Inspection on 04/03/09 for Denmark Hill, 164

This inspection was carried out on 4th March 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Denmark Hill, 164 05/03/08

Denmark Hill, 164 14/12/06

Denmark Hill, 164 20/09/05

Denmark Hill, 164 21/10/04

Denmark Hill, 164 02/06/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOME ADULTS 18-65 Denmark Hill, 164 164 Denmark Hill Camberwell London SE5 8EE Lead Inspector Sonia McKay Unannounced Inspection 4th March 2009 10:00 Denmark Hill, 164 DS0000022724.V374588.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 Denmark Hill, 164 DS0000022724.V374588.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. Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Denmark Hill, 164 Address 164 Denmark Hill Camberwell London SE5 8EE 020 7733 4979 0207 733 4979 h4060@mencap.org.uk www.mencap.org.uk Royal Mencap Society 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) Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 7 5th March 2008 Date of last inspection Brief Description of the Service: 164 Denmark Hill is a registered care home providing care and accommodation for seven people with learning disabilities. The Royal Mencap Society is the Registered Provider. The property is a large detached house in a residential street. It is adapted to make it accessible to people who use wheelchairs or other mobility needs. Accommodation is provided over two floors with all bedrooms for single occupancy. The home is close to local amenities and public transport connections. Prospective residents are given a copy of the Service Users guide that gives information about the home and the services provided. A copy of the most recent Commission inspection report is available, on request, from the staff office. Fees range from £963.97 to £1849.00 per week and depend on the individual care needs of each resident. Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 Star. This means the people who use this service experience Adequate quality outcomes. This inspection was carried out over two days. The methods used to assess the quality of service being provided were: • • • • • • • • Talking with the home manager Looking at the ‘Annual Quality Assurance Audit’ completed by the home manager (this document is sometimes called an ‘AQAA’ and it provides the Commission with information about the service) A tour of the communal areas of the home Looking at records about the care provided to two of the residents Looking at records relating to recent staff recruitment and training Looking at the way medicines are handled by staff in the home Looking at issues that the Commission has been notified about since the last inspection and how they were handled Talking to a placing authority social worker The Commission would like to thank all who kindly contributed their time, views and experiences to the inspection process. What the service does well: Assessed and changing care and support needs are reflected in written plans for staff reference. Residents are consulted about their plans and life in the home. Risk assessment is used to encourage independence. Prospective residents have the information they need to help them to make an informed decision about moving to the home. The information is accessible. Recruitment procedures are good and necessary checks are taken up before people are appointed. Residents are able to take part in age, peer and culturally appropriate activities and are part of their local community. They are supported to maintain relationships with friends and family. Meals are varied and enjoyed and residents are involved in all aspects of meal preparation. Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 6 Staff help each resident to maintain their personal care and individual preferences are provided for. Staff seek medical advice as required and medication is administered safely. The large home is reasonably clean and comfortable. What has improved since the last inspection? What they could do better: This has been a difficult period for staff and this is reflected in the high turnover and sickness levels. Staff have, at times, lacked the necessary support of regular supervision. More must be done to develop the team and to ensure that they are adequately trained to meet the current needs of the residents. More could be done to ensure preventative healthcare is planned properly and to maintain a record of healthcare for one resident. The kitchen is in need of redecoration and the safety of some areas, such as the laundry room must be improved. More must be done to ensure that fire-fighting equipment is readily available at all times. A broken ceiling hoist must be repaired. Areas of home management have slipped during this difficult period. The future of the home remains uncertain and more must be done to ensure that notifications are made and safeguarding issues are recognised and followed up properly. Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 7 Complaints are not recorded properly. The home manager is not registered with the Commission. 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. Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective residents have the information they need to help them to make an informed decision about moving to the home. The information is accessible and there is more information about how placement fees are spent. EVIDENCE: There is a written guide to the services that the home provides. This is useful for residents who are considering moving to the home and also to provide existing residents with information about the home and how it runs. The guide is written in plain language and there are pictures to make it more accessible to residents who might find text only information harder to understand. As required in the previous inspection report, there is now more information about placement fees and how they are spent. As this may differ for each resident (fees may be higher for residents who have higher staff support needs) an individual breakdown is produced and inserted in to the guide. Needs assessment is part of the referral process for accommodation in Mencap services. The home is fully occupied during this inspection and no resettlement work is underway at this time. Local authorities who wish to refer someone to the service do so by sending a community care assessment of care needs for Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 10 consideration and if a placement seems appropriate there is then a series of visits and assessments. This helps prospective residents to experience life in the home before making a decision to move in for a trial period. Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Assessed and changing care and support needs are reflected in written plans for staff reference. Residents are consulted about their plans and life in the home. Risk assessment is used to encourage independence but more should be done to look at the current risk management strategies relating to high emotional needs of some of the residents. EVIDENCE: Staff maintain files of written information about each resident. These are stored in the office but are available to the resident if they wish. Some of the residents have worked with key staff to develop their own plans and some are produced in accessible formats with pictures and symbols (for example, activities plans). Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 12 Mencap is introducing a new format for planning care. These are called core plans and they are written for staff reference; describing how each person prefers to be cared for and supported in key areas. The method of planning is person centred. Meaning that the resident themselves is involved in planning their care and in setting the goals. Plans are written in the ‘first person’ as if the resident has written them themselves. The home manager aims to further improve the planning systems by more frequent plan review to consider the outcomes of previous goals and plans. The new style of plan has not been fully introduced and key workers are working to transfer and update existing information into the new format over the coming months. The plans seen were up to date and had been reviewed recently. Advocates are involved when major decisions are to be made if a resident needs that type of support. Best Interests meetings are convened if people are assessed as needing multi-disciplinary assistance in making decisions about healthcare and treatment. Residents meet with their key workers each month to discuss their plans and how things are going for them. This is a good way of monitoring things in between more formal planning and review meetings. Key workers write monthly reports to provide a record of what is happening for each resident. Residents also attend house meetings where they can discuss house issues together with staff. Residents each have a set of documents called risk assessments. These are about everyday risks that the resident may be exposed to, for example health and safety in the home environment and in the community and risks related to moving and handling operations. Some residents have risk assessments relating to their emotional needs as some have behaviour that is sometimes described as challenging. The risk assessments seen were detailed and had been reviewed recently. The placing authority is currently looking for alternative placements for two of the residents as their emotional needs are proving hard to meet at this home. The frequency and intensity of the incidents of aggressive behaviour is sometimes high and staff and other residents are often involved and sometimes injured. It is recommended that risk assessments in regards to emotional needs be reviewed to provide staff with clear information about what action they should take if techniques to de-escalate volatile situations do not work. It is noted that both staff and residents have raised concerns about the stress they are under as a result of living with high levels of aggression. It is also noted that Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 13 some of these issues are currently being looked at under the local authority safeguarding vulnerable adults’ procedures. Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are able to take part in age, peer and culturally appropriate activities and are part of their local community. They are supported to maintain relationships with friends and family although relationships with peers within the home are sometimes difficult. Meals are varied and enjoyed and residents are involved in all aspects of meal preparation. EVIDENCE: Each resident has an individual weekly activities programme that includes a range of leisure and educational activity. Residents are encouraged and supported to be involved in household chores such as shopping, cooking and cleaning their bedroom. Each person has a range of community based activity and the home manager considers this an area that the home does well in. Residents are supported to maintain family links and friendships and to attend religious services of their choosing. Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 15 During this inspection residents were observed to be engaged in a range of activities at home and in the community. Some residents have one to one staff support and this enables a good level of community access. The communal lounge has a television and musical equipment and there is large rear garden with a lawn and seating area. The large dining room is also used for arts and crafts. Residents have the use of a house mini-bus and designated drivers from within the team. There are also trips to local pubs, cafes, restaurants, discos, cinemas and sports centres. There is also a computer with internet access and one resident is supported to surf the internet looking up things about his interests. Mencap fund staff costs for each resident to have an annual holiday. The local community is culturally diverse, as is the group of residents and the staff team. This means that people’s cultural needs are better understood and catered for. Residents are able to choose what to have for breakfast and lunch and each person chooses the menu for one evening meal each week. Menu cards with pictures and photographs are available to help people make choices. Food stocks are adequate and correctly stored. Staff and residents eat together in a large dining room or at the kitchen table. However, some of the residents do not get on well together and this has an adverse affect on the quality of the day to day experience of life at home. This is being looked at by the placing authority and alternative placements are being sought for two of the residents. The home manager recognises that an area that could be improved is not allowing a concentration of support on more challenging residents to prevent others from enjoying a full range of activities. Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staff help each resident to maintain their personal care and individual preferences are provided for. Healthcare is generally good but more could be done to ensure preventative healthcare is planned properly and to maintain a record of healthcare for one resident. EVIDENCE: There are written plans about the preferred personal care routines of each person and any staff assistance needed. Residents’ appearances suggest that staff are providing the help that they need, including tactful verbal prompting to ensure weather appropriate clothing. The home currently provides a service to two women and five men and there are both male and female staff. Same gender personal care assistance is available and individual gender preferences are also considered. Technical aids and equipment are available to maximise independence. Although a bedroom ceiling hoist to an en-suite bathroom is not currently working and the resident, who has mobility needs, is using the level access Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 17 shower in a ground floor communal bathroom instead. The home manager plans to improve support to residents with physical disabilities by accessing the most appropriate equipment to support their mobility needs within the next twelve months. All residents are registered with a local GP. A record is made of the healthcare of each resident, although one set of records could not be located. The manager said that the resident is keen to read his care plans but sometimes removes records and destroys them. This is not ideal and, given that the resident is not able to manage his own healthcare needs, thought should be given to how a permanent healthcare record can be retained. This will ensure that staff have the necessary records to help the resident follow any medical advice and follow up treatment and appointments. Another resident attends a wide range of healthcare appointments. Records show that he gets the specialist input that he requires and systems are in place for staff to monitor his health. There is evidence that staff seek healthcare advice appropriately and take residents to accident and emergency clinics and doctor’s appointments as necessary. Information about routine health screening is available in formats accessible to residents with a learning disability. The home makes referrals to a specialist psychology team for adults with a learning disability. Accessible health action plans are in place. These plans have been developed for people who find text only plans difficult to understand. The plans are not currently being used to best effect in planning routine healthcare appointments and health screening. For example, areas of basic healthcare planning such as arranging dental check ups have not been considered in one plan looked at. Staff maintain good daily records for each person. Mood, general health, continence, additional medication required and behaviour and healthcare appointments are generally well documented (other than for one person whose records could not be located). Weight is monitored closely and professional advice from dieticians incorporated where necessary. Detailed records are also kept of any epileptic seizure. None of the residents are self medicating. The current residents are assisted with taking their medication, which is stored securely in a locked medication cabinet. A measured dose system is in place, provided by the local pharmacy. Staff induction training includes the safe use of medication and the medication administration procedures in place at the home. A sample staff signature list is available. Consent to be administered medication by staff has been obtained from each resident by use of a form with symbols to aid understanding. Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 18 A spot check of medication administration showed no gaps in recording, indicating that medication had been given at the right times. There is guidance for when staff should administer medications that are to be used only occasionally in specific circumstances, for example high agitation. A spot check of a medication prescribed for this purpose indicates that the correct number of tablets were in stock. There are no controlled drugs in stock although a correct storage is available if any are prescribed. Staff have been trained to fully administer some prescribed medications, for example emergency medication for a person who experiences epileptic seizures. Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 19 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. Systems are in place to enable residents and relatives to raise concerns but the staff do not keep adequate records of the concerns raised and what was done about them. Poor recording of complaints was the subject of a previous requirement that remains unmet. The home manager must take swift action to improve in this crucial area of recording. The home manager has failed to keep the local authority informed of a high level of incidents. This has resulted in a delay in looking at current issues under safeguarding procedures. This does not provide residents with adequate safeguards against potential abuse. EVIDENCE: Residents have opportunity to raise concerns during regular house meetings and meetings with their key worker. The home manager said that the service could improve by better recording of the action taken when residents raise concerns. A relative also uses a small notebook to communicate with staff when a resident goes for home visits. Sometimes concerns are raised in the communications made. There is a log to record complaints. The log has no record of recent complaints, although there is evidence that the home has received complaints and taken some action to investigate. For example, a relative complained that a resident Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 20 was not dressed properly when she visited. This is not recorded in the record of complaints and it is not clear if the complaint was substantiated or not. There is ongoing staff training in adult protection and POVA (Protection of Vulnerable Adults). Home managers have attended training this year. There are adult protection procedures in place, and a copy of the local authority (Lambeth) adult protection procedures are available for staff reference. There have been two safeguarding referrals made by the home since the last inspection. The first referral was not done quickly or effectively and the home manager has since met with the local authority to ensure that correct and timely referrals are made in future. During this inspection an immediate requirement was issued as many incidents that had been recorded in a written log in the home had not been reported to the placing authority or the Commission. Feedback from the placing authority indicates that they have not been kept up to speed properly. Issues relating to these incidents, which involve residents hitting staff and other residents and property damage are now being looked at under the local authority adult protection procedures and a high level of incidents are now being reported. Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 21 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, 26, 27 & 30. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The large home is reasonably clean and comfortable, although the kitchen is in need of redecoration and the safety of some areas, such as the laundry room must be improved. More must be done to ensure that fire-fighting equipment is readily available at all times and issues relating to a broken ceiling hoist used by one resident must be resolved in accordance with his needs and preferences. EVIDENCE: The home is comfortable, homely, cheery and bright. A domestic assistant is employed to help the staff and residents to keep the large home clean. The home was reasonably clean and tidy although areas, such as the kitchen, are in need of re-decoration. The freezers were in need of de-frosting and the fire blanket was not in its holder on the wall. This was raised during the inspection and the fire blanket was located and replaced. This indicates that necessary safety checks on the Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 22 availability of fire fighting equipment should be done more often. Many door handles are wobbly and this is apparently an ongoing issue. The dining room and two bedrooms has been re-decorated recently and one of the residents was having more durable fittings fitted in his bedroom during the inspection as there has been a high level of property damage recently. The home is situated in an area that affords good access to local amenities and public transport. Level access, adequate doorway widths and ramped access are provided to enable people who use wheelchairs, and other mobility aids, easy access to the ground floor communal areas and garden. The home is in keeping with other homes in the local area. A stair lift is available as one of the residents of the first floor has increasing mobility needs. All bedrooms are single occupancy. Bedrooms are personalised and reflect the taste and interests of the person accommodated. During the last inspection it was noted that one bedroom had an unpleasant odour of urine. A requirement was issued as a result. The carpet has been replaced and the room smells better. The requirement is therefore met. One resident has a bare window and no curtains. This does not provide adequate privacy. There are two bathrooms, one with a Jacuzzi facility, and one with a level access shower. All have toilets. There is also a separate toilet. The bathrooms and toilets are bright and airy and are located close to bedrooms and communal areas. The, doors are fitted with locks with an appropriate override facility to be used in an emergency. The home has adequate and accessible communal space comprising of a large well-furnished lounge, dining room and kitchen/diner. There is also a large garden with tables and chairs and ramped access. The kitchen has a wheelchair accessible food preparation area. There is a laundry room on the ground floor. The washing machine and dryer have been replaced recently. The laundry room also houses a large boiler and pipe work. The boiler used to be covered by a protective shutter. This shutter is now open and the boiler and pipes are exposed. This is potentially dangerous. COSHH materials (substances hazardous to health, like cleaning materials) are locked away in the laundry room. There are adequate hand washing facilities available. A ceiling hoist in an en-suite bedroom is not working and the resident is currently using a level access shower in a ground floor communal bathroom Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 23 instead of his en-suite bath. During the inspection it was unclear as to whether the hoist was going to be repaired or what the preferences and needs of the resident are. The home manager has identified that repairs and environmental standards could be improved and there are plans to assign staff to specific responsibilities for monitoring these areas. Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. This has been a difficult period for staff and this is reflected in the turnover and sickness levels. Staff have, at times, lacked the necessary support of regular supervision. Recruitment procedures are good and necessary checks are taken up before people are appointed. More must be done to develop the team and to ensure that they are adequately trained to meet the current needs of the residents. EVIDENCE: There are three members of staff on duty during the day and two members of staff on duty at night. Two residents have one to one support for periods of the day. One member of staff stays awake at night and another is asleep, but available for emergencies. A staff sleeping room is available. There is also a manager on-call at all times. There is a team of relief/bank workers available to cover sickness and staff holidays. Staff duty rotas examined showed that these staffing levels had been maintained. Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 25 All new staff undergo Mencap induction and foundation training that covers learning disability, health and safety, risk assessment, challenging needs, inclusion, medication, mental health issues, manual handling, first aid and fire safety. Training in valuing, protecting, including and involving residents is also provided. An induction and training programme for the Denmark Hill service is also in place and covers in-house procedures and individual guidelines and training for working with the people living in the home. The home manager recognises that staff could be better trained to deal with the very challenging situations that occur in this home. Staff are booked to attend a two day training session that aims to provide the team with more support to meet current challenging needs. Staff will also be trained in how to remove themselves from aggressive situations (breakaway techniques). Given that three members of staff have been injured at work this training will be useful. Discussion with the manager and staff indicates that staff are working in a stressful situation. There are high rates of sickness and staff turnover. The home has recently recruited five support workers and two deputy managers. Staff were observed delivering one to one support to a high standard. The support required is intense and this is reflected in careful shift planning that enables staff to move between residents during the shift. This is good practice. Mencap offer a wide range of staff and management training. A training and development schedule for 2009/10 is yet to be fully developed. The home manager is currently re-organising each members of staffs training records so that he has a better idea of what training to book them onto. There are currently ten permanent care workers. Five have attained a vocational qualification in care (NVQ at level 2 or above). There are currently four vacancies and bank staff are filling in. Further staff recruitment is underway. Recruitment records for two of the newer staff were examined and were in accordance with Regulation. This means that satisfactory checks had been made before they commenced work in the home. Each member of staff is issued with an Identity card and these cards are replaced every two years. The frequency of staff supervisions dipped in 2008 and this has been addressed with the appointment of two new deputies who are now part of the supervision matrix. The frequency of staff supervision has now increased to an adequate level. There are plans to include performance appraisal as part of the supervision process. Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Areas of home management have slipped during this difficult period. The future of the home remains uncertain and more must be done to ensure that notifications are made and safeguarding issues are recognised and followed up properly. A larger management team has been put in place to do this. EVIDENCE: A home manager has been in post for almost two years. He is qualified and experienced but has yet to complete his registration with the Commission. His application was rejected because it was incomplete. He has yet to submit another application. The home manager has failed to keep the Commission and local authority updated on the high level of incidents occurring in the home. Safeguarding Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 27 issues have not been handled well and complaints have not been properly recorded. It is unclear whether the registered provider had reported on this as the reports of the monthly visits were not all available. Only some of the regulation 26 visit reports are available as hard copy. Most are stored on the computer. These reports should be available as a hard copy. The manager now has two deputies in post, both are qualified and experienced. The home manager also assesses that as staff are increasingly more able to deal with the day to day challenges of working in the home he will have more time to complete management tasks. The future of the home is uncertain. Recent rent increases may reduce the financial viability of the home and de-registration and relocation of the current residents is being considered. Residents and their families are being consulted about this and a fair rent revue is pending. Mencap has a continuous improvement plan and extensive quality monitoring mechanisms in place. These include regular visits on behalf of the registered provider, discussion with residents and sampling of records. There are also annual service audits. Records were noted to be generally well kept and systems and checks are in place to ensure environmental health and safety. Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 28 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 X 2 X X 2 X Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 29 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2 Standard YA19 YA22 Regulation 17 17 22 Requirement There must be a record of the healthcare of each resident. The registered person must maintain a record of all complaints made by service users or representatives or relatives of service users or by persons working at the care home about the operation of the care home, and the action taken by the registered person in respect of any such complaint. And the registered person must, within 28 days after the date on which the complaint is made, or such shorter period as may be reasonable in the circumstances, inform the person who made the complaint of the action (if any) that is to be taken. This previous requirement is not met. Action must be taken to meet this requirement and to maintain the required records. The boiler and hot pipe work must be covered to prevent injury. Steps must be taken to ensure DS0000022724.V374588.R01.S.doc Timescale for action 30/06/09 30/06/09 3. 4. YA24 YA24 23 23 31/05/09 31/05/09 Page 30 Denmark Hill, 164 Version 5.2 5. 6. 7. YA24 YA27 YA32 23 23 18 that fire fighting equipment is in place and ready for use at all times (the fire blanket was found to be missing during this inspection)l The freezers must be defrosted 31/05/09 on a regular basis. The ceiling hoist must be 31/05/09 repaired. The registered person must 30/06/09 ensure that there is a staff training and development programme which meets the Sector Skills Council workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users’. This previous requirement is not met. Action must be taken to meet this requirement and to maintain the required records. The registered person must ensure that the Commission is notified, without delay, of any event in the care home that adversely affects the safety of any resident. IMMEDIATE REQUIREMENT Issued on 13/03/2009, with immediate effect. The inspector has since received many new and back dated notifications. 8. YA42 37 13/03/09 Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 31 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 YA9 Good Practice Recommendations Staff should review risk assessments and risk management strategies relating to challenging emotional needs with input from the multi-disciplinary teams involved. The review should consider advice given to staff in managing incidents of aggression. Health action plans must be developed for each resident. These plans should consider and plan for the need for any preventative healthcare checks. Reports of the outcomes of the monitoring visits conducted in accordance with regulation 26 should be printed off and retained in the home. Window coverings (curtains, blinds etc) should be available to preserve the dignity of residents. 2. 3. 4. YA19 YA43 YA26 Denmark Hill, 164 DS0000022724.V374588.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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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