Inspection on 26/11/07 for Good Neighbours House

This inspection was carried out on 26th November 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 33 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 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 08/07/2008.

CARE HOME ADULTS 18-65 Good Neighbours House 38, Mary Datchelor Close London SE5 7AX Lead Inspector Sonia McKay Unannounced Inspection 26 & 27 November 2007 09.15 th th DS0000007106.V350403.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 DS0000007106.V350403.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. DS0000007106.V350403.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 DS0000007106.V350403.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. 14th November 2006 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. DS0000007106.V350403.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by one inspector over the course of two days. Residents, staff and visitors provided information about the service during discussion. Documents relating to care, staffing and the physical environment were also examined and there was a tour of the premises. Before the inspection the registered manager completed an Annual Quality Assurance Audit (sometimes called an AQQA). This provides the Commission with written information about the service, staff and training. What the service does well: What has improved since the last inspection? What they could do better: DS0000007106.V350403.R01.S.doc Version 5.2 Page 6 The residents’ care plans need to be improved so that they properly show the residents’ goals and cultural and religious needs. They need to be reviewed at six monthly intervals. Some of the residents’ health care needs are not well recorded. Some have not had training in how to meet some health care needs, such as diabetes. Staff must have to better information about the needs of newer residents and how they are to be safely supported. The home has a satisfactory complaints procedure but residents need to be given more opportunities to express their views. Complaints and concerns raised verbally to staff must be addressed properly and reported to the manager. There must be improvements to the home’s systems for informing the Commission about allegations. This will contribute to the further protection of residents. The records of meals served do not show how residents’ health care needs are met through menu planning, as changes to the planned menu are not recorded. There must be better assessment and understanding of peoples cultural needs. More must also be done to ensure a satisfactory level of kitchen hygiene at all times. Residents need to have more opportunities to give their views to the managers about how the home runs. Residents’ meetings are not held often enough. Staff need to have information about the medicines residents take, so that they can recognise side effects. Twenty-six requirements for action are made in this report. Many are requirements made after the previous inspection in November 2006. There must be significant improvement in the management of this service and in the monitoring of it by the registered provider, who should have picked up the service deficits during regular (monthly) unannounced inspections of the service which have not taken place. 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 DS0000007106.V350403.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. DS0000007106.V350403.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 DS0000007106.V350403.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 must include the full range of details required by Regulation. The home obtained appropriate information about the needs of people most recently admitted, but did not provide confirmation that they could meet the needs identified within the information obtained. Staff have insufficient information on which to base their care delivery for newer residents and this was deemed to be a matter that required immediate attention. EVIDENCE: During the previous inspection 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. The Registered Manager must ensure that potential residents are given a copy of the service user guide so that there is clarity about the DS0000007106.V350403.R01.S.doc Version 5.2 Page 10 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. A revised guide is not yet available, although the manager said that all of the additional information required to update the guide has been supplied to the head office (Scope) and he is currently waiting for copies of the revised guide to be printed and supplied to the home. (See requirement 1) The files of two residents who moved into the home recently were examined to see how well peoples needs are assessed before a placement in the home is offered. A range of appropriate information had been obtained from health professionals about the needs of one of the residents, who moved to the home in June 2007. This information includes a copy of a Care Programme Approach Care Plan drawn up in June 2007, a Speech and Language therapists report and Physiotherapists report. There is a care plan/assessment, based on and very often replicating a copy of a care plan from a previous healthcare setting (the care plan says that the resident was first admitted in 1994 although the resident has not lived in the home before). The care plan is not signed or dated and there is no evidence that the resident has agreed or been involved in developing the plan. There is no evidence that the plan/assessment or actions identified therein have been reviewed. Another resident moved into the home very recently (November 2007). Information obtained before admission includes a copy of the care plan drawn up under Care Programme Approach in April 2007, and Physiotherapy and Occupational therapy reports. A plan describing the placing authorities expectation of the service is not available. The home manager said that he had visited the resident before he moved in and that the purpose of the short-term placement is to help the resident to rehabilitate to more independent living in the community. There is no written plan for how the resident will be cared for whilst living in the home or of the support required to enable him to achieve his goal. An immediate requirement was issued during the inspection because the newer residents did not have written plans describing the care and support they require whilst living in the home. There were no assessments of risk in place either. The registered persons were required to ensure that care plans and risk assessments be put in place immediately and be available to staff and DS0000007106.V350403.R01.S.doc Version 5.2 Page 11 supplied to the Commission by 30/11/07. (See requirement 2) Staff on duty said that they did not know the resident well yet, although some had read the historical information obtained during referral. Some members of staff were observed to be reluctant to provide care without another member of staff with them. This was raised with the manager on 29th November 2007 who said that a staff had also raised this concern with him after the inspection and he had subsequently scheduled a staff meeting for the forthcoming week to discuss the new residents care and support needs. During the previous inspection a requirement was made for the home to confirm in writing that the home can meet the assessed needs of any prospective resident. This must form part of the admission procedure. Written confirmation that the home is able to meet the needs of people admitted to the home since the last inspection are not in place. The requirement is therefore not met. (See requirement 3) DS0000007106.V350403.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 & 9. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Care plans do not adequately reflect the residents’ cultural and religious needs or their goals, and in some cases are absent altogether. 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. Care plans must be developed in consultation with residents to ensure that their views form the basis of the plan. 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 DS0000007106.V350403.R01.S.doc Version 5.2 Page 13 with their wishes and goals. During the inspection of November 2006 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 was also little recorded information about residents’ cultural and religious needs. Care planning for three residents was tracked during this inspection, one resident had no written plans for how care and support are to be provided at all, one had an assessment/plan that was not sufficiently detailed, was not signed by the resident or dated. This indicates lack of consultation. A resident who has lived in the home for a number of years has a better plan in place although, again there must be greater emphasis on making these plans more centred on the person individual needs (health needs and cultural needs inclusive) and on skills development and on reviewing them on a regular basis (at least twice a year or when needs change). (See requirements 5, 6 & 7) Risk assessments are not in place for two residents. An immediate requirement was issued during the inspection in regard to two specific case files. Evidence that action was taken was supplied to the Commission at the time of writing this report. (See requirement 2) Residents meetings have taken place four times in 2007. Minutes examined indicate that on some occasion only the agenda items have been recorded, there is no record of discussion or decisions made. (See requirement 8) DS0000007106.V350403.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 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 daytime activities including attending colleges and day centres. 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. The home manager should review the way in which food supplies are obtained to ensure that appropriate ingredients are available. EVIDENCE: DS0000007106.V350403.R01.S.doc Version 5.2 Page 15 Some residents go to day centres and college placements. One resident spoke of enjoying a computer course. Two activities officers are employed by the home. Both staff were absent during both days of the inspection. Staff on duty were concentrating on personal care and meal arrangements, and as a result additional ‘one to one’ support for activities and interaction was not available. There is a wheelchair accessible vehicle and a handyman/driver who is able to provide transport to and from colleges and day services. Although not available, a member of staff said that one of the activities officers is also able to drive the house vehicle. 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. Residents who are able to go out without staff support were doing so. Staff on duty said that as the activities officers were not on duty they were too short of staff to support planned activities for those who need more ‘one to one’ time. (See requirement 9) 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. The manager and staff members said that none of the sixteen residents currently living in the home have a key to the front door or to their bedroom doors. 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 override a lock system in case of an emergency). The resident and any involved advocates or representatives should be consulted as part of the risk assessment process. (See requirement 10) 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. Feedback from residents about the food was mixed, three residents said it was either “Alright or “OK”, one said it was “Good”. The care plan for another DS0000007106.V350403.R01.S.doc Version 5.2 Page 16 resident who is of Caribbean origin and who does not communicate verbally says that she does not like English food, preferring her own Caribbean dishes. No Caribbean options were served during the inspection and staff could not demonstrate how people’s cultural needs are considered when devising the menu. This has been the subject of a requirement in the previous inspection report. The requirement is not met. (See requirement 11) During this and previous inspections the menu options do not reflect some residents’ health care needs, for example, the need for a diabetic diet or reducing diet. There is little information available in the kitchen area about who should be having what type of meals. Staff on duty (including an agency chef visiting the home for the first time to cover staff absence) did not even know that one newer resident has diabetes. This is dangerous and must be addressed. (See requirement 11) The home has recently changed the way in which food supplies are purchased. They used to buy in bulk, but now buy locally on a weekly basis, although residents are not routinely involved (the manager said that an administrator purchases the items required at a local supermarket). Food stocks were low and limited. There was little fresh produce available and quite a lot of individual ready meals in the freezer. On both days of the inspection the planned menu could not be prepared as ingredients in stock did not match the menu. Alternatives were cooked instead. 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 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. DS0000007106.V350403.R01.S.doc Version 5.2 Page 17 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’ health care needs are not considered fully enough and not all staff have been trained to understand their needs properly. Medication is given properly according to the doctor’s instructions, although there must be more information about the medications in use and the side effects and staff must have clear guidance about risks associated with non-compliance. EVIDENCE: During the previous inspection the manager stated that staff were to receive training in how to provide care in a manner which is respectful and mindful of the privacy and dignity of residents. A requirement was made for the manager to supply information about how this training will be implemented and monitored. Discussion with the manager during this inspection indicates that he has no monitoring plan. Additionally there is no guidance for how a new resident should be supported with personal care, this is evidence of poor planning and inadequate monitoring. (See requirement 12) DS0000007106.V350403.R01.S.doc Version 5.2 Page 18 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. There is no information about the healthcare professionals involved in the care of two newer residents (or any contact details); both residents have complex healthcare needs. This makes healthcare difficult to track, for example, letters offering appointments were on file but in some cases there is no record of whether the appointment was attended and if it was, what the outcome of the appointment had been. 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. Following the previous inspection staff training in the ‘health conditions of residents living in the home and the implications for care’ were required to ensure that residents’ health care needs are adequately integrated into the care plans and the practices of the home. There is some progress in the area of training, although the manager cited budget constraints as a reason for a planned training programme to be abandoned before all of the team could be trained. The additional training included training in meeting the needs of people with diabetes, epilepsy and behaviours that can be challenging. As the team are not full trained the requirement is not fully met. (See requirement 13) Medications are stored securely in a staff office; a suitable refrigerator with a lock was purchased the day after the inspection, but is not currently in use (for medicines that need to be kept cool). Records seen on the inspection visit were generally in good order. Stocks of medication were checked and blister pack stock correlated with records. The home does not currently keep patient information sheets about the medications administered in the home. These must be obtained from the pharmacy, as they are useful for residents and staff. (See requirement 14) Some staff have attended training in administering medication. Training certificates seen state that there is an element of ‘testing’ at the end of the course, as required in the previous inspection. A new resident (without a care plan or risk assessment) has been refusing to take a wide range of prescribed medication for an extended period. An immediate requirement was issued during the inspection. The registered persons must ensure that the healthcare needs of residents are assessed properly, and staff must seek advice from a medical practitioner immediately. (See requirement 15) DS0000007106.V350403.R01.S.doc Version 5.2 Page 19 The home manager contacted a General Practitioner and the residents care manager to address these issues and to take advice about how best to support the resident. The immediate requirement is therefore met. DS0000007106.V350403.R01.S.doc Version 5.2 Page 20 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 and concerns raised verbally must be addressed under the complaints procedure to ensure that they are acted upon. Improvements to the home’s systems for informing the Commission 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 audiotape and large print. Although the service user guide refers to the complaints procedure the details are not included as required. There have been two formal complaints made to the home over the last year, both complaints were investigated and substantiated. Residents who were asked said that they would raise concerns verbally with staff if they had any. Discussion with a relative indicates that these concerns are not recorded and in some cases have not been fully addressed. It is important that the complaints procedure be in keeping with the needs of DS0000007106.V350403.R01.S.doc Version 5.2 Page 21 residents, some of who are unable to write a formal written complaint. Staff must record any verbal complaint that they are not able to resolve immediately, so that the manager is made aware and can investigate and take appropriate action. (See requirement 16) 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. The manager confirmed that the home holds a copy of the Southwark Safeguarding Adults procedures for reference. An allegation was made by a relative that is currently being investigated under adult protection procedures. The Commission was notified verbally of this by the registered manager during the inspection. This indicates that these notifications are not being made properly and the systems to do so must be improved. (See requirement 17) Issues relating to a newer resident not having a care plan or risk assessment, and being non-compliant to medication without medical advice being taken were referred to the local authority Safeguarding Adults team for investigation. At the time of writing this report a placing authority review had been scheduled and medical advice had been taken. 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. DS0000007106.V350403.R01.S.doc Version 5.2 Page 22 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, 26, 27 & 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 that is currently underway. Areas of the home were not adequately heated and immediate action was required to ensure that residents are kept warm. Care must also be taken to ensure adequate hygiene in the kitchen, which was found to be dirty during this inspection. EVIDENCE: The building is currently undergoing a programme of refurbishment. The exterior of the building has been improved including painting window frames. The bathrooms and WCs have been redecorated since the last inspection. 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 DS0000007106.V350403.R01.S.doc Version 5.2 Page 23 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. All of the bedrooms are single occupancy. 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 hoists used to assist residents are made. At the time of the inspection staff, residents and visitors said that the central heating was not working in some bedrooms on the first floor of the home. An immediate requirement was issued for the registered persons to ensure that there is adequate heating in all areas of the home. Confirmation that the central heating system is fully operational was required. It could not be fully repaired immediately and alternative heating sources were purchased instead (plug in radiators). (See requirements 18 & 19) 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, but were broken at the time of this inspection. (See requirement 20). During a tour of the premises it was noted that the kitchen was dirty. An immediate requirement was issued for the registered person to ensure that the kitchen and food preparation areas be thoroughly cleaned immediately. The registered manager hired a cleaning company to undertake a deep clean of the kitchen the day after the inspection. The immediate requirement was therefore met. (See requirement 21) The third floor of the building is vacant. Although some residents are still using the Jacuzzi bath and another bathroom on the third floor (even though the WC in the bathroom is not working), as recent bathroom refurbishment on the second floor of the home does not include a Jacuzzi bath. DS0000007106.V350403.R01.S.doc Version 5.2 Page 24 The manager said that he hoped to have the Jacuzzi bath moved to the second floor where it is more accessible, as soon as possible. There are plans for further refurbishment and improvements planned. DS0000007106.V350403.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35. 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: There are four members of staff on duty at all times of the day and two staff on duty overnight. The activities officers were not on duty and there were insufficient staff to undertake ‘one to one’ commitments and provide support to people who need to go out with a member of staff. (See requirement 9) Each day a senior member of staff devises a written shift plan, designating what staff are responsible for whilst they are on duty. This is a recommendation from the previous inspection report that has been implemented. DS0000007106.V350403.R01.S.doc Version 5.2 Page 26 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, satisfactory evidence of identity or statement of medical fitness. Files examined did not have evidence of adequate identity checks, for example copies of recent utilities bills to verify addresses. All files checked have evidence of a satisfactory check on criminal records. Progress in meeting this requirement will be examined during the next inspection if new staff have been employed. (See requirement 22) There are twenty-four care staff. Thirteen members of staff have already attained a National Vocational Qualification in care (NVQ) at level 2 or above and a further three members of staff are currently undertaking the award. Twenty-three staff are female and one is male (excluding the home manager). 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) Supervision records indicate that staff have not received regular and recorded supervision from a line manager often enough. (See requirement 23) DS0000007106.V350403.R01.S.doc Version 5.2 Page 27 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 & 42. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Twenty-six requirements for action are made in this report. Many are requirements made after the previous inspection in November 2006. There must be significant improvement in the management of this service and in the monitoring of it by the registered provider, who should have picked up the service deficits during regular (monthly) unannounced inspections of the service. 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. DS0000007106.V350403.R01.S.doc Version 5.2 Page 28 The manager said there is a senior staffing restructuring underway. Three senior staff are to be appointed by April 2007. The deputy home manager commenced a period of planned extended leave during the inspection. This mans that there is a reduced management presence in the home. The home manager said that they system for conducting unannounced monthly visits on the home to monitor quality has changed. Registered managers working within Scope now visit each other’s homes to undertake visits on behalf of the registered provider. No visits have taken place at Good Neighbours House since April 2007. This is evidence of inadequate monitoring of the service. (See requirement 24) Discussion with the manager indicates that there are no clear plans for quality assurance in place. 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. 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. (See requirement 25) 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. 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. Failure to assess the needs and risks relating to the care of newer residents has significant risk to health and safety of staff and residents. During the inspection a relative highlighted that one of the residents wheelchair ankle straps was broken. This placed the resident at risk of injury. Although the relative had complained to staff about the fault a week prior to the inspection, no one had arranged for a repair. This was raised with the manager during the inspection and a repair was swiftly organised for the following day. This is evidence of inadequate checking of mobility aids, inadequate reporting of faults and also failure to address or record a complaint made by a relative. (See requirements 26 & 16) DS0000007106.V350403.R01.S.doc Version 5.2 Page 29 A call alarm system is in place in bedrooms and bathrooms in case of emergency. The manager said that the system is not checked professionally as it is old and due for replacement. A system of internal checks should be put in place to ensure safety until the system is replaced. (See recommendation 1) DS0000007106.V350403.R01.S.doc Version 5.2 Page 30 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 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 1 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 3 X 1 X X 1 X DS0000007106.V350403.R01.S.doc Version 5.2 Page 31 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 YA2 YA9 12(1) & (15(1) The registered person must ensure that care plans and risk assessments are put in place (for two new residents) immediately. Care plans and risk assessments must be available to staff and supplied to the Commission by 30/11/07. Immediate requirement DS0000007106.V350403.R01.S.doc Version 5.2 Page 32 Timescale for action 12/03/08 30/11/07 issued during the inspection. The Commission received evidence that this requirement was addressed as required. The requirement is therefore met. The Registered Person must 31/01/08 ensure that residents are given written confirmation of the home’s ability to meet their assessed needs. The timescale of 01/04/07 for meeting this previous requirement is not met. The Registered Person must 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. 5 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. 12/03/08 3 YA3 14(1)(d) 4 YA6 12, 15(1) 12/03/08 DS0000007106.V350403.R01.S.doc Version 5.2 Page 33 The timescale of 01/04/07 for meeting this previous requirement is not met. 6 YA6 15(2)(b) The Registered Person must ensure that reviews of care plans are conducted by the home every six months. 12/03/08 7 YA6 YA19 15(1) 12(1)(a)(b) The timescale of 01/04/07 for meeting this previous requirement is not met. The Registered Person must 12/03/08 ensure that care plans include details of residents’ health care needs and how the home will address them. The timescale of 01/06/07 for meeting this previous requirement is not met. 8 YA8 YA33 24(3) 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. Although there is some progress, the timescale of 01/04/07 for meeting this previous requirement is not met. 12/03/08 9 YA13 18(1) The registered person must ensure that there are sufficient staff on duty at all times to enable residents who require staff support to access the community, or engage in activities. Planned ‘one to one’ time DS0000007106.V350403.R01.S.doc 31/01/08 Version 5.2 Page 34 10 YA16 12(4)(a) 13(4)(b) with staff must be covered during staff absence. 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. 12/03/08 11 YA17 12(4)(b) 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 timescale of 01/04/07 for meeting this previous requirement is not met. 31/01/08 12 YA18 12(4)(a) 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. The timescale of 01/04/07 for meeting this previous requirement is not met. 12/03/08 13 YA19 YA32 YA35 12(1)(a)(b)(3) The Registered Person must ensure that staff receive training in the residents’ health conditions and the 12/03/08 DS0000007106.V350403.R01.S.doc Version 5.2 Page 35 implications for care practise. Although there is some progress the timescale of 01/06/07 for meeting this previous requirement is not met. 14 YA20 13(2) The Registered Person must improve the arrangements for dealing with medication by ensuring that: • The home has access to patient information sheets about all items of medication they administer The timescale of 01/06/07 for meeting this previous requirement is not met. 15 YA19 YA20 12(1) The registered persons 30/11/07 must ensure that the healthcare needs of residents are assessed properly, and staff must seek advice from a medical practitioner immediately. This was an Immediate requirement in regard to the care of one resident. The Commission received notification that action had been taken to address this requirement as required. The requirement therefore met. 16 YA22 YA42 22 17 is 12/03/08 The registered persons 31/01/08 must ensure that a record is kept of all issues raised or DS0000007106.V350403.R01.S.doc Version 5.2 Page 36 17 YA23 37 complaints made by service users, or their representatives, details of any investigation, action taken and outcome; and this record is checked at least three monthly. 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. 31/01/08 18 YA24 23(2) The registered persons 28/11/07 must ensure that there is adequate heating in all areas of the home. Confirmation that the central heating system is fully operational must be sent to the Commission; If it cannot be repaired fully by 28/11/07 details of the alternative arrangements for heating the home must be supplied. This was an Immediate requirement. The Commission received notification that the central heating had been repaired, although work is planned to address problem areas identified with the central heating system. The registered persons 12/03/08 must confirm that the central heating system has been repaired and is fully operational in all areas of DS0000007106.V350403.R01.S.doc Version 5.2 Page 37 19 YA24 23(2) 20 21 YA24 YA24 23(2) 23(2) the home. Confirmation must include evidence of a current maintenance contract for breakdowns. The registered person must 12/03/08 ensure that the sluice be repaired. The registered persons 30/11/07 must ensure that the kitchen and food preparation areas be thoroughly cleaned. This was an Immediate requirement. The Commission received notification that the kitchen had been deep cleaned by an outside agency. The requirement is therefore met. 22 YA34 19 Sch 2 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. 30/11/07 23 YA36 18(2) The Registered Person must ensure that all staff receive regular and frequent supervision. The timescale of 01/04/07 for meeting this previous DS0000007106.V350403.R01.S.doc 31/01/08 Version 5.2 Page 38 requirement is not met. 24 YA39 26(5)(a) The Registered Person must ensure that the CSCI is sent copies of reports of visits to the home carried out by managers. The timescale of 01/04/07 for meeting this previous requirement is not met. 25 YA39 24(2) The Registered Person must ensure that a copy of the report of the quality assurance exercise is supplied to the CSCI and to residents of the home. The timescale of 01/06/07 for meeting this previous requirement is not met. 26 YA42 12(1)(a) 13(4) The registered person must ensure that there are adequate checks on wheelchairs and mobility aids in the home. And that action is taken to rectify any fault as soon as possible. 24/12/07 12/03/08 31/01/08 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. DS0000007106.V350403.R01.S.doc Version 5.2 Page 39 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 DS0000007106.V350403.R01.S.doc Version 5.2 Page 40 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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