Inspection on 29/08/07 for George Lane, 103

This inspection was carried out on 29th August 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

George Lane, 103 27/08/08

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 08/07/2008.

CARE HOME ADULTS 18-65 George Lane, 103 Catford London SE13 6HN Lead Inspector Sean Healy Unannounced Inspection 29th August 2007 10:30 DS0000025621.V344403.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 DS0000025621.V344403.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. DS0000025621.V344403.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 PLUS (Providence & Linc United Services) Care Home 4 Category(ies) of Learning disability (0) registration, with number of places DS0000025621.V344403.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th November 2006 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. At 29/8/07 the homes fees are set at £245 per month for support and accommodation, and are paid directly to Lewisham council. This charge includes food provided. Support costs are paid for by the local authority as part of a block contract. 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. DS0000025621.V344403.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection site visit took place on 29th August 2007 and the inspection closed on the 5th September. It was facilitated by the team manager, who proposes to become the Registered Care Manager. Three residents were present for part of the inspection and two of these gave their views about the home. The method of inspection included discussion with the homes manager, and two of the support staff. The building was also inspected for health and safety, suitability for service users and cleanliness. Service users records and other documentation about how the home is run were examined. Care assessments and care plans were examined to ensure that care needs were being planned for and the owners and service users were questioned about these plans, to check that plans were being put into action. It was not possible to inspect staff recruitment and training records, as these were not available at the home. This is a concern and is the subject of a repeated requirement. 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 user-led, and all of the service users have been involved in decoration of their own rooms, which are well maintained. The home was clean and tidy. Almost all of the staff are know residents well and hardly any agency staff are used. This helps residents to get the help they need from people who know them well. DS0000025621.V344403.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The homes information about the service provided needs to be improved so that residents are able to know what is offered before moving into the home. Contracts and Tenancy agreements still need to be updated to show the details of the cost of support and other charges made for individual residents living at the home. The homes manager and residents do not know anything about these costs at the moment. The manager should ask residents about whether they want to, or are able to manage their own medication and write down the decision that is made for each resident. At the moment one resident is learning to do this but the others have not been asked. There still needs to be a greater commitment to supporting staff to achieve NVQ qualifications, as none of the current staff are yet qualified in this area. This has been a requirement since 2005 and no improvements have been made to help the staff to become qualified. The home’s senior management will now need to provide a written plan to show how they will help staff to get this qualification. This will be part of an improvement plan for the home. There is still not a manager for the home who is registered with the Commission for Social Care and Inspection. There have been three different managers for the home over the past four years, and only one of them has been registered with CSCI. There has not been a registered manager working at the home for more than three years. The care provider must make sure that a manager applies for registration as soon as possible. The home’s senior management will now need to send a completed application to CSCI so that a manager can be registered for the home as soon as possible. This will be part of an improvement plan for the home. There are no records of staff recruitment and employment kept at the home, so these cannot be inspected at the home at the moment, which stops the inspector from checking the records to see that staff are being recruited DS0000025621.V344403.R01.S.doc Version 5.2 Page 7 properly and properly checked before starting work at the home. Copies of these records must be kept safely at the home for inspection. The homes manager and the organisation should discuss with care workers the number of days training offered annually, to see whether more days could be offered, and see that the decision about training needed could be made by the manager in discussion with care staff. The home’s Quality Assurance system has had some improvements made, but it needs to show more clearly how they have listened to residents, and information on residents’ views must be produced at least every year, and included in any development plans for the home. 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. DS0000025621.V344403.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 DS0000025621.V344403.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 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: There was a requirement at the last three inspections for the registered person to ensure that residents have accurate and up-to-date contracts and tenancy agreements, which reflect the organisations name change and registration change, and that these changes be reflected in the Statement of Purpose and Service Users Guide. This has now been done and these documents now include the organisations new name and address. Therefore this requirement was met. However the Statement of Purpose and Service Users Guide do not contain the following information and must be updated to ensure it is included: 1. Relevant qualifications and experience of the registered provider and manager and of the care staff who work in the home. (Currently the Statement of Purpose and Service Users guide only refer to the house manager completing training with Lewisham partnership, and may be either social work trained are NVQ4 qualified in management of care. The only DS0000025621.V344403.R01.S.doc Version 5.2 Page 10 reference to staff training or experience in these documents state that staff are required to attend induction training and also encouraged to work to achieving NVQ level 2 or level 3 in care. This should instead state that: “ at least 50 of the care staff employed in the home will be qualified to NVQ level 2/3. It should also state that the manager will be qualified to NVQ level 4. The training that staff employed at the home are expected to undergo in order to meet the needs of residents should also be included. 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 such as sensory impairment, personal care, physical disability and educational opportunities for residents should also be mentioned. 3. Key contract terms covering the admission process, and occupancy obligations are not clearly mentioned either in the Statement of Purpose or other Service Users Guide, and should be clearly referred to. For example there is no mention of the separation of housing responsibilities and care support responsibilities, although the housing is provided by a housing association requiring at tenancy agreement to be signed and a contribution to be made towards accommodation costs. The tenancy agreement states that should a resident refuse support that it is a breach of the tenancy agreement. This is an important issue to highlight to any prospective residents, and currently there is no mention of this in the documents provided during the referral process. 4. The fees to be charged for support costs are not mentioned at all, and there is no mention of who will be responsible for paying the fees, although currently the local authority is responsible. (See repeated requirement YA1 below) (Refer to Requirement YA1) There was a requirement made at the last inspection 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 and the requirement is now repeated. Failure to comply with this requirement in relation to ensuring sufficient information is contained in resident’s contracts may result in enforcement action. (Refer to Repeated Requirement YA1 and YA5) The following extract from the last inspection report may be helpful in doing this: “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, but no mention of DS0000025621.V344403.R01.S.doc Version 5.2 Page 11 this is made in the terms and conditions statement between the home and the service user. 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 service user. In this case the local authority pay fees for all service users and this should be referred to in the service users’ guide and in contracts/terms and conditions.” As was the case at the last inspection all the residents have a full assessment of their care needs provided by the placing authority, who are currently Lewisham social services for all four residents. DS0000025621.V344403.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: As was the case at the last inspection: 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 service users to have a better voice in their care planning. All have had an annual review in either December 2006 or January 2007 with 6-month reviews happening in June 2007. There was involvement from key workers, GPs, the manager and other interested parties. The notes taken from 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. DS0000025621.V344403.R01.S.doc Version 5.2 Page 13 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. This shows good attention to protecting and safe guarding service users and staff. DS0000025621.V344403.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: The following was found to be consistently in keeping with the findings of the last inspection: 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 have been improved and expanded to 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. DS0000025621.V344403.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. 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 often and really enjoys her job on the speaking up group. She said that she gets to meet lots of people in other homes and really likes trying to help them have a better service. She said the staff are very nice and helpful. 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. Two residents said that they see their family as much as they like, and that the staff help them to do this. 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. One resident said “Staff are very respectful and don’t disturb me when I want to spend time in my room.” 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. Residents spoken to said they choose what they want to eat, and the food is good. DS0000025621.V344403.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 are independent in personal care and this is shown in their care plans. All are fully mobile and have minimal support in personal care. All residents’ files contained good health care support plans, which have been reviewed annually. The last reviews took place in December 2006 and January 2007 with a six-monthly review taking place in June 2007. All residents are registered with a GP and have annual check ups. All are registered with a dentist and have at least annual visits to the dentist. Other regular health care appointments include visits to the optician and chiropodist. One resident is undergoing assessment for possible dementia, and communications was previously viewed as a barrier to completing this assessment. Staff say they have noticed some changes in behaviour, which merit a re-assessment. It is recommended that the manager review the whole teams consistency in their approaches to communicating with this resident and also consider a referral for Speech and Language support as an aid to carrying out this assessment. DS0000025621.V344403.R01.S.doc Version 5.2 Page 17 (Refer to Recommendations YA 19) All residents are on medication, which is managed by the home with the residents’ permission, and this has been agreed in their care plans. Boots Chemist is used for all medication and most of the residents are being encouraged and supported to sign for the medication to help their understanding of what the medication is for. The Community Pharmacist visits annually to check the record keeping and there is good, consistent recording of medication given. There was a recommendation made at the last inspection for the home to review whether self-medicating is appropriate for any of the residents. This has not yet been done but the manager agreed that this is still appropriate. (Refer to Repeated Recommendation YA20.) DS0000025621.V344403.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. Residents feel that their concerns are listened to and acted on and they are protected from harm by the home. EVIDENCE: The home has a good complaints policy in place that was last reviewed in 2006. Service users 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 service users, and service users say they feel confident to speak with the manager whenever they have any concerns. There have been no complaints since the last inspection. One resident said that: “The staff and manager listen to her and are very helpful when she needs help”. The home has a copy of the Lewisham Adult Protection Policy. Staff spoken to show that they had a good understanding of how to report suspicions of abuse. 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. Two staff interviewed said that they would welcome a refresher training session these areas with a focus on supporting people with communications support needs. It is recommended that the home provide this training for staff as part of the planned training schedule for the home. (Refer to Recommendation YA22 and YA23) DS0000025621.V344403.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 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents’ home is homely, comfortable, safe and clean. 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. As was the case at the last inspection: The premises are suitable and well maintained. 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 and decoration. 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 number of years and two of them said they are very happy there and they get out a lot in the local community. The home is well furnished and residents have been able to choose the decoration of their own rooms and other areas in the home. DS0000025621.V344403.R01.S.doc Version 5.2 Page 20 The premises are clean and 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 kitchen surfaces had been replaced at the last inspection six months ago. DS0000025621.V344403.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 and 35 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Staff are competent and effective, but not yet qualified to the level needed for this home. The home’s recruitment practices do not yet adequately demonstrate that they protect service users, which creates potential risk to service users. The staff training records held did not demonstrate that they are appropriately trained and NVQ training is not adequate. EVIDENCE: The staff team consists of one Manager and five support workers. All of the staff employed at the home have received a full induction and undergone an assessment over a six-month probation period. Staff were seen to be very respectful and consider it in their dealings with residents, and spoke about the residents in a very sensitive and supportive manner. One resident said that: “ Staff always helpful and are willing to help me when I need it” There is a good atmosphere in the home and the staff communicate well with each other and with the residents. Staff are experienced and confident in working with its resident group. One resident is undergoing assessment for possible dementia, and communications was previously viewed as a barrier to DS0000025621.V344403.R01.S.doc Version 5.2 Page 22 completing this assessment. Staff say they have noticed some changes in behaviour, which merit a re-assessment. It is recommended that the manager review the whole teams consistency in their approaches to communicating with this resident and also consider a referral for Speech and Language support as an aid to carrying out this assessment. (Refer to Recommendation YA19) The manager confirmed that none of the current staff are qualified to NVQ level 2/3. Although two staff are on the NVQ course, one of these has deferred completion. This falls far short of the required standard for NVQ qualifications, and at least three care workers should have been qualified since 2005. (Refer to Repeated Requirement under standard 35 of this report) There was a requirement at the last inspection for the registered provider to ensure the employment information for all of this staff will work at the home is kept at the home for inspection. This requirement was not met and is now repeated. (Refer to Repeated Requirement YA34) This information is contained in Schedule 2 of the Care Home Regulations. The provider’s failure to provide this information at the home for inspection presents a potential risk of possible oversights made during recruitment going unchecked. Recruitment records are kept at the organisation’s head office. An inspection in June 2006 showed that appropriate CRB checks had not been consistently carried out for all staff employed by the registered provider, who were recruited prior to April 2006. As there are no staff employment records available at the home it was not possible to specifically check the recruitment records of the staff employed in this home. Since the inspection the homes manager confirmed that a secure lockable cabinet has been purchased and will be used to keep staff records available for inspection. There was a requirement at the last two inspections that the Registered Person must set timescales to ensure that all staff are supported to achieve the appropriate NVQ qualifications; this has not been done yet. Staff who are qualified to the appropriate NVQ levels are now less than at the last inspection, and in fact none of the current care staff are qualified. This is due to staff moving from the home to another home managed by the care provider. The Registered Provider must ensure that enough care staff are supported to go on the appropriate NVQ course so that at least 50 of care staff become qualified to NVQ level 2/3. The Responsible Individual has been notified of this in advance of drafting this report and asked to provide an improvement plan to implement this requirement. (Refer to Repeated Requirement YA35.) The manager explained that all staff receive induction training at the start of their employment, and that subsequently training is set as part of the appraisal system. Both he and the staff interviewed confirmed the induction training has happened and is structured, and that regular annual training is planned, and provided by the organisation. However as the training records were held at the DS0000025621.V344403.R01.S.doc Version 5.2 Page 23 Central office, it was not possible to inspect the standard of training offered. In addition comments made by a number of staff suggest that they may only be receiving in some cases only three working training days per year. One member of staff has not had Adult Protection training in a number of years, and felt that sensory impairment training for the whole team would be an important and addition to the training programme for the home. The registered provider and the registered manager must ensure that staff training records are maintained at the home for inspection, and that these records show staff to have at least five paid training and development days per year. (Refer to Requirement YA35) DS0000025621.V344403.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 benefit from a well run home, but historically management changes are a cause for concern and the current manager is not registered with CSCI. Resident’s views underpin the home’s development processes, but better planning of development issues is needed. Resident’s safety and welfare is promoted and protected by the home policy and practices. EVIDENCE: At the last two inspections there was a requirement for the Registered Person to submit an application for the registration of the manager of the home with CSCI. Again this has not been done. The last Registered Manager appearing on the registration document moved from the home more than three years ago, to work in another home. The last team manager was moved to another home in June 2006, and the current manager took up his post at that time. The current manager intends to apply to register as a registered care manager. DS0000025621.V344403.R01.S.doc Version 5.2 Page 25 This is now an urgent matter and has been the subject of requirements at three previous inspections. The Responsible Individual has been notified of this in advance of drafting this report and has been asked to provide an improvement plan to implement this requirement. (Refer to Repeated Requirement YA37.) The new Manager has registered on an NVQ level 4 course in care management and hopes to complete the course early in 2008. At the previous two inspections the Registered Person was required to ensure that a formal quality assurance monitoring system and annual development plan was put in place. Improvements have been made to the quality assurance systems in the home, which are sufficient while awaiting a standardised quality assurance system to be introduced by the registered provider. Therefore this requirement is deemed as met pending the introduction of the new system. While there is lots of good information is being passed between service users, staff and the organisation it would be better if this were pulled together formally to include in a development plan for the home. This will be addressed by the new system. The person in control of the home visits consistently every month and reports any issues in writing. 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. There have been improvements made since the last inspection, 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. Practical issues such as the decoration of the home and upkeep of the garden are clearly being addressed. 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. DS0000025621.V344403.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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 X 34 1 35 2 36 X 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 4 14 X 15 4 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 DS0000025621.V344403.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 Timescale for action 31/01/08 2 YA1 17.2 Schedule 4 (8) 3 YA34 7,9 & 19Sch. 2 The Registered Provider must ensure that the details of the fees to be paid are included in the home’s Statement of Purpose and Terms and Conditions for each service user as required by NMS. As discussed in this report YA1&5. This was a requirement from the last inspection, Timescale 28/2/07 not met, and is now repeated. Failure to meet this requirement may result in enforcement action The Registered Provider must 31/01/08 ensure that the details currently omitted from the homes Statement of Purpose and Service User Guide, as discussed in this report Standard YA1, be included within the stated timescale The Registered Provider must 30/11/07 ensure that employment information about all of the staff who work at the home is kept at the home for inspection. This information is contained in Schedule 2 of the Care Home Regulations. This was a DS0000025621.V344403.R01.S.doc Version 5.2 Page 28 4 YA35 18.1 c 5 YA35 18(1)a 6 YA37 8, 9 requirement from the last inspection, Timescale 28/2/07 not met, and is now repeated. Failure to meet this requirement may result in enforcement action The registered provider and the 31/12/07 manager must ensure that staff training records are maintained at the home for inspection, and that these records show staff to have at least five paid training and development days per year. The Registered Person must set 31/10/07 targets and timescales, to ensure that all staff are supported to achieve the appropriate NVQ qualifications, to meet the requirement for the home to have 50 of staff qualified to NVQ Level 2/3 certification. This was a requirement of the last two inspections, timescales 31/03/06 and 28/02/07 not met. The timescale has been revised and failure to meet this requirement may result in formal enforcement action being taken. An improvement plan has now been requested from the Responsible Individual requiring that at least three care staff employed at 103 George Lane, have secured a place on a recognized NVQ level 2/3 course by the 31/10/07, and confirmation in writing of the names of these staff, and the course details to be sent to the Regulation Inspector by 31/10/07. The Registered Person must 12/10/07 ensure that an application for registration of the manager is submitted to the Commission. This was a requirement of the DS0000025621.V344403.R01.S.doc Version 5.2 Page 29 previous three inspections, timescale 01/12/05 and 31/03/06, and 31/12/06 not met. Failure to meet this requirement may result in formal enforcement action being taken. An improvement plan has now been requested from the Responsible Individual requiring that an application for registration of a registered care manager for 103 George Lane is submitted to and received by the Central Registration Team for CSCI by Friday 12th October 2007, and that confirmation in writing be sent to the Regulation Inspector confirming that this application has been submitted by 12/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA19 Good Practice Recommendations It is recommended that the manager review the whole teams consistency in their approaches to communicating with the resident discussed in Standard 19 of this report, and also consider a referral for Speech and Language support as an aid to carrying out assessments. The Registered Provider and Manager should review whether it is appropriate for any of the service users to self medicate. This is a repeat of a recommendation made at the last inspection It is recommended that the manager considers providing whole team training on Adult Protection and Complaints with a focus on supporting people with sensory support needs 2 YA20 3 YA22 YA23 DS0000025621.V344403.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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