Inspection on 25/01/08 for Elm Cottage

This inspection was carried out on 25th January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elm Cottage 17/07/08

Elm Cottage 30/01/07

Elm Cottage 21/02/06

Elm Cottage 09/09/05

Elm Cottage 30/03/05

Elm Cottage 07/12/04

Elm Cottage 26/02/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 7 Lucerne Road Elmstead Market Colchester Essex CO7 7YB Lead Inspector Gaynor Elvin Unannounced Inspection 25th January 2008 16:00 7 Lucerne Road DS0000017739.V358599.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 7 Lucerne Road DS0000017739.V358599.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. 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 7 Lucerne Road Address Elmstead Market Colchester Essex CO7 7YB 01206 822794 F/P 01206 822794 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) Partnerships in Care Ltd Manager post vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, under the age of 65 years, who require by reason of a learning disability (not to exceed 3 persons) 30th January 2007 Date of last inspection Brief Description of the Service: 7, Lucerne Road is a registered care home providing accommodation for three people under the age of 65 years who have an acquired brain injury. It is one of two homes in the area owned by Partnership in Care. The home runs two programmes of care: one for community rehabilitation and the other being long term supported living assistance for service users requiring maintenance of their rehabilitative state, who may also present with behavioural problems, which can be managed within the home. 7 Lucerne Road is small, detached bungalow situated in a small residential cul de sac in the village of Elmstead Market, approximately five miles from the town of Colchester. The home is within walking distance to local village amenities, which includes a shop, a pub and the local GP surgery. The village is on the main bus route to the town of Colchester and the seaside town of Clacton on Sea. Single accommodation is provided and a communal shower room. The home has a lounge and dining/sitting room for shared activities. Previous inspection reports are available from the home, Partnerships in Care and our website www.csci.org.uk. As at February 2007, the fees for accommodation were stated as ranging from £295 to £322 per day. 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This unannounced inspection took place on 25th January 2008. All of the Key National Minimum Standards (NMS) for Young Adults, and the intended outcomes, were assessed in relation to this service during the inspection. The Annual Quality Assurance Assessment (AQAA), a self-assessment that focuses on how well outcomes are being met for people using the service, was completed by the home and returned to us prior to the visit to the home. Information received in the self-assessment provided us with some detail to assist us in understanding how the registered persons understand the service’s strengths and weaknesses and where they will address these. The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at relating to the residents, staff recruitment and training, staff rosters and policies and procedures. Time was spent talking to the staff and residents. The residents accommodated at Lucerne Rd have sustained an Acquired Brain Injury (ABI) and have varying degrees of permanent cognitive disability following the early stages of recovery. This includes changes in concentration, awareness, perception and insight and, in some cases, long term and/or shortterm memory loss. Discussion was limited with some residents regarding care delivery. This report has been written using accumulated evidence gathered prior to and during the inspection. The home has been without a registered manager since October 2005. What the service does well: This service provides a safe, comfortable and homely environment in support of the people who live there and the readjustment and reconstruction of their new lifestyle. The residents have a good, trusting relationship with the care staff. The staff are positive in their approach to their work and work well as a team. They respect the needs of the residents and provide care that is good although mainly of an intuitive nature. 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 7 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 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 8 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): 2 Quality in this outcome area is poor. People wanting to use the service cannot be assured that all their needs and aspirations are fully considered and planned for prior to their admission and therefore cannot be confident that their needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One new resident had been admitted to the home since the last inspection. The resident was admitted from a hospital setting following the initial recovery phase. Their care file was reviewed. A completed assessment was not evident that identified their needs, strengths and abilities and the social side of care including aspirations at the time of their admission to the home. Information gained from a full assessment would enable the staff team to identify and plan for the residents changing needs necessitating the move to a more independent lifestyle within the residential care setting. We noted that the care plan in use was from the previous establishment and a new care plan had not been generated to guide staff in providing the most appropriate and agreed care and support that met the individuals assessed needs. 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 9 Information provided in the Annual Quality Assurance Assessment (AQAA) indicated that the homes admission policy assures the opportunity for prospective residents to make a number of visits to the home in progressive duration to ensure a detailed introduction, compatibility with other residents and the opportunity to meet the staff and see the facilities available. The resident confirmed that they had visited the home prior to their admission. 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 10 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 and 9 Quality in this outcome area is poor. People using the service cannot be assured that choice is promoted or that the care and support received is planned; tailored and recorded according to assessed and changing needs, with goals to aspire to. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Whilst we were at the home, we observed and heard staff interacting well with residents. From observation and discussion with residents it was clear that they had a good and trusting relationship with the care staff. The care staff generally understood the individuals’ needs and provided a level of care that the residents appreciated. We looked at all the resident’s care plans. One of which was from a previous establishment and no longer relevant to their current needs, abilities or required support within a residential care setting. For example it contained 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 11 references to nursing intervention, injectable medication intervention, weekly food diary and an intense one to one rehabilitation programme. From discussion with the resident it was evident that ability and motivation had greatly improved throughout the recovery process and the care plan relating to the residents functional and cognitive abilities was out of date. We observed the resident to prepare their evening meal and they spoke about their preference for a healthy eating plan and how they planned and shopped on a set budget provided by the service. Risk assessments, dated September 2006 were also from the previous establishment and had not been reviewed or updated to reflect the decision making process in aspects of responsible risk taking. The resident wished to ride a bike. However staff said that they needed more direction and guidance in supporting the residents particularly in capacity issues and areas where needs have changed. The care plans for the other residents provided information about their abilities and needs and how staff should support these. There remained scope for developing the person centred approach to care planning with a greater focus on identifying more preferences, maintaining and developing strengths and detail on promoting choice and self worth. This would help the team evidence further that they appreciate the diversity of the residents in their care. Residents future aspirations or goals were not identified in the care plans and more work needs to be completed on the social aspect of the care plans to ensure that residents’ needs are being met. Reviews were carried out with the multidisciplinary team in accordance with the Care Programme Approach to determine effectiveness of the rehabilitative/care programme. However care plans were not revised or in some cases generated to reflect any new information, changes or monitoring required because of the review. Date entries on care plans and risk assessments indicated that they had been reviewed but did not demonstrate if care-planning arrangements or risk management strategies were evaluated to see if they were still valid and beneficial for the individual or if their needs had changed. A representative of the company also highlighted this issue during the monthly monitoring visit in November 2007. We noted one need’s assessment had not been reassessed since admission in July 2003. The home’s system for meal provision did not promote choice or create normal experiences within a residential care setting for those people with higher dependency needs. (See outcome area lifestyle). A representative of the company, on behalf of the responsible person, also highlighted this issue in the homes monthly monitoring visit undertaken in November 2007. A report of the findings is made and a copy of which is sent to the Commission. 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 12 The home had no written policy and procedure for the management of residents’ finances and care-planning records did not identify the arrangements in place for those residents able to manage their own finances with support. We were informed that residents’ finances and associated records were held and managed at another establishment (Elm Park). Small amounts for personal expenditure were released on request and collected by a member of staff. One resident said that their monies were collected and held by Elm Park and a weekly sum was sent down each week, if any additional money was required they had to go through the procedure of request and authorisation. The system at Lucerne Road for the safekeeping and management of this money was secure, records identified transactions with corresponding receipts and a running balance was confirmed by signature. The balance was checked and correct. 7 Lucerne Road DS0000017739.V358599.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, 14, 15, 16 and 17. Quality in this outcome area is adequate. People using the service cannot be assured that their rights and choices are promoted or that they will always be provided with the opportunity to engage in activities that meet their social needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Cognitive problems restrict prospects for individuals with ABI of returning to previous employment, training or lifestyle. The people currently using the service were either being supported in maintaining their rehabilitative state following their recovery or supported on a rehabilitation programme within the care setting, looking towards a more independent outcome. 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 14 The staff spoke of the importance of daily routines and their role supporting the residents through their planned individualised daily programmes of simple activities in and outside of the home, to maintain and improve functional performances in every day living skills. Residents confirmed that they participated in community based activities and maintaining a daily living programme within the home. Staff viewed community access and inclusion essential for resident’s quality of life but felt that opportunities were becoming more limited due to low staffing numbers stating that on occasions there have been one member of staff supporting three residents, residents spoken with confirmed this. The service has its own car that is shared with the sister home, however this is not big enough to enable the three residents to go out as a group and staff had suggested the consideration of a people carrier. Staff advised us that family links were strongly encouraged, and where they were able, adopted a partnership approach with family members. This helped to increase chances of successful rehabilitation. Important dates were recorded in individual care plans for the staff to support the residents in maintaining links with family and friends on birthdays and anniversaries. Those supported on a programme towards a more independent outcome were provided with the opportunity to plan and prepare their own meals, which is good practice. However, since the last inspection the organisation has changed the system for the homes meal provision for those resident’s with higher dependency needs. The new system does not promote choice or enable those people to maintain the maximum possible level of independence and control in their lives. A 7-week rolling daily menu was planned at another establishment (Elm Park). A member of staff collected the food such as the meat, tinned produce, bread and other ingredients, to produce the planned weekly menu, from this establishment each week. A small budget was supplied for staff to purchase the perishable foodstuffs such as the vegetables, fruit and milk. Although not all residents have the ability to cook this practice does not create normal life experiences with regard to choice and participating in daily activities related to menu planning and shopping or having ‘take-out’ meals when they choose. The information provided in the AQAA completed in October 2007, some four months prior to the visit to the home, indicated that the manager was looking to address the current menu arrangements with the organisation. 7 Lucerne Road DS0000017739.V358599.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 and 20 Quality in this outcome area is adequate. People who use the service can be sure that their healthcare needs are met. Medication practices were not sufficiently robust to fully protect people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Records showed a proactive approach with regard to GP and specialist services being contacted in a proactive manner as and when necessary and that residents saw health professionals on a regular basis to monitor and promote well-being such as the dentist, optician and cervical screening. Although it was brought to our attention by residents and staff that there has been times when appointments have had to be rescheduled due to low staffing levels. Mental capacity assessments were evident for treatment. Care plans reflected individual medication prescribed and included information relating to the side effects and adverse reactions of medicines being taken by the individual, which is good practice. 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 16 One resident self medicated although this was seen to be dietary supplements such as vitamins and not prescribed medication. The medication system was reviewed and we found that the home continues to receive prescribed medication dispensed in bottles or the Dossett system, a system normally used for people who self-medicate. The system provides medicines for seven days. Previous inspections identified that this system poses potential hazard in that all tablets for a particular time are placed together within the same compartment, making it difficult for the care staff to identify individual tablets administered, refused or even dropped. We reviewed the Medication Administration Records (MARs) and noted that the prescription details of required medication was hand written a potential cause for error. The date and signature indicating the receipt of the correct medication was blank. The medication system needs review to reduce potential risk of error within a care setting and ensure the protection of the person receiving the medicines. 7 Lucerne Road DS0000017739.V358599.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): Quality in this outcome area is adequate. The home’s adult protection policy and procedure and current practice is not robust enough to safeguard the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff spoken with were aware of the procedure to take in the event of a complaint being made. Residents spoken with felt confident in raising any concerns and that they would be listened to. The Commission had not received any complaints with regards to this service during the last twelve months. The home has a policy and procedure for safeguarding people who use the service. Although the policy is detailed in the prevention of abuse through good practice and how to recognise abuse it does not follow Department of Health guidance in that it does not ensure that all issues relating to safeguarding adults are automatically referred to the Local Authority. The policy is not specific to the home and does not include local authority procedures with regard to the appropriate steps to take in making a referral or raising a suspicion, the alert forms in use and appropriate department and telephone number. This does not ensure staff have guidance on what to do and therefore may be misguided in relation to the steps to take in the event of a suspicion or allegation to safeguard the people who use this service. Staff had received training in safeguarding issues. 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27 and 30 Quality in this outcome area is adequate. People using the service benefit from an environment that is clean and homely but is not sufficiently maintained to promote their safety and wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The premises were inspected. The home was clean and comfortable with no unpleasant odours. Despite the on going environmental problems due to the size and layout of the building, in general, the home is domestic in scale and provides a homely environment. Due to the layout and small passageways of the bungalow, the home is not suitable for wheelchair users. One resident requires the use of a walking frame; the resident and staff indicated this proved difficult to manoeuvre at times. 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 19 Since the last inspection the service had addressed a requirement to improve the laundry facilities, which now meet National Minimum Requirements and reduces the risk of infection. This in turn has provided the staff with suitable office facilities. The laundry facilities were previously in the office. Residents spoken with were pleased with their rooms and had a lot of their own possessions with them. The home has a lounge and dining/sitting room for shared activities. The home does not have a bathroom and the three residents use a wet room with a shower. Consideration has still not been given to installing a bath so that a choice is available. Staff and residents pointed out that the wet room continually floods, as the floor is not sufficiently slanted to allow water to run into the waste outlet. This poses a slip hazard to residents. A maintenance person is employed by the organisation to maintain Lucerne Rd and other establishments run by the organisation. Information provided in the AQAA indicated that the home experienced difficulties in accessing the services of the maintenance person over the last twelve months, which has resulted in a decrease in routine maintenance checks and repairs. Staff confirmed that this was still the case and the maintenance log showed jobs that were still outstanding such as the shower, toilet cistern, side gate, a weather board for the front door since November 2007 to stop the rain and drafts coming and a new blind for a residents bedroom requested in October 2007. Maintenance to the home, carried out in a timely manner, will help to ensure the safety and well being of the people living there. We observed waste bins to be full and a large collection of domestic waste bags outside the kitchen. Staff indicated that collection contracts for domestic, clinical and feminine waste were not regular enough. The domestic waste was classed as business waste and had not been collected since before Christmas. The clinical waste bins were full due to the high useage of continence pads and were last emptied three weeks ago. The review of waste collection contracts would help ensure that hygiene in the home is maintained and potential health risks are reduced. 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 20 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): 31,32,33,34,35 and 36 Quality in this outcome area is poor. Staff recruitment practices and staffing numbers, support and supervision are not sufficient to safeguard those living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the staff rota to ascertain identification and numbers of staff employed at the home. Data provided in relation to this area in the AQAA was not clear. The manager was not identified on the rota and there was no indication of which member of staff was in charge of the day-to-day management in her absence. A senior member of the care staff undertook some management duties however this impinged on the calculated staffing numbers of a very small team and reduced her time supporting the residents. There were gaps in the rota and no indication of who covered and worked those shifts. Without this information we were unable to assess that the home was adequately staffed or managed. We noted during the visits to this home and the sister home that staff were taken away from caring duties to collect supplies and petty cash from another establishment, which we were informed was twenty minutes away. Staff said 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 21 that this arrangement often took them away from the home, which reduced the staffing numbers in one home or the other. Staff recruitment files are not held in the home and these were viewed at the sister home. We were unable to locate a recruitment file in the office for one care staff member identified on the staff rota and on duty at Lucerne Road. The member of staff informed us that she commenced employment in November 2007. A later telephone conversation with the designated responsible person for the company advised us that this documentation could possibly be with the Human Resource person for the company. Without these recruitment records we are unable to determine that the home continues to provide a satisfactory recruitment procedure to ensure the residents are safeguarded by the employment of suitable staff for the job. The staff member told us that she had attended a short course training in subject areas: The brain and how it works; Eating and swallowing, Health and safety, Breakaway - techniques in avoidance of potential risks to safety and Safeguarding vulnerable adults following the commencement of her employment. However she was unaware of the Common Induction Standards (CIS) and had not undertaken a formal induction linked to CIS and completed through planned working and assessment. This staff member also confirmed that she had not received any formal supervision. We looked at the recruitment and training files for two other staff members. Each contained documentation relating to an application form identifying previous employment, two references, health declaration and a job description. We noted that the files did not contain the original Criminal Record Bureau (CRB) certificates. Although there was a statement as to the date of receipt of the CRB check and the associated reference number there was no indication that the check was found to be satisfactory. The absence of these certificates was raised at the last inspection. Arrangements should be in place to ensure Criminal Record Bureau (CRB) disclosure certificates are made available for inspection purposes to confirm that the necessary recruitment procedures have been taken to protect residents. Information provided in the AQAA indicated that all staff undergo a thorough induction and are offered a full range of specialised training on an ongoing basis, which is overseen by the (organisations) Human Resources Manager. This was not evidenced in the sample of staff files reviewed One training file for a staff member who commenced employment in 2002 showed that she had achieved a National Vocational Qualification level 2 in 2004 and attended a short course training in Adult protection in April 2004, Health and Safety in August 2005 and Infection Control in February 2007. Records showed that formal and recorded supervision was received in August 2005 and July 2006. 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 22 The other training file showed that the staff member had attended a short course training in Health and safety in May 2006, Safe medication administration in Feb 2006, First aid appointed person in August 2006, Food Safety in October 2006, Adult protection in February 2007 and Infection control in 2007 and received one formal and recorded supervision in June 2006. There was no recorded evidence of the staff member undertaking and completing an Induction and Foundation assessment course linked to the Common Induction Standards or having received any training pertinent to the residents specialist needs relating to Acquired Brain Injury. Staff said that staff meetings were rare and there were no recorded minutes available to examine. Formal supervision within an acceptable frequency, supported by regular staff meetings, ensures staff development needs are being met and that opportunities to discuss current issues and working practice are provided. A requirement in relation to this issue was not met in the given timescale of June 2006 and repeated again for May 2007. The information provided in the AQAA of October 2007 stated that the service could do better by improving documented supervision sessions and that plans for improvement in the following twelve months from the AQAA being completed included ‘to set up a structured supervision system’. It is disappointing to find that this requirement remained outstanding at the time of the visit to the home. 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41,42 and 43 Quality in this outcome area is poor. The home is not effectively and efficiently managed. A lack of commitment to continuous improvement in quality services and support does not assure the safety and quality of life of people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for nearly one year and has not applied or completed the registration process with The Commission for Social Care Inspection and since the last inspection has not completed any relevant training for managers. The manager is a trained speech and language therapist, a clinical practitioner, and has no previous experience of residential care homes or managing one. She is currently responsible for running this service and another small registered care home provided by the same organisation. It came too light during this inspection that the manager also 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 24 continues to hold a post at a private hospital, also run by the same organisation as a speech and language therapist for one day each week. The role of a registered manager is a demanding role and it would be usual to expect full time hours to be covered. In the case of a manager being responsible for two establishments operated by the same provider, an exception is considered where the two homes are in close proximity and caters well for small numbers of people whose needs are very similar. In this case, due to the additional role undertaken by the manager outside of the day to day management duties of the registered establishments, this management arrangement is not considered to be effective due to the further reduction in time spent at each care home. The manager was not on duty at either home when we visited and staff said that they rarely saw the manager during a week. We noted that the manager was not identified on the rota and staff were unaware of her whereabouts on a daily basis. Staff had raised concerns about the difficulties faced in contacting the manager when not on either site with a representative of the company during the monthly monitoring visit undertaken in July 2007. This inspection has highlighted that improvements identified at the previous inspection have not been sustained and requirements relating to essential elements of day-to-day management such as staff supervision and support and quality monitoring and assurance remain outstanding. The AQAA indicated that the service is run as ‘a department of Elm Park’ (the organisations independent hospital). Organisational management arrangements such as menu planning and food provision, budget allocation and policies and procedures (documented in detail in other areas of this report) detract from, the home’s stated purpose and National Minimum Standards and this has a negative impact on a personalised service and outcomes for residents. The manager does not refer to quality assurance and monitoring systems in the AQAA and we found that steps had not been taken to address this area despite it being a repeat requirement from previous inspections. Robust quality assurance and monitoring systems would identify strengths and weaknesses in the service and enable the staff team to make improvements to standards and services where needed and ensure it is run in the best interest of the people who live there. Certification relating to maintenance, service and safety inspection with regard to electrical installation, gas safety and fire safety equipment were in date. Fire safety logs indicated that fire safety equipment such as alarms and lighting were checked weekly. The last fire drill in the home was undertaken in April 2007, to ensure residents and staff are reminded of procedures these need to be carried out more frequently. 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 25 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 1 3 X 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 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 3 32 2 33 2 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 2 1 2 2 2 2 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 YA6 Regulation 14 Requirement Needs must be fully assessed and reviewed for potential and current residents. Known and identified care and support needs may have been subject to change and you need to be aware of all individual circumstances to provide an appropriate service. Residents must have a written plan of care and support to ensure care staff are informed as to how their needs in respect of their health and welfare are to be met. Residents’ care plans must be kept under review and updated accordingly to ensure that care staff are clear about the latest decisions that effect the person and what they need to do to deliver consistent, appropriate and safe care. The homes systems and practices must be reviewed to ensure those residents’ rights and individual choice is promoted. By actively supporting people to make choices prevents DS0000017739.V358599.R01.S.doc Timescale for action 01/04/08 2. YA6 15 01/04/08 3. YA7 YA16 YA17 12 01/04/08 7 Lucerne Road Version 5.2 Page 27 institutional practice. 4. YA20 13 (2) The system used for the administration of medication must be assessed for the risk it presents to service users and action taken to minimise any identified risk. Robust policies and procedures for safeguarding adults must be in place that are relevant to the home and include Local policy and guidelines to ensure staff are well informed so that the correct procedure is followed in the event of a suspicion or allegation of abuse and the risk to residents is reduced. Attention must be given to the wet room to provide adequate drainage of excess water to reduce the potential slip hazard and help to ensure the safety and well being of the people using these facilities. The premises must be suitable to meet the needs of the residents and the homes stated purpose and provide the option of a bath. Fourth repeat requirement not met within timescale. Training must be provided to staff to help them have greater skills and knowledge specific to the specialist needs of people living in the home. This will enable them to provide an improved quality of care and meet residents’ needs more effectively. Staffing levels must demonstrate that they are sufficient to ensure the residents’ needs are fully met, especially in relation to social needs. All required recruitment documentation must be available for inspection to confirm that the necessary recruitment DS0000017739.V358599.R01.S.doc 01/04/08 5. YA23 13(6) 01/04/08 6. YA24 13(4) 01/04/08 7. YA27 23 01/04/08 8. YA32 18 01/04/08 9. YA33 18 01/04/08 10. YA34 19 Schedule 2 01/04/08 7 Lucerne Road Version 5.2 Page 28 11. YA35 18(2) 12. YA36 18 (2) 13. YA39 24 procedures have been taken to protect service users. New staff employed to work at the home must receive an induction that meets the Common Induction Standards through planned working and have their understanding assessed and ensure that for the duration of the induction training a member of staff who is appropriately qualified and experienced is appointed to supervise the new worker. This process of induction for care staff new to the home and/or inexperienced provides essential training and support to ensure safe and consistent practice that is appropriate and enables managers to assess their competence, understanding and ability to fulfil their role and residents are not subject to potential harm and/or neglect. Regular recorded supervision must be provided to all staff, to guide the way staff work, to reflect on their work practices and assess their learning and development needs. Appropriately supported care staff develop their practice effectively and will provide an improved quality of care and meet residents needs more effectively. This requirement was not met within given timescales of 01.06.06 and 01.05.07. Robust quality assurance and monitoring systems must be developed to identify strengths and weaknesses in the service and make improvements to standards and services where needed and ensure it is run in the best interest of the people DS0000017739.V358599.R01.S.doc 01/04/08 01/04/08 01/06/08 7 Lucerne Road Version 5.2 Page 29 who live there. This is a fourth repeat requirement not met within previous timescales of 30/1/07, 31/01/06, 31/03/05 & 1/09/05. 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 YA6 Good Practice Recommendations There remains scope for developing a more person centred approach to care planning, with greater focus on identifying more preferences, maintaining strengths and abilities and detail on promoting independence and self worth. A review of the refuse and clinical waste collection would help prevent the spread of infection and the reduction of waste accumulation and smell would provide a better impression of the home within a residential area. The home would benefit from the implementation of a training and development plan for staff individually and for the team as a whole, to ensure appropriate training is planned for and accessed throughout the year. Staff would benefit from policies and procedures that are specific to the home and their work, giving the opportunity for them to be involved in their development and ensuring they understand and apply them in practice. 2. YA30 3. YA35 4. YA40 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 7 Lucerne Road DS0000017739.V358599.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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