Inspection on 15/03/07 for Hindmans Road, 10

This inspection was carried out on 15th March 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 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hindmans Road, 10 15/09/08

Hindmans Road, 10 24/09/07

Hindmans Road, 10 16/02/06

Hindmans Road, 10 01/09/05

Hindmans Road, 10 17/03/05

Hindmans Road, 10 18/08/04

Hindmans Road, 10 30/03/04

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 09/07/2008.

CARE HOME ADULTS 18-65 Hindmans Road, 10 London SE22 9NF Lead Inspector Sean Healy Unannounced Inspection 15th March 2007 11:00 Hindmans Road, 10 DS0000007094.V306155.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 Hindmans Road, 10 DS0000007094.V306155.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. Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hindmans Road, 10 Address London SE22 9NF 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) 0208 693 8950 LINC Care Home 3 Category(ies) of Learning disability (0) registration, with number of places Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th February 2006 Brief Description of the Service: 10 Hindmans Road is a Care Home providing accommodation and personal care to three people with a learning disability, currently all men. Hexagon Housing Association, a voluntary organisation who leases the building to CHOICE SUPPORT, owns the building. The service is provided by PLUS, (Providence and Linc United Services) a voluntary organisation. The home is located in East Dulwich, close to shops, Peckham Rye Park, pubs, the post office and other amenities. The home consists of a two-storey building, one bedroom downstairs with en-suite facilities, and accessible to wheelchair users. All the home’s bedrooms are single. The home has a garden to the rear. Information about the service provided is made available to current and potential service users in the homes Statement of Purpose and Service Users Guide. The recent CSCI report is currently kept at the home. At 15th March 2007, the homes fees are set at between £32.95- per week and £65.05- per week for a portion of the cost of accommodation and support. The reason for the difference was explained as applying to whether residents are under or over 60 years of age. The majority of the cost of support and staffing are met by the referring social services authority, however these costs are not made explicit by the home in either residents contracts or in the Service User Guide. There is an additional charge made for food of £29.40 weekly, payable by each service user. Transport is not provided by the home and any costs are payable by each service user. Service users have to pay for other personal expenses such as hairdressing and personal shopping. The provider’s email address is: None available Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 15th March 2007. The team manager, who proposes to become the Registered Care Manager, facilitated it. Two residents were present for part of the inspection but did not choose to give their views about how they felt living at the home. The method of inspection included discussion with the homes manager, and three of the support staff. The building was also inspected for health and safety, suitability for residents and cleanliness. Resident’s records and other documentation about how the home is run were examined. Care assessments and care plans were examined to ensure that care needs were being planned for, and the owners and residents were questioned about these plans, to check that plans were being put into action. The social worker responsible for the two residents was also consulted, about her views on the quality of care and about staffing levels. A senior manager for the Registered Provider also was contacted regarding staffing levels, staff employment records, and the need to have the manager registered with CSCI. What the service does well: What has improved since the last inspection? The residents have had a review of their care needs with their social worker, to help them to have more interesting activities and enough help to do them. The home now asks residents about what they would like to eat, and the staff write down this information so that residents can be helped to have a healthy diet. Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 6 The medication that residents take is now written down in a way that makes sure that mistakes can’t be easily made. The home has also asked the GPs about the best medication for the residents to make sure it is right, and that they are helped not to have any pain. The staff have had training about how to help people and to understand them better. What they could do better: The home must make sure that when the support residents need has changed, this must be written down properly, so that the staff will know what needs to be done differently, and how best to help them to get to do the things they like and need. The people who live at the home must be given information about what the home charges for allowing them to stay at the home, and the cost of the help that they get from staff. The people who live at the home must be given information that will help them to say what they need and want, and to have help to have this written down in a way that they can best understand, using pictures, or tapes that they can listen to. They should also be able to have other people to help them write down or say the things they want to do. When the home looks after money for residents, the manager must make sure that the residents fully agree with them doing this, and that this is written down properly. The home must have enough staff to give residents the help they need to go out, and they must not ask residents to go out to places that they do not wish to go to. At the moment this sometimes happens because they are not enough staff. The home needs to get a special Scales to help some residents to easily weigh themselves, so they can plan to stay healthy. The manager and staff need to understand better how they should make sure that residents are safe and protected from harm. The staff need to go on more training to help them to be qualified to do their jobs. The manager must make sure that there are enough staff working in the home to help residents, especially when going out in the local community. They must talk to social services properly about this, and not do anything that will cause harm by not having enough staff. Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 7 The manager must keep the information at the home, about how staff are given their jobs, and how they check that they are good and safe to work with residents. The manager must ask residents about how they think improvements can be made in how they help residents. The manager should ask other people who are trained to understand the residents needs, to come and help them give their views, and to say what they want. 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. Hindmans Road, 10 DS0000007094.V306155.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 Hindmans Road, 10 DS0000007094.V306155.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 Quality in this outcome area is poor This judgement has been made using available evidence, including a visit to this service. Resident’s individual aspirations and needs are assessed but assessed needs are not reflected in care planning. Residents have individual written contracts about the service they can expect, but these are not adequate, as they do not reflect fees or costs for support for each resident. EVIDENCE: All three residents who have lived in the home of the past year, have had a full assessment of needs provided by social services, by whom they were placed in the home. Currently only two residents live at the home and there is one vacancy. There is one social worker responsible for ensuring that residents care needs assessments are up-to-date. This has been happening, with the last care review meetings for all service users having taken place in October 2006. These review notes show good details of the assessed needs in a range of areas for the two residents, and goals are being set for improving services for both residents. However, the review for both residents was not followed by a review of the care plans, and the existing care plans reflect the same needs for one resident, as was the case in May 2006. These care plans do not reflect important issues arising from the care review in October 2006. For example it Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 10 was said that the resident should have a holiday and as yet no plans have been put in place to try to make this happen. The social worker said she was very surprised to hear that staffing levels had been reduced since the review meeting in October 2006, and was concerned that the assessed needs of this resident were not being met by the home, and may be putting the resident or staff at risk. A senior manager for the registered provider, who has responsibility for the home, also confirmed that he feels they are not properly funded to provide the level of staff support described in the care assessment for one resident. The registered provider and the manager of the home, must ensure that the care assessments are properly agreed with the social worker, and are able to be supported by staffing levels, and that a clear statement is made by the home to social services, about their ability to provide adequate staffing levels to meet the assessed needs of this resident. (Refer to Requirement YA2) The registered provider and the manager of the home must also ensure that the assessed needs of each resident are fully reflected in care plans. (Refer to Requirement YA6) Residents at the home are provided with License Agreements, and these are dated 1994 for both residents. These documents do not adequately show residents the service they can expect, or the fees to be paid. The registered provider must ensure that all residents are given statements of terms and conditions, or contracts, which show the services they can expect, the individual cost or fees, and who is responsible for paying these fees. (Refer to Requirements YA5) Hindmans Road, 10 DS0000007094.V306155.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 at least once during a 12 month period. 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. The residents assessed needs are not adequately reflected in individual care plans, and the residents are not fully supported to make important decisions about their lives. Risk assessments do not adequately protect residents and staff. EVIDENCE: There was a requirement at the last inspection for the Registered Provider to ensure that the care plans for the residents are kept under review, and that useful notes of these reviews are made in the care plan, to include goals set, strengths and needs, a health action plan, and annual holidays. The need to set up a “Communications Passport” for one resident was also included in this requirement. This requirement was only partially met and is repeated, with some amendments to reflect the work that has been done. The home must complete a full and comprehensive care plan for each resident, addressing in writing all of the issues identified in care reviews, including health care issues and agreed goals. (Refer to Repeated Requirement YA6) Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 12 A review of all of the residents care plans took place in October 2006, and this involved a social worker, the team manager, and the residents. Goals were discussed and it was emphasised that for one resident, two to one support was needed when going out in the community. It was also emphasised that there was a need to ensure the resident had a goal in place to go on holiday next year. A range of other issues were discussed, but none of these were transferred into the residents’ care plans, though some of them were being worked on in an unplanned way. There is also a Person Centred Plan, which has been started for one resident, but which requires much more information before it is a usable document, and it is clear that the resident is not aware of the content of this plan. It was not possible to confirm clearly whether staff had any training in Person Centred Planning approaches. It is important that staff receive training in the use of this Person Centred Planning approach, and put this plan into action. (Refer to Requirement under Standard YA35) There was a requirement made at the last inspection for the registered person to ensure that residents be supported to find out about Person Centred Planning, and to make one for themselves involving family and friends. As discussed above this has not been fully achieved, and the requirement is repeated. (Refer to Repeated Requirement YA6) There was a requirement at last inspection for the registered provider to ensure that one resident had a written agreement about being supported with access to his money, and how it would be spent, including support to purchase insurance. This has not been done, and is repeated and rephrased. The registered provider and manager must ensure that when they are acting as appointees for any residents, this decision must be supported by a written and signed statement or agreement, signed by the resident or their representative. (Refer to Repeated Requirement YA7 rephrased) There was a requirement at the last inspection the registered provider to ensure that arrangements for the use of the home’s car by residents who do not own it, to make payments when they use it. This requirement is no longer needed as this resident does not now live at the home. There are a range of risk assessments in place for areas such as boating, going out in the community, swimming, cooking, supporting one resident when becoming agitated in the community, and giving medication. These are being regularly reviewed. However the risk assessments did not adequately cover the assessed needs of one resident who should have two to one support when in the community. However, the rota showed that there are times when only one member of staff is on shift, and the staff and the manager confirmed that predominantly it is necessary to bring two residents out together to achieve two staff being present on outings. This sometimes means that one resident Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 13 will go out with the other resident, to their GP appointments, or to other places, which are of no interest to them. Risk assessments do not take account of the frustration or agitation that this may cause. The home must ensure that risk assessments regarding these issues are reviewed with full involvement from social services, and relevant other professionals, and with the resident, to ensure that both staff and residents are always safe. (Refer to Requirement YA9) Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. 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 supported to take part in activities, and to be part of the local community. Personal and family relationships are maintained and encouraged, but resident’s rights to choose when to be alone are not always respected. Good food, of the resident’s choosing, is offered on a daily basis. EVIDENCE: Residents are actively supported to go out in the community, and to participate in a range of activities such as boating, bowling, going out of the pub, going to a sensory room and a social club, and to the church and for walks in the park. These activities are being recorded in order to monitor that residents had been offered these choices. There has been improvement in the consistency of activities since the current manager has been in the home. Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 15 All residents have some involvement from the families. One resident has visits every two months, from his niece and nephew, and recently had a well attended birthday party with about 20 people attending. All residents have friends they go to visit, and get involved in going to barbecues, birthday parties, and other outings. There was a requirement at last inspection for the home to ensure that one resident is offered choices as to where he sits when in the home, and that he be made aware of activities outside of the home that he might want to participate in. This requirement was met, and there has been significant involvement from the Multi Disciplinary Team’s behaviour and speech and language professionals, and this has resulted in improved communication with this resident, and in an increase in activities outside of the home. Two staff spoken to agreed that there are now a range of activities happening consistently for this resident. There are also good records being kept showing that these activities are happening (Refer to standard 12 for details) However, in the past month staffing levels have been reduced by up to one member of staff, without consultation, and it seems that further reductions may happen, due to a resident vacancy. Examination of the home’s staff rota, and discussions with staff and the manager, and with the social worker, suggested that there are not enough staff to ensure that residents are able to choose when to be alone, and when not to join in activities. In fact it was suggested that sometimes residents have to join in activities not of their choosing, in order to ensure enough staff are available to go out one resident. This is clearly not an acceptable situation, and the registered provider must ensure that priority is given to reviewing this problem with social services, and any other relevant professionals, in order to make sure that all the residents are able to choose whether or not to get involved in activities. (Refer to Requirement YA16) The homes records of food consumed by residents, and discussion that residents and staff, showed that there is good food and a healthy diet being offered to residents on a daily basis, which include offering them choices of preferred food. Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 and 21 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents receive personal care support in the way that they prefer, but physical needs of residents may not always be met. Medication is well managed, and ageing an illness is handled with respect. EVIDENCE: All residents have a personal care plan in place, which shows in details how to support them in getting up in the morning, toileting in batting, and a range of other personal care needs. These were reviewed in May 2006. One of the residents, who has an important support need regarding eating and drinking, has a good speech and language assessment in place, with written guidance through staff in how to provide support. Two residents are weighed weekly as part of their care support, and staff and the manager showed awareness of the importance of consistently doing this. There is involvement from a dietician for one resident, and the staff again showed a good knowledge of the requirements of the dietician. Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 17 There was a requirement at the last inspection for the home to ensure that one resident has his weight regularly taken, or to seek agreement with the physiotherapist as to why his weight may not be taken. The annual review meeting in October 2006 identified a problem with accessing appropriate weighing scales. The manager said that there have been difficulties in getting this specialist scales, but hopes to get it soon through the housing department. This requirement is partially met and is now repeated. (Referred to Repeated a Requirement YA19) One resident has complex health care needs and is receiving input from speech and language therapist, physiotherapist, and the dietician. There are good support plans in place to cater for his health care needs. All residents are registered with the GP, dentists, and have support from health care professionals on the Multi Disciplinary Team. All residents have a health care action plan in place, which caters for a range of health care needs. There was a requirement at the last inspection for the home to ensure that medication dosages on the administration sheet match those on the prescription from the GP. This is now being met. The home has a medication policy, which was last reviewed in June 2006. The Southwark NHS PCT provides a visiting pharmacist who last inspected in June 2006. A report is on file showing good management of medication, and storage is good. There was a recommendation at the last inspection asking that the home should ensure that residents be support to record their wishes regarding death and dying and make a will if necessary. This has now been done. Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home listens to residents and takes their concerns seriously. Residents are not fully protected by the homes Adult Protection policy. EVIDENCE: The home has an up-to-date complaints policy, which was last reviewed in June 2006. There is also a complaints logbook in place, to help to track and monitor the complaints process. No complaints have been recorded since 2005. The home’s policy on Adult Protection refers to the London borough of Lewisham, and is not the correct policy for Southwark, or for the home. There are some differences in how reporting should happen, and the lines of responsibility for the provider and the local authority. The manager said that he has the Southwark policy, but this could not be found during the inspection. In discussion with staff, there was not clarity on their part about who is responsible for carrying out investigations in relation to adult protection issues, and it is clear that all staff in the home would benefit from Adult Protection training, particularly in relation to the Southwark policy. The registered provider and the manager must ensure that the home has an up-to-date Southwark policy on Adult Protection available, and that both the manager and staff receive training in how it works. (Refer to Requirement YA23) Hindmans Road, 10 DS0000007094.V306155.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The environment is homely, comfortable and safe, and is kept clean and well maintained. EVIDENCE: The home consists of a two-storey building, one bedroom downstairs with ensuite facilities, and accessible to wheelchair users. All bedrooms are single, with each resident having their own room. The home has a garden to the rear, with good space and storage available. The house is a good state of repair, and is located in a good area, with parks and shops, and is well serviced by public transport. It is wheelchair accessible to the ground floor and garden area, which is important from the needs of one resident. This residence bedroom is located at the ground floor, with easy access to bathroom and toilet facilities. The home is well maintained and is kept very clean, and is free from any clutter in the hallways and rooms. Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The care staff have not been supported to gain the required qualifications, and are not employed in sufficient numbers to meet the assessed needs of the residents. There is no evidence available to show whether residents are protected by the home’s recruitment policy and practices. EVIDENCE: There was a requirement at the last inspection for the staff to receive training and supervision to support their understanding and best practice. This is now met. There has been good involvement from external professionals on the Multi disciplinary Team, which has helped staff to become more aware of issues regarding communications, challenging behaviour and motivation, and this has resulted in increased understanding and more engagement in activities with residents. One out of the five support staff has in NVQ 2 qualification. At this point more than 50 of the support staff should have achieved this qualification. (Refer to Requirement YA32) Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 21 The staff team is made up of a 5.5 support staff and the team manager. All of the staff had induction training in line with the “Skills For Care” requirements. One new member of staff is currently undergoing the Learning Disabilities Award Framework induction, which is appropriate to the needs of the residents. A speech and language therapist has been involved up to twice weekly, and now comes more sporadically. The team manager feels that this has resulted in a big improvement in the communications support offered to one resident, and now objects of reference and cues are being used consistently by the staff to communicate with this resident. There is a six-month induction and probation period in effect for new staff at the home. Good records are being kept of this induction, and staff are being consistently schedule to training relevant to the needs of the home. This includes health and safety, fire safety, moving and handling, first aid, understanding challenging behaviour, medication, complaints and adult protection. There was a requirement at the last inspection the staffing levels at the home to be reviewed, and to include the practice of lone working during the day, against the needs of the residents. During the last inspection there was only one member staff on shift for up to three hours, contrary to stated minimum staffing levels. As discussed under Standard 2 in this report, the social worker responsible for carrying out reviews, was unaware that this is still happening. Since the review meeting in October 2006 staffing levels have been further reduced. The current stated levels given by the homes manager, and by the senior manager of the provider, state staffing levels as 5.5 support staff and the manager, with an additional post of up to equivalent of one worker to provide cover for training and absence. The senior manager and home’s manager agreed that this was not enough to provide enough staff to be able to go out two to one, at any time with the resident who is assessed as needing this level of support. The senior manager and the social worker agreed that there is a need to have an urgent review of staffing levels, with the involvement of other relevant professionals, to ensure that the staffing levels, and practices in the home safely support this resident, while protecting staff and other residents in the home. (Refer to Repeated Requirement YA33) Recruitment records are kept at the organisation’s head office. An inspection in June 2006 showed that appropriate CRB checks had not been consistently carried out for all staff employed by the registered provider, who were recruited prior to April 2006. As there are no staff employment records available at the home it was not possible to specifically check the recruitment records of the staff employed in this home. The Registered Provider must ensure that employment information about all of the staff that work at the home, is kept at the home for inspection. This information is contained in Schedule 2 of the Care Home Regulations. The provider’s failure to provide this information at the home for inspection presents a potential risk of possible Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 22 oversights made during recruitment going unchecked. It was noted that as part of this inspection the home’s manager and a senior manager for the provider were asked to provide CSCI with this information, but failed to do this. (Refer to Requirement YA34.) The organisation’s training manager schedules training and there is appropriate training being scheduled. All of the staff have had an annual appraisal and have a personal training development plan. As the home primarily supports people with learning disabilities, and there is a clear lack of staff training and experience in applying the preferred planning approaches of Person Centred Planning, it is recommended that this training be included in the homes training schedule. (Refer to Recommendations YA35) Hindmans Road, 10 DS0000007094.V306155.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The Registered Manager is not yet qualified to NVQ level 4. Service users views do not underpin the home self-monitoring and development practices. The homes health and safety practices do not fully protected staff and service users. EVIDENCE: The current manager started working at the home in June 2006, and intends to apply to become register as a registered care manager with CSCI. The manager said he completed a form for the application, and will chase this up to ensure that it is submitted to CSCI. The registered provider must ensure that the home has a manager who is registered with CSCI. (Refer to Requirement YA37) Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 24 The home’s manager is not yet qualified to NVQ level 4, as is required by this post, but has been participating in the course and is awaiting achievement of the care component of this qualification. It is expected that he will complete this by Jan 2008. The manager has already achieved a certificate in management, and has the relevant experience working with residents with similar care needs as those in the home. He has also demonstrated a calm and reflective approach in working in the management of challenging behaviour, which is very beneficial to supporting staff and residents in the home. There was a requirement at the last inspection for the registered person to make sure that residents are consulted and support are to make a plan to improve the quality of care provided at the home, as part of the homes quality assurance system. This requirement was not fully met and is repeated. (Refer to Repeated Requirement YA39) The manager felt that residents may not be able to effectively give their views and that maybe it is possible that the residents who are more capable of giving their views will have the homes practices reflect their needs more than those of other residents. Currently there is not any effective involvement from independent advocacy, to support residents to express their views, and it is recommended that the home try to identify in consultation with residents appropriate advocacy support. (Refer to Recommendation YA39) The home keeps good records on all issues relating to health and safety, with the exception of being able to produce an up to date 5 year Electrical Safety Certificate. This was not available at the home and was not copied to CSCI after the inspection despite requests to do so. The Registered Provider must ensure that there is an up to date 5 year Electrical Safety Certificate for the home available on the premises, and that a copy is sent to CSCI. (Refer To Requirement YA42) There are safe working practices regarding moving and handling, fire safety, food hygiene and infection control. There have been no reports of dangerous diseases or occurrences, and there are good records on the testing of fire equipment, water and gas within the home. Hindmans Road, 10 DS0000007094.V306155.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 1 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 3 2 X 2 X X 2 X Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 26 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 12.1 a Requirement Timescale for action 30/06/07 2 YA5 5.1 3 YA6 15 The Registered Provider and manager must ensure that one residents care assessment is reviewed, and full agreement is reached with social services regarding safe minimum staffing levels while travelling in the community, and that such agreement is fully implemented. The Registered Provider and 31/07/07 manager must ensure that all residents are in possession of a contract or statement of terms and conditions to include the correct fees to be paid in relation to their individual care and support, an up to date description of the service and support and who is responsible for payment of fees The Registered Person must 30/06/07 ensure that service users’ care plans are up to date and reflect the assessed needs of the residents as discussed in this report Standard 2. This is a repeat of a requirement made at the last inspection, Timescale 30/04/06, partially met. Timescale DS0000007094.V306155.R01.S.doc Version 5.2 Hindmans Road, 10 Page 27 revised. 4 YA6 15 The Registered Person must ensure that service users are supported to find out about Person Centred Planning, and to make one for themselves, involving their friends, family and professionals, including a representative from the authority that arranged for them to live at the home. This was a requirement of the last 2 inspections Timescale of 30/10/05 and 30/04/06 partially met.Timescale is now revised. The Registered Provider must seek formal written agreement from residents and/or their representatives, for written authorisation to manage their finances. This was a requirement from the last two inspections Timescales 30/11/05 and 30/04/06 not met, now revised. The Registered Provider and manager must ensure that residents risk assessments, include the risks regarding not being able to provide appropriate support and staffing, for one resident, while travelling outside of the home. The Registered Provider and manager must ensure that residents are only asked to engage in activities beneficial to their care and support and not for any other reason The Registered Person must ensure that the resident who requires this support be weighed regularly as recommended by the physiotherapist, or grounds for not doing this discussed and agreed with them, and any action taken to manage the risk DS0000007094.V306155.R01.S.doc 31/07/07 5 YA7 12(2) & 20.3 31/07/07 6 YA9 12.1 a & 13.4 b 30/06/07 7 YA16 12.1 a 30/06/07 8 YA19 12(1)(a) 13(4) 31/07/07 Hindmans Road, 10 Version 5.2 Page 28 9 YA23 13.6 10 YA32 18.1 a & c 11. YA33 12(1)(a) 12 YA34 19 Sch.2 13 YA37 8&9 of the service user losing weight and/or not eating, to safeguard their health and well-being. This is a repeat of a requirement made at the last inspection, Timescale 31/03/06, partially met. Timescale revised. The Registered Provider must ensure that there is a copy of the local borough’s adult protection procedure in the home, and that staff are familiar with it. The Registered Provider must ensure that enough of the care staff are enrolled on an NVQ level 2/3 course to ensure that at least 50 of the staff become qualified at this level The Registered Person must ensure that staffing levels at the home are reviewed, in consultation with social services and any other relevant care professionals, to ensure that the staffing levels, and practices in the home safely support residents, while also protecting staff and others, as discussed in this report under Standard 33. This is a repeat of a requirement made at the last inspection, Timescale 30/04/06, not met. Rephrased and Timescale revised. The Registered Provider must ensure that employment information about all of the staff that work at the home is kept at the home for inspection. This information is contained in Schedule 2 of the Care Home Regulations. The Registered Person must ensure that an application for registration of the manager is submitted to the CSCI as DS0000007094.V306155.R01.S.doc 30/06/07 30/09/07 30/06/07 31/07/07 30/06/07 Hindmans Road, 10 Version 5.2 Page 29 14 YA39 24 15 YA42 23.4 required by the Care Standards Act 2000. The Registered Person must ensure that service users are consulted and supported to make a plan to improve the quality of care provided at the care home and reflect their decisions, wishes and feelings in the way the home is run. The support may be via advocacy services. This is a repeat of a requirement made at the last inspection, Timescale 30/06/06, not met. Rephrased and Timescale revised. The Registered Provider and manager must ensure that an Five Year Electrical Safety Certificate is acquired for and kept at the home, and a copy of this be sent to CSCI 30/09/07 30/06/07 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 2 Refer to Standard YA35 YA39 Good Practice Recommendations The Registered Provider and manager should include Person Centred Planning in the homes schedule for staff training The Registered Provider and manager should find appropriate advocacy support for residents to enable them to express independent views on the management and quality of care provided at the home Hindmans Road, 10 DS0000007094.V306155.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH National Enquiry Line: 0845 015 0120 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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