Inspection on 20/04/06 for Gibson House

This inspection was carried out on 20th April 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 27 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gibson House 18/01/07

Gibson House 06/10/05

Gibson House 20/05/05

Gibson House 07/09/04

Gibson House 27/05/04

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

CARE HOME ADULTS 18-65 Gibson House 12 The Grange Bermondsey London SE1 3AG Lead Inspector Lisa Wilde Unannounced Inspection 20th April 2006 10:00 Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Gibson House Address 12 The Grange Bermondsey London SE1 3AG 020 7252 3762 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.odyssey-csft.org Odyssey Care Solutions for Today Mrs Phyllis Mary Phillips Care Home 8 Category(ies) of Learning disability (0), Sensory impairment (0) registration, with number of places Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th October 2005 Brief Description of the Service: Gibson House is a purpose-built detached home with its own very large gardens. It is close to a lot of bus routes and street parking is available but on meters. There are no train or tube stations very close to the home. The home is spacious, built for eight service users with learning difficulties and sensory impairment who have large single bedrooms with ample bathroom and communal facilities, including a sensory room. There is a lift for people who live on the first floor. There is a kitchen on each floor and generally the home is run as if the upstairs and downstairs are two units. The home was designed as a home for life where service users are supported to be as independent as possible. The fees for a place at this home are £61.80 The home makes the Commission’s reports available in the reception area. On the day of this inspection there was one service user vacancy. Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day in April 2006. Although it was an unannounced inspection the inspector called the home a few days beforehand to let them know she was coming so that the service manager who is responsible for a few homes in this organisation could also be there. The inspector met with the service manager, the new manager of the home and one of the new deputies who had been at the home since December 2005. She then went to meet service users, tour the building, speak with staff and look through files and documents. She also checked medication stocks, petty cash and some service users’ money. There had been a meeting about this home in December 2005 between the Commission and senior managers in the organisation to talk about the problems here and how concerned the Commission were about it. The organisation had assured the Commission that they were committed to making things better at this home and the Commission had allowed the home a few months extra between the last inspection and this one so that they could have a bit more time to do all the work that had been necessary. This inspection concentrated on the requirements that had been made at the last inspection and did not look at many other areas. The service users at this home either cannot speak or communicate in different ways so the inspector met with all the service users and spent a little time with them but could not say that she knows how they feel about living at this home. On other inspections the inspector has called or met with the families of service users but did not this time because so little had changed since the last inspection that she did not feel that this would be helpful right now. She will contact all service users’ families during the next inspection. The inspector found that very little had changed since the last inspection. The service manager and manager agreed with this but also talked about the big pieces of work that had started such as training and staff changes which are discussed throughout the main part of this report. The main change that has occurred is that there is now new a management team in place. One deputy started in December 2005 and the other will start the week after this inspection. The new manager started at this home two days before this inspection but before that he managed another Odyssey home for several years. Although the inspector was very concerned at the lack of progress in making things better for service users she was also pleased to find that some change had taken place since the new deputy had been in post. The manager showed the inspector work that he had already done and ideas that he had. He had begun to draw up an action plan with the service manager Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 6 for how he was going to make sure that things got better immediately for service users. The inspector decided that the best way forward here was to allow the organisation and the new managers a little more time to improve things at this home but made it clear that if there had not been new managers in place that enforcement action would have been taken at this point to ensure that the home met the standards. An additional requirement is that the organisation now meets with the Commission to finalise an Improvement Plan which will put in place extra work and targets that the home must meet to convince the Commission that this home is providing an acceptable level of care and that enforcement action is not necessary. To avoid making many more requirements in this report many necessary pieces of work will be stated in that Improvement Plan which will be finalised at a meeting to be arranged soon after this inspection. There is one general requirement made under Standard 39 that all the work in this Improvement Plan is carried out. What the service does well: What has improved since the last inspection? What they could do better: Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 7 The standards assessed at this inspection showed that the home must do more to make sure that: • information for service users is in a language or form that they can understand. • service user plans fully address how identified goals are to be worked towards and how the plans are to be changed if the plan does not work. • all individual areas of need (particularly aggressive or potentially harming behaviour) are addressed in the service user plans in a way that describes a programme designed to eventually change the behaviour. • plans emphasise positive behaviour and ability so service users are helped to move on or develop independence as much as is possible. • staff know about service users’ and their families’ views and that service users and their families’ make decisions about how they live at this home. • risk assessments are reviewed regularly so that service users are not put at risk of harm and they are supported to take reasonable risks and live as independently as possible. • service users possessions do not get mixed up with others or lost. • the systems for administering, recording and monitoring of medication stocks at the home are effective and safe. • the home knows that its procedure for listening to service users and acting on those views is working. • staff are fully trained in the area of protection from abuse and are aware of the organisation’s policies and procedures in this area so they can protect service users from harm. • the entire home is decorated and furniture and fittings are bought so that the place is homely and comfortable throughout. • specialist advice is sought to make sure that staff are supporting service users to bath and go to the toilet safely. • the staff team as a whole is not fully aware of the specific needs of the service user group with regard to disability issues and sensory impairment. • enough staff trained to NVQ 2 in Care so that service users are supported by a qualified staff team. • there are enough staff on duty so that service users can do what they want on their own and not to have to spend time in groups just because there aren’t enough staff to help them. • staff are fully supervised and have their work and training needs assessed annually so that service users are offered care by staff who receive the right amount of advice and support. • the home is well run and the requirements of this report and any other monitoring agency are met. • the views of service users and their families are gathered and the home then tries to improve things in the ways that they want. • there are effective systems in place to monitor all areas of the service and make sure that staff are always trying to make things better for service users. Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 8 • • polices and procedures are regularly reviewed so that staff may not be being given the best advice and guidance and staff read and discuss policies and procedures with their managers. there is enough financial and business planning in place to cover the problems that may come up over then next few years with the home closing and people having to move out so that service users are properly supported during what will be a very difficult time for them. 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. Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 9 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 Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Service Users’ Guide is not in a language or form that could be understood by the service user group at this home and it does not include some of the areas required by the standard. Service users and their families are not provided with all the information they need to make an informed choice about where to live or about what they can expect from the home once they are there. EVIDENCE: There were previous requirements that the Registered Individuals must ensure that the Service Users’ Guide is drawn up in a format that can be understood by more people from the service user groups for which the home is registered e.g. learning disabilities and sensory impairment and that the Registered Individuals must ensure that the Service Users’ Guide covers all areas required by Regulation 5 and Standard 1. This work had not been done although the organisation is looking into ways to use video to make information more useful for service users. (See Requirements 1 & 2) All the service users at this home moved in together several years ago and although there is now one vacancy, no one new will be moving in as the service is due to close in the next few years when the building is sold. Because of this there have been no assessments of any new service users. Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service user plans do not address fully how identified goals are to be worked towards and how the plans are to be changed if the plan does not work. Not all individual areas of need (particularly aggressive or potentially harming behaviour) are addressed in the service user plans in a way that describes a programme designed to eventually change the behaviour. Plans focus on managing the behaviour on a day-to-day basis without emphasising positive behaviour and ability which means that service users are not being helped to move on or develop independence as much as is possible. Work has started to use advocates and try and find out what they service users and their families’ want but right now the home does not do enough to make sure that service users make their own decisions as far as possible. Risk is not regularly reviewed which means that service users may be being put at some risk of harm or may not be being supported to take reasonable risks, develop skills and be as independent as possible. Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 12 EVIDENCE: There is a lot of information in the service users’ files much of which is out of date or not in use. Many of the support guidelines in place to tell staff how to support service users have not been reviewed for several years. The manager acknowledged that there is a lot of work to do around care planning and risk assessment at this home. He talked about the piece of work that he intends to do over the next few months. This will include reviewing all elements of each service user’s care to make sure that it is still effective and what the service user and their family wants. This work is included in the Improvement Plan mentioned in this report’s summary. There was a previous requirement that the Registered Manager must ensure that Service User plans focus on forward planning and how staff will support service users to achieve identified goals, develop positive behaviour and minimise negative or challenging behaviour and maximise independence. These plans must be reviewed at regular intervals to allow for plans to be changed if they are not working to ensure (as far as possible) that goals are met by the time the next six monthly multi disciplinary review takes place. Some work had been done on some files to show that staff do now think of short term goals for service users and then review those plans every three moths to see if the goals have been reached. Not all the service users have had this work done with them yet and the staff team has a long way to go to be fully focussed on the service users’ needs and how to meet them so although work has started it is not possible to say that the requirement is met. (See Requirement 3) A local advocate has been to visit the service to start supporting service users in their reviews to make sure their opinions are heard. However generally throughout this home there has not been an ethos of providing information to service users in ways that they can find useful and things have been done to them as opposed to with them. The format of the Service User Guide and the lack of care planning and review of support guidelines are signs of how staff are not responding to the changing needs of service users. It is not possible to say that service users make decisions about their lives with support as needed but it would not be useful at this stage to make any requirements in this area as the home has a huge piece of work to do over the next few months on other standards. This issue will be looked at again at the next inspection. Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although some work has been done in these areas since the last inspection service users are not provided with individual programmes of activities, both inside and out of the home, that engage and stimulate them. Staffing levels do not yet allow service users to move around the home as they choose or to undertake individual activities. Service users are supported to keep in touch with their families both by them coming to this home and by service users going out to meet with them. Service users are offered varied meals and staff try to make sure that they get what they understand what service users want. EVIDENCE: There was a previous requirement that the Registered Manager must ensure that service users are engaged in fulfilling and appropriate activities while in the home. There were problems with assessing this as clear records are not Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 14 kept of what each service user does each week. There are monthly reviews done but in these things such as cleaning teeth and getting dressed are included as activities so they are not useful when trying to find out what other activities in and outside of the home service users do each week. At the last inspection staff had told the inspector that the problem wasn’t that activities were booked for service users but that sometimes they didn’t happen because staff didn’t want to do it or there weren’t enough staff on duty to do them. The new deputy manager has been more active within the home to try and assess what is and isn’t happening. The new manager has begun work on drawing up a more flexible staff rota so that there are more staff around when service users need them the most. This will be assessed again at the next inspection. (See Requirement 4) Service users are supported to keep in contact with their families and they can visit when they choose. Service users attend day centres but friends from these services do not often come back to the home and although the organisation has a policy of allowing service users from different homes to visit each other this does not seem to be in operation at his home. There was a previous requirement that the Registered Manager must ensure that staff talk to and engage appropriately with service users while in their company. The service manager talked about the training that has started with the staff team which is around how to work properly with service users and the inspector didn’t see any staff talk inappropriately to service users during this inspection. The service manager said that the organisation has issued verbal warnings to staff who have acted inappropriately and will do so again if they find further examples. Although it was difficult to assess this fully the requirement is met but attention will be paid to these issues throughout the next few inspections to make sure that staff continue to develop their skills in this area. Staff cook for service users as they are not able to do this for themselves. The kitchens are locked as the manager said that issues of risk are too high for them to be able to leave them open. He said that given that service users could not cook or make themselves drinks in the kitchens anyway that there would be no advantage to opening the kitchens anyway. This issue will be discussed with the manager again at the next inspection. Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The systems at the home for keeping track of service users’ clothes and bed linen are not effective which means that service users possessions are mixed up with others and on occasion mislaid. The physical and healthcare needs of service users are met by staff making sure that they attend for regular GP and clinic appointment and bring in specialist professionals when there are emergencies. The systems for administering, recording and monitoring of medication stocks at the home are not being entirely effectively operated which means that the home is not keeping an accurate account of all medication that is brought into the home. EVIDENCE: There were previous requirements that the Registered Manager must ensure that the systems for checking that service users’ have both sufficient and appropriate clothing, including underwear are improved and that the Registered Manager must ensure that service users’ bed linen and clothing does not get mixed up or mislaid. There have been two complaints since the Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 16 last inspection that have been made about clothes going missing or being mixed up. The complaints were followed up by the service manager and the complainants were satisfied with the way the complaints were investigated. Keyworkers are now responsible for service users’ clothes and money has been taken from service users’ accounts to make sure they have enough clothes of the type they like to wear. Given that those complaints were recent the inspector was not prepared to remove the requirements until more time has been allowed to se if the new systems are working but the two requirements have now been merged into one. (See Requirement 5) Service users have GPS, attend regular health care appointments and additional or emergency healthcare needs are managed as required. Some service users have quite a lot of problems with their health and staff discussed some of those issues in the daily handover and showed that they understood how to meet those needs. There was a previous requirement that the Registered Manager must ensure that all medication is signed for at the point of administration. There were still some gaps in the recording of medication. There was a previous requirement that the Registered Manager must ensure that all stocks of medication are regularly and effectively checked. The medication is now checked regularly but the system that is used does not make sure that any mistakes or errors in administration or recording are found the inspector found examples of where errors had occurred that were just carried on when the next check took place. There was a previous requirement that the Registered Manager must conduct an immediate investigation into the missing co-proxamol and send a report of this investigation to the CSCI. This had been done. There was a previous requirement that the Registered Manager must ensure that all medication to be returned to the chemist is recorded in the Returns Book as soon as it is identified as returnable rather than when it is being taken to the chemist. No staff were aware of what the Returns Book was which was a concern in itself. One service users has to take a particular medication before they have a blood test yet there was no explanation of how often he has a blood test, whether the medication has ever been taken and there was no mention of this medication in their file. (See Requirements 6 - 10) Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Work has been done in the area of complaints since the last inspection but the current system for recording complaints does not fully monitor the process of investigation or whether the complainant was happy with the outcome which means that the home cannot know whether its procedure for listening to service users and acting on those views is working. Staff are not fully trained in the area of protection from abuse and are not aware of the organisation’s policies and procedures in this area which means that service users may be being put at risk of harm. EVIDENCE: There was a previous requirement that the Registered Manager must ensure that the correct contact details for CSCI, along with a brief explanation of their purpose, is included in the Complaints Policy and Procedure and Service Users’ Guide. The details had been changed in the Complaints Policy but not in the Service User Guide. The requirement was not fully met but the Service User Guide part can be included in the requirements under Standard 1. There was a previous requirement that the Registered Manager must ensure that a Complaints Book is maintained that provides a chronological record of all complaints at the home, including details of investigations, timescales for action and whether the complainant was satisfied with the outcome. Details of the recent complaints were recorded in a file but there was no clear record of how long the investigation took or whether the complainant was satisfied with the outcome. One complaint from a day centre had not been logged. The home Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 18 doe not keep records of the informal day-today concerns from service users, their relatives or other people and this means that they cannot find out about patterns of concern or problem that service users are having and take action to prevent them happening again or make the service better in the ways that service users want. (See Requirements 11 & 12) There are policies in place within the organisation around protecting vulnerable adults from abuse but as discussed later in the report staff have not generally been made aware of the policies of the organisation. Work around making sure staff are aware of the organisations’ policy is included in the Improvement Plan. As discussed under the standard about training, the records for staff training were not complete in that training they had received before they were employed by Odyssey are not available. The records that were available showed that some staff had not attended training in the area of protection from abuse. Although general requirements are made later around training, this area is particularly important and has been highlighted with a separate requirement here.(See Requirement 13) Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The standard of decoration and quality of furniture and fittings is not acceptable and some of the bedrooms are bare with not enough thought given to making them individual to each service user which means that service users are not living in a homely and comfortable place. The bathrooms in the homes are institutional in decoration and in their fixtures and fittings, although some work has been done in some of them since the last inspection. The home could not show that service users have the specialist equipment that they need to meet their individual needs with regard to bathing and showering which means that staff may not be working entirely safely and service users may be put at some risk of harm. EVIDENCE: There was a previous requirement that the Registered Provider must supply a copy of the planned maintenance and renewal programme for the fabric and decoration of the premises to the CSCI. This had not been done. Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 20 There was a previous requirement that the Registered Individuals must ensure that the general decoration of the home is regularly renewed and the environment is homely and comfortable throughout. No work had been done on the home since the last inspection except in the bathrooms. There was a previous requirement that the Registered Individuals must ensure that work is done in all bathrooms to ensure that all repairs are carried out and any worn areas/fittings are made good or replaced. Bathrooms must be decorated and/or additions made to provide a comfortable and pleasant, homely environment. Some work had been done in some of the bathrooms to make them more pleasant but it was still not possible to say that they were homely or comfortable. There was a previous requirement that the Registered Individuals must ensure that the staff shower is fixed. This had been done. There was a previous requirement that the Registered Individuals must ensure that an Occupational Therapists assessment is made of all service users who need assistance with bathing. showering, transferring or moving to ensure that the most appropriate aids and fittings are being used in the home. These assessments must be reviewed every time a service users needs change. The new managers were not certain about the moving and handling needs of service users but there had been no Occupational Therapists assessments of how staff are currently working with service users during bathing or toileting. The Occupational Therapist is coming to the home at the moment but that is to review service users’ needs for when they move on from this home. (See Requirements 14-17) There was a previous requirement that the Registered Manager must ensure that the home is clean and free from offensive odours at all times. On the day of the inspection the home did not smell although this time the home knew the inspector was coming. This issue will be monitored again on the next unannounced inspection. Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although staff talked of feeling comfortable in offering basic support around personal care and health and safety issues, the staff team as a whole is not fully aware of the specific needs of the service user group with regard to disability issues and sensory impairment. There are not enough staff trained to NVQ 2 in Care meaning that service users are not supported by an appropriately qualified staff team. The staff team is not fully effective because there are not enough staff on duty or they are not used effectively to enable service users to engage in meaningful individual activities and not to have to spend time in groups. Staff are not yet fully supervised and have not had their work and training needs assessed annually which means that service users are not being offered care by staff who are receiving the right amount of advice and support. EVIDENCE: There are two new deputy managers at the service although due to previous issues when this home was taken over by Odyssey one of the staff is called a deputy manager and the other a senior support worker. The job descriptions for the two posts are similar but not the same although they both have areas Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 22 where the requirements of the post are greater than the other. The manager stated that he intends for both posts to be the same in practice, both people will do the same work, have the same responsibilities, both will supervise staff and deputise in his absence. (See Requirement 18) There was a previous requirement that the Registered Individuals must ensure that plans are finalised for the management structure of the home and then recruit to the vacant posts. This had been done and there is now a new management team in place. There was a previous requirement that the Registered Individuals must ensure that suitably qualified, experienced and skilled staff are recruited to the vacant posts at the home. This had been done although the organisation has a policy of keeping some posts vacant and filling them with temporary bank staff so that there is more flexibility around covering staff sickness and annual leave. The Service Manager said that the organisation may have put extra permanent staff into those roles given the current problems in the service but there were not any additional staff recruited suitable for this service. This issue will be looked at again at the next inspection. There was a previous requirement that the Registered Individuals must ensure that the home meets the target of 50 of its care staff holding or undertaking the NVQ Level 2 in Care (or equivalent). The records sent through from the head office on the day of the inspection were incomplete but the service manager said that four staff are currently doing or already have the NVQ. This does not meet the target of 50 of staff holding it. The manager must also find out if the bank staff that he is using have the qualification as they are counted in this total. (See Requirement 19) There was a previous requirement that the Registered Individuals must ensure that the staff undertake training that enables them to identify, understand and meet the needs of the service user group with regard to learning disabilities and sensory impairment issues. The service manager talked through the training that has already been given to the staff team and showed a list of what has been planned. As with other issues discussed in the report there is evidence that work has been stated in this area but it has not been completed and the requirement is not met yet. (See Requirement 20) There was a previous requirement that the Registered Individuals must ensure that there are enough staff on shift at all times to enable service users to engage in meaningful activities and not to have to spend time in groups due to there not being enough staff to allow them to undertake individual programmes. As mentioned earlier under the standards talking about activities, work has started in this area in that the rota is being altered and the manager is looking at better allocation of staff time but this requirement is not yet met. (See Requirement 21) Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 23 The organisations’ recruitment records are not held in the homes and the inspector will be going to their head office to assess the records for all the homes at a later date. The Commission now has a form that has to be held on file for all staff which is a form of checklist for recruitment records and which is signed by one of the Registered Individuals. (See Requirement 22) There is work required around training plans for this home but as stated earlier, rather than create new requirements in this report this work has been outlined in the Improvement Plan. The new deputy has begun to supervise staff and the plan is for this to occur monthly. The manager was not certain if the other deputy manager had receive supervision training. The manager believed that appraisal of staff had been done early this year but the files showed that some staff had not been appraised, other appraisals did not have dates on them and some were not complete. (See Requirements 23 & 24) Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 42 & 43 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not yet well run. The number of unmet requirements from previous inspections shows that the management of this home had not been taking effective action to ensure it meets the requirements of The Care Home Regulations 2001 and the National Minimum Standards. However, there are now new managers in the home and there are signs that things may improve in the next few months. The home does not do enough to gather the views of service users and their families and then try to improve things in the ways that they want. The home does not have effective systems in place to monitor all areas of the service and make sure that staff are always trying to make things better which means that things have stayed the same or got worse for service users over the past few years. Some polices and procedures have not been reviewed for along time which means that staff may not be being given the best advice and guidance. Staff Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 25 have not read and discussed any of the policies and procedures for a long time which means that they do not always know how the organisation wants them to work with service users. Health and safety procedures are operated effectively by staff which means that service users are protected from harm. There is not enough financial and business planning in place for this home to cover the problems that may come up over then next few years with the home closing and people having to move out which means that the home may not be organised enough and problems may occur which could have been avoided. EVIDENCE: There is an new manager in the service who has been a manager at another Odyssey home for a number of years and who was registered with the Commission there. He now needs to submit an application to the Commission for this home although as he was already aware of this and had only been in post for two days there is no need at this point to make a requirement about it. There was a previous requirement that the Registered Individuals must ensure that quarterly reports are made to the CSCI that describe the planned process for the closure of this home, consultations that are taking place and the risk assessed move-on of the service users. The organisation is keeping the Commission informed of the work that is being done in this area. The home does not currently have in place a system that makes sure the home can monitor and develop all areas of the work. The organisation does have a system in operation at its other homes that this inspector has seen that looks at service users goals and feeds those into a quarterly action plan but that is not working at this home. The organisation does conduct the monthly visits to the service by an external manager or service manager and send these through to the Commission as required. A survey about what people think of the home has recently been sent out to service users’ families and other professionals who work with the home but the results of this are not back yet. Given the current state of this home and the workload that will be placed in the new manager to ensure that the home meets the National Minimum Standards, it would easer if an external, professionally recognised system is used that can be followed by staff. (See Requirement 25 and Recommendation 1) As stated throughout this report, an additional Improvement Plan is required to make sure this home does the work necessary to meet the standards and this will be finalised and agreed at a meeting between the organisation and the Commission at a later date (See Requirement 26) Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 26 Polices and procedures have not been read or discussed with the staff team for a long time and the manager has a plan to introduce a policy into the team meetings so that he can be sure that staff understand how to work at the home. This work will be included in the Improvement Plan for the home. There was a previous requirement that the Registered Manager must ensure that all procedures and systems for ensuring adequate fire prevention and management are adhered to. All fire systems were checked and found to be operated effectively. All health and safety systems were being operated as they should be and all necessary documents and certificates were in place. There was a previous requirement that the Registered Manager must ensure that the London Fire and Emergency Planning Authority (LFEPA) are contacted to undertake a safety inspection of the building. The petty cash system in operation currently does not effectively safeguard money as there is no record of what money is being used for and two staff do not countersign any receipts. The managers were aware of this and had bought a book ready to change the system and could discuss this new system with the inspector. A requirement is not being made at this inspection but this issue will be looked at again at the next inspection. The service users’ money that was checked by the inspector tallied with the accounts. The organisation is the corporate appointee for service users and the home is sent monthly statements from head office for each service user. Only the managers have access to the cards for service users accounts. There is currently no business/financial plan for the home; there is one for the organisation but not an individual plan for the home that looks at where he home is going in the next few years and plans for issues that are expected to arise. Given the planned closure of the home and move on of service users this is particularly important right now. (See Requirement 27) Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 27 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 1 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 2 26 1 27 2 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 X 2 2 X 3 2 Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 28 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5 Requirement Timescale for action 01/08/06 2. YA1 5 3. YA6 15 The Registered Individuals must ensure that the Service Users’ Guide is drawn up in a format that can be understood by more people from the service user groups for which the home is registered e.g. learning disabilities and sensory impairment. Unmet requirement: Previous timescales 30/09/05 & 21/11/05 The Registered Individuals must 01/08/06 ensure that the Service Users’ Guide covers all areas required by Regulation 5 and Standard 1. Unmet requirement: Previous timescales 30/09/05 & 21/11/05 The Registered Manager must 01/08/06 ensure that Service User plans focus on forward planning and how staff will support service users to achieve identified goals, develop positive behaviour and minimise negative or challenging behaviour and maximise independence. These plans must be reviewed at regular DS0000060232.V291396.R01.S.doc Version 5.1 Gibson House Page 29 4. YA14 5. YA18 6. YA20 7. YA20 8. YA20 intervals to allow for plans to be changed if they are not working to ensure (as far as possible) that goals are met by the time the next six monthly multi disciplinary review takes place. Unmet requirement (although work has started): Previous timescales 31/08/05 & 21/11/05 16(2)(m)(n The Registered Manager must ),18(1)(a) ensure that service users are engaged in fulfilling and appropriate activities while in the home. Unmet requirement (although work has started): Previous timescale 21/11/05 12 (1) (a) The Registered Manager must ensure that the systems for checking that service users’ have both sufficient and appropriate clothing, including underwear are improved and that service users’ bed linen and clothing does not get mixed up or mislaid. Unmet requirement (two requirements that have now been merged into one): Previous timescales 30/12/04, 31/07/05 & 21/11/05 13 (2) The Registered Manager must ensure that all medication is signed for at the point of administration. Unmet requirement: Previous timescale 31/10/05 13 (2) The Registered Manager must ensure that all stocks of medication are regularly and effectively checked. Unmet requirement: Previous timescale 31/10/05 13 (2) The Registered Manager must ensure that all medication to be returned to the chemist is recorded in the Returns Book as soon as it is identified as returnable rather than when it DS0000060232.V291396.R01.S.doc 01/08/06 01/08/06 14/05/06 14/05/06 14/05/06 Gibson House Version 5.1 Page 30 9. YA20 13 (2) 10. YA20 13 (2) 11. YA22 22 12. YA22 22 13. YA23 13 (6) & 18(1) (c) (i) 23 (2) (b) 14. YA24 is being taken to the chemist. Unmet requirement: Previous timescale 31/10/05 The Registered Manager must ensure that staff are aware of and use the Medication Returns Book. The Registered Manager must ensure that when a particular medication is to be given at irregular times there are clear guidelines for the use and monitoring of that medication on the service user’s file. The Registered Manager must ensure that a Complaints Book is maintained that provides a chronological record of all complaints at the home, including details of investigations, timescales for action and whether the complainant was satisfied with the outcome. Unmet requirement (although some work has been done): Previous timescale 21/11/05 The Registered Manager must ensure that day-to-day comments and concerns from service users, their families and others are recorded so that action can be taken to address any patterns of concern and plans can be made to improve the service in ways that service users want. The Registered Manager must ensure that all staff attend effective training around abuse/protection of vulnerable adults. The Registered Provider must supply a copy of the planned maintenance and renewal programme for the fabric and decoration of the premises to the Commission. DS0000060232.V291396.R01.S.doc 14/05/06 14/05/06 01/08/06 01/08/06 01/09/06 01/08/06 Gibson House Version 5.1 Page 31 15. YA24 23 (2) (d) 16. YA27 23 (2) (b) & (d) 17. YA29 23 (2) (n) 18. YA31 18 (1) (a) 19. YA32 18 (1)(a) (c) (1) Unmet requirement: Previous timescales 30/12/04, 31/08/05 & 21/11/05 The Registered Individuals must ensure that the general decoration of the home is regularly renewed and the environment is homely and comfortable throughout. Unmet requirement: Previous timescale 21/11/05 The Registered Individuals must ensure that work is done in all bathrooms to ensure that all repairs are carried out and any worn areas/fittings are made good or replaced. Bathrooms must be decorated and/or additions made to provide a comfortable and pleasant, homely environment. Unmet requirement (Although some work had been done): Previous timescale 30/09/05 & 21/11/05 The Registered Individuals must ensure that an Occupational Therapists assessment is made of all service users who need assistance with bathing. showering, transferring or moving to ensure that the most appropriate aids and fittings are being used in the home. These assessments must be reviewed every time a service users needs change. Unmet requirement: Previous timescale 31/08/05 & 21/11/05 The Registered Individuals must ensure that the current deputy manager and senior support worker have the same title and job description if they are to be expected to have the same role and responsibilities. The Registered Individuals must ensure that the home meets the target of 50 of its care staff DS0000060232.V291396.R01.S.doc 01/08/06 01/08/06 01/08/06 01/08/06 01/08/06 Gibson House Version 5.1 Page 32 20. YA32 18 (1) (c) (i) 21. YA33 18 (1) (a) 22. YA35 19 (1) (b) 23. YA36 18 (2) 24. YA36 18 (2) & 18 (1) (c) (i) 25. YA39 24 holding or undertaking the NVQ Level 2 in Care (or equivalent). Unmet requirement: Previous timescales 30/09/05 & 31/12/05 The Registered Individuals must ensure that the staff undertake training that enables them to identify, understand and meet the needs of the service user group with regard to learning disabilities and sensory impairment issues. Unmet requirement: Previous timescale 31/12/05 The Registered Individuals must ensure that there are enough staff on shift at all times to enable service users to engage in meaningful activities and not to have to spend time in groups due to there not being enough staff to allow them to undertake individual programmes. Unmet requirement: Previous timescale 21/11/05 The Registered Individuals must ensure that the Commission’s recruitment form is completed for all staff and held on file at the home. The Registered Manager must ensure that all staff are supervised at least six times a year by a line manager who has been trained to offer such supervision. The Registered Manager must ensure that staff receive an annual appraisal of their performance which includes an assessment of their training needs. The Registered Individuals must ensure that an effective quality assurance system, base on seeking the views of service users, their families and others DS0000060232.V291396.R01.S.doc 01/08/06 01/08/06 01/08/06 01/08/06 01/08/06 01/09/06 Gibson House Version 5.1 Page 33 is in place in the home. 26. YA39 24 The Registered Individuals must ensure that the action identified within the Improvement Plan is completed within the required timescales. The Registered Individuals must ensure that there is a business and financial plan in place for the home. 01/09/06 27. YA43 25 (2) (c) 01/08/06 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 YA39 Good Practice Recommendations The Registered Individuals should consider introducing a professionally recognised quality assurance system. Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 34 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gibson House DS0000060232.V291396.R01.S.doc Version 5.1 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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