Inspection on 07/01/09 for Gloucester Road (22)

This inspection was carried out on 7th January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gloucester Road (22) 20/12/07

Gloucester Road (22) 08/11/05

Gloucester Road (22) 12/04/05

Gloucester Road (22) 09/11/04

Gloucester Road (22) 18/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Gloucester Road (22) 22 Gloucester Road Kingston Upon Thames Surrey KT1 3SJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: David Halliwell     Date: 1 4 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Gloucester Road (22) 22 Gloucester Road Kingston Upon Thames Surrey KT1 3SJ 02085470610 02085463832 pm-gloucesterroad@together-uk.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Together Working for Wellbeing care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home 22 Gloucester Road is a large, detached property situated on the outskirts of Kingston upon Thames. Town centre facilities are within easy reach and the home is conveniently situated for access to public transport networks. The property is owned by the Local Authority, the Royal Borough of Kingston but the project is managed by Together Working for wellbeing. The home has a contract with a local Primary Care Trust. The local primary care trust also contributes to the funding of the project. The home offers six bedrooms on the ground floor of the property and a further ten bedrooms on the first floor. The home has a large garden to the rear, mostly laid to lawn with a range of mature trees and shrubs. 16 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The stars quality rating for this service is adequate. This means that people who use these services experience adequate quality outcomes. They said that they like to be called residents. A completed Annual Quality Assurance Assessment (AQAA) was received prior to the inspection. No enforcement activity has occurred since the last inspection. This was an unannounced inspection visit and was carried out over 2 days. The Inspection covered all the key standards in the National Minimum Standards for Younger Adults. Care Homes for Adults (18-65 years) Page 5 of 35 The inspection involved a tour of the home, a review of all the homes records and formal interviews with 2 staff including the Manager. 4 residents were spoken with formally and more informal interviews were conducted with 2 other residents as a part of the tour of the home. 5 staff and 4 residents files were inspected as was the policies and procedures manual for the home. 6 requirements have been made as a result of this inspection and 1 recommendation has been made. A number of these requirements are repeated from the last inspection and must now be met within the new timescale if enforcement action is to be avoided. Feedback on the requirements and recommendations was given verbally to the Manager at the end of the inspection visit. The residents and staff were very helpful and they are to be thanked for their assistance over the course of this inspection visit. The agencies Registration Certificate with the Commission for Social Care Inspection was seen displayed appropriately in the hall just outside the main office. There have not been any changes in the ownership of 22, Gloucester Road since the last inspection however a new Manager started in October 2008. What the care home does well: What has improved since the last inspection? What they could do better: Specific areas identified in this report are as follows: 1. Each resident should have a comprehensive needs assessment that covers all areas of their needs including their cultural needs. These assessments should be reviewed at least annually and care plans revised and updated appropriately. 2. Care plans must be reviewed and updated regularly (at least once annually) or as the needs of the resident change. Residents and other parties should sign and date the care plans. 3. Care plans should contain specific care plan objectives that relate to the needs assessments and to the Care Programme Approach documentation where appropriate and state how care aims are intended to be met. 4. It is strongly recommended that once the new medication procedures are in place Boots are asked to come and review the effectiveness of the new procedures. 5. An inventory of residents valuable belongings must be drawn up and maintained and kept up to date by key workers for all residents valuable belongings that are kept in their bedrooms.. 6. The following areas of the home that were found to need some further improvement work - The rear back stairway needs redecoration as it is stained and the paintwork needs renewal. - The toilet by bedroom no 8 needs another overhaul with special attention to be paid to the floor. This needs to be fully sealed so as to avoid the penetration of urine is causing bad odours and a potential health hazard. Replacement radiator covers are required throughout the house, the Manager told us that this was planned for 2008, but as yet has not been completed. - In the toilet by bedroom no 15 the boxing needs replacement and the floor needs to be fully sealed. The radiator cover in this room must be replaced as it is badly damaged by urine. 7. Documentary evidence required under Standard 34 of the National Minimum Care Homes for Adults (18-65 years) Page 7 of 35 Standards must be gathered for all the staff members at Gloucester Road and be held on the staff files for review and inspection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users cannot at present be assured that their needs are being re assessed or that their individual aspirations and wishes are being taken into account in the assessment process. Evidence: This standard requires the service to ensure that individual residents needs are assessed and that their aspirations are taken into account in the process. Needs assessment information should be supplied by the referring agencies and also the homes staff should carry out a needs assessment of the resident in the home. This information should be linked with any risk assessment information and the care plans. At this inspection we looked at 4 of the residents files. There was little evidence that an updated needs assessment had been carried out by the home in 2008 on any of the 4 files inspected including a newly admitted resident. However for this person there was a pre admission needs assessment provided by the referring agency that does cover the main areas of her needs. Residents had not Care Homes for Adults (18-65 years) Page 10 of 35 Evidence: signed the information that was seen on file. This is an important way of showing that the resident has been involved in the process and agrees with the content of the assessments. Therefore a requirement is made that for each resident there should be a comprehensive needs assessment that covers all areas of their needs including their cultural needs. Needs assessment information from referring authorities should be taken into consideration and these assessments should be reviewed at least annually and care plans revised and updated appropriately. The new Manager has explained that this work has been given a high priority and will be addressed in the near future with all the residents files now under review. This requirement must be met within the new timescale set out in this report. Care Homes for Adults (18-65 years) Page 11 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The individual residents care plans seen on the residents files does not reflect the assessed and changing needs and personal goals of the residents.Therefore they may not be assured that they will be supported to make decisions about their lives with assistance as needed. Risk assessments do help to ensure that they will be supported to take risks as part of an independent lifestyle although this would be more effective if they were integrated with care plans. Evidence: 4 residents files were inspected and we spoke to 4 residents over the course of this inspection. In 3 of the 4 residents files we could see that care plans had been drawn up however these plans had not been reviewed or revised in the last 6 months. For the other resident no care plan had yet been drawn up given that they had only recently within the last month been admitted to the home. However it might have been expected that a draft care plan would have been seen on the file. It is a requirement that care plans are reviewed and updated regularly (at least once annually) or as the Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: needs of the resident change. Residents and other parties should sign and date the care plans. This is important since it provides agreement and commitment to the contents of the plans. The 4 residents that we spoke to did say that they had been involved in their care planning meetings although they were less aware of what these plans really meant for them. The care plans that we saw on the 3 residents files did not contain specific care plan objectives. Care plan objectives describe how the aims of the care plans will be achieved. Lack of care plan objectives may hinder the process of review of the care plans since there is nothing specific against which to measure and monitor the residents progress. It is a requirement that care plans should contain specific care plan objectives that relate to the needs assessments and to the Care Programme Approach documentation where appropriate and state how care aims are intended to be met. All residents confirmed that they do have a key worker and that they are able to communicate with their key workers appropriately. The Manager and staff also confirmed that all residents have a key worker who they receive support from on a regular basis. Residents interviewed by us confirmed that the staff at Gloucester Road do respect their rights to make their own decisions where appropriate. Care staff also made it clear that they involve the residents wherever possible in making their own decisions in order to assist in supporting a positive move towards independence. The Deputy Manager told us that the daily community meetings are now held monthly in the unit and they involve the residents as much as is possible, to make decisions about different aspects of their lives. This includes menu planning and daily activities as well as planning the routine maintenance tasks that have to be undertaken every day and which involves the residents. Residents confirmed with us that they attend these meetings. We saw minutes of these monthly meetings that confirm they have been held and the issues that were discussed. Risk assessments had been carried out for 3 of the 4 residents however as was found at the last inspection risks identified in these risk assessments were not addressed in the residents individual care plans. The Manager explained that it is planned to put in place a risk management plan for each resident who has had a risk assessment and that this will be linked in with the care plans. This would help to ensure the best protection for the resident and create the link between the risk assessments and the care plans that is required. Care support staff confirmed that they are involved with Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: the residents in completing the risk assessments in order to support residents to lead as independent a lifestyle as possible. Care Homes for Adults (18-65 years) Page 14 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to take part in appropriate activities and are to a reasonable extent involved in local activities. Residents have appropriate relationships and their rights and responsibilities in their daily lives are recognised and respected by the staff in the unit.Residents are offered a healthy diet and they are assisted in learning cooking and food preparation skills. Evidence: We found evidence that care staff do encourage the residents to keep their relationships with family and friends if residents wish to do so. The Deputy Manager told us that visitors to the home are encouraged and that they use the visitors book to sign in. The visitors book that was seen in the front entrance hall was evidently in regular use. The Deputy Manager also said that residents are enabled to take part in appropriate activities by the care staff. Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: Most of the residents living at Gloucester Road moved there directly from the Netherne Hospital where their previous activities are not recorded on the files now held at Gloucester Road. Interviews with 4 residents and 2 staff said that more outside services and activities are being used. We were told that each resident has a weekly activities timetable that helps them to remember what has been planned with them each week. Evidence of this was seen on residents files. The Manager told us that information is provided to residents by staff about local activities that residents say they are interested in. Residents told us that they do attend some local community events although their wishes for an active community social life are somewhat limited. Information is made available and staff do encourage residents to be involved as much as possible in local activities. Some residents told us that they like to go to the shops. Residents make full use of local public transport facilities in order to get out and about and to see friends and family. 1 resident who was interviewed said, the bus service is not bad and there is a bus stop just down the road here. All residents living at 22, Gloucester Road are registered to vote in elections and are supported by staff to do so if they wish. We saw that some information is made available within the home about local activities for residents to take up if they wish. Some of the residents we interviewed told us that they do keep in regular contact with their families and friends. Staff were seen to encourage the residents to keep and maintain contacts with family and friends so that they benefit from having appropriate relationships. Residents confirmed to us that the homes policy on privacy is upheld appropriately within the home. Residents have keys to their own rooms and to the front door, they are able to see their GP when they need to and to choose their GPs. Staff were seen by us to knock on residents doors before entering and service users were seen to have the opportunity to spend time in their own company as and when they wish. Some residents participate in household chores and those that we interviewed said that they enjoyed these responsibilities and were all very clear as to when and what they have to do. Residents can be assured that their rights and responsibilities are respected in their daily lives. Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: The Cook informed us that there is a weekly menu and that there are always 2 choices of meals for the residents. Residents are enabled to make choices at the menu planning stage and special needs are catered for. 4 service users interviewed said that they have been asked about what food they would like to see on the menu and what they wish to eat on a daily basis. Menus that were seen were varied and nutritious in the food being provided. Residents confirmed that they all enjoy the food they receive at Gloucester Road. The recently completed Annual Quality Assurance Assessment (AQAA) for Gloucester Road says that menu choices need to be improved further and that those residents who have diabetes need to be offered a wider choice of meals. Consultation with a dietician is also proposed. The Manager told us that this is being developed at the present time. Cultural needs and wishes of the residents are also taken into account with the provision of appropriate foods, which meets their stated needs. Residents can therefore be assured that they will be offered a healthy diet and that they should enjoy their meals and mealtimes Care Homes for Adults (18-65 years) Page 17 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and healthcare is provided according to service users individual needs. Clinical support for specific health care is provided by General Practitioners, District Nurses and by the psychiatric multi disciplinary teams as well as other specialist services such as chiropody, sight and hearing services thus ensuring that residents do have a good quality of life. Procedures for the administration of medication need to be reviewed so as to avoid errors. Evidence: The Deputy Manager told us that residents have the choice of when they get up, when they go to bed and what they do during the day. The residents we interviewed at this inspection also said that they choose when to go to bed, when to have a bath, what they wish to wear and what activities they do during the day. Residents did not raise any concerns with us about their key workers. Residents at 22, Gloucester Road continue to receive regular input from their Consultant Psychiatrist, Community Psychiatric Nurses and from other professionals in Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: their clinical teams. This means that residents do receive support in the way they prefer. With regards to the health care of the residents the Manager informed us that all residents are supported to keep well through accessing appropriate healthcare and associated mental health care support. All residents are signed up with local GP surgeries and some are registered with local dentists. The Manager told us that annual health checks take place at the GP surgeries. The Manager said that whether or not a resident uses the dentist is left up to the residents own decision but staff will encourage residents to use this service if required. Residents who we spoke to said that they go to see their GPs as and when necessary and that they have the monthly meetings with their clinical teams. They said they prefer not to go to the dentist. Forms are in place to monitor residents visits to these healthcare professionals however they are still only being used patchily. Discussion was had with the Manager about this who said that it might be because there is a duplication of this information being recorded. The Manager told us that the Deputy Manager is responsible for the medication practices carried out within the home. We were told that only those care staff who have received appropriate training are allowed to administer medication to the residents. The homes policies and procedures manual was inspected and was seen to contain appropriate policies for the control of medication. We reviewed the records for the administration of medication to residents and these were seen to be appropriately completed and in line with the homes policies and procedures. A stock take check was also carried out by us together with the senior member of staff (responsible for medication on that shift) for the administration of controlled medications. The levels of medication held within the home did not match the MAR sheet records. Records were inspected for 3 different residents and significant errors were found on each record. This is a serious breach of the homes policy and procedures. It was agreed with the Manager that this would be investigated immediately and that the procedures will be completely reviewed to ensure no further mistakes are made in this area. This is a requirement. The Manager assured us that all staff are booked on to a training course for 4th February in order to receive medication training and to be fully briefed as to how the new procedures work. We were told that the Boots Pharmacy do a regular inspection of the homes procedures and it is strongly recommended that once the new Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: procedures are in place Boots are asked to come and review the effectiveness of the new procedures. Although training in medication for staff is a part of the overall agencies training plan, staff training records showed that staff received this training in 2006. Staff interviewed confirmed that they had received this training then. Residents vary in their ability to administer their own medication. The home actively supports those who wish to self medicate and trained staff organise the ordering, the storing and the administration of medication with service users. The Manager is advised that following recent changes in the legislation, an appropriate medication cabinet will be required for controlled drugs. Care Homes for Adults (18-65 years) Page 20 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents may be assured that their views will be listened to and acted upon appropriately. They may also be assured that they will be protected from abuse, neglect and self-harm. Evidence: Residents told us that they feel their views are listened to and acted upon. They also all said that if they had a complaint they know the procedure to be followed and would do so if they needed to. Staff interviewed confirmed with us that the residents are all aware of the complaints process and that the whole staff group took any issues raised by residents seriously. The complaints record was reviewed, no complaints had been made since the last inspection visit. The home has an adult protection policy (POVA) and the Manager informed us that since the last inspection some of the staff group had received POVA training. At the last inspection a requirement was made that all staff receive POVA training from an outside and recognised trainer at least once every 2 years. The Manager has told us that all staff are booked onto a POVA training course with the Royal Borough of Kingston upon Thames in January and February this year. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: When the staff group have received this training the requirement will have been met. Certificates of staff attendance will be required to be seen. Regular training in this area should mean that staff are better aware of what abuse is and the safeguards in place for the protection of the residents should they need them. We saw the allegation of abuse record and 1 allegation had been made in 2008 since the last inspection. Evidence was seen by us that the correct procedures have been followed. The appropriate authorities were informed and an action plan implemented. A vulnerable adults conference was held with the appropriate parties including the referring local authority. All the agreed actions were taken appropriately except that the Commission was not informed of the event. We told the Manager that in future the Commission for Social Care Inspection should be informed and the Manager confirmed that this would be done. The policies and procedures manual for the home includes a whistle blowing policy and a policy on dealing with violence and aggression. Understanding the policies and procedures is a part of the staff induction process and staff are asked to sign to say that they have read and understood the policies and procedures. A review of staffing records held on staff files confirmed that all staff had signed such an agreement. The Manager said that the home does look after some residents money. We reviewed the financial records for these transactions that all were in order. All transactions are dated and signed for by both staff and residents to confirm satisfaction by all parties. We found no anomalies. At the last inspection it was recommended that an inventory for residents valuable belongings be drawn up and maintained and kept up to date by key workers for all residents valuable belongings that are kept in their bedrooms. This is now a requirement. Review of 4 of the residents files evidenced that this has not been thoroughly carried out. The completed AQAA received from the home confirms that this still needs to be done as it has only partially been completed. Inventories must be signed and dated by the residents concerned in agreement to the contents. This should add to the measures already in place to ensure the protection of the residents property. Care Homes for Adults (18-65 years) Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users do live in safe and comfortable surroundings and said that they are happy living in this environment.Service users may be assured that the home is clean and hygienic. Evidence: We reviewed all areas of the home to assess the quality of the environment and decor. Generally the home was found to be clean and hygienic although there are still some areas that do need to be refurbished and are rather tired from considerable use, specifically the bathrooms and toilets. We were told by the Manager that a budget has been set aside for major refurbishments in the home and that there is a plan in place now for 2009 for the bathrooms and toilets all to be refurbished and redecorated as required. We were also told by the Manager that the kitchen is due for a complete overhaul and refurbishment in 2009. 4 residents bedrooms were inspected with the permission of those residents. They told us that they are happy with their rooms. Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: The following elements of the requirement made at the last inspection to do with the environment are here repeated since they have not yet been met. It is required that the following items are addressed, areas of the home that were found to need some further improvement work 1. The rear back stairway needs redecoration as it is stained and the paintwork needs renewal. 2. The toilet by bedroom no 8 needs another overhaul with special attention to be paid to the floor. This needs to be fully sealed so as to avoid the penetration of urine is causing bad odours and a potential health hazard. 3. Replacement radiator covers are required throughout the house, the Manager told us that this was planned for 2008, but as yet has not been completed. 4. In the toilet by bedroom no 15 the boxing needs replacement and the floor needs to be fully sealed. The radiator cover in this room must be replaced as it is badly damaged by urine. Environmental health officers carried out an inspection in April 2008 report was also seen and all the recommendations have been met. The Manager showed us evidence that the electrical wiring safety check was carried out successfully in February 2006 and this is understood to be valid for 5 years. We asked to see the records for checks on water temperatures and the Manager provided the homes records for this. They revealed that these tests have been carried out each week as is required. Tests carried out all indicated that the hot water temperatures were within the prescribed limits. Care Homes for Adults (18-65 years) Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users do benefit from clarity of staff roles and responsibilities but service users cannot be fully assured that they are supported by a competent and qualified staff team given the lack of documentary evidence on staff files. An appropriate recruitment policy and induction process helps protects residents and ensure that they are supported appropriately. However until regular and formal 1:1 supervision is provided to all staff, service users cannot be assured that they will benefit from well-supported and supervised staff. Evidence: The Manager informed us that other than for her own post no new staff have been recruited to the home since the last inspection. We were told at the last inspection that there is a training programme underway to ensure that all staff will be NVQ qualified by the end of the year. The Manager at that time said that all of the staff group had either completed their NVQ level 2 training or were doing the NVQ at level 3. Inspection of the training files this time did not however show any newly gained NV Qualifications. While staff who interviewed confirmed that they were completing their NVQ training and some evidence of NVQ training certificates was seen in the office records it remains that staff files should Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: include certificated evidence for all training undertaken by staff. The Manager told us that the home does have a recruitment policy and procedure and that all staffing posts are filled by application and interview. Evidence of these processes being used was seen when we inspected the staffing files. A review of 5 of the staffing files evidenced 1. That suitable application forms are completed as a part of the process but only 3 of the 5 files inspected actually had application forms in them. 2. Usually 2 references are obtained including one from the last employer, however 2 staff files had no references. 3. All staff files reviewed had proper Criminal Record Bureau (CRB) checks that had been carried out for staff employed within this home. The Manager is reminded however that all CRB checks should be renewed every 3 years and that those CRB checks carried out in 2004 need now to be renewed. 4. Other official documentary evidence confirming the identification of staff either in the form of a passport, birth or marriage certificate needs to be held on file, this information was only seen on 3 of the 5 files inspected. 5. Training certificates and other evidence of qualifications gained by the staff member should also be held on the staffing files such as that for NVQ training. Evidence of NVQ qualifications was not on the files. 6. Staff files should include signed and dated copies of their contracts. Contracts were only seen on 2 of the 5 files inspected. It is therefore now a requirement that documentary evidence required under Standard 34 of the National Minimum Standards be gathered for all the staff members at Gloucester Road and be held on the staff files for review and inspection. This is a repeat requirement and must now be met within the new timescale if enforcement action is to be avoided. This will help to ensure that recruitment practices meet the required standards. The Manager informed us that a structured induction programme is offered to new staff. Documentary evidence of this was seen and staff at interview said that it had been helpful to them to better understand their roles and functions at Gloucester Road. We were told that Together do offer a comprehensive training plan for staff that covers the essential and priority training needs for staff working in their homes. The Manager informed us that staff may attend as many internally provided training courses as they are assessed to need in order to carry out their job appropriately. At the last inspection it was recommended that as a part of the managers role an annual training needs analysis be undertaken of the whole staff group at Gloucester Road and maximum use made of the training provision. This has since been carried out and the Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: new Manager showed us a training matrix that identifies all the training undertaken by the staff group. It also highlights the gaps where staff need to undertake further training. This is a useful management tool and should assist greatly with ensuring that all staff are sufficiently well trained to meet the needs of the residents. Training for staff has included - Fire prevention - POVA - 1st Aid - Medication - Food hygiene Additional training for staff that would compliment and expand the scope and range of the existing in house training packages would be a useful addition to the staff training package. Suggested areas are in some of the most important key areas for staff skills and knowledge including: Needs assessment, care planning, developing action plans, monitoring and review. Health and safety. From discussions with the Manager and from interviews with 2 staff it is clear that at present staff receive ongoing supervision and support in the work they undertake and a supervision record is maintained that is signed by both parties. However the record made of key areas of discussion or of all the decisions and agreements made still falls short of what is required. The Manager agreed that there is still work to be done in continuing to improve the quality of staff supervision in the home. It is essential for instance that there is discussion in supervision with staff about how to implement in practice the homes philosophy and aims when working with individual residents. Equally it is essential for the successful delivery of care to residents as well as providing job satisfaction for staff, that supervisors help them to monitor their work with individual service users and analyse the success or not of care plan outcomes in meeting their residents needs. Supervision should be carried out on a 1:1 basis once every 2 months. Supervision notes must be maintained regularly and kept on staff files and areas of discussion in supervision must be detailed enough to cover the monitoring of work with individual residents and the analysis of care plan outcomes, support and professional guidance, and the identification of training and development needs. Annual appraisals need to be carried out and copies held on file. Care Homes for Adults (18-65 years) Page 27 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be confident that they benefit from a well run home. Service users may also be confident that their rights and best interests are safeguarded by the homes record keeping policies and procedures. Evidence: The Manager told us that she took up this post on 1st October 2008, she said she is in the process of registering herself as manager with the Commission. She said she is currently studying to achieve her NVQ level 4 Management Award and expects to finish this in the near future. Previous experience includes working as a deputy manager for 2.5 years at a care home for adults. We were shown information to do with relevant Health and Safety legislation. Policies and procedures were also seen for Health and Safety, risk assessment, moving and handling and fire. The Manager explained that health and safety and maintenance checks are carried out on a daily and weekly basis and paperwork supporting this was seen by us at this inspection. This means that needs are identified quickly and Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: residents are therefore better supported and protected within the home. The Manager told us that a new fire risk assessment has recently been carried out on 8th January 2009 and evidence of this was seen at this inspection. The Manager explained that all the fire fighting equipment in the building is new since 17.9.07 including fire extinguishers and smoke detectors; and new emergency lighting was installed in February 2007. We saw evidence of this. Other records were inspected to check the regularity of fire drills (last fire drill was held on 14.12.07), break glass testing and emergency lighting tests. The Manager explained that all furniture within the home now meets the B.S fire proof standards. Fire drills should be held at least 6 monthly, none have been held since the last inspection. The Manager informed us that all staff receive training in fire safety, first aid, food hygiene, and infection control. This was not however supported training records that we inspected. Satisfactory certificates were seen for: Boiler 17.11.08 Gas 23.6.08 Fire alarms 9.6.08 Fire extinguishers 15.8.08 Emergency lights 10.11.08 Water and legionnaires tests 26.6.08 PAT electrical testing 8.7.08 Mains electrical system 24.5.06 (5 years) All food was seen to be stored appropriately and properly labelled with dates of opening and expiry. Fridge and freezer temperatures records were checked and records indicate that they came within the acceptable ranges. Accident records were checked and the policy and the procedures for dealing with accidents were seen to be recorded correctly. Hot water temperatures were checked and records indicated that they came within the acceptable range. The last water temperature test recorded was for 2nd January 2009. At the time of this inspection no fire doors were seen to be wedged open and the building appeared to be secure. Care Homes for Adults (18-65 years) Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 6 14 Risks that have been identified in the risk assessments should be specifically addressed in the care plans in order to minimise the risks to the residents. 01/03/2008 2 23 18 All staff should receive POVA 01/04/2008 training from an outside recognised trainer at least once every 2 years. Certificates of staff attendance will be required. 3 24 23 The following areas of the 01/04/2008 home need some further improvement work: In the kitchen a tile was missing that needs replacement so as to avoid a health hazard. The ground floor bathroom floor and toilet bowl needs replacement as discussed with the Manager. The rear back stairway needs redecoration as it is stained and rather tired. The toilet by bedroom no 8 needs another overhaul with special attention paid to the floor that needs to be fully sealed so as to avoid the penetration of urine that Page 30 of 35 Care Homes for Adults (18-65 years) cause bad odours and potential health hazards. Replacement radiator covers are required throughout the house, the Manager told the Inspector that this is planned for 2008. In the toilet by bedroom no 15 the boxing needs replacement and the floor needs to be sealed. 4 34 19 That documentary evidence 01/02/2008 required under Standard 34 of the National Minimum Standards be gathered for all the staff members at Gloucester Road and be held on the staff files for review and inspection. This will help to ensure that recruitment practices meet the required standards. 5 36 18 Supervision: 01/03/2008 Supervision should be on a 1:1 basis once every 2 months. Supervision notes must be maintained regularly and kept on staff files and areas of discussion in supervision must be detailed enough to cover the monitoring of work with individual residents and the analysis of care plan outcomes, support and professional guidance, and the identification of training and development needs and Annual appraisals need to be carried out and copies held on file. Care Homes for Adults (18-65 years) Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 Each resident should have a comprehensive needs assessment that covers all areas of their needs including their cultural needs. These assessments should be reviewed at least annually and care plans revised and updated appropriately. In order to meet the NMS. 01/03/2009 2 6 15 Care plans should contain 01/03/2009 specific care plan objectives that relate to the needs assessments and to the Care Programme Approach documentation where appropriate and state how care aims are intended to be met. In order to meet the NMS. 3 6 15 Care plans must be reviewed 01/03/2009 and updated regularly (at least once annually) or as the needs of the resident change. Residents and other Care Homes for Adults (18-65 years) Page 32 of 35 parties should sign and date the care plans. In order to meet the NMS. 4 23 13 An inventory of residents 01/03/2009 valuable belongings must be drawn up and maintained and kept up to date by key workers for all residents valuable belongings that are kept in their bedrooms. In order to meet the NMS. 5 24 23 The following areas of the 01/03/2009 home that were found to need some further improvement work. The rear back stairway needs redecoration as it is stained and the paintwork needs renewal. The toilet by bedroom no 8 needs another overhaul with special attention to be paid to the floor. This needs to be fully sealed so as to avoid the penetration of urine is causing bad odours and a potential health hazard.Replacement radiator covers are required throughout the house, the Manager told us that this was planned for 2008, but as yet has not been completed.In the toilet by bedroom no 15 the boxing needs replacement and the floor needs to be fully sealed. The radiator cover in this room must be replaced as it is badly damaged by urine.This is a repeat Care Homes for Adults (18-65 years) Page 33 of 35 requirement and must now be met within the new timescale if enforcement action is to be avoided. In order to meet the NMS. 6 34 17 That documentary evidence 01/03/2009 required under Standard 34 of the National Minimum Standards be gathered for all the staff members at Gloucester Road and be held on the staff files for review and inspection. This will help to ensure that recruitment practices meet the required standards. This is a repeat requirement and must now be met within the new timescale if enforcement action is to be avoided. In order to meet the NMS. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 20 It is strongly recommended that once the new medication procedures are in place Boots are asked to come and review the effectiveness of the new procedures. Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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