Inspection on 18/12/07 for Hainault

This inspection was carried out on 18th December 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hainault 11/11/08

Hainault 16/11/06

Hainault 09/09/05

Hainault 04/05/05

Hainault 07/09/04

Hainault 11/05/04

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 Hainault 35 Lesney Park Road Erith Kent DA8 3DQ Lead Inspector Maria Kinson Unannounced Inspection 18th December 2007 09:30 DS0000038196.V353709.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 DS0000038196.V353709.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. DS0000038196.V353709.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hainault Address 35 Lesney Park Road Erith Kent DA8 3DQ 01322 335252 01322 338106 j.woodland@mcch.org.uk www.mcch.co.uk MCCH Society Ltd 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) Jean Woodland Care Home 14 Category(ies) of Learning disability (13) registration, with number of places DS0000038196.V353709.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated: 13 Date of last inspection 16th November 2006 Brief Description of the Service: Hainault is registered with the Commission for Social Care Inspection to provide personal care for thirteen adults with a learning disability. The home opened in October 1988 and is operated by MCCH. Hainault is a large, old, detached building on two floors, with a large, rear garden. There is no lift. The house is divided into three flats. Flat 1 can accommodate two people, flat 2 five people and flat 3 six people. All service users have single bedrooms, apart from two service users who share a room in flat 2. All bedrooms have washbasins and three rooms have en-suite facilities. Each flat has a lounge, kitchen, bathroom and toilet(s). Flat 3 has very spacious communal rooms. There is an office and a small sensory room on the ground floor. MCCH charges each person £1,063 per week to live in the home. The amount that each person contributes to the fee depends on his or her financial circumstances. The fee does not include items such as personal clothing, toiletries and activities. This information was supplied to the commission on 08/01/08. DS0000038196.V353709.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on 18th December 2007. The inspector visited all of the flats to observe interactions between staff and the people living in the home. All of the communal areas and a selection of bedrooms were viewed. Care, medication, health and safety and staff records were examined. The inspector was joined by an ‘expert by experience’ for part of the inspection. ‘Experts by Experience’ are people who visit a service with an inspector to help them get a picture of what it is like to live in or use the service. The ‘expert by experience’ spoke with people that use the service and staff about choice, participation and community involvement. Comment cards were sent to five people that use the service, six relatives, seven health care professionals and ten members of staff. The commission received 13 responses, four from people that use the service, three from relatives, five from staff and one from a health care professional. Since the last inspection the home had applied to the commission to reduce the number of registered beds from 14 to 13. The application was approved. There were thirteen people living in the home on the day of this inspection. What the service does well: People said they liked living at Hainault and looked happy and relaxed. Assessments were completed before people moved into the home and provided good information about peoples needs. Support plans were detailed and were based around people’s individual needs, likes and dislikes. Information about people’s health care needs was recorded and the arrangements for monitoring issues such as seizures were included in the care plan. People were supported to attend health care appointments. People said they could make decisions about how and where they spent their time in the home and community and were supported to take part in activities and events that they enjoyed. Visiting arrangements were flexible. DS0000038196.V353709.R01.S.doc Version 5.2 Page 6 Complaints were investigated promptly and staff said they would report concerns or allegations to senior staff. The home was clean, tidy and comfortable. Staff could attend relevant training sessions and were supported to work towards obtaining a qualification in care. Fire safety arrangements were good and equipment was inspected and serviced regularly. What has improved since the last inspection? What they could do better: Some people did not did not know how much they were paying for the service and had not received a written contract. Care plans provided detailed information about the assistance that people required and about how they wanted to be supported. One support plan stated that staff should use a specific piece of equipment that was not available in the home. Staff did not keep adequate records about medicines that were supplied to the home. This made it difficult to know how much medicine should still be in the cupboard and whether people were receiving their medicines. DS0000038196.V353709.R01.S.doc Version 5.2 Page 7 The home was using a significant amount of bank staff. This meant that people were often supported by a number of different staff. Some concerns were raised about communication and team working. Fire drills were taking place but it was not always clear in the records how a person responded or if they followed the correct procedure. People may be at risk of injury because the hot water temperature was not controlled in some of the showers. The manager said that unannounced visits were taking place regularly but it was not possible to discuss the findings, as she had not received the reports that were completed in respect of recent visits. Information about pre employment checks had improved. Some parts of the form were not fully completed and a photograph was not obtained for one staff member. There were some systems in place to monitor the quality of the service but this did not include consultation with people’s relatives or representatives. Most staff received formal supervision but the period between sessions was sometimes too long. 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. DS0000038196.V353709.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 DS0000038196.V353709.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): 2 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff obtained information about peoples needs and preferences. This helped staff to meet peoples needs on admission to the home. Some people had not received a contract. This meant they did not know what support they should receive or what they were paying for. EVIDENCE: One person moved into the home in November 2007. Records showed that there were various meetings and assessments to obtain information about the persons support needs and preferred routines. Information was obtained from relatives, the previous carers and other professionals such as an occupational therapist and physiotherapist. Adaptations were made to the building and some new equipment such as a ceiling hoist was obtained. This ensured that the home was suitably equipped to meet the person’s needs. As the person has limited sight staff obtained guidance about the most appropriate colour scheme for the room. Daytime staffing levels were reviewed and increased and the late shift was extended so that there would be adequate staff to meet the person’s needs. DS0000038196.V353709.R01.S.doc Version 5.2 Page 10 Although the records indicated that the persons needs were thoroughly assessed there was little consideration of how the person would fit in with the other service users, a number of which were older and less active and how staff would adapt to the changes that were required. See recommendation 1. One person that moved into the home in November 2007 did not have a contract and had not received any information about the terms and conditions of occupancy or fees. See requirement 1. Another person had received a contract but the section about fees was blank and the document was not agreed or signed by the service user or their representative. The manager said that contracts were discussed and agreed with relatives during person centred planning meetings. DS0000038196.V353709.R01.S.doc Version 5.2 Page 11 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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Support plans included information about people’s individual needs and preferred routines. People said they were able to make decisions about how and where they spent their time in the home and community. EVIDENCE: The care records for two people that lived in different parts of the home were examined. The files included a pen portrait, which provided basic information about the person’s history, social contacts and a summary of their support needs. There was other guidance for staff about specific issues such as the management of epilepsy, eating and drinking and moving. Support plans were very detailed and in some instances included advice from other professionals such as speech and language therapists and physiotherapists. Some plans included photographs to show how the person should be positioned and moved. All of the records seen included information about the persons likes and dislikes and preferred routines such as when they liked to go to bed and DS0000038196.V353709.R01.S.doc Version 5.2 Page 12 what they liked to eat. Within the plans there was information for staff about how they could promote personal choice particularly for people that could not say what they liked or disliked. For instance one plan stated that a person could indicate what drink they preferred if they were able to smell various juices. Although support plans were good overall one plan that provided information for staff about communication was not up to date and did not reflect what was happening in the home. Staff that were questioned about this plan were not familiar with the equipment listed in the plan and could not state if it was available for use. See recommendation 2. People said they could do what they wanted during the day and of an evening. People told us that they could decide when they wanted to go to bed and get up, if they wanted to have a shower or a bath and were encouraged by staff to make decisions and do things for themselves. Potential risks were identified and the action that staff should take to avoid people from being harmed was recorded. Staff recognised that some risks would remain despite all their efforts and knew that some activities were essential to people’s quality of life and wellbeing. One person said they liked to go out all day on their own. This person took a mobile phone, as they said they sometimes got lost. DS0000038196.V353709.R01.S.doc Version 5.2 Page 13 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 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were supported to undertake activities and events that they enjoyed in the home and community. The menu was varied and people said they enjoyed their meals. EVIDENCE: Information about people’s personal interests and hobbies was recorded and staff supported people that wanted to attend social events and activity sessions. Some of the people living in the home attended local day care services where they could undertake various courses to improve their existing skills or learn new skills, take part in sports and relaxation classes and visit local places of interest. Some of the people that we spoke with said they were able to go to the shops and enjoyed attending the local clubs. DS0000038196.V353709.R01.S.doc Version 5.2 Page 14 On the day of the inspection some of the people that were at home were wrapping Christmas presents, one person went shopping with a staff member and others were doing puzzles or watching television. A weekly activity planner was developed for one person who liked to go out in the evening. It was not clear if the planner was always followed as activities such as swimming did not appear to be taking place. Staff said there had been some difficulties with transport. Records of recent activities showed that some people had received a head and foot massage, attended aromatherapy sessions and visited local shopping centres and cafes. Two people went to see the Christmas lights. Some people received regular visitors and often spent time with their family during weekends and holidays. Information about food was recorded and some people said they sometimes helped staff to prepare the menus. Separate menus were prepared for each flat based on peoples likes and dislikes and individual needs. Two menus were examined. The menu showed that people received a good variety of different foods and popular dishes such as roast dinners; a traditional cooked breakfast and a takeaway meal were included. Staff provided assistance to eat and food was prepared according to the instructions outlined in the persons support plan. DS0000038196.V353709.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff worked in partnership with other professionals to meet people’s needs and expectations. Staff could not account for all of the medicines that were used in the home, as they did not maintain adequate records. EVIDENCE: Support plans included information about health and personal care issues and stated whether the person had any preferred routines, likes or dislikes. One plan included detailed information about the management of epilepsy and stated how frequently staff should check the person overnight and when they should seek support from other professionals. Information about who they wanted to support them with personal care and what they liked to wear was recorded. The inspector was able to verify that the plan was followed as the person was wearing the type of clothing that they said they liked and was supported in recent weeks by female staff. Records indicated that health issues were monitored. Staff arranged GP appointments if people were not able or did not want to do this themselves. DS0000038196.V353709.R01.S.doc Version 5.2 Page 16 Written feedback about the service was obtained from one health care professional that was in regular contact with the home. The person said that staff usually respected peoples privacy and dignity and were usually able to meet people’s health care needs. Three relatives provided written feedback about the service. Most relatives said the home usually provided the support that their family member required and staff were usually able to meet their family members needs. The management of medication was assessed in two flats. There was guidance for staff about the type of support that each person required to take their medicines and when and how they liked to receive their medicines. Three medication charts were examined. There was little or no information on all three charts about when medicines were supplied to the home and about how much medicine was received. This issue was identified during the previous inspection. Continued non-compliance may lead to enforcement action being taken. See requirement 2. It was not possible to establish if one person had received their supplement drinks on three dates, as the records were incomplete. The remaining records showed that people received their medicines regularly and on time. Medicines were stored securely. The home had notified the commission about three medication errors in the period since the last inspection. All of the issues were managed appropriately and additional training was provided for staff if necessary. DS0000038196.V353709.R01.S.doc Version 5.2 Page 17 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 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were procedures in place to protect people using the service and to ensure that their concerns were listened to and addressed. EVIDENCE: The home had a complaints procedure, which included a timescale for responding to concerns. The home had received five complaints in the period since the last inspection. Information about complaints was difficult to locate as some letters were kept in a file and some were kept on the computer. The manager should ensure that all information relating to complaints is kept together. Complaints were logged on a special form and the manager confirmed that the home received the complaint and was investigating the persons concerns. Complaints were investigated promptly and the person that made the complaint was advised about the manager’s findings. Action was taken where possible to learn from complaints and to stop similar issues from occurring again. CSCI received an anonymous complaint about the management of the service in July 2007 and two concerns about the service in November and December 2007. The complaint was passed to the provider to investigate and the concerns were discussed with the manager and considered during this inspection. No evidence could be found to support the allegations but it was identified during the investigation that there were some issues to be addressed in respect of team working. See standard 38. DS0000038196.V353709.R01.S.doc Version 5.2 Page 18 The money records for two people were checked. All money received for a person or paid out on their behalf was recorded. Where possible staff obtained receipts as proof of purchase or provided an explanation about how money was used. Recent purchases included Christmas presents for relatives and friends, lunch trips, activities and personal toiletries. The homes safeguarding procedure was reviewed and updated in March 2007. The procedure includes notifying social services and CSCI about allegations of abuse and obtaining medical support for people if necessary. Staff said they would report concerns or allegations to senior staff and were confident that the management team would refer concerns onto social services for investigation. Three staff had attended safeguarding training sessions since the last inspection and new staff received abuse training during induction. In the period since the last inspection the manager had referred two allegations to the local authority for investigation under their protection procedure. One staff member was dismissed as a result of an investigation. The manager notified the Commission for Social Care Inspection (CSCI) about significant events that occurred in the home. DS0000038196.V353709.R01.S.doc Version 5.2 Page 19 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, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and comfortable. People had adequate personal space and there were areas where they could spend time with their friends and family. EVIDENCE: A decision had been made to rebuild the home. The new building will be built in the grounds of the existing home. People that use the service will be able to see how the building work is progressing and where they will live. This should make the transition to a new environment easier for some people. The home was maintained to a satisfactory standard overall but some paintwork was chipped and parts of the corridor carpet in flat 3 were taped down. In view of the plans to rebuild the home the commission will not be making any requirements about the environment unless there is a risk to peoples health and safety or the planned building work is delayed. The DS0000038196.V353709.R01.S.doc Version 5.2 Page 20 reception area and some of the bedrooms had been redecorated since the last inspection. Lounges, dining rooms and kitchens were spacious and pleasantly decorated. Efforts had been made to make some of the larger rooms that sometimes appear rather institutional, look homely and welcoming. There were Christmas cards in all of the lounges and a Christmas tree with decorations. Bedrooms were personalised with photographs, pictures, and items that reflected people’s interests and hobbies. A number of people had their own televisions and music systems. The home has a large garden. The lawn and grounds were well maintained. One person said that they liked to use the swing. All areas were clean and tidy and people said the home was always fresh and clean. The boards that were placed over the damaged work surfaces in the kitchens had been sealed to avoid dirt collecting around and under the edges. DS0000038196.V353709.R01.S.doc Version 5.2 Page 21 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 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home uses bank staff regularly to cover vacant posts and staff sickness. This is likely to affect continuity of care and may account for some of the concerns raised about communication. The home completed adequate checks when recruiting new staff. This protects the people that use the service. Staff had access to relevant training but did not always receive regular supervision. EVIDENCE: 67 of care staff had attained a vocational qualification in care at level two or above. This exceeds the standard set by the Department of Health. The commission had agreed that staff records could be held centrally if a form that listed the documents and checks that the company had undertaken was kept in the home for inspection. The forms for two new members of staff were examined. The agreed form was in use and a number of improvements were noted. Records showed that all of the necessary pre employment checks were completed and important documents such as proof of identity and written references were obtained. One file did not include a recent photograph of the DS0000038196.V353709.R01.S.doc Version 5.2 Page 22 employee and information about the type of criminal record bureau disclosure obtained (enhanced or standard) was not recorded. See recommendation 2. A provider relationship manager from CSCI completed some additional checks on staff recruitment records at the company’s head office in January 2007. All of the files examined during this visit contained adequate information and documents. Two relatives and two staff members expressed concerns about the use of agency and bank staff. One relative said the service would be better if there were “more staff that are not agency or bank” another relative said the home required “more consistent staffing”. Two staff members said the home used a lot of bank and agency. One staff member said they found it “quite stressful” when they were the only permanent member of staff in their flat. The rota did show that a significant number of bank staff were used to cover staff vacancies, sickness and absence. Although the manager tried to ensure consistency by using staff that were familiar with the home it was clear that some service users were receiving support from a number of different staff. During one week in November 2007 seventeen different bank staff were used to cover various shifts in one flat. Although the posts where staff were sick or absent cannot be filled action should be taken to provide better continuity of care for the people living in the home. The manager should aim to fill the existing vacancies and explore the possibility of bank staff working on line for a period. See information re relationship between staff and management under standard 38. Two relatives said that staff did not always inform them about important issues for instance one person said they were not told that their relative’s key worker had changed. Three members of staff also raised concerns about communication stating, “information was not always passed on” or “shared with staff”. See requirement 3. Most people said they were treated well by staff and that carers usually listened to their views. Staff had access to a comprehensive programme of training. During the past year some members of staff had attended fire safety, medication, moving and handling, epilepsy, COSHH, infection control and safeguarding training sessions. Staff confirmed that they received regular training and 50 of staff listed training as one of the homes main strengths. Some staff said they received regular supervision and others stated they had not received supervision for some time. Records showed that staff received supervision but sessions did not always take place every eight weeks. See recommendation 4. Supervision records were agreed and signed by the staff member and supervisor. DS0000038196.V353709.R01.S.doc Version 5.2 Page 23 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 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides good outcomes for people that use the service but future progress is likely to be hindered by poor team working. Some work was taking place to monitor and improve the quality of care provided in the home but this did not include feedback from service users or their representatives. Health and safety issues were well managed but some concerns were identified about hot water temperatures. EVIDENCE: The manager was assessed by the commission in December 2007 and was found to have suitable qualifications and experience to manage a care home for people with a learning disability. The manager had completed the registered managers award (RMA) and has a National Vocational Qualification DS0000038196.V353709.R01.S.doc Version 5.2 Page 24 (NVQ) in care at level four. The manager said she received regular supervision and could obtain advice and support from her line manager. Information about the relationship between staff and management was variable. Staff that we spoke with on the day of the inspection said the manager was approachable and helpful but some of the surveys completed by staff raised concerns about communication and support. One staff member commented that some staff were, “very reluctant to cooperate” and it was noted that some staff had found some of the recent changes difficult. No evidence was found to suggest that the relationship between staff and management was affecting the people that used the service. The service development manager had already identified the need for team building sessions. See recommendation 5. There was little evidence of quality assurance work taking place. The manager stated that unannounced visits were taking place but reports from visits that were undertaken in July, August and November 2007 could not be located. See requirement 4. The manager said that a medication audit was completed in September 2007 but there was no written information about the findings in the home. Staff completed a weekly ‘walking route’ audit to identify maintenance and health and safety issues. The home had developed a satisfaction survey but this was not used as the company were preparing a survey. See requirement 5. The management of health and safety issues was mostly good. Records showed that equipment such as hoists, assisted baths, gas appliances and portable electrical appliances were serviced regularly and the water system was assessed. The Service Development Manager advised the commission that the main electricity installation had been reassessed and quotes were being obtained for the work that was required. The Service Development Manager said the work should take place in January 2008 and agreed to notify the commission once the work was complete. Hot water temperatures were checked regularly but there was little evidence that action was taken to regulate some of the shower temperatures that were in excess of 47oC. See requirement 6. Fire safety arrangements were good. A new fire alarm system was fitted in 2007 and fire safety equipment was checked and serviced regularly. Fire drills were taking place regularly but records did not always state how staff or people that used the service responded. One report indicated that staff assembled in the wrong area but did not state if any action was taken to address this issue. See recommendation 6. The previous requirement to ensure that staff received regular fire safety training updates was addressed. DS0000038196.V353709.R01.S.doc Version 5.2 Page 25 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 X 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 2 2 X X 2 X DS0000038196.V353709.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 YA5 Regulation 5 Requirement The Registered Person must ensure that people receive a contract before they move into the home or at the very latest on the day they move in. The Registered Person must ensure that adequate records are maintained about medicines received in the home. Repeated requirement. The previous timescale of 14/03/07 was not met. The Registered Person must take action to provide better continuity of care for people using the service. The Registered Person must ensure that the Registered Manager receives a copy of ‘regulation 26’ reports. The Registered Person must establish a system for reviewing and improving the quality of care provided in the home. This must include consultation with service users and their representatives. Repeated requirement. The previous timescale of 09/05/07 was not met. The Registered Person must DS0000038196.V353709.R01.S.doc Timescale for action 22/05/08 2. YA20 13 17/04/08 3. YA33 18 22/05/08 4. YA39 26 17/04/08 5. YA39 24 22/05/08 6. YA42 13 17/04/08 Page 27 Version 5.2 ensure that hot water temperatures are regulated unless the risk assessment shows that service users are capable of controlling risks or are unlikely to come into contact with excessively hot water. 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 YA2 Good Practice Recommendations The Registered Person should ensure that the preadmission assessment includes consultation with existing service users or consideration of whether the person is likely to get along with and ‘fit in’ with the people that are using the service. The Registered Person should ensure that support plans are accurate and up to date. The Registered Person should ensure that the staff recruitment form is completed in full. The Registered Person should ensure that care staff receive supervision six times a year. The Registered Person should take action to improve team working and professional relationships. The Registered Person should ensure that fire drill records include information about how people respond to the drill and about any action that is taken to address concerns. 2. 3. 4. 5. 6. YA6 YA34 YA36 YA38 YA42 DS0000038196.V353709.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup 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 DS0000038196.V353709.R01.S.doc Version 5.2 Page 29 - 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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