Inspection on 02/05/07 for Garrards Road 25

This inspection was carried out on 2nd May 2007.

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

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

Other inspections for this house

Garrards Road 25 08/09/09

Garrards Road 25 02/09/08

Garrards Road 25 09/01/08

Garrards Road 25 28/07/06

Garrards Road 25 12/01/06

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

CARE HOME ADULTS 18-65 Garrards Road 25 Streatham London SW16 1JS Lead Inspector Sonia McKay Unannounced Inspection 2nd May 2007 10:00 Garrards Road 25 DS0000065068.V338009.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 Garrards Road 25 DS0000065068.V338009.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. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garrards Road 25 Address Streatham London SW16 1JS 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) 020 8696 6775 020 8696 6773 joanbone@caretech-uk.com Caretech Community Services Ms Caroline Mordi Care Home 12 Category(ies) of Learning disability (12), Physical disability (6) registration, with number of places Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st January 2007 Brief Description of the Service: Garrards Road is a residential care home registered to provide care and accommodation for twelve people with a learning disability aged between 18 and 65 years. The home is set in it’s own grounds facing a large park with a lido. Ramps and handrails are available at the entrance to the ground floor. It is conveniently located for public transport and for local shopping areas. The home is divided into three units. All are self-contained with separate entrances to each. The ground floor is for six people with physical disabilities with varying degrees of learning disability. The first floor offers accommodation to four people with a learning disability and other complex needs such as mental health difficulties. The second floor offers accommodation to two service users with learning disabilities. The home has use of a vehicle and employs a support worker/driver to assist with the numerous journeys back and forth to the various day services/activities attended. Prospective residents are given a copy of the Service Users Guide that gives information about the home and the services provided. A copy of the most recent CSCI inspection report is available in the home on request. Fees range from £1275.00 to £1763.71 per week and depend on the individual care needs of each service user. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out over four days by one inspector. It involved talking with the newly appointed home manager, people using the service and staff on duty and also observing day-to-day activity. Records relating to care, training and health and safety were examined and there was a tour of the premises. The purpose of the inspection was to examine key areas of service provision. Since the last key inspection in July 2006 there have been two additional inspections. These were conducted on 7th November 2006 and 31st January 2007. The CSCI Pharmacist inspector examined the homes handling of medication in July 2006 and January 2007. Reference to the outcomes of these visits is made in this report. A high number of adult protection alerts in 2006 resulted in increased monitoring of this service by the Commission and the local authority Safeguarding Adults team. The local authority are currently holding monitoring meetings attended by Senior CareTech management, local authority Care Managers from Boroughs who are placing people in the home, Health Professionals, Advocates and the Commission. These monitoring meetings are ongoing at this time. As part of the monitoring of the safety of the service, local authorities were asked to undertake full reviews of the service provided to each person living in the home. Placing authorities and advocates provided feedback about recent meetings with each person living in the home about how the placement is going for them. The Commission served notice of the proposal to impose a condition of registration that prohibits the home from admitting any new residents in February 2007. What the service does well: What has improved since the last inspection? A new home manager has been appointed and there is improvement in staff training. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 6 Staff training has increased and staff are meeting more often as a team and with their line manager. Staff morale has improved. The kitchen door is now automatic allowing access for residents who use wheelchairs. The vetting of staff during recruitment has improved. Staff have been moved around in the home so that staff with relevant training are now working in the area of the home that best suit their experience and skill. 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. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Information provided to people who are using the service must be revised to include more information about fees and current staffing. The aspirations and needs of prospective service users have not been fully assessed before they move into the home and prospective residents cannot be confident that any challenging or complex behavioural needs can be met. EVIDENCE: There is an informative Statement of Purpose and Service Users Guide. These documents were reviewed in January 2006 and must be revised to include up to date information about staffing and the handling of complaints. (See requirement 1) The information provided to people using the service must be revised in accordance with recent changes in the Care Homes Regulations of 2001 that came into force in September 2006. The ‘Service Users guide and associated individual contracts must provide greater detail relating to the standard package of services provided. The terms and conditions (including fee levels) that apply to key services (both personal Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 9 care and food) and the payment arrangements (resident contribution/local authority contribution) must be stipulated. The guide must also state whether the terms and conditions (including fees) would be different in circumstances where a person’s care is funded, in whole or in part, by someone other than the resident. (See requirement 2) No new people have moved into the home since the last key inspection in July 2006. The manager described the process for assessing the needs of individuals referred to the service. Resettlement staff at the CareTech central office request a copy of the Local Authority care needs assessment, care plan and any specialist assessments. If the central office identifies a vacant placement in a suitable CareTech service, a CareTech resettlement officer and the home manager then visit the person referred and complete their own care needs assessment. The person referred is given an opportunity to visit the service to experience life in the home and to get to know staff and other people living in the home. When a new person moves into the home there is a three-month trial period after which the suitability of the placement is examined. During the last ten months there has been concern from local authorities that the assessed needs and risks posed to people living in the home have not been fully assessed and addressed. Issues of client compatibility have also been of concern. For example, one person, who has since moved to another service, exhibited behaviours that posed a risk to other people using the service. Another resident, who has since moved to another service, had dangerous behaviours that were not well managed resulting in an injury. Matters relating to this incident are the subject of an ongoing complaint. It is essential that care needs and risks be fully investigated when a person is first referred for a placement in the home. The person referred must have an opportunity to understand and discuss any restrictions on choices they may make or on their freedom whilst they are living in the home. Relevant health and social care needs and associated risks must be understood and documented so that an assessment can be made of the ability of the service to meet a persons needs. (See requirement 3) Evidence gathered during the January inspection indicated a need for rapid improvement in the vetting of new staff during recruitment, staff supervision and staff training. CareTech took immediate action to assess the recruitment, training needs and skills of each member of staff and to move staff to a work environment better suited to individual skills, training and experience. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 10 This is a particular concern on the first and second floors of the home that offer accommodation and support to people with a learning disability, secondary mental health issues and/or complex behavioural needs. The Lambeth Learning Disability Partnership undertook an audit of the complex needs service in late 2006 and produced a report in January 2007. The report’s findings were that there were a number of areas where action was required. These included: the need for a consistent staff team; the need for staff support, training and supervision; the need for staff to understand challenging behaviour; the need to assess and manage risk appropriately; and, to implement individually tailored support and planning for each service user. CareTech have appointed a small team of senior managers to project manage the change and improvement programme. Occupancy contracts now identify which particular bedroom will be occupied under the agreement, as required in the previous inspection report. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although planning with people has improved, each persons personal life goals are not yet fully reflected in written plans for each person and risk assessment must be better developed to ensure that staff fully understand how to support greater independence for each person. EVIDENCE: Each person has a set of documents called Individual Support Requirements. These plans are written in the first person, for example, How I want staff to assist me and How I dont want staff to treat me. The areas covered in these plans include brief but salient information about: • Preferred sleep patterns and any support needed • Personal care • Continence needs • Communication • Nutrition Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 12 • • • • • Daytime activities Household chores Mobility needs Religious and cultural needs Relationships and emotional support During the previous key inspection it was noted that care plans did not cover all areas of care need identified and did not include recommendations made by health professional in some cases. A requirement was made to ensure that care plans are sufficiently detailed to reflect the changing needs of each person. Although there is progress in the area of care planning there are no clear goals identified for some service users. The new home manager and staff are in the process of developing person centred plans and associated goals with each service user. Current plans are incomplete, for example there is little information about cultural and faith needs. (See requirement 4) People need and receive varying levels of support to make decisions. Two service users have advocates who visit them regularly and address issues with the service on the person’s behalf if necessary. There is evidence in minutes of residents meetings that service users make decisions about activities and menu choices. Observation of interaction between staff and service user provided evidence that service users are encouraged to make decisions where possible. People who live in the home receive varying levels of support with managing their finances. A requirement was made to ensure that the nature of and reason for the support required be documented. Initial drafts of these individual financial support plans are in place for each person, but on reviewing these documents with the home manager during this inspection, it is noted that there are areas of financial support are in need of review to ensure that residents finances are adequately protected. (See requirement 5) In December 2006, one resident, who has since been moved from the service, sustained injury during an episode of challenging behaviour and property damage in his bedroom. The resident was known to damage property and play out dangerous behaviour, suggesting a failure to adequately assess environmental risks, such as window glass in bedrooms. Given that the first floor unit is described as being ‘designed for people with challenging behaviour’ it would be expected that these environmental factors would be considered and appropriate action taken. The glass has since been strengthened. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 13 Each resident has a range of risk assessment papers, although an overall audit tool identifying areas of risk to consider is not in place. As a result of a previous requirement, risk assessments that are in place have been reviewed recently and additional risk assessments have been written after specific incidents, for example, when a resident tried to get out of a moving vehicle. Discussion with staff indicates that not all risks are fully documented and staff on duty did not understand a risk assessment relating to one resident who is at risk of absconding during fire alarm testing or evacuation drills. Staff must be aware of all of the risks posed to residents to ensure their safety. There are no risk assessments in place in regard to moving residents who need assistance with transfers and no assessment of the risks relating to the prevention of pressure sores. Although it is noted that there is no record of the occurrence of any pressure sores, it is essential that staff are aware of what to be aware of and what to do if they notice any change in a persons skin condition in a risk area. (See requirement 6 and recommendation 1) Confidential records about residents are stored securely in lockable staff offices on the ground floor. Garrards Road 25 DS0000065068.V338009.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): 12, 13, 14, 15, 16 & 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are opportunities for people to take part in community and some household activities and leisure pursuits and to maintain friendships and relationships with family and friends. Residents enjoy their meals, which are nutritionally balanced and culturally appropriate. EVIDENCE: The seven people currently using this service are involved in a variety of daytime activities; these include attending day centres, college courses, supported employment training and personal and household shopping. Each person requires staff support to go out in the community. The home has two house vehicles that are wheelchair accessible to assist with transportation and a driver is usually on duty each day. Use of the vehicles has to be carefully planned to ensure that each resident attends planned appointments and activities. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 15 Staff also support residents to take part in community based leisure activities that include swimming, trips to the seaside and other places of interest such as cinemas, pubs and clubs. During the course of the inspection residents were observed to be involved in a range of activities that included attending a college course for work experience, household and personal shopping, going to an evening social club, garden games and watching television. Group outings are discussed and decided upon during residents meetings. One resident said “ I like football and going to the disco and club”. Another resident uses the dial-a ride taxi service to go out and see friends and is planning a trip to a live wrestling match and a holiday. She said, “ I am happy here”. Feedback from a recent placement review is positive overall but highlights a need for the service to offer more opportunities for skills development and interests such as Internet access. One resident said, “I cry when I stay indoors I want to go out more”. There has been difficulty in arranging a placement at a day service. On the day of the inspection a member of staff was working on a weekly activities planner with the resident, to enable her to plan trips and activities for the coming week. One ground floor resident said that he wants to live somewhere else and that he is bored and lonely at times, missing friends from his previous home and residents that have moved out recently. (See recommendations 2 & 3) There are now three residents living on the ground floor, three residents have moved out since the last key inspection. One resident had ‘one to one’ staffing. There is generally less going on each day and fewer people around to have chat with. There are four residents living on the first and second floor. One resident has moved out since the key inspection visit. Staff working on the first and second floors support one resident who presents particularly challenging ritualised behaviour whilst out in the community. This has led to incidents in cinemas, restaurants and parks that have resulted in the resident from being banned from returning. The placing authority and health professional involved have met with the staff each month to discuss current issues and an alternative placement, better able to support the persons needs, is currently being sought. Finding suitable activities for this person, who is keen to go out, as much as possible, is proving challenging for staff. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 16 There are no set times for getting up or going to bed. Residents generally wake when they choose and at a time suitable for the days activities ahead. Some residents need assistance to read and understand letters and written guidance is available on how this is to be done with each person. Residents move around the floor on which they are living freely, and some use the keypad security entry system if they are able. Some residents cannot go out without staff support or are at risk of absconding and the keypad system provides additional security. Residents are encouraged to take part in household chores such as shopping and tidying up their bedrooms, although written information about what chores each person are able and willing to complete is vague. Visitors are welcomed and some residents maintain relationships with family and friends by visits and telephone calls. Meals are flexibly timed and are served in the dining areas on each of the three floors. Records indicate that residents choose a range of dishes. Breakfasts are individually chosen and some residents are encouraged to prepare these meals themselves. Meals are nutritionally balanced and reflect the cultural needs of the residents accommodated. The ground floor dining area has improved accessibility for people using a wheelchair, although the kitchen equipment us not yet accessible. Advice is being sought from an Occupational therapist on how accessibility can be achieved. (See requirements 13 & 14) Garrards Road 25 DS0000065068.V338009.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 & 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Steps are taken to ensure that residents receive personal care in the way they require but more must be done to ensure that they receive personal care, as they prefer. Physical health care needs are not adequately documented to ensure continuity of health care. Continued problems with medication handling indicate that current systems do not provide adequate safeguards for residents. EVIDENCE: Residents require varying levels of staff support to maintain their personal grooming. This ranges from full support to verbal prompting. Personal care is provided in private, either in bedrooms or in bathrooms. Staffing is planned to have both male and female staff are on duty to provide ‘same gender’ support. Personal care assistance being requested from the first or second floor staff team if necessary because of staff absence. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 18 Some residents have complained about not receiving same gender support with personal care at times when two members of staff are needed to assist with transferring a person. One resident has recently complained about the way his personal care is supported by staff. Guidelines for how each person wishes to be assisted with washing and bathing are in place, but must be better developed, with the input of each person, to ensure that staff have adequate written information about personal preferences. (See requirement 7) Another resident spoke happily about being able to go back to a hair salon of her choice to have her hair treated and braided. There is a designated key worker system in place, although changes in staffing have resulted in frequent changes. On occasions when additional staff are required they are supplied via an agency or a bank system. All residents are registered with a local GP practice and each resident has a document called a Health Action Plan. These documents are at different stages of completion. Residents are encouraged to own and complete these documents with support from staff. This is good practice. These documents should be completed with the input or advice from relevant health professionals. (See requirement 8) One resident was unwell during the inspection and staff quickly booked a GP appointment. Another resident was scheduled to visit a physiotherapist but declined to attend the appointment. Records of health care for two residents show that recording is incomplete in some cases, for example, records of appointment outcomes could not be located and essential health information given by a dietician has not been included in a nutritional care plan. This does not provide residents with continuity of healthcare. (See requirement 8) One resident is described as being at risk of developing pressure sores and in need of a visual check of skin health during personal care. This is not mentioned in a personal care plan and it is not clear how this is being monitored or whether staff have been advised of the changes in skin condition to be aware of and what action to take. (See requirement 8) ‘Read and Sign’ documents are in place in each persons file alongside various guidelines for working with people and supporting their needs. Staff are Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 19 required to sign to acknowledge that they have read and understood each guideline. Examination of these documents indicates that in some cases staff had read and signed a document before it was written. This brings into question the validity and effectiveness of the system. One service user uses a positive airflow mask at night to assist her to breathe. A requirement was made in the previous inspection report for clear guidance and staff training in the use of this equipment. A detailed care plan is now in place around use, operation and maintenance of the equipment, where to get replacements and the care of masks. The Commission pharmacist completed an inspection on 28th July 2006 and made a requirement for improved handling of medications. Although there was evidence that residents had been receiving their medicines regularly, quality in this area was poor overall as there were issues with recording and stock control which could put residents at risk. The following areas of improvement were required: • Medication Administration Record charts must accurately reflect the dose being given • All medicines and MAR charts must carry full instructions for use • All changes, for example, stopping a medicine, must be authorised by the Prescriber, and indicated on the MAR chart • If a medicine is not received with the monthly supplies, this must be queried with the Pharmacy and the Prescriber • Unused medicine must be returned on a regular basis • Medicines must be stored at the correct temperatures • Medication audits and stock checks must be carried out regularly to pick up and address issues The CSCI Pharmacist inspected the service again on 11th January 2007 and noted the following: Residents are receiving their medicines regularly, and quality in this area has improved, however there are some continuing issues with recording and storage. The service was required to ensure that the administration and control of medicines be improved, in particular: • Medicines must be stored at the correct temperatures • Medication audits and stock checks must be carried out regularly to pick up and address issues • All prescribed items are entered onto the record the day they are received • Ensuring that there is a record of use for all prescribed medicines. • Ensuring that quantities of medicines brought forward from the previous month are added to the medicines record to provide a complete audit trail and to enable a stock check to be carried out. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 20 Progress was again examined during a random inspection of the service on 31st January 2007 when it was noted that these issues had been addressed but there was no evidence that staff had been assessed as competent to administer medication after receiving medication training. A requirement was made to provide evidence of individual staff competence. During this inspection visit, a member of staff identified a problem with medications stored on the first floor. Stock audits are not being conducted on the ground floor. The home manager completed a detailed audit of medication handling throughout the home immediately and identified a number of problems: • 3 prescribed medications were not in stock for one resident • 2 prescribed medications were not in stock for another resident • 6 tablets of medication prescribed for one other resident are missing and unaccounted for • The ‘opening date’ for a prescribed liquid eye medication had been recorded incorrectly, making the ‘use-by’ date inaccurate • One medication was being administered to a resident at the wrong time • One medication had been administered to a resident without a record being kept on one occasion The home manager took immediate action to obtain medications that were out of stock, revise written procedures in regards to stock checking and reordering and commence an investigation into the missing tablets. (See requirement 9) During this inspection it was also noted that an acting manager (who no longer works in the home) had completed an assessment of the competence of individual staff in regards to medication handling. Given the problems identified in the most recent audit it is essential that staff are adequately trained and assessed as competent by a qualified person before they administer medication to residents. (See requirement 10) Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service has not maintained a record of complaints and details of how they have been resolved. Concern for the safety of residents has been such that there is close monitoring of the service by the Local Authority under Safeguarding Adults protocols. There is a need to develop and deliver staff training that will ensure that staff can understand and appropriately deal with the sometimes complex and challenging needs of some of the residents. EVIDENCE: Information about any complaints that have been made about the service is limited. The records are not up to date in the home and could not be examined in full during this inspection visit. (See requirement 10) Information about complaints was not supplied in the pre-inspection questionnaire completed by the recently appointed home manager. (See requirement 11) Feedback from placing authorities and representatives is that complaints have not been handled well or responded to in a timely fashion. Residents have an opportunity to raise issues and discuss matters in residents meetings, and during the course of the inspection, following advice from an attending Psychologist, residents on the ground floor began having a meeting Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 22 with staff during the afternoon shift change over to ‘handover’ information that they feel to be important about the day. This will be beneficial to two of the residents who complained of feeling bored and lonely. There have been nine adult protection investigations since the last key inspection, and two investigations involving resident’s finances immediately before the last key inspection. During these investigations the registered provider has taken appropriate action to safeguard residents during the investigation by suspending staff if necessary. The outcomes of these investigations have included disciplinary proceedings against staff and dismissal in some cases. The Local Authority Safeguarding Adults team have recently provided the staff team with additional training in protecting vulnerable adults. Comments from professional indicate improved communication from the service in recent months and the service has been notifying authorities correctly when an incident, allegation or accident occurs. Although staff have now nearly all been trained in non violent crisis intervention, there is still concern from professionals involved in the care of the residents that the training provided be more based on understanding the function of behaviours in order to prevent them. The registered provider is currently working with the local specialist health teams to expand the training that staff receive. Feedback from staff about the extra training in supporting people with challenging behaviour that the registered provider has already provided is positive. Although some spoke of feeling worried about the safety of one resident when out in the community as the resident does not recognise dangerous situations and limited physical intervention is sometimes required. (See requirement) During this visit, arrangements to safeguard the cash balances held on behalf of one resident were checked. All money held in safe keeping is stored in a locked safe and the home manager has responsibility for holding the key. Resident’s request cash and a record is kept of money taken. It is noted that valuable documents are also stored in the safe. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the large home is clean, spacious and well furnished, it is not fully accessible to service users with a physical disability. EVIDENCE: The large home is divided into three separate areas. Each area is selfcontained and offers individual spacious bedrooms with en-suite bathrooms that are well decorated and furnished. There is ramped access to the ground floor entrance and a large but poorly maintained front garden that is not wheelchair accessible. Two requirements were made in the July 2006 inspection report in regard to aids and adaptations available to residents living on the ground floor, which is registered for 6 adults with physical disabilities. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 24 Whilst there are recent improvements to the dining room area with an automatic door-opening device, accessible table and some accessible electrical kitchen equipment, an occupational therapists assessment of the premises is not available. Residents who use wheelchairs have limited access to kitchen facilities and no access to the communal garden. This is not in keeping with the stated purpose of the ground floor unit. (See requirements 13 & 14 and recommendation 5) Bathrooms on the ground floor are suitable for people with mobility needs and walk-in showers, shower chairs and a parker bath are available. The first floor unit is poorly ventilated with little airflow; this causes high indoor temperatures on warm days that are uncomfortable for residents and staff. (See recommendation 4) The interior of the property is tastefully decorated throughout, with coordinated colour schemes and the home is clean and hygienic. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There is progress in developing a qualified staff team, although there are areas of training that staff require to equip them to meet the needs of residents. Recruitment procedures now provide residents with adequate protection and staff are better supervised, both as individuals and as a team. EVIDENCE: A random inspection was carried out in January 2007 to assess the adequacy of the staffing arrangements. There was evidence that staff had not been adequately vetted, trained, supported or were not sufficiently experienced to deliver the type of care and support required by residents with complex needs. Urgent action was required to ensure the safety of all residents. New requirements were issued for the registered person to complete an audit of all staff recruitment records, experience and training and take appropriate action. The subsequent providers action plan summarises poor record keeping as a key failure and an undertaking to ensure that all documents checked at head office be copied to personnel files in the home. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 26 Steps were also taken to re-organise staffing within the service so that staff that have been vetted in accordance with safe practice, with relevant training and experience are now available on each floor. This information also informed the current training programme. Examination of three sets of recruitment records during this inspection indicates that essential checks have been carried out. There is also evidence of induction training. There was evidence that staff were not meeting together often enough and staff were being supervised by staff without the necessary experience or training. The provider management team and acting manager at that time re-organised the supervision matrix so that only the acting manager and two deputy managers met with staff for these essential one to one meetings. A log of the meetings that have taken place since January 2007 indicates that the majority of staff are now having regular supervision meetings. However two members of staff, including a deputy manager, have received none at all. Three well-attended team meetings have been held since February 2007 and minutes are available. Senior staff have met together twice in this period. There is no office space on the first or second floors. Staff discuss issues and conduct handover meetings between shifts in a currently vacant bedroom but this issue must be resolved permanently to ensure effective and confidential communication between staff. There is also concern from the local health teams and placing authorities that the training available to equip staff to manage challenging behaviour is inadequate. Discussions are underway as to how these deficits can be met. (See recommendation) A record of recent training indicates training is being provided on a regular basis and a recently increased programme is currently underway. It is noted however that only one member of staff had undertaken training in risk assessment. Given the nature of the service, poor performance in the area of risk assessment and needs of the residents this must be prioritised. (See requirement 15) Only two members of staff have attended training in infection control. All staff must have knowledge of this issue to ensure the safety of both residents and staff. (See requirement 16) Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 27 There are currently 24 staff in the home. 5 of the staff have an NVQ 2 and 4 have an NVQ 3. A further 9 staff are either enrolled to start the course or are currently studying. This is evidence of progress in developing a qualified staff team. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There has been poor continuity of home management and this has impacted and the running of the home. Although an overall quality assurance plan has been developed it is not in place as yet. The registered provider has taken steps to increase the monitoring of the service by a small team of senior managers during the recent drive for improvement. EVIDENCE: There has been no registered manager in the home since August 2006. A series of interim management arrangements were in place until February 2007, when the newly appointed manager was appointed. This has been unsettling for staff and residents. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 29 The manager has experience in a similar care setting, an NVQ 4 and the Registered Managers Award (RMA). An application to register with the Commission has been received and is being processed at this time. An independent assessor has completed three audits of the service provision and made useful recommendations for improvement. Internal monitoring systems in 2006 failed to ensure compliance with regulation and minimum standards of service. The findings of the most recent quality assurance assessment were not available. The registered provider is introducing a new quality assurance approach that is being introduced to this service shortly. Internal monitoring systems in 2006 failed to ensure compliance with regulation and minimum standards of service. There is evidence of increased quality monitoring in recent months in the form of senior managers conducting regular unannounced visits, talking with staff and residents and observing care practice. These checks have been conducted during the day and at night and the results recorded. There are current safety certificates of the professional tests conducted on electrical appliances, electrical circuitry and gas appliances. There is a pest control contract in place and a pest problem is being treated. The LFEPA (Fire Authority) inspected the home in January 2007 and made a number of requirements for action to be taken to improve fire safety in the home. The registered provider action plans states that all areas identified as in need of improvement have now been addressed. Evidence of the revised documents could not be located during the inspection. To be of any value any revised fire information must be circulated appropriately. (See recommendation 6) Fire drills and equipment checks are conducted regularly. Each month a member of staff completes a visual environmental health and safety check and records the results. Hoists and ceiling tracking were being professionally checked on the day of the inspection. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 30 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 1 3 2 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 2 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 2 X 2 X 2 3 X Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 31 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 YA1 Regulation 4 Requirement The registered persons must revise the statement of purpose and include information about staffing and staff training and qualifications. The registered person must revise the service users guide in accordance with recent changes in legislation. The timescale of 30/03/07 for action to be taken to meet this previous requirement is not met. 3. YA2 14 12 The registered person must ensure that the health and social care needs and any associated risks for any person referred be fully assessed and documented. The registered person must develop and agree with each service user an individual plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. 15/06/07 Timescale for action 31/08/07 2. YA1 5 31/08/07 4. YA6 15 29/06/07 Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 32 Although there is progress in developing these plans they are not yet of a suitable standard. The previous timescales of 31/10/06 and 31/03/07 are not fully met. The registered person must 29/06/07 review the nature of support that each service user requires to manage their finances. These arrangements must provide adequate protection from financial abuse and must be documented and reviewed regularly. The registered person must 15/06/07 ensure that a thorough review of risk assessment documentation takes place. Risk assessments must identify clear action to be taken to reduce any identified hazards. The review must: • Take into account each service users health and social care needs • Take into account each service users current life goals and skills development programmes • Take into account each service users occupation and leisure interests • Take into account known behavioural support needs • Include any risks associated with moving and handling support • Include any risks associated with moving and handling equipment, including checks, maintenance and repairs • Include any risk of pressure sores • Be conducted by someone appropriately trained and DS0000065068.V338009.R01.S.doc Version 5.2 Page 33 5. YA7 15 6. YA9 12 13 Garrards Road 25 7. YA18 15 12 8. YA19 12 experienced to undertake such a task • Involve service users, staff and professionals as appropriate The registered persons must ensure that sufficiently detailed guidelines about how each service user wishes to be supported with personal care are developed with the input of each service user. The registered person must ensure that all health care records are kept accurately, contemporaneously and in sufficient detail. Steps must be taken to ensure that staff: • Understand the healthcare needs of all service users including the prevention of pressure sores where relevant • Work with service users and health professionals to make plans for pro-active healthcare • Understand the purpose of the written tools they are using • Understand what information to record, when and how to record it 29/06/07 15/06/07 9. YA20 13(2) 15/06/07 The registered person must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home. Ensuring that: • Prescribed medications are available at all times • Administration of any medication is recorded at the time of administration • Medication is administered at the correct time • Justified stock audits are DS0000065068.V338009.R01.S.doc Version 5.2 Page 34 Garrards Road 25 10. YA20 18 conducted regularly, with recorded outcomes and details of any action taken as a result • ‘First opened’ dates are recorded accurately for medications with finite expiry dates dependant on opening date The registered person must 15/06/07 ensure that there is evidence that staff have been assessed as competent to administer medication. The timescale of 16/02/07 for action to be taken to meet this previous requirement is not met. The registered person must 27/07/07 supply the Commission with a statement containing a summary of the complaints received during the twelve months preceding this inspection and the action taken in response. The registered person must 15/06/07 maintain a record of all complaints made by service users or representatives or relatives of service users or by persons working at the home about the operation of the care home, and the actions taken by the registered person in respect of any such complaint. The registered persons must 31/08/07 ensure that the ground floor kitchen and laundry room are suitable for stated purpose; accessible, meet service users’ individual and collective needs in a comfortable and homely way; and have been designed with reference to relevant guidance. Although there is progress the previous timescale of 31/03/07 is not met. 11. YA22 22(8) 12 YA22 17(2) Sch 4(11) 13. YA24 23 16 Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 35 14. YA29 23 16 15. 16. YA32 YA35 18 18 The registered person must 31/08/07 ensure the provision of environmental adaptations and disability equipment necessary to meet the home’s stated purpose and the individually assessed needs of all service users. Although there is progress the previous timescale of 31/01/07 is not met. The registered person must 30/06/07 ensure that staff receive training in risk assessment. The registered person must 30/06/07 ensure that staff receive training in infection control. 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 YA9 Good Practice Recommendations The registered person should develop a risk audit tool that enables staff to methodically assess risks posed to service users and tracks current risk assessments and review dates. The registered person should provide a wider range of activities available in the home in the communal areas and consider internet access. The registered person should review how staff support residents to maintain and develop friendships and relationships to ensure that residents are being given an appropriate level of support. The registered persons should seek professional advice on increasing the airflow through the first floor unit to prevent high temperatures on hot days and to make the unit a more comfortable living area. The registered person should ensure that an occupational therapist or other suitably qualified therapist completes an assessment of the premises, and that any recommendations made be responded to. DS0000065068.V338009.R01.S.doc Version 5.2 Page 36 2. 3. YA15 YA15 4. YA24 5. YA29 Garrards Road 25 6. YA42 The registered person should circulate any revised fire safety information. Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH 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 Garrards Road 25 DS0000065068.V338009.R01.S.doc Version 5.2 Page 38 - 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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