Inspection on 24/09/07 for Hindmans Road, 10

This inspection was carried out on 24th September 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 12 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 15/03/07

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 24th September 2007 10:00 Hindmans Road, 10 DS0000007094.V346929.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.V346929.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.V346929.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 0208 297 1207 PLUS (Providence & Linc United Services) Trevor Anthony Lewinson Care Home 3 Category(ies) of Learning disability (0) registration, with number of places Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category; 2. Learning Disability - Code LD The maximum number of service users who can be accommodated is: 3 15th March 2007 Date of last inspection 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 £34.55- per week for a portion of the cost of accommodation and support. 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 Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 5 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.V346929.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection site visit took place on the 24/09/07. The inspection ended on the 1/10/07 following discussion with a senior manager for the provider regarding staffing levels and recruitment information, and following discussion with Citizens advocacy about their involvement. The team manager, who is now the Registered Manager, facilitated the inspection. Two residents were present for part of the inspection but were unable to give their views about how they felt living at the home. Observations were made of staff working with one resident. The method of inspection included discussion with the home’s 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 manager and staff were questioned about these plans, to check that these plans were understood and 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, and staff employment records. Citizen’s advocacy who have recently become involved in providing support also gave their views on how residents were being supported. What the service does well: There is evidence of good care, and residents’ needs are assessed with their input. There is good help provided by health care professionals such as psychology and physiotherapy and speech therapy. Relationships with family and friends are encouraged and supported. (Although there is little family involvement) Staff are enthusiastic about working at the home, and help residents to go out and attend parties and barbeques. The staff support the residents to shop and cook meals that they like, and are very sensitive and helpful in the way the provide support. The home was warm and homely, the residents have been involved in decoration of their own rooms, which are well maintained. The home was clean and everything worked well. Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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. Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 8 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 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. 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. The summary of this inspection report can be made available in other formats on request. Hindmans Road, 10 DS0000007094.V346929.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 Hindmans Road, 10 DS0000007094.V346929.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): 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 all 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: There was a requirement made at the last inspection for the registered provider and manager to ensure that one residents care assessments be reviewed, and agreement be reached on social services regarding safe minimum staffing levels while travelling in the community, and to implement any agreements made. This has not been done and this requirement is now repeated. The following information was provided in the last inspection report and remains the same, as adequate action was not taken to meet the requirement made: 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 Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 11 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 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. This was a requirement at the last inspection and is now repeated in an Improvement Plan requested from the registered person following this inspection. This requirement was discussed as part of a CSCI Management Review. The Responsible Individual has been notified of this and asked to provide an improvement plan to implement this requirement. Failure to meet this requirement will result in enforcement action. (Refer to Repeated Requirement YA2) There was a requirement made at the last inspection for the registered provider and manager to ensure that all residents are in possession of a statement of terms and conditions to include correct fees to be paid in relation to care and support. This has not been done and this requirement is now repeated. The residents do not have adequate terms and conditions in place, and the current licence agreements with the housing association is dated the 9th September 2002, and shows monthly charges of £102.40 for accommodation, which is not correct as the current charges are set at £35.44 per week. All of the following information was noted at the last inspection and still remains relevant: 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, what the fees include and who is responsible for paying these fees. This was a requirement at the last inspection and is now repeated. Failure to meet this requirement within the timescale given may result in enforcement action. (Refer to Repeated Requirement YA5) Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 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 two inspections for the home to ensure that residents care plans are up-to-date and reflect assessed needs of the residents. The last review of care plans with social services in October 2006 showed a list of goals for each resident, which were not included in care plans at the last inspection. The successful outcome of the residents were as follows: 1. Health action plan was completed for both residents but it is very sketchy and does not show the full range of support needed (refer to details and standard 19) 2. Copies of the speech and language reports were sent to social worker Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 13 3. The home has Identified new opportunities for activities for residents. The manager has done a lot with the team to achieve the goals identified in the review meeting and this progress will be reviewed in November 2007. However this has not been achieved within a structured care planning process and the written evidence to show the things that have happened is not available. The care plan has not been revised since last inspection. The care plans are both residents must be revised to include all of the issues from the last review of October 2006, and to show achievements and progress made. Although some progress has been made the requirement from the last inspection is now repeated and will be the subject of an improvement plan for the home. This was a requirement at the last two inspections and is now repeated in an Improvement Plan requested from the registered person following this inspection. This requirement was discussed as part of a CSCI Management Review, and is now the subject of an improvement plan for the home and will result in enforcement action if not achieved. (Refer to Repeated Requirement YA6) There was a requirement made at the last three inspections for the home to ensure that residents are supported to find out about Person Centred Planning and to make a plan for themselves. There has been no change to the written Person Centre planning documents since last inspection. However these documents a well laid out with appropriate sections for information, wording and photos, which will be very helpful to the residents who do not read. The manager has held a two-day Person Centre planning workshop with the staff team, and to key workers have been scheduled for Person Centred planning training in November 2007. It is envisaged that these two key workers will lead on the Person Centre planning process in the home. It is recognised that you to communications issues with both residents that the development of the Person Centre planning booklets will be a longer-term prospect and that is has now begun. Therefore this requirement is deemed as having been met, with a further recommendation to invite advocacy representatives to become involved in the planning process. (Refer to Recommendation YA6) There was a requirement made at the last three inspections for the registered provider to ensure that there is a formal written agreement in place, to authorise the home to manage the residents finances for them. Both residents’ finances are currently being fully managed by the home, but there is no formal agreement, which allows this to happen. This requirement is again repeated. This requirement was discussed as part of a CSCI Management Review, and is now the subject of an Improvement Plan for the home and will result in enforcement action if not achieved. (Refer to Repeated Requirement YA7) Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 14 The manager has now got advocacy involvement for both residents as a result of a recommendation from the last inspection report. It is hoped that this will improve the consultation process between the residents and the home, and that advocacy will be invited to be involved in care planning, and in expressing residents need in the review of assessed needs and staffing levels. The currently home provides a service for two residents with profound Learning Disabilities and complex communication support needs. There is a vacancy at the home for the pat seven months. There has been involvement from health care professionals such as; speech and language, challenging behaviour, and physiotherapy to help service users in care planning. The staff were seen to work sensitively with residents and regularly use objects of reference and other tools to enable choices to be made. Residents attend a sensory impairment workshop regularly where stimulatory equipment is used. It is recommended that all staff are trained in working with sensory impairment and this be identified in the training plans for the home. (Refer to Recommendation YA35) There was a requirement made at the last inspection for the home to ensure that residents risk assessments include risk regarding not been able to provide adequate two to one support for one resident. The manager has carried out a review of this risk assessment, which showed that staff should only support the resident one-to-one when going to local community activities such as the park at the local shop, but that other longer range activities should be carried out only with two to one support. This level of staffing does not comply with the assessed need of 2 to 1 support, and the risk assessment was carried out without involvement from other relevant professionals and social services, and is therefore not appropriately agreed. This was a requirement at the last inspection and is now repeated. This requirement was discussed as part of a CSCI Management Review, and is now the subject of an improvement plan for the home and will result in enforcement action if not achieved. (Refer to Repeated Requirement YA9) Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good 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, and resident’s rights to choose when to be alone are now 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. Weekly trips to a sensory room are supported and it is believed that residents enjoy this activity. I observed staff supporting one resident to have a massage, which is an important part of daily activities, and this was carried out in a very sensitive and competent manner in the privacy of his room. Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 16 All residents have some involvement from their families although to a limited degree. One resident has visits every two months, from his niece and nephew. 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 residents are only asked to engage in activities beneficial to their own care and support. This was made as staffing levels at that time had been reduced by up to one member of staff, without consultation, and it seemed that further reductions might happen, due to a resident vacancy. In fact it was suggested that sometimes residents had to join in activities not of their choosing, in order to ensure enough staff are available to go out one resident. This requirement is now met and the activities plans and handover notes showed that residents are now asked to participate only in their own activities. Two staff spoken to also confirmed that this is now happening. Two staff spoken to said that there are a range of activities happening consistently for residents. There are also good records being kept showing that these activities are happening. 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.V346929.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,and 20 Quality in this outcome area is adequate 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 April 2007. 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. There was a requirement at the last two inspections 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. This requirement is now met. The annual review meeting in October 2006 identified a problem with Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 18 accessing appropriate weighing scales. The manager has now got specialised scales for the home and the staff have been inducted in how to use it. The residents weight is now being taken and recorded weekly and there are signs of improvements in weight for this resident. 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. Good records are being kept of contact residents have with healthcare professionals. Although the residents reviews and care plans do refer to a range of health care needs, there is no overarching health action plan in place for residents, which encompasses the full range of healthcare needs and there are no references in plans for how often residents will need to visit healthcare professionals. Healthcare needs in the home are at a significant level and merit a more detailed planning and review system be used. One residents plans refers to a removal of a cataract and an intended referral to a neurologist but the details are sketchy and show no real mention of plans to be actioned for the current year. Comments from citizens advocacy on behalf of residents who have high levels of epilepsy seizures, suggest that much more specialist support is needed regarding monitoring and intervention of epilepsy, but this was not specified in healthcare plans for these residents. The home must put in place a comprehensive healthcare assessment and health action planning system for all residents and ensure that these include more specialist support regarding epilepsy. (Refer to Requirement YA19) 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. Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 19 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. The home listens to residents and takes their concerns seriously. Residents are now 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. Staff showed a good knowledge of how to respond to complaints. There was a requirement made at the last inspection for the home to have a copy of the Southwark Adult Protection policy available and that the staff are made familiar with it requirements and guidance. This requirement has now been met. There is now a copy of this policy at the home and the staff and manager showed a good knowledge of how reporting should happen, and the lines of responsibility for the provider and the local authority. There have been no adult protection referrals since the last inspection. Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 20 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 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.V346929.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 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 adequately supported to gain the required qualifications, and are not employed in sufficient numbers to meet the assessed needs of the residents. There is not sufficient evidence available to show whether residents are protected by the home’s recruitment policy and practices. EVIDENCE: There was a requirement made at the last inspection for the registered provider to ensure that enough care staff are enrolled on an NVQ2/3 course to ensure at least 50 of the care staff are qualified. This was met. 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. Since the last inspection one other staff has begun the NVQ level 2 course and one is about to start this course. However this level of staff qualification does not yet meet the requirement for qualified staff although there has been an improvement in the attempts made to have enough staff enrolling on the NVQ course. It is hoped that the current number of staff either enrolled on the course or about to start it will achieve the required level of qualified staff. The registered provider must ensure that at least three care staff are qualified to NVQ level 2/3 by 30/9/08. (Refer to Requirement YA32) Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 22 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. Advocacy is now involved in the home providing support for two residents. 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 two inspections for the staffing levels at the home to be reviewed. During the last inspection there were occasions noted where the assessed staffing levels of two to one required for supporting one resident when out in the community were not being met, without any formal agreement with social services or the commissioning agent. This is still happening and although the manager has reviewed the risk assessment for doing this, it was not discussed or agreed with social services or with any other of the resident’s representatives. As discussed under Standard 2 in this report, the social worker responsible for carrying out reviews was unaware that this is still happening. 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. At the last inspection 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. However this review was not called by the management of the home, which continues to leave the resident and staff vulnerable. Following the current inspection visit to the home I contacted the homes senior management and social services again, and have been assured that this review will take place in November 2007 to resolve this matter, and that a separate meeting has been arranged with the commissioning agent to discuss funding issues. The multi-disciplinary challenging needs team have also become Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 23 involved and it is hoped that they will carry out an u to date assessment of the need for two to one support as an aid to this review. Advocacy has also now become involved and have said they are available to become involved in the review process on behalf of the resident concerned. This was a requirement at the last inspection and is now repeated. This requirement was discussed as part of a CSCI Management Review, and is now the subject of an Improvement Plan for the home and will result in enforcement action if not achieved. (Refer to Repeated Requirement YA33) There was a requirement made at the last inspection for the registered provider to ensure that employment information for staff is kept at the home for inspection. This was partially met and is repeated. Examination of five staff employment records showed only one to have an enhanced CRB document. (See separate comments and requirement below) consistent omissions were made on start dates, references, (none had this information) poor recording of training with some showing the last training received as September 2006 and another with no training information recorded, none had a record of induction received and none had a copy of the contract of employment. The Registered Provider must ensure that complete 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 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 only partially complied with this request. This was a requirement at the last inspection and is now repeated. Failure to meet this requirement will result in enforcement action. (Refer to Repeated Requirement YA34) The main recruitment records for the home are kept at the organisation’s head office. The home now has a system in place for keeping staff recruitment and employment information, and a pro-forma document is now in place for each member of staff. However examination of five staff pro-forma documents showed that four out of five did not have an enhanced CRB, which included a check against the POVA register. While all for of these staff were employed prior to the introduction of the POVA register it is required that a current CRB is carried out for these staff to include a POVA check. (Refer to Requirement YA34) The organisation’s training manager schedules training and there is appropriate training now being scheduled. All of the staff have had an annual appraisal and have a personal training development plan. At the last inspection it was mentioned that 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, and it was Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 24 recommended that this training be included in the homes training schedule. This has now been done. However as discussed above the training records for each member of staff are poorly maintained and do not adequately demonstrate the training received by staff. All individual staff training records must accurately show the training they have received. (Refer to Requirement YA35) Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 25 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 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 protect staff and service users. EVIDENCE: There was a requirement at the last inspection for the registered person to submit an application for the registration of a manager for the home to CSCI. This is now been done and the manager was successfully interviewed and registered. The registration certificate is on display and is dated July 9, 2007. The registered manager is experienced shows commitment to improving the quality of care for the residents. He also showed a good understanding of learning disability issues and is working closely with other healthcare Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 26 professionals to improve the care in the home. The manager has an NVQ level 4 in management and has almost completed the NVQ level 4 in care. The home is part of a larger registered charity that also provides support for residents and other homes. At organizational level there is a six monthly conference for residents, with a separate consultation group where residents representatives visit homes to ask for residents views on how the organisation is run. There are monthly monitoring visits carried out by senior manager looking at management in care within the home, and the manager has identified a range of early is in the CSCI annual quality return (AQAA) which could be entered on a development plan for the home. However given the level all of need regarding communications and learning disability, this group of residents cannot easily participate in the organizational consultation process, and the home itself does not have an individual means of carrying out annual surveys, or quality audits. There is now independent advocacy support available to residents but this is not yet part of the consultation process for improving the quality of care. The registered provider and manager must ensure that the home has an effective quality assurance system, which includes meaningful consultation with residents or their representatives on the quality of care provided. This was a requirement at the last inspection and is now repeated. This requirement was discussed as part of a CSCI Management Review, and is now the subject of an Improvement Plan for the home and will result in enforcement action if not achieved. (Refer to Repeated Requirement YA39) There was a requirement at the last inspection for the registered provider to ensure that the home had a five-year electrical a certificate in place. This has now been done and a requirement is met. The annual quality return, which is provided, to CSCI and information from the last inspection in March 2007 showed that the health and safety issues within the home are being well managed. Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 27 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 3 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 2 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 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 2 X X 3 X Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 28 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 YA2 Regulation 12.1 a Requirement 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. This was a requirement from the last inspection, Timescale 30/06/07 not met, and is now repeated. Timescale revised. Failure to meet this requirement may result in formal enforcement action. An improvement plan has now been requested from the Responsible Individual requiring that this requirement is met by 30/11/07 The Registered Provider and 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 DS0000007094.V346929.R01.S.doc Timescale for action 30/11/07 2 YA5 5.1 29/02/08 Hindmans Road, 10 Version 5.2 Page 29 3 YA6 15 4 YA7 12 (2) & 20.3 5 YA9 12.1 & description of the service and support and who is responsible for payment of fees. This was a requirement of the last inspection with a timescale of 31/7/07 not met. Timescale revised. Failure to meet this requirement may result in enforcement action The Registered Person must 31/12/07 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 two inspections, Timescale 30/04/06, and 30/06/07 partially met. Timescale revised. Failure to meet this requirement may result in formal enforcement action. An improvement plan has now been requested from the Responsible Individual requiring that this requirement is met by 31/12/07 The Registered Provider must 30/11/07 seek formal written agreement from residents and/or their representatives, for written authorisation to manage their finances. This is a repeat of a requirement from the last three inspections, Timescales 30/11/05, 30/04/06 and 31/07/07 not met, now revised. Failure to meet this requirement may result in formal enforcement action. An improvement plan has now been requested from the Responsible Individual requiring that this requirement be met by 30/11/07. The Registered Provider and 30/11/07 DS0000007094.V346929.R01.S.doc Version 5.2 Page 30 Hindmans Road, 10 13.4b 6 YA19 12.1 a&b 7 YA32 18.1 a&c 8 YA33 12(1) (a) 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. This was a requirement from the last inspection, Timescale 30/06/07 not met, and is now repeated. Timescale revised. Failure to meet this requirement may result in formal enforcement action. An improvement plan has now been requested from the Responsible Individual requiring that this requirement is met by 30/11/07 The home must put in place a 29/02/08 comprehensive healthcare assessment and health action planning system for all residents and ensure that these include more specialist support regarding epilepsy. The registered provider must 30/09/08 ensure that at least three of the homes care staff are qualified to NVQ level 2/3 The Registered Person must 30/11/07 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 two inspections, Timescale 30/04/06, and 30/06/07 not met. Timescale revised. Failure to meet this DS0000007094.V346929.R01.S.doc Version 5.2 Page 31 Hindmans Road, 10 9 YA34 10 YA34 11 YA35 12 YA39 requirement may result in formal enforcement action. An improvement plan has now been requested from the Responsible Individual requiring that this requirement is met by 30/11/07 19 The Registered Provider must Schedule2 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. This was a requirement of the last inspection, Timescale of 31/7/07 not met. Timescale revised. Failure to meet this requirement will result in enforcement action 19 The Registered Provider must ensure that a current up to date enhanced CRB check is available at the home for all staff to include a POVA check. The Registered Provider must confirm to CSCI in writing, including application reference numbers, that applications have been submitted for the four staff who do not currently have them 17.2 sch.4 The Registered Provider and manager must ensure that all individual staff training records accurately shows the training they have received. 24 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 DS0000007094.V346929.R01.S.doc 31/12/07 30/11/07 31/12/07 31/12/07 Hindmans Road, 10 Version 5.2 Page 32 requirement made at the last two inspections, Timescale 30/06/06, and 30/09/07 not met. Timescale revised. Failure to meet this requirement may result in formal enforcement action. An improvement plan has now been requested from the Responsible Individual requiring that this requirement is met by 31/12/07 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 YA6 YA35 Good Practice Recommendations It is recommended that the home invite the residents advocacy representative to become involved in the care planning process on behalf of the residents It is recommended that all staff are trained in working with sensory impairment and this be identified in the training plans for the home. Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hindmans Road, 10 DS0000007094.V346929.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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