Inspection on 26/04/07 for Eaton Lodge

This inspection was carried out on 26th April 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Eaton Lodge 24/04/08

Eaton Lodge 25/10/07

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Eaton Care 14 Eaton Gardens Hove East Sussex BN3 3TP Lead Inspector Jennie Williams Key Unannounced Inspection 26th April 2007 10:00 Eaton Care DS0000068127.V335765.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 Eaton Care DS0000068127.V335765.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. Eaton Care DS0000068127.V335765.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eaton Care Address 14 Eaton Gardens Hove East Sussex BN3 3TP 01273 777911 01273 777948 eaton@vigcare.com 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) VigCare (Hove) Ltd Anthony William Burgess Care Home 10 Category(ies) of Learning disability (10), Physical disability (10), registration, with number Sensory impairment (10) of places Eaton Care DS0000068127.V335765.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users must be aged between eighteen (18) and sixty-five (65) years on admission. Service users with a learning disability only to be accommodated, who may also have a physical disability or sensory impairment. One service user aged over 65 years at the time of admission, within the service user category of Learning Disability (LD) may be accommodated. New Registration Date of last inspection Brief Description of the Service: Easton Care is a care home registered for ten (10) places for service users, of either gender, aged between eighteen (18) and sixty-five (65) years of age on admission, who have a learning disability who may also have a physical disability or sensory impairment. The home is not registered to provide nursing care. District nurses will supply nursing input when needed. The home is located in a quiet residential area of Hove. Vigcare Ltd are the registered providers, who owns numerous care homes throughout the South of England, predominantly older people services. The home was previously a nursing home and has been renovated for its current use. All rooms are for single occupancy and are located on the ground and first floor. All rooms are provided with a toilet and shower en suite facilities. There is a lounge room, dining area and activities room located on the lower ground floor. There is a garden area located at the rear of the home, however is currently not accessible to service users. In addition to en suite facilities there is; one communal bathroom with an assisted bath and toilet facilities. There are a number of disabled toilets located throughout the home. Weekly fees are £1212.35. There are additional fees; hairdressing (£10), chiropody, physiotherapy, alternative therapies and personal clothing/toiletries. A full list of what is not included in the fees can be found in the Service Users Guide. This information was provided to the CSCI on the 26 April 2007. Prospective service users find out about the home through social service referrals, websites and brochures sent to various agencies. Eaton Care DS0000068127.V335765.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. It should be noted that following recent CSCI consultation, it was identified that service users prefer to be called people who use services. The Registered Manager confirmed that they use the term service users. For the purpose of this report, people who use the service will be referred to as service users. This unannounced key inspection took place over seven and a half hours on the 26th April 2007. Two service users were present throughout the inspection. All service users were spoken with. Due to the disability of some of the service users, the Inspector had limited communication contact with them. Care plans were viewed. The Registered Manager and two staff were spoken with during the inspection process. Four staff files were viewed. Ten relative/visitor comment cards were sent to the home of which two were returned. One identified the relative/visitor wished to speak to an Inspector. This individual was contacted. Limited information was provided as this person has had limited contact with the home. A pre-inspection questionnaire was received on the day of the inspection. A tour of the environment was provided and some individual rooms were viewed. Medication procedures were inspected. The quality assurance system was discussed and complaint procedures were viewed. Copies of the staff rota were viewed. No menus were available for inspection. Service users monies were checked. No health and safety records were viewed as this information was viewed during the registration process. There were two service users residing at the home on the day of the inspection. What the service does well: The pre admission process ensures that only service users whose needs can be met at the home are admitted. Prospective service users will be provided with an opportunity to ‘test drive’ the home. Service users are supported to be part of the community. Routines within the home are flexible and within the individuals choice. Visitors are welcomed at the home. Health professionals’ specialist advice is accessed when necessary. Medication procedures in place ensure that service users and staff are safeguarded. Service users were observed to be offered a choice in meals and routines of daily living were observed to be flexible. Eaton Care DS0000068127.V335765.R01.S.doc Version 5.2 Page 6 There is a complaints procedure available at the home, reassuring those involved that they will be listened to and that action will be taken, if necessary. There are procedures in place for the Safeguarding of Adults. There are clear procedures in place for the safe handling of service users monies. The home has been refurbished to a standard that complies with the National Minimal Standards. The home was clean and free from offensive odours. There are currently suitable numbers of staff on duty and service users are safeguarded by the recruitment procedures in place. Staff were observed to have a good professional rapport with service users. Staff spoken with all confirmed that they find the Registered Manager to be supportive, knowledgeable and approachable. The quality assurance and quality monitoring system being developed will ensure that the home is run in the best interest of service users. What has improved since the last inspection? What they could do better: Prospective service users and representatives must be advised of the facilities and services that are stated in the Statement of Purpose/Service Users Guide that are not currently being provided. Urgent action is required to ensure that care plans are implemented to provide clear, accurate and up to date guidance for staff to ensure all assessed needs of the service users are met. Priority must be given to develop and implement risk assessments to ensure any unnecessary risks to the health or safety of service users are identified and so far as possible is eliminated. Individuals/representatives must be involved in this process to ensure choice and preferences are reflected. Clear guidance is required to be provided on the way a service user receives personal support Nutritional assessments need to be undertaken and records maintained of food provided to service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory. It is recommended as good practice that any hand written prescriptions are double signed by staff who have received medication training to safeguard service users and staff from errors being made. It was discussed with the Registered Manager the importance of obtaining information of what courses/job opportunities are available within the area. Information should be obtained and shared with staff so they are aware of the Eaton Care DS0000068127.V335765.R01.S.doc Version 5.2 Page 7 opportunities available when assisting individuals developing care plans and setting personal objectives and goals. The garden is currently inaccessible for service users to use. Priority must be given to ensure this facility can be used during the periods of nice weather. Urgent action is required to ensure that staff receive structured induction and foundation training to ensure the aims and objectives of the home are met. Mandatory training, including Safeguarding Adults must be provided so that staff and service users health, safety and welfare are promoted and protected. The designated person of the company must undertake monthly Regulation 26 reports to monitor the running of the home and provide guidance and supervision to the Registered Manager. Other minor shortfalls noted, which have not been reflected as a requirement or recommendation have been noted throughout the inspection report. 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. Eaton Care DS0000068127.V335765.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 Eaton Care DS0000068127.V335765.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, 3 & 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users/representatives are not provided with accurate information regarding the services and facilities provided at the home. The pre admission process ensures that only service users whose needs can be met at the home are admitted. EVIDENCE: There is a Statement of Purpose and Service Users Guide available for prospective service users. These document do not provide accurate information on the facilities and services currently provided at the home. It provides information regarding a sensory room and computer room being available at the home for service users to use. These facilities are not currently provided and no timescale could be provided to the Inspector. The Registered Manager confirmed that these facilities would be in place if and when a service user is admitted requires these facilities. Prospective service users, representatives and contracting social workers must be made aware that these facilities are not currently available, prior to a placement being agreed. The Statement of Purpose and Service Users Guide must be amended if these facilities are not going to be provided in the near Eaton Care DS0000068127.V335765.R01.S.doc Version 5.2 Page 10 future. Prospective service users should also be made aware that there is not currently the staffing structure in place as advertised in the Statement of Purpose. The Registered Manager confirmed that an activities co-ordinator, chef and domestic staff would be employed when more service users are admitted into the home. Staff are currently undertaking these roles, whilst providing care to the service users. The pre-inspection questionnaire demonstrates that arrangements are being made for documents to be made available in an appropriate format for service users. Makaton software has been purchased for this purpose. The Registered Manager undertakes the pre-admission assessments of all service users. One pre-admission was viewed that provided suitable information for the home to assess if the needs can be met with the current services and facilities provided at the home. The Registered Manager confirmed he visited the second service user, however was unable to undertake a full assessment. Information was obtained from social services, nursing staff and the manager from the previous establishment where the person resided. The Responsible Individual and Registered Manager have been advised throughout the registration process that service users with specialist needs must not be admitted prior to the staff receiving relevant training. Neither of these service users were in a position to visit the home prior to admission, however the Registered Manager confirmed that it is proposed that all prospective service users visit the home prior to moving in. Overnight trial visits are available with prior agreement. The Registered Manager confirmed that there was no one residing at the home from any minor ethnic community, social/cultural or religious groups with any specific needs or preferences. The home does not have dedicated accommodation to provide intermediate care, however respite care is available if there is a spare place available. The Registered Manager confirmed that he does not plan to take emergency admissions. This is conflicting to the information in the Statement of Purpose. Eaton Care DS0000068127.V335765.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 poor. This judgement has been made using available evidence including a visit to this service. Service users are at risk of their assessed needs not being met, due to no care plans having been developed by the care home. Risk assessments have not been developed or implemented, placing staff and service users at risk. EVIDENCE: It was concerning to note that the only two service users accommodated had no care plans or risk assessments in place formulated by the care staff at Eaton Care. Social services care plans were being used, along with information obtained from other professionals. Information read did not provide the reader with clear information on the assessed needs of the individual or provides information regarding the individual’s choice and preferences. Information that assists an individual to maintain some independence was not recorded eg. mobility or continence aids Eaton Care DS0000068127.V335765.R01.S.doc Version 5.2 Page 12 being used. Some information in an individual’s file was out of date and did not pertain to their current needs. It was iterated to the Registered Manager that care plans must be implemented to provide clear, accurate and up to date guidance for staff on how to meet the assessed needs of individuals. The Statement of Purpose advises that care plans will initially be reviewed after the four-week trial period. This is not occurring as one service user had been residing at the home for over two months and had not had an initial care plan implemented. The Registered Manager identified during the registration period that person centred care planning will be implemented. He will be undertaking training on developing person centred planning in July 2007. There were no risk assessments in place for service users. One health professional assessment had identified one service user as being very high risk for falls. There was no risk assessment in place to provide staff with information on how to reduce these risks. Urgent action is required to ensure that any risks to an individual is identified and action taken wherever necessary. The relative/visitor spoken with and the other survey received demonstrated that there were no concerns in relation to the care provided at the home. Eaton Care DS0000068127.V335765.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users routines within the home are flexible and their own choice. Service users are provided with a choice for meals, however the lack of recording does not evidence if food provided is of nutritional value. EVIDENCE: There is no service user currently involved in any education or occupation. It was discussed with the Registered Manager the importance of obtaining information of what courses/opportunities are available within the area. Information should be obtained and shared with staff so they are aware of the opportunities available when assisting individuals developing care plans and setting personal objectives and goals. One service user spoken with confirmed that he was unhappy living at the home as he misses friends he made at his previous accommodation. There Eaton Care DS0000068127.V335765.R01.S.doc Version 5.2 Page 14 was evidence that the home has been proactive in ensuring these individuals maintain regular contact. One relative/visitor survey demonstrated that the home always contacts them on their relative/friend behalf. Service users are supported to be part of the community. Staff spoken with confirmed that one service user is taken out two or three times a week. One service user is not actively involved in outings, as this individual prefers to remain in their room. Due to the limitations in mobility with service users, staff and the Registered Manager said that access to transport can restrict outings. The Registered Manager confirmed that they propose to buy a vehicle for the home in the future. There is a ‘pat dog’ brought into the home every two weeks that staff confirmed service users enjoy. The home proposes to employ an activity co-ordinator when at least five service users are residing at the home. The Statement of Purpose identifies that service users will be encouraged and supported to pursue their own hobbies and interests with each service user having an individual activity plan formulised with the activities co-ordinator. Visitors are welcomed at the home. There is a visitor’s book located at the entrance of the home that all visitors must sign when entering and leaving the home. It was confirmed and the Inspector observed on the day that routines within the home are flexible and within the individuals choice. Staff were observed to talk and interact with service users and not exclusively with each other. Staff were observed to knock on individual room doors prior to entering. There was no information available at the home for the Inspector to ascertain the variety and quality of food provided at the home. No menu has been implemented and service users choose what they wish to eat on the day. Staff were recording the food intake of one service user, however there was a scoring system on the form and not all staff had recorded what the individual ate, only using the scoring system. No nutritional record was available for any service user. There was limited food noted to be stored at the home, however it was confirmed to the Inspector that it was shopping day on the day of the inspection. There is no cook currently employed at the home and staff are undertaking this duty, with some not having any food and hygiene training. The home proposes to employ a cook when additional service users are admitted to the home. Eaton Care DS0000068127.V335765.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. 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. Lack of information available at the home does not ensure that service users receive personal support in the way they prefer and require. Service users are safeguarded with the procedures in place for dealing with medications. EVIDENCE: Care was observed to being provided whilst ensuring service users privacy and dignity are respected. There was no clear guidance in the records providing information on how an individual prefers to be guided, moved, supported and transferred. Service users were observed to use mobility aids. There was no information in the care plans regarding these. All staff have not received suitable training in use of a hoist. Two staff are always present when using the hoist and it was confirmed to the Inspector that at least one of the staff present has undertaken manual handling training. The Registered Manager confirmed that all staff have been shown how to use the hoist. Eaton Care DS0000068127.V335765.R01.S.doc Version 5.2 Page 16 It was confirmed to the Inspector that district nurses and other specialist advice is sought when necessary. The Registered Manager confirmed that a physiotherapist is currently being arranged to assess a service user. Care plans had not been implemented by the home using information from their assessments. Some information being used by the home as guidance is inaccurate or out of date. A GP was currently being accessed for one service user. There are temporary guidelines in place for staff to follow in the event of a service user having an epileptic seizure until training has been provided for the administration of anti-convulsing medication. A comment received from a relative/visitor survey stated ‘they are very attentive to …. needs and support him very well’. A staff member confirmed that there are policies and procedures in place for all aspects of dealing with medications. The content of these were not read. Medication Administration Records (MAR) charts viewed demonstrated that medication is generally being signed for at the time of administration. One MAR chart demonstrated on one day that a service user had refused their medication, however the MAR charts had been signed as being given. No requirement has been made in relation to this as the Registered Manager will address this with the individual involved. There were no controlled drugs being kept at the home. The Registered Manager confirmed that he is currently arranging medicines to be blistered packed with a supplying pharmacist. This new system will be commencing at the end of May. It was confirmed that staff administering medications have received training and additional training has been arranged for the middle of May. It is recommended as good practice that any handwritten prescriptions are double signed by staff who have received medication training. This is to reduce the risk of errors occurring and assist in safeguarding staff and service users. The Registered Manager confirmed that he will be implementing a list of sample signatures of staff administering medications so it can be tracked who undertook the administration of medicines. Eaton Care DS0000068127.V335765.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures in place ensure complaints are dealt with appropriately, reassuring those involved that they are being listened to and that action will be taken, if necessary. Lack of training for staff in Safeguarding Adults places service users at risk and allegations not being dealt with appropriately. EVIDENCE: There is a complaints procedure available at the home. It is recommended that a timescale be included so people making a complaint know the expectations. The home has not received any complaints to date and no concerns have been expressed directly to the CSCI. A survey received from a visitor/relative demonstrates that they know how to make a complaint. The home has implemented a restraints policy, however it is the ethos of the home to not have to restrain service users, only in circumstances where all other methods to calm the situation have been resourced and where there is an imminent risk to the well being of an individual. There are procedures in place for the Safeguarding of Adults. The Registered Manager undertook Safeguarding Adult training in December 2006. There has been no training provided to staff. A senior carer spoken with, who confirmed they are sometimes in charge when the Registered Manager is not on duty, was not familiar with the processes to follow in the event of an allegation being made. Eaton Care DS0000068127.V335765.R01.S.doc Version 5.2 Page 18 Service users are supported to maintain their own finances wherever possible. Clear records and receipts are maintained for any personal allowance held at the home. Eaton Care DS0000068127.V335765.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are suitable indoor facilities for service users. Service users are restricted in accessing outdoor facilities. Service users live in a clean environment. EVIDENCE: The Inspector did not undertake a thorough inspection of the home on this occasion as the CSCI Registration Team prior to the service being registered undertook a site visit. The environment was assessed as complying with the National Minimum Standards. All rooms are for single occupancy and are located over the ground and first floor. They are all provided with en suite facilities that consist of a hand basin, toilet and showers (wet rooms). There is a passenger shaft lift available to assist service users to access all areas of the home. It was noted at the pre Eaton Care DS0000068127.V335765.R01.S.doc Version 5.2 Page 20 registration site visit that corridors on first and particularly second floor would be difficult for some persons with moulded wheelchairs to access. Service users spoken with were happy with their individual rooms. Some unoccupied rooms were in the last stages of being completed/tidied up and had minimal furniture in them. No beds are currently provided, however the Registered Manager confirmed that prospective service users will be provided with a choice if they prefer to bring in their own beds, providing these are suitable for their needs. Beds will be provided by the home wherever necessary. Staff are currently using one room as a staff room so they are closer to the service users currently residing at the home. A staff room will be provided to staff when a service user needs the room. Rooms being occupied were observed to be personalised to reflect the individual’s choice and character. There is a dining room, lounge room and activities room provided on the lower ground floor. These rooms are currently not being used. The size of these rooms will pose difficulties if all 10 service users wish to use them together, particularly if service users admitted have their own moulded wheelchair. The character of these rooms will improve as more service users are admitted and it becomes a ‘home’. There is one communal bathroom with an assisted bath and disabled toilet. This toilet area was being used as storage for mops, buckets and a laundry skip. Consideration must be given in relation to storage of equipment to ensure service users are able to continue using facilities independently. There are no designated toilets for visitors and no facilities are currently provided for exclusive use by staff. There are a number of communal disabled toilets throughout the home. The Registered Provider and Registered Manager must give consideration into identifying specific facilities for staff and visitors to use. Any minor shortfalls noted were discussed with the Registered Manager on the day of the inspection, who confirmed that these will be addressed. There is a good-sized garden at the rear of the building that is currently inaccessible to the service users. It was confirmed at the pre registration site visit that the outside to the property is being landscaped and the provider discussed a level lawn with raised flowerbeds for service users to be able to tend if desired and a patio area. Access to the rear garden must have ramps fitted. No work had been done to the garden area at the time of the inspection. No timescale for works to be done was able to be provided to the Inspector. It Eaton Care DS0000068127.V335765.R01.S.doc Version 5.2 Page 21 was discussed with the Registered Manager that this be given priority so service users can make use of this facility throughout the summer period. The laundry and kitchen are located on the lower ground floor of the home. The washing machine has a sluice cycle. The Registered Manager confirmed that further work will be done on the laundry area. The home does not currently have any contractual agreements in relation to disposing of clinical wastes. The Registered Manager confirmed that this was currently being arranged. Staff will require training on the appropriate use of this facility as it was noted that inappropriate wastes were being disposed of in clinical waste bags. There were no offensive odours noted on the day of the inspection. Eaton Care DS0000068127.V335765.R01.S.doc Version 5.2 Page 22 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. Service users are safeguarded by the recruitment procedures in place. Service users and staff are placed at risk due to the lack of training. EVIDENCE: The pre-inspection questionnaire demonstrates that there are eight care staff employed, of which three have achieved their National Vocation Qualification (NVQ) 2 or above. The Registered Manager confirmed that three additional staff are enrolling to undertake NVQ level 2 and one enrolling for NVQ level 3. Staff spoken with confirmed that at present there is always sufficient staff on duty. The Registered Manager is currently accessing the Residential Forum information to provide him with some guidelines on staffing levels for when additional service users are admitted. It was discussed during the registration period that it was proposed to have 1:1 staff/service user ratio with two ancillary staff. There is currently two staff on every shift. Staffing numbers will need to be reviewed when additional service users are admitted as staff are also currently undertaking cleaning and cooking duties. Eaton Care DS0000068127.V335765.R01.S.doc Version 5.2 Page 23 Staff files viewed identified that all recruitment checks are undertaken for staff. References are obtained, along with an application form and an enhanced Criminal Record Bureau (CRB) undertaken for all staff, including Protection of Vulnerable Adults (POVA) checks. Staff spoken with confirmed that they have received a job description and contract. Staff were observed to have a good professional rapport with service users. When asked how the staff are one service user commented ‘alright’. It was noted that there was no structured induction or foundation training for new staff, nor the mandatory training including Safeguarding Adults (Adult Protection). When asked, a staff member commented that one change they would make within the home was to improve the training. The Registered Manager confirmed that he has been trying to access mandatory training through the registered providers for a period of time. The importance of specialist training for this type of service was iterated to the Registered Manager and Responsible Individual during the registration process. Staff have not received any formal supervision to date. Staff and the Registered Manager confirmed that this was commencing to be put into place. During registration, the Registered Manager identified that he has no formal experience of supervising or appraising staff, or risk assessments, although he had conducted these at great length at his previous employment. The Registered Manager confirmed that he has/will be undertaking relevant courses to address these shortfalls. Eaton Care DS0000068127.V335765.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 & 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The quality assurance and quality monitoring system being developed will ensure that the home is run in the best interest of service users. The health, safety and welfare of service users and staff are not promoted and protected so far as is reasonably practicable. EVIDENCE: The Registered Manager was registered with the CSCI during the registration process of the new service. He is a Learning Disability Registered Nurse. He confirmed that he will be commencing the Registered Manager Award course at the beginning of May 2007. He has experience of challenging behaviour, multiple complex needs, associated mental health/learning disability, supported living for both sexes and varying ages. Eaton Care DS0000068127.V335765.R01.S.doc Version 5.2 Page 25 Staff have not had sufficient or recent training to enable them to work safely. There was no evidence of the Responsible Individual, designated by the company, monitoring the running of the home or providing guidance and supervision to the Registered Manager. Alongside the training, the importance of the care staff and the Registered Manager receiving regular recorded supervision was discussed during the registration process as being required. Nothing has been arranged at the time of the inspection. Staff spoken with all confirmed that they find the Registered Manager to be supportive, knowledgeable and approachable. They confirmed that they also found external management approachable. The quality assurance process was discussed with the Registered Manager. Due to service being newly registered, limited quality monitoring has been undertaken. He confirmed that head office of the company undertakes quality assurance checks. It was confirmed that feedback is sought from staff, service users and visitors/representatives. The questionnaires will be provided to service users in a suitable format. It was discussed with the Registered Manager that when developing a quality monitoring process, that feedback is sought from visiting health professionals and other stakeholders. It was also recommended that an analysis of these results be made available to service users and other stakeholders. Policies and procedures would have been discussed during the registration period. The Registered Manager confirmed that he is currently reviewing all policies and procedures. The pre-inspection questionnaire identified that some policies and procedures were not applicable and were not in place. Policies for continence promotion and pressure relief are pertinent to a service with this category and should be implemented. All relevant health and safety certificates were provided to the CSCI during the registration process to demonstrate that the new build complies with all relevant building regulations and legislation. Fire alarms are tested weekly. The Registered Manager confirmed that an external company has undertaken a fire risk assessment. The Registered Manager confirmed that he requires health and safety training. Staff spoken with confirmed that fire procedures were discussed with them on commencement of employment. It was confirmed that no fire training has been provided at the time of the inspection. It was noted during the registration site visit that fire exits from the side of the building on the ground floor were found to have steps. No health and safety records were viewed at this inspection due to it being a newly registered service. Eaton Care DS0000068127.V335765.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 2 2 3 3 2 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 1 36 1 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 3 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 2 X 2 2 X 1 X Eaton Care DS0000068127.V335765.R01.S.doc Version 5.2 Page 27 N/A 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 YA6 Regulation 15 Requirement That care plans are implemented to provide clear, accurate and up to date guidance for staff to ensure all assessed needs of the service users are met. That risk assessments are implemented to ensure any unnecessary risks to the health or safety of service users are identified and so far as possible is eliminated. That nutritional assessments are undertaken and records maintained of food intake in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory. That clear guidance is provided on the way a service user receives personal support, ensuring individuals preferences are adhered to. That staff receive training in Safeguarding Adults to ensure that service users are safeguarded and allegations of abuse are dealt with within the current guidelines. DS0000068127.V335765.R01.S.doc Timescale for action 08/06/07 2. YA9 13(4) 08/06/07 3. YA17 16(2)(i) Schedule 4 (13) 25/05/07 4. YA18 12(3) & 15 08/06/07 5. YA23 13(6) 29/06/07 Eaton Care Version 5.2 Page 28 6. 7. YA24 YA35 23(2)(o) 8. YA42 9. YA39 That the garden is made accessible and safe for service users to use. 18(1)(a) & That all staff receive structured (c)(i) induction and foundation training to ensure the aims and objectives of the home are met. 18 (1)(a) That all staff receive mandatory & (c)(i) & training to ensure all peoples 23(4)(d&e) health, safety and welfare are promoted and protected. 26 That Regulation 26 reports are undertaken to monitor the running of the home and provide guidance and supervision to the Registered Manager. 29/06/07 30/05/07 29/06/07 31/05/07 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 YA20 Good Practice Recommendations That any hand written prescriptions are double signed by staff who have received medication training to safeguard service users and staff from errors being made. Eaton Care DS0000068127.V335765.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Eaton Care DS0000068127.V335765.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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