Inspection on 16/05/06 for Garthowen

This inspection was carried out on 16th May 2006.

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 29 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Garthowen 01/10/07

Garthowen 09/05/07

Garthowen 14/11/06

Garthowen 06/01/06

Garthowen 14/06/05

Garthowen 28/01/05

Garthowen 06/08/04

Garthowen 12/02/04

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

CARE HOME ADULTS 18-65 Garthowen 78 Barrowgate Road Chiswick London W4 4QP Lead Inspector Sarah Middleton Unannounced Inspection 16 & 17th May 2006 9:35 th Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 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 Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 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. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Garthowen Address 78 Barrowgate Road Chiswick London W4 4QP 0208 995 9702 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) www.together-uk.org Together Working for Wellbeing Oluminde Ojudun Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th January 2006 Brief Description of the Service: Garthowen is a detached, three storey building situated in a residential area in Chiswick, close to local facilities and transport. The home is registered for twelve service users with mental health problems. The London Borough of Hounslow is the main purchaser and has blocked purchase seven of the bed places. The home is owned and managed by Together Working For Wellbeing. The accommodation has nine single bedrooms on the first floor. There is a selfcontained flat on the ground floor and two flats on the second floor. Service users who are ready to move on to more independent living use the latter. The lounge is a designated smoking room. The dining room can be used as a quiet area in between meals. There are no lifts in the building so it is only suitable for service users with good mobility. Service users are expected to participate in cooking, looking after their own laundry and helping with some domestic tasks around the home. After a settling in period, service users are expected to become more involved in some form of activity outside the house during the day. This is specified in their care plans. Key workers support service users to learn new skills and work in conjunction with other professionals in helping them to move on to independent living. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. Gavin Thomas, Regulation Inspector, assisted Sarah Middleton for two hours on the second day of the inspection. A total of twelve hours, excluding planning time and report writing, was spent on the inspection process. The Inspector carried out a tour of the home and inspected service user plans, staff files and maintenance records. Four service users and three members of staff were spoken with as part of the inspection process. There were no visitors on the days of the inspection. It must be noted that it is sometimes difficult to ascertain the views of the service users with mental health needs. An additional visit on the 29/03/06 was conducted for the purpose of following up the requirements from the previous inspection report and as part of the ongoing monitoring of the home. There had been a serious incident at the home in February 2006. This incident is currently being investigated and handled by the Police. There is also an ongoing complaint also being investigated in relation to this serious incident. The Registered Manager and the Deputy Manager, both of whom were present throughout the inspection days, assisted with the inspection process. All key Standards were inspected at this inspection, several requirements were re-stated from the last inspection and some had been ongoing for several inspections. Seventeen new requirements were made. An immediate requirement was made regarding care plans and risk assessments that needed to be completed on the service user who was on a six-week trial. An immediate requirement was issued regarding providing more detailed risk assessments on all service users. A third immediate requirement was issued regarding providing relevant and necessary training for staff. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The Inspector identified several shortfalls within the home. The main issues were with regard to care plans and risk assessments. These had not been completed on a service user who was on a six-week trial period in the home. Also those care plans and risk assessments that were viewed by the Inspector were not in sufficient detail. One care plan had not been updated since the service user had been admitted. This was of particular concern as this service user has serious health problems and difficulties in motivation and engaging in activities. The Registered Manager and staff, who complete the documentation regarding service users, must consider more carefully exactly what the presenting needs and risks are and record this in detail. This information informs staff how to support and work with the individual service user and alerts staff to any potential risks both to the service user and others. Two immediate requirements were issued relating to the above shortfalls. The Inspector acknowledges that for some service users they can take care of their own personal health needs. There are other service users who cannot or refuse assistance and input from health professionals. Care plans must clearly show individual’s health needs and where they need encouragement and support. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 7 If health needs are not to be addressed risk assessments must be completed detailing how the home will meet its duty of care in monitoring a service user who refuses to take care of their health. Leading on from the above, individual meals must be recorded, wherever possible, especially for any service users who have health/physical care needs. Staff must be confident they are able to monitor service users meals to ensure the home is promoting a healthy, nutritious and well balanced diet for all service users. There are a number of outstanding concerns in relation to the premises. The home is a large old building that potentially could be welcoming and appealing for service users, staff and those who visit it. In it’s current form, it needs appropriate investment into the décor, furnishings and flooring. As it is a large house, the maintenance programme must clearly reflect the work that has been identified as needing to be addressed for the forthcoming year. The shortfalls noted in detail in Standard 24 must be dealt with, as these issues have been ongoing for some time. The Inspector noted that there had been a large leak above a service user’s kitchenette and this was very near to a light fitting. The health and safety of both service users and staff have to be considered at all times and action should have been taken to minimise the risk, for example not using the shower room above the kitchenette and not using the kitchenette until the problem was resolved. Training programmes, although in place, was not clear as to when staff had attended courses. An immediate requirement was made for all staff to attend training and access information regarding how to manage conflict and aggression, and how to support service users with alcohol/drug issues and severe and enduring mental health needs. This must be booked for the next few months for all staff, including relief staff, who currently work regularly in the home, to ensure all staff have received the necessary and relevant training to work effectively in the home. There were several shortfalls in relation to health and safety. Fire drills and the testing of call points had not occurred on a regular basis. Water temperatures had not being taken of all areas of the home where service users have access. The Gas Safety record and the testing for Legionella was also out of date. Evidence must be available regarding ensuring all the bathing and shower facilities have thermostatic controls so that water does not rise above a certain temperature. Health and safety and servicing records must be regularly checked to ensure all necessary and legal procedures are being followed and are up to date. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 8 The home currently aims to provide rehabilitation to service users with the aim for all to move on to more independent accommodation. This was not evident for all service users living in the home. Activities, for some service users were in place, these were mainly for service users who were motivated and able to engage in daily sessions both in the home and out in the community. There must be more evidence to demonstrate how staff promote daily living skills and encouraged service users who have motivational issues. The home should consider if it is to offer a home for service users with long standing chronic mental health needs, who are not likely to gain independent living skills and thus move on to living in the community. The home has had a regular turnover of staff and reasons for this should be considered, by the Registered Manager and Registered Provider. Due to this turnover, NVQ’s had not been taken up by all members of staff as most of them were working through their probation period. Once this is completed all staff must gain a place to begin studying for this qualification. Staffing levels must also be reviewed to ensure the minimum of two members of staff working in the home is sufficient to meet the needs of the service users. The home is large and staff must feel confident and safe to work alone at times and to sleep in the home at night alone. In addition, the Registered Manager must have competent staff working in adequate numbers so that they are able to fulfil their role effectively. The home has many management issues that need to be addressed and the Registered Manager must have the time to complete this work. Medication systems and spot checks on medication must be addressed to ensure staff are aware of the procedures to follow if there is a medication error. Management must be aware of any discrepancies and take appropriate action where necessary. Staff employment files must contain all the required documentation, such as proof of qualifications and a recent photograph of the member of staff. The Registered Manager must check staff files to ensure they are satisfied with the information they receive regarding applicants. The Statement of Purpose and Service Users Guide must be amended, updated and be available for service users, their representatives and for inspection. Finally, the systems in place for reviewing the quality of care in the home need to be more detailed with a clear overall report, preferably an annual report, that can evidence areas that have been reviewed and are working well and areas where there is room for improvement. Service users views must be obtained and included into any report, thus showing how the home has consulted with service users and how their comments will be addressed for the forthcoming year. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 9 The Registered Manager must not carry out monthly Regulation 26 reports, as this must be conducted by an independent person, who visits the home unannounced and records their findings in a monthly report. Copies of these reports must be supplied to the CSCI for monitoring purposes. To conclude, the home has many areas that need urgent action to ensure the home provides a safe, stimulating and welcoming home for the service users. Attention must be paid to the requirements, as many have been re-stated over a number of inspections. 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. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 10 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 Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service Users Guide had not been updated and amended. This shortfall needs to be addressed in order for service users to have accurate information regarding the home. Prospective service users are assessed prior to admission to ensure the home is confident they can meet their needs. Attention needs to be paid on completing care plans and risk assessments on newly admitted service users to ensure staff are aware of the service users needs and any potential risks. Prospective service users are encouraged to visit the home in order for them to make an informed decision about moving in. EVIDENCE: The Statement of Purpose and the Service Users Guide had not been updated and amended and therefore are re-stated requirements. The home had a new service user who was on a six-week trial. Social Services had completed an assessment; a care plan and risk assessment and these were viewed by the Inspector. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 12 In addition the home had also carried out a pre-admission assessment regarding the service user’s abilities and mental health needs. The Registered Manager informed the Inspector that he had devised the pre-admission document, as there had not been one in place. The Inspector made a recommendation that the pre- admission assessment includes the service users cultural and religious needs. The six-week trial period is for staff to assess if they feel the home can meet the service users needs. A review takes place after this period and a decision is then made. The Inspector issued an immediate requirement regarding a lack of documentation on the new service user. The home had not completed their own care plan and risk assessment and were solely using the information that had been sent by the referrer and the information obtained from the pre admission assessment. This immediate requirement is combined with Standard six and the completed care plan and risk assessment is to be forwarded on to the CSCI. The Inspector discussed with the Registered Manager, the importance of beginning the process of completing a care plan and risk assessment on a service user who is on a six week trial, to ensure the home is fully aware of their identified needs and any potential risks and hazards to both themselves and/or to others. As staff become familiar with the service user and their needs, documentation can be added to and altered accordingly. The Inspector was shown on the second day of the inspection a care plan and risk assessment that had now been completed on the new service user. The Registered Manager confirmed that prospective service users and their representatives are encouraged to visit the home, spend some time meeting other service users and members of staff and then overnight stays are then planned. The Inspector asked service users how they had been admitted and they confirmed they had several opportunities to visit the home and stay over night prior to the six-week trial period. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans were in place within the home however work is needed to ensure care plans are completed on new admissions and that they are reviewed on a more regular basis. The documentation on service users is crucial to ensuring staff have up to date detailed information. Service users have the opportunity to make decisions on a daily basis and are supported by staff to do so. Risk assessments are to be more detailed and relevant to the service user in order to safeguard both the service users and others. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 14 EVIDENCE: As noted earlier, an immediate requirement was issued regarding completing care plans on recently admitted service users, see Standard 2 for further details. Furthermore a requirement was made for the home to obtain a photograph of each individual service user, as there were two files viewed where this was not in place. The Inspector viewed a sample of care plans and overall these detailed the service users social and personal care needs. There was an additional part to the care plan that had been added in January 2006 regarding one service user, but as they have complex mental health and physical needs, the overall care plan should have been reviewed earlier, as this had not been done since they had been admitted seven months earlier. A requirement was made for service users needs to be reviewed on a more regular basis. The Inspector spoke with this service user who has motivational problems and does not readily engage in activities. It had been recorded at the last key inspection that this service user had voiced their concerns regarding their mental health. The Inspector spoke with the Registered Manager, with the service users agreement, regarding the discussions that had taken place during this inspection. The service user had expressed various thoughts and feelings regarding their mental health needs and their thoughts on living in the home, in particular since the serious incident that had occurred. The Inspector was informed that this service user was due for a mental health review within the next few weeks and the future of the placement would be looked at during this review. Other care plans outlined service users interests, capabilities and mental health needs. The Inspector was informed that one service user, who occasionally asks to see their care plans and risk assessments, becomes upset if certain things are written about them. The Inspector stressed the importance to the Registered Manager of recording all of a service users history, needs and potential risks. This is imperative for the safety of other service users, staff and visitors. The home may need to consider where particular pieces of information is stored if this causes distress and instability for certain service users. The home operates a keyworker system, where one member of staff is allocated to a service user and meets with them on a regular basis. These meetings enable service users to talk about any issues or concerns they might have. Staff encourage and promote service users to make decisions on a daily basis. The Registered Manager and staff who were spoken with described how the culture within the home is to enable service users to be as independent as possible and to enable service users to feel confident in making choices about their lives. Overall service users manage their finances and staff monitor this area of their lives only if there is cause for concern. One some care plans viewed there was evidence that service users had contributed to what had been written about their identified needs. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 15 Risk assessments were viewed and although they covered some details of service users lives they did not cover some of the potential risks that the Inspector had noted through discussions with staff and service users. For example, most service users smoke in their bedrooms, yet this had not been noted on risk assessments. In addition, one or two service users have on occasion taken illegal substances; again this had not been highlighted as a potential risk to both themselves and others. An immediate requirement was made that all risk assessments must be updated and completed in more detail to cover every possible eventuality. These risk assessments must be forwarded on to the CSCI within the agreed timescale. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Social activities are in place for some service users, but attention to those who do not readily engage in daily activities need to be addressed in order to monitor service users motivation and mental health needs. Service users are encouraged to have regular contact with family and/or friends in order to maintain personal relationships. Service users are promoted to take an active role in preparing and cooking meals for all service users. The service encourages service users to eat a healthy balanced diet in order to maintain optimum positive health. Individual meals need to be recorded as much as possible so that staff can review individual’s choice of food. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 17 EVIDENCE: Social activities are in place for some service users, as they attend day centres, drop in centres and have obtained voluntary work a few days a week. Staff members encourage those service users they feel able to consider taking up voluntary work and support them in identifying suitable places that might offer occupation, social interaction and possibly lead to employment. However the Inspector noted that there are at least three service users who do not engage in daily activities. It was acknowledged with staff that there can be difficulties in motivating and encouraging those service users who might feel anxious, depressed and/or paranoid, however the Inspector spoke with the Registered Manager regarding putting into place a programme of structured activities where staff make a point of spending time with these particular service users and try to offer them some form of small occupation and activity, either in the home or in the community. One member of staff spoken with stated they did not know how to motivate those service users who refuse to take part in activities. Staff must seek ways to share ideas about how to prompt and support service users who struggle to get through the day. Where staff need training or how to motivate and provide rehabilitation sessions, then this should be offered as part of their professional development. The Inspector made a requirement that activities and interactions must be promoted and evidenced on daily records and on the activities board that the home uses, to ensure staff know they must spend some time each day with those service users who do not have daily structured activities. Service users with family and friends are encouraged to visit them or have them visit the home. Service users asked said they could see their family whenever they chose to. Staff were seen to knock before entering service users bedrooms and service users confirmed they have keys to their bedrooms. Service users receive their personal mail. Service users can choose when to be alone and the Registered Manager stated that staff monitor how these service users are if they spend time in their rooms all day. Staff were seen to interact with service users, although at various times during the inspection staff were seen to be in the office and in the back office/sleeping in room on several occasions. Since the serious incident, the Registered Manager stated that one of the major changes is that staff are spending more time out of the office and with service users. He confirmed this is happening on a more regular basis. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 18 Service users prepare and cook a main evening meal once a week and take part in washing up. These duties are delegated at the morning community meetings. Those service users asked said they had to make a meal once a week and that staff supported them if they needed assistance. Most of the service users asked said they enjoyed cooking a meal for everyone. There are several kitchens within the home as there are two for those service users who are encouraged to be independent. These were all viewed and were being maintained satisfactorily, other than one where the ceiling has had a major leak, for further explanation see Standard 24. Main meals are recorded on the menu sheets but the Inspector could not ascertain what individual service users had eaten for breakfast, lunch or if they had eaten an alternative meal at dinnertime. This was discussed with the Registered Manager and a requirement was made for individual meals to be recorded. This is particularly important for those service users whose health and nutrition needs have to be closely monitored. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users receive support and encouragement with their personal care in a way they prefer. Improvements need to be made to demonstrate how service users health needs are to be met in order to promote good health for all service users. The shortfalls identified regarding medication systems are to be addressed to ensure the service users health and safety is safeguarded. EVIDENCE: The Inspector was informed that the majority of service users take care of their personal hygiene. A few service users require prompting and encouragement to change their clothes or to have a bath. Service users are able to make choices regarding when they get up and go to bed. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 20 The Inspector had difficulty in assessing when service users had accessed health services and was informed that this was documented on daily records. The Inspector was told by the Registered Manager that many service users visit health professionals independently and members of staff are not always aware when these visits have occurred. The Inspector was concerned that it was not clear on care plans and where relevant risk assessments, if service users needed support or advice to access health care services. The Inspector made a requirement that health needs must be clearly noted on individual care plans and made a recommendation for the home to consider introducing a system, such as a health form, to record when a service user has had a health appointment or refused to see a health professional. The Inspector discussed with the Registered Manager the need to have the balance between service users right to choice and independence along with the home’s duty of care to support service users and ensure their health needs are met. The Inspector who briefly assisted with this inspection viewed the medication policies, which included information regarding those service users who selfmedicate and found these to be satisfactory. Staff receive training from both the local Pharmacist and through in house training, such as completing a medication competency assessment. Medication systems were tracked and recording sheets were viewed. The medication that is not blistered is counted once a week and recorded. The Inspector viewed these records and it was found that a few days prior to the inspection it had been noted that medication was down on what there should have been. A message had not been left for either the Registered Manager or the Deputy Manager, both of whom had not been aware of this error. In addition a Regulation 37 notifying the CSCI of this mistake had not been completed. A requirement was made that medication systems must be made more robust. Additional medication was checked and counted and was found to be correct. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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. The home has a clear complaints procedure and service users were confident that their complaints would be listened to and acted on. Policies and procedures are in place to protect the service users. As noted earlier in the report, documentation regarding service users need to be in place, detailed and reviewed in order to minimise the risk and harm to the service user and others. EVIDENCE: There had been no record of complaints since the last inspection, other than the ongoing complaint regarding the serious incident that had occurred earlier in the year. The home now has a complaints book in place to clearly record complaints and action taken. The complaints procedure was visible and freely available for service users. Those service users asked stated they would either talk to their keyworker or the Registered Manager if they had a complaint. The home had obtained a copy of the No Secrets guidance document from the Department of Health and informed the Inspector that the Local Authorities Safeguarding Adults co-ordinators had visited the home last year and offered training and information on safeguarding adults. As the staff team had altered over the past months the Inspector advised the Registered Manager to seek a refresher course for existing and new members of staff. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 22 There had been a serious incident regarding two service users earlier in the year and this was currently being appropriately investigated by the relevant professionals, such as the Police and the Registered Providers. This is an ongoing investigation. There have been no other adult protection investigations since the last key inspection. As noted earlier various documentation regarding service users, such as care plans and risk assessments were not always completed, or in sufficient detail or reviewed within an appropriate timescale. This could jeopardise service users health and safety and this is a combined requirement with Standard 6. The majority of service users manage their own finances, however this area was not inspected during this inspection. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26 & 30 Quality in this outcome area is poor. This has been made using available evidence including a visit to this service. There are major shortfalls regarding the environmental standard of the home. Work is needed to ensure the home is well maintained and that maintenance is reviewed and recorded and addressed on a regular basis thus offering a warm, modern and welcoming home for the service users to live in. Service users bedrooms offer the space and privacy they need as and when they require. As noted earlier the home has several areas needing to be addressed regarding the standard of the home and the maintenance department needs to assist the Registered Manager in addressing the requirements regarding the water supplies and fittings to ensure the health and welfare of service users is considered. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 24 EVIDENCE: A tour of the home was carried out and samples of rooms were viewed. Overall these were not well maintained and the Inspector found several areas requiring attention, as follows: • Broken window in ground floor bathroom. • The flooring in the ground floor bathroom must be replaced as it is stained and is unhygienic and unwelcoming. • Room 11 on the first floor, the carpet around the wash basin must be replaced or made good as it is stained and becoming threadbare. • The furniture in room 11, that is currently vacant, must be replaced as it is old and stained/marked with cigarette burns. • In the ground floor kitchenette, attached to room B1 near the main stairs, the leak above this kitchenette must be fixed and the ceiling painted. • The shower room above room B1 must not be used until the leak has been fixed. • The main hall carpet, where there is a large tear must be made good and safe or replaced. • The paintwork, in particular the skirting boards and doorframes all need to be sanded back and re-painted. • Overall the home needs brightening, cleaning and modernising to make it more homely and appealing for those who live, work and visit the home. All of the above is combined into one re-stated requirement. The Registered Provider and the Registered Manager must look at ways to address the ongoing requirements that have been made regarding the poor environmental standard of the home. The Registered Provider must recognise the need to invest in the ongoing maintenance of the home, as these areas will need work and will be assessed continuously by the CSCI. It is recognised the restrictions the Registered Manager has with regards to the major refurbishment of the home that is needed, however he must regularly make checks on the home and monitor the areas needing work. This would form part of the quality assurance reviews that must take place, see Standard 39 for further information relating to this area. There is a maintenance programme in place but this did not include exact dates of work that is to be done and only outlined the short, medium and long-term maintenance plans for the home. This is part of the re-stated requirement that timescales for maintenance must be included in the programme. The garden had recently been cleared by staff and service users and is a welcoming outside space for service users to use during the summer months. The communal lounge and dining area is spacious and offers service users plenty of space to be with others or alone as they so choose. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 25 The home had addressed the cobwebs that had been in the home at the previous inspection. The Inspector viewed a small sample of service users bedrooms. These rooms were lockable and were spacious. The Registered Manager stated they had consulted with the Registered Provider’s maintenance department to try and ascertain if the services and fittings comply with the Water Supply Regulations. However they informed the Inspector that so far they had been unsuccessful in seeking this confirmation. This is a re-stated requirement. The laundry/utility room is separate to the main kitchen and service users have specific days they do their personal laundry. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Work is needed to ensure staff have the opportunities and a place, once they have completed their induction period, to study for an NVQ. The qualification will encourage staff to gain new skills and knowledge in order to meet the needs of the service users. The staffing levels need to be sufficient in number so that the various needs of the service users can be met. Recruitment procedures are to be made more robust in order to protect the service users. Evidence regarding the training members of staff receive need to be available. Staff are to attend training on subjects highlighted in the evidence section within the next few months so they are able to respond to service users needs appropriately and can feel equipped with the information and skills necessary to support both service users and other members of staff. Staff receive one to one support and supervision so they can reflect on their practice and seek guidance and direction. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 27 EVIDENCE: There are ongoing difficulties in the home in meeting the target of 50 of staff either studying for an NVQ or to have obtained this qualification. The issues the Registered Manager faces is that the majority of staff do not remain in post long enough to work through their probation period and then register to study for the NVQ. Although the Inspector recognised the ongoing problem a restated requirement was made to ensure new members of staff have a place to gain this relevant qualification as soon as the probation period is completed. There are two staff vacancies at present and the turnover of staff has been regular over the past few months. The Registered Manager informed the Inspector of the difficulties in retaining members of staff. The vacant hours are filled by regular relief staff who are familiar with the home and the service users. The Registered Manager stated the home does not use agency workers. The Inspector was concerned that at times there are only two members of staff working on a shift and that due to the size of the home and the various small corridors/rooms within the home, members of staff could be left vulnerable. The staffing level has always been the minimum of two members of staff working on a shift, but in light of the serious incident and altered ways of working in the home and with the high staff turnover, the Inspector made a requirement that staffing levels must be reviewed and monitored on a regular basis to ensure this level can appropriately meet the needs of the service users. Evidence must be available to demonstrate this staffing level is sufficient to support and offer rehabilitation for the service users, as they need to be able to gain the skills and confidence to move on successfully into the community. Staff meetings take place on a regular basis and minutes were viewed by the Inspector. The Inspector who assisted with the inspection viewed the staff employment files. They were informed that applicants visit the home and are shown around by the service users who are also involved with the interviewing process. The files viewed contained completed application forms, one had been completed on the computer and had not been signed by the member of staff, the Inspector advised that this must be signed by the applicant when applying for a position. Criminal Record Bureau checks had been carried out and health statements had been completed. Proof of qualifications were not available on the staff files viewed and a recent photograph was absent from one of the files. A requirement was made that staff employment files must contain all that is required as stated in Schedule 2. The Inspector also discussed with the Registered Manager the need to keep well-maintained staff files in order for information to be easily accessible for both the Registered Manager and the inspection process. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 28 The Inspector viewed the individual training files. These did not contain certificates of attendance or information regarding the courses and training staff had received. There is an ongoing rolling programme of courses available for staff on mandatory subjects such as fire safety and first aid and additional subjects on mental health, managing diversity and alcohol and drug awareness. However it was not clear exactly when staff had attended courses and the Inspector made a requirement that evidence of training must be available to ensure staff are receiving regular and ongoing training to meet their needs. Furthermore discussions took place with the Registered Manager regarding the training offered to staff following the serious incident. Although there had been various types of support offered to staff, staff had not received training on issues particularly relevant to the incident. An immediate requirement was made that all staff must be enrolled on to courses regarding working with service users who are potentially aggressive and working with service users with drug and alcohol needs. The Inspector wanted to ensure that the Registered Manager prioritises obtaining places on the relevant courses for all members of staff working at the home, including the Registered Manager. The Inspector who assisted with the inspection process viewed supervision records. These demonstrated that supervision is held on a regular basis. The Inspector made a recommendation that the supervisor and supervisee sign supervision notes. Currently the Registered Manager supervises all members of staff. The Deputy Manager will also be supervising members of staff in the near future, once they have completed their probation period. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A staffing review needs to take place to ensure the Registered Manager has the time to meet the demands of the role. This includes ensuring sufficient staff work in the home, thus freeing the Registered Manager to take care of running the home to the best of their ability. Systems for reviewing the quality of care needs to be developed further. A report, which includes service users opinions, needs to be devised to highlight the areas the home recognises needs attention and the areas that are working well, to ensure the service users are living in a home that constantly reviews how it operates. An independent professional needs to carry out and complete monthly, unannounced visits, to ensure service users are receiving the best care. There are major shortfalls regarding the servicing and health and safety records. These shortfalls need to be addressed in order to protect the health and safety of the service users, members of staff and visitors. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 30 EVIDENCE: The Registered Manager has been in post for two years and is in the process of studying for the Registered Managers Award in care, he aims to complete this course in July 2006. The Registered Manager is currently a keyworker to a service user, supervising all the members of staff and as noted in Standard 39, often contributes to and completes the monthly Regulation 26 reports. The Inspector made a requirement for the Registered Manager to be supported to focus on his managerial role and to have sufficient numbers of staff working in the home for him to carry out the necessary duties he has to perform. The requirements made at this inspection and the general running of the home demand the full attention and time of the Registered Manager to ensure the home makes the necessary improvements. The home has some systems in place to review the care in the home. Service users surveys had been completed and there was an overall annual report completed that examines various aspects of the home. However there was no overall summary or report available that demonstrated the areas the home has worked on and areas that still need attention. The timescale for this requirement had not yet run out, therefore this requirement remains in this report. The Inspector was informed by the Registered Manager that they often complete or contribute to the monthly Regulation 26 reports. A requirement was made that Regulation 26 visits must not be carried out by the Registered Manager. These visits must be unannounced and carried out by an independent person, thus ensuring the home is reviewed by an objective person. These reports must then be forwarded on to the CSCI. This had not been done for the past few months. In addition, the Regulation 26 reports viewed by the Inspector, in particular one report that examined the environmental standard of the home did not highlight any of the issues the Inspector identified and described earlier in the report. The Inspector queried with the Registered Manager the effectiveness of these monthly reports if they are not going to demonstrate accurately how the home is running and the issues that are in urgent need of addressing. The Inspector made a re-stated requirement as there was no evidence that the bathing and shower facilities were thermostatically controlled. The Inspector made a re-stated requirement regarding window restrictors on all windows above ground level. The windows had been measured the day before the inspection but work had not commenced. Subsequent to this inspection the Registered Manager notified the Inspector that these had been fitted. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 31 A requirement was made as the Gas Safety record and the testing for Legionella was out of date, subsequent to this inspection the Inspector was informed, by the Registered Manager, that these two areas had been addressed and were now up to date. Fire drills and fire call point tests had not been carried out on a regular basis and a requirement was made. Evidence was seen that the home had an up to date electrical installation test. A requirement was made that water temperatures must be taken on a regular basis of all areas where service users have access. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 32 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 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 3 26 3 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 2 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 x 1 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 x 2 x x 1 x Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 33 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(1)(c) Schedule 1 Requirement The Statement of Purpose must be updated to include all of the criteria as set out in Schedule 1 of the Care Homes Regulations 2001. (Timescale of 28/02/06 Not Met). The Service User Guide must include all of the criteria as set out in Regulation 5 of the Care Homes Regulations 2001. (Timescale of 28/02/06 not met). Those service users on a trial period or recently admitted must have a risk assessment and care plan completed. Immediate requirement issued, documentation to be forwarded on to the CSCI. Timescale for action 30/06/06 2. YA1 5(1)(a-f) 30/06/06 3. YA2YA6 15(1)(2)(b) 26/05/06 Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 34 4. YA6YA23 5. 6. YA6 YA9 7. YA12YA13 Service users care plans must be reviewed on a regular basis and alterations made when service users needs change. 17(1)(a) Schedule The home must have a 3 photograph of all service users. 13(4)(c) Risk assessments must be completed in detail highlighting all potential identified risks in a service users life, e.g. smoking, using drugs/alcohol and eating a high fat/poor diet. Immediate requirement issued, all updated risk assessments to be forwarded on to the CSCI. 16(m)(n) Evidence must be available regarding the activities and rehabilitation offered for the service users. There must be an increase in activities for those service users currently with no daily structured programme. 17(2) Schedule 4 Records must be kept of the food/meals service users eat on a daily basis. In particular for those service users with health/physical needs. 15(2)(b)(c)(d) 17/07/06 30/06/06 31/05/06 31/08/06 8. YA17 17/07/06 9. YA19 12(1)(a)(3) 15(1) 17/07/06 The health needs of the service users must be clearly outlined on care plans and where service users refuse treatment this must be documented with risk assessments completed. Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 35 10. YA20 13(2) Medication systems and 12/06/06 checks must be made more robust to identify any medication errors. The Registered Provider must ensure there is a planned maintenance and renewal programme that includes the shortfalls relating to the physical standards as stated under the section titled environment of this report. The programme must also include timescales for addressing the shortfalls. A copy of the maintenance plan must forwarded on to the CSCI with the response to the draft report. (Timescale of 31/03/06 not met). The home must arrange for work to be carried out as advised by a Plumber to ensure that services and fittings comply with the Water Supply (Water Fittings) Regulations 1999. (Previous timescale 31/03/06 not met) Further progress must be made for registering staff to undertake NVQ training. (Timescale of 31/03/06 Not Met). 31/07/06 11. YA24 23(2)(b)(d) 12. YA30 13(4)(c) 17/07/06 13. YA32 18(1)(a)(c)(i) 29/09/06 Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 36 14. YA33 18(1)(a) 15. YA34 19(1((b)(i) 16. YA35 18(1)(a)(c)(i) The Registered Provider and Manager must ensure there are suitable numbers of staff working in the home to meet the needs of the service users. This staffing level must be reviewed on an ongoing basis. Staff employment files must contain the necessary documentation as outlined in Schedule 2. Training records must be clear and up to date with evidence of the training that has been undertaken. The Registered Person must ensure that staff receive the training relevant to them for the work they are to perform. Immediate requirement issued, proof of training booked to be forwarded on to the CSCI by the timescale given. The Registered Provider must ensure there are sufficient numbers of staff working in the home to enable the Registered Manager to carry out their managerial duties effectively. Quality assurance and monitoring systems must be devised and implemented. (Within previous timescale of 31/05/06). 31/08/06 31/05/06 17/07/06 17. YA32YA35 18(1)(a)(c)(i) 16/06/06 18. YA37 12(1)(a),18(1)(a) 01/09/06 19. YA39 24(1)(a)(b)(2)(3) 31/05/06 Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 37 20. YA39 26 21. YA42 13(4)(c) The Registered Manager 31/05/06 must not contribute to, or complete Regulation 26 monthly reports. Copies of Regulation 26 reports to be forwarded on to the CSCI. Documentary evidence 30/06/06 must be obtained to confirm that bathing and showering appliances are thermostatically controlled. (Timescale of 31/03/06 not met). The Gas Safety Record & the certificate for the testing of Legionella must be up to date and available for inspection. The recording of water temperatures must be taken in all areas where service users have access. There must be a record of regular testing of the fire equipment/call points and fire drills must be held at different times & on a regular basis. The home must ensure that all windows accessible to vulnerable service users (2 metres) above ground level are restrained in accordance with NHS guidance, which states that the openings to these windows should be restricted to 100mm. (Previous timescale 30/04/06 not met). 30/06/06 22. YA42 13(4)(a)(c) 23. YA42 13(40(a)(c) 30/06/06 24. YA42 23(4)(c)(v)(e) 30/06/06 25. YA42 13(4)(a)(c) 31/05/06 Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 38 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA2 YA19 Good Practice Recommendations Pre-admission assessments should include identifying cultural and religious needs. Forms recording when service users have attended a health appointment/or when an appointment has been made should be devised to clearly demonstrate the home has addressed service users health needs. The supervisor & the supervisee should sign supervision records. 3. YA36 Garthowen DS0000022889.V293090.R01.S.doc Version 5.1 Page 39 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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