Inspection on 13/06/06 for Faircross Avenue

This inspection was carried out on 13th June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 40 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Faircross Avenue 05/06/07

Faircross Avenue 10/11/05

Faircross Avenue 14/06/05

Faircross Avenue 20/01/05

Faircross Avenue 28/09/04

Faircross Avenue 27/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Faircross Avenue 100 Faircross Avenue Barking IG11 8QZ Lead Inspector Mr Roger Farrell Key Unannounced Inspection 13th June 2006 12.20p Faircross Avenue DS0000027898.V299859.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 Faircross Avenue DS0000027898.V299859.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. Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Faircross Avenue Address 100 Faircross Avenue Barking IG11 8QZ 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) 0208 591 5655 0208 471 6959 nasserkass@aol.com Mr Nasser Kassouri Mrs Beverley Rose Kassouri Mr Nasser Kassouri Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th November 2005 Brief Description of the Service: 100 Faircross Avenue is a registered care home providing accommodation and support to three people who have learning disabilities. It is a compact midterrace property, a short walk from shops and transport links of Barking town centre. All three residents have lived at this house for over six years and are well settled. One of the owners, Mr Kassouri was the manager, but in January 2006 another person was appointed to this lead post. An application to register this person is overdue. Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last visit to Faircross Avenue was on 2 February 2006, three weeks after the new manager had been confirmed in post. The report of that additional visit sets out the concerns that had been raised over the past year. The owners have been reminded that inspection reports must be available at the home, including at service users reviews with their care managers and health care key worker. They can also be seen on www.csci.org.uk. This unannounced inspection took place on Tuesday 13 June 2006 between 12.20 and 6.15pm. The manager was on duty and was available through the day to help with the inspector’s checks covering all the core standards. At the start of the visit the inspector discussed a number of issues, including: • In July 2005 there was a meeting with the owners to discuss concerns, including Mr Kassouri not being at the home in accordance with the rota. The owners said they were going to appoint a new manager. In January 2006 they wrote saying this had happened. The Commission still has not received an application to register this person. The inspector said that this must be submitted without delay. The registered persons had been sent the standard pre-inspection questionnaire in April, and were asked to return this by 8 May 2006. This had not been received. The manager said that she had completed most sections, and had passed it to the owners to enter certain information such as the current level of fees. She gave a commitment that this and other paperwork asked for would be returned within a week. Previous inspection reports had asked for a plan setting the schedule to expand and upgrade the home, and projected timescales when these improvements would be introduced. This had not been received. The owners were asked to provide details of their involvement in managing residents’ personal money, including accounts. This had not been received. • • • The inspector found the manager helpful and cooperative in responding to the enquiries. However, she was restricted in some areas such as not being able to access computer records as there have been enduring problems with the home’s pc not working; and some information – such as controlling residents’ money – not being made available by the owners. Improvements have been achieved in a number of areas following legal action by the Commission through issuing ‘Immediate Requirement Notices’. These include better fire safety monitoring and staff training; providing residents with Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 6 adequate food; keeping the kitchen clean; having available details of who is working at the home; and ensuring the rota is a true record of who is on duty. However, the headline conclusion is that this remains a service that is failing to provide its residents with the minimum level of service and facilities required by the regulations and standards covering care homes. As a result of this visit the owners were served with eight further ‘Immediate Requirement Notices’ for failures to comply with “The Care Home Regulations 2001” for the following breaches: • • • • • • • • Unaccounted for surplus tablet; Supply of prescribed medication not available; Failure to demonstrate training for those who handle medication; Failure to carry out checks on staff; Not having up-to-date care plans or risk assessments; Inadequate accounts covering residents’ personal money; Failing to review the service and describe how improvements will be made; Not having available ‘monthly reports’ showing that the owners are monitoring the service. Residents are not receiving the level of service or quality of facilities they should reasonably expect when measured against legally required standards. Unless the registered persons respond to this report with a sufficiently detailed action and improvement plan, the Commission will consider enforcement to ensure compliance. What the service does well: What has improved since the last inspection? The manager has started to set up some more accountable record systems necessary to show compliance with the regulations covering care homes. Nevertheless, this remains a failing service, with a continuing record of not complying with key requirements set in inspection reports. A major example of this is not having up-to-date support plans and risk assessments covering residents’ day-to-day needs. Equally, little evidence is available to show that residents are helped to have worthwhile lifestyle opportunities. Other than attending some evening clubs, activity is largely limited to going to local shops and the park. Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 7 What they could do better: Last November’s inspection reports said – “Based on the findings at the last three inspections, it is not possible to describe any recent positive aspects of this service. The overall impression given at these visits remains that the residents are at best being provided with a basic, at times inadequate board and lodging service, rather than the professional approach the owners promise in their ‘statement of purpose’.” Care managers responsible for supporting residents were alerted at the end of last year by an anonymous complainant who raised issues about deficiencies in basic elements of care – such as worn out shoes, broken furniture not being replaced, and residents not getting their personal money. Social workers were asked to follow up on such elementary expectations in reviews of the services the residents receive. A fundamental concern raised by the Commission in previous reports was that Mr Kassouri was not fulfilling his responsibilities as the manager. He was spending considerably less time at the home than was shown on rotas. A consequence was that there was usually only one person on duty, at times involving long shifts. There is now a manager on duty during weekdays. However, there has been no improvement in demonstrating that staff have been fully checked, or have the training to be responsible for residents - such as giving out medication. Staff cover remains mostly one person on duty, regularly doing long shifts. For a number of years the owners have spoken about improving the home by incorporating the next-door house. Their plans show improvements such as making the bedrooms larger with their own showers and wc, and creating an office and sleep-in room. They also intend to add two extra places. However, they have failed to produce a definite proposal saying when this upgrading will be achieved. Inspection reports over the last year have highlighted a range of concerns, and first stage legal action has been taken on a number of areas for a failure to maintain safe working practices. The consistent theme of last year’s reports was that this was a poorly managed and failing service, reflecting the absence of an onsite manager presence. As stated, a range of benefits have resulted from having a new manager. Nevertheless, this position has not been ratified by submitting an application to register the manager. Further, the need to repeat requirements over a number of reports, and the serving of further ’Immediate Requirement Notices’ means that this remains a service of significant concern to the Commission. At this visit 35 of the 43 standards were considered. Only three are scored as satisfactory. Twenty are rated as ‘partially met’, with nine recorded as ‘unmet – notably under the headings covering care practices and the duties of the registered persons. The owners have been asked to provide a detailed ‘improvement plan’ in response to this report. This needs to include itemised statements setting out Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 8 how they will achieve enduring compliance with each of the requirements listed at the back of this report. They also need to provide a detailed description and estimated timescales regarding the planned upgrading of facilities they have been saying they intend to carry out for over two years. 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. Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 9 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 Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome area is ‘adequate’. This judgement has been made using available evidence including a visit to the home. The main form said to be available to be used for assessments is no longer used for established residents as part of their care plans. The manager had just started using a new tick-list assessment form with the help of a community psychiatric nurse, but these had not been completed. Guidance was given on making sure the ‘statement of purpose’ is factually correct. EVIDENCE: The manager has reviewed the ‘statement of purpose’, and a copy will be submitted as part of her application. The inspector said that all the information must be factually correct, including details of the staff team and the normal level of cover. All residents were established in this setting prior to the current owners taking over. Two residents moved to this house with the previous provider in 1998, with the third person joining the group two years later. The inspector has been shown a set of assessment forms and guidelines, and assurances have been received that these would be used for any prospective resident. The manager is aware of the range of areas that must be covered as set out in Standard 2.3 of the ‘National Minimum Standards’. These assurances included a commitment that compatibility with established residents would be a major consideration. Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is ‘poor’. This judgement has been made using available evidence including a visit to the home. The reflects the registered persons’ failure to comply with requirements on important areas such as having up-to-date care plans, and records showing how residents’ personal money is handled. Legal action has been taken on these two areas. EVIDENCE: At the last visit in February 2006 the manager said she was reviewing the service user files. A ‘team leader’ who worked one day a week had last revised these files nearly three years ago. A ‘Statement of Support and Action Plan’ had been introduced, with bullet point entries under twenty-one or more headings. These provided some good practical advice on assisting the residents with day-to-day living needs. There was also an intention to add ‘person centred planning’ sheets. The flaw in the system was that Mr Kassouri as the manager was ‘key-worker’ to all three residents. It became increasingly clear that he was spending considerably less time at the home than he claimed. That generation of care plans were not updated, and it was difficult to see how service users were being helped beyond providing assistance with daily domestic routines. Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 12 The new manager has introduced a new way of setting out the files, with a front index sheet, but this revision was far from complete. In particular, the ‘Care Plan’ sections were blank, or had information over three years old. The manager was currently completing ‘Functional Assessments’ with the help of the community psychiatric nurse (cpn) who has worked with the residents over many years. She showed the inspector examples of these twelve-page ticklists. She said preparing up-to-date care plans had been delayed until this exercise was completed. However, important areas such as restrictions on going out unaccompanied need to be updated urgently, including doing risk assessments. Whilst the involvement of the cpn is positive, the requirement to have current care plans has been carried over in three inspection reports and has not been achieved. The owners were therefore served an ‘Immediate Requirement Notice’ for a failure to comply with Regulation 15 of “The Care Homes Regulations 2001”. Two weeks later the manager sent examples of the new style care plans. A recent addition to the files is a two-page ‘Strengths and Needs’ section. The manager explained steps she has taken to establish individual residents’ ‘likes and dislikes’ and involve them in decision-making. However, those residents asked about how their personal money is handled were not clear about their entitlement, including any mobility allowance. At the inspection in February 2006 the manager was unable to present details of service users’ personal income and expenditure, saying that the owners controlled this matter, including access to personal bank accounts. It was requested that an explanation be provided as part of the action plan response. This was not received. At the visit on 13 June 2006 no such details or accounts were available setting out income and expenditure undertaken on behalf of service users. Therefore, the owners were served with an ‘Immediate Requirement Notice’ for a failure to comply with Regulation 17(1)(a) and Schedule 4, para 9 of “The Care Homes Regulations 2001”. Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is ‘poor’. This judgement has been made using the available evidence, including a visit to the service. There is a continuing failure to have available up-to-date plans and records of how residents are supported to take part in social, recreational and leisure activities. With some exceptions, such as attending evening clubs, activity is largely limited to going to local shops and parks with staff. The manager is reviewing this area, but planned activities such as car boot sales and horse riding have decreased considerably. On the positive side, meal planning and food hygiene have improved and are now scored as ‘good’. EVIDENCE: At the inspection in February 2006 the new manager described her commitment to increase residents’ opportunities to access community facilities. The action plan that followed said that residents were being consulted on how they wanted to be supported to be involved in a wider range of activities. However, at this recent visit both the ‘weekly programme’ on display, and the ‘activity plans’ in the care plan files were considerably out of date. There is little evidence that the programmed ‘in-house’ activities are taking place according to these plans. Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 14 The manager gave an overview of how each person spends their time. The main activity is that residents continue to go to two or three evening clubs. One resident still attends literacy lessons, another having recently dropped out of an art and crafts class. One person uses the local library regularly. Residents are said to have become bored with the once popular horse riding classes. Car boot sales were also popular, but opportunities to go to these have ceased. Rather than following any specific plan, the main activity is going with staff to local shops and parks. Other than a couple of trips up to London, no other planned outings have occurred over the last year. Some years ago holidays were planned, but these too no longer happen. Therefore, there remains little scope or achievement to report under these headings. One resident needs staff with him for all outside activities. The two other residents had agreements decided in reviews about going out to local shops and facilities on their own - but the guidelines and risk assessments covering these have lapsed as is generally the case with all parts of the care plans. The manager said that part of the ‘Functional Assessments’ being carried out is to take a fresh look at how residents can be helped with their lifestyle opportunities. She had made an appointment to accompany all three residents to a local college to see what courses were coming up. She was also alert to one matter where a service user may be at increased risk when he went out. Nevertheless, this service needs to be able to demonstrate a much more planned and better documented approach to helping residents with their social, educational and leisure opportunities. The requirement on this matter is carried forward. Reports have described a slapdash and negligent approach to providing meals. Menu planning was not taking place, there was no day-to-day coordination of meals, and with staff improvising with what food was in the cupboards or getting take-away from the fish and chip shop. Inspectors found mouldy foodstuffs, items past their ‘use-by’ date, and a dirty fridge. In June 2005 the owners were served with ‘Immediate Requirement Notices’ for a failure to maintain an accurate record of the food provided; and in November 2005 for a failure to maintain adequate standards of food hygiene. Two anonymous complainants had raised concerns with the Commission about food, including saying one person at times had to use his own money to buy sandwiches as he did not like the meals being served. The current manager said that this is one area where she had made considerable improvements. This includes - having a planned menu that is followed, or recording where a resident requests an alternative on the day; using fresh vegetables and having fruit available; and carrying out regular checks to make sure hygiene standards are being followed. At this unannounced visit the meal being prepared was according to the menu, and did include three types of fresh vegetables. The ingredients for the next meal were available, including salad items. The fridge was clean, as were other parts Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 15 of the kitchen. The improvements in kitchen hygiene are reflected in the last report by an environmental health inspector following an unannounced check carried out at the end of January 2006. Two residents made comments on the improved standard of meals – one comment being – “It has got better…. Yes, we do get asked what we want.” Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is ‘poor’. This judgement has been made using available evidence including a visit to the service. This includes a failure to operate safe arrangements for the storage, administration, and recording of medication. This has resulted in the owners being served with three Notices instructing them to comply with regulations covering safety with medication. EVIDENCE: As stated above, the manager has started doing new assessments on each resident. She is working with a cpn who has known all three residents over many years and has been their main health service link worker. Also, the new style ‘service user files’ have a medical section. These have tracking sheets for listing all contacts with the GP, dentist, optician, chiropodist and so on. There were also details of recent general health care checks. The home has switched pharmacy, and now uses the Boots ‘monitored dose system’, supplied with printed instruction and recording sheets. Medication is stored in a filing cabinet in the dining room. At the last visit this was not locked. At this recent visit two significant errors were found: • An unused tablet was stored in the filing cabinet for return to the pharmacy. An audit trail indicated that this was one of the two doses DS0000027898.V299859.R01.S.doc Version 5.2 Page 17 Faircross Avenue that should have been administered three days earlier on 11 June 2006. The mar sheet was signed saying both doses had been given on that day. There was no record saying why this item was surplus, nor could an explanation be offered. • A resident had seen his GP the previous week on 7 June 2006, and had been prescribed a course of medication. This item of medication was listed on the instruction and recording sheet. No supply of that medication was available, nor a record saying why this medication was not being administered in line with the doctor’s instructions. Subsequently the manager discovered that this medication had been delivered to the home the previous week, had been placed in the desk, and no information had been passed on. Furthermore, details of that GP consultation had not been entered on the GP tracking sheet. Further • Part of the arrangements with the supplying pharmacy set up three months earlier was that they would provide staff training on the safe handling of medication. No such training had taken place, nor was there one booked. There was no record of staff training on the safe handling of medication or competency assessments, other that an assumption that this training may have been covered with other employers or as part of NVQ training. The manager was asked to do an audit of staff training on this topic and send it to the Commission. The registered persons were served with three ‘Immediate Requirement Notices’ relating to Regulations 13(1);13(2); and 18(1)(c)(i) of “The Care Homes Regulations 2001” for these failings. Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is ‘adequate’. This judgment has been made using available evidence including a site visit to the service. The manager has made sure that that the necessary information is available to follow if there is a complaint or allegation, and has told staff about their responsibility to follow the guidelines. EVIDENCE: The new manager can demonstrate compliance with previous requirements about having information available covering complaints and protection issues. This has involved correcting errors in the previous complaint guidelines, and having contact details for the Commission. A complaints log is available, which records two minor matters that have been raised, such as residents not agreeing on which tv channel to watch. At the end of last year an anonymous complaint was received listing a range of poor practice. This included a resident not having adequate shoes; broken furniture not being replaced; residents not getting their personal money; and the lounge being used by staff as a bedroom. As a result a strategy meeting was held, and each placing authority held a review, including looking at the issues raised. A further anonymous complaint was received, mainly listing the issues that have been set out in inspection reports. Placing authorities were advised to read inspection reports, and discuss issues at subsequent reviews. The manager has been reminded that copies of inspection reports must be available on request at the home. Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 19 There is adequate information available at the home on the steps that must be followed if there is an allegation or suspicion of abuse. A pack called ‘Say No to Abuse’ is on display. All staff had now signed to say that they have been given a copy of the General Social Care Council’s code of practice, and are aware of the phased programme of enrolment. This section covers the expectations regarding residents’ money. As stated earlier, the owners have failed to provide details on how they manage residents’ money. At this visit the manager was unable to give sufficient detail. Her understanding is that the placing authorities pay residents’ personal money to the owners. One resident is given cash twice a week and signs for this, but it is unclear if this matches his weekly entitlement. Two other residents are not given cash. One person has his cigarettes bought for him, which staff hold, but there is no account. As with the other resident who does not have cash, minor spends are put through the home’s petty cash system. The Registered Persons were served with an ‘Immediate Requirement Notice’ for failing have available up-to-date accounts of service users personal monies handled by staff and the owners, covering all transactions and balances, in compliance with Regulation 17(1)(a) and Schedule 4, para 9 of “The Care Homes Regulations 2001”. Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is ‘poor’. This judgment has been made using available evidence including a site visit to the service that involved taking photographs. Residents are provided with poor facilities, which are considerably below the expected standard. The owners’ proposals to improve the home environment have not moved forward. This remains a cramped, tatty and poorly maintained house. The owners must demonstrate improvements or the Commission will consider legal action to ensure compliance. EVIDENCE: Residents continue to be provided with a poor standard of accommodation. This includes two of the bedrooms being very small; the lounge being used as the staff bedroom; the dining room mainly being used as an office; and an outside toilet with stained walls and fitments. The overall decorative standard and quality of some furnishings is poor. The front and rear exterior look neglected, with peeling paint and debris dumped in the small back garden. At this visit staff had to use containers to capture rainwater spilling into the dining room/office. Over a number of years the owners have said their intention is to upgrade the home including incorporating the next-door house which they own. Initial proposals involved expanding to the rear and adding up to five extra places. Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 21 Planning permission was not granted for this more ambitious scheme. A scaled down version believed to be within planning guidelines was put forward a year ago. This includes increasing the size of bedrooms and installing private showers and wc’s; creating facilities for staff; and adding two additional places. The owners have said that the upgrading scheme will improve the building throughout. This has been the reason for not tackling fading decoration or improving the existing facilities. At the last inspection the manager said that she had been ask by the owners to be involved in progressing this improvement scheme. The owners were asked to provide an improvement plan, setting out the schedule of works and giving estimated timescales. This was not received. At this visit no firmer proposals could be described. Furthermore, the manager was not familiar with the plans finalised a year ago. This report sets a deadline for the owners to provide an improvement business plan covering the proposed upgrading and expansion. This needs to include estimated timescales for completion, and say how existing residents will be supported during the building works. Alternatively, the improvement plan needs to itemise a schedule of works setting out the redecoration of the existing facilities. This must include, as appropriate, the replacement of furniture and equipment. The manager said that she has ensured better household cleanliness. This follows concerns stated in reports about poor standards of hygiene in the kitchen and bathroom. However, there is still a lack of attention to detail. For instance, last November the owners were told to replace the broken fitments in the bathroom. Yet, the old broken toilet seat remains discarded in the garden. The owners’ lack of responsibility is also shown by a failure to replace broken equipment. Reports last year talked of examples such as the main phone being out of use with no action to fix it, and staff attempting to get a picture on a portable tv as the main set in the lounge was broken. At this recent visit the manager could not access some records as the computer was broken. The the fax machine was also out of order. At this visit the inspector took a set of photograph of the facilities. He explained the protocols that would be followed where photographs are used in legal action. He said that future visits may also involve taking photographs as part of evidence gathering if it is necessary to demonstrate inadequate facilities and unsafe conditions as part of legal proceedings. Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is ‘poor’. This judgement has been made using available evidence including a visit to the home. There is now a regular manager presence, but routine cover is one support worker on duty, often working long shifts. The owners are failing to carry out fresh CRB checks. There is little evidence of staff training arranged by the home. EVIDENCE: Inspection reports over the past year have detailed a range of concerns and set requirements under this group of standards: • The need to have on display a duty rota that is a true record of the cover provided. An ‘Immediate requirement Notice’ was served on the owners for a failure to comply with this responsibility on 15 June 2005. The rota sheet on display now includes the manager’s hours; gives the full name of staff; and is amended if there are changes to the planned cover arrangements. • To have available an up-to-date ‘statement of purpose’ that includes an accurate description of the staff cover provided, including – the number, designation and contracted time of each post – including the manager’s hours and any other supervising positions such as ’deputy’ or ‘teamleader’. DS0000027898.V299859.R01.S.doc Version 5.2 Page 23 Faircross Avenue A page has been added to the ‘statement of purpose’ giving cover details. This is normally one support worker on duty between 10am and 6pm; followed by a support worker on from 6pm to 10pm, who then does a sleep-in, and is on duty between 8am and 10am the following day. The manager’s hours are normally 9am to 4pm Monday to Friday. It does not set out exact details of the staff complement as requested. At this visit the staff team consisted of – manager (full-time) and 4 part-time support workers (20 or 22 hours each). This is insufficient to cover the rota pattern described above. The manager said that the additional hours, and any gaps due to holidays and sickness, are covered by these part-time workers doing extra hours. Recent rotas show ‘long shifts’ of 28 hours (8am thru to 10am the following day, including the sleep-in duty). There is no systematic record of staff training. Other than the induction checklist, staff files do not have details of training in the core topics. The manager was asked to provide a training matrix, but this was not received. Basic food hygiene has been the only course offered over recent months, other than in-house briefings by the manager on areas such as fire safety. All staff are said to have done foundation training, including two who were undertaking NVQ’s, but these are linked to other employment. Employers have a legal responsibility to vet staff, including making sure a person is suitable by carrying out a fresh CRB check. With one exception, staff files contained CRB certificates obtained by other employers. For instance, the certificate of the most recent person to start had a different surname, and was over two years old. The manager said that she had raised the matter of vetting with the owners, but they were saying that it is the responsibility of the worker rather than the employer to pay for these legally required checks. The owners were served with an ‘Immediate Requirement Notice’ for a failure to comply with Regulation 19/Schedule 2, para. 7 and 8 of “The Care Home Regulations 2001” by not showing that they were carrying out the necessary checks. Staff files do not contain a copy of the terms and conditions of employment, and the manager could not confirm that she had been issued with a contract. There was evidence that staff meetings are held occasionally, the last being two months earlier. There was also evidence that occasional supervision was taking place. Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 41, 42 and 43. Quality in this outcome area is ‘poor’. This judgement has been made using available evidence including a visit to the home. This rating is determined by the owners failure to demonstrate how they are monitoring the quality of the service, and presenting firm proposals about the general upgrading they have been promising for more than two years. Since this manager took over there has been an improvement in the records covering safety monitoring. EVIDENCE: As stated in the summary, a range of benefits have resulted from having a new manager. This includes having available paperwork that shows more systematic health and safety monitoring. This includes in-house checks of fire equipment and drills; general electrical and gas certificates; and satisfactory reports from the fire authority and environmental health. The one gap was that tests of electrical equipment were now due. Nevertheless, delays in fixing or replacing essential equipment such as the computer and fax machine still reflect a negligent approach by the owners. Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 25 The policies and procedures are generally commercially available versions that have not been adapted to this service beyond inserting the name of the home. The manager said that she had worked on adapting some, but these could not be accessed as the computer had failed again. One of the owners visits two to three times each week, but is not fulfilling the responsibilities set out in Regulations 24 and 26 regarding ‘monthly reports’ and quality monitoring checks - nor developing an improvement plan. Producing an improvement plan has now been made a statutory requirement. The owners were served with two ‘Immediate Requirement Notices’ for a failure to comply with Regulation 24 and 25 of “The Care Home Regulations 2001” for not fulfilling their responsibilities to monitor the service and plan improvements. Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 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 2 26 2 27 2 28 2 29 2 30 2 STAFFING Standard No Score 31 X 32 1 33 2 34 1 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 1 1 1 2 2 2 1 Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes – The twelve repeated items are specified below. 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 YA1 Regulation 4 Requirement Timescale for action 29/08/06 2. YA6 15 The ‘Statement of Purpose’ submitted as part of the manager’s application must contain accurate information, including - the number, designation and contracted hours of each post. This matter has been repeated over two or more reports. 11/09/06 Have available an up-to-date service user plan. This needs to include who will take a lead on supporting the service users with identified needs, such as having an allocated key worker. This matter has been repeated over two or more reports. On 16 June 2006 the registered owners were served with an ‘Immediate Requirement Notice’ for a failure to comply with this responsibility. Include in the care plans the steps taken to seek and incorporate the views and individual choices of service users. Include in the care plan files risk assessments covering specific support needs and any restrictions, such as going out alone. DS0000027898.V299859.R01.S.doc 3 YA7 15 11/09/06 4 YA9 15 11/09/06 Faircross Avenue Version 5.2 Page 28 5 YA12 YA13 YA14 16(2) (m),(n) 6 YA15 16(2)(m) 7 YA16 12(2) 8 YA18 16(2)(e) 9 YA19 17(1)(a)/ Sched 3 10 YA20 13(2) Consult with service users, and arrange a suitable programme of educational, leisure and social activities. Make suitable staff cover arrangements to enable these activities to take place. Maintain a record of such activities. This matter has been repeated over two or more reports. Include in care plans service users’ links with family and friends, and as appropriate, how these links are supported. Consult with service users regarding the daily routines and arrangements in the home, such as using their lounge in the evenings. Also continue to maintain records that show they are being offered a reasonable choice and variety of meals. This matter has been repeated over two or more reports. Specify in care plans the assistance service users need with personal care. This must include help with having, and caring for a suitable range of clothing and footwear. Make sure there is an accurate record of all contacts with health care professionals, including the GP, psychiatrist; cpn; dentist; optician; and chiropodist. Make suitable arrangements for the ordering, storage; administration; recording; and disposal of medication. Make sure staff are familiar with the policy, procedures and guidelines covering these responsibilities. On 16 June 2006 the registered owners were served with an ‘Immediate Requirement Notice’ for a failure to comply with this responsibility. 11/09/06 11/09/06 11/09/06 11/09/06 28/08/06 28/08/06 Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 29 11 YA20 13(2) Have available procedures and guidelines covering the management of medication that are specific to this home. On 16 June 2006 the registered owners were served with an ‘Immediate Requirement Notice’ for a failure to comply with this responsibility. Have documentation available that confirms that all staff that handle medication have received appropriate training. On 16 June 2006 the registered owners were served with an ‘Immediate requirement Notice’ for a failure to comply with this responsibility. Have available a record that shows the medication system is audited and monitored. This may include periodic checks by the supplying pharmacist, and covering this area in the ‘monthly checks’. Have available a copy of the procedures and guidelines covering service users’ money and financial affairs. The arrangements for assisting residents with their personal money must be included in their care plans. This must specify any appointee arrangements; and set out the arrangements for acting as an agent or representative for bank accounts. On 16 June 2006 the registered owners were served with an ‘Immediate Requirement Notice’ for a failure to comply with this responsibility. At least once a year carry out a review of each service user’s support arrangements, that includes providing their care DS0000027898.V299859.R01.S.doc 28/08/06 12 YA20 13(2); 181)(c) 28/08/06 13 YA20 24 04/09/06 14 YA23 17(1)(a), (2)/ Sched 4, para 9; 20 28/08/06 15 YA23 17(2)/ Sched 4, para 9; 20 11/09/06 Faircross Avenue Version 5.2 Page 30 16 YA24 23(2);24 17 18 19 YA24 YA24 YA24 23(2);24 23(2) 23(2) 20 YA25 24 21 YA26 16(2)(c) 22 YA26 16(2)(c) 23 YA27 23(2) 24 YA28 24;23(3) (b) 25 26 YA29 YA28 16(2)(a) 12 manager with an audit of personal monies. Carry out an audit of the furniture, fitments and equipment used by residents and staff. Repair or replace any broken or faulty items. Have available a maintenance log, including specifying when defects will be made good. Repair the structural damage that is allowing rainwater into the dining room. Maintain the exterior of the building in a good state of repair, including repainting surfaces that have flaking paint. Include in the ‘Improvement Plan’ the timescales by which it is intended to provide residents with private and communal space that meets the standard set out under Section 6 of the NMS. Provide service users with adequate bedroom furniture and fittings. Please refer to standard 26.2 of the NMS. Provide residents with a suitable lock and key to their bedroom, unless to do so is a risk as specified in their care plan. Maintain the bathroom and toilet in an adequate state of decoration and repair. Make sure there are suitable locks. Include in the ‘Improvement Plan’ the arrangements to provide staff with adequate sleep-in facilities, and space to store their personal belongings. Restore the fax facility. Have available a procedure that sets out restrictions on residents using their lounge and dining room – such as the use of the lounge by staff sleeping in, and the dining room being used as the office. 11/09/06 28/08/06 28/08/06 04/11/06 11/09/06 11/09/06 11/09/06 11/09/06 11/09/06 28/08/06 28/08/06 Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 31 27 28 YA30 YA32 YA35 23(2)(o) 18(1) Clear the debris from the garden, 28/08/06 and take necessary steps against vermin. Ensure staff have the necessary 11/09/06 skills and experience for the tasks they perform, including understanding the needs of adults with a learning disability. Have available a record of the staff training, specifying when they have completed training in the core areas, including – a general induction; fire safety; food hygiene; medication; basic first aid; moving and handling; infection control; adult protection procedures; GSCC’s code of practice; and general health and safety. This matter has been repeated over two or more reports. Have available all the required information on staff that demonstrates a responsible management approach to the selection and vetting of staff, in accordance with Reg 19, and as set out in Schedules 2 and 4. This matter has been repeated over two or more reports. An ‘Immediate Requirement Notice’ was served on the registered owners on 15 June 2005 to make sure staff vetting details were made available. On 16 June 2006 the registered owners were served with a further ‘Immediate Requirement Notice’ for a failure to comply by not carrying out the required CRB checks on staff. 29 YA34 19/ Sched2; 17(2)/ Sched4 28/08/06 30 YA36 18(2) Ensure that all staff are appropriately supervised, and DS0000027898.V299859.R01.S.doc 11/09/06 Faircross Avenue Version 5.2 Page 32 31 YA37 8; 9 32 YA39 24; 26 maintain a record that demonstrates that individual supervision is occurring at least six times in a year. This matter has been repeated over two or more reports. Provide an application to register a manager who is fit to manage the care home. This matter has been repeated over two or more reports. At least once a year carry out a review of the service, including consulting with service users and their representatives. This must take into account the ‘monthly monitoring reports’ that must be undertaken by the registered owners. This matter has been repeated over two or more reports. 28/08/06 11/11/06 33 YA39 24 On 16 June 2006 the registered owners were served with an ‘Immediate Requirement Notice’ for a failure to comply with this responsibility to have reports on the conduct of the home. Provide the Commission with a copy 11/09/06 of the service improvement plan. It is recommended that this include the plans to expand and upgrade the home, and projected timescales when these improvements will be introduced. Reference should also be made to the arrangements for the service users during the period of any building activity affecting their living arrangements. This matter has been repeated over two or more reports. On 16 June 2006 the registered owners were served with an ‘Immediate Requirement Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 33 34 YA40 12(1)17 Notice’ for a failure to comply with this responsibility. Review the policies and procedures, making sure these are relevant to the service provided in this setting. This matter has been repeated over two or more reports. Have available for inspection the required documentation. It is expected that the responsible person in charge of the home is aware of, and can locate essential documents such as the fire log, accident book, complaints details, health and safety certificates, and the full names of staff working at the home. This applies to documentation such as policies and procedures held on a computer. This matter has been repeated over two or more reports. Arrange for the homes electrical appliances to be tested by a competent person, and have confirmation confirming these safety checks. Have available for inspection a set of annual financial accounts. 04/11/06 35 YA41 17 28/08/06 36 YA42 13(4 (c) 11/09/06 37 YA43 25 28/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Faircross Avenue DS0000027898.V299859.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Faircross Avenue DS0000027898.V299859.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. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!