Inspection on 25/01/08 for Elm House

This inspection was carried out on 25th January 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elm House 10/07/08

Elm House 23/01/07

Elm House 14/02/06

Elm House 08/06/05

Elm House 20/01/05

Elm House 21/06/04

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 18-65 192 Wivenhoe Road Alresford Colchester Essex CO7 8AH Lead Inspector Gaynor Elvin Unannounced Inspection 25th January 2008 10:15 192 Wivenhoe Road DS0000017727.V358605.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 192 Wivenhoe Road DS0000017727.V358605.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. 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 192 Wivenhoe Road Address Alresford Colchester Essex CO7 8AH 01206 824443 01206 824443 jrassell@partnershipsincare.co.uk 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), Learning disability over registration, with number 65 years of age (1) of places 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home may accommodate 3 persons of either sex who fall within the category of learning disability The home may accommodate one named person, aged 65 years and over, falling within the category of learning disability The total number of service users accommodated in the home must not exceed 3 persons The home may provide assistance to one additional person during the day in order they may use the rehabilitation kitchen. The staff member assisting this person must be additional to staff provided in the home. 23rd January 2007 Date of last inspection Brief Description of the Service: 192, Wivenhoe Road is a registered care home providing accommodation for three people under the age of 65 years who have an acquired brain injury. This is one of two homes in the area owned by Partnerships in Care. An acting manager is currently managing both homes following the resignation of the registered manager in October 2005. 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 have behavioural problems, which can be managed within the home. 192 Wivenhoe Road is a detached house situated on the outskirts of the village of Alresford, approximately five miles from the town of Colchester. The home is within walking distance to the village amenities, which include a shop, pub and train station. Single room accommodation is provided, two of which have en suite facilities, one with a bath the other with a shower. The communal bathroom has a shower. The home has a comfortable, safe and fully accessible dining room, lounge and sitting room for shared activities or private use and a large back garden. Car parking for visitors is available at the front of the house. 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. 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 5 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 6 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 and 7th February 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 the manager during the second visit. The residents accommodated at Wivenhoe 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 with the residents regarding care delivery was not appropriate. 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. 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 7 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. 192 Wivenhoe Road DS0000017727.V358605.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 192 Wivenhoe Road DS0000017727.V358605.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): 2 and 4 Quality in this outcome area is adequate. People wanting to use the service can be confident that their needs are assessed prior to admission to ensure the care home can meet their needs, but cannot be assured that changing needs are fully considered when re entering the home after a period of time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Wivenhoe Road does not accept unplanned or emergency admissions. Records showed that residents were admitted on the basis of a full pre admission assessment undertaken by the acting manager, in addition to information received from the independent multidisciplinary team and assessments from various specialists such as the Consultant Neuro-psychiatrist. This ensured that the staff team are fully aware of the assessed needs of the individual and that they were able to meet them. However evidence demonstrated that a full assessment of needs was not undertaken when a resident was re entering the home after a period of time to ensure the home still had the capacity to meet the individuals changing needs. 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 10 The completed Annual Quality Assurance Assessment (AQAA) confirmed that the homes admission policy assures the opportunity for prospective residents to make a number of visits to the home in progressive duration. This ensures a detailed introduction, compatibility with other residents and the opportunity to meet the staff and see the facilities available. At the time of the inspection there were no residents in the home that were using advocacy services. Information in the AQAA states that this service was discontinued in September 2007. The service user guide had not been updated and continued to state that an advocate from MIND visits the service monthly. 192 Wivenhoe Road DS0000017727.V358605.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): 6,7,8 and 9 Quality in this outcome area is adequate. People using the service can be assured that staff have a good knowledge of their daily care however they had no recorded long term goals to aspire to and their choice is not promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During this inspection, the residents looked well cared for and from observation of their body language and behaviour, it was clear they had a good and trusting relationship with the care staff. Each resident had a plan of care that provided information about their abilities and needs and how staff should support these. The care plans of the two residents accommodated were inspected and these contained a description of the residents needs in respect of daily living in sufficient detail to enable staff to understand how to support the individual in areas such as personal care, communication, behaviours associated to their acquired brain injury (ABI), medication and community access. 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 12 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. We also noted that the homes practice and new system of meal provision did not promote peoples choice (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. Residents future aspirations or goals were not identified in the care plans and we noted that more work needs to be completed on the social aspect of the care plans to ensure that residents’ needs are being met. This could relate to the, sometimes, limited information on assessment. The care plans were not drawn up with the individual and each plan stated that the individual did not have the mental capacity to participate in the process. Records should show how this decision has been reached and by who in accordance to the Mental Capacity Act Code of Practice. The home must familiarise itself and refer to the Mental Capacity Act 2006. We noted that one person did not have an allocated social worker or advocacy provision. Records did not show that advice regarding the input of an Independent Mental Capacity Advocate was sought through Social Services or Mental Health in the recent event of a medical decision taken to not provide active surgical treatment. Risk assessments were evident and identified potential risks that individual’s with an ABI face on a daily basis due to impaired memory, impaired cognitive functioning and challenging behaviour. Whilst this aspect of risk assessments were in keeping with good practice, the team need to work on linking more detailed risk management strategies into the care planning process, so that any action required to reduce or monitor the risk is clear and consistent for staff, and subsequently evaluated, as well as guide staff clearly of what to do in a crisis situation. We were informed by staff of one incident occurring in the community that unnerved staff resulting in the resident not going out as much as they ought to. Date entries on care plans and risk assessments indicated that they had been reviewed regularly 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. 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 13 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 as a consequence of the review. 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 to support residents in their financial matters. 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. The system at Wivenhoe 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. 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. People using the service cannot be assured that they will always be provided with the opportunity to engage in activities that meet their social needs or that their rights and choice are promoted. 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 being supported in maintaining their rehabilitative state following their recovery. 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. The daily programme for one person 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 15 with high and complex needs and a very limited attention span incorporated looking at books, listening to music, one to one chats and walking in the garden within their activity plan. We noted that the home had limited activity resources such as books to enable staff to engage effectively with residents. One member of staff said that she had brought in her own books to use. Staff spoken with viewed community access and inclusion essential to the rehabilitative process. However due to the varying levels of challenging and inappropriate behaviour displayed during one incident in the Community they did not feel confident to support some residents on a one to one basis and this was not considered in the current staffing levels. It was also said that staffing levels particularly reduced opportunities for going out in the car. During the second visit to the home we found that the main lounge was being used as a temporary bedroom for a resident whilst being nursed on strict bed rest for a minimum of six to eight weeks. This was not suitable as it imposed restrictions on movement in the home and daily routine for the other resident, of which they did not understand and were unable to participate in the decision making process, and therefore this impacted on their behaviour and usual lifestyle. 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. The organisation had changed the system for the homes meal provision that did not enable the people who live there to maintain the maximum possible level of independence, choice and control in their lives. A 7-week rolling 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. Those currently resident do not have the ability to cook however this practice does not provide the opportunity for residents to exercise choice, participate in daily activities related to menu planning, shopping or having ‘take-out’ meals. We also noted during the second visit to the home that this practice did not enable staff to meet the nutritional needs of a resident discharged from hospital. The set food supplies and budget limited ad-hoc alternatives. This did not allow for additional foods to encourage appetite, supplement a lack of appetite and meet the individuals’ nutritional needs. 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 16 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. 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 17 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 using the service cannot be sure that their changing needs will be assessed and reviewed to ensure that the service can still meet them in an effective way. 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. The team need to ensure care plans are revised or generated to include this information including any changes or monitoring in the care to be provided, to ensure continuity. We noted during the second visit that a resident had returned to the home following discharge from the general hospital and was being cared for in a bed 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 18 set up in the home’s main communal lounge. The resident was not given active treatment in hospital for a broken hip and conservative treatment was prescribed that required strict bed rest for 6-8 weeks. A full assessment of changing needs had not been undertaken by the management of the home to fully consider whether the home was still able to meet the changing needs of this person. A revised care plan was brief and did not provide clear instruction for staff in how to support the persons changing needs such as pain relief, monitoring and associated behaviour; nutritional needs; constipation due to immobility and codeine derived pain relief medication; lifting and moving; non compliance with medication; prevention, identification and monitoring of pressure areas; and personal care and hygiene while nursed in bed. During the visit we observed the situation to be unmanageable in that it affected the behaviour of each of the residents due to their high and complex cognitive and behavioural needs and care arrangements did not promote dignity, safety or well being of the resident. The home did not have the capacity to manage the individuals changing needs in that the facilities of the home were no longer suitable. The residents’ bedroom and washing facilities were on the first floor. The homes staffing arrangements were not adequate and although this was being addressed by the use of agency staff it was known that this persons behaviour escalated with unfamiliar faces due to impaired cognitive ability. Staff also indicated that agency staff working shift times was shorter and they had already experienced time spans of reduced staffing numbers. The home did not have appropriate lifting equipment; medical and community nursing support was minimal and the situation impacted on the outcomes for the other resident. Care plans reflected individual medication prescribed and included information relating to the side effects and adverse reactions of medicines being taken by each resident, which is good practice. Medication continues to be dispensed from the GP surgery into Dossett boxes, a system normally used for self- administration. The system provides medicines for seven days. Since the last inspection an improved version had been introduced for some residents that provided clearer information for the staff to identify each tablet, thus reducing potential risks by enabling care staff to identify what medication is being administered or refused. It was brought to our attention by staff that in some instances medication is crushed or disguised for administration and that the initial main prescriber has approved this practice. Records must show any deviant from the British Pharmaceutical Guidance in the administration of medication is approved, including rationale for the decision with appropriate risk assessments; and is only taking place within the context of existing legal and best practice frameworks. This will ensure the protection of the person receiving the medicines and the care worker involved in giving the medicines. The homes policies and procedures should reflect this. 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. 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. They indicated that the current service users were not able to make a written complaint but any verbal concerns or complaints would be listened to, taken seriously and acted upon appropriately. The Commission had not received any complaints with regards to this service during the last twelve months. The staff were not aware of any complaints received since the last inspection. The complaints log book was not available and therefore it was not possible to assess whether a system had been established for logging and recording complaints or concerns received verbally, the action taken and outcome, including action for future practice and review as required from the last inspection. There is 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 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 20 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. The Commission was informed of a recent allegation through a notification. We noted that there had been a time lapse from the date of the allegation and the date of the notification; also the notification did not detail an outcome. We therefore followed up the notification and it was brought to our attention that the local authority safeguarding team had not been alerted and was only done so following our advice. The manager told us that she had followed instruction from her line manager that the local authority should only be alerted in the case of actual injury. The outcome of the allegation resulted in the dismissal of a member of staff. 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Wivenhoe Road provides people with a clean, comfortable and homely place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The premises were inspected. The home continues to provide the residents with a clean and homely environment that is suitable to their needs. A maintenance person is employed by the organisation to maintain Wivenhoe Rd and other establishments run by the organisation. Information provided in the AQAA indicated that the home had 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. 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 22 On the day of the first visit to the home there was an accumulation of rubbish bags outside the front door and we were informed that amongst these were clinical waste. Staff did not have access to the waste and clinical waste bins as they were stored in the garage and the door was broken again and had not been repaired satisfactorily despite requests. A representative of the company, on behalf of the responsible person, reported in the homes monthly monitoring visit undertaken in July 2007 that the garage door was problematic and that maintenance advice would be sought to remedy the situation. We requested immediate attention to this issue and the maintenance person arrived within the hour, repaired the door and the waste was removed. Staff advised us that they were experiencing difficulty in getting a shower sorted out that had low water pressure and no hot water. The other shower was also not working efficiently and staff had taken steps by trying to descale the showerhead. Maintenance to the home, carried out in a timely manner, will help to ensure the safety and well being of the people living there. 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 23 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 first visit that care staff were liaising with staff from the sister residential home by phone to arrange collection of supplies and petty cash from another establishment, which we were informed was twenty minutes 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 24 away. Staff said that this arrangement often took them away from the home, which reduced the staffing numbers in one home or the other. We were informed by staff, and later confirmed by the manager, that new longer shift patterns were being introduced to ensure adequate weekend cover. Long shift patterns could impact on quality of care particularly in instances of lone working, managing challenging behaviours over a long period and a lack of support. Initially staff recruitment records were not accessible when these were requested as they were locked away in the office the key was not at the home. Following a phone call made by a member of staff to the independent hospital, the key to the office was delivered to enable us to view staff recruitment records. We were unable to locate a recruitment file in the office for the newest member of staff, identified on the staff rota, who had commenced employment at the home in the beginning of January 2008. 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. We looked at a sample of five care staff files. Each contained documentation relating to an application form identifying previous employment, two references, health declaration and a job description. We noted that in all the files examined the original Criminal Record Bureau (CRB) certificates were not available for our inspection, 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 available for inspection to confirm that the necessary recruitment procedures have been taken to protect service users. 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. We did not find evidence of this for all staff. Records for one member of staff, who commenced employment in June 2006, did not show that a full induction incorporating the Common Induction Standards was undertaken and completed through planned working and assessment and this was confirmed by the staff member. Training attendance certificates were evident for first aid and food safety undertaken in 2006 and ‘Working with Families’ in August 2007 and moving and handling in August 2007. The five files inspected showed gaps in training and update in core areas including safeguarding adults, medication, health and safety, managing 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 25 challenging behaviour, infection control and areas specific to the residents needs. Staffing records contained few supervision records. One had recorded supervisions dated June 2005 and July 2007, another dated January 2005, March 2005 and June 2006 and the other did not contain any recorded supervisions since commencement of employment in June 2006. Staff said that staff meetings were limited 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. 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 27 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 on each of the visits we took to the home. On the second visit she came to see us after being informed that we were there. We noted that the manager was not identified on the rota and the staff informed us that they were informed verbally of the manager’s whereabouts usually the day before. 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. Staff spoken with told us that they found the large folder of policies and procedures ‘hard going’, in that they were generic to all Brain Injury Services and not specific to the home and they were not easy to find or read. Policies and procedures are necessary to guide staff in their working practice specific to the home and the needs of the people who live there. The organisations health and safety management generally undertook monthly health and safety audits at the home. There were no records of any audits undertaken between August 2007 and December 2007. One was undertaken in January 2008. A fire safety service inspection for fire extinguishers, the firm alarm system and emergency lighting was undertaken in December 2007. The record log for routine fire safety equipment checks showed us that generally this was 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 28 undertaken weekly, however there were no recorded entries for December 2007 and only one for January 2008. Staff told us that fire drills were not carried out regularly as mostly there was only one member of staff on duty. 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. 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 29 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 2 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 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 2 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 2 2 2 3 X LIFESTYLES Standard No Score 11 X 12 X 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 2 1 2 X 3 2 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 YA6 Regulation 15 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. 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 institutional practice. Timescale for action 01/04/08 2. YA7 YA16 YA17 12 01/04/08 3. YA14 16(2)(m)(n) People living in the home must be provided with the opportunities and support to live a lifestyle within the home that meets their expectations, preferences, needs and aspirations in an individual way to promote well being. The home must consider how it can best provide meaningful occupation and stimulation for DS0000017727.V358605.R01.S.doc 01/04/08 192 Wivenhoe Road Version 5.2 Page 31 the residents. 4. YA20 13 (2) The system and method used for the administration of medication must be assessed for the risk it presents to residents and action taken to minimise any identified risk. This must be recorded in individual plans of care 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. 01/04/08 5. YA23 13(6) 01/04/08 4. YA34 19 Schedule All required recruitment 2 documentation must be available for inspection to confirm that the necessary recruitment procedures have been taken to protect service users. 18 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. The introduction of long shifts 01/04/08 5. YA32 01/04/08 6. YA33 18 01/04/08 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 32 must not impact negatively on the standard of care provided to residents. 6. YA35 18(2) 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 DS0000017727.V358605.R01.S.doc 01/04/08 7. YA36 18 (2) 01/04/08 8. YA39 24 01/06/08 192 Wivenhoe Road Version 5.2 Page 33 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 who live there. This requirement was not met within the previous given timescale of 31.03.05 and 01.05.07. 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 YA8 YA18 Good Practice Recommendations Management and staff should familiarise themselves with the Mental Capacity Act (MCA) 2005, code of conduct, implementation and how it affects their work and ensure that the service’s assessment and care planning records are consistent with MCA code of practice guidelines. This area should be covered in the homes induction and training programme. 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. 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. YA6 3. YA35 4. YA40 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Colchester Fairfax House Causton Road Colchester Essex CO1 1RJ 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 192 Wivenhoe Road DS0000017727.V358605.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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