards and will further safeguard service users, staff and anyone visiting the service. 10 43 24 That management within and external to the home implement more robust quality monitoring systems. This will ensure the home is run effectively and is meeting the aims and objectives of the service. 27/02/2009 27/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 19 That professional training be accessed for staff to ensure they have a full understanding of how to best care for someone with diabetes and any associated risks or emergencies that may result from this healthcare need. That staff are provided with an opportunity to attend external training so ideas and good practices can be shared with staff from other services. 2 35 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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