Inspection on 12/02/08 for Heathside Neurodisabillity Unit

This inspection was carried out on 12th February 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Heathside Neurodisabillity Unit Blackheath Brain Injury Rehabilitation Centre 80-82 Blackheath Hill Blackheath London SE10 8AB Lead Inspector Sean Healy Key Unannounced Inspection 12th February 2008 10:00 DS0000068121.V343305.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 DS0000068121.V343305.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. DS0000068121.V343305.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heathside Neurodisabillity Unit Address Blackheath Brain Injury Rehabilitation Centre 80-82 Blackheath Hill Blackheath London SE10 8AB 020 8692 4007 020 8694 8316 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) Four Seasons Healthcare Properties (Frenchay) Limited Kapila Prasad Medagoda Care Home 18 Category(ies) of Physical disability (15), Physical disability over registration, with number 65 years of age (3) of places DS0000068121.V343305.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection: 20th June 2006 Brief Description of the Service: Heathside Neurodisability Unit is a care home with nursing, providing support, accommodation and rehabilitation for up to 18 residents. The home specialises in providing neuro-disability rehabilitation. Although it is intended that resident’ stays at the home would be limited to the time needed for rehabilitation, the home’s practice is to allow some residents to stay until suitable alternative accommodation can be identified. To this end the services of a Community Liaison Officer is employed to identify move-on accommodation and to help sort out funding and benefits issues. A number of residents have been at the unit for approximately seven years. The provider is a private company, is called “Four Seasons Healthcare Properties (Frenchay) Ltd,” having changed its name since the last inspection. The responsible individual has regular contact with the unit. The home is supported by senior management links with another brain injury unit based on the same site, which offers access to other health professionals such as Neuropsychology. The day-to-day management of the unit is delegated to a Registered Care Manager. This manager, who is a trained nurse, leads a team of 10 nursing staff and approximately 20 support staff. The home employs inhouse physiotherapy, occupational therapy, speech and language therapy services, and access to a neuro-psychologist from a neighbouring unit. The home employs a housekeeping team and a health and safety/maintenance officer. The home is housed in purpose built modern premises. The premises are part of a complex that also houses two other units, both of which are inspected by the CHAI. The home is spacious, well lit and fully wheelchair accessible. It is comprised of 18 single bedrooms, 15 of which have en-suite shower and toilet facilities, which are fully accessible. There are also four other separate toilets, one bathroom and one other shower-room all of which are accessible. The home is located on Blackheath Hill. The area has a number of local shops, civic amenities and public transport. There is parking available to visitors on DS0000068121.V343305.R01.S.doc Version 5.2 Page 5 site. There is currently no resident’s vacancy. Since the last inspection there has been a change in the registered care manager and the previous registered manager still retains a senior management role in the home. Information about the services provided was last reviewed in May 2006, and is made available to current and potential service users in the homes Statement of Purpose and Service Users Guide. Each resident has a copy in their room. The recent CSCI report is currently referred to in the home’s Statement of Purpose, and a copy is kept in the manager’s office. The manager agreed to make this available to service users in a more public area of the home. At 12th February 2008, the homes fees range from £1,205 per week to £2,087 per week, dependent on the level of support and specialist care required. This fee covers all of the homes charges including food. Residents have to pay for other personal expenses such as hairdressing, transport and personal shopping. The provider’s email address is: andrea.walker@fshc.co.uk DS0000068121.V343305.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality Rating for this service is 3 Star. This means that the people who use this service experience good quality outcomes. The inspection was unannounced and was conducted over a two-day period. The inspection was facilitated by the registered care manager, supported by the clinical services manager. The inspection ended on the 29/2/08 after receipt of further information regarding staff induction and recruitment checks. The process included interviews with three residents, and feedback from two families of the residents. Two support staff, one staff nurse, one physiotherapist one speech and language therapist and the homes cook were also interviewed. The inspection also included a tour of the premises and examination of four residents’ files, six staff files, recruitment records and maintenance records. The view of a local borough representative regarding adult protection issues were also considered. What the service does well: The residents receive personal support to meet their needs, both physical and emotional. This is being done in a committed and caring manner. Staff are friendly and respectful of residents. Residents and family members commented that they feel safe and that staff understand them and are very helpful. Staff are well inducted and trained and the atmosphere in the home is relaxed and friendly. The home makes sure that all staff have been treated fairly during recruitment and that all their work histories and police checks are properly done before coming to work at the home. There is a range of health care professionals involved in helping the staff and in supporting the residents to overcome significant health care problems. Health care and health and safety are very well managed and protect residents and staff. The care planning and review meetings are regular, at least every two months, which is important as the nature of support is rehabilitation, with a view for residents to move on quickly to more suitable accommodation. Care plans regarding health care and risk assessments to protect residents are good. DS0000068121.V343305.R01.S.doc Version 5.2 Page 7 The building is fully wheelchair accessible with excellent bathroom and en-suite facilities, and is well decorated and clean, with good natural light and is well maintained and safe. Specialist services such as Physiotherapy and Occupational Therapy are provided within the home, and there is regular involvement from a range of health care professionals, ensuring that good health care support is provided. The staff team is experienced and well trained with more than 50 having achieved NVQ qualifications. What has improved since the last inspection? What they could do better: The home must make sure that all long-term residents care plans include activities that they like to take part in, and that the care planning system shows that each resident is being offered activities they like in the home and out of the home on a regular basis. These activities should include personal development and training opportunities for long-term residents. The daily records kept by staff also must include details of social and leisure activities and details of resident’s mood and expressed interests. The homes contracts with residents must include details of the fees to pay, and details of termination notice, and must be signed by the residents to show that they have agreed and understood. Some staff have said that the change in their work patterns, which now means that they did 12-hour shifts, has had an effect on their ability to work DS0000068121.V343305.R01.S.doc Version 5.2 Page 8 effectively in providing the care for residents. The homes management should seriously consider these comments and investigate whether resident’s care is being affected by the change in shift patterns. Formal supervision for care staff and nursing staff needs to be improved so that all staff have supervision should least six times a year. This will help them to be better able to do their jobs, and to feel supported by the homes management. The home should consider employing a driver, as currently there is limited availability of drivers to drive the homes car. Doing this should help residents to more regularly go out in the community. The home should consider employing an activities coordinator to improve the level of social and leisure care activities for residents. A number of staff said they feel strongly that this would improve the social and leisure activities for residents. The home should also look at the way key workers and others staff such as the cook are involved in care reviews, and other meetings, so that they are able to participate fully to represent the residents needs in these meetings. There is a need for the home to provide more opportunities for residents to have more social, leisure and educational activities and for staff to have some training in how to do this. 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. DS0000068121.V343305.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 DS0000068121.V343305.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, 3 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents do not have all of the information they need to make an informed choice about whether to move to the home. Resident’s individual aspirations and needs are not fully assessed in the areas of social and leisure care and religious and cultural needs, which may result in important needs not being met. Each resident has a written contract showing terms and conditions but these do not adequately provide all of the information needed by residents. EVIDENCE: There was a recommendation made at the last inspection for the home to provide copies of the Statement of Purpose and Service User Guide to prospective residents, so as to enable them to make a decision as to whether to move into the home. The home is now doing his and this recommendation has been met. There was a second recommendation made for the home to make the CSCI Inspection report available to both residents and their families. The home is now doing this and this recommendation is also met. The CSCI inspection report is now kept in an open area at the main reception. The homes annual quality report shows that they provide long-term support for approximately 9 DS0000068121.V343305.R01.S.doc Version 5.2 Page 11 residents, but the homes Statement of Purpose and Service Users Guide does not provide adequate information about how these residents’ social, leisure, religious, and educational activities will be provided for. The home must include more information about this in the home’s Statement of Purpose. (Refer to Requirement YA1) The homes Statement of Purpose and Service Users Guide do not contain information about the range of fees charged to residents. This information must be included in these documents. (Refer to Requirement YA1) In addition to this to the restriction of those other than “18 to 65 years olds” living at the home should now be removed from the home’s Statement of Purpose, as this is no longer a condition of registration. There was a recommendation made at the last inspection for the home to involve advocacy support for a resident who was considering being moved from the home. This has now happened and the resident is still living at the home. The community liaison officer has identified other residents who also need advocacy support and this is now being provided. Therefore this recommendation has been met. There was a requirement made at the last inspection for the home to ensure social, educational, religious, and cultural needs be included in care assessments for all residents. This requirement has not been met and is now repeated. (Refer to Repeated Requirement YA2) Examination of four residents files, all of whom have been living at the home for more than one and half years, and some who have been living at it the home for up eight years, showed that assessments are very detailed in relation to health, medical, communications, and risk assessments needs, and that these had been completed prior to admission. The homes primary reason for being is to provide support and rehabilitation for victims of trauma. The assessments showed excellent detail in a broad range of health-related information, and a number of assessments showed the main reason for admission to be brain injury, with a range of secondary medical support needs such as pneumonia, poor mobility, behavioural support needs, alertness orientation, capacity could to consent, diet and mobility. However none of the assessments examined showed information about the resident’s social, leisure, cultural, or educational and development support needs. While there is a system for including some information about these areas in a progress report and later in the discharge of report during the months following admission, this information is not transferred onto a care plan. The home does not initially plan to provide long-term care for residents and so social care provision has not been a feature of the homes expertise. A senior manager commented that it has been hard to find move on options for some residents, and the home is DS0000068121.V343305.R01.S.doc Version 5.2 Page 12 now reviewing whether it intends to continue to provide long-term care. Other professionals and staff in their home commented that they felt more should be done to provide long-term residents with consistent activities in and outside of the home. Examination of four long-term residents care assessments and care plans supported this view. There was a recommendation at the last inspection for the home to include in residents contracts, details of the cost of care provided, and the reasons for any variation compared to other residents. This recommendation was not met and due to the introduction of new care standards regulations since the last inspection, this has now become a requirement. There is a contract in place between the home and care commissioners, which shows fees to be paid and what is involved and included. Separately the residents are given a contract between the home and themselves, and examination of two of these contracts showed that these had not been signed by the residents, and did not contain information about the fees to be paid or information about any action to be taken when there is a breach of contract, termination, or notice periods. The home must ensure that this information is included in these contracts, and that they are signed by the residents or by their representatives. (Refer to Requirement YA5) DS0000068121.V343305.R01.S.doc Version 5.2 Page 13 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 adequate This judgement has been made using available evidence including a visit to this service. Residents cannot be completely sure that their assessed and changing social care needs are reflected in their individual care plans. Residents are given adequate independent support to be able to make decisions about their lives in relation to financial matters. The home does an excellent job in assessing risk with residents, to enable them to remain as independent as possible, and to regain mobility in a safe environment. EVIDENCE: Examination of four residents files showed that the home provides excellent care plans for residents in relation to their health and rehabilitation support needs, and that these are regularly reviewed by a range of relevant health care professionals. There are weekly meetings, which take place allowing staff to discuss progress and concerns, and there is a separate professional report, called a progress report, which is compiled at various stages in the months after admission. This includes a broad range of care support needs. However DS0000068121.V343305.R01.S.doc Version 5.2 Page 14 none of these care plans adequately address social, leisure, cultural and developmental needs of long-term residents. The result is that residents in the home described as long-term residents, one of whom has been at the home for eight years, do not get adequate planning or a review of these areas of support. In a number of cases discussed with staff and with the homes management, discussion showed that some more physically dependent residents do not go out regularly. Of four residents files examined two of these residents had not been out in more than two weeks, and there is very limited planning in place for activities in the home, such as domestic tasks games or educational pursuits. Some rehabilitation care staff said they felt that they are not adequately are involved in developing residents social care plans, or in the six-monthly and 12 monthly care review meetings. There was a requirement at the last inspection for the home to review all residents care plans to ensure that they have greater detail regarding social, educational, and leisure interests, showing how these are to be met. This has not been adequately carried out and this requirement is now repeated. (Refer to Repeated Requirement YA6) Examination of the daily handover notes for four residents showed good information about health support needs but contained little information about what residents had been doing with their leisure time or about their mood or expressions of interests. It is recommended that the homes management work with staff to improve the recording of this information in daily records so that it can then be used and fed into the review system. (Refer to Recommendation YA6) Is worth noting that the number of staff spoken to suggested that care planning for social leisure and development issues for residents could be delegated to some of the rehabilitation support staff. At least one of the rehabilitation support staff interviewed expressed a keen interest in getting involved in this area of care planning. A number of staff and professionals working at the home suggested that resident’s social care and activities generally could be improved by having a dedicated social care/activities coordinator employed. It is recommended that the homes management explore this option for developing the care planning system. (Refer to Recommendation YA6) There was a requirement made at the last inspection for the home to ensure that in cases where the home was responsible for residents finances, there would be written agreement put in place allowing the home to carry out this function. Although some discussion has taken place about this issue, and the manager said that verbal agreements have been made, there are as yet no written agreements on relevant residents files. This requirement is not fully met and is now repeated. (Refer to Repeated Requirement YA7 partially met) DS0000068121.V343305.R01.S.doc Version 5.2 Page 15 Three residents currently have all of their benefits managed by the home and these are paid into a bank account, which is administered by the registered provider. There was a second requirement for the registered provider in consultation with advocacy services to ensure the residents financial interests are promoted and protected, and that the residents concerned be issued with regular statements of money held on their behalf. Some discussions have taken place at various meetings regarding these issues, and this issue should now be included in agreements regarding the management of residents finances as discussed above. Therefore a separate requirement is no longer made regarding the provision of statements. Since last inspection the home has involved advocacy services for six residents who are currently receiving advocacy support. Provisions are made for all residents’ sexual and religious preferences such as inviting their religious representatives to the home, and supporting visits from homosexual and heterosexual partners. Examination of four residents care files showed that all have a range of risk assessments on file, which are being regularly reviewed. These risk assessments include areas such as moving in handling support, eating, pressure sores, and management of behavioural issues. All risk assessments are being reviewed and recorded as part of the six monthly review system, and there is evidence of more regular reviews where necessary. DS0000068121.V343305.R01.S.doc Version 5.2 Page 16 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 adequate This judgement has been made using available evidence including a visit to this service. Residents are not supported to fully take part in age, peer and culturally appropriate activities, and are not participating fully in their local community. Residents have appropriate personal, family and sexual relationships, and their rights are respected. A healthy diet is provided and meals are provided at times which suit residents. EVIDENCE: The nature of this service, and the needs of the residents on admission, normally means that they would be unable to engage in many of the activities available to them before admission. For example many residents are admitted as a result of physical trauma and have to undergo a period of treatment and rehabilitation before being able to take part in activities again. However a number of longer-term residents would benefit from having a structured plan for individual social and leisure activities, and activities in the local community. Staff have expressed that they were having problems in taking some residents DS0000068121.V343305.R01.S.doc Version 5.2 Page 17 out, as most residents have mobility support needs and the local area is hilly, and has a lot of road traffic. At the last inspection the home had looked into this problem and had bought a small bus in addition to the existing car, to enable more people to regularly get out. However there is now a shortage of drivers, which prevents some residents from going out regularly. Staff have expressed concern about this and the homes management are aware of the problem and are trying to recruit more drivers. However it remains a problem, and the home’s care planning for long term residents does not adequately reflect the social, leisure, cultural and developmental needs of these residents. It is now the case that some long term residents have not gone out for a two week period, and that care plans and handover records does not show adequate individual planning in this area. (See comments and requirement under Standard 6 of this report) Three residents and two families of residents commented very positively about staff, saying that the staff are always very respectful and are always available to help them when they need it. I observed that staff always address residents by their names, and are careful to ask permission before entering their rooms. There are no restrictions placed on resident’s rights and there is a good atmosphere within the home. The residents spoken to said that the food provided is very good and that they are offered choices in advance of meals each day. There was a problem at the last inspection about residents having to wait during mealtimes, as the dining area was very limited in space. However dining facilities in the home have now been improved and there are now two areas available for dining. A number of staff commented that this has resolved the crowding problem. (See also Standard 28) On the day of inspection the senior speech and language therapist in the home raised concerns about the ability of the home to provide for special diets for some residents, and requested that the homes cook attends a meeting to discuss and agree improvements that should be made. The homes manager gave assurances that the concerns raised would be looked into, and that appropriate action would be taken to ensure that all residents who require a special diet, are able to have it consistently, and that staff are made aware of their responsibilities. It is recommended that this issue be examined and addressed as soon as possible. This was discussed with the registered manager on the day of inspection, and the speech and language therapist expressed confidence that this would happen. (Refer to recommendation YA17) DS0000068121.V343305.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents receive personal support in the way they prefer and require it, and their physical and emotional needs are being met. Residents do retain and control their own medication where appropriate. EVIDENCE: The homes assessment system does identify the likes dislikes and preferences of residents in relation to personal care needs, food preferences and some activities. Many residents are highly physically dependant and care is taken by the home to provide all care and support in a sensitive manner, through discussion with residents and their families. There are a range of highly skilled health care professionals employed by the home such as physiotherapists, Occupational Therapists and qualified nurses, who provide support and advice on a daily basis. Neuro-psychology support is also available when needed, within the homes own staff team. Other health care needs, such as nutrition and dental care are well supported. Each resident has excellent care plans in place to support all health care needs and involving specialist health care professionals. DS0000068121.V343305.R01.S.doc Version 5.2 Page 19 The home’s medication policy caters for residents to self medicate, and currently none of the residents are self-medicating. The home has an adequate medication policy, which was last reviewed in 2005. The home should review the medication policy to ensure it is consistent with current best practice. (Refer to Recommendation YA20) Medication is stored, recorded and administered safely by the trained nursing staff. There are also suitable arrangements in place for the safe disposal of medication by a licensed agent. Resident’s abilities and wishes regarding selfmedication are now being fully assessed as part of the homes assessment process. There is now a standard assessment form for doing this, which is comprehensive, and reflects the homes medication policy guidance on selfmedication. Currently one resident self medicates. There were areas of concern raised by healthcare professionals within the home regarding poor communications between care staff, nurses and other healthcare professionals. I discussed this with a number of care staff and health care professionals and found that the homes management had acted effectively in listening to all concerned, and that improvements had been made in the areas needed. Some of these areas included how care staff follow the guidance regarding mobility support for residents and how they communicate with other professionals to ensure they are providing a good quality of care. It was generally felt that the homes management acted effectively to make the necessary improvements. DS0000068121.V343305.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 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents feel their views are listened to and acted on appropriately, and that they are protected from abuse, neglect and self-harm. EVIDENCE: The home has a complaints policy in place, which was last reviewed in March 2006. There have been five complaints recorded since last inspection. One of these was about a member of staff refusing to provide support immediately when requested. This was investigated and it became clear there has the member of staff concerned was also already engaged in administering medication and could not be reasonably expected to respond immediately to the request. Another complaint was regarding a member of staff’s ability to provide adequate information for a care review. This was investigated and the member staff was subject to disciplinary action as a result of refusing to provide the necessary information when requested. Another complaint was from a health care professional who works within the home, and concerned the inconsistency of staff in providing the right type of food for residents who had special dietary needs. This was being investigated by the home at the time of the inspection. The home keeps a register of complaints including dates received and dates when the complaint investigation is completed. This register shows that the DS0000068121.V343305.R01.S.doc Version 5.2 Page 21 majority of complaints were completed within 28 days, and that the home was responding quickly to complaints and concerns. The home has another protection policy in place, which was last reviewed in March 2006. This policy is detailed and has recently had some guidance added regarding when to involve the police, and a useful spreadsheet directing staff and management in their responsibilities. Staff have confirmed that they had received information about this from the management of the home. There have been two adult protection allegations reported since last inspection. One of these was first reported in October 2007, and concerned a resident who said that he had been physically abused. This was reported to the adult protection team and was investigated by the home. This investigation could find no evidence to support the allegation, and the lack of information regarding dates made it difficult to fully investigate the allegation. The home received some advice from the at the protection team, as they felt the home should not have carried out an investigation without first reporting the matter to the police. The home was quick in amending it’s adult protection policy guidance to ensure that the police are now immediately notified of any allegations of assault or theft. The adult protection team’s advice also identified a need for some further training for the homes management in relation to adult protection investigation and report writing. The homes manager said he would be taking up the offer of further training by the registered provider. A resident made an allegation in January 2008 by a resident about their treatment by a member of their family. This allegation was withdrawn. As the home has taken quick action to amend its policy and other protection and provide clear advice and training for its managers in carrying out adult protection investigations, it is felt that the home has addressed any concerns regarding its ability to implement the local authority adult protection policy, and discussion with the manager has shown a good understanding of how to adequately protect residents under this policy. DS0000068121.V343305.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): 24,28 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents live in a homely comfortable and safe environment, and shared spaces are adequate in size, The home is maintained to a very high standard of cleanliness and hygiene. EVIDENCE: All residents have a private single room, and 15 out of the 18 bedrooms have en-suite toilet and shower facilities. The home is large bright and well maintained. (Please refer to the “Brief description of the home”, to the front of this report) The home is fully wheelchair accessible and is suitable for it’s stated purpose. At the last inspection the homes dining room was seen to be inadequate for the number of people using it, and a requirement was made for the registered provider to ensure that the dining area be suitable in size for the purpose of providing meals for all residents. The home has now got a second dining area, which is located in the living room area. Discussion with staff, residents and DS0000068121.V343305.R01.S.doc Version 5.2 Page 23 families who were visiting suggest that this is a suitable alternative, and does not impact on residents using the living room for other purposes. Therefore this requirement is now met. As was the case at previous inspections the home is maintained to a very high level of cleanliness and hygiene. Good records are being maintained, and there are good systems in place for checking and monitoring practices to prevent infection and to protect staff and service users. Laundry is done in a separate area by a housekeeping team and cooking is done in a modern and clean kitchen by dedicated kitchen staff. I examined the kitchen and food storage areas and found that they were very well maintained and kept in a spotless condition. All flooring and tiling in kitchen and bathroom areas too are very well maintained. Although continence management is an issue for this home, the home was free from unwanted odours and smells throughout. The home has a maintenance plan in place for 2008 and this plan currently includes the repainting and redecoration of bedrooms, the reception area and corridors. DS0000068121.V343305.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 and 36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents are supported by a competent staff team, but they are currently not effective in providing all of the support needed, which results in residents sometimes not getting enough support for activities. Recruitment and induction of staff are well managed, but individual staff supervision is currently not well managed, which has an effect on staff support and development. EVIDENCE: There was a recommendation made at the last inspection for the home to monitor staff attendance at training. This is now happening and the home senior manager says she keeps a database regarding all attendance and said that there has been an improvement in attendance at training. All staff have their roles clearly defined in their job descriptions, and there is a good relationship between staff and management, and between the different professionals employed. Discussion with staff show that they have a clear understanding of residents’ needs and how to defer to others involved, such as Occupational Therapists or Physiotherapists. Discussion with some of the homes professionals showed that there had been some communication problems between care staff and clinical staff, but that the homes DS0000068121.V343305.R01.S.doc Version 5.2 Page 25 management had effectively intervened to improve communications. There is a culture within the home for health care professionals to voice their opinions when they feel there are problems arising, and this has been done a number of occasions, and management has taken an account of their views. Concerns regarding staff not consistently following guidance on how to provide residents with the right food, or in how to support residents with mobility equipment have been raised and openly discussed with management. One professional commented that they felt management act effectively in supporting both themselves, and the care staff, to deal with these areas of concern. A number of care staff also commented that improvements had been made to enable them to understand and follow the guidance given to them. 13 of the 23 health care assistants are qualified to NVQ level 2/3, representing more than 50 of the care staff, which meets the NVQ training requirements for the home. There is an induction programme in operation, which meets the sector skills training council’s requirements, and there is a very good general training plan in the home, and a range of appropriate training is provided for staff. The home is staffed by a registered manager who is a trained nurse, and there are always at least two trained nurses working in the home day and night, supported by between two and three care staff. (Rehab. assistants) Some residents require one to one care, and when this is contracted for there is an additional staff member allocated to work with that resident. Staffing levels have been agreed with the commissioning authorities, and seem adequate for the support required. Staff meetings take place every month, with weekly care review meetings involving a range of staff also taking place. I observed staff to communicate very well with residents, and residents and relatives commented that staff are very sensitive and supportive in how they speak with residents. Over the past year there has been a change made in how the homes rota system works, and this new system has required staff to now consistently work 12 hours shift patterns. A number of staff including some of the homes management expressed concern about how the change in shift patterns has affected staff ability to consistently provide activities for residents. A number of staff said that because they were fewer workdays in the week, they feel they cannot easily follow through on plans for residents. They also feel that the long shifts are fatiguing, causing a lack of physical ability to go out with residents, most of who are wheelchair users. I examined the record of activities outside of the home for a number of residents and found that these residents were not getting out regularly, with more than a two-week period since two of these residents had been out of the home. These residents are long-term residents, having lived in the home for a number of years. Given the level of concern about the impact of the change in shift patterns, the homes manager and registered provider must investigate these concerns and ensure that resident’s support for activities is not being unduly impacted on. (Refer to Requirement YA33) DS0000068121.V343305.R01.S.doc Version 5.2 Page 26 A number of people interviewed also said that they felt there should be an activities coordinator in place in the home, to provide better coordination and management of activities for residents. Although the home has two cars available to support residents to go out in the community, there are no drivers currently employed. Having suitable transport available for residents is particularly important given the level of physical support residents need in this home. It is strongly recommended that the management of the home consider both of these issues, and put in place plans to improve the opportunities for long-term residents to participate in activities outside of the home. (Refer to Recommendation YA33) Recruitment practices are now good, and staff CRB records are now being held until inspected by CSCI. The home now ensures that CRB forms are held until inspected by CSCI. There is good adherence to equal opportunities practices in the recruitment process, with pre-arranged questions relevant to the post advertised being asked of all candidates. At least two managers form the interview panel, and all staff interviewed by me said that they felt that interviews are fairly conducted. The home provides good structured induction training for care staff and nursing staff. All of the staff interviewed were able to describe a range of training they have done in the last 12 months which includes moving in handling, infection control, swallowing, health and safety, adult protection, fire safety, complaints, equal opportunities training, training on respecting diversity, and other relevant training. The home employs up to nine nursing staff, and checks are done to ensure that these are registered with the Nursing and Midwifery Council. Staff files show that their training during and following induction is consistent, but later in the employment period there is no evidence to show that enough thought is given to individual training needs and personal development. None of the care staff files examined had an individual training and development assessment profile, or an individual training plan showing intended training for the future. During my interviews with staff, a number of staff commented on some ideas they had for developing the role in the home. For example one member of staff said they would like to do more work in activities coordination for residents, and another said that they would like to have a more structured role in carrying out their duties within care review meetings. These are areas which have been highlighted as important areas for development within this report. The home must develop individual training and development assessments and plans for each member of staff and ensure that these are kept on file. (Refer to Requirement YA35) None of the staff files examined had evidence of consistent supervision being carried out. Discussion with a number of staff confirmed that staff are not receiving regular two monthly supervision. One staff member said it was at least four months since they last had formal supervision, and another said it was well over a year ago since formal supervision took place. Annual DS0000068121.V343305.R01.S.doc Version 5.2 Page 27 appraisals are not happening for staff. The homes manager said that he accepted that this is an area that needs to be improved on, and that he had now begun the process of putting in place supervision and appraisal schedules for all staff. (Refer to Requirements YA36) DS0000068121.V343305.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents benefit from a well run home, and there is good leadership and management practices in operation. Residents are confident that their views underpin the homes development, and there is now an annual quality audit system in place. Residents and staff health and safety is actively promoted in the home. EVIDENCE: There has been a new care manager in post at the home since September 2007. This manager is a qualified Register General Nurse and has worked within the organisation for a number of years. Hes experienced in the management of physical and health care needs relevant to the residents of this home. The previous manager was promoted to the post of clinical manager within the organisation, and has maintained involvement in a line management capacity to the registered manager. The care manager had been interviewed to DS0000068121.V343305.R01.S.doc Version 5.2 Page 29 become the registered care manager for the home with CSCI, and at the time of inspection was awaiting the outcome of the interview. The new manager is supported on a weekly basis by the clinic services manager who is present at the home on a daily basis. The care manager has scheduled an NVQ level 4 course and is due to begin this course by May 2008. However the manager has limited experience in working in a care home setting, and agrees there is a need to undergo some additional training in care planning with regard to social leisure and educational aspects of care planning. The manager also agreed that there is a need to do some further training in the investigation and recording of adult protection situations, as recommended by the local authority. (Refer to Recommendation YA37) All of the staff interviewed commented positively on the abilities of the management within the home, and on their commitment to making improvements when necessary. Some staff commented that they have sometimes been delays in getting equipment replaced, for example there was a delay in the replacement of the shower chair for one resident, and this can have an impact on the care provided to residents. The manager agreed to be aware of this and to avoid such delays in future. There was a requirement made at the last inspection for the home to ensure that there is an annual quality audit system in operation, which fully reflects the views of residents. This has now been done and the home has a quality assurance system in place, and quality reviews are carried out once a year. The home does have some good quality assurance systems in place and does have regular consultation with residents and their families. There is a good culture of inviting family to review meetings, and due to the nature of the service being provided these reviews are held every 8 to 12 weeks, providing a good opportunity for the home to consult directly with residents. I discussed this with two families who said that they are asked for their ideas and comments by the home for these reviews. In addition to this some surveys are being carried out to find out about residents views on how the home is run, the most recent being about the quality of food provided. There are also weekly meetings with residents as a group, taking place each Friday and chaired by the registered manager, and there are quarterly meetings with relatives. Leaflets, surveys, suggestion boxes are readily available to encourage residents and relatives to raise any concerns and air their views. The home takes the management of health and safety very seriously and is able to show that there is a high standard of checks and balances in place for making the home safe. The home has a long-standing health and safety and maintenance officer who has worked at the home for the past 10 years. There is a health and safety policy in place including a fire safety risk assessment, which was reviewed in May 2007. This review involved the health and safety coordinator and the clinical services manager, and is very detailed in its description of how to protect residents and staff. The fire alarm is tested weekly and records are consistently kept. Fire evacuation drills are done DS0000068121.V343305.R01.S.doc Version 5.2 Page 30 quarterly on there is a clear understanding of how to support residents including where to take them to within the building during the course of a fire drill. Two staff interviewed were able to clearly describe the arrangements for supporting people during a fire evacuation drill. A hydropool is used for the purposes of physiotherapy, and this pool is tested monthly for bacteria content. The home’s water system was tested for legionella in January 2008, and all gas, and electrical, and hoist maintenance certificates are up-to-date. Kitchens are well maintained and kept very clean. Manual Handling, fire, infection control and food hygiene training is provided for all staff. An appointed first-aider training is also provided. There is a health and safety committee set up to review all H&S issues. DS0000068121.V343305.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 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 X 26 X 27 X 28 3 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 X 3 X X 4 X DS0000068121.V343305.R01.S.doc Version 5.2 Page 32 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 YA1 Regulation 4.1 a,b&c and 5 Requirement Timescale for action 30/09/08 2 YA2 12.1 &12.4b 3 YA5 5 The registered provider must ensure that the homes Statement of Purpose and Service Users Guide includes adequate information about how long-term residents’ social, leisure, religious, and educational activities will be provided for, and information about the range of fees charged to residents. The registered manager must 30/09/08 ensure that in consultation with each resident that all residents care assessments include social, educational, religious and cultural needs in accordance with this regulation. This is a repeat of a Requirement made at the last inspection, Timescale 31/10/06 not met, now revised. Continued failure to meet this requirement may result in enforcement action. The registered provider must 30/09/08 ensure that the homes written contracts or statements of terms and conditions with residents contain information about the fees to be paid and information DS0000068121.V343305.R01.S.doc Version 5.2 Page 33 4 YA6 15.1& 15.2 5 YA7 12.2 6 YA33 21 7 YA35 18.1 about any action to be taken regarding a breach of contract, and termination or notice periods. The registered manager must review all residents Care/Support Plans to ensure that they include greater detail in respect of individual social, educational and leisure interests, showing how these are to be met. Plans must be reviewed 6 monthly. This was a requirement of the last inspection, Timescale 31/03/06 partially met, and is now repeated with a revised timescale. Continued failure to meet this requirement may result in enforcement action. The registered provider and manager must ensure that there are written and signed agreement on individual residents files, regarding the support provided for some residents, with the management of their finances and benefits. Families and advocacy should be used to facilitate this if needed. This was a requirement from the last inspection partially met. Timescale of 30/09/06 now revised. Failure to meet this requirement may result in enforcement action The homes manager and registered provider should investigate concerns raised by staff, regarding the impact of recent shift pattern changes on the quality of social care provided to residents, with a view to ensuring that residents support for activities is not being unduly impacted on as discussed in this report. The registered provider and DS0000068121.V343305.R01.S.doc 30/09/08 30/09/08 30/09/08 30/09/08 Page 34 Version 5.2 8 YA36 18.2 manager must develop individual training and development assessments and plans for each member of staff and ensure that these are kept on each individual staff file. The registered provider and manager must ensure that all care and nursing staff receive formal supervision at least six times a year with their line manager, and that written records of these are kept on their personal files 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations The registered provider and manager should review the quality of daily record notes for each resident to ensure that there is adequate information being recorded regarding residents social and leisure activities, mood and wellbeing and expression of interests as discussed in this report The registered provider and manager should explore the suggestions of staff regarding the employment of an activities co-ordinator as discussed in this report, with a view to improving the levels of these activities for some residents The registered provider and manager should investigate concerns raised by the speech and language therapist, with regard to the provision of special consistency of food for some residents and the participation of relevant staff in planning meetings as discussed in this report The home should review the medication policy to ensure it is up to date and consistent with current best practice. The registered provider and manager should consider improvements in the provision of transport for residents as discussed in this report The registered manager should consider participation in further personal training in the investigation and recording DS0000068121.V343305.R01.S.doc Version 5.2 Page 35 2 YA6 3 YA17 4 5 6 YA20 YA33 YA37 of adult protection allegations DS0000068121.V343305.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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