Inspection on 09/02/07 for Gubbins Lane

This inspection was carried out on 9th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gubbins Lane 04/11/05

Gubbins Lane 13/09/05

Gubbins Lane 31/03/05

Gubbins Lane 22/02/05

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Gubbins Lane 26 Gubbins Lane Harold Wood Romford Essex RM3 0QA Lead Inspector Cathie McGeoch Unannounced Inspection 9th February-21 February 2007 10:00 st Gubbins Lane DS0000027853.V330047.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 Gubbins Lane DS0000027853.V330047.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. Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gubbins Lane Address 26 Gubbins Lane Harold Wood Romford Essex RM3 0QA 01708 384525 01708 384525 sara@outlook.org.uk 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) Outlook Care Ms Sara Petley Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 4th November 2005 Brief Description of the Service: 26 Gubbins Lane is a care home registered to provide care, support and accommodation to 6 adults of both sexes aged between 18-65 with physical and learning disabilities. The home is a one level purpose built property and gardens with car parking facilities to the front of the building. The home is located in a residential area of Harold Wood, close to shops, public transport and the M25, A127 and the A12. The home employs staff, working a roster, which gives 24-hour cover. Information on the service available at 26 Gubbins lane is available in the Statement of Purpose which is available on request. Fees are currently £1,072.57 per week. Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The first part of this inspection was unannounced, so the manager, staff members and service users were unaware that the inspection was going to take place. The inspection took place on 09/02/07 and started at 10am and finished at 3.20pm. An arrangement was made with the manager to go back to the home to complete the inspection on 13/02/07 and the inspector was there from 9.50am until 4.15pm. The inspection was extended by 8 days to allow for the feedback questionnaires to be returned. Therefore, the last date of the inspection was 21/02/07. The inspector undertook a tour of the building, viewed service user and staff files, as well as other records kept within the home. The inspector held discussions with the manager, some of the people working in the home and observed some of the service users. The inspector spoke to 4 relatives. All of the views obtained during this inspection have been included in this report. The inspector sent questionnaires for the people working in the home. At the time of writing this report 8 have been received completed. If any questionnaires are received following the completion of this report, the views will be included in the next inspection report. The inspector would like to thank the service users and the staff members for facilitating this inspection and contributing to the regulation process. This is the first key inspection for this inspection year and all key standards, as well as many others, were covered during this inspection. One requirement made at the previous two inspections is not met. Unmet requirements impact on the welfare and safety of service users. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. What the service does well: Service users’ individual aspirations and needs are assessed. Service users make decisions about their lives with the assistance they need. Service users are supported to take risks as part of an independent lifestyle. Service users are able to participate in appropriate activities both inside and outside the home. Service users are encouraged to maintain appropriate relationships with each other and relatives. Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 6 Service users are offered a healthy diet and are supported at mealtimes. Service users receive personal support in the way they require and their physical and emotional health needs are met. Staff members said: “Service users sometimes need to be woken in the morning in order to attend an activity.” “ Although the service users can not verbally communicate, they are able to make choices about their personal support in their preferred methods of communication.” “All the staff care about the welfare of all the service users.” “Service users are able to choose how long they sleep as we have 24 hour waking night staff. Staff will sometimes need to intervene with their sleep or bathing so that they can attend their chosen activities.” One relative said that they have previously raised concern about the way their relatives shaving has been done, but said that this has been resolved now. Appropriate action is taken in relation to the shortfalls identified in the medication practice within the home. Complaints are dealt with appropriately and are resolved in a satisfactory timescale. Appropriate action has been taken in response to the protection of service users. Overall, service users live in a homely and comfortable environment, which is appropriate for their needs. Service users are supported by the home’s recruitment policy and practices in relation to permanent staff members. Service users are generally supported by a competent, qualified and effective staff team, Service users benefit from well supported and supervised staff members. Staff comments included: “I have been given the opportunity to read all the policies and procedures and had 3 days of shadowing staff members on duty before being included in the rota. The induction and support that I have received is good.” “I receive regular supervision, I can talk to the acting manager about anything and feel supported.” “I enjoy coming to work, the atmosphere in the home is good and very supportive, I can talk to the acting manager about anything.” I receive regular supervision, this is a supportive team and I can discuss any issues with the acting manager.” Service users benefit from a well run home which has effective leadership. One relative said: “I am very satisfied with the home, the acting manager is excellent, we feel involved and are made to feel welcome when we visit. I can raise any issues with the acting manager and he will quickly resolve it, this says a lot about the home.” Another relative said: “The home is well run, the acting manager and manager are both very good, we were sorry to see the manager go, but we have no Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 7 complaints about how the home has been run since this time.” One staff member said: “This is a well run home and the service users are well cared for.” Services users can be confident that there are effective quality assurance and monitoring systems in place. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Some of the standards tested during this inspection have been exceeded and have scored 4. Staff members should be commended on this. What has improved since the last inspection? What they could do better: Whilst the Statement of Purpose includes information for prospective service users, the staffing section requires updating. Overall, service users’ assessed and changing needs are reflected in their individual support plan, but this was not the case for 1 service user. The wishes for the ageing, illness and death have not been explored with 1 service user or their relatives. There has been a delay in informing the CSCI of the outcome of adult protection referrals. Some of the bedroom carpets require replacing. A higher priority needs to be given to ensure all areas of the home are free from offensive odours. Attention is needed to ensure that agency staff have had the relevant employment checks completed prior to commencing work in the home. Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 8 Action needs to be taken in relation to the staffing levels and amount of staff covering in the home to ensure that all service users receive continuity of care and their needs are met. One staff member said: “Although there are always sufficient staff members on duty to meet residents’ needs, at times it can be difficult for permanent workers to work alongside 2 bank workers and fulfil the duties to the best of their ability.” Another staff member said: “We have a lot of relief staff here, but things are not too bad at the moment as we are not fully occupied. It is very busy when the home is full.” Another staff member said: “We need more staff here as some service users require two staff members to support them which leaves 1 staff member with all the other service users and I believe this places them at risk.” One relative said: “ There are some different staff working in the home whom we do not know, but a lot who we do know.” The health, safety and welfare of service users may be compromised by lack of robust action taken to ensure food stocks are checked and emergency exits are kept free from hazards. Notifications that should be sent to the CSCI in relation to the health and well being of service users need to be given a higher priority. 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. Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose includes information for prospective service users, although the staffing section needs updating. Service users’ individual aspirations and needs are assessed. EVIDENCE: Following this inspection, a copy of the Statement of Purpose (SOP) was sent to the CSCI as requested. The SOP contains all the relevant information as outlined in Schedule 2 of The Care Homes Regulations and was last updated in October 2005. However, it requires updating to correctly reflect the amount of staff working in the home, their qualifications and experience. The Registered Person must update the Statement of Purpose to include the amount of staff working in the home, their qualifications and experience. This is requirement number 1. During this inspection, the inspector viewed the files for 3 service users who have all lived in the home for a considerable length of time. The inspector viewed the assessment for the service user who is the most recent to move into the home. This assessment was completed by the manager of the home prior to the service user moving in. In addition, copies of recent assessments were obtained from other agencies involved with the service user, such as Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 11 occupational health and speech and language and copies of these reports are kept on the service user’s file. Gubbins Lane DS0000027853.V330047.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 good. This judgement has been made using available evidence including a visit to this service. Overall, service users’ assessed and changing needs are reflected in their individual support plan, but this was not the case for 1 service user. Service users make decisions about their lives with the assistance they need. Service users are supported to take risks as part of an independent lifestyle. EVIDENCE: During this inspection, the inspector viewed the individual support plans for 3 service users living in the home. The home adopts person centred planning and those viewed included personal care, health, choices, culture, religion and social activities and a pictorial format is also available for service users. A profile has been drawn up which includes the service user’s likes, dislikes, wishes and feelings and a life history was also on file for 2 service users. There was evidence on the files viewed, that regular Local Authority reviews take place and a copy of the minutes are kept on file. Staff members actively participate in these reviews and where appropriate relatives are invited to Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 13 contribute and attend. In addition, the home complete their own reviews which usually takes place on a 6 monthly basis. The inspector spoke to the acting manager about the religious needs for 1 service user as the support plan stated to attend church occasionally. But, whilst reviewing the daily log the inspector noted that this service user had not attended church this year. The acting manager provided a review document dated April 2005, which stated that the service user should not attend church regularly. The acting manager confirmed that on occasions this service user does attend church. The CSCI is satisfied that the change in the frequency of attending church is due to the service user’s changing needs. Although, the plan in relation to religious activities for this service user may mean that all staff members may not be clear about the frequency for this service user to attend church. The Registered Person must ensure that service users’ assessed and changing needs are reflected in their individual service user plan and this is amended and changed when the individual’s needs are reviewed. This is requirement number 2. On all the service users’ files viewed there was an “Infringement of rights” form completed which covered occasions when decisions have been made that may impact on the rights of the service users. This form outlined the reasons why this was the case. The acting manager confirmed that relatives, where appropriate, are included as much as possible when decisions are made regarding the service users. One relative said: “I am very happy with the support and care they receive, we are contacted and kept up to date about any appointments, we are made to feel welcome in the home.” Outlook Care acts as the appointee for all the service users in the home. Monies are paid into individual service users’ accounts, which is managed by Outlook Care. When service users require funds this is requested by the manager and is paid into the service user’s local bank account. A record of expenditure is kept within the home and the acting manager monitors this. All service users within the home have access to an advocate. The inspector viewed a copy of the minutes of the relatives’ meetings, which were held regularly in the home until July 2006. These meetings provided them with the opportunity to raise any issues and be involved in the plans and development of the home. The manager said that these meetings are no longer taking place as relatives preferred to be involved in the meetings that specifically related to their relative. The inspector viewed the risk assessments for 3 service users, which have all been regularly reviewed. These assessments include specific risks identified including behaviour, personal safety, absconding, lifting and handling and an Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 14 assessment has been made how to reduce these risks. In addition, staff members have guidelines in place for staff to ensure that they know how to deal with specific issues relating to individual service users. Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to participate in appropriate activities both inside and outside the home. Service users are encouraged to maintain appropriate relationships with each other and relatives. Service users are offered a healthy diet and are supported at mealtimes. EVIDENCE: During this inspection, the inspector observed some of the service users going out to do some shopping and was informed that they had lunch whilst they were out. During this inspection, the inspector viewed the activity plans and daily records for 3 service users. The service users are provided with the opportunity to participate in local community groups including a day centre, a music and movement group, shopping and visiting places of interest. In addition, service users have the opportunity to participate in activities within the home such as watching videos, listening to music, cooking, art and craft activities, reading and sensory activities. Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 16 As mentioned elsewhere in this report, relatives are encouraged to participate in the lives of the service users. On the second day of the inspection a service user went out with two relatives and this happens on a weekly basis. One relative said: “The majority of staff are excellent, they are approachable and we can raise any issues with them. We are made to feel welcome and ask us whereabouts in the home we would like to spend time with our relative.” During the inspection, the inspector observed the service users in the main living area relaxing, listening to the TV, or looking at magazines. One service user was observed listening to some music in their room and independently accessing different parts of the home. One staff member said: “The service users have a range of activities to participate in and staff have a good rapport with them.” During this inspection, the inspector viewed the food available in the home as well as the weekly menu. At the time of the inspection, there were limited supplies in the fridge and freezer. The supplies viewed included meat, fish, vegetables, fruit and dairy produce. The manager confirmed that the shopping was still to be done and is carried out twice a week. The menus viewed constitute a nutritious and balanced diet. The inspector was informed that no service users had any special dietary requirements. The inspector observed one service user being assisted by one staff member at lunchtime to eat their soup. Gubbins Lane DS0000027853.V330047.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): 18,19,20,21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive personal support in the way they require and their physical and emotional health needs are met. Appropriate action is taken in relation to the shortfalls identified in the medication practice within the home. The wishes for the ageing, illness and death have not been explored with 1 service user or their relatives. EVIDENCE: The views of staff members obtained in relation to the personal support service users receive include: “Service users sometimes need to be woken in the morning in order to attend an activity.” “ Although the service users can not verbally communicate, they are able to make choices about their personal support in their preferred methods of communication.” “All the staff care about the welfare of all the service users.” “Service users are able to choose how long they sleep as we have 24 hour waking night staff. Staff will sometimes need to intervene with their sleep or bathing so that they can attend their chosen activities.” Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 18 One relative said that they have previously raised concern about the way their relatives shaving has been done, but said that this has been resolved now. During this inspection, the inspector viewed the health plans for 3 service users. There was evidence that service users are supported to attend regular health appointments including visits to the GP, hospital, optician, speech and language and occupational therapy. In addition, staff members within the home complete regular monitoring in relation to specific behaviours. The manager confirmed that referrals are made in relation to specialist health services if deemed necessary. All service users’ weight is monitored and a record is maintained. At the time of the inspection, one service user had been admitted to hospital. The manager confirmed that a staff member visits the hospital daily, and ensure that their personal needs are met. One staff member said: “I feel that the service users are very well cared for and their needs are met.” An inspection took place on 05/06/06 by the CSCI pharmacy inspector, which was at the request of the home. During this inspection, 2 requirements were made in relation to NMS 20. Firstly, “The registered manager must ensure that the records for the administration of medicines are clear and accurate to evidence that service users are receiving their medicines as recorded.” During this inspection, the inspector undertook a medication audit for 1 service user. This medication was in blister packs and the Medication Administration Records were signed and dated appropriately. Therefore, this requirement has been met. Prior to this inspection, the CSCI has received a notification that during a medication audit two tablets were found to be missing. As a result, the home has put in systems to monitor the administration of medication and complete medication audits twice a week. Medication is also checked during the monthly monitoring visits. The CSCI has also received another notification in relation to the administration of medication and is satisfied that this is being dealt with appropriately. The second requirement was that the: “The registered manager is required to provide a maximum/minimum thermometer to ensure that when medicines for cold storage are stored in the home then the product license conditions of storage are being met and the medicines remain viable. The provider’s record sheet should then be used to indicate that the max/min & current temperatures are recorded and the thermometer is being reset in accordance with the home’s policy & procedure.” During this inspection, the inspector noted that the maximum and minimum temperatures for cold storage medications are maintained on a daily basis. Therefore, this requirement has now been met. Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 19 During the pharmacy inspection 4 good practice recommendations were made in relation to the medication practice within the home. On 04/01/07 the CSCI received a response to this inspection, which stated that all of these recommendations have been implemented in the home. It is commendable that the staff members working in the home have incorporated these recommendations. At the time of inspection, a plastic storage box, which is lockable, was being used for cold storage medication. The inspector raised concern that this was not suitable to ensure the safe storage of this medication. There was no medications requiring cold storage at this time and on the second day of this inspection, the manager had purchased a metal lockable box. On one of the 3 files viewed, there was evidence that the arrangements to be made in the event of a service user’s death had been discussed with only two of the service users and or their relatives. But there has been no attempt to discuss these arrangements with 1 service user, or their relatives. The Registered Person should ensure that the arrangement to be made in the event of a service user’s death has been explored with the service user if appropriate or their representative. This is requirement number 3. Gubbins Lane DS0000027853.V330047.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 good. This judgement has been made using available evidence including a visit to this service. Complaints are dealt with appropriately and are resolved in a satisfactory timescale. Appropriate action has been taken in response to the protection of service users, but there has been delay in informing the CSCI of the outcome. EVIDENCE: During this inspection, the inspector viewed a copy of the complaints record. There has been one complaint since the last inspection, which was made by a relative. This complaint was dealt with appropriately and the complainant informed of the outcome. One relative has raised concern about the parking and access to the home. There was evidence that this issue has been taken up with the appropriate person. The inspector also viewed a letter sent to the home complimenting the staff for a piece of work they had undertaken. Prior to this inspection, the CSCI received a complaint from a person who wanted to remain anonymous. The information provided was passed to Havering Social Services and this was dealt with under their Adult Protection Procedures. In addition, the CSCI passed this information on to Outlook Care. A strategy meeting was convened and the decision was taken that all staff within the home should be reminded of the home’s Whistle blowing and Protection of Vulnerable Adults Procedures but no further action was necessary. During this inspection, the manager confirmed that these recommendations have been met with staff attending POVA training on 12/02/07 and 16/02/07. Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 21 During this inspection, the inspector spoke to 4 staff members about the action to take in the event they should have concerns about adult protection. They were all clear about the procedures to be followed. The CSCI received two more notifications from the home regarding matters, which relate to the protection of service users. Appropriate action has been taken regarding these matters and referrals were made to the appropriate authorities. However, the CSCI has not been kept up to date regarding the developments regarding any of these matters. The Registered Person must ensure that the CSCI is kept informed of any developments in relation to adult protection issues. This is requirement number 4. Gubbins Lane DS0000027853.V330047.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): 24,25,26,27,28,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall, service users live in a homely and comfortable environment which is appropriate for their needs. Although some of the bedroom carpets require replacing and priority needs to be given to ensure all areas of the home are free from offensive odours. EVIDENCE: During this inspection, the inspector undertook a tour of the premises accompanied by the acting manager. The living room/dining area and kitchen presented as clean and had furnishings that were homely and welcoming. The manager informed the inspector that the carpets in the living area and hall area had recently been replaced. Each service user in living in the home has their own bedroom and specialist equipment is provided for those who need it. The bedrooms were all clean, well ventilated and nicely decorated. The services users and, where appropriate, their relatives have been encouraged to personalise their bedrooms with pictures, photographs, soft toys, ornaments and mobiles. The flooring in some Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 23 of the service users’ bedrooms have been replaced and presented clean and appropriate for the service users. However, the carpet in bedroom 1 needs to be replaced and it has stains on it that cannot be removed. The chair in 1 service user’s bedroom was quite badly stained on the first day of the inspection. However, this cover had been removed and washed and was clean when viewed on the second day of the inspection. The carpet in bedroom 2 looks worn and had very little pile left, but also had stain marks on it and therefore, requires replacing. The carpet in bedroom 4 and 5 require either cleaning or replacing as they too had stains on them. The Registered Person must ensure that in the carpets are replaced cleaned or replaced in bedrooms 1,2,4 and 5. This is requirement number 5. During the tour of the premises, the inspector raised concern that there was an unpleasant smell in both bathrooms. The manager said this was not due to the fact there were any blocked sewerage pipes or the storage of clinical waste but due to the fact the bathrooms would have been used. The inspector raised the issue about the staff members ensuring that the windows are opened for a period of time to ensure these rooms are kept well ventilated and eliminate unpleasant smells. The manager opened these windows on the day of the inspection. Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst, service users are generally supported by a competent, qualified and effective staff team, attention is needed to ensure the staffing levels and amount of staff covering in the home is appropriate. Service users are supported by the home’s recruitment policy and practices in relation to permanent, staff members but this is not the case for agency staff members. Service users benefit from well supported and supervised staff members. EVIDENCE: Information provided in the pre inspection questionnaire which was sent to the CSCI prior to this inspection states 8 out of 10 staff have completed the NVQ training. One staff member who has recently started working in the home confirmed that they have completed the NVQ level 2 and 3. The inspector spoke to 1 agency staff member about the training that they had undertaken. They were able to produce a training card, which highlighted that they had undertaken training in Basic Food Hygiene, moving and handling, first aid and the NVQ foundation course. This worker confirmed that they had completed training in adult protection but this training was not on the card. The inspector was unable to view the training that the other agency staff had undertaken as a copy of this is not kept in the home. It is particularly important that the home are aware of the training that agency staff have undertaken, as they Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 25 have been reliant on using these staff to covers vacancies in the home. Since this inspection, the service manager has confirmed that they have contacted the agency and asked for a profile for each agency staff member in relation to the training they have undertaken. Information provided in the pre inspection questionnaire states that staff have undertaken training in Fire safety, Basic Food Hygiene, First Aid, Manual Handling, Health and Safety, Medication, Person centred planning and peg feeding. During the last two inspections, a requirement was made that the: “The registered manager must ensure that, in regards to the number of residents and their assessed level of needs, appropriate numbers of persons are working at the care home at peak evening hours to ensure the needs of all residents are met effectively.” During this inspection, the manager confirmed that additional staffing have not been put in place as it is felt that the levels are appropriate to meet the needs of the service users. At the time of this inspection one service user was not living in the home. Therefore, it is accepted that during this period the staffing ratios were appropriate in meeting the service users’ needs. One staff member said: “Although there are always sufficient staff members on duty to meet residents’ needs, at times it can be difficult for permanent workers to work alongside 2 bank workers and fulfil the duties to the best of their ability, bank workers cannot do some of the tasks that permanent staff are able to do.” Another staff member said: “We have a lot of relief staff here, but things are not too bad at the moment as we are not fully occupied. It is very busy when the home is full.” Another staff member said: “We need more staff here as some service users require two staff members to support them which leaves 1 staff member with all the other service users and I believe this places them at risk.” One relative said: “ There are some different staff working in the home whom we do not know, but a lot who we do know.” At the time of the inspection, the inspector was not provided with evidence that any assessment had been undertaken to demonstrate how staffing levels are determined in relation to the assessed needs of residents. Although staffing levels were adequate on the day of the inspection, the inspector was not fully satisfied that staffing levels at all times were sufficient to ensure that service users’ needs can be met and that service users and the staff are safeguarded from harm, at all times. The registered persons are therefore required to demonstrate to the Commission how staffing levels are determined in relation to the assessed and changing needs of service users, so that the welfare of both service users and staff are safeguarded at all times. This is requirement number 7. The inspector was informed that the home have been using 26 agency staff to cover vacancies in the home although some of these staff have not worked in the home for over 8 months. The manager confirmed that where possible the same agency workers are used to cover shifts and generally agency staff are Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 26 used to cover 2 or 3 of the shifts a day in the home. Three new staff members have recently been recruited to work in the home, but there remain staff vacancies in the home. The Registered Person must ensure that the employment of temporary staff within the home will not prevent service users from receiving continuity of care as is reasonable to meet their needs. This is requirement number 8. During this inspection, the inspector viewed the recruitment files for 4 members of staff. The relevant checks, including Criminal Records Bureau Checks had been undertaken prior to all of the staff commencing employment in the home. The inspector requested to see evidence that all agency staff have had the relevant checks undertaken by the employment agency. However, this information was not available. Following this inspection, the service manager confirmed that the manager checks the cards that the agency provides their employees with when they commence employment in the home and this includes the date and number of the CRB. However, this does not ensure that the full checks in accordance with the Care Homes Regulations have been completed by the agency. As stated earlier in this report, the service manager has requested that the agency provide a full profile on each agency staff member, which includes evidence that they have undertaken all the relevant checks prior to them commencing employment. The Service manager offered to provide the CSCI with this information as soon as it is obtained. This will be checked during the next inspection. The Registered Person must demonstrate that they are satisfied that all agency staff had had the relevant checks completed prior to commencing employment in the home. This is requirement 9. On the staff files viewed there was evidence that new staff undergo a thorough induction programme. The inspector spoke to a relatively new staff member who said: “I have been given the opportunity to read all the policies and procedures and had 3 days of shadowing staff members on duty before being included in the rota. The induction and support that I have received is good.” The inspector spoke to 4 staff members about the support they receive. Their comments include: “I receive regular supervision, I can talk to the acting manager about anything and feel supported.” “I enjoy coming to work, the atmosphere in the home is good and very supportive, I can talk to the acting manager about anything.” I receive regular supervision, this is a supportive team and I can discuss any issues with the acting manager.” There was evidence on the staff files viewed that regular supervision and appraisals take place and copies of the discussions that have taken place are kept on file. Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 27 Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,41,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home with effective leadership. Services users can be confident that there are effective quality assurance and monitoring systems in place. 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 may be compromised by lack of robust action taken to ensure food stocks are checked and emergency exits are kept free from hazards. Notifications need to be given a higher priority. EVIDENCE: Prior to this inspection, the CSCI was informed that the Registered Manager had been moved to another home whilst an investigation takes place regarding some issues that a staff member had raised. At this time, an experienced Registered Manager from another home came to cover at the home and this Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 29 was still the case at the time of this inspection. The Acting Manager had good knowledge about the service users and the general operation of the home. Since this inspection, the CSCI has been informed that the Registered Manager will be returning to work at Gubbins Lane, in March 2007. Information in the Statement of Purpose states that The Registered Manager has the NVQ level 3 in Mental Health Care and has completed the Outlook Care Management training programme and holds a certificate in Advanced Management in Care and NVQ level 4 in care. In addition, she is currently in the process of completing the Registered Managers Award. One relative said: “I am very satisfied with the home, the acting manager is excellent, we feel involved and are made to feel welcome when we visit. I can raise any issues with the acting manager and he will quickly resolve it, this says a lot about the home.” Another relative said: “The home is well run, the acting manager and manager are both very good, we were sorry to see the manager go, but we have no complaints about how the home has been run since this time.” One staff member said: “This is a well run home and the service users are well cared for.” The atmosphere in the home was friendly, informal and welcoming. All staff members spoken to during this inspection said that management were approachable and they could discuss any issues. Whilst there has been some issues of concern in relation to medication and staffing, the organisation has dealt with these appropriately. During this inspection, the inspector viewed the reports that are completed monthly which form part of the quality assurance systems within the home. Regular visits have been undertaken and there was evidence that the acting manager ensures that any issues have been identified, are actioned. Until recently, these reports have been sent to the CSCI on a regular basis and although it is no longer necessary to send them the service manager has agreed to continue doing this as a way of keeping the CSCI up to date with ongoing developments within the home. This is good practice. The acting manager informed the inspector that any requirements or recommendations made during any of the CSCI inspections for other Outlook care homes are implemented into all of the homes. This is good practice. Service users’ files are stored appropriately to ensure service users’ confidentiality is maintained. The organisation of the service users’ files is excellent and information could be retrieved easily. During this inspection, the inspector viewed a copy of the records for the health and safety checks that have been undertaken in the home. Regular fire drills have taken place and the last one took place in December 2006. Whilst undertaking a tour of Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 30 the premises the inspector noted that a delivery of supplies was blocking access to one of the fire exits. The inspector discussed this with the manager who removed them immediately and accepted that this was not appropriate. The Registered Person must ensure that all fire exits remain free from any hazards, which could inhibit emergency access out of the building. This is requirement number 10. The inspector saw evidence that regular checks are completed on the specialist equipment in the home to ensure it is in good working order and safe. An environmental health inspection took place on 08/06/05, which reported: “Very good standard, premises and practice.” Risk assessments have been completed in relation to both fire and the environment. Portable appliance testing was completed on 14/01/07 and a gas inspection took place on 20/07/06 and the home has kept copies of medical device alerts. During this inspection, the inspector checked the log of fridge and freezer temperatures, which had been taken daily apart from a 3-day period when a new thermometer was purchased. Whilst checking the food stores, the inspector noted that there were some eggs, which were dated 27/01/07 and therefore were out of date. This could place service users at risk of food poisoning. The manager disposed of these eggs at the time of the inspection. The Registered Person must ensure that out of date food is disposed of and a system is put in place to ensure that food stock is checked to ensure that no service user is given out of date food. This is requirement number 11. During this inspection, the inspector viewed the records of accidents and incidents that have happened in the home. From the records viewed, the CSCI is satisfied that appropriate action has been taken to ensure the safety and welfare of the service users. However, there was 3 incidents that should have been notified to the CSCI as they affect the safety and wellbeing of the service user. A requirement has been made elsewhere in this report and relates to NMS 23. Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 2 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 2 32 3 33 2 34 2 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 4 x LIFESTYLES Standard No Score 11 x 12 3 13 4 14 3 15 4 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 2 3 4 3 x 3 1 x Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 32 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4(1)(a) Requirement The Registered Person must update the Statement of Purpose to include the amount of staff working in the home, their qualifications and experience. The Registered Person must ensure that service users’ assessed and changing needs are reflected in their individual service user plan and this is amended and changed when the individuals needs are reviewed. The Registered Person should ensure that the arrangement to be made in the event of a service user’s death has been explored with the service user if appropriate or their representative. The Registered Person must ensure that the CSCI is kept informed of any developments in relation to adult protection or any other significant incidents affecting the safety and welfare of the service users. The Registered Person must DS0000027853.V330047.R01.S.doc Timescale for action 06/04/07 2. YA6 15(2)(b) 06/04/07 3. YA21 12(1)(a) 06/04/07 4. YA23 37(1)(c)(e) 06/04/07 5. YA26 16(2)(c) 06/05/07 Page 33 Gubbins Lane Version 5.2 7. YA33 8. YA33 9. YA34 10. YA42 11. YA42 ensure that in the carpets are replaced cleaned or replaced in bedrooms 1,2,4 and 5. 18(a) The registered persons must 25/05/07 demonstrate to the Commission how staffing levels are determined in relation to the assessed and changing needs of service users, so that the welfare of both service users and staff are safeguarded at all times. 1891)(b) The Registered Person must 06/04/07 ensure that the employment of temporary staff within the home will not prevent service users from receiving continuity of care as is reasonable to meet their needs. 19(2)(4)(a)(b) The Registered Person must 06/04/07 (i)(c)5(b)(d) demonstrate that they are satisfied that all agency staff had had the relevant checks completed prior to commencing employment in the home. 23(4)(c )(v) The Registered Person must en 06/04/07 that all fire exits remain free fro any hazards, which could inhibi emergency access out of the building. 16( 2(i) The Registered Person must 06/04/07 ensure that out of date food is disposed of and a system is put in place to ensure that food stock is checked to ensure that no service user is given out of date food. Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 34 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Gubbins Lane DS0000027853.V330047.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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