Inspection on 06/06/06 for Desmond House Ltd

This inspection was carried out on 6th June 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Desmond House Ltd 18/12/06

Desmond House Ltd 14/12/05

Desmond House Ltd 19/07/05

Desmond House Ltd 01/03/05

Desmond House Ltd 19/07/04

Similar services:

Whiteley House

Tyndale Avenue

2-10 Norfolk Road

Bennfield House Nursing Home

Eastfield Residential Home

Sign Health

Springwood

Fairburn Mews

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Desmond House Ltd 16-18 Desmond Avenue Hull East Yorkshire HU6 7JZ Lead Inspector Angela Sizer Unannounced Inspection 6th June 2006 10:00 DS0000044243.V298654.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 DS0000044243.V298654.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. DS0000044243.V298654.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Desmond House Ltd Address 16-18 Desmond Avenue Hull East Yorkshire HU6 7JZ 01482 448865 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) Desmond House Ltd Mr Colin Achmed, Mrs Sharon Achmed Mr Graham Achmed Care Home 19 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (19), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (19) DS0000044243.V298654.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registration category MD(E) is to enable service users already resident in the home to remain there upon reaching pension able age (as long as the home can continue to meet their needs). 14.12.05 Date of last inspection Brief Description of the Service: Desmond House is a care home providing accommodation and personal care for 19 persons who have enduring mental health problems that mean that they have to live at Desmond House. The category for older people is to make sure that individuals can continue to have Desmond House as their permanent home as they approach and pass the age of 65. The care home is privately owned. The accommodation consists of two adjacent semi-detached houses. It is situated close to Beverley Rd, a main thoroughfare into the centre of Hull. The home has 13 single and three double rooms, two of the single rooms and one double room have en-suite facilities. There are two lounges and a dining room. There is a garden to the rear and a small parking area. The weekly fees are currently £295.50 – information supplied by G. Achmed on 6.6.06. The registered manager stated that inspection reports are available to the residents and these are displayed on the notice board in the dining room. The manager also stated that prospective residents are offered a copy of the home’s statement of purpose and service user guide, but there was no evidence to confirm that any of the existing residents had received this information. DS0000044243.V298654.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection and took place over 7 hours. Prior to the visit surveys were posted out to; 17 residents and 16 were returned, 1 relative and this was returned, 16 staff members and 5 were returned, 11 health and social care professionals 5 were returned and 9 to general practitioners of which 5 were returned. A tour of the premises was undertaken and a number of records were looked at including residents’ and staff files. Two residents’ care records were tracked during the site visit and 3 staff personnel files were looked at. Four of the staff were spoken to find out what it was like working in the home and what training, management and support was offered to them. The majority of the residents were spoken to throughout the day regarding the care they receive and what it is like to live in the home, some of their comments have been included in this report. A visiting care co-ordinator was spoken to and their views about the home were gained. Events in the home which have occurred since the key inspection on 6.6.06 have also been considered in this report. The registered manager, Mr G. Achmed was present throughout the inspection visit and feedback was given at the end of the day. An official notice was issued and evidence was brought away from the home in relation to the recruitment procedure. The records indicated that some staff had started working in the home prior to the Criminal Records Bureau disclosures being applied for. This practise is unsafe and could put residents at risk. The possibility of enforcement action on this issue was discussed with the manager. The inspectors would like to thank the residents, manager and staff for welcoming them into the home and contributing to the content of this report. What the service does well: DS0000044243.V298654.R01.S.doc Version 5.2 Page 6 The staff are friendly and open in their approach to visitors and the atmosphere is welcoming. Residents commented about staff being “friendly and caring”. Residents made several positive comments during the visit about the home, staff and manager some of these included; “I go to the staff if I need anything”, “everyone gets on here”, “Graham tries to help us when he can”. Meals are well presented and the menu is varied. Residents comments included; “the food is lovely”, “we get allsorts to eat”. Records in relation to resident’s finances were well kept and up to date, this makes sure that residents and their representatives know exactly what monies are available to them. What has improved since the last inspection? What they could do better: The recruitment procedure is currently unsafe and the home on several occasions has employed staff prior to the CRB check being applied for, it is important that the home makes the proper checks before a person starts working in the home to make sure that they are right for the job and safe to DS0000044243.V298654.R01.S.doc Version 5.2 Page 7 work with vulnerable people. During the inspection the need for this check to be completed in all except “exceptional circumstances” was explained to the manager. It was agreed that he would contact CSCI to discuss whether particular circumstances were exceptional. Since the site visit this has happened once; on this occasion it was agreed that the circumstances were not exceptional and that the recruitment of a member of staff should be conditional on the CRB check being complete. In view of this, and the ongoing improvement at Desmond House, it was decided by CSCI that enforcement was not the preferred option at this point in time although this issue will continue to be monitored. Although staff receive some training this area remains inconsistent and several staff members who have been employed for some time have not received mandatory training in; first aid, food hygiene, protection of vulnerable adults, moving and handling and health and safety. Supervision is offered to staff, but this is on an informal basis and continues to be inconsistent and irregular. The content of the records looked at did not meet the national minimum standard. Some paperwork including care plans and risk assessments require further improvement. These do not provide sufficient detail about the residents’ specific and individual needs and any risk that may be present, nor do they provide the care staff with guidance or direction in carrying out their duties. Records must be kept that detail residents’ choices, particularly around sharing rooms and when someone does not want to share a room this must be addressed. 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. DS0000044243.V298654.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 DS0000044243.V298654.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 Quality in this outcome is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents receive an assessment of need prior to or soon after admission. The contract/statement of terms and condition does not fully cover all services offered within the fee. EVIDENCE: Residents are usually admitted with a full community care assessment and care plan, if this is not available the home undertakes its own assessment, confirmation of this was gained when speaking to the manager and staff, although basic the assessment did cover the required areas in standard 2. There had been no residents admitted recently and therefore other existing residents’ files that were looked at and these did contain a community care assessment and care plan from the Local Authority. The contract/statement of terms and conditions was looked at for several residents, this does not include all services that are offered to residents. With regard to point 8 on the home’s contract that states; Wilful and deliberate damage caused by a resident to Desmond House, service users’ and staff property, written notes suggested that the home had contacted the care management team regarding the capacity for one resident, but there had been DS0000044243.V298654.R01.S.doc Version 5.2 Page 10 no formal meeting or decision recorded about incidents of damage to the home. DS0000044243.V298654.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The home has made some improvements to the care planning and risk assessment process, this requires further expansion in order to fully meet the needs of the residents and ensure their safety. Residents clearly state that they feel safe and well cared for within the home although some are unable to express their views. Some choice is offered to residents, but often a more paternalistic approach is adopted by management and staff, therefore limiting choice and autonomy. EVIDENCE: Two of the residents’ files were looked at and the content within the care plans and risk assessments remained minimal as stated in the previous inspection report dated 14.12.05. The manager stated that some of these had been updated and various systems were in operation, he also went onto to say that dedicated time is required by management in order to audit and update all of the systems and currently the registered manager undertakes shifts as a carer on a daily basis. The manager’s hours need to be structured and where care hours are undertaken other support must be in place to compensate. From speaking to the residents it was unclear whether they were aware of the DS0000044243.V298654.R01.S.doc Version 5.2 Page 12 content of the care plan, who their key worker was, or if any risks were being managed. Four of the staff spoken to had limited knowledge about what the care plan entailed and some comments included, “we are not really involved in drawing up the care plan, although we do sometimes attend the reviews”. Staff showed a general awareness of resident’s, but their knowledge about specific needs and risks was limited. Prior to the inspection some information was gained from the Commissioning Unit at Hull City Council in relation to the poor standard of the care plans, risk assessments and general documentation. Several of the residents were spoken to throughout the day and the majority were not aware of the content of their care plan or risk assessment, some said “I have signed it, but I am not allowed to read it”, another resident stated “I have read and signed my care plan, but haven’t seen it for a long time, I am not sure who my key worker is just now”. From observation it was clear that some of the more able residents are free to and go and the majority lead a fairly independent lifestyle. Other residents who are less able and have communication problems tend to be less independent and Notices were seen in most bedrooms stating what to do every morning, to get washed, brush teeth, get dressed etc. This could be viewed as a paternalistic approach and therefore limiting the choice and autonomy residents have. On previous inspections a resident had stated that they would prefer a single room, this was recorded as an action for the management to do. During this inspection the resident had changed their mind and stated that he had changed his mind and would stay where he was. If this occurs in the future the management must give consideration to this area and record any action taken. Reviews are held on a regular basis and documentation was in place to confirm this. Key workers do not currently review the care plan on a monthly basis and are not always involved in the reviewing process. DS0000044243.V298654.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. On the whole residents are encouraged to lead an independent lifestyle. Outings and social events do take place, but there is a lack of in-house activities offered. The menu is varied and overall residents are satisfied with the food on offer. EVIDENCE: Prior to the inspection visit taking place questionnaires were sent out to all of the residents. Out of the 16 returned some of the comments included lack of activities in the home saying that the only thing that happened is bingo. During the inspection several of the residents were spoken to about the range of activities and outings, it was confirmed that some activities do take place, but tend to be bingo or a board games. Occasionally an outside entertainer will come to the home. One or two of the more able residents go out with the manager on a regular basis, other less able residents are not included in this. One resident spoke about opportunities to go to adult education and how much this had helped in building confidence and self-esteem. The resident stated DS0000044243.V298654.R01.S.doc Version 5.2 Page 14 that Graham (manager) had helped initially, but he now goes to the college alone. Other residents informed the inspector that they go to local community centres and day centres on a regular basis. The home offers a varied menu, the week’s menu is displayed on the notice board in the dining room. Prior to the visit several of the surveys from residents indicated that they liked the food “sometimes”, during the inspection visit all of the residents who were spoken to only had positive comments about the food stating,” the food is lovely here, the cooks are very good”, “I like everything that is offered”, “sometimes there is too much, it is very nice”. There were no negative comments on the visit to the home. Lunch was observed and consisted of toasted sandwiches followed by fruit, the main meal of the day is served at teatime and consisted of sausage, chips and mushy peas followed by fruit sponge and custard. From speaking to the residents it was confirmed that if there is something that they do not like on the menu then they can have an alternative, “the cooks often ask us for new suggestions”, evidence of this was recorded in the residents meetings. Breakfast and supper are also offered, there are set times for drinks (hot), staff explained that cold drinks are available throughout the day. Residents confirmed that they “are quite happy to have drinks at set times”. From speaking to several of the residents it was confirmed that the staff and manager supports them in maintaining relationships both inside and outside of the home. Visitors are welcome at any time and private areas are available to use. DS0000044243.V298654.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents physical and emotional needs are not fully met, there are set bathing times restricting choice and several errors in the medication recording procedure were noted. EVIDENCE: Since the last inspection the manager has contacted the Infection Control Unit and sought advice re training and infection control procedures. During the site visit it was noted that alcohol gel is now in place and staff were observed using this and carrying out safe working practices. All staff have now undertaken the infection control training and from speaking with four of them it was clear they had an understanding of infection and how to manage it. During the visit two residents commented about not being able to have a bath either everyday or when they wanted to, this is restricting choice and selfdetermination. There is a bathing rota. The majority of residents did not see this as a problem. Residents confirmed that they see healthcare professionals including their GP, Community Psychiatric Nurse, District Nurse and Psychiatrist on a regular basis, this was also confirmed from reading the case files. DS0000044243.V298654.R01.S.doc Version 5.2 Page 16 The home has a medication procedure and on the whole is adhered to, from inspecting the medication administration records several errors in recording were noted with regard to PRN medication the total was not carried forward to the next sheet and therefore the stock did not balance. The manager and senior carers who administer medication have undergone medication training with the pharmacy, the manager did not know whether this was accredited or not. Lloyds the pharmacist are currently not visiting the home to audit the medication due to issues with the local Primary Care Trust. DS0000044243.V298654.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a complaints procedure that enables residents to express their concerns/complaints. The residents’ protection is not always safeguarded, specifically regarding additional charges for damage to the home and not all staff have undertaken the POVA training. The home’s recruitement procedure is not robust and could put residents at risk of abuse. EVIDENCE: The home has a complaints procedure, this was displayed in the dining room. From speaking to several of the residents it was clear that they were aware of what they would need to do in order to make a complaint. One person stated, “I had a problem a while ago, but I talked to the staff and it was sorted out”. All of the surveys returned from the residents confirmed that they knew the home had a complaints procedure. The home has not had any complaints since the last inspection on 14.12.05. The home has a copy of the multi-agency Protection of Vulnerable Adults procedure and from speaking to four staff members it was evident that they had not undertaken any official training course. The recruitment procedure is not safe and the home continues to commence employment prior to a full CRB check being received, two of the staff looked at did not have a POVA 1st nor a CRB in place until 1 month after they started working in the home. Failure to ensure that staff have the correct checks in place prior to employment could put residents at risk from abuse. DS0000044243.V298654.R01.S.doc Version 5.2 Page 18 As stated in Standard 5, the contract issued to the residents’ requires them to pay for any damage they may cause to the home, regardless of their capacity to consent or capacity to understand their behaviour, there was no multidisciplinary agreement in place. The financial procedure was examined and records were looked at that detailed the personal finances of residents, these were all found to be in good order, accurate and balanced with the cash held in the home. From speaking to two residents it was clear that they received their personal allowance and managed their own money for the week. One resident said, “I get my money and decide what I am going to buy myself, although it doesn’t go very far once I have bought my cigarettes”. DS0000044243.V298654.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 and 30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Some improvements to the décor have been made. Some areas of the environment does not fully meet the residents needs. The home was clean and there were no offensive smells. EVIDENCE: A tour of the premises was undertaken and several improvements were observed, the main hallway, stairs and landing in house no 16 has been recarpeted, some of the resident’s bedrooms have been redecorated. The home has undertaken an audit of the building in order to prioritise what areas require updating and renewal, there remains some disparity between what the home sees as acceptable and what the inspection report identifies as a requirement. Some areas of the home are still looking tired and require to be on the maintenance programme. This includes the renewal of carpets and redecoration, as currently the environment continues to look “institutional”, décor is basic and in some areas poor. The manager stated that “the dining room carpet is to be replaced in 2006, but no date was given as to when this might happen. DS0000044243.V298654.R01.S.doc Version 5.2 Page 20 The home has two bathrooms one downstairs and one upstairs, the water temperature was tested this was 55.8 degrees centigrade and requires attention to ensure residents do not scald themselves. The lock on the bathroom door was not working properly and this should be a double operable lock and allow staff entry in an emergency. The home has now employed a handyman for 16 hours per week and on the day of the inspection was observed painting the main lounge area. Room 18’s door was noted to have the fire closing mechanism missing when this was discussed with the manager he stated that “it had been taken off as the resident had damaged it previously”. During the tour of the premises six residents were spoken to in their bedrooms and their views gained about the environment; “I like my room and I have got my own things in here”, “I would like it decorating and some pictures putting up”, “I need a new armchair it is old and worn”. There were no offensive smells present and the home was clean and hygienic. The domestic staff work very hard to maintain these standards and from speaking to staff it was confirmed that the hours for cleaning are in addition to the actual care hours. Staff have received infection control training and were observed to carry out safe working practices using the appropriate equipment that has been put in place since the last inspection. The home has a dedicated laundry room, which contains an industrial washer and dryer, there is a separate hand washing and a sluice facility. DS0000044243.V298654.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The home does not have staffing levels which ensure that the broad spectrum of residents needs are fully met. The service provider’s recruitment practices and records do not protect residents and are unsafe. Staff receive informal support from management, but formal supervision remains inconsistent and the written record is insufficient evidence to demonstrate that staff are properly supported. EVIDENCE: Discussion with residents, staff and manager confirmed that there were insufficient staff on duty to undertake social activities or accompany residents out of the home if required. Some comments from residents included; “I would like to do more activities, but there are not enough staff to do this”, “the staff are too busy to do anything like that”. Also from the 16 surveys sent to residents 5 commented that there were not enough activities offered in the home. DS0000044243.V298654.R01.S.doc Version 5.2 Page 22 Three staff files were looked at confirming that 2 new employees had commenced work without a POVA 1st or CRB check being undertaken, these were applied for one month later. A code B notice was issued and records detailing employee start date and CRB checks were taken as evidence by CSCI. This has been a requirement for the last two inspections on 19.07.05 and 14.12.05 and has been explained to the registered manager and the directors of the company that this is a breach in regulation and could put the residents at risk of abuse by employing people who have not been checked out properly. Enforcement action is being considered at this time. Training was evidenced in some staff files, but was lacking in others. There is no clear evidence of which staff have undertaken what training, from speaking to staff it was clear that they have undertaken some training and also that more has been available this year since the last inspection. Three staff files were looked at and from the staff surveys that were returned to the CSCI it was clear that not all of the mandatory training including health and safety, first aid, food hygiene, protection of vulnerable adults and moving and handling. During the inspection visit 4 staff members were spoken to confirming that some training had been offered since the last inspection. The staff group demonstrated some awareness of mental health issues, but this was limited and they had little knowledge about the care planning or risk assessment process and some are not involved in this at all. From the information sent to the CSCI from the manager prior to the visit it was stated that several of the staff who are employed as either a cook or domestic also undertake key working roles, therefore it is imperative that they receive training in the mandatory areas and also undertake some mental health /challenging behaviour training as some of the residents can display very challenging or difficult behaviour to manage. Although there are areas in need of attention it should be noted that the staff offer some good care and support to the residents this was directly observed and some comments from residents included; “S is lovely, if I have a problem I can go to her”, “staff always help me if they can”, “C is my key worker and I really like her”. Out of the 16 staff members only 3 have achieved NVQ level 2, the manager stated that several others are currently undertaking this training. The staffing hours remain the same as previous, 2 staff on shift 24 hours per day, domestic and cook hours are in addition, but the managers hours are not supernumerary and he undertakes care shifts on a daily basis. During the inspection the manager stated, “I do shifts everyday and find it difficult to fit all of the paperwork in, I know someone needs to be in the office all of the time to sort out the files and supervision”. The staffing level is that agreed by the previous regulating authority and under current protocols the home is not required to meet the current standard. A recommendation is made that the staffing levels be reviewed with a view to making the manager’s hours supernumerary, that is separate from the staff time for the direct delivery of care. DS0000044243.V298654.R01.S.doc Version 5.2 Page 23 From speaking to staff it was confirmed that they are offered informal support whenever they need this, but formal supervision is not offered as regular as it should be. Some staff struggled to understand what constituted supervision, there were insufficient written records in place to confirm that staff receive the supervision they require in order to offer good support to residents and review their key worker role/care plan on a regular basis. Three of the staff surveys that were returned also stated that supervision was not offered on a regular basis. DS0000044243.V298654.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality outcome in this area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Residents live in a home where the management and administration systems have raised concern about the ability to care for vulnerable people. Residents do not always benefit from how the home is run, although they confirm that they are happy with the conduct of the management and staff. There are some outstanding issues with regard to the recruitment procedure for the home and therefore currently does not provide a safe place to live. EVIDENCE: In relation to the management of the home both residents and staff stated that the manager and co-owners were available at any time and also that they were “open and approachable”. The quality of care plans, risk assessments, supervision, training records and recruitment practices have raised concerns about his understanding of ensuring residents are looked after and safe at all times. DS0000044243.V298654.R01.S.doc Version 5.2 Page 25 The registered manager stated that he had commenced NVQ level 4, but has made a decision not to continue. The company have decided to support the deputy manager to achieve NVQ level 4 in Care and then progress onto the Registered Manager’s Award, after which an application will be made for her to become the new Registered Manager. The quality assurance system is basic and evidence seen consisted of residents’ meeting on 1.3.06, staff meeting on 3.5.06, there was no evidence that residents, staff or other stakeholders had completed questionnaires. The system requires attention and must include the views of all people who live, work and visit the home, an annual report should be prepared and shared with the residents and other relevant parties including a copy to be forwarded to the CSCI. A recent visit from the Commissioning Unit, Hull City Council has raised concerns about the care offered and documentation resulting in an improvement plan being issued to the home with a short timescale of 1 month to improve. The health and safety of the residents is not always safeguarded, due to the lack of training in relation to moving and handling, first aid, POVA and infection control. All of the mandatory training courses must be offered within six months of employment commencing and then kept up to date after that. From speaking to staff it was evident that some had undertaken more training than others, there was no evidence to give clear indication of who had done what training and one file looked at stated that infection control had been achieved whilst working at another home, but there was no written evidence or certificate to confirm this. Regulation 26 visits are not currently being undertaken, the manager explained that this is because all three of the directors also undertake shifts within the home. Mr Graham Achmed, Registered Manager and Director was present throughout the inspection and was given feedback at the end of day. DS0000044243.V298654.R01.S.doc Version 5.2 Page 26 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 X 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 1 X 2 X X 1 x DS0000044243.V298654.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action 06/10/06 1 YA5 12,13,17 The registered person must ensure that the contract/statement of terms and conditions states what services are included or not included in the fee.(Previous timescale 14/03/06 – not met) The registered person must ensure that the care plans give detail of all needs and direction to care staff on how to implement these. (Previous timescale 14/03/06 – not met) The registered person must ensure that key workers review the care plan on a monthly basis with the resident. The registered person must ensure that any restrictions placed upon residents are clearly documented and appropriate support from an advocate or impartial party is sought to ensure that choice is offered. DS0000044243.V298654.R01.S.doc 2 YA6 15,17 06/10/06 3 YA6 15,17 06/10/06 4 YA7 15,17 06/10/06 Version 5.2 Page 28 5 YA9 6 YA14 7 YA16 8 9 YA18 YA20 10 YA23 11 YA23 12 YA24 The registered person to further develop the existing risk assessment in order to include all aspects contained within the assessment of need. (Previous timescale 14/03/06 – not met) 12,13,16,17 The registered person must ensure that regular and varied activities occur both inside and outside of the home and must include all of the residents. 12,13,17 The registered person to ensure that choice is promoted for all residents and any restrictions have been agreed in the individual care plan and contract. 12,13,16,17 The registered person must ensure that all residents can choose when to bathe. 12,13,16,17 The registered person must ensure that the medication procedure is adhered to, all PRN medication must be carried forward to maintain accurate stock control. 12,13,16,17,37 The registered person must ensure that if a resident is to be charged for damages, then a multi-disciplinary agreement is in place and where possible the resident or advocate to consent. (Previous timescale 14/03/06 – not met) 12,18,19 The registered person must ensure that all staff undertake the protection of vulnerable adults training. 23 The registered person must ensure that the home is maintained in a comfortable and homely way, the carpets in the main lounge, DS0000044243.V298654.R01.S.doc 12,13,17 06/10/06 06/10/06 06/10/06 06/10/06 06/10/06 06/10/06 06/10/06 06/12/06 Version 5.2 Page 29 small lounge, dining room, bedrooms 2 and 6 require replacing. Other areas including some bedrooms and the bathrooms require redecoration. (Previous timescale 14/06/06 – not met) 13 YA27 23 The registered person must 06/12/06 ensure that the upstairs bathroom water temperature is regulated as near to 43 degrees centigrade as possible. The lock on the door is not working and requires replacing with a double operable lock. The registered person must 06/12/06 ensure that at least 50 of the staff group have undertaken NVQ level 2. The registered person must 07/06/06 obtain all the following information in respect of person working in the home. -Two written references -A current CRB check (Previous timescale 11/02/04, 14/03/06 not met) The registered person must 06/12/06 ensure that the staff receive the mandatory required and keep these up to date; health and safety, first aid, moving and handling, POVA, infection control. The registered person must 06/10/06 ensure that supervision with staff is undertaken at least 6 times per year and is recorded. (Previous timescale 14/03/06 – not met) DS0000044243.V298654.R01.S.doc Version 5.2 Page 30 14 YA32 17,18 15 YA34 19, Sch 2 16 YA35 17,18 17 YA36 12,13,17,18 18 YA37 9 The registered manager should have achieved NVQ level 4 in both Care and Management by the end of December 2005. 06/12/06 19 YA42 12,13,16,17,23 The registered person must seek advice and direction from the Health and Safety Department with regard to having a professional check on the water system, work practice risk assessments and COSSH assessments. (Previous timescale 14/03/06 – not met) 23 06/10/06 20 YA42 21 YA42 The registered person must 06/10/06 ensure that all fire doors are working correctly, the selfclosing device on bedroom 18 requires replacement. To contact the Fire Department for their guidance. 12,13,16,17,37 The registered person must 06/10/06 ensure that all accident records are correctly recorded and assistance sought from health care professionals as appropriate. 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 YA33 Good Practice Recommendations The registered person should review the homes staffing level in the light of the changing needs of service users and also with a view to the manager’s hours becoming supernumerary. DS0000044243.V298654.R01.S.doc Version 5.2 Page 31 DS0000044243.V298654.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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