Inspection on 04/10/05 for Fen Grove (76)

This inspection was carried out on 4th October 2005.

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

The inspector found 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fen Grove (76) 07/02/07

Fen Grove (76) 05/07/05

Fen Grove (76) 06/01/05

Fen Grove (76) 30/06/04

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 Fen Grove (76) 76 Fen Grove Blackfen Kent DA15 8QQ Lead Inspector Elizabeth Brunson Unannounced Inspection 4th October 2005 10:00 Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 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 Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 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. Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Fen Grove (76) Address 76 Fen Grove Blackfen Kent DA15 8QQ 01622769100 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) MCCH Society Limited Mrs Tina Donna Morgan Care Home 4 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th July 2005 Brief Description of the Service: 76 Fen Grove is a care home, which provides care for up to four adults with learning disabilities. Maidstone Community Care Housing Ltd (MCCH) operates it. The home is a detached bungalow, situated in a residential area and within easy reach of local transport, services and shops. There is a large kitchen/diner, a lounge with patio doors, which open onto the garden and a small utility room. There is no dedicated office, so the utility room is also used as an office. The home has a bathroom with toilet and there is an additional toilet. There are two single bedrooms and one double and a large rear garden. At the time of the inspection, there were four service users in residence and no vacancies. Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced, from midday onwards and one inspector was in the home for five hours. One service user was at home all day and the other three-service users returned home during the afternoon. It was not possible to find out the views of service users due to communication issues but their care was observed. The manager and other staff on duty during the day were spoken to. The communal rooms, garden and service users’ bedrooms were seen. Records were looked at, including service users’ individual case files. What the service does well: What has improved since the last inspection? What they could do better: Service users still did not have proper contracts for their residence in the home. These should set out exactly what services would be provided. Service users’ health care appointments must not be overlooked, all possible steps must be taken to prevent service users developing pressure ulcers and medication must not be allowed to run out. As at the last inspection, staff vacancies had meant that too many bank and agency staff were working in the home. More permanent staff must be recruited so that service users can go on more outings and participate in more leisure time activities. Some parts of the building and garden needed attention and a proper office was badly needed. Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 6 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. Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 Excellent assessment information was on file but contracts for service users were still needed, in order to provide full information about the services to be provided. EVIDENCE: As at previous inspections, there was a great deal of information about service users on file, which included their likes and dislikes, how they preferred to spend their day and how they would like to be supported. Permanent staff spoken to knew the service users well. Comprehensive contracts for service users were still needed. Relatives and their relatives or representatives needed clear information about the terms and conditions of residence in the home. (See requirement 1) Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 9 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 & 9 Most service users had taken part in planning meetings but these needed to be more regular and to involve all service users. Service users were encouraged to make choices but the shortage of permanent staff made the further development of communication difficult. Risk assessments were in place. EVIDENCE: Regular individual or person centred planning meetings had been held with service users and their relatives. One meeting was taking place on the day of inspection. However, the service user had chosen not to attend, as she did not wish to miss swimming, which was said to be one of her favourite activities. Planning meetings should be held at times convenient for service users. Two other service users were to have planning meetings on the following day. One of these was several months overdue. These meetings should be held six monthly. (See recommendation 1) Permanent staff said they encouraged service users to make choices about their food, clothing, activities and other aspects of their lives. However, as none of the service users living in the home had speech, this depended on staff being able to communicate effectively with service users. Service users had communication passports but it was difficult for new and temporary staff to Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 10 communicate effectively. It is hoped that, when the home is fully staffed, priority can be given to developing communication in the home. This would assist service users in making and communicating their choices and decisions. (See recommendation 2) Permanent staff wanted service users to lead as full lives as possible and to develop their interests and activities. Risk assessments had been completed for service users’ participation in activities and for using transport. Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 11 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 & 16 Service users participated in activities and had some involvement in the local community but these aspects of their lives could be further developed. Service users’ rights were respected in the daily routines of the home. EVIDENCE: Service users attended day centres and enjoyed activities at home such as aromatherapy, listening to and making music, watching videos and TV. Service users also went shopping; out for meals and on occasional day trips and all service users went on holiday with staff during the summer. However, as at the previous inspection, daily records showed that service users’ involvement in activities outside the home, apart from attendance at day centres, was limited and not in line with their individual activity plans. The manager said this was due to the shortage of permanent staff and particularly of staff who were drivers. Staff were still planning to use the taxi card scheme, which should enable service users to go out more regularly. (see recommendation 3) Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 12 Service users used local shops and other facilities and went for walks in the local area. Relationships with neighbours and other local people were said to be cordial but staff said that service users had little genuine community involvement. Community involvement can be difficult to achieve but it is hoped that this can be developed further when the home has a full, permanent staff group. (see recommendation 4) Service users’ likes and dislikes were clearly documented on file, as part of person centred planning. There were also guidelines in place for working with service users in their preferred way. Most staff were seen to talk to and interact with service users and all staff addressed service users in a friendly but respectful manner. Service users did not have keys to the front door or to their bedrooms and the manager said it would be difficult for them to use these. The bathroom and toilet doors were lockable and personal care was given discretely and in private. Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 13 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): 19 & 20 Service users’ health care needs had been attended to but some further work was needed. Medication was safely stored and properly administered but there must be a system in place to ensure that stocks do not run out. EVIDENCE: Information about service users’ health care needs was seen on file and staff had supported service users in obtaining the necessary services. However, a hospital appointment made a year previously for one service user in August 2005 was overlooked and a further appointment had not been made. This was drawn to the attention of the manager for immediate action. A system must be put in place to ensure that this does not happen again. One member of staff had recently attended a health facilitator course and other staff were booked to attend, so this should help. Not all health care appointments noted in the diary had been recorded in service users’ files, together with outcomes. (see requirements 2 & 3) Service users had done well in gaining or reducing weight in line with need but some service users had not been weighed regularly. It is appreciated that this is difficult with such a reduced permanent staff group and few drivers, as service users had to be taken to a local hospital to be weighed. (see recommendation 5) Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 14 One service user had a small pressure ulcer, which was being monitored and treated by the district nurses. A new mattress had been provided. It was noted from the file that this service user had previously suffered from pressure ulcers. Pressure ulcer risk assessments should be completed, where indicated. (see requirement 4) Medication was safely and properly stored. A sample check of medication and administration records was made and this was satisfactory. Given the shortage of permanent staff, there had been occasions when staff had come back on duty in order to administer medication and they are to be commended for this. An incident of medication not being given had been properly dealt with and recorded and no harm had resulted. Records showed that the supply of lactulose prescribed for two service users ran out and there was none in stock for a few days during July/August. (see requirement 5) Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 15 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 & 23 A complaint had been properly dealt with and service users were protected from harm and abuse. EVIDENCE: There had been one complaint since the last inspection, which had been properly dealt with. There was a form available for service users to make a complaint, which included pictures and symbols. It would be difficult for service user to complain without assistance. No adult protection concerns had been reported since the last inspection. Staff spoken to were aware of safe practice and the manager and senior support worker were in close touch with service users, staff and day-to-day events in the home. Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 16 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, 29 & 30 The home was sufficiently spacious, comfortable, clean and generally well maintained, though some work was needed on the house and garden. Mobility aids were in place but a walking frame needed attention. EVIDENCE: Bedrooms were sufficiently spacious and highly personalised. The double room needed some redecoration. Given the spacious kitchen, there was adequate communal space for four service users, though the lounge was relatively small for four service users. The appearance of the lounge carpet had recently been improved by professional cleaning but it was faded/marked in places and needed to be replaced. The lounge suite needed recovering/replacement. The toilet seat in the main bathroom needed repairing or replacing and this was drawn to the attention of the manager. There was still no office or private facilities for staff supervision or other meetings. (see requirements 6 & 7 and recommendations 6 & 7) The garden was attractive with flowers and mobiles but external paintwork and broken brickwork in the garden still needed attention. (see recommendations 8 & 9) Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 17 All parts of the home appeared to be clean and there were no offensive odours. Tracking hoists and a mobile hoist were in place, along with the necessary aids in the main bathroom. One service user used a walking frame and the padded top of this needed attention. (see requirement 8) Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35 & 36 The permanent staff team was very depleted and had done well to maintain a good service, with the support of seconded staff. NVQ and update core training had fallen behind and staff supervision needed to be more regular. EVIDENCE: Two additional support workers had left the home since the last inspection and there were now 4.5 vacancies. There were only three support workers in post, one of whom had been off sick for some time, in addition to the manager and senior support worker. The manager and permanent staff team are to be commended for maintaining a good standard of care to service users during such a difficult period. However, the service given had inevitably been affected by the staffing situation, as mentioned under previous standards. Four new staff had been appointed but were not yet ready to start work. Two staff had been seconded from another MCCH home to join the staff team for up to six months. Bank and agency staff were regularly used to cover shifts but most were said to be familiar with the home, as on the day of inspection. It is important that MCCH takes all possible steps to reduce the turnover of staff and staff shortages, such as reviewing salary levels and other conditions of service, together with the recruitment strategy and process. (see recommendation 11) Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 19 Update training for staff in fire safety and moving and handling was still overdue and arrangements need to be made to provide this. The senior support worker had an NVQ 3 qualification but the three permanent support workers in post had not done NVQ training. Staff recruitment records were seen at the last inspection, when it was noted that there were no recruitment records kept in the home for one member of staff. This record was still not complete. (see requirements 9 & 10 and recommendation 10) Staff spoken to said they had been well supported in their work by the manager and senior support worker. Staff had received 1:1 supervision, though this had not been sufficiently regular for all staff, due to the staffing situation. (see recommendation 12) Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 20 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 & 42 The home was well managed and the health and safety of service users had been protected. Information about MCCH’s monitoring of the service is needed. EVIDENCE: The home had been well managed during a difficult period by an able manager and senior support worker. An office was badly needed, to provide more space for the organisation and storage of records and for staff supervision. Evidence that the views of service users underpin all self-monitoring, review and development by the home, was not available and MCCH are asked to provide this. Monthly visits had been made to the home since the last inspection, apart from in July. (see requirement 11 and recommendation 13) Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 21 The building appeared to be safe and no hazards or risks to the safety of service users were identified. The manager said that the annual check of the electrical equipment had recently been carried out and that hoists had been regularly serviced and checked. Records showed that fire equipment had been regularly tested and checked and that fire drills had been held at the correct intervals. Food was properly labelled and stored and fridge/freezer temperatures had been monitored. Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score Standard No 22 23 Score X 3 X X 1 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X 2 3 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 2 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Fen Grove (76) Score X 2 2 x Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X 3 x DS0000038222.V255213.R01.S.doc Version 5.0 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA5 Regulation 5 Requirement Service users must have a copy of their agreement, specifying the terms and conditions between the home and the service user. The format for this agreement should include all matters listed under this standard. (This matter has been outstanding since April 2002). A system must be established to prevent service users’ hospital appointments being overlooked. Service users’ health care appointments and their outcomes must be recorded. Risk assessments of the possibility of pressure ulcers developing must be carried out and recorded, where indicated and all possible steps taken to reduce any risk. Sufficient stocks of prescribed medication must be retained in the home. Adequate office facilities must be provided in the home. This should include additional storage facilities for records, facilities for staff supervision, meetings and administrative work. (Previous DS0000038222.V255213.R01.S.doc Timescale for action 01/12/05 2 3 4 YA19 YA19 YA19 13(1) 13(1) 13(1) 01/12/05 01/12/05 01/12/05 5 6 YA20 YA24 13(2) 23(1) 05/10/05 01/02/06 Fen Grove (76) Version 5.0 Page 24 7 8 9 YA24 YA29 YA34 23(2) 23(2) 17 10 11 YA35 YA39 18(1) 26 timescale of 01/05/05 not met & most recent timescale of 01/12/05 not yet reached) The toilet seat in the bathroom must be repaired/replaced. The service user’s walking frame must be repaired. Those documents relating to the recruitment of staff listed under schedule 3 to the regulations, must be retained in the home. (Previous timescale of 01/09/05 not met) Update training must be provided for staff. Monthly, reported visits must be made to the home by the provider. 11/10/05 01/12/05 01/12/05 01/12/05 01/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA2 YA7 Good Practice Recommendations Service users’ planning meetings should be held six monthly and at times at times convenient for service users. Further work on developing communication should be undertaken, once the home is fully staffed, in order to assist service users in making and communicating their choices and decisions. Service users should be given the opportunity to participate in more leisure time activities outside the home and in line with their individual activity plans. Staff should support service users in increasing their involvement with the local community, when the home has a full, permanent staff group. Service users should be weighed regularly. The lounge carpet should be replaced and the suite should be recovered/replaced. The double bedroom should be redecorated. The broken brick area in the rear garden should be repaired/removed. DS0000038222.V255213.R01.S.doc Version 5.0 Page 25 3 4 5 6 7 8 YA12 YA13 YA19 YA24 YA24 YA24 Fen Grove (76) 9 10 11 YA24 YA32 YA33 12 13 YA36 YA39 The external paintwork should be attended to. Staff should be encouraged to undertake NVQ training. MCCH should take every possible step to reduce the turnover of staff and staff shortages, such as reviewing salary levels and other conditions of service, together with the recruitment strategy and process. Staff should receive formal 1:1 supervision at least three monthly. MCCH are asked to provide CSCI with information about the self-monitoring, review and proposed development of the home and the ways in which service users views underpin this. Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Fen Grove (76) DS0000038222.V255213.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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