Inspection on 27/06/08 for Delos Community Ltd, 7 Poplar Street

This inspection was carried out on 27th June 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 no outstanding requirements from the previous inspection report, but made 22 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Delos Community Ltd, 7 Poplar... 20/05/09

Delos Community Ltd, 7 Poplar... 27/10/08

Delos Community Ltd, 7 Poplar... 16/01/07

Delos Community Ltd, 7 Poplar... 29/11/05

Delos Community Ltd, 7 Poplar... 08/02/05

Delos Community Ltd, 7 Poplar... 24/06/04

Delos Community Ltd, 7 Poplar... 08/01/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Delos Community Ltd, 7 Poplar Street Willowtree House 7 Poplar Street Wellingborough Northants NN8 4PL Lead Inspector Ansuya Chudasama Unannounced Inspection 27th and 30th June 2008 10:00 Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Delos Community Ltd, 7 Poplar Street Address Willowtree House 7 Poplar Street Wellingborough Northants NN8 4PL 01933 222452 01933 677881 mikebrennan@delos.org.uk www.delos.org.uk Delos Community Limited 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) Manager post vacant Care Home 10 Category(ies) of Learning disability (10), Learning disability over registration, with number 65 years of age (10), Mental disorder, excluding of places learning disability or dementia (10), Mental Disorder, excluding learning disability or dementia - over 65 years of age (10) Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - Code PC To residents of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD and Code LD(E) Mental disorder excluding learning disability or dementia - Code MD and Code MD(E) The maximum number of residents who can be accommodation is 10. 2. Date of last inspection 16th January 2007 Brief Description of the Service: 7 Poplar Street is situated in a residential area close to the town centre of Wellingborough. The home is also known as Willowtree House and is one of four registered homes within easy walking distance of each other, supported by a Head Office and Day Centre in separate premises. The collective facilities are known as the Delos Community where people using the service are known as members. The home provides personal care and support for up to nine members whose primary care need is due to having a learning disability, but who may also have mental health problems. The range of fees at the home start at £637 and increases depending on the needs of the person using the service per week. The inspector was informed that the Statement of Purpose had been reviewed but a copy was not available in the home. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This home has 0 star rating and this means that the people using the service receive a poor service We went to the home without telling any one that they were going to visit on the 27th and 30th of June 2008. This was the first time the inspector had visited the home. We spoke to the staff, a manager from another home and the Responsible Individual registered person for the home. The manager for the home was on holiday on the first day of the inspection. On the second visit to the home the manager was on duty in the afternoon but the inspector was at the main office looking at information that was not available in the home. The home does not have an office so there fore a lot of the information is kept at the main office. At the inspection we talked to most of the people who live in the home. We looked at information about policies and procedures, which tells the staff how to do things in the home. We looked at the training that they do to look after the people living in the home. We looked at information about some of the people who live in the home to find out how their needs are being met by the staff. This is called case tracking. We watched how the people living in the home and staff got a long together. The home had sent us their annual quality assurance assessment (AQAA) after they were sent reminders by letter and phones calls. A senior support worker completed this document. A comment on the AQAA indicated that the home had recognised there had been a lack of leadership at times and ‘we have developed as a team, but without direction’. The CSCI had also received a complaint about the home about not managing the needs of one of the people living in the home. We made an immediate requirement at this visit. This is when something is a serious cause for concern and must be changed quickly days to safeguard people living in the home. This was about how staff had been recruited. There is a special check by the Criminal Records Bureau (CRB) that must be carried out each time a person is employed in the home before they start to work in the home. This was not followed by the home and the home could place the people living in the home at a risk if the person was not suitable to work with them. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 6 The age range of the people living in the home was said to be from the oldest person being 81 years old and the youngest person being 54 years old. We would like to thank the staff, and the people living in the home for their time in helping with this inspection. This inspection report should be read alongside the National Minimum Standards for Younger Adults. What the service does well: Some of the people living in the home say they: • • • • • • ‘Like it here’ ‘The staff are nice’ Those who are able to verbally communicate know who to tell if they are unhappy. They go on holiday ‘Help lay table’ ‘Like the food’ Some of the staff spoken to say: • • • • • • • That they enjoy working at the home. They attend training to help them meet the needs of the people they look after. They help people to look after themselves’ and ‘like to see them improve’. They have team meetings They work well together and support each other They say the senior staff is nice and supportive Some get on well with the manager. The Inspector observed: • • • • • Staff were talking to the people living in the home in a positive and caring manner. The staff were working well together They know what food people living in the home enjoy The staff were observed asking and assisting those people who needed help at lunchtime. They had good understanding of the needs of the people using the service. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The home should ensure that: • • • People using the service are involved in their care plans and they are updated after having a review for people living in the home to reflect accurate care intervention required Ensure that the staff are employed when satisfactory safe guarding checks have been made Ensure that the safe guarding team of social services are informed of any incidents that are safeguarding of vulnerable adults and arrangements must be made to ensure safeguarding referrals are made when incidents occur that adversely affects the health and wellbeing of people living in the home. Structured activities must be undertaken to ensure that satisfactory stimulation and motivation is gained for all people living in the home. Ensure that there are enough staff on duty to meet the needs of all the people living in the home all of the time and have enough staff so all the people in the home can do activities and go out The people living in the home needs to know that they can be confident that no one other than staff sees or hears personal information about them. Ensure that advocates are involved in helping people living in the home to make decisions about their care and living in the home Staff sign and date important documents. The people living in the home should be provided with aids and adaptations to keep them more independent Provide person centred planning to meet the needs of people living in the home. Ensure that all assessments are available for inspection. Ensure that Incidents/accident forms are sent to CSCI under regulation 37 of the Care Standards Act • • • • • • • • • Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 8 • • Provide a quality assurance system that monitors the views of the people living in the home and staff, and meets the regulation Ensure staff are provided with the training they need to meet the needs of the people living in the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4, Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home admits people with special needs however staff are not always trained in the specialist needs and these may not be met. EVIDENCE: We were informed that the statement of purpose and service user guide had been reviewed but a copy was not available in the home. It was said that a copy could be obtained from the main office of the organisation. A copy of this was asked for when we visited the office but the Responsible Individual person was not able to find this and said that a copy would be sent to the CSCI. At the time of writing this report this was not received. Staff informed us that the last person admitted to the home had visited the home and their family had been involved in this process. The file of a new person admitted to the home was inspected. However the initial assessment undertaken by the last manager, which was said to have been a lengthy document, was not available in the file. We were told informed that the manager had discussed the assessment of this person with staff. We Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 11 were told that the assessment stated that the placement was not suitable to meet the person’s challenging behaviours and the person would not be compatible with other people living in the home. It was stated that a more specialist placement was needed to meet the person’s needs. However we were informed that the final decision was made by senior management to accept the admission of this person at the home. Information we read on a progress report after the person had been admitted to the home after two and a half weeks showed that the persons stay at the home as being ‘chaotic and disruptive to staff and residents’. It also stated that all the behaviours noted in the person’s assessment have been present. This showed that the home was struggling to meet the person’s needs. The report also talked about the ‘whole team requires training on behaviour approaches’. The staff had not received training on how to manage challenging behaviours. The home did not have a care plan in place but the report talked about the person’s care plan ‘should be in place very soon’. The report was not signed and dated by the person completing this. (See section on staffing) The information read in the accident/incident record dated February 08 showed that one of the people living in the home had become stressed and very tearful. This was because one of the people living in the home with behaviours that challenge had been screaming for over two hours. The person wanted to move to another home, as they could no longer stand the screaming any longer. We were informed that the people living in the home had now got more used to the person’s inappropriate behaviours. Staff spoken to stated that some nights the person living in the home screamed through out the night and the staff were very stressed. The staff who had been on a sleeping in duty did not get any sleep and they were very tired the next day. Since the inspection we were told that “since the intervention programme began in May that screaming at night had been eliminated” and “that on occasions where staff are kept up they are sent home first thing in the morning and replaced”. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People who use the service have basic care plans but some are difficult to understand and some do not have all the information recorded about how to meet the person’s needs in full. EVIDENCE: Evidence showed that a care plan was not put in place for a person who had very high needs prior to their admission. A review carried out for this person in March 08 stated that a structured routine plan was not provided. This was after the person living in the home had been at the home for over 7 months. It was acknowledged by management that this did not happen and stated that it was due to staffing problems. Information read in the specific care plan’ dated 12th of February 08 was signed by the manager and a staff member but Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 13 there was no evidence to show that the persons family or representative or an advocate had been involved with this process. The plan did not explain in detail how to manage the person’s behaviour problems. In the planed intervention section it talked about the care team to write up guidelines with support from other professionals to manage the person’s behaviours. These guidelines were not seen in the person’s file. Staff spoken to were not aware of this information and were not able to find this information in the file. It was stated that they had learned how to manage the person’s behaviours by learning from other staff. The organisations behaviour analyst who also managed two of the organisations other services undertook a behaviour support assessment of the person living in the home on the 21/2/08. The action plan discussed in the review of 6th of March was not all included in the care planning document. We were told that this person did cooking as an activity at the day centre but this was not recorded in the plan and a risk assessment was not available for this activity. We were informed that the staff had started to do the care plans and it was said that they did these when they have time. This was also due to not having an office, and being interrupted by phone calls and people living in the home needing their support. Another care plan was looked at and this was very confusing and difficult to understand. We asked the staff to explain the care plan information and it was stated that this was the old care plan, which the staff also found confusing to understand. We were told that the manager had introduced a new care planning format, which they found easy to understand. The daily notes recorded for one of the people living in the home were being recorded separately by staff working in the home, and by another staff working on a one to one basis with them. Some of the people working with one of the people living in the home had not seen the care planning documents or had been involved in the care planning process. There was no evidence that the family or a representative or an advocate had been involved to represent the views of the people living in the home with care planning documents. The care plans also needed reviewing to ensure they were up to date with information to help staff meet the needs of the people living in the home. We were told that the home had started doing person centred planning (PCP). This information was looked at and it was noted that this was not PCP. The information seen was about the person living in the home and about their likes and dislikes, and this was good. However this did not include information about meeting the person’s aspirations and goals. Risk assessment for one person living in the home was seen for swimming, activity in the community, road safety, and being in the car. Other risk assessments for example, staff working on their own with the person living in the home, accessing the garden, kitchen, the bathrooms, using the stairs, medication, assessment of the persons vulnerability and risk to other people living in the home were not available. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 14 The home did not have an advocate to represent the views of the people living in the home. However we were told that most of the people living in the home were not happy about the inappropriate behaviours displayed by certain people living in the home (See section on assessment). Some of the people living in the home said that they would like to go out and one said ‘have a cup of tea out’ but due to being short of staff this was not happening. There was little evidence to show that the views of the people living in the home were being sought by the home. The home did not have an office. The main phone is located in the main corridor of the home and staff also had a cordless phone that they could use. We were told that this phone did not always work properly and this was witnessed on the day of the inspection. We were concerned that information about people living in the home was being discussed on the phone where other people could hear the conversations. The staff spoken to were also concerned that they were talking to other professionals on the phone about people living in the home. Since the inspection we were told, “the phone is fine. The handsets do not pick up a good signal in the kitchen and dining room due to unknown interference, but neither of this is suitable for confidential discussions and therefore should not impact its use”. The staff used the dining room to hold meetings and speak to professionals about the people living in the home. This did not provide them with much privacy because the kitchen hatch was joined with the dining room and this was open. There fore staff and the people living in the home would be able to hear the conversations. When this happened the people living in the home were asked nicely to leave the room and to go to the lounge. We were also told by one person living in the home to use the dinning room for looking at a file when we were in the main lounge. They said that this was where the staff did their writing. After the inspection we were told that the “kitchen hatch is lockable. There is also a quiet lounge and a meeting room in the centre over the road available for private meetings”. Staff spoken to, said that they needed an office to do their administrative work. This was to ensure that confidentiality was maintained for people living in the home, by having confidential conversations in the office. The Responsible Individual told us that the home did not have an office because this was the ‘members home’. Observation showed that the staff conservations on the phone and the use of communal areas to do their administrative work did not give a homely feel. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this outcome area is Adequate This judgement has been made using available evidence including a visit to this service. Most of the people living in the home are not given the opportunity to take part in a variety of activities both within the home and in the community. EVIDENCE: Staff said that more activities were needed and this included taking the people living in the home out in the community. We were told that the home needed more staff to take people out in the community. We were told that the people who were mobile were able to attend the day centre run by the organisation. One person in the home recently started having day care one to one with staff Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 16 five days a week due to their behaviours that challenged. This inappropriate behaviour’s were observed on the days of the inspection. We were told that one person living in the home went to the organisations day centre five times a week and another person went twice a week for three hours. One person said that they just sat and did drawing and did not go out. They said that they were bored at the centre. The rest of the people living in the home did not have any day care. On the day of the inspection it was observed that two staff on duty were very busy. We saw one person living in the home sitting in the sun lounge by them selves. They said that they would like to go out and have a ‘cup of tea’. Staff stated that there were not enough of them to take them out. In the main lounge there was one person sitting in a wheelchair sleeping. Another person was sitting on the settee and looked uncomfortable. They were in a sloughing position and had fallen a sleep. Another person was sitting in an armchair. Staff spoken to stated that two people living in the home had recently been on holiday abroad with staff and it was said that they enjoyed this. It was also stated that a holiday at Butlins had been booked for some of the people living in the home. We were told that people living in the other sister homes used to visit the home. However they were asked not to come due to the inappropriate behaviours displayed by one of the people living in the home. We were also told that the home had a lovely birthday party for two of the people living at the home. Many people came to the party. We were told every body enjoyed themselves and it was one of the best days that they had for a long time. However we were informed that one of the people living in the home was kept away from the party, and agency staff looked them after. This was due to their challenging behaviours. The staff spoken to had a good understanding of the dietary needs of the people living in the home. The menu rota showed that the meals were chosen by the home. This was done on a 4 weekly rotation basis for three months. Information read in the kitchen stated that certain food had to be on the menu and a list was recorded of the certain food to put on the menu per week. On the form it was stated that this was CSCI requirement. However this information is incorrect. Standard 17 of the National Minimum Standard states that the outcome for people living in the home is offered a healthy diet and enjoys their meals. We were informed that the dietician had been involved with one of the people living in the home that was case tracked. It was said that all the staff did not have training on a person’s special dietary needs until 6 months after the person was admitted to the home. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 17 We observed the cook cooking lots of food and we were told that they were going on holiday and this food was being frozen for staff to use. The reason this was being done was because the two staff on duty would not have time to prepare food and look after the people living in the home. The cook also helped people living in the home at meal times, and with toileting when staff were very busy with other people living in the home or with other chores. At lunchtime the staff were observed using white plastic disposable aprons for people living in the home. This was not very dignified and the practice felt very institutionalised. We were told that the home had aprons, which were better than the plastic ones. The staff were observed talking and helping the people using the service in a sensitive and kind manner. Some of them were being supported with eating their food. One of the people using the service was observed shouting at lunchtime. We asked how the other people in the home felt about this behaviour, and it was stated that the people living in the home had become used to it. It was observed that every one enjoyed the food. The people using the service also told us that ‘they liked the food’ We were told that the home had an activity person but when the person left they were not replaced. It was said that the home had 30 staff hours vacant but management had not decided what the hours were going to be used for in the home. The staff were observed talking to the people living in the home in a kind manner when they were able to do this. However due to the high needs of the people being cared for and doing other chores such as cleaning, cooking, laundry work, giving out medication and only having two staff on duty meant they were not able to spend quality time with them. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The personal care needs of people living in the home are not met satisfactorily and their dignity is not maintained EVIDENCE: On the day of the inspection one person was sitting in a wheelchair in the lounge. Another person was sitting on the settee and they were observed slouching on the settee, and did not look very comfortable. This person was observed needing two staff to support them to walk to the dining room. One person used a zimmer frame to mobilise. The staff were observed supporting the person by walking them to the dining room for their lunch. Some of the people living in the home had clothes that looked very old and some had holes in them. Some of the people were not dressed suitably and their clothes were not coordinated properly. One person was wearing a dress with buttons missing and this showed their underwear. The person’s nails Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 19 were seen to be long and dirty. There were also other people in the home who had long nails. Some of the people living in the home did not have their hair combed properly. This was discussed with staff and it was said that some of the people living in the home did not have a lot of money and some people’s clothes were bought from charities. We were told that some of the people used the community hairdressers. Some staff said that they were concerned that the standard of care in the home was not up to a high standard, and they were not happy with how things were being run in the home. It was said that the staff were being left to their own devises and the manager spend more time at the main office than they did at the home. Staff also said that all the people in the home had their own needs but they felt that the home was not meeting these needs. The rota showed that the person who had one to one with staff had five days a week from 8:30 in the morning to 4:30 in the afternoon. It was said that this one to one working with staff had started recently. The two staff in the home had to manage the needs of the person with the challenging behaviours the other two days and all the evenings. We observed that as soon as the person with challenging behaviours arrived in the home, their inappropriate behaviours would start. Staff worked hard to maintain their privacy and dignity when displaying inappropriate behaviours, but this was not always possible. Also spending the amount of time with the person meant that the other people living in the home did not receive the support and attention that they needed. We were told that most of the people in the home were not able to use the baths. . The home had a hoist for the bath but it was said that the people living in the home were ‘scared to use this’. The staff used the commode to help wash people in the shower. Since the inspection we were told that “of the nine residents living in the home three can independently access any of the homes bath/shower facilities, three have a shower as a preference, three require the use of a hoist to access the bath. Of the final three, only one has shown ‘fear’ of using the hoist-something, which has been remedied by use of a seat belt devise on the hoist chair”. Staff spoken to stated that sometimes they have to cancel medical appointments due to being short of staff. On the second day of the inspection, there was one permanent and agency staff on duty. One staff was on a training day. We were told that two appointments with health professionals for people living in the home were going to be cancelled. This was because there would only be one staff in the home to look after the needs of the rest of the people living in the home. However the other staff returned from their training early and therefore the appointments were not cancelled. The staff said that the health professionals were called when the people using the service were not feeling well. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 20 We read a letter from the RI to staff, which said when the home was monitoring medication; it was found that 80 ml liquid diazepam medication was missing. The records read also showed that there were inconsistencies of medication being provided at the home and management felt that that the ‘members health and wellbeing are being compromised’. The medication trolley was kept in a small room where the homes files were kept. The room was very hot. Medication temperatures were not being kept. We were told that the home had kept controlled drugs in the last 12 months in a small metal tin, which is kept in the medication cabinet. This does not comply with current regulations and guidance issued by the Royal Pharmaceutical society. The training records showed that 10 staff had half day medication training in May 08 and they were waiting for the certificates. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The service does not inform the appropriate agencies of the accidents and incidents of concerns and therefore put the safety of people living at the home at a risk EVIDENCE: Some staff stated that they had read the policies and procedures on safeguarding of vulnerable adults. But some staff had also been on training courses on safeguarding of vulnerable adults procedures. There were new staff who did not have any training on safeguarding of vulnerable adults procedures One person living in the home was observed to have a bruise on their right arm and this was discussed with staff on duty. We were told that they had a bruise chart and they would record this information in their file. The social services safe guarding team had not been informed about this incident and the CSCI had not been informed under regulation 37 of the Care Standards Act 2000. We were informed that the accident and incident forms were completed by the home and the manager signed them and these were sent to the main office. Information read about one person living in the home had a bruise on Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 22 their forehead dated 3/2/08. But this was not reported to the CSCI or Social services safe guarding team. The accident and incident forms seen at the main office showed that none of them had been sent to the CSCI. There were incidents that should have been reported to social services safe guarding team but this had not happened. Refresher training about safeguarding of vulnerable adults procedures is needed for management to understand when accidents and incidents have to be reported to the appropriate agencies. We were told that the home had received one complaint from a family because it was felt that their family members needs were not being met. The information on how this was investigated by the home was not available in the home. This information was asked for at the office, however this was not provided. The commission had received an anonymous complaint regarding concerns about one of the people living in the home running around the house naked and screaming and displaying inappropriate behaviours. Evidence from talking to staff, and reading the assessments and observations on the inspection days showed that this behaviour was happening in the home. This was discussed with the Responsible Individual who stated that they had appointed a staff member to work with the person with challenging behaviours. The staff member worked five days a week from 8:30 in the morning to 4:30 in the afternoon. The rota showed that the rest of the time the person did not have one to one with staff. The staff recruitment files inspected showed that a new staff member had started work by shadowing a staff without having a POVA first check and a CRB check. We saw this person working on their own without being supervised by an experienced staff on duty. This was because the home did not have enough staff on duty to manage the needs of all the people being cared for. An immediate requirement was issued to the home to insure that the home did not start any staff on duty without first receiving their POVA first check and that the home had to ensure that staff with POVA first check were working with another experienced staff member. The staff can only work on their own after they have received their CRB check. Another staff file inspected showed that there were no references. An action plan was received from the Responsible individual the next day explaining the action that they were going to take to ensure that their recruitment procedures at head office did not make these mistakes when recruiting staff. We read a letter from the RI to staff, which said when the home was monitoring medication; it was found that 80 ml liquid diazepam medication was missing. This was discussed with the Responsible individual at the office. Who stated that they had carried out an investigation but they were unable to find out what had happened to the missing medication. We were not informed Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 23 about this incident under regulation 37. The social services safe guarding team had also not been informed of this concern. The police were also not informed of this incident. We asked to look at the findings of the investigation carried out by the responsible individual but the information could not be found. The records read also showed that there were inconsistencies of medication being provided at the home and management felt that that the ‘members health and wellbeing are being compromised’. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home is not always clean and tidy and the physical environment does not always meet the specialist needs of the people living in the home. EVIDENCE: Staff spoken to and evidence showed that suitable furniture was needed in the home. The settees in the lounge were old and not suitable to meet the needs of the frail people that were observed sitting on them. The sofas in the sunroom were old and worn down and had holes and needed replacing. Staff told us that the money to replace the sofas was approved at the beginning of the year but it was stated that it takes such a long time to get things done. Wheelchairs were seen stored in the sun lounge and this did not Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 25 give the room a homely feel. It was stated that these were spare wheel chairs and the home did not have storage to put these chairs away. Suggestions were made by staff in how to make the room feel more homely for the people living in the home. These suggestions were good and would encourage other people living in the home to use the lounge more often. At the inspection only one person living in the home was observed using this room. We were told that an occupational therapist assessment (OT) had recently been carried out for the environment. It was said that the out come of the assessment of the home had not been received from the OT. We were told that a practical day assessment date was to be confirmed for some of the people living in the home. This was when the OT would come and assess the individual needs of the people living in the home. A very small room in the home was being used for storing files of people using the service and other administration files. The medication cupboard was also stored in this room. The room was very small that it was not possible to have a chair in the room to sit on and to do the administrative work. We had to have the room door open when in this room, as it was very hot in side. The staff informed us that they used the dinning room of the home to do their administrative duties. This was observed on the day of the inspection when staff were giving a hand over to the next shift. When we arrived it was observed that the dining room had food on the floor. The big dining table looked old and worn out. We were told by senior staff on duty that the table was handmade and needed polishing but met the needs of the people living in the home. The chairs in the dining room were not suitable to meet the needs of all the frail people living in the home, as they did not provide the necessary support. It was noticed that for one person the chair was not big enough for them to sit comfortably. One person was observed holding on to the side of the armchair to help them get up in the lounge. However the wooden chairs in the dining did not have side arms to help support the person to get off the chair safely. The staff were observed struggling to get a person in a wheel chair in the dinning room. One of the people living in the home was asked to get up from their chair to get the wheelchair in the room. It was also observed that certain people at the back and near the window could not leave the table until the people in front of them got up to let them out. The room had two chairs on each corner with one chair having plastic aprons. One of the people using the service had their zimmer frame near one of the chairs. The dinning room felt crowded, even though one of the people living in the home who had decided to have their lunch in the sun lounge. One person living in the home was in hospital and the other two people living at the home were at the day centre. We were informed that when all the people are having their lunch at the weekend, the dining room is very crowded. It was also said that the main Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 26 lounge was crowed in the evening when staff and the people living in the home sat together. We were told that the bathrooms were not user friendly (see personal and health care support). We were told that the home had not had a domestic cleaner for 9 months. It was said that the domestic cleaner only started last week after the home had a visit from social services commissioning service. We spoke to the domestic staff and were informed that they worked twice a week at the home and worked 4 hours each day. The days the staff worked at the home were not the same days each time and the staff were not aware which day the person was coming to clean the home. The day the inspection was undertaken, the hours of the domestic staff was not recorded. On the day of the inspection the side door leading to the laundry room outside was opened by one of the manager of the services, as there was a smell in the corridor. The tour of the garden showed that the shrubs needed cutting back and the garden was uneven. This was therefore not suitable for most of the people living in the home. We were told that the staff had difficulty getting a person living in the home in their wheel chair to the annexe where the person’s bedroom was situated. We were told that the dining room and hallway had been painted recently. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 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. The homes recruitment procedures are not robust and there fore put the lives of people using the service at a risk of potential abuse. EVIDENCE: New Staff spoken to stated that they were given an induction and this consisted of shadowing staff. They had an induction document that they were completing but this was replaced by another new induction document and the staff had to complete this. The staff started the learning disability qualification in May 08. Evidence from looking at the rota and talking to staff showed that new staff had been left on their own to manage the service when a member of staff have to go out. Newly appointed staff also work on the rota with agency staff. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 28 Staff spoken to stated that there were not enough staff on duty to meet the needs of the people living in the home. It was said that once they had 4 staff on per shift and this was gradually reduced to 3staff, and now there were only two staff on per shift. They said that they were not able to take the people living in the home out to do activities such as going to the park, feed the ducks, and shopping. It was also said that some times when staff have to take some one to the GP, one staff is then left on their own in the home. Staff said that it was difficult to manage the needs of the people living in the home in the evening because of the work they had to manage. We observed when the cook went on holiday on the day of the inspection at lunchtime. The staff had to prepare the evening meal and this reduced the time the staff were able to spend time with the people living in the home. The cook in the home only worked five days a week. The staff had to prepare the meals the other two days. The staff rota showed that one staff who was shadowing a member of staff was not included on the staff rota. Another staff member who worked on a one to one with a person living in the home was shown to be working as 1.5 hours a day. However the staff spoken to stated that they worked full time and five days a week from 8:30AM to 4:30PM. The rota was difficult to understand, and we had to ask staff what free time meant and it was said that this was the day the staff was not working at the home. The home needs to ensure that the information recorded on the staff working rota is clearly recorded with the names of all the staff working at the home and the time they start and finish. The position that the staff has in the home needs to be recorded. The manager needs to write the hours that she will be spending at the home and the hours that she works at the main office. This is to ensure that staff are aware of where the manager will be each day. The rota also showed that a volunteer had spent six months at the home but evidence from the inspection showed that this person was undertaking care duties that permanent care staff undertook. Evidence showed that the staffing hours at the home was not meeting the needs of the people being cared for. We were told that staff had a lot of paper work to do and they worked very hard. It was also stated that they enjoyed working with the people living at the home but it was felt by some that the standard of quality had gone down and what was needed was more staff and training. The staff spoken to had not received any training on challenging behaviour. It was also said that all the staff did not have training on a person’s special dietary needs until 6 months after the person was admitted to the home. The training records inspected and staff spoken to evidenced that some of staff had not done food hygiene course, epilepsy, challenging behaviour, infection Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 29 control, dementia, manual handling, medication, fire awareness, mental health, crisis intervention, and person centred planning. Some staff told us that they got on well with the manager but felt that the manager needed to spend more time at the home. It was said that that some times the manager spends two days at the home. And the rest of the time was spent at the main office. It was also stated that the staff were not sure which days the manager was going to be at the home. Staff felt that they were not being provided with guidance in how they should be doing things correctly. Staff spoken to stated that they were not receiving regular supervision but it was stated that if they needed advice, they spoke to management. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 30 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,41,42 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The people living in the home do not benefit from a well run home and management systems are not sufficient to ensure an acceptable level of service is provided for people living in the home. EVIDENCE: We were told in the AQAA that ‘We have developed as a team, but without direction’ and it was said that team building was needed, ‘to improve the way we work, more effectively for members to receive improved services’. It was also said they needed ‘to move forward as a team with new manager’, ‘to Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 31 promote stability to our members, while dealing with management changes. It was also said that they needed to ‘work together as a team’ and ‘by fully committing to support the new manager’. We were told at the inspection that management also needed to listen to staff. Records of regulation 26 visits were not available in the home and one that was found was dated November 06. This was discussed with the Responsible Individual (RI) at the main office. They stated that they had carried out a visit in April 08 and this was being typed up. However they had not done any more visits since then. The RI was asked to send us the regulation 26 visit report for April and other visits carried out this year. But this was not received on the day of writing this inspection report. The RI told us that he was not carrying on with this role but another person had been identified. The service did not have a quality assurance system that met the standard. No questionnaires had been sent out to people living in the home or their relatives. As detailed in the staffing section, some staff in the home had not received training in food hygiene, fire awareness and infection control The recruitment procedures of the home were not robust and put the lives of the people living at the home at a risk. The accidents and incidents that occurred at the home were not being reported to the relevant agencies under regulation 37 of the Care Standards Act and under safe guarding procedures. (see section on concerns and complaints). The RI stated that they had a difficult time last September when the manager left. We were told that the senior staff was paid as a team leader to manage the service, and the RI monitored the service. We were not informed of the interim measures put in place after the last manager had left the home. Some staff spoken to stated that they had not been involved in a fire drill but some staff had. The last fire drill was carried out on the 10/4/08. The time the evacuation took place needs to be recorded. The home must ensure that all staff are involved in a fire drill practice. This was because it was said by staff that they can read information but by doing things in practice they know what to do and they feel confident. The emergency lighting testing was not being carried out on a monthly basis. Since the inspection we were told that “in a way this is true-the emergency lighting is tested on a weekly basis. The fire officer had visited the home on the 11th of June 08 and three recommendations had been made. Two recommendations were met and one for the fire risk assessment for the premises was being reviewed. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 32 The Environmental health officer had visited the home and had issued 4 Recommendations and one of which was that “all food handlers should be supervised and instructed and or trained. A number of food handlers who worked unsupervised currently have no formal food hygiene training”. The emergency call system procedures read showed that three sister homes are connected to this home for attending to emergencies. It was stated in the procedures that the staff in the main home had to ‘ go as quickly as possible to help’. This then meant that one staff was left to manage the home on their own. We were told that his had happened when a new member of staff was left on their own for a few hours. This was because the other staff had to go to another home. This happened in the evening. Some staff spoken to were concerned and frightened that they might be called out in the middle of the night. They felt unsafe walking to another sister home in the middle of the night. The staff were concerned that the home had people who had high needs in the home and to be left with one staff was putting the people and staff at risk. The home needs to undertake risk assessments for this practice. A risk assessment was required for all the radiators in the home to ensure that the frail people in the home are protected from hurting themselves. A risk assessment for using the stair lift for individual people living in the home was required. A risk assessment needed to be carried out for a person who was registered blind but had a room on the second floor of the home. Generic risk assessments were seen. The staff spoken to stated that since they had a management of change, the staffing hours were reduced to having two staff on per shift. It was also stated by most that management was not listening to them. The staff were not getting regular supervision to monitor their practice. The staffing hours showed that the needs of the people are not being met. A recommendation was made at the last inspection to state that a qualified first aider should be on duty in the home at all times. But this was not happening. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 33 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 2 2 1 3 1 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 2 33 1 34 1 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 2 1 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 1 X 1 2 1 X 2 1 X Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 34 No 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 YA2 Regulation 14 Requirement Assessments of peoples needs must be completed in full and linked to the care plans to make sure that their needs are met in full. The existing people living in the home must be consulted about the compatibility of prospective new service users Action must be taken to ensure that the person with challenging behaviour is appropriately placed and their needs met. Management must demonstrate the home’s capacity to meet the assessed needs (including specialist needs) of all individuals admitted to the home. DS0000039660.V367710.R01.S.doc Version 5.2 Timescale for action 01/09/08 2 YA2 14 30/08/08 3 YA3 14,12 29/08/08 4 YA3 12,16 & 23 29/08/08 Delos Community Ltd, 7 Poplar Street Page 35 5 YA6 15 6 YA18 12(4)(a), 7 YA20 13-2 8 YA41 17 9 YA12 12(1)(a), 12(4)(b)16(2)(m) &(n) A care plan containing sufficient information that is clear must be in place for each assessed need and kept up to date when changes occur, to ensure people receive the care and support that they require. People must always receive the support needed to maintain an acceptable level of personal hygiene to ensure they can live their lives in a dignified manner. There must be suitable handling, recording, and administration of medicines. The storage of controlled drugs needs to comply with current regulations to ensure the people living in the home are protected Written records maintained about the people living in the home must be signed and dated by the person completing them so there for we know who are recorded the information People living in the home must be provided with stimulation and social and emotional support to enable Version 5.2 30/09/08 04/08/08 22/08/08 15/08/08 26/09/08 Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Page 36 10 YA22 12(1), 13(6) 11 YA30 16(2)(j) &(k) & 23(2)(d) 12 YA24 23 13 YA33 18 & 19 14 YA33 17 15 YA34 7, 9, 19 Schedule 2 them to receive sufficient support to maintain a satisfactory level of social and emotional wellbeing. Incidences of safeguarding must be reported in accordance with local policy to safeguard the people living at the home. All areas of the home must be clean and free of odours so that people have a pleasant environment in which to live. The premises must meet the needs of the people in relation to their age and physical limitations. There must be sufficient staff on duty to be able to meet the needs of the people living at the home at all times. The staff working rota must have the names of all the staff working at the home recorded and other information stated in the report to ensure accurate records are kept and the needs of the people living at the home are met A POVA First Check as a minimum must be secured alongside two references and all other matters Version 5.2 04/08/08 04/08/08 26/10/08 22/08/08 22/08/08 30/07/08 Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Page 37 15 YA35 18(1)(a) &(c)13(5) & (6) 16 YA37 9(1), (2)(b)(i) & 12(1) 17 YA42 12 18 YA42 13,37 listed in schedule 2. This is to protect the people living at the home, from receiving care by someone who may not be suitable to work in a care home. An immediate requirement was issued on the day of the inspection. Staff must have received as a minimum specific training relating to the individual needs of a person before being allowed to provide care to them, to ensure their safety and the protection and safety of people using the service. Management of the home must be effective and sufficient to ensure people receive the care and support required to meet their individual needs. The policy regarding the emergency call out arrangements between homes must be reviewed to ensure that there is no detrimental impact on the home Accidents and Incidences must be reported in accordance with the homes policy, to the relevant agencies Version 5.2 22/09/08 29/09/08 29/09/08 15/08/09 Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Page 38 19 YA39 24(1),(2) &(3) 20 YA10 12-4 21 YA42 13,18 and under regulation 37 to CSCI There must be a 30/09/08 system for quality monitoring that seeks the views of people living in the home, so that standards improve and people have an opportunity to influence the running of the home. Confidentiality of 30/09/08 people living in the home must be maintained. Action must be taken 29/08/08 to meet the requirements made by the Environmental Health Officer to protect the health and safety of people living in the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA42 Good Practice Recommendations A qualified First Aider should be on duty in the home at all times. Delos Community Ltd, 7 Poplar Street DS0000039660.V367710.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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