Inspection on 12/06/08 for Good Neighbours House

This inspection was carried out on 12th June 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 25 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Good Neighbours House 22/05/09

Good Neighbours House 26/11/07

Good Neighbours House 14/11/06

Good Neighbours House 01/12/05

Good Neighbours House 18/08/05

Good Neighbours House 30/12/04

Good Neighbours House 17/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Good Neighbours House 38, Mary Datchelor Close London SE5 7AX Lead Inspector Sonia McKay Key Unannounced Inspection 12 & 13th June 2008 09:30 th Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Good Neighbours House Address 38, Mary Datchelor Close London SE5 7AX 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) 0207 703 7451 0207 252 7105 good.neighbours@scope.org.uk www.scope.org.uk SCOPE Pasteur Djatchi Care Home 16 Category(ies) of Physical disability (16) registration, with number of places Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Physical disability - Code PD The maximum number of service users who can be accommodated is: 16 26th November 2007 Date of last inspection Brief Description of the Service: Good Neighbours House is a purpose built care home which provides care and accommodation for up to sixteen adults who have a physical disability. The home is fully accessible to people who use wheel chairs. Each resident has his or her own room. The home has three floors, access to the upper floors is by stairs or the two passenger lifts. None of the bedrooms on the top floor of the home are currently in use. Three residents live in accommodation which is used to develop independent living skills and, as appropriate, to facilitate a move to independent living in the community. The home is located close to the centre of Camberwell where there is a busy shopping centre, banks, restaurants and pubs. Public transport routes are close by. The charges for the current residents are between £2,000 and £6,000 a month. There have not been changes in the ownership, management or service registration details in the last 12 months. Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection was carried out over two days. The first day of the inspection was carried out by two inspectors and a pharmacist inspector. The second day of the inspection was carried out by one inspector. The methods used to assess the quality of service being provided include: • • Talking with the interim home manager and area manager Looking at the Annual Quality Assurance Audit document completed by the registered home manager (this document is sometimes called an AQAA and it provides the Commission with information about the service) Talking to staff on duty during the inspection Talking to four of the current residents A tour of the premises Looking at records about the care provided to four of the residents Looking at records relating to staff recruitment and training Looking at the way medicines are handled by staff in the home Looking at issues that the Commission has been notified about since the last inspection and how they were handled • • • • • • • The Commission would like to thank all who kindly contributed their time, views and experiences to this inspection process. What the service does well: What has improved since the last inspection? Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 6 Serious concerns about the care of two people admitted to the home before the last inspection are addressed by better care planning and risk assessment and one of the residents said that he has now settled in well. There has been an improvement in consultation with the residents as a group, and residents have requested and obtained some additional resources as a result. There is a bigger television in the communal lounge and it is now wall mounted to make it easier for more people to watch together. There is better television reception in bedrooms and a bigger room for arts and crafts. This is evidence that the service is beginning to listen to and act on the views of residents in a practical way. There is progress in adding menu choices that better meet people’s cultural backgrounds. Feedback about the food is generally good and kitchen cleanliness has improved. Staff have been trained in how to respect peoples privacy and dignity. What they could do better: The information available to potential residents does not include the full range of details required by Regulation. This means that people cannot make an informed choice about moving to the home. Prospective residents must also be assured that their needs have been assessed and can be met by the home. There must be a more ‘person centred’ approach to planning care with residents and care must better reflect people’s personal needs, goals and skills development. Key working must be more co-ordinated and all written plans and risk assessments must be reviewed regularly or when a persons needs change so that their current needs are always reflected in the written plans. Care plan information should also be available to staff when they plan each shift so that any planned care and support is actually delivered. Residents are able to lead lives of their choosing if they have a sufficient level of mobility and independence to obtain it for themselves. Residents with higher support needs are less able to have a good quality lifestyle of their choosing as they rely on staff for support. Staffing needs are unclear and people are not getting the additional support to engage in activities they are assessed as needing in some cases. There is an institutional feel to the home and there is little opportunity for people to develop their independent living skills. More must be done to ensure that the building is safe and homely. Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 7 It is not clear whether staffing levels are sufficient to meet the needs of the current residents. Training is needed to make sure that staff have the skills and knowledge to better meet residents’ health care needs. The service has been going through significant instability in recent months, as interim management arrangements are in place whilst the manager is on leave. This has delayed the required service improvement. Scope must make more effort to ensure that building is a safe place to live and work and to ensure that a quality service is provided. The Commission will require an improvement plan detailing how Scope will address requirements made in this report and those not met from previous inspection reports. Failure to evidence improvement will lead to consideration of enforcement action by the Commission. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The information available to potential residents does not include the full range of details required by Regulation this means that people cannot make an informed choice about moving to the home. Prospective residents must also be assured that their needs have been assessed and can be met in the home. Resettlement procedures could not be examined as no new residents have moved to the home since the last inspection, however serious concerns relating to inadequate assessment and planning for the two most recent admissions have been addressed. EVIDENCE: During the previous two inspections it was noted that the written guide given to prospective residents does not reflect the amendments to Regulation 5 of the Care Homes Regulation 2001, which were introduced in July 2006. The changes require, amongst other matters, greater detail to be included about the standard package of services provided, the terms and conditions which apply, fee levels and payment arrangements. The document must be reviewed and amended to ensure that it includes all of the information required by regulation. Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 10 The Registered Manager must ensure that potential residents are given a copy of the service user guide so that there is clarity about the services the home provides. Consideration should be given to making the document available in a range of formats appropriate to the residents’ communication needs. A requirement was made about this. The AQAA (Annual Quality Assurance Audit) states that the home plans to produce the guide in a brochure format with thought being given to making it easy to read and accessible. The revised guide is at draft stage but is not yet being distributed. The requirement is therefore not met. (See requirement 1) The statement of purpose and the service user guide do not include adequate information about the size of the bedrooms. This information should be added as part of the planned review of the documents. During the previous inspection it was noted that two residents had been admitted to the home without adequate assessment and planning. Staff were unsure what the residents needs were and were unable to support them effectively because of this. An immediate requirement was issued and the matter referred to the local authority that placed the residents. Appropriate care planning and assessment work was undertaken and the immediate requirements were met. There have been no new residents admitted to the home since the last inspection, so it was not possible to see whether the resettlement procedures have improved. A resident who moved in prior to the last inspection said that he had now settled in well. The last two inspection reports have required that the home manager confirm in writing that the home can meet the assessed needs of any prospective resident. This must form part of the admission procedure. Discussion with the acting home manager indicates that although Scope has such a document as a template, it had not been used in the home. He said that new residents would receive confirmation that their needs have been assessed and can be met by the home. But as there are no new residents this has not been demonstrated and the requirement cannot be deemed as met. (See requirement 2) Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 11 Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There must be a more ‘person centred’ approach to planning care with residents and care must better reflect personal needs, goals and skills development. Key working must be more co-ordinated and all written plans and risk assessments must be reviewed regularly or when a persons needs change so that their current needs are always reflected in the written plans. Care plan information should also be available to staff when they plan each shift so that any planned care and support is actually delivered. There has been an improvement in consultation with residents as a group, and residents have requested and obtained some additional resources as a result. EVIDENCE: The planning and assessment records of four residents were examined. The plans are in some cases informative and in other cases less so. There is also a lack of regular review and some of the care plans and risk assessment have not been reviewed in over a year. Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 13 Specific plans around the care of the four individuals were looked at and not all planned care could be verified as happening. Some plans were more detailed than others. Shift plans for staff do not always take into account the individual care plans of each person. For example, shift plans about personal care and activity routines are different to the planned routines described in individual files in some cases. The lack of regular care plan review may also be a factor, as peoples needs, routines and preferences may have changed and this may not be reflected in their written plans. The acting home manager completed an audit of all care plans review dates, and this audit indicates that some plans are well overdue for review. There has also been some work to find records and to re-organise the individual files into proper sections so that information is more accessible. Some records are not in place and are stored in plastic bags, awaiting filing. The management team said there are plans to introduce a more person centred approach to care planning and re-introduction of the full range of Scope planning and assessment tools. This will encourage a more holistic approach and, if done correctly, will address long standing unmet requirements in regard to care planning review frequency, planning for skills development, healthcare planning and planning to meet cultural needs, which remain unmet at this inspection. (See requirements 3, 4, 5 & 6) Some of the sections in individual files are completely empty. There is a section for monthly key worker meeting reports, and in some cases there are no reports available. Some care plans are overdue for scheduled review and in some cases care plans from 2005 are in place. Some care plans are not signed by the resident or the staff member who completed them. There is insufficient evidence of regular consultation, planning and review with residents. (See requirement 7) A requirement in regard to better consultation with residents during group meetings has been addressed, there has been a residents meeting and there are minutes available. The management team said that the issues raised at the meeting have been addressed and have resulted in the purchase of a bigger television in the communal lounge that is now wall mounted to make it easier for people to watch, there is better television reception in bedrooms and a bigger room being dedicated to arts and crafts activity. This is evidence that Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 14 the service is beginning to listen to and act on the views of residents in a practical way. There is inadequate risk assessment and review. Given that some residents have a wide range of care needs in addition to a physical disability, it is essential that staff are given clear and up to date information about each aspect of care and support required and any associated risk factors. This includes risk assessment of moving and handling assistance required. Risk assessments are in place in some cases but are overdue for review. (See requirement 8) Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents are able to lead lives of their choosing if they have a sufficient level of mobility and independence to obtain it for themselves. Residents with higher support needs are less able to have a good quality lifestyle of their choosing as they rely on staff for support. Staffing needs are unclear and people are not getting the additional support to engage in activities they are assessed as needing in some cases. There is an institutional feel to the home and there is little opportunity for people to develop their independent living skills. EVIDENCE: Some residents attend day centres or adult education courses at local colleges. There are two activities co-ordinators employed by the home. There is a wheelchair accessible vehicle and a handyman/driver who provides transport to and from colleges, day services and other appointments. Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 16 Some residents are able to go out independently while others need more assistance, particularly with transport. Residents were observed to be relaxing in the lounge watching television and reading newspapers, some alone and some in small groups. Other residents were spending time alone in their own bedrooms. Some residents had been able to go on holiday during 2007, although there is no funding provision for holidays and this is funded separately by residents themselves. This should be made clear to potential residents. Residents can make and receive visits from friends and family members. They can see their visitors in private if they use their bedrooms. Shift planning is not effectively matched to individual care needs in some cases. Some residents have additional one to one time to meet their care needs as part of the package of care purchased by the local authority, and this is not evident in shift planning records. Discussion with home managers during this inspection indicates that they are aware of this problem and are looking at ways of better communicating the daily needs/routines/one to one time/activities of all residents to seniors planning the staff resource on each shift. (See requirement 9) It is noted that activities planned for the day of the inspection were not taking place and some of the residents were observed to be colouring in pictures at the dining tables on both days of the inspection. One resident complained of being bored, wanting to go out more, wanting more opportunities to practise walking outside and wanting more people to talk to. Staff said sometimes there are not enough staff to provide one to one time. The AQAA states that the service aims to provide residents with a more active and fulfilling lifestyle in the next twelve months. The activities co-ordinator was assisting a resident to prepare for a birthday lunch with a family member, and there is progress in making more space for activities (a bigger arts and crafts room). There is also a bigger television and better television reception. During the previous inspection it was noted that none of the residents have a key to the front door or to their bedroom doors. A requirement was issued and no action has yet been taken is not met. If a decision is made to deny any resident a key to their own home and living areas, this decision must be supported by a written risk assessment. The decision to provide keys must also entail an assessment of any risks that this poses and how they are to be addressed (for example, the need to over-ride a lock system in case of an emergency). The resident and any involved Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 17 advocates or representatives should be consulted as part of the risk assessment process. (See requirement 10) There is a large kitchen with a hatch that is open to a communal dining room. Meals are prepared by a cook who works between Monday and Friday. At weekends one of the care staff prepares the meals. The cook and care staff have received training in food hygiene. As required in previous reports, there is some progress in adding menu choices that better meet peoples’ cultural backgrounds. Feedback about the food is was generally good on the inspection although there are two complaints recorded from two residents about the quality of particular meals. Kitchen cleanliness has improved. There are adequate supplies of food in stock, although not all opened items that were stored in the refrigerator had been labelled with an opening date. This could lead to food poisoning as staff may use ‘out of date’ food. (See requirement 23) At the last inspection there was a lack of information about the nutritional needs of the residents and a requirement was issued. During this inspection it is noted that staff, including the cook, were able to describe the special diets that some residents are on and there is a record kept for easy reference in the kitchen. Some of the residents need assistance to eat and others need adapted cutlery and crockery. These needs are provided for. Staff give any necessary assistance patiently and discreetly. There is an area in the dining room where residents can access fresh water, although the hot water dispenser is currently broken so residents have to ask staff to prepare them a hot drink in the main kitchen. This may be reducing their skill levels and independence. The main kitchen is inaccessible to people who use a wheelchair and none of the ovens or sinks are accessible. This reduces the opportunity for skills development and independence. Two of the residents live in semi-independent flats and have small kitchenettes. Equipment in these kitchens is old and not well organised for people with a physical disability. Advice should be sought about how these kitchens can be better appointed and equipped to meet the needs of the people using them. (See recommendation 2) Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. More must be done to ensure that residents receive personal care and support in the way that they currently need and prefer. Information about peoples overall health and personal care is difficult to find, as records are not well maintained. There are significant gaps in recording and a failure to implement advice given by health professionals. This does not provide resident with adequate support to maintain good health. MEDICATION JUDGEMENT EVIDENCE: Most residents need some form of assistance to undertake their personal care. As noted earlier in this report, the preferences described in individual plans are not always added to the duties on shift. This means that residents are not getting their personal care as they have agreed with the service. In one case a file section on bathing is completely blank although the resident requires assistance. (See requirement 11) Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 19 There is progress in providing staff with training around preserving peoples’ privacy and dignity, and this addresses an outstanding requirement in this regard. People wishing to use a bathroom on the third floor are restricted to using it before nightfall, as the lighting is poor. This means that one resident regularly bathes in the late afternoon. This is fine if it is her preference, but not if it solely done at this time because of the poor lighting. Times for getting up and going to bed are flexible, staff said that some residents like to get up late in the morning and this was being honoured during the inspection. Residents are registered with a local GP, dentist and optician. The GP refers people to specialist clinics as necessary. There is evidence of specialist input, but not of how advice given is implemented by staff. There are speech and language therapists involved in the care of the resident. Recent review feedback indicates concern that staff do not provide adequate support with using a computerised communication tool. The key working systems are not robust. Monthly key working reports are not in place in many cases, and the quality of some reports that are in place indicates that they are task focused, with tasks such as ‘tidying up a bedroom’ identified as key work for that month. During the last inspection it was noted that healthcare needs could not be easily tracked as records were badly kept and organised. The homes AQAA identifies medical recording as a required area of improvement in the next twelve months. There has been some re-organising of files since the last inspection, but they still contain a vast amount of old and out of date information. A section called ‘medical interventions’ is completely empty in some files. (See requirement 13) There are letters and records on file that show that health care appointments, both specialist and routine, are attended. However, there are still gaps in recording. Regular weight checks are not routinely conducted, and those that have been have been recorded are in a communal book as opposed to a personal record. Failure to review care plans and risk assessments in a timely manner does not ensure that there is adequate consideration of a persons current healthcare needs. Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 20 Observations in daily records are not always adapted to the specific monitoring needs of individuals; for example, a changing sleep pattern may indicate that one resident is becoming mentally unwell. Failure to monitor and record these indicators may reduce the quality of feedback to other health professionals involved and may lead to late intervention. Daily notes about another resident are detailed and provide clear feedback about advice given at various healthcare appointments attended. There is inadequate assessment of moving and handling. One resident needs full assistance and uses a hoist for transfers. A care plan that was drawn up in 2005 is in place (although overdue for review) and there is no risk assessment available on file. Staff spoken with were confident about the moving and handling routines that they use, but this support must be fully assessed and a written plan for safe transfers put in place and reviewed regularly or when a persons needs change. All assistance with transfers must be risk assessed and reviewed regularly also. (See requirement 8) There is little progress in training staff about the specific needs and health conditions of the current residents, for example, training in meeting the needs of people with diabetes, epilepsy and behaviours that can be challenging. The requirement is not met. This is further addressed in the staffing section of this report. (See requirement 12) MEDICATION EVIDENCE Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is improvement in the way the service records and responds to complaints and the action they have taken has improved the service that people are getting. Procedures are in place to ensure that vulnerable adults are safeguarded from abuse and the home responds appropriately to allegations of misconduct. However, the service has failed to notify the Commission of significant events in the home. EVIDENCE: The Scope complaints procedure is published in a leaflet called ‘Complaining isn’t wrong- it’s a right’. The leaflet details the actions that residents or others may take if they wish to make a complaint. The leaflet can be made available in a variety of formats, including audiotape and large print, and is available in poster formats in communal areas of the home. The record of complaints show that there have been three complaints recorded since the last inspection. The complaints were investigated and the complainants given feedback. The records also show what actions were taken to rectify issues. One complaint was from a day service and as a result of the complaint there is better communication between the services. Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 22 Failure to record complaints properly was an issue during the previous inspection. Evidence of current recording indicates that the staff are recording complaints made by residents and the requirement is therefore met. Scope has a procedure entitled ‘Responding to protection allegations/ disclosures’. Staff have received training in the use of the procedure from the Registered Manager and a Scope ‘National Protection Adviser’. The policy includes the need to involve other agencies including the police, local authority Social Services Department and the Commission. Homes are required to give information to the Commission about a range of incidents including allegations of misconduct. A copy of the Local Authority safeguarding procedures are available for staff reference. Since the last inspection, Scope managers have worked with the Local Authority safeguarding team to investigate an anonymous allegation about a member of staff, who was suspended during the investigation to ensure the safety of residents. This is good practise. The allegations were found to be unsubstantiated and the member of staff re-instated, although the investigation highlighted areas of potentially poor service, poor record keeping and poor staff organisation. Incident records show that there have been a number of injuries that the Commission was not notified about. For example, the death of a resident and a number of falls resulting in minor injuries. This was an issue at the last inspection and a requirement made in this regard is not met. (See requirement 14) The organisation has safe policies and procedures for managing residents’ money and valuables. The home’s staff and manager are not allowed to take on the role of appointee for residents. Records of the management of personal allowances are maintained. Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 & 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. More must be done to ensure that the building is safe and homely. EVIDENCE: The premises allows access throughout for people who are wheel-chair users. There is adequate communal space for residents, although the main kitchen is not accessible to people who use wheelchairs. There is a large dining room with adjoining television lounge. There are also more private sitting spaces available in the hallways and lobby area of the home. A small smoking room is at the front of the building as is a small private room with a payphone. The dining room has doors to an open grassed area which, although not part of Good Neighbours House is a pleasant area for residents to sit in the warm weather. Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 24 All of the bedrooms are single occupancy. The bedrooms seen were, in some cases, personalised, clean and tidy, but show signs of the need for redecoration. Other bedrooms are less well furnished and personalised. A member of staff said that bedrooms are generally better when residents are willing to spend their own money. Some bedroom furnishings are worn and badly repaired. There are sharp edges and peeling areas on some of the work surfaces in bedrooms and many bedrooms are too small to accommodate the minimum standard of furnishings expected. Although there has been some redecoration since the last inspection, bedroom doors are painted black, and one door still has a nameplate for a previous occupant. The lighting is poor in bedrooms and communal areas. Residents would benefit from an overhaul of the physical environment and this refurbishment should be carried out with advice from an Occupational Therapist so that the varied needs of people living in the home are considered. (See recommendation 2) The statement of purpose and the service user guide do not include adequate information about the size of the bedrooms. This information should be added as part of the planned review of the documents. Some of the bedrooms are too small to allow the specified items of furniture to be included in the room, do not have a wash hand basin, and en-suite facilities are not provided. Bathroom and WC facilities are close to all of the bedrooms. Some of the baths and WC’s are adapted for people with disabilities and showers are also available. Hoists are available to enable residents to use the facilities. On the ground floor one of the WCs has an over-head tracking hoist. A first floor bathroom with an adapted bath is not in use as the ceiling is too low to allow a hoist to be used. There is a passenger lift but it is poorly lit and does not have a mirror that would assist residents who use wheelchairs to get in and out of the lift with a better view. During the previous inspection an immediate requirement was issued as central heating was not working in some areas and some of the bedrooms were cold. Alternative heating was put in place as an interim measure, while a part was replaced in a boiler. The immediate requirement was met. Many portable heaters are still in bedrooms although staff said that the heating had been repaired. A resident thought that his heating was still not working. Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 25 Portable heaters present a hazard and should not be routinely used in bedrooms. The third floor of the building is vacant. There are empty bedrooms and corridors that were in regular use many years ago when the home accommodated more people. Most rooms are used for storage; one room is used for staff meetings and another for maintenance and repair work. Two residents regularly use bathroom facilities on the third floor and anybody can access this vacant area by using the passenger lift or staircase. The windows on the third floor of the home are not fitted with restrictors, so they open fully. Some unlocked rooms contain cleaning fluids and decorating materials and chemicals. Windows on the communal staircase and in some bedrooms were also noted to have no opening restriction. A window in a third floor bathroom has many long anti-climb spikes that project into the room when the window is opened. These issues present a risk of injury. This indicates that there is inadequate risk assessment and a failure to monitor the safety of the physical environment and to take action to ensure safety. (See requirement 15) There is an unpleasant smell of urine coming from a toilet on the third floor of the building. (See requirement 16) Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. It is not clear whether staffing levels are sufficient to meet the needs of the current residents, as essential review of individual care arrangements has not taken place. Although many staff know the residents well they are not trained fully trained in meeting their wide-ranging needs. Staff are not supervised often enough. This means they are not receiving enough support with key areas of their work. EVIDENCE: Each day there are currently four or five carers on duty and an activities coordinator. There are two carers on duty at night and an on-call system for management advice out of hours should the need arise. There is a cook and a maintenance person/driver between Monday and Friday. There is also an administrator and manager. A recruitment drive is underway as there are staff vacancies currently covered by agency staff or regular staff doing additional hours. Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 27 There are twenty-four care staff. Twelve staff have already attained a National Vocational Qualification in care (NVQ) at level 2 or above and a further four are currently undertaking the award. More staff must undertake the award. (See requirement 17) During the previous inspection a requirement was made as there were not enough staff on duty to undertake all of the one to one time needed to complete activities with certain residents. There is still a lack of clarity about who should be getting additional time, although staffing numbers are to be slightly increased to improve staff availability. (See requirement 18) A previous requirement to ensure that staff are trained to meet the specific health needs of the residents is only partly met. (See requirement 9) A requirement to better assess staff during recruitment could not be fully examined as no new staff have been employed since the last inspection, when it was noted that in some cases employment records did not have a complete or detailed employment history. Progress in meeting this requirement will be examined during the next inspection if new staff have been employed. (See requirement 19) There is no team training and development plan in place, although the AQAA states that a range of training is available. (See requirement 20) As the manager has been on leave for an extended period of time, an interim manager has begun to supervise the senior carers, but examination of carer files indicates that they have still not been supervised with the required frequency. Although there is some progress, a previous requirement made in this regard is unmet. (See requirement 21) Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The service has been going through significant instability in recent months, as interim management arrangements are in place whilst the manager is on leave. This has delayed the required service improvements in some cases. The Commission will require an improvement plan detailing how Scope will address requirements in this report and those not met from previous inspection reports. Failure to evidence improvement will lead to consideration of enforcement action by the Commission. Scope must make more effort to ensure that building is a safe place to live and work and to ensure that a quality service is provided. EVIDENCE: The manager of the home has been registered under the Care Standards Act since 2002. The statement of purpose of the home confirms that the Manager Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 29 holds management and care qualifications and has worked in social care for more than ten years. The registered manager has been a period of extended leave. Another Scope manager is managing the home in his absence, with input from an area manager. The interim managers facilitated this inspection. Monthly inspections in accordance with Regulation 26 are carried out by one of a team of Scope managers. A requirement to ensure that these visits are carried out is met and monthly reports are available in the home. The outcome of a recent safeguarding investigation indicates a need for better home management. Failure to address many outstanding requirements from the Commission, additional requirements in this report and failure to meet national minimum standards in many areas indicates a need for rapid service improvement. After the last inspection, the registered persons were required to submit an improvement plan to the Commission. A plan was submitted but the registered manager went on a period of extended leave soon after and there is slow progress in implementing the plans. There is inadequate quality assurance checking. The results of a survey sent to residents in 2005 have still not been published. A follow up quality assurance exercise was planned for 2007, but so far this has resulted in only a series of questions being put to residents. There is no analysis of the information obtained or feedback to residents. A requirement was made in the previous inspection report for a copy of the report which results from this exercise to be supplied to the Commission and to residents of the home. This requirement is not met and is replaced by a wider requirement in regard to quality assurance. (See requirement 22) The record keeping processes in the home must be improved. This was evident from the residents’ health care records and the care plans. In addition the systems for notifying the Commission of incidents/allegations are inefficient. An annual fire risk assessment is overdue for review and wider environmental risks have not been adequately considered and addressed. (See requirement 15) During the last inspection a requirement was issued as there was evidence of inadequate checking of mobility aids, such as wheelchairs, and a fault reported by a relative had not been actioned for repair. This placed the resident in danger of injury. Discussion with the maintenance person who organises wheelchair checks and repairs indicates that there is now a record of checks. The record simply says the date that all wheelchairs were checked. The record should detail which specific wheelchairs chairs were checked. (See recommendation 3) Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 30 A call alarm system is in place in bedrooms and bathrooms in case of emergency. During the previous inspection the manager said that the system is not checked professionally as it is old and due for replacement. A system of internal checks has been put in place to ensure safety until the system is replaced. Staff responded quickly to a test alarm call placed from a bathroom during the inspection. Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 2 27 2 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 2 X 2 X 1 X 2 2 X Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 32 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 The Registered Person must ensure that the service user guide is reviewed and amended so that it includes all of the information required by Regulation and the National Minimum Standards. The timescale of 01/09/07 for meeting this previous requirement is not met. A copy of the revised guide must be supplied to the Commission by 2. YA3 14(1)(d) The Registered Person must ensure that residents are given written confirmation of the home’s ability to meet their assessed needs. The timescales of 01/04/07 and 31/01/08 for meeting this previous requirement are not met. 3. YA6 12, 15(1) The Registered Person must DS0000007106.V365317.R01.S.doc Timescale for action 31/10/08 31/10/08 31/10/08 Page 33 Good Neighbours House Version 5.2 ensure that care planning systems are improved by ensuring that there is reference to skills development, enabling residents to maintain their skills, to be given opportunities to use them and have the chance to learn new skills in keeping with their wishes and goals. This requirement was first made at the inspection of August 2005. The timescale of 01/09/07 for meeting this previous requirement is not met. 4. YA6 12(4)(b) The Registered Person must ensure that the care plans include details of the residents’ cultural needs and how they will be addressed by the home. The timescale of 01/04/07 for meeting this previous requirement is not met. 5. YA6 15(2)(b) The Registered Person must ensure that reviews of care plans are conducted by the home every six months. The timescale of 01/04/07 for meeting this previous requirement is not met. 6. YA6 YA19 15(1) 12(1)(a)(b) The Registered Person must 31/10/08 ensure that care plans include details of residents’ health care needs and how the home will address them. 31/10/08 31/10/08 Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 34 The timescale of 12/03/08 for meeting this previous requirement is not met. 7. YA7 12(2) 15(2) The registered person must ensure that service users are consulted about their care and that evidence of this consultation is available on file (by signing that they agree the contents of their care plans and risk assessments). The registered person must ensure that risk assessments are in place for all moving and handling tasks and any other risk factors. These plans must be reviewed regularly (at least every six months) or when a persons needs change. The registered person must ensure that service users receive their allocated ‘one to one’ time with staff. The registered person must ensure that if it is judged unsafe to issue a resident with a key to their bedroom that this is supported by a written risk assessment to which the resident and any involved advocates or representatives have been party. The timescale of 01/04/07 for meeting this previous requirement is not met. 11 YA18 15 The registered person must ensure that all residents are consulted about their personal care needs and DS0000007106.V365317.R01.S.doc 31/10/08 8 YA9 12(1) & (15(1) 31/10/08 9 YA13 18(1) 31/10/08 10. YA16 12(4)(a) 13(4)(b) 31/10/08 31/10/08 Good Neighbours House Version 5.2 Page 35 12. YA19 12(1)(a)(b) these needs and preferences must be drawn up into specific plans that are communicate to all staff on shift. The Registered Person must ensure that staff receive training in the residents’ health conditions and the implications for care practise. Although there is some progress, the timescale of 12/03/08 for meeting this previous requirement is not met. 31/10/08 13 YA19 15(1) 12(1)(a)(b) The Registered Person must ensure that there is a clear record of current medical input, health care and treatment. It is required that the Registered Person inform the CSCI without delay of any occurrence to which regulation 37 applies. The timescale of 22/01/07 for meeting this previous requirement is not met. 31/10/08 14 YA23 37 15/08/08 15. YA24 YA42 12(1) 13(4) 23 The registered person must 29/08/08 complete an environmental risk assessment and take action to ensure that all areas of the home are safe for residents and staff. The assessment must include: • Windows • All areas that are accessible to residents • Fire safety DS0000007106.V365317.R01.S.doc Version 5.2 Page 36 Good Neighbours House • • Kitchen hazards C.O.S.H.H 16. YA30 16 17. YA32 18 18. YA33 18 19. YA34 19 Sch 2 The outcome of the assessment must be supplied to the Commission along with an action plan with timescales for any remedial work identified as necessary. The registered person must ensure that all parts of the home are free from offensive odours. The registered person must ensure that all care staff attain an NVQ at level 2 or above. The registered person must ensure that there are sufficient staff on duty to meet the needs of the residents (including support for one to one time assessed as necessary) The Registered Person must ensure that staff recruitment practise includes obtaining full employment histories and all documents and checks as specified in regulation. Progress in meeting this requirement could not be fully examined as no new staff have been employed. 29/08/08 28/07/09 15/08/08 28/07/08 20. YA35 18 24 The registered person must 29/08/08 ensure that there is a staff training and development programme which meets the Skills for Care workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. DS0000007106.V365317.R01.S.doc Version 5.2 Page 37 Good Neighbours House 21. YA36 18(2) The Registered Person must ensure that all staff receive regular and frequent supervision. Although there is some progress the timescales of 01/04/07 and 31/01/08 for meeting this previous requirement are not met. 31/10/08 22. YA39 24 (1) 23. YA42 16 13 The registered person must establish and maintain a system for reviewing and improving the quality of care. The registered persons must ensure that opened items of food stored in the refrigerator are labelled with a date of opening so that stale food is not consumed. 31/10/08 15/08/08 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 YA42 Good Practice Recommendations The registered manager should devise a system to check on whether emergency call alarms located in bedrooms and bathrooms are functioning correctly. Appropriate action should be taken if a fault is identified. The registered person should seek advice from an Occupational Therapist about how the building can be better lit, decorated and furnished to meet the needs of the current residents. The registered person should ensure that the ‘in-house’ checks made on each person’s wheelchairs are recorded in sufficient detail. 2. YA24 3. YA42 Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Good Neighbours House DS0000007106.V365317.R01.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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