Inspection on 20/09/06 for Hope House

This inspection was carried out on 20th September 2006.

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 32 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hope House 04/09/08

Hope House 27/04/06

Hope House 13/12/05

Hope House 01/07/05

Hope House 28/01/05

Hope House 04/05/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Sandford House 5-7 Sandford Close Wivenhoe Colchester Essex CO7 8JN Lead Inspector Gaynor Elvin Unannounced Inspection 20th September 2006 09:30 Sandford House DS0000017926.V312714.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 Sandford House DS0000017926.V312714.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. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sandford House Address 5-7 Sandford Close Wivenhoe Colchester Essex CO7 8JN 01206 823647 01206 823647 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) Mr Ashraf Hussain Ahmed Hussain, Aktar Hussain Manager post vacant Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 5 persons) 27th April 2006 Date of last inspection Brief Description of the Service: Sandford House is located on a residential estate situated in the small quayside town of Wivenhoe. The home is within walking distance to shops, pubs and cafes and a regular bus route provides access to Colchester. The home is registered to provide accommodation for five service users of either sex. Single bedrooms and two communal bathrooms are located on the first floor. A lounge and dining room on the ground floor. Information was not readily available regarding fees and additional charges during the inspection process and was omitted from the pre inspection documentation, submitted upon request to the Commission. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on 20th September 2006, over five hours, carried out by two inspectors. All of the Key National Minimum Standards (NMS) for Young Adults and the intended outcomes were assessed in relation to this service during the inspection. This inspection was the second ‘Key’ inspection to have been undertaken during this current year. A random inspection visit was also undertaken during June 2006 to review the action taken within agreed timescales to comply with regulatory requirements identified in the last and previous CSCI inspection reports. The outcome for the random inspection in June indicated that the day to day management of the service, the maintaining of statutory records and procedures in relation to care practice and the operation of the home continued to fall below the requirements of the National Minimum Standards and Regulatory requirements. Twenty requirements were repeated as a result of the random visit and seven requirements were carried over from the previous inspection. As a result of the random inspection, the Commission for Social Care Inspection had significant concerns about the persistent failure to comply with legal obligations and relatively little or no improvement evidenced in the level of compliance or outcomes for service users. Notification received by the Commission with regard to the reinstatement of Ms Sophie Baidoo to the position of manager was viewed as a positive step and enforcement action was temporarily suspended. The Registered Provider, Mr Ahmed Hussain received a Warning Letter informing him that if an improvement in the level of compliance was not evident after a period of three months, the CSCI will serve notice under the Care Homes Regulations 2001. Mr Hussain was requested to provide an improvement plan detailing the steps to be taken to achieve the objectives within the improvement plan, meet National Minimum Standards and outstanding requirements. The improvement plan was received prior to this inspection. It did not provide a planned and detailed strategy to achieve objectives or improve outcomes as requested. The Local Authority identified concerns highlighted during the random monitoring visit and previous inspections. A crisis management meeting was called and the agreed action to be taken included the provision of staff input from the Social Services Community Intensive Support Team to monitor staff interaction with, and approach, to service users, environmental issues and to provide additional support to the three service users accommodated at the time. One service user has since been found an alternative placement and the remaining two service users are being supported to visit and choose alternative placements. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 6 Inspector’s conclusions to this and previous inspections indicate that the complex health and psychological needs and requirements of the remaining two service users far exceed the capacity of the service to provide for them. This judgement has been made using available evidence brought to the attention of the Commission by the Local Authority and Environmental Health Organisation, the random monitoring visit and this inspection. The summary of this inspection concludes that some aspects of the assessed ratings have improved although there remain a relatively high proportion of National Minimum Standards that do not meet requirements. These include a significant proportion of unmet standards carried forward from previous inspection visits. What the service does well: What has improved since the last inspection? What they could do better: Previous inspections, including the one to which this report refers, conclude that the home still does not have effective and efficient leadership and management. A clear understanding of the regulatory requirements and National Minimum Standards is required to enable the service to formulate an adequate and reliable strategy to ensure that service users receive a fully appropriate, safe and supportive service to meet their needs and aspirations. The following areas remain in urgent need of improvement: • • • Regular assessment and monitoring of service users current and changing needs and preferences. Agreed and planned approaches to meeting care and support outcomes. The applications of good care practice within a revised and improved care plan structure, consultative in nature, promoting independence, choice and strengths and protecting service users. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 7 • • • Development of improved strategies to ensure that people with more complex mental health needs receive appropriate emotional and social support. Development of improved strategies to identify, divert and manage challenging behaviours. Care workers recruitment, induction and appropriate training to protect and support service users living at the home. 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. Sandford House DS0000017926.V312714.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 Sandford House DS0000017926.V312714.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): 1, 2, 3 & 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Service users do not benefit from an appropriately informed Statement of Purpose or Service User Guide. Service users do not benefit from knowing that their individual aspirations and needs are assessed and planned for. The home does not have the overall capacity to meet the service users needs. Service users do not benefit from an agreed terms and conditions of residence or confirmation from the home that their needs can be met by the service. EVIDENCE: Several revised versions of the Statement of Purpose and Service Users Guide have been submitted to the Commission since April 2006. The most recent Statement of Purpose submitted in July 2006 does not meet regulatory requirements and is already in need of updating with regard to staffing details. A lot of the information provided is not current in that it identifies proposals and plans such as training and recruitment and can be confusing to the reader. The document also indicates that the service is intended to meet mental health needs. The home is not registered to accommodate people with a mental health need. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 10 The Service User Guide submitted to the Commission did not meet Statutory Requirements. Part of the Service User’s Guide is the service terms and conditions in respect of the provision to service users of accommodation, food and the personal care and support required by the individual; and a residential contract for the provision of services and facilities by the registered provider to the service user. It is not appropriate to identify staff wages, staff education, maintenance, utility bills, decoration of own room or the homes general improvement as part of the service users fees in this document. There is a lack of understanding within the homes management that there is an expectation that structured activities and appropriate staffing support is maintained as per the contractual agreement with Social Services. It is also not appropriate to include rigid authoritarian house rules within the residential contract such as, ‘ every one will remain seated until after they finish their meal’, and ‘ the telephone will not be answered during mealtimes’ and ‘ the table will be cleared when everyone is finished, washing up etc, is to be done and the kitchen left clean then everyone can have a cup of tea’, which detract from a person centred approach. Any issues with regards to the conduct of mealtimes should be addressed within a residents meeting and agreed by the residents as a group. Any household tasks must be agreed according to the service users abilities and agreed within an individualised support plan. The fieldwork visit concluded that this document was not specific to each person where such individual matters are relevant. The documents were not provided in alternative formats for those whose literacy skills are limited. The two files examined were not able to inform the inspection that the home had consulted service users about the care they were to receive or confirmed in writing from the home to service users that their needs could be met. This is a regulatory requirement. As highlighted in previous inspection reports, the primary need of the remaining service user’s was their mental health problems; a service the home is not registered to provide. It was evident the service users needs were not within the boundaries of the home’s conditions of registration and admission criteria at the point of admission. Applications for admission of these service users was agreed without consideration of the specialist care the resident requires, or the skills, ability or knowledge of the staff caring for them. The consequences of this are that in a number of respects the home’s arrangements are falling short of those that need to be in place, particularly in relation to the level of appropriate support that must be available. Discussions have taken place at previous inspections and meetings with the Registered Provider with regard to the breach in registration regulations. The Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 11 Commission advised that the home required significant development to demonstrate an overall capacity of the home to meet current service users needs in support of a proposed variation to the current registration conditions for those named service users. The home was not able to demonstrate further development in the overall capacity of the home to meet current service users needs. Good quality training is not provided to equip staff to develop and be aware of current good practice. Community Nurses and Social Services raised concerns with regard to the deterioration in service users health and support needs, levels of skills within the staff team and staffing levels and that the service users were not receiving the level of care specified in placement contracts. A Crisis Planning meeting was called. The multi professional health and social team and the homes newly proposed registered manager attended the meeting. Action taken by Social Services included additional support to the service users within the home provided by the Community Intensive Support Team for a period of nineteen days. Shortly after the support team withdrew from the home, an alternative placement for one service user was sought by Social Services in partnership with the service user and their family. Urgent and reasonable efforts are currently being made by Social Services with the remaining two service users to plan an empowered transition into an alternative service of choice that can better meet their needs. Sandford House DS0000017926.V312714.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Care plans are poorly developed and out of date. Service users needs and changing needs are not regularly assessed and personal goals are not reflected within a regularly reviewed and evaluated individual plan of care and support. Service users do not benefit from a consultative, inclusive and empowering approach to their care and support. Service users were not supported to take risks within a planned risk management framework as part of an independent lifestyle. EVIDENCE: Service user care files were disorganised and contained some current but mostly historical data causing confusion; and therefore reliability and usefulness of the files is called into question in how staff are able to consistently deliver the most appropriate current and agreed care and support. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 13 One file contained a care plan drawn up by the Primary Health Care Team and additional documentation from their previous care establishment of more than three years ago. The files did not provide evidence of regular, effective assessment of current and changing needs carried out by the home nor did they clearly set out how specialist requirements will be met through positive and planned interventions. The files did not follow the principle of person centred planning. Notes taken from care management reviews onto scraps of paper were loose within the files, including a new medication review. Staff did not demonstrate the necessary skills required to support and encourage the individuals to be fully involved in their care planning arrangements. It is expected that the home, together with the service user and their representatives, draws up a focused and person centred care/support plan. The plan should be generated from the assessment process and care management reviews and; set out a detailed action plan tailored to the individual advising staff on how to deliver the most appropriate support required to meet needs and achieve outcomes. The degree of knowledge and skills of staff required to support the service users effectively is limited in terms of addressing the more complex aspects of their current presenting needs. The consequences of this led Social Services and the Community Intensive Support Team to provide additional and in house support to the service users and constructive guidance to the service during a period of crisis. Incident logs were evident in each of the service users files documenting episodes of challenging behaviour. The home called the police on one occasion due to incessant shouting by one service user. Another incident report indicated that the behaviour was triggered by inappropriate approaches by inexperienced staff such as inherent questioning about issues the service user was not prepared to discuss or was upset about. Current and reviewed risk assessments and risk management strategies were absent, particularly relating to recorded incidents of suicidal ideas and attempts of self harming with scissors. Trigger factors of challenging behaviour, emotional and psychological needs were not identified. Social Services expressed concern regarding the inability of management and staff to follow basic recommendations in risk management strategies. In response to a request made by the acting manager during a recent Social Service Crisis Planning meeting, the Community Nursing Services and Occupational Therapist provided the home with detailed guidance and advice in general crisis management, staff approach and budget management. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 14 Reference was not made to, and clear individualised pro active and re active care and support plans were not generated to meet identified assessed needs incorporating the Management Strategies provided. Regular review was not evident to determine effectiveness or seek potential alternatives. Although it is acknowledged that a multidisciplinary approach to care and support is a positive approach, the process should not rely entirely on information from the Local Authority, as appeared to be the case in this and previous inspections. The home must be seen to work pro actively to identify appropriate responses to meet assessed needs and positive outcomes. With regard to the recent episodes of challenging behaviour exhibited by one individual, the Social and Health team provided detailed guidance in how to create an environment where behaviours are less likely to occur and how to diffuse situations and the steps to take in a crisis. Other guidance identified money management, stress management and positive confidence building as areas of support for one individual, requiring a consistent approach to achieve desired outcomes. The guidance recommended that support was to be agreed and planned in areas such as mood and stress management – supporting the service user in keeping a mood diary; varied cost free activities in and outside of the home to in still a sense of personal responsibility, awareness and consequence of actions and to agree forms of coping strategies. The budgeting plan was basic and brief listing weekly expenses and stating ‘bank card and money in locked box’, ‘black book for recording’ and ‘to meet Occupational Therapist to discuss progress’. There was an absence of meaningful decision making and method to ensure that carers who are required to undertake tasks are clear about when, why and how to assist and support the service user. It lacked a detailed plan of action on how staff can provide basic tuition and support to the individual for developing financial understanding, management and budgeting skills, appropriate review and management strategies. This was further evidenced on the morning of the inspection when staff expressed concern that the individual was particularly anxious that morning and gone to town alone with their bankcard. They were unsure of how to manage this situation and the potential consequences. They were unaware of a management strategy for when the individual was unable to manage their financial budget. There was no documentary evidence of the support provided to the service user to manage a mood diary. Coping strategies described by the Occupational Therapist was not reflected within a support plan to review progress or deterioration and update outcomes. A weekly activity chart had only been completed for two days of this month, for one week in August and one week in July. Whilst it is acknowledged that daily consultation with service users took place with regard to the day-to-day aspects of the home such as mealtimes, food preference and décor; there was no evidence to show that the culture of the Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 15 home had been influenced by the views of the people who live there. For example, the statement of terms and conditions and contract contained institutionalised house rules. The service users are not provided with opportunities to participate in activities, which enable them to influence key decisions in the home such as involvement in selection of staff and statement of purpose. Service user surveys/questionnaires sent to the home by the Commission were returned in June. The general overview was satisfactory; the residents with the help of the staff completed the surveys. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users do not enjoy a stimulating and fulfilling lifestyle to promote wellbeing. There was no indication that care plans were active documents that reflected developing and emerging needs towards optimal independence, interpersonal and social skills. EVIDENCE: Due to their complex needs, the service users currently did not participate in any forms of paid, supported or volunteer employment or therapeutic work placements. The acting manager indicated that she was exploring options for one service user who had requested to work with older people. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 17 The service users in the main have access to organised community based activities. They attend a course at the Adult Education Centre weekly and go to the Gateway Club one evening a week. There was no indication of person centred discussion and decision making around the development of weekly activity charts; agreed within a support plan. The activity charts did not appear to serve any purpose particularly as they were incomplete; one was completed for two days of this month, one week in August and one week in July; the other was completed for two days in September and just one week in July. There was no available evidence to indicate that service users were encouraged or supported on a regular basis to pursue their own interests and hobbies, or that they spent their time involved in structured and purposeful occupation and participation to explore and extend their potential. Staff told inspectors that there were more opportunities to take the service users out and participate in leisure activities now there were only two residents. Service users confirmed on previous inspections that they were able to maintain links with family and friends inside and outside the home. One service user survey indicated that the residents contributed to the household tasks and staff confirmed that the residents participated in menu planning, shopping, meal preparation and cooking. Whilst this may be a positive approach for residents to develop independent living skills, care files did not reflect support planning objectives and the decision making process behind this. The menu was not fully examined on this occasion; discussion with staff indicated that improvements had been made regarding the quality and nutritional content of the food. There was no information available regarding menu planning, food consumed, support strategies or monitoring in relation to one service user with a known eating disorder. One service user spoken with expressed satisfaction with the food and indicated that they did participate in meal preparation on some occasions, although it was not clear whether they were supported in basic cooking skills and food preparation from fresh/raw ingredients. An external consultant had recently provided in house training in basic food hygiene. Staff indicated that staff and the service users attended this. Again support plans were not evident to indicate the levels of participation, understanding or competence achieved in this area. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Service users physical and emotional health needs are not met. Service users are not protected by the homes policies and procedures for dealing with medicines. EVIDENCE: A further aspect of the care files that had not developed since the previous two inspections related to physical and emotional care needs and other areas pertinent to monitoring mental health well being such as nutritional needs, weight monitoring, appetite or medication monitoring. No improvement had been achieved to care management practice particularly in relation to one service user with a known eating disorder. The action recorded for staff briefly stated ‘staff to monitor up to one hour after eating’. Guidance for staff to provide care in the least obtrusive and most supportive and consistent manner, observing dignity and respect was not included. Nor did the care plan reflect the complexity and significance of the care support required for this individual, such as identified trigger factors, Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 19 warning signs, appropriate supporting and monitoring strategies or when professional healthcare intervention is required. A record of food intake was evident with some entries stating if vomiting had occurred. Appropriate monitoring identifying mood, amount of food consumed, support provided, when vomiting took place or any diversion strategy implemented was not included. From the care files for this individual it was not clear as to the healthcare follow up, investigation and long-term management of a hiatus hernia. Associated care planning arrangements did not reflect the support, monitoring and review with regard to pain and discomfort and symptoms, such as regurgitation. Individual plans lacked assessment information determining considered decisions taken relating to service users retaining, administering and controlling their own medication where appropriate or alternative strategies for care staff assuming control. It is important that those able to maintain some control over their medication are given the opportunity and support to do so. There was no evidence relating to the assessed competence of staff in medication administration or the understanding of the medication prescribed to service users including purpose, monitoring and side effects, particularly with regard to Lithium medication. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The complaints and adult protection policies require review to ensure they are clear and effective and provide the correct information for staff and service users. Physical and verbal aggression is not understood and dealt with appropriately by management and staff to protect the rights and best interests of the service user. EVIDENCE: A complaint procedure was in place and the document featured a number of symbol and picture images to assist the reader with the meaning of the document. The words and text used, however, was not produced in an ‘easy read’ format and as such the registered person should review the document to ensure that all service users can directly access the policy and procedure. Information stated within the document for use by service users was not consistent with the information stated within the homes complaints procedure. It was not clear that the service users were able to voice their concerns to a staff member. All returned and completed Service user surveys/questionnaires indicated that their allocated Community nurse within the Learning Disability team was their preferred person to go to if they had any concerns or were unhappy. The resident spoken with confirmed they had a stable and trusting relationship of many years with their community nurse and would only discuss concerns with her. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 21 The home is in receipt of the Local authority policy and procedures for the protection of vulnerable adults, which provides guidance relating to the duty of the local authority, managers, carers and care home proprietors. The service is also required to produce its own procedure that links the service to the Local authority procedure to provide specific advice and clearly informs staff of the steps to be taken in the event that a referral is required. It was pleasing to not that staff had undertaken training in relation to the underpinning knowledge of safeguarding adults. The approach to challenging behaviour in the home was concerning, particularly as restraint training for inexperienced and unqualified staff was initially suggested by the acting manager. The service users have experienced significant changes and unrest within the home in the last twelve months, particularly relating to staff and management changes. Most individuals exhibit difficult behaviours because they are misunderstood and/or because they are living lives that do not make sense. They may feel isolated, powerless or without joy; devalued by others or too often their troubling behaviours are due to their illness or a delayed response to traumatic events or difficult changes. A completed survey received by the Commission from the relative of a service user indicated that staff changes were causing anxiety for the individual. The homes policy and procedure for risk management for challenging behaviour, was brief and did not provide detailed information to guide staff. It did not reflect appropriate management of a situation and/or protection of the service user or other service users. It did not reflect the decision-making process, assessment or person centred approach to reaching the procedure to be taken. The procedure only covered a strategy to leave the Service User to calm down and attendance to be given to an injured member of staff. Staff had recently received a one-day introduction to the concept and philosophical way of management and self-protection when presented with challenging behaviour, which is positive. However, staff need to be aware of measures they can take to prevent challenging behaviour and would benefit from risk and conflict management training. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home provided a clean, comfortable and domestic environment. The home had not addressed previous requirements to ensure the health and safety of service users. EVIDENCE: Standards 25 – 28 and their intended outcomes were assessed as met at the last Key inspection in April 2006, and were not reassessed during this inspection. The home provided a clean, comfortable and homely atmosphere for most parts, and a programme of redecoration was continuing. The lounge area was fitted with strip fluorescent light fittings, which are not domestic in nature. They remained unprotected and were potentially a hazard, especially where service users have behavioural disturbances. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 23 No action had been taken to address requirements with regard to health and safety relating to the light fittings in the last two inspections. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Staff and service users do not benefit from clarity of staff roles and responsibilities. Staff are not adequately trained and competent to do their jobs to the level that is required to fully support the service users. The service had not yet achieved an adequate proportion of carers having attained an NVQ qualification in care at level 2 to ensure a competent staff team to support the residents. Service users did not always benefit from a cohesive and consistent staff team deployed in adequate numbers to meet all their assessed needs. The procedure carried out for the recruitment of staff was not robust and did not provide the safeguards to offer protection to people living in the home. Residents do not benefit from staff trained in specialised areas pertinent to their needs. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 25 EVIDENCE: The staff records were viewed to ascertain compliance with regulatory requirements. Information relating to recruitment, job induction, training and supervision were requested. Based upon the information provided by the acting manager, the files of seven staff showed shortfalls in compliance. All of the files contained a photo of the staff member, documentary evidence of a satisfactory enhanced criminal record check and a satisfactory POVA First check. Three of the seven files did not contain an application form and one was incomplete. Four of the seven files did not contain two references. Only one file contained a job description and only one file contained a copy of a contract of employment. The file for the proposed registered manager did not contain a job description or a completed application form and the references available on file were out of date. The information held and the checks undertaken are inadequate to meet the regulatory requirements and National Minimum Standards (NMS). The Registered Person is required to ensure that all employees whose role is to provide personal care must be recruited in accordance with requirements to maintain an adequate level of safe practice. Only two of the sample had information on file that confirmed their start date as an employee. There was no evidence to indicate that new or existing staff had commenced Skills for Care, Common Induction and Foundation Standards. A review of the training undertaken by the staff was considered, based upon the information available. Five out of six staff had attended training relating to safe guarding adults; food hygiene and fire prevention, which is a positive start. The level of the training undertaken in relation to ‘underpinning’ skills was adequate as an introductory level to support staff. Staff presented a caring but intuitive approach to providing care and support. They were unable to demonstrate the knowledge, skills and competence required to effectively meet the service users needs. Further development is required in the programme to ensure that further initiatives in essential aspects of care provision for service users is provided particularly in areas highlighted within the body of this report, such as assessment of risk and risk management, care planning, key working and accredited medication administration. Records indicated that less than 50 of staff employed to provide personal care and support had attained an NVQ in care practice at level 2 as required by National Minimum Standards. Records indicated, however, that one carer had Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 26 applied to commence NVQ 2 and a further staff member to commence NVQ 3. Five members of staff had attended a two-day Learning Disability Award Framework (LDAF) induction. At the time of inspection the acting manager was not able to demonstrate that the staff team have the skills and experience necessary for the tasks they are expected to perform. There was no evidence available to indicate that training needs assessment had been undertaken for the staff team as a whole, nor was there evidence that each staff member has an individual training assessment and profile. The acting manager advised inspectors that this had been done but the documentation to evidence this was not available for inspection. Although it is recognised the service is currently only accommodating two residents, concerns had been raised by the Environmental Health Officer and Social Services that the current staffing levels at night did not reflect the changing and complex needs of the service users. The ratios of care staff to service users must be determined according to the assessed needs of the residents; and where care staff on duty undertake cooking and cleaning duties they must not be included within calculated care hours. It was brought to the inspector’s attention that the home had recruited a volunteer and it was pleasing to note that appropriate checks had been carried out. The exact role and contribution from the volunteer worker was not clear from the staff records. The Registered Provider must ensure that the contribution of a volunteer worker does not replace paid staff roles and undertake tasks, which are the responsibility of paid staff. Staff indicated that support and direction has improved in the last few months in that they are being given the opportunities to undertake training and are receiving supervision. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 27 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, 38, 39, 41, 42 & 43 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Service users do not benefit from a home managed by an experienced person who is registered and has satisfied the CSCI that they are fit to do so. Staff and service users lack support and direction from a sound leadership and management approach. Quality assurance and monitoring systems are not in place to safeguard service users. Service users do not benefit from competent and accountable management of the service. The extent to which the Registered Person is maintaining regulatory required records remains in need of considerable improvement and currently does not protect service users rights and best interests. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 28 EVIDENCE: Since the last monitoring visit the home had reinstated Mrs Sophia Baidoo to the position of manager. The Commission has received an application of proposal for registered manager. Ms Baidoo holds a professional qualification as a Social Worker. She does not have any current experience in running a registered care home and does not have a management qualification. Current and applicable references were not available. The manager remains, at the time of this inspection, unregistered. It is expected that the Registered Provider undertakes a full and responsible recruitment procedure prior to appointing an individual to manage the care home to ensure full and satisfactory information is available in relation to that person; in respect of current and relevant references, a full working history of employment, and relevant qualifications, experience and skills required to run a care home. From available evidence and this inspection visit it was apparent that Ms Baidoo relied heavily on Social Service support and was unclear of what action to follow in a crisis. As previously mentioned, she had requested more in depth step-by-step guidance from Social Services in areas such as crisis management, service user financial budgeting and advice re staff approach. It was not evident that the Registered Provider had provided Mrs Baidoo, the acting manager with a full and robust induction to the service and role of manager; and Mrs Baidoo has not received any supervision since commencement of her employment. With respect to quality issues and monitoring, the acting manager indicated that she has continued to develop the homes approach to quality issues and stated that audit sheets are being prepared to evaluate the information that has been gathered, these were not available at the time of inspection. It is necessary for the Registered Person to ensure that the home has the capacity to continuously self-monitor, using an objective verifiable method, audit and evaluate outcomes to inform future practice. To date the inspection process has concluded that the service has some considerable work to do to achieve satisfactory improvements to the way in which the service is delivered and outcomes for service users. This is particularly concerning as currently the service is not running at full capacity and only two service users are accommodated. Various statutory records were inspected. The following were found to be incomplete or did not comply with regulation: • Statement of Purpose and complaint procedure Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 29 • • • Service Users Guide including statement of terms and conditions and contract Incomplete records of persons employed Service Users Individual plan Support for service users in financial management and budget planning were areas requiring development highlighted in previous inspection reports and most recently by Social Services. Robust systems for financial management and auditing purposes were still not evident. An agreement, signed by the acting manager, the key worker and the service user, hand written on a scrap of paper within the file notes indicated that the sum of £82.00 in payment for college courses will be paid back to the home by the service user in weekly instalments of £5.00 per week. An invoice or receipt of the £82.00 paid out by the home, weekly invoices to the service user from the home or receipts for the £5.00 received were not evident in the service users file for audit purposes. The Environmental Health Officer (EHO) for the Borough Council Planning and Protection Food & Safety Team, raised concerns in August following an incident reported under Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR). The report related to an injury sustained by a staff member from a service user. The concerns raised included the lack of health and safety policies and procedures in the home; inadequate staffing levels, inexperienced and untrained staff and the lack of risk assessments and risk management strategies. A second inspection, in October, was carried out by the Environmental Health Officer (EHO) to review risk assessments with regard to safe working practice; and Health & Safety policies and procedures in the home. Evidence was underway that attempts had been made to address some risk assessments, which is positive. Some risk assessments were missing and those in place required review and further work to ensure they are appropriate and relevant to working practice. The home was requested to address these and to contact the EHO when completed. Staff had not received induction and foundation training that meets Skills for Care specification on all safe working practice topics. The hot water safety system in the home is not fool safe in that the thermostatic water temperature is controlled off the boiler and the control panel is on the front of the boiler together with the heating control. Two previous prohibition orders not to use the bath have been made in the past due to the water temperature control being altered mistakenly and not the heating, and the hot water temperatures have exceeded a safe temperature. The home is advised to provide individual thermostatic control valves to the hot water outlets of the bath, shower and basins in the home to reduce the risk of scalding in the event of the water temperature control on the boiler being altered. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 30 Sandford House has been operating at a high level of non compliance for approximately just over a year and this is, in the opinion of the Commission, chiefly a management and leadership difficulty. Reports following the registered persons monthly visits to the home, as required in Regulation 26 of the Care Standards Act 2000, are brief; and do not detail any actions taken for improvement and do not identify any concerns. Reports have not been forthcoming to the Commission, as requested, since June. Mr Hussain was requested to provide an improvement plan detailing the steps to be taken to achieve the objectives within the improvement plan, meet National Minimum Standards and outstanding requirements. This was submitted to the Commission within the given timescale on August 8th 2006 and prior to this inspection. The Improvement Plan did not inform the Commission of planned and detailed strategies to achieve required objectives or improve outcomes, as requested; and did not demonstrate a full understanding of the National Minimum Standards and Regulations. It is noted that the Registered Persons and the acting manager are of the view that the improvement plan had, in fact, been met in terms of compliance. At the time of this inspection no annual development plan was available to provide a clear strategy in addressing the ongoing shortfalls highlighted within previous reports. A Business plan submitted in June did not provide clear information with regard to key elements or forecasts detailing how the home is likely to provide acceptable quality services for people who will use them. The Commission was not able to fully assess the likely viability, improvement and benefits to the service from some of the statements it contained. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 1 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 2 32 2 33 2 34 2 35 2 36 3 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 2 13 3 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 2 2 X 1 1 1 Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 32 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulatio n 4(1)(a,b, c)(2) Requirement The Registered Person shall compile in relation to the care home a written statement (in these regulations referred to as ‘the statement of purpose’) which shall consist ofA statement of the aims and objectives of the care home: A statement as to the facilities and services which are to be provided by the registered person for service users: and A statement as to the matters listed in Schedule 1. The Registered Person shall supply a copy to the CSCI and shall make a copy available on request for inspection by every service user and any representative of a service user. This is a repeat requirement not met within given timescales. 2. YA1 5(1)(a,b, c,d,e,f)(2 )(3) The Registered Person shall produce a 03/12/06 written service users guide to the care home. This is a repeat requirement not met within given timescales. Timescale for action 03/12/06 Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 33 3. YA1 6(a,b) The registered Person shall keep under review and, where appropriate, revise the statement of purpose and service user guide and notify the CSCI and service users of any such revision within 28 days. This is a repeat requirement not met within given timescales. 03/12/06 4. YA2 14 (1) (a,b,c,d) Sch3(1a) The Registered Person shall not provide accommodation to a service user at the care home unless: the needs of the service user have been assessed by a suitably qualified or suitably trained person; the registered person has obtained a copy of the assessment; there has been appropriate consultation regarding the assessment with the service user or their representative The registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of health and welfare. This is a repeat requirement not met within the given timescale. 03/12/06 5. YA3 12 The Registered Manager must demonstrate the home’s capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. This is a repeat requirement not met within given timescales. 03/12/06 6. YA5 5 ( c) The Registered Manager must ensure the contract agreed between the service user and the home specifies all arrangements as detailed in NMS 5.2 and the individual is provided with a copy. 03/12/06 Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 34 7. YA6 YA9 14(2)(a,b ) 17(1)(a) Schedule 3 (1)(a) The registered person shall ensure that the assessment of service users’ needs is kept under review and revised at any time when it is necessary to do so having regard to any change of circumstances. This is a repeat requirement not met within set timescale. 03/12/06 8. YA6 15(1)(2)( a,b,c,d) 17(1)(a) Schedule (1) (b) The registered person shall, after 03/12/06 consultation with the service user, or representative, prepare a written plan as to how the service user’s needs, in respect of his health and welfare, are to be met, make the plan available to the service user and keep the plan under review. This is a repeat requirement not met within given timescale. 9. YA7 12 The registered person must ensure rights are only limited through an assessment process, recorded in the care plan and regularly reviewed. 03/12/06 10. YA12 YA14 16 (2)(m)(n) The registered person shall consult 03/12/06 service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. This is a repeat requirement not met within set timescales. 11. YA17 17 (2) Schedule 4(13) The Registered Person must keep records of the food provided for service users in sufficient detail to enable the person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for the individual. 03/12/06 Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 35 12. YA19 YA18 YA20 17(1)(a) Schedule 3 (3) (m) The Registered Person must keep a record of any plan relating to the service user in respect of medication, nursing, specialist health care or nutrition. This is a repeat requirement not met within agreed timescales. 03/12/06 13. YA20 13 The Registered Manager must ensure staff receive appropriate medication training and formal assessment of the carers competence to safely administer medicines. This is a repeat requirement not met within given timescale. 03/12/06 14. YA22 22 The Registered Person shall establish 03/12/06 a procedure for considering complaints and the procedure shall be appropriate to the needs of the service user. The Registered Person shall make 03/12/06 arrangements, by training of staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of abuse. This is a repeat requirement not met within set timescale. 15. YA23 (5) 13(6) 16. YA24 13(4)(a) The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practical free from hazards to their safety. This is a repeat requirement not met within given timescales. 03/12/06 17. YA32 18(1)(a) The registered person shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such DS0000017926.V312714.R01.S.doc 03/12/06 Sandford House Version 5.2 Page 36 numbers as are appropriate for the health and welfare of service users. 18. YA34 19(1)(b) The registered person shall not employ a person to work at the care home unless he has obtained in respect of that person all the information and documents specified in paragraphs 1-7 of Schedule 2. This is a repeat requirement not met within set timescales. 19. YA35 18(1)( c) (i)(ii) The registered person shall ensure that the persons employed to work at the care home receive training appropriate to the work they are to perform. The Registered Person must ensure that the home complies with the Care Standards Act and Regulations. The Responsible Persons must ensure that action is progressed within agreed timescales to implement requirements identified in CSCI inspection reports. This is a repeat requirement not met within agreed timescales 21. YA38 12 The Registered Person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users and; to make proper provision for the care and, where appropriate, treatment, education and supervision of service users. 22. YA39 24 The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. 03/12/06 03/12/06 03/12/06 03/12/06 20. YA37 Care Standard s Act Section 22 03/12/06 Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 37 This is a repeat requirement not met within set timescales. 23. YA41 17(1) The registered person shall maintain 03/12/06 in respect of each service user a record which includes the information, documentation and other records specified in Schedule 3 relating to the service user. This is a repeat requirement not met within given timescales. 24. YA41 17(2)Sch edule 4 (8) The registered person shall keep a record of the care home’s charges to service users, including any extra amounts payable for additional services not covered by those charges, and the amounts paid by or in respect each service user. This is a repeat requirement not met within set timescales. 25. YA41 17 (3) The registered person shall ensure that the records referred to in Schedule 3 and Schedule 4 are kept up to date; and are at all times available for inspection in the care home by any person authorised by the Commission to enter and inspect the home. 26. YA41 19(1)(b) The registered person shall not employ a person to work at the care home unless he has obtained in respect of that person all the information and documents specified in paragraphs 1-7 of Schedule 2. 27. YA42 13(4)(a) The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practical free from hazards to their safety. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 38 03/12/06 03/12/06 03/12/06 03/12/06 This is a repeat requirement not met within given timescales. 28. YA43 17(2)Sch edule 4 (3) 03/12/06 The registered person shall maintain and keep a record of all accounts in the care home. This is a repeat requirement not met within set timescales. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA16 Good Practice Recommendations The Registered Person should ensure that service users responsibilities for housekeeping tasks (e.g. cooking, cleaning etc is agreed; according to and specified in individual support plans. The Registered Person should ensure service users are encouraged and supported to retain and administer their own medication where able, within a risk management framework. The Registered Person should ensure policies and procedures are service specific and staff are aware of and understand the contents and apply these in practice. 2. YA20 3. YA23 Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 39 4. 5. YA31 YA31 6. YA33 7. YA40 The Registered Person should ensure that staff have clearly defined job descriptions linked to achieving service users individual goals as set out in the service user plan. The Registered Person should ensure that the contribution of volunteer workers does not replace paid staff roles and that volunteers do not undertake tasks, which are the responsibility of paid staff. The Registered Person should ensure that staffing levels day or night, are regularly reviewed to reflect service users changing needs, and maintain their health, safety and welfare. The Registered Person should ensure policies and procedures are service specific and staff are aware of and understand the contents and apply these in practice. Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. Extracts may not be used or reproduced without the express permission of CSCI Sandford House DS0000017926.V312714.R01.S.doc Version 5.2 Page 41 - 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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