Inspection on 02/09/08 for Garrards Road 25

This inspection was carried out on 2nd September 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 15 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 09/01/08

Garrards Road 25 02/05/07

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 23/11/2008.

CARE HOME ADULTS 18-65 Garrards Road 25 Streatham London SW16 1JS Lead Inspector Sonia McKay Unannounced Inspection 2 , 4 & 5th September 2008 10:00 nd th Garrards Road 25 DS0000065068.V370545.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.V370545.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.V370545.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 Caretech Community Services Post Vacant Care Home 12 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD 2. Physical Disability - Code PD The maximum number of service users who can be accommodated is: 12 9th January 2008 Date of last inspection 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 and varying degrees of learning disability. The first floor and second floors are separate but are staffed by one team. These floors can provide care and accommodation for six people with a learning disability and behaviours that challenge. 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 Commission inspection report is available in the home on request. Fees currently range from £1125.00 to £1577.06 per week and depend on the individual care needs of the person using the service. Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out over three days. A regulation manager from the Commission joined the inspection on the first day. The methods used to assess the quality of service being provided were: • • • • • • • • • • • • • • • Talking with the newly appointed home manager Looking at the ‘Annual Quality Assurance Audit’ completed by the home manager (this document is sometimes called an ‘AQAA’ and it provides the Commission with information about the service) Talking to staff on duty during the inspection Talking to four of the seven residents A tour of the communal areas of the premises Looking at records about the care provided to three of the residents Looking at records relating to recent staff recruitment and training Looking at the way medicines are handled by staff in the home Looking at issues that the Commission has been notified about since the last inspection and how they were handled Sending surveys to residents, relatives, staff and visiting professionals Completed surveys were received from: Five members of staff Five residents A relative One care manager The Commission would like to thank all who kindly contributed their time, views and experiences to the inspection process. What the service does well: A placing authority care manager said that the staff, “Appear to be caring towards service users and they follow manual handling procedures correctly”. And, “If the service user is able to take medication independently the staff will support them to do so”. . A mother of one of the residents said, “ I think the home is run well. It is always clean and staff are very helpful and all the clients seem quite happy when I see them.” Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 6 One resident nodded positively to a member of staff who assisted him to complete a survey about what he thought of the home. The member of staff noted that the resident nodded positively and signed a ‘thumbs up’ to all the questions asked. Residents were assisted by members of staff to complete the survey that the commission sent to them. Although comments are not recorded in all cases the feedback in the questionnaires is positive. Staff recognise safeguarding issues and raised appropriate alerts. Steps are taken to ensure physical health and there is good reactive healthcare if a resident is unwell. Medication is administered correctly and effort is made to enable residents to be more independent in this area. The ground floor of the home is well decorated and maintained and is suitable for people who use wheelchairs. Their independence may be limited as kitchen facilities are not all accessible. Prospective residents have the information they need to make a decision about whether the home is right for them and they have an opportunity to visit and ‘test drive’ the service before making a decision to move in for a trial period. Residents said that they enjoy the meals served and some are involved in meal preparation. What has improved since the last inspection? What they could do better: A placing authority care manager thought that the service could do more to communicate the service users living in the home in regards to the outcome of investigations into concerns they have raised. Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 7 High staff and manager turnover has caused much disruption to the service and limited the progress of improvement plans and team development. Some of the areas of concern raised in this report have been raised and addressed in recent years and have once again slipped back. Complaints are investigated but may not always result in a correct decision in terms of whether the complaint is substantiated. This affects the actions taken and appropriate action has been delayed when concerns have been raised about staffing levels. Systems to safeguard residents against financial abuse must be revised and strengthened to ensure adequate protection. The first and second floors are in need of refurbishment and the environment is not suitably planned or adapted to meet the needs of people with challenging behaviour. First floor bedrooms and bathrooms are poor and have a bad smell. There are persistent problems with heating and ventilation. Residents have not always received personal care in the way that they require and wish. This may be due to staffing levels and shift planning problems. Residents do not always get the assistance they need to exercise at home. More must be done to ensure that assistance with self-medication is safe and to train staff to administer newly prescribed medications that require less invasive administration. This will be more dignified for the resident concerned. More should be done to ensure thorough assessment of the needs of prospective residents, and to document plans for how these needs will be met. Changing needs and risks are not documented in care plans in some cases. This is potentially dangerous for residents and staff. Residents have moved in and staff are following paperwork from a previous home instead of developing their own. As all of the current residents needs staff support to access the community, adequate staffing levels are essential to allow residents to develop and maintain a quality lifestyle and to maintain a level of community presence. In some instances this is proving difficult. 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.V370545.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 3 & 4. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Prospective residents have the information they need to make a decision about whether the home is right for them and they have an opportunity to visit and ‘test drive’ the service before making a decision to move in for a trial period. More should be done to ensure thorough assessment of the needs of prospective residents, and to document plans for how these needs will be met. EVIDENCE: There is an informative Statement of Purpose and Service Users Guide. The Service Users Guide was reviewed in January 2008. It has information about the fees and what elements of care and support they are for, in accordance with recent changes in legislation, and as required in the previous inspection report. The guide is produced in an ‘easy to read’ format, using plain English with photographs and pictures to make it more accessible to people who may find ‘text only’ documents difficult to understand. The guides include the individual contract arrangements for each person living in the home. There is a process for assessing the needs of individuals referred to the service. Resettlement staff at the CareTech central office request a copy of the Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 10 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 the staff and residents. The annual quality assurance audit (AQAA) states that existing service users are actively encouraged to take part in the pre-placement assessment of any prospective service users. Their thoughts and opinions are recorded and used as part of the decision-making process with regard to suitability. When a new person moves into the home there is a three-month trial period after which the suitability of the placement is reviewed. The Registered Provider agreed to restrict admissions to the home as part of a service improvement strategy being monitored by the Commission and the local authority. Improvement was such that this voluntary embargo was lifted on the ground floor of the home in the later part of 2007; this allowed places to be offered to people with a physical disability. The Registered Provider has continued to restrict any new admissions to the first and ground floor units. The stated purpose of which is to provide care and accommodation to adults with a learning disability and other complex needs, such as mental health problems and emotional difficulties. The stated aims of this unit are still under review. There are currently four residents, two on each of the units. There have been two admissions to the ground floor unit of the home since the last inspection visit. Examination of documentation available for one of the new residents indicates that care needs had been assessed by the home manager before the placement was offered. A local authority ‘community care assessment of need’ is not available, as the placements were offered in an emergency. There are environmental safety issues at the previous home, also owned by the Registered provider. This is not ideal. Care plans for this setting have not been developed. Care plans, based on initial assessment, should be developed with all new residents, and placing authorities involved in all resettlement plans, whether temporary or permanent. (See recommendation 1) Staffing levels had not been increased to reflect the additional time needed to assist with personal care of the new residents. Residents and staff commented that this had made things difficult. Staffing levels were increased by one member of staff over the course of the three days of this inspection. It is recommended that additional staffing needs be better considered during the admissions assessment process. (See recommendation 2) Garrards Road 25 DS0000065068.V370545.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 adequate This judgement has been made using available evidence including a visit to this service. Changing needs and risks are not documented in care plans in some cases. This is potentially dangerous for residents and staff. EVIDENCE: At the time of this inspection care there are numerous files of records for each resident, and information is not easily located. The AQAA states that the home manager assessed that written information available to staff concerning each resident was fragmented. An area that continues to be worked upon, with senior staff meeting to discuss and agree on what information on what depth of information is required for each person. The area manager intends to deliver workshops on maintaining individual record to monitor progress in achieving consistency. A member of staff thought that the care plans could be updated more frequently as peoples needs and wishes may change. Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 12 Care plans are not in place for two new residents who moved into the home because of environmental safety problems at their previous home, which is also owned by the same provider. Care plans and risk assessments from the previous home are being used as an interim measure. Although reviewed most recently in February 2008 in the previous home, new care plans and risk assessments relating to the new placement must be put in place. (See recommendation 2) Care and support plans and risk assessments for a resident on the first floor were examined. These were sufficiently detailed and had been reviewed regularly. Care and support plans for a resident on the third floor were examined. These plans were comprehensive but need rationalising and clarifying, as some areas of uncertainty were identified. These were discussed with the home manager. Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. As all of the current residents needs staff support to access the community, adequate staffing levels are essential to allow residents to develop and maintain a quality lifestyle and to maintain a level of community presence. In some instances this is proving difficult. Residents said that they enjoy the meals served and some are involved in meal preparation. EVIDENCE: 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. Annual holidays have been difficult to organise because of staff turnover. Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 14 During the course of the inspection residents were observed to be involved in a range of activities that included attending a college classes in music, personal shopping, playing games on a computer and watching television. A member of staff thought an area that the service was doing well was in involving service users in the community, planning activities and making service users lives fulfilled. Staffing availability sometimes restricts activity levels and community access. A member of staff commented, “ Some residents that need escort to a day centre or college might not have it if other residents need to be attended to’. During the three days of this inspection staff were observed to struggle to plan shifts that met the support needs of the residents. For example, one ground floor resident, who requires daily physiotherapy, did not have a session until the third day of the inspection. Staff said they knew it should be done each day but they did not have the time. Another ground floor resident was unable to attend a medical appointment. One resident of the first floor was unable to attend a planned swimming trip (despite being asked to prepare for a trip to the swimming pool), as staff on duty did not have appropriate swimwear. A resident of the third floor only left the premises for a brief period during the three days of the inspection. Records show that he is escorted to access the community for a few hours on one day of each week to buy personal items, such as toiletries, from the local shops. A recent letter from his psychiatrist states that the resident has ‘significant unmet social care needs’ in the placement. This is because staff have imposed restrictions on his community access as a result of a legal action. Risk assessments state that the resident should only go out in the afternoons with two members of staff. There is no Care Programme Approach (CPA) meeting record available. There are insufficient staff on duty for the resident to be taken out very often. Recent input from the behaviour support team recommends a structured timetable of activities. The resident was observed to spend most of his time watching television and sitting in a communal lounge on the first floor. Discussion with the home manager indicates that there is a lack of clarity as to what the resident should or should not be allowed to do. Examination of documents on file highlighted a need for clarification from the court, social work review of the issues, the possible need for the involvement of an advocate and an increase in the current staffing levels to meet his current unmet social needs. (See recommendation) Visitors are welcomed and some residents maintain relationships with family and friends by visits and telephone calls. Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 15 There are no set times for getting up or going to bed. Residents generally wake when they choose and/or are prompted to wake at a time suitable for their planned daytime activity. Residents move around the floor on which they are living freely, and some use the keypad security exit/entry system if they are able and if it is safe for them to do so. Residents are encouraged to take part in household chores such as cooking, shopping and tidying up their bedrooms. 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 individually and some residents are encouraged to prepare these meals themselves. Meals are nutritionally balanced and reflect the cultural needs of the residents accommodated. Food stocks were ample and contained fresh produce that was stored and labelled correctly. A record is kept of what each person eats. The ground floor kitchen/dining area has accessible worktops and tables for residents who use wheelchairs. Main kitchen appliances (cooker, sink and fridge) are not accessible to people who use wheelchairs, so the kitchen is not currently suitable for people who can cook independently. It also limits opportunity for the skills development of current residents. Advice has been sought from an occupational therapist on how accessibility can be improved, although progress towards greater accessibility is limited. The middle floor kitchen door is no longer locked (during the last inspection it was locked), but the kitchen is now only used to prepare snacks that do not need cooking. Staff said that a resident is displaying behaviour that has resulted in the first floor communal kitchen being deemed unhygienic. Meals are prepared in the top floor kitchen and carried down to the first floor residents instead. Garrards Road 25 DS0000065068.V370545.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents have not always received personal care in the way that they require and wish. This may be due to staffing levels and shift planning problems. Steps are taken to ensure physical health and there is good reactive healthcare if a resident is unwell. Residents do not always get the assistance they need to exercise at home. Medication is administered correctly and effort is made to enable residents to be more independent in this area. More must be done to ensure that practise is safe and as dignified as possible. 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. There are wellequipped bathrooms on the ground floor and hoists and ceiling tracks available for assisting residents with a mobility need. Staffing is planned to have both male and female staff are on duty to provide ‘same gender’ support. Guidelines for how each person wishes to be assisted with washing and bathing are in place. Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 17 Assisted personal care has been challenging for staff, as residents on the ground floor often need two members of staff to assist with moving and lifting. Staff from the first and second floors have often been telephoned to come down to the ground floor to assist ground floor staff in meeting the personal care needs of the current residents. This has led to complaints from residents and a safeguarding referral in regard to potential neglect. A resident said, “It is difficult for me. Staff are busy, I know that. They need someone in the dining room. If I need to go to the toilet I can’t always wait for them. Something should be done!” Staffing levels of concern to one placing authority. A care manager commented, “ I feel at present there are too many people who require a higher level of support, especially around morning and night time when attending to personal care needs. If two people are to support with transferring service users via the hoist this leaves one staff member with three other service users”. A member of staff commented, “We need enough staff to support service users at all times because at times some of them need one to one or two to one support which is not available at all times”. Staff on all floors said that shifts had been difficult to plan, because of this. Staff on the first and second floors said that having to leave residents to go downstairs to assist staff on the ground floor had caused disruption to early morning routines. It is noted that some first and second floor residents are autistic and require structured and consistent routines to enable them to get ready for the day effectively. There are also incidents of challenging behaviour that require staff supervision to maintain safety. This may be compromised by reducing the staff available on these floors. (See requirements 1 & 2) 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. There is up to date contact information about who is involved in each person’s health care. Staff maintain a record of each persons healthcare needs and the outcomes of any appointments. These records are organised to make it possible to track each person’s healthcare. Records indicate that residents attend a range of health checks and hospital appointments. All are registered with a dentist and an optician. Records indicate that medical advise is taken when residents show signs of being unwell and staff on duty were able to describe how residents with communication difficulties show signs of pain and ill health. Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 18 During this inspection it is noted that one ground floor resident had indoor physiotherapy on only one of the three days (guidelines are that this is exercise is required each day). Another ground floor resident was unable to attend a physiotherapy appointment, as there was not enough time for staff to take him. As noted in the previous inspection report, there is a need for better integration of the person centred health action plans with existing health planning and recording systems, to avoid confusion, replication or omission, and to ensure that the health action plans are subject to regular review. The new manager is currently reorganising records. (See requirement 3) A placing authority care manager said that the staff, “Appear to be caring towards service users and they follow manual handling procedures correctly”. And, “If the service user is able to take medication independently the staff will support them to do so”. Each floor of the home has a lockable medication storage area. The temperature is checked and recorded on a regular basis. Recordings indicate that medications are stored within safe temperature limits. Staff do not administer medication until they have bee trained and assessed as competent. Examination of medication stocks and records on the ground floor and the first floor of the home indicate that: • All prescribed medications are in stock • Medication Administration Records are up to date with no gaps in signature recording • Examination of medication stored in blister packs correlated with records of medication administration, indicating that medication is being administered at the correct time • Justified stock checks of tablets happen regularly and the results are recorded • There are no controlled drugs in use although adequate storage is available if they are prescribed One resident aims to be more independent with taking her medication. It was noted that the medication is given up to two hours (8.00am) before the resident takes it herself (usually with a drink at about 10.00am). During this period the medication is left in a medication pot on a bedside cabinet in an open bedroom. This is not safe. Staff have made an entry on the MAR chart (A dot) to record that the medication has been put in the residents bedroom but not taken yet. Staff on duty said that they did this at 8.00am because the medication sheet said 8.00am.This practise should be reviewed to ensure the safety of other people living in the home. Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 19 (See requirement 4) One resident experiences seizures. There are two types of emergency medication prescribed. One that is taken orally and an older type that has to be administered rectally by staff. Both medications are in stock because not all staff have been trained to administer the new medication (including night staff). Staff must all be trained to administer the new medication because this is an option that better preserves the residents dignity. (See requirement 5) Guidelines are in place for the use of ‘As Required’ medications and this includes staff who can authorise the use of medication for emotional and behavioural difficulties. Home remedies are not kept in stock. (See recommendation 4) Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 20 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 adequate This judgement has been made using available evidence including a visit to this service. Complaints are investigated but may not always result in a correct decision in terms of whether the complaint is substantiated. This affects the actions taken and appropriate action has been delayed when concerns have been raised about staffing levels. Staff recognise safeguarding issues and raised appropriate alerts. Systems to safeguard residents against financial abuse must be revised and strengthened to ensure adequate protection. EVIDENCE: The complaints procedure is satisfactory and it is available in a pictorial format, making it easier to understand. Residents who commented said that if they had a complaint they would raise it with the manager and staff. Records indicate that the manager has acted swiftly to recognise possible safeguarding concerns and address a recent complaint from a resident about arrangements for his personal care in the morning. The resident felt that he had had to wait too long for assistance from a member of staff. Some residents attend ‘house’ meetings. These are opportunities for residents to talk about the home and raise issues or concerns, and for them to be discussed and resolved informally. There are two recorded complaints since the last inspection in January 2008. One, from a care manager, about staffing levels on the ground floor being too low. The complaint was unsubstantiated, although these concerns are still evident at this inspection. Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 21 The AQAA states that there have been 20 complaints in the last 12 months. 7 were upheld. Only 80 were resolved within 28 days. The home manager has raised the issue of staffing levels internally and staffing levels were also discussed during a recent monitoring meeting with the Local Authority Safeguarding team. Staffing levels were raised on the ground floor during this inspection. A placing authority care manager thought that the service could do more to communicate with the service users living in the home in regards to the outcome of investigations into concerns they have raised. The home manager and staff have a good understanding of safeguarding procedures and have demonstrated use of the procedures to safeguard residents. Staff have received training and were able to communicate reporting procedures if they were concerned about a safeguarding issue. Residents need assistance to manage their financial affairs and to look after their money. Each resident requires slightly different support based on the need to allow personal preference and as much independence as is safely possible. All money held in safe keeping is stored in a locked safe and the home manager has responsibility for holding the key. Staff have access to a petty cash system that gives them limited access to funds belonging to residents. Records are kept of both systems of safekeeping. Receipts are retained for any money spent on behalf of a resident or where staff support has been required. A spot check showed receipts were accurate and available as recorded. It is noted that valuable items and documents held in safekeeping are not currently recorded (cheque books and bank cards). This is unsafe. A resident was given an out of date bankcard to go out shopping with during the inspection. The new bankcard was in the safe. If a record of bankcards and valuable documents was kept this may have been addressed before the inspection. A spot check of cash balances and associated records showed that: • Foreign exchange (such as Euros) is not checked and recorded. This is unsafe • Cash balances did not tally with records of money held on behalf of one resident. The recording system in place is complicated and does not give an accurate record of what is held in the safekeeping of staff (See requirement 6) Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 22 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, 25, 26, 27, 28, 29 & 30. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The ground floor of the home is well decorated and maintained and is suitable for people who use wheelchairs. Their independence may be limited as kitchen facilities are not all accessible. The first and second floors are in need of refurbishment and the environment is not suitably planned or adapted to meet the needs of people with challenging behaviour. First floor bedrooms and bathrooms are poor and have a bad smell. There are persistent problems with heating and ventilation. EVIDENCE: The home is situated in a residential area close to open space, shops, leisure facilities and public transport links. There is off road parking and a large garden. The home is divided into three units; each with it is own entrance. The units are situated on each of the three floors of the home. Each unit is staffed independently. Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 23 There is ramped access to the ground floor entrance and a large, but poorly maintained, front garden. There is limited access to this garden for people who use wheelchairs. Bathrooms on the ground floor are suitable for people with mobility needs and walk-in showers, shower chairs and a parker bath are available. Accessibility is an issue in the kitchen area. An Occupational Therapist assessed the premises and has produced a report identifying how the kitchen can be made fully accessible. Some improvements have been made as a result, for example, the kitchen work surface is larger and accessible to people who use wheelchairs and dining tables are of an appropriate height. During the last inspection it was noted that an automated door providing access to the kitchen/diner was broken. This made it impossible for residents to open the door. The door was repaired but is once again not working and is now wedged open so that residents do not become stranded in the kitchen unable to get out. As this is a fire door there are safety implications. (See requirement 9) The ground floor of the home was clean and tidy. The first and second floors were less so. Bedrooms on the first floor are personalised and well decorated. Furniture is in good repair. A recommendation from the previous inspection has not been implemented and is repeated in this report. 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 5) A recommendation from the previous inspection has not been implemented and is repeated in this report. The Behaviour Support team have provided advice for how a resident can be assisted safely in the first floor kitchen and encouraged to become involved in the preparation of meals and snacks. This advice includes changing the type of cooker in use or fitting it with a protective cover (the cooker has ceramic plates). (See recommendation 6) The kitchen is not currently in use as staff have deemed it to be unhygienic because of the challenging behaviour of a resident. The fridge is in a staff office (currently registered as a bedroom). Four kitchen cabinets are damaged. A fire extinguisher has fallen off the broken wall mount. A dishwasher facia is missing. The ceiling décor is water damaged. The kitchen needs complete refurbishment. The need for this is also highlighted in the AQAA. (See requirement 12) The second floor has a small kitchen, currently being used to prepare meals. Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 24 There is damage from smoke evident around the cooking area and ceiling. (See requirement 11) There is water damage in many areas of the home, caused by a flood from a top floor toilet. (See requirement 11) Free- standing heaters are in use on the top floor and central heating is reported as not working. The top floor was cold. (See requirement 10) This is exacerbated by a broken window opening mechanism on the top floor landing and staircase. The window is open all the time, making the stairs and top floor cold in bad weather. The registered provider has recognised the need for staff on the first and second floors to have a confidential office area and a vacant bedroom has been turned into an office. This means that the home does not currently have the twelve bedrooms it is registered to have. There are currently only eleven bedrooms designated for the use of residents. Two bedrooms on the first floor are occupied and both are in a poor state of repair. Both have en-suite bathrooms with old floor drainage systems. The bathrooms are damp, poorly decorated and have a bad odour. The odour in one bedroom and en-suite bathroom, occupied by a resident who is nonverbal, is most unpleasant. The bad smell must be addressed. (See requirement 7) Both bedrooms have extensive damage to décor, fixtures and furnishings. Both residents have behaviours that can prove challenging to the environment. It is noted that the registered provider has restricted any further admissions to these floors at this time. Furniture is not sufficiently robust or secured and there is significant damage, broken chests of drawers and wardrobes. Net curtains are torn and hanging off. Resident’s clothes are heaped in the bottom of a wardrobe that has no door panels. A bedroom door hinge is broken and the door is damaged. There is a broken toilet seat. (See requirement 8) A first floor bedroom window has been broken and replaced. There are shards of broken glass on a ground floor roof below. The resident was observed to be standing at a window banging the glass and trying to re-hang a torn net curtain during the inspection The new glass should be covered with a protective film so that it stays in place if smashed. Broken glass should be removed. (See recommendation 7) Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 25 Problems with the drainage should be investigated and rectified with advice from the Environmental Health Department. Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 26 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, 33, 34 & 35. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There is limited progress in developing a qualified staff team, and many staff are yet to complete vocational training. Staff turnover remains high. Recruitment practises provide residents with adequate protection. Staffing levels and shift planning are of concern. There are insufficient staff on duty to provide all care as planned at times. EVIDENCE: There are currently 18 full time staff, and six part time staff. Staff turnover remains high. Thirteen members of staff have ceased employment in the home in the last twelve months. This affects consistency and continuity. There are both male and female staff and there is cultural and ethnic diversity, reflecting that of the resident group and local population. A mother of one of the residents said, “ I think the homes run well, it is always clean and staff are very helpful and all the clients seem quite happy when I see them.” Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 27 Only four members of staff have achieved a vocational qualification in care (NVQ at level 2 or above). A further 20 of the staff team are currently undertaking the qualification. Only 16 of staff have been trained in the safe handling of food. As all staff are involved in cooking this must be addressed to ensure good food hygiene. (See recommendation 8) A staff-training programme is in place and there has been significant investment in staff training in the last twelve months. High staff turnover has possibly reduced the impact of the training investment. A member of staff thought that induction training could be improved by better supervision, although thought that the induction that they had ‘mostly’ covered what they needed to know when they started work in the home, and there had been several training sessions which they had found useful. A record of induction examined is incomplete (only day one and week one of employment induction have been recorded) even though the member of staff started work in the home in March 2008. . A member of staff commented, “ Information and communication is vital but at times communication is lost between staff and this really needs to be addressed”. The service could get better at employing the right people to care for the service users “People with more experience”. A member of staff thought that the home provided good training and thought that their training was up to date. Another a member of staff agreed, “ I enjoy training and feel that the training we have received is excellent”. There is a staff-training matrix in place and a range of appropriate training sessions on offer. This includes training in the specific needs and medical conditions that current residents have. Recruitment practise was examined by the Commission provider relationship manager earlier this year. His inspection indicates safe practise in recruitment in terms of checks made and criminal disclosures. Residents are involved in staff recruitment. The manager describes the way that residents are actively involved in the selection of staff in the AQAA (annual quality assurance audit). ‘ The residents show the individual applicants around the home and conduct their own interview. A record of the residents opinions and thoughts is retained in the home as an aid to deciding whether the candidate is suitable for a position within the home’. This is good practice. Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 28 There were two staff on early duty on the ground floor on the first day of the inspection. This had been increased to three members of staff on day two of the inspection. On day three of the inspection the manager had put three members of staff on the late shift on the ground floor also. Inadequate staffing levels has been raised an issue by residents, staff and professionals. Staff were observed to struggle to meet peoples needs and staff planned activities. Some activities are not happening as a result. This includes essential physiotherapy for a resident on the ground floor. A resident on the second floor has significant unmet social needs as a result of inadequate staffing levels. Many residents have additional one to one hours of care to provide support for specific activities or goals. This has proved difficult to coordinate and is not recorded well in shift planning. (See requirement 13) Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 29 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. High staff and manager turnover has caused much disruption to the service and limited the progress of improvement plans and team development. Some of the areas of concern raised in this report have been raised and addressed in recent years and have once again slipped back. EVIDENCE: The previous registered manager left the service to work in another home in the group in February 2008. A new manager is in place but has yet to complete Commission registration to be assessed as a fit person to run the service. There has been significant change in the management of this service in recent years and staff and residents would benefit from a period of stability. There are two deputy managers. Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 30 The new manager has focussed his attention on trying to sort out records in the home, although files are still in need of attention and records are not easily located in some cases. A placing authority care manager commented, “ Managers are approachable and communicate and listen attentively and successfully”, although it is sometimes difficult to get through to the home manager when phoning and no one answers at all. Having e-mail would be an easier form of contact rather than phoning and not getting an answer each time. A member of staff commented, “ The home manager operates an open door policy so even the service users have free access to the manager and they can always express their feelings to him”. Another member of staff said, “ I have a good working relationship with my manager which I feel is very important to maintain a healthy working environment”. Staff member thought that team communication could be improved, “The service could improve by be a more supportive to staff and more open debate to sort out situations between staff”. There is also a new area manager, who visits the service each month in accordance with Regulation 26, to monitor the service on behalf of the registered provider. Copies of the outcomes of these visits are supplied to the manager. The reports produced are adequately detailed. There is a new quality assurance team in place and quality assurance systems are being developed. The previous home manager advised that an audit of the service is underway. There are a range of appropriate health and safety checks in place. This includes the regular checking of the home environment and professional testing of equipment in use at the home. COSHH materials are stored securely (substances hazardous to health, like cleaning and laundry products). Staff receive induction training in safe working practices and there is health and safety policy and procedure in place to provide guidance. Records relating to resident personal finances are inadequate. This was raised in previous inspection reports, was addressed but has again slipped back. There is concern that the environment is not safe enough, in that there is a problem with some of the fire doors (ground floor kitchen, a residents bedroom on the first floor). Fire extinguishers have fallen off and not been replaced (first floor kitchen). Glass may not be sufficiently protected in areas of the home where challenging behaviours are likely to occur. (See requirement 14 and requirements made elsewhere in this report). Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 31 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 3 2 2 3 2 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 1 26 2 27 2 28 2 29 2 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 X 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 2 X 2 2 X Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 32 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. 2. 3. Standard YA18 YA19 YA19 Regulation 12 12(1) 12 15 Requirement Residents must receive appropriate and timely support to maintain their personal care Residents must receive planned physiotherapy sessions. The registered person must ensure that residents individual Health Action Plans are reviewed alongside other documents relating to healthcare planning and recording. The previous timescale of 31/05/08 is not met. Self medication support guidelines must be revised to ensure safe practise for all residents All staff must be trained to administer all prescribed medications (new medication for a resident who experiences frequent and prolonged seizures) There must be accurate records of all money, and valuable items belonging to residents that are held in staff safekeeping. All areas of the home must be free from unpleasant odours. (Specific problem identified in DS0000065068.V370545.R01.S.doc Timescale for action 07/11/08 07/11/08 31/12/08 4. YA20 13(2) 07/11/08 5. YA20 13(2) 31/12/08 6. YA23 17 07/11/08 7. YA24 16(2) 14/11/08 Garrards Road 25 Version 5.2 Page 33 8. YA26 16 9. YA29 YA28 23(2) first floor bedrooms and bathrooms). Each service user must have a bedroom that has furniture and fittings sufficient and suitable to meet individual needs and lifestyles. The registered person must ensure that residents are able to open the ground floor kitchen door. The previous timescale of 29/02/08 is not met. All areas of the home must be adequately heated (top floor central heating not working). Areas of décor damaged by smoke and water must be repaired (ground floor, first floor and second floor). A kitchen on the first floor must be refurbished. At all times there must be suitably qualified, competent and experienced staff working at the home in such numbers as are appropriate for the health and welfare of service users. Fire doors must be in good working order 31/12/08 14/11/08 10. 11. YA24 YA24 23 23 14/11/08 31/12/08 12. 13. YA24 YA33 23 16 18 31/01/09 07/11/08 14. YA42 23 07/11/08 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. 3. Refer to Standard YA2 YA6 YA3 YA16 YA13 Good Practice Recommendations Care plans should be developed for all new residents during their assessment and admission procedure. The need for increased staffing levels should be considered during any resettlement process. The home manager must seek clarification on restrictions imposed on one resident of the second floor, to ensure DS0000065068.V370545.R01.S.doc Version 5.2 Page 34 Garrards Road 25 4. 5. YA20 YA24 6. YA29 YA42 YA24 YA42 YA35 that the residents’ legal rights are protected. The registered person should take medical advice about suitable home remedies, such as analgesics. The registered persons should takes steps to increase the ventilation on the first floor to prevent high temperatures on hot days and to make the unit a more comfortable living area. The registered persons should change the type of cooker in use on the middle floor kitchen or provide a safety cover to prevent residents touching hot ceramic plates. Window and other glass should be protected with film so that shards of glass do not drop out if the glass is smashed. More staff should undertake a vocational qualification in care (NVQ at level 2 or above) and all staff involved in meal preparation should be trained in food hygiene. 7. 8. Garrards Road 25 DS0000065068.V370545.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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.V370545.R01.S.doc Version 5.2 Page 36 - 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. 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