Inspection on 14/11/06 for Good Neighbours House

This inspection was carried out on 14th November 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 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 12/06/08

Good Neighbours House 26/11/07

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 08/07/2008.

CARE HOME ADULTS 18-65 Good Neighbours House 38, Mary Datchelor Close London SE5 7AX Lead Inspector Ms Alison Pritchard Unannounced Inspection 14 November 2006 & 19 January 2007 1:40 th th Good Neighbours House DS0000007106.V301906.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.V301906.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.V301906.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 (0), Physical disability over 65 registration, with number years of age (0) of places Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 16 (sixteen) people with physical disability some of whom may be over 65 years old. 1st December 2005 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 is 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. In January 2007 there were no vacancies in the home. There were nine male and seven female residents. One of the residents is over 65 years of age. The Manager stated that when vacancies arise information is made available to potential residents by informing local social services departments, by advertising on the organisation’s website and by informing other managers within the organisation about vacancies. He also said that residents are given information about CSCI reports in the residents’ meetings and through discussions with key workers. The charges for the current residents are between £2,300 and £6,000 a month. The manager stated that no additional charges are made. Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out over two days. Two inspectors visited the home on the first day but did not complete the inspection. This visit lasted for approximately five hours. The Registered Manager had planned to take a period of annual leave after this and the second visit was arranged to take place after his return. One of the inspectors made this visit and it lasted for eight hours. The inspection methods included observation of care practice; discussion with residents and staff, both informally and through interviews; inspection of residents’ files and a range of records and policy documents. Involved professionals were sent survey forms so that they could contribute to the inspection process. All of the residents were sent survey forms so that they could respond formally and anonymously. At the time of writing none of these surveys has been returned. Feedback was received from three professionals. The CSCI also has access to information gathered through notifications from the home. A pre-inspection questionnaire was sent to the home prior to the visits asking for information. This questionnaire was returned to the CSCI. All of this information has been taken into account in compiling this report. The inspection visits were facilitated by the Registered Manager and staff who were helpful and courteous throughout the process. What the service does well: What has improved since the last inspection? The Registered Manager has ensured that risk assessments are now in place to support two residents’ use of a kitchen which they use to prepare their own meals. The kitchen is now cleaner and more hygienic. Residents’ property lists have been audited. A redecoration and refurbishment programme is now underway and it is anticipated that this will significantly improve conditions in the home. Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 7 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.V301906.R01.S.doc Version 5.2 Page 8 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 must include the full range of details required by Regulation. The home obtained appropriate information about the needs of the person most recently admitted, but did not provide confirmation that they could meet them. EVIDENCE: At the time of the inspection visits there were no vacancies and there had been no admissions to the home since 2005. The Manager has stated that when vacancies arise information is made available to potential residents by informing local Social Services departments, by advertising on the organisation’s website and by informing other managers within the organisation about vacancies. A copy of the service user guide was given to the inspector. The document 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. 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 Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 9 should be given to making the document available in a range of formats appropriate to the residents’ communication needs. The file of the person most recently admitted to the home included a full assessment carried out by the placing social worker. However written confirmation that the home can meet the assessed needs was not on file. This must form part of the admission procedure. Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 10 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. Care plans did not adequately reflect the residents’ cultural and religious needs or their goals. Reviews of the care plans are not held often enough. Residents need more opportunities to contribute their views to their care plans and to the way that the home runs. Residents’ meetings should be held more often so that residents have the chance to give their views about how the home runs. EVIDENCE: Three care plans were examined. At the inspection of August 2005 a requirement was made that care planning include 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. It was found that the plans did not adequately comply with this requirement, neither did they describe how residents’ assessed needs and personal goals were to be addressed by the home. There Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 11 was also little recorded information about residents’ cultural and religious needs. Residents were aware of who their key worker is. Each resident is allocated two key workers so that if the main person is not available because of holidays or sickness the co-key worker can step in. The Team Leader was covering the duties of a key worker who had left her post. One resident had requested a change in key worker and this was due to take place the following month when a review of the key working allocation was planned. Reviews of care plans are not being conducted by the home every six months so this limits the opportunities that residents have to participate in drawing up their plans. The need for six monthly reviews of care plans was first raised in August 2005, at the subsequent inspection in December 2005 this was found to be met. However this progress has not been sustained throughout 2006. The files examined contained notes of reviews by placing social workers. In most cases the reviews involved residents and, where possible, family members. A minority of the reviews were carried out without the placing social worker making a visit to the home to consult with the resident and find out their views of the placement. This further limits these residents’ opportunity to share their views about their care. While this is outside control of the home it is recommended that the Registered Person request the direct input of the residents to reviews. One of the residents has been provided with a communication aid which has significantly increased her opportunities to communicate with people who do not know her well. This is a positive development and enabled her to share her views with the inspector. Residents’ meetings have previously been held regularly at the home, however no minutes of meetings were available for 2006. The Registered Manager said that two meetings were held during the year but the minutes were unavailable. The meetings should be held more frequently so that residents have a regular opportunity to contribute their views to the running of the home. Minutes should act as a method of ensuring that decisions taken at the meeting are actioned and that residents receive feedback about their involvement and participation. At the last inspection it was required that risk assessments be put in place to support residents using the independent living kitchen. These have now been put in place. Further reference is made to risk assessments in relation to health care below. Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 12 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 take part in a range of day time activities including attending colleges and day centres and doing voluntary work. They are supported to make and receive visits from family members and friends. If residents are not given keys to their bedroom, contrary to their expressed wishes, this must be supported by a documented risk assessment. There are concerns relating to how and if the special dietary and nutritional needs of some service users are being met. The menu records do not show that the meals assist in meeting residents’ nutritional, health care and cultural needs. EVIDENCE: Several of the residents go to day centres, others attend college placements and one person undertakes voluntary work at a city farm. Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 13 Two activities officers are employed by the home. One of these staff has just returned to work after a period of absence and this has had some impact on the provision of activities. However it is anticipated that this situation will improve now that the team is complete. Some residents are able to go out independently while others need more assistance, particularly with transport. The home has a minibus which is accessible to wheelchair users. A driver / handyman is employed by the home and the activities officers are able to drive the minibus. Some residents said that the availability of transport sometimes limits their access to local community facilities. However they said that they enjoyed the trips out which include visits to local pubs and restaurants. One resident is supported to attend his Church through the assistance of another member of the congregation and this is important to him. Two of the male residents attend a men’s group twice a week. Other activities include attending classes at the local leisure and sports centre – Peckham Pulse. Some residents had been able to go on holiday during 2006 and said that these had been successful and enjoyable. The fees do not include provision for a holiday and this is funded separately by residents. 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 rooms. There are rooms on the upper floor of the home which are used for private meetings, such as reviews. Residents are able to choose whether to join in group activities. Some residents said that they may choose to spend time alone in their rooms and their privacy is respected. Since the inspection the Registered Manager has stated that three of the sixteen resident have chosen to have keys to their rooms; twelve have chosen not to. The Manager said that it has been judged unsafe for one resident to have a key. This decision must be supported by a written risk assessment and note should be taken of the need for the lock to be over-ridden in case of emergency. The resident and any involved advocates or representatives should be consulted as part of the risk assessment process. 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 seven of the care staff have received training in food hygiene. The feedback from residents about the food was positive. One of the residents said that she occasionally has food which reflects her culture. The menu records do not reflect this and the record of changes made to the planned menu was incomplete. The menu did not reflect some residents’ health care needs, for example the need for a diabetic diet or for a cholesterol reducing diet. The residents would benefit by the cook and care staff receiving training in the importance of nutrition and diet in meeting health care needs. Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 14 Some of the residents need assistance to eat and others need adapted cutlery and crockery. These needs are provided for. Staff give the necessary assistance patiently and discreetly. There is an area in the dining room where residents may make hot drinks and access fresh water. Three residents cook and plan their meals with some assistance from staff, using the independence kitchens. Risk assessments are in place to support this. Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. 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. Residents said that they were looked after in the way they wished. However residents’ health care needs are not considered fully enough and staff have not had the training to understand their needs properly. Medication is given properly according to the doctor’s instructions, but staff would benefit from training in medication matters. EVIDENCE: The feedback from three residents spoken to in detail about the care provided was positive. One thing appreciated by residents is that they know most of the staff well and do not have to explain how they should help them as they might with a person less familiar with their needs. Another person said that they felt this was the best home of the three in which he had lived. This person was particularly appreciative of the transport that is available to take him to the day centre and also said ‘if I need help to go shopping there is always someone to take me.’ Some feedback received from a professional involved with a resident was less positive. The home’s investigation into an incident has led to some recommendations aimed at improving staff communication skills and the Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 16 standards of care. The manager has stated that staff are to receive training in how to provide care in a manner which is respectful and mindful of the privacy and dignity of residents. It is required that the home inform CSCI how they will ensure these matters are included in care practice and these matters should be monitored by managers. A health care professional expressed satisfaction with the overall care provided to the residents. The records of how the home supports residents to attend health care appointments were in poor order. Some records were in residents’ individual files, others in a separate file. Records in the separate file were mixed up, some residents did not have a section in the file, some records were filed in the wrong place. This does not assist the monitoring of the residents’ health care needs. There was no evidence from the menu records that health care needs are taken into account when planning or providing meals. Three residents’ files, which were examined, included details of health problems. One of these residents has a number of health needs, including diabetes. The resident had been supported to attend a training course at a hospital to learn how to manage the condition, this is good practise. However staff had not been provided with any training in the condition, so this limits the extent to which they can support the resident to manage his own condition. There was evidence to show that more support of this kind is needed as the person does not keep to a diet which is suitable for his diabetic condition. This was not recorded on the resident’s file, nor was there any risk assessment evident to try to minimise the effects of this behaviour. There was little indication that the resident’s needs which arise from this and other health conditions were taken into account in care practise, or that staff had sufficient knowledge about how to do so. These issues raised concerns at both of the inspection visits and these were shared verbally with the Registered Manager on each occasion and confirmed in a letter after the second visit. Staff training in health conditions and the implications for care must be provided. Improvements are required to ensure that residents’ health care needs are adequately integrated into the care plans and the practices of the home. The health care professional who provided feedback about the home stated that medication was appropriately managed. Medication records seen on the inspection visit were generally in good order. However there were unexplained gaps for some items of medication on two evenings during the week of the second inspection visit. Stocks of medication were checked and these doses had gone from the blister packs which, senior staff felt, would indicate that the medication had been given. The home does not currently keep patient information sheets about the medications administered in the home. These should be obtained from the pharmacy as they will be useful for residents and staff. The ‘staff training Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 17 monitoring sheet’ which was provided by the home does not include any reference to training in medication issues. Since the inspection the Registered Manager has provided information that training was provided in 2004 and 2005 to staff who administer medication. Staff who are shift leaders are coached by the Registered Manager or the Team Leader in safe medication practises. It is recommended that additional training is sought from an authoritative source, such as community pharmacy services and that it includes input on how medications are used and how to deal with and recognise problems in its use. Competency assessments must be conducted for each person who has responsibility for administering medication. Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure but residents need to be given more opportunities to express their views. Complaints about the home have been made to outside professionals and these need to form part of the home’s quality assurance systems. Improvements to the home’s systems for informing the CSCI about allegations will contribute to the further protection of residents. EVIDENCE: The complaints procedure of Scope 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 audio tape and large print. Although the service user guide refers to the complaints procedure the details are not included as required. There have been no formal complaints made to the home over the last year. Residents who were asked said that they would talk about any worries with their key worker or with senior staff in the home. The options available for residents to use to discuss issues or concerns will be increased when the residents’ meetings are held more frequently. This will encourage discussion of issues raised by service users. Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 19 Issues of concern have been raised with a placing social worker and with other professionals involved with a resident. These issues were not recorded in the complaints record. It is important that these issues are recognised as complaints even if they are not made directly to the home. It is required that a record is made of these issues so that it can be used to detect patterns of concerns. It is important that the home is open to making improvements and see complaints as an aspect of feedback on the services they provide. There have been no substantiated adult protection issues. 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 CSCI. Homes are required to give information to the CSCI about a range of incidents including allegations of misconduct. These notifications have not been made properly and the systems to do so must be improved. The Registered Manager confirmed that the home holds a copy of the Southwark Safeguarding Adults procedures for reference. 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.V301906.R01.S.doc Version 5.2 Page 20 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, 25, 26, 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The decorative state and the homeliness of the building will be improved by the programme of redecoration and refurbishment which is currently underway. EVIDENCE: The building is currently undergoing a programme of refurbishment. This will improve the appearance of the outside of the building and the conditions and appearance in the home. Redecoration is required and planned for the whole building. The bathrooms and WCs are to be redecorated first as these are in particular need of improvement. The premises allow access throughout for people who are wheel-chair users. There is adequate communal space for residents. This consists of a large dining room and living room. There is also sitting space 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 Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 21 open grassed area which, although not part of Good Neighbours House is a pleasant area for residents to sit in the warm weather. All of the bedrooms are single. Bedrooms seen were personalised, clean and tidy, but showed signs of the need for redecoration. 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 WCs 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. Regular checks of the mobility equipment are made. The cleaner is employed through an agency for fifteen hours each week. The cleanliness of the building will be improved by the planned redecoration. There is a dedicated laundry room in which residents may do their own laundry, with any necessary assistance from staff. Sluice facilities are available on the first floor of the building. Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 22 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): 31, 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. The staffing levels are adequate but better organisation will make sure that residents’ needs are properly attended to. Training is needed to make sure that staff have the skills and knowledge to better meet residents’ health care needs. The standard of vetting and recruitment practices needs improvement to make sure that residents are safe and looked after by people who are appropriately experienced for the work. EVIDENCE: A selection of staff files was examined, that of the most recently recruited staff member in particular detail. One of the files did not include a job description. The Registered Manager has confirmed since the inspection that the staff member has now been issued with a job description. All staff have been issued with the General Social Care Council Code of Conduct. Eleven members (55 ) of the care staff team hold NVQ level 2 or above. There was evidence from a variety of sources that the staff team need to develop further skills in caring for people with specific health conditions. This was found in relation to the needs of residents who have diabetes, and challenges which are presented by another resident’s condition. The Registered Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 23 Manager must ensure that the training and development plan reflects the range of knowledge and skills that staff need to do their jobs competently. Staff should have been provided with training in how to competently help someone with diabetes around the time of admission of the person with these needs. The care staff team is made up of the Registered Manager; a Team Leader; one Senior Support Worker (this post is currently vacant) and fourteen support workers, three of whom work solely at night. In addition there are five support workers who are part of the staff bank and work when members of the permanent team is unavailable as a result of sickness or annual leave. This allows for people who know residents well to provide care rather than temporary agency staff. This was identified as a strength of the home by a resident. There are also two activities workers, an administrator, a driverhandyman and a cook. Staff turnover is low and many members of the team have worked at the home for a significant period of time. There are four members of staff on duty at all times of the day and two staff on duty overnight. The staffing levels are adequate for the numbers of residents. However there were indications that shift planning can be improved to ensure that all staff are clear at the beginning of the shift about their responsibilities and that all tasks are covered properly. One person on each shift is identified as the shift leader. The Inspector discussed with the Team Leader the duties of a shift leader and was informed that there is no list of shift leader duties. It is recommended that this is drawn up and discussed with all of the staff, particularly those who lead shifts, so that there is a shared understanding of the role and its responsibilities. One of the employment records did not have a complete or detailed employment history. Employment histories must include the full dates of employment and the addresses of the employers so that records can be checked as necessary. On the record of a recently employed member of staff the supporting statement contained little information to adequately fill in the gaps on the employment history, nor, according to the notes, were they discussed at the interview. In addition the file did not include a copy of a document to verify the person’s identity, nor did it include a photograph or a statement of the person’s medical fitness to carry out the job. This indicates a need to improve recruitment procedures to ensure that they are thorough and contribute to the protection of residents. The majority of staff receive individual supervision from the Registered Manager or the Team Leader. In most cases this takes place regularly. However one file showed that the last recorded supervision session took place in 2004. A monitoring system must be introduced to ensure that all staff receive regular recorded supervision sessions. Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 24 Staff meetings are held in the home. Although the minutes of the meetings showed that there was a gap between August and November 2006 the Registered Manager provided assurance that a meeting had been held between these two dates, but the minutes were not available. The minutes seen showed that discussion covered both staff and resident issues. Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 25 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 management systems need to be made more robust. This is needed to ensure that record keeping assists in providing good quality care. Improvements in the system to notify the CSCI about certain events in the home will further safeguard residents’ best interests . Health and safety matters are generally well attended to. Improvements to the frequency of fire drills has ensured that fire safety is maintained. 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 holds management and care qualifications and has worked in social care for more than ten years. Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 26 The Registered Manager confirmed that visits made by senior managers are unannounced as required by regulation. There have been a number of changes at a senior level within Scope and as a result there have been a number of different people carrying out the visits. The most recent visit was made by the Registered Manager’s line manager. There were six reports of visits made in 2006 available for inspection in January 2007. The manager provided assurance that a visit had taken place in December but the report was not yet available. It is required that reports of these visits be forwarded to the CSCI. A quality assurance exercise was undertaken by a student on a placement at Good Neighbours House in 2005. The exercise included the input of residents. It is intended that a follow up quality assurance exercise be conducted in 2007. A requirement is made that a copy of the report which results from this exercise is supplied to the CSCI and to residents of the home. 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 CSCI of incidents were inefficient. After the second inspection visit on 19th January the CSCI was sent copies of five incidents which took place between 7th November and 9th December 2006. All of these incidents should have been notified to the CSCI ‘without delay’. An immediate requirement concerning this issue was made on 19th January 2007. The staff team has undertaken a range of health and safety training courses. These include moving and handling; infection control; fire safety and risk assessment. A fire risk assessment was conducted in July 2006. At the first visit to the home it was found that fire drills were not taking place quarterly. However at the second visit the frequency was found to have increased and a drill took place on 15th January 2007. Weekly checks of the fire safety systems are recorded and the fire extinguishers were serviced in January 2007. Electrical equipment is checked annually to ensure its safety. Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 2 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 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 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 3 X 2 X 2 3 X Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 12, 15(1) Timescale for action The Registered Person must 01/09/07 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 date for compliance was 01/03/06. A new date for compliance is set. 2. YA1 YA25 5 The Registered Person must 01/09/07 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 Registered Person must 01/04/07 ensure that residents are given written confirmation of the home’s ability to meet their assessed needs. DS0000007106.V301906.R01.S.doc Version 5.2 Page 29 Requirement 3. YA3 14(1)(d) Good Neighbours House 4. YA6 12(4)(b) 5. YA6 15(2)(b) 6. YA6 YA19 15(1) 12(1) (a)(b) 24(3) 7. YA8 8. YA16 12(4)(a) 13(4)(b) 9. YA17 12(4)(b) 10. YA18 12(4)(a) 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 Registered Person must ensure that reviews of care plans are conducted by the home every six months. The Registered Person must ensure that care plans include details of residents’ health care needs and how the home will address them. The Registered Person must ensure that residents are given the opportunity to give their views on the running of the home through regular and recorded residents’ meetings. 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 Registered Manager must ensure that the meals provided for residents reflect residents’ needs which arise from their health and from their cultural backgrounds. The Registered Manager must inform CSCI how he will ensure care is provided in a manner which is respectful and mindful of the privacy and dignity of residents. 01/04/07 01/04/07 01/06/07 01/04/07 01/04/07 01/04/07 01/04/07 11. YA19 YA32 12(1) (a)(b)(3) 12. YA35 YA20 13(2) The Registered Person must 01/06/07 ensure that staff receive training in the residents’ health conditions and the implications for care practise. The Registered Person must 01/06/07 improve the arrangements for DS0000007106.V301906.R01.S.doc Version 5.2 Page 30 Good Neighbours House 13. YA24 YA25 YA34 23(2)(d) 14. 19 sch 2 15. YA36 18(2) dealing with medication by ensuring that: • the home has access to patient information sheets about all items of medication they administer; • all staff who administer medication are trained by an authoritative source such as a pharmacist; • competency assessments are made of all staff who are responsible for administering medication; • medication administration records are completed each time that medication is to be administered. The Registered Person must 01/04/07 confirm the date by which the redecoration and refurbishment of the home will be complete. The Registered Person must 01/04/07 ensure that staff recruitment practise includes obtaining full employment histories and all documents and checks as specified in regulation. The Registered Person must 01/04/07 ensure that all staff receive regular and frequent supervision. The Registered Person must 01/03/07 ensure that the CSCI is sent copies of reports of visits to the home carried out by managers. The Registered Person must 01/06/07 ensure that a copy of the report of the quality assurance exercise is supplied to the CSCI and to residents of the home. It is required that the Registered Person inform the CSCI without delay of any occurrence to which regulation 37 applies. 22/01/07 16. YA39 26(5)(a) 17. YA39 24(2) 18. YA23YA41 37 Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 31 19. YA41 17(2) sch4 para 13 The Registered Person must 01/03/07 ensure that changes to the planned menu are recorded in sufficient detail to provide evidence that residents’ diets are satisfactory in relation to their nutritional and other needs. 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 YA6 YA7 Good Practice Recommendations The Registered Person should ensure that residents are given reasonable opportunities to contribute to their placement reviews. Consideration could be given to encouraging the social work staff to visit to meet the resident and to the use of advocates to facilitate residents’ contributions. The Registered Person should ensure that issues of concern raised with external agencies are recorded in the record of complaints so that the record can be used to detect patterns of concerns. The Registered Provider should ensure that shifts are organised efficiently so that residents’ needs for support are met. 2. YA22 3. YA33 Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Good Neighbours House DS0000007106.V301906.R01.S.doc Version 5.2 Page 33 - 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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