Inspection on 27/08/08 for George Lane, 103

This inspection was carried out on 27th August 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

George Lane, 103 29/08/07

George Lane, 103 09/11/06

George Lane, 103 26/01/06

George Lane, 103 17/10/05

George Lane, 103 22/06/04

George Lane, 103 24/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 23/11/2008.

CARE HOME ADULTS 18-65 George Lane, 103 Catford London SE13 6HN Lead Inspector Sean Healy Unannounced Inspection 27th August 2008 12:00 George Lane, 103 DS0000025621.V370298.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 George Lane, 103 DS0000025621.V370298.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. George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service George Lane, 103 Address Catford London SE13 6HN 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 8265 8671 0208 778 6145 lawrenceo@plus-services.org PLUS (Providence & Linc United Services) Manager post vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places George Lane, 103 DS0000025621.V370298.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: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 4 29th August 2007 Date of last inspection Brief Description of the Service: 103 George Lane is a converted Victorian house situated on a quiet road between Lewisham and Catford. It is one of a group of homes for adults with learning disabilities, all of which are in the London Borough of Lewisham. It is close to shopping centres, local transport and a range of public amenities. The Registered provider, Providence Project, has merged with another other care organisation in April 2006, to form PLUS (Providence, Linc, United Services). The organisation has now made appropriate amendments to the registration/certification with the Commission for Social Care Inspection to reflect this change. The building is owned and maintained by London & Quadrant Housing Association. The home accommodates four adults with learning disabilities. It aims to provide a comfortable, homely atmosphere in a safe and clean environment. Each service user has their own bedroom, and shares communal facilities, which includes lounge, kitchen/diner and garden. At the time of this inspection, there were two men and two women resident at the home. Information about the service provided is made available to current and potential service users in the homes Statement of Purpose and Service Users Guide. Each resident has been given a copy of these documents. The recent CSCI report is currently kept in a file in the hallway cupboard and is accessible to residents. George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 5 At 27/8/08 the homes fees for three residents are set at £255.80 per month for support and accommodation, and are paid directly to Lewisham council. The fees for one resident are £598.60. This charge includes food provided. Residents do not yet have adequate contracts to describe the fees or the reason for differences in charges. The local authority as part of a block contract pays for support costs. The care provider has not yet broken the cost down to show support costs for individual residents. Residents have to pay for other personal expenses such as hairdressing, transport and personal shopping. The home does not have an email address. George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality Rating for this service is 1 Star. This means that the people who use this service experience adequate quality outcomes. This inspection site visit took place over two days on 28th August 2008 and ended on the 1st September following receipt of information about staff recruitment and employment. The inspection was unannounced, and was facilitated by the Manager, who has now applied to CSCI to become registered care manager. During the inspection three residents were observed being helped by staff. Four residents planning files were examined. Three support staff were interviewed and six staff files were examined to see recruitment, supervision and training records. The inspection included examination of records and policies and procedures, and a tour of the building. Four of the six requirements made at the previous inspection have now been met. The main area lacking in progress is that the home does not yet tell residents in writing the cost of their service. Residents seem to be very happy at this home, and there has been much improvement in the care and management provided. The atmosphere was relaxed and friendly. The manager and staff involved Residents and spoke with them regularly. What the service does well: Residents are enabled to lead independent lifestyles. Two residents spoke to the inspector, and said that they are happy in the home, and have good support from staff. They said that the staff and manager are friendly and help them when they need it. There is evidence of good care – residents’ needs are assessed with their input, and good links are maintained with health and care professionals, counsellors, and family (if appropriate). Staff are enthusiastic about working at the home, and creative in helping residents to achieve do the things that they want to. The home listens to residents and when activities are no longer enjoyed by residents other activities are quickly found to replace them. The home was warm and homely in appearance, and the routines of the home are led by the residents. The home was clean and tidy. George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. George Lane, 103 DS0000025621.V370298.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 George Lane, 103 DS0000025621.V370298.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 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ are not in possession of all of the information they need to help them to make informed decisions about where they live. Prospective residents’ individual aspirations and needs are being assessed by the home. Residents have contracts or statements of terms and conditions informing them of their rights and responsibilities, however, these documents need to be updated to include fees, and who pays them. EVIDENCE: At the last inspection the homes Statement of Purpose and Service Users Guide did not contain the following information and a requirement was made for these documents to be updated to ensure they included: 1. Relevant qualifications and experience of the registered provider and manager and of the care staff who work in the home. 2. The type of support to be provided needs to be better specified within the Statement of Purpose/Service User Guide. The support for people with learning disabilities is a main feature of the support provided, but is not adequately mentioned in the Statement of Purpose. Other support issues George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 10 such as sensory impairment, personal care, physical disability and educational opportunities for residents should also be mentioned. The homes Statement of Purpose and Service Users Guide were revised in September 2007 and now include this information and therefore this requirement was met. There was a requirement made at the last two inspections for the registered provider to ensure the details of fees to be paid are included in the homes Statement of Purpose and in the Statements of Terms and Conditions (contracts) for each resident. This requirement was not met. Each resident has a tenancy agreement, which now has the organisation’s name included, but which does not show the fees to be charged. This tenancy agreement has been signed by each of the residents and contains a section called “payment for the property” which includes sections for breaking down the fees. However, the amount to be paid for each is not completed at all. A separate accommodation charge of £245 per month is paid by each of the service users to Lewisham Partnership and includes food. The home and provider are in effect working in partnership with the local authority in respect of the management of residents’ finances. The home is one of a number of homes managed by the provider, that is part of a block contract with Lewisham local authority, who are the commissioners for all of the residents’ services in this home. The commissioners have not broken down the cost of care and support for each individual resident, and therefore the provider at the moment cannot determine the cost of each individual residents cost of care. The residents nonetheless are entitled to know who is funding their care and how much it costs for their support, food and any other charges. Because this information is not readily available to the provider, and the provider is not making any charges to the residents directly, in the interests of allowing the residents to have the benefit of management focus on their care and support at this time, the requirement is now temporarily removed from this report. A new requirement is now made asking the registered provider and responsible individual to formally raise this issue with the service commissioners as deficiency. The registered provider must show evidence that this has been raised with the Lewisham commissioners. (Refer to Requirement YA1 and YA5) The following general guidance should form a basis for these discussions: “The fees to be charged must specify the amount of fees to be paid, with a breakdown of what the fees are for, e.g. care and support, food, transport, or any other services. They should also be clear reference as to who pays the fees where the fees are being paid by anyone other than the resident. In this case the local authority pay fees for all residents and this should be referred to in the service users’ guide and in contracts/terms and conditions.” George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 11 As was the case at the last inspection all the residents have a full assessment of their care needs provided by the placing authority, which are currently Lewisham social services for all four residents. George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 12 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 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents can be sure that all of their assessed needs and personal goals are reflected in their individual plan, and they do get help to make decisions about their lives. They are supported to take assessed risks, which enable them to be more independent. EVIDENCE: I examined four residents care plans and risk assessments. Each of the four residents has a personal profile and a personal care plan, which has been regularly updated. There is also a ‘life plan’, which is their person-centred plan. This allows the residents to have a better voice in their care planning. All have had an annual review during the period of January to July 2008 attended by the resident, social worker, the resident’s keyworker, the registered manager and the service manager. There was also involvement from relevant GPs and other health care professionals. The notes taken from George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 13 these reviews are very detailed and show that previous aims of service users have been reviewed and new aims for achievement or activities have been set. The residents are able and independent, and some are involved actively in the organisation’s service users’ speaking up group. One resident is on the organisation’s Board of Management. Two residents described their work on the speaking up group and said that they carry out monthly interviews with service users in other homes, asking for their views about how their home is run. Both of these residents said they are very happy in doing this work and are able to feed back the views of service users in many homes to the Board of Management. Excellent systems are in place to enable residents to fully make independent decisions about their lives. Three out of the four residents ask the home to safeguard their money; the other resident is totally independent in managing his money. Within the home, two of the residents ask for views about how the home is run, and feed these comments back to the home’s manager. Each resident has a full range of risk assessments, which have been reviewed as part of the care planning review process. There are many risk assessments and all are being regularly reviewed at least every six months by the home. The last reviews took place between January and July 2008. This shows good attention to protecting and safe guarding residents and staff. However one resident’s bedroom is impacted on by some behaviours and there is regular damage caused and coffee stains on paintwork. Also a bed is fixed to a wall and a wardrobe is locked due to damage caused to clothing. Although these issues are long standing there is no mention of how these issues, or how they are managed in the care plan for this resident, and there is not a written agreement regarding the locking of the resident’s wardrobe. Although I am not suggesting that locking the wardrobe is inappropriate, the lack of a formal agreement with social services and with the resident or a representative, and the lack of a statement in the care plan, which would then be regularly reviewed, means that the residents rights to access to personal belongings are unduly affected. The home must ensure that these issues are formally reviewed and agreed and included in this residents care plans. (Refer to Requirement YA6 and YA7) George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents have appropriate activities and are part of the local community. They have good relationships with family and friends, and their rights are respected and responsibilities are recognised in their daily lives. A healthy diet is provided for and meals are provided at times which suit residents best. EVIDENCE: All residents have assessments that clearly state their interests and preferred activities that were in place when they moved into the home. These include education, training and leisure activities. Care plans reflect these activities, and these include residents’ views on desired new activities. Three residents have voluntary jobs, for which they receive a small payment. These jobs include working at the Salvation Army shop, office cleaning and acting as resident’s representatives on the speaking up group. George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 15 There are also good links with the local adult education system and a number of residents attend classes. All residents have full access to activities in the local community and further afield in London. Staff provide support when necessary but also enable residents to go out independently when they are able to. Daily records showed that staff do work well and creatively to involve residents in the daily running of the home, in order to foster their abilities as much as possible. Activities include going to public houses, cafes, boating in Surrey Docks, gardening and attending service users’ groups and day centres. One resident said she goes out every day, and really enjoys her job on the speaking up group. She said that she gets to meet lots of people in other homes, and sees her family and boyfriend regularly, all of whom are welcomed into her home. Three residents said the staff and manager are very nice and helpful and support them to get out to meet other people. All residents have regular family who come to see them. One resident visits her sister each Saturday and another visits his mother who lives very near by. Three residents said that they see their family as much as they like, and that the staff help them to do this. I observed staff working in supporting a resident in preparing to go out and there was excellent communication about where they were going and what they were going to do. All residents have their own rooms for which they have their own key. Staff respect service users’ right to privacy and only enter the room with permission. Two residents said “Staff are very respectful and don’t come into my room without being asked.” Three out of four residents have a key to the front door, and the fourth asks the staff to look after her key. Residents are involved fully in shopping, and cooking and are offered choices of food on a daily basis. Good records of menus are kept, and the manager reviews these to see that good food is being offered. This has resulted in an improved diet for two service users. Three residents spoken to said they choose what they want to eat, and the food is good. George Lane, 103 DS0000025621.V370298.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 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents receive personal support in the way they prefer and their needs are being met in all other areas. Support with medication is appropriate for the service users’ assessed needs. EVIDENCE: All Residents’ files examined showed health care needs are well managed with good input from a range of health care professionals. Residents are registered with a GP and regularly attend a dentist and chiropodist. A dietician is also involved in providing advice in the management of diet and weight. There is support provided by psychology and psychiatry in the area of communications and motivation. Residents files showed pictures are used to help residents understand documentation if they were unable to read, and also used in weekly activity plans. Healthcare and medication is being reviewed by the home every six months. The last reviews took place between January and July 2008. George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 17 All of the residents have learning disability support needs and more than half need support in washing and dressing. There are also communications support needed for some residents. There are some challenges presented in providing support in personal care and dressing and keeping bedrooms in a good state of repair. The personal care plans are well written showing what residents need support with and what they should be left to do for themselves. All of the staff showed a good knowledge of these areas, and the care plans for residents in how to provide the support needed are very detailed. This enables a very good level of understanding by staff in the support needed. I observed staff providing support for two residents and they were very competent and communicated very well with the residents always reassuring them. The home has a written Medication policy that is clear and up to date. Four residents are using prescribed medication and no controlled medication is being used. Medication is stored in a locked room in a private area, and this is safe and secure. The Boots Pharmacy blister pack is used to administer medication. Records are well maintained with minimal omissions recorded. The Boots pharmacist attends the home twice a year and medication is delivered every 28 days. All of the care staff have been trained in administration and management of medication. No controlled drugs are being used at the home. The manager feels that staff are competent in administering medication and in understanding it’s effect on residents. There was a recommendation made at the last inspection to review whether any residents were able and wanted to learn how to self medicate. This was done for all residents and two residents now partially self medicate with some support from staff. George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The Residents feel their views are listened to and acted on, and that they are adequately protected from abuse and neglect. EVIDENCE: The home has a good complaints policy in place that was last reviewed in 2007. Three Residents were able to describe to whom they would speak if they had any concerns about the service being provided. There is a good relationship between the staff and residents, and the staff showed a good awareness of how to deal with complaints. There have been no complaints since the last inspection. Two resident said that the staff and manager listen to them but that they have no reason to complain. The home has a copy of the Lewisham Adult Protection Policy. There have been no reported adult protection issues since the last inspection. It is a number of years since many of the staff have had adult protection and complaints training. Three staff I interviewed showed a good knowledge of how to respond to allegations or suspicion of abuse. George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 19 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): 24,26 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally homely comfortable and clean but some communal areas and residents bedrooms are in need of redecoration EVIDENCE: 103 George Lane is a converted Victorian house situated on a quiet road between Lewisham and Catford. It is one of a group of homes for adults with learning disabilities, all of which are in the London Borough of Lewisham. It is close to shopping centres, local transport and a range of public amenities. The premises are suitable in design and layout for the needs of the residents. Accommodation is provided for four residents, all of who have individual rooms. These rooms, and the premises as a whole, are in a good state of repair but some areas are in need of redecoration and repair. The home is not wheelchair accessible but none of the current residents need a wheelchair and there are no vacancies. All of the residents have lived at the home for a George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 20 number of years and three of them said they are very happy there. The home is well furnished and residents have been able to choose the decoration of their own rooms and other areas in the home. The premises are clean and generally well maintained. There is one bathroom with a WC and sink, and a separate ground floor WC. The residents do cleaning with support from staff and there is a rota for doing this. There is no clinical waste. A maintenance book is being used and a repairman provided by the Registered Provider carries out any repairs needed. The following issues need to be included in the homes plan for maintenance and renewal: 1. The hallway stairs and landing and all toilets and bathroom need redecoration. (Walls on the stairway are stained and some wood is loose on the stairs, but doesn’t present a risk in usage) 2. One residents bedroom cabinet is damaged and the light shade needs to be replaced 3. One resident’s bedroom had coffee stains on the walls and did not have any personal photos/pictures or belongings. The walls should be cleaned a few times a week as resident’s behaviour causes them to be restained. 4. There are no curtains in one resident’s room and a bare wire mesh is used to prevent objects from being thrown from the window. This needs to be reviewed to see if it is possible to improve the aesthetics of the window to make it look more homely 5. The radiator cover in this resident’s bedroom has a gap in the middle. There should be a full length cover fitted 6. One resident’s bed is fixed to the wall due to the resident constantly wanting to move it. This bed is an iron grill type of design with metal feet, giving a cold and harsh look to the room. The home should consider reviewing whether changes can be made to replace the bed for one, which looks more homely. 7. Doors in hallways and to residents bedrooms are becoming yellow and need repainting (Refer to Requirement YA 24 and YA26) George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 and 36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staff are competent and experienced and qualified to provide the service. There is not enough evidence to show that recruitment and employment is well managed. Staff now receive appropriate training and are well supervised. EVIDENCE: The current staff team consists of a manager and six and a half care staff, four of whom are women and one man. There are 1.5 other posts, which are vacant, and the home intends to recruit to one of these. The gender of this staff group equally represents that of the residents. The cultural backgrounds of the residents are not equally reflected in the make up of the staff team, but staff receive equal opportunities and diversity training to increase awareness of residents cultural support needs. The staff levels provide support each day as follows: • 8am to 5pm three care staff • 5pm to 9pm 2 care staff with a third sometimes for evening activities • 9pm to 8am one sleepover staff with support from on call management George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 22 The staff say that they feel they are able to do their job with this level of staffing although they feel that it is busy. They said the manager is available to provide extra support a number of days a week and also does shift work with the residents about three days a week. There was a requirement made at the last inspection for the home to ensure that a minimum of 50 of the care staff be qualified to NVQ level 2/3. This requirement had been repeated a number of times at previous inspections. Three of the six care staff currently employed now have NVQ 2/3, and another member of staff is currently studying for NVQ level 2. Two of the three staff interviewed said they had completed NVQ2 or NVQ3. This shows an improvement in the number of qualified staff since last inspection, and this requirement is now met. There was a requirement made at the last inspection for the home to ensure that appropriate documentation in relation to staff recruitment and employment be kept at the home. Today’s inspections shows that the homes management has taken reasonable action to ensure that evidence of all of the recruitment and employment information for each member of staff is available. A system has been put in place to include records of the information needed and the majority of the information needed is available at the home. The providers Human Resource manager gave assurances that any information not yet included in staff files at the home is available at the provider’s head office. Examination of six staff files showed that the following information is still not fully included in all staff files: 1. Staff files need copies of proof of identity such as birth certificates/passports. None of the files examined contained these documents 2. One staff file did not contain a second reference and another had a reference, which was taken up two months after the staff commenced employment. All staff recruitment must include taking up two acceptable references before commencement of employment 3. Signed and dated induction checklists are not being maintained for new staff. None of the staff files examined had a complete induction schedule on file. The manager and two staff said that although they felt induction had taken place, these were not completed. 4. One file examined showed that this member of staff had commenced work without having a current CRB disclosure received. This member of staff commenced work in June 2008 and at the time of inspection a disclosure had not been received although an application had been made. The manager and human resource manager had ensured that a POVA First disclosure was received before this member of staff was allowed to resume work. 5. None of the files I examined showed the staff to have had an individual training and development plan agreed with their manager. The manager George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 23 confirmed that these are not yet in place. However all files showed that all staff have had between five and seven days training in the previous 12 months. Comments and written confirmation received by CSCI from the provider organisations newly appointed Human Resources Manager shows commitment to better management of this information. This shows an improvement both in the documentation provided and in the providers commitment to ensuring all of the required information will be made available. The homes management must ensure that all staff have two acceptable references taken up and kept on file at the home before commencement of employment. (Refer to Requirement YA34) The homes management must ensure that all staff files include a copy of the staff member’s birth certificate and passport (if available) and copies of any relevant work permits as appropriate. (Refer to Requirement YA34) The homes management must ensure that for all new staff an acceptable CRB disclosure is received by the home prior to commencement of employment. ( Refer to Requirement YA34) The homes management must ensure that a signed and dated induction checklist, which meets the requirements of Skills for Care, be completed and maintained on file at the home for all new staff. (Refer to Requirement YA35) The homes management must ensure that all staff have a training and development plan on file, which has been agreed with their manager (Refer to Requirement YA35) All staff files examined showed that staff are receiving formal supervision with their manager at least every six weeks. The staff interviewed also confirmed that this is happening. George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents do now benefit from a well run home but some improvements are still needed. Some important areas of staff recruitment and induction not consistently monitored by the registered provider. The health and safety of residents are now protected by the homes practices. EVIDENCE: There was a requirement made at the last inspection for the provider to ensure that an application for registration of a manager is submitted to CSCI, as the manager at that time had been at the home for some time and the last Registered Manager appearing on the registration document moved from the home more than three years previously, to work in another home. The manager has now submitted an application for registration and at the time of inspection was awaiting an interview. This requirement is therefore met. George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 25 The current manager has now completed an NVQ level 4 course in care management and is awaiting an outcome on the marking of coursework. The person in control of the home visits consistently every month and reports any issues in writing. However important information about staff recruitment was not addressed in these visits, allowing potential for residents to be placed at risk. Assurances have been now given that these issues are now being addressed and improvements in the homes staff records suggest that these will be adequately monitored in future. These will be checked again at the next inspection. (Refer to requirements made under Standard 34) The service manager attends service users’ annual reviews and there is lots of work being done by two service users who ask the views of the people who live at the home about how it’s managed. The home had been holding six to eight weekly house meetings with residents, but now these are happening monthly and are used to discuss their experiences and improvements they would like to have made. The majority of the residents can speak up independently, and support is offered by staff for those who need it. Notes are kept and used to make improvements. The home keeps good records on all issues relating to health and safety. There are safe working practices regarding moving and handling, fire safety, food hygiene and infection control. There have been no reports of dangerous diseases or occurrences, and there are good records on the testing of fire equipment, electrical equipment, water and gas within the home. George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes one outstanding requirement regarding providing residents with information about the cost of their service 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 YA5 Regulation 5.1 Requirement The registered provider and responsible individual must formally raise the issue regarding the deficiency in provision of information to residents about charges for support, accommodation and food, with the local authority commissioners. Evidence must be provided showing that this has been raised, showing any responses or decisions reached. The registered provider and manager must ensure that the strategies for the behavioural management of a resident as discussed in this report YA6 are reviewed with involvement from the resident and social services, and decisions reached be included in this residents care plan. This is to ensure the resident’s rights are fully protected. The registered provider and manager must ensure that all of the areas of maintenance DS0000025621.V370298.R01.S.doc Timescale for action 31/12/08 2 YA6 YA7 15 (1) (2) 31/12/08 3 YA24 23 (2) b & d 31/12/08 George Lane, 103 Version 5.2 Page 28 4 YA34 19 (1) (b) Sch. 2 5 YA34 19 (1) (b) Sch. 2 6 YA34 19 (1) (b) Sch. 2 7 YA35 18 (1) (i) 8 YA35 18 (1) (i) and decoration discussed in this report under Standard 24, are included in the homes plans for maintenance and renewal The registered provider must ensure that two satisfactory references are on file for a member of staff discussed in this report under Standard 34. This is to ensure the protection of residents The registered provider must ensure that copies of all staff birth certificates and passports (if available) be kept on file at the home as proof of identity. This is to ensure the protection of residents The registered provider must ensure that a CRB disclosure be obtained for all new staff before commencement of employment. This is to ensure the protection of residents The registered provider must ensure that there is a completed signed and dated record of induction on file for all staff. This is to ensure that all staff are enabled to fulfil the aims of the home and to meet the needs of the residents The registered provider must ensure that there is a staff training and development plan agreed between each staff member on their manager, and a copy is held on file at the home. This is to ensure that all staff are enabled to meet the needs of the residents, and plan for their own development 30/11/08 31/12/08 31/10/08 31/12/08 31/12/08 George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations George Lane, 103 DS0000025621.V370298.R01.S.doc Version 5.2 Page 30 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. 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