Inspection on 27/04/06 for Hope House

This inspection was carried out on 27th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 37 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 20/09/06

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 Final Key Unannounced Inspection 27th April 2006 10:30 Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 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.V292602.R01.S.doc Version 5.1 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.V292602.R01.S.doc Version 5.1 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.V292602.R01.S.doc Version 5.1 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) 13th December 2005 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. The provider currently does not have a Statement of Purpose to inform prospective service users about their service. 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.V292602.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on 27th April 2006, over four and half 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. Following the last inspection carried out on the 13th December 2005, the Commission for Social Care Inspection (CSCI) met with the Registered Provider in February 2006, to share and underline the seriousness of the continuing concerns highlighted within the report, and to discuss the responsibilities of the Registered Provider to move the home forward, in a way expected by the CSCI. The CSCI was informed that support from an external consultant had been engaged to guide the Registered Provider in addressing the extensive agenda for action highlighted in the two previous inspections and monitoring visit; including 22 statutory requirements and 3 recommendations made in the last inspection report. Written and verbal progress reports were subsequently submitted to the CSCI identifying action the home had taken to address Statutory Requirements. This inspection focused on the homes’ progress in addressing the extensive agenda for action; and this report compares the action plan provided by Sandford House following the previous inspection to the findings of this inspection. The inspection process included discussion with Mr Ahmed Hussein, one of the Registered Provider’s, Mr Balgobin, external consultancy and advisor to the Providers and a care worker; examination of staff files, service users care management files and associated documentation and other records required to be kept in the home, as well as inspection records. Three service users were currently accommodated at the home and all three were out during the inspection. An opportunity arose for an informal discussion with one service user upon their return to the home, following lunch. The remainder of the service users returned at the conclusion of the inspection enabling a brief conversation to take place. No other care staff was seen. Of the 22 Key NMS inspected only 2 were met indicating 9 compliance. Overall, 40 NMS and their expected outcomes were inspected of which 6 were met indicating 15 compliance; 5 of those achieved related to environmental NMSs with regard to recent improvements made to the maintenance and décor of the home. Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 6 The inspection report highlights that compliance with NMS reflective of appropriate professional practice remains a clear difficulty for Mr Hussein, the Registered Person, even with external consultative support; and the number of NMS not achieved required significant further development to demonstrate an overall capacity of the home to meet service users needs. 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 is not being adequately managed. There is a lack of experienced skilled workers and the workforce is not appropriately recruited, inducted, trained or supervised. Care management continues to be poor with a lack of an agreed, assessed or planned approach to meeting care outcomes. These are the major factors in the quality of the care experience for service users. The areas that need to be improved have been reviewed from the previous inspection. The following areas remain in need of urgent improvement: • • • Effective and efficient leadership and management. Strategic day-to-day management. Evaluation of the regulatory requirements and National Minimum Standards, against the homes practice, to formulate a clear and decisive plan for improvements to be made. Admission procedures require development to ensure the home has the full capacity to meet the needs of the people admitted to the service. • Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 7 • Principal documentation such as The Statement of Purpose and Service User Guide require development. Care workers recruitment, training and supervision development to protect people living at the home. requires • • Care management, assessment and monitoring remains an area for further development. The application of good care practice within a revised and improved care plan structure, consultative in nature, promoting independence and choice and protecting service users. Development of improved strategies to ensure that people with more complex mental health needs receive appropriate emotional and social support. Management of prescribed medicine administration. Management of service users money. The development vulnerable adults. of improved procedures for the protection of • • • • • • The development of a functional, proactive approach to quality assurance and quality monitoring. Efficient business accounting and financial procedures enabling effective audit, ensuring financial viability and safeguarding service users. • The CSCI continues to be seriously concerned with the standard of professional practice and care outcomes for service users living at Sandford Close and the service will continue to be closely monitored, with a view to seeking legal advice about possible enforcement action. Discussion regarding the shortfalls will be addressed with the Responsible Persons as a follow up to this report. Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 8 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.V292602.R01.S.doc Version 5.1 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 Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 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 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. The home did not provide adequate information to current and prospective service users with regard to the facilities and services available. The home did not operate a thorough pre admission assessment process, giving care and attention to ensuring the home was admitting individuals whose entire assessed needs could be fully met. Service users admitted to the home had specialised needs, which fall outside the boundaries of the conditions of registration. EVIDENCE: The home had not fully finalised the revised version of the Statement of Purpose and no further action had been taken to review the Service User Guide or contract of the terms and conditions. None of these documents previously met with regulation and the home had failed to meet statutory requirements, within the timescale given, to produce the required documents that complied with National Minimum Standards. A progress report submitted in March 2006 by the Registered Provider stated that a revised Statement of Purpose, to meet with regulatory requirements and Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 11 National Minimum Standards, was now in place. However the finalised document was not available for inspection. A Care Management Assessment or a pre admission assessment was not evident in service users’ care files. The home had yet to develop a robust policy and procedure informing professional practice on the admission process. The CSCI was recently informed by an out of county Social Service department of the termination of a placement at Sandford House due to concerns regarding the lack of essential elements of care management and financial management within the home. As highlighted in previous inspection reports, the primary need of some 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. The immediate 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. The three service users accommodated have been living at the home for some time and the degree of knowledge and skills of staff required to support them effectively is limited in terms of addressing the more complex aspects of their presenting support and emotional needs relating to mental health. Discussions have taken place at previous inspections and meetings with the Registered Provider with regard to the breach in registration regulations and the requirement to apply for a proposed variation to the current registration conditions for those named service users; with supporting evidence that the home is able to meet their assessed needs. The Commission has not received this. It was advised that the home required significant development to demonstrate an overall capacity of the home to meet current service users needs. In response to this the home has given notice of four weeks to one service user causing distress and anxiety to the individual concerned. A working partnership with Local Authorities and specifically with the service user and suitable advocacy support was not demonstrated to ensure reasonable efforts are made within a person centred planning process, to enable a planned empowered transition into an appropriate service of choice. Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 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 & 10 Quality in this outcome area is poor. Individual plans did not reflect person centred planning, ensuring clearer identification of a persons support needs, strengths and aspirations and did not include regular review and evaluation to ensure the best way they can be met for optimal development. Service users were not supported to take risks within a planned risk management framework as part of an independent lifestyle. Service users did not benefit from a consultative, inclusive and empowering approach. Service users did not benefit from practice that promoted their confidentiality. EVIDENCE: A care planning structure and individual care plans had been introduced since the last inspection although, of those sampled, none gave a clear indication that the service user was integral to the decision making process or engaged in Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 13 any meaningful way with developing the plans, although an agreement for care, signed by the service user and the key worker, was included. It was concluded from discussion, the care plans had been written by the external consultant, who was not employed by the home to work with the service users. In the previous inspection it was indicated that reviews, involving Placing Authorities had either been undertaken or were in the process of being done. In discussion with the Acting Manager at that time regarding the homes role in the reviews gave the impression that the home tended to rely heavily on the Local Authority lead in these matters and gave this as a reason for the care plans not being developed. Subsequent action plans received by the CSCI indicated that care plans were being updated once the documentation from the reviews was received. Although it is acknowledged that a multidisciplinary approach to reviews is a positive approach, the process should not rely entirely on information from the Local Authority, as appeared to be the case. On inspection, there was no evidence seen to support the providers action plan that the new care plans in place were generated from a recent needs assessment or related to review outcomes and agreed action plan, recently carried out by the Care Programme Approach multi professional team. A concern also raised by a Social Worker. The care plans did not provide a clear detailed approach to how service users needs and aspirations could be met and were not adequate to provide sufficient direction to carers. For example to support the development of social skills and interaction the action plan stated ‘plan meaningful activity of his choice’ and to support a service user with money management the plan stated ‘planning and a weekly planning record’. Care plans did not contain elements 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 service users. To achieve consistency and appropriate support, the methods need to be clear and less subjective. One service user expressed a wish to move on to a less dependant setting. The care planning approach and discussion at the time of the inspection provided no evidence that this was being planned for and required significant improvement to ensure positive outcomes that meet more care objectives. Specified risks acknowledged within some care plans were under developed, particularly with regard to behavioural, mood and personality, medication and mental health issues. Agreed management strategies were not evident in all care plans sampled. The data and assessment material seen on files did not reflect adequately the complexity of care support required for service users. Unnecessary and inaccurate use of language such as ‘diversity therapy’ (instead of ‘diversion therapy’) did not provide inexperienced, untrained staff with clear actions to be Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 14 taken to implement diversion therapy, so that appropriate management of anti social and challenging behaviour could be appropriately managed. There were no arrangements in place to monitor care arrangements for one service user with a known eating disorder. 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 home had been influenced by the views of the people who live there. Service Users’ financial arrangements were examined. Service users have a lockable tin for personal allowance and bankcards etc, located in a locked cupboard within the dining room, to which service users did not have access. Although the previous system was not adequate in relation to protecting the service users from abuse by appropriate support and record keeping procedures. This system detracts from the decision making process and the rights of the individual, in that responsible risk taking was not being considered. One service user indicated that they would like support in managing money particularly in preparation for moving on to a more independent lifestyle. Current financial decision making abilities, including the understanding of basic concepts relevant to finance and the support required to maximise capacity to make financial decisions, was not reflected within a risk management and care planning process. In response to an allegation of possible financial abuse by person or persons previously employed at Sandford House, a recording system had been introduced. Although there is some procedural aspect to the process whereby transactions were recorded and receipts obtained, service users were not offered the opportunity to control or appropriately participate in the process. The process is completely undertaken by care staff in order to demonstrate how service users spend their money. Based upon the sample examined and a fairly limited check undertaken, the cash in the tins balanced with the book and the receipts corresponded with transactions recorded. However a detailed inspection of the service users financial arrangements, cross referencing with bank statements was not undertaken, as they were not available. As an additional safeguard, staff check each balance at the commencement of each shift. However records of the check and the total of each individual balance is recorded in the staff communication book, left in the dining room, not secure and in breach of confidentiality. Similar issues relating to breaches of confidentiality were raised at previous inspections and remain a concern. Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is poor. The home did not demonstrate a commitment to offer opportunities and support to establish a structured and purposeful lifestyle. Social needs and personal development were not assessed and activities were not matched to enable service users to maximise their potential by building on their interests and skills to achieve stated goals. There was no indication that care plans were active documents that reflected developing and emerging needs towards optimal independence, interpersonal and social skills. EVIDENCE: Service users in the main have access to organised community based activities such as Adult Education College, Horse Riding and Gateway. However current support planning objectives were not focused in a planned or structured way towards identified needs and stated objectives, for example, a move towards a less dependant setting. Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 16 There was no indication of person centred discussion and decision making around the development of individual weekly activity programmes; agreed within a support plan. Activities were unfocused with a lack of imagination to explore and extend service users potential, developing interests and skills. One young man expressed negativity and dislike at having to attend a needlework course at college. When asked why he went to needlework classes he explained he was unable to attend previous courses and for him to continue college he had to undertake three new courses, of which he had not made a positive choice. The current service users did not participate in any forms of paid, supported or volunteer employment or therapeutic work placements, although one service user stated he would like to be supported in a more structured lifestyle developing skills and finding some form of work experience. There was no evidence to suggest alternative opportunities had been explored to enable the service user to further develop learned skills or participate in work experience. Service users confirmed during discussion on previous inspections that they were able to maintain links with family and friends inside and outside the home. The menu was not fully examined on this occasion; discussion 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. Service users spoken with expressed satisfaction 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. Service users care records did not reflect nutritional needs, weight monitoring and appetite, areas pertinent to monitoring mental health well being. Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 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 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. Service users do not fully benefit from the arrangements in place to promote healthcare monitoring, personal, emotional and social needs and to preserve privacy and dignity. EVIDENCE: A further aspect of the care plans that had not developed since the previous inspection related to physical and emotional healthcare needs, particularly in relation to mental health problems and eating disorders. One care plan contained a nursing intervention plan, which was historic and had not been updated. Mr Hussein indicated the service users received regular local Community Nurse support although care plans and associated documentation did not reflect this. A moving and handling assessment had recently been carried out for one service user with muscle weakness. Although a positive inclusion, the results of the assessment were not carried over into the care planning process. The presence of a risk assessment does not inform staff of what they are required to do. Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 18 No improvement had been achieved to care management practice particularly in relation to one service user with a known eating disorder, who in the opinion of the inspector looked very underweight. 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, warning signs, appropriate supporting and monitoring strategies or when professional healthcare intervention is required. There were no records pertaining to daily food consumed or regular weight monitoring. 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. Medication prescribed was identified within the care plans however information relating to the side effects and adverse reactions of medicines being taken by individuals was not readily available. Medication administration practice was not observed and records were not fully inspected on this occasion. Prescribed medication was held in a locked cupboard in the dining room and personal medication administration records were laying on a shelf in the dining room and not stored appropriately to preserve confidentiality. From the three staff files examined, two members of staff had received medication administration instruction from a local pharmacist. 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 and side effects. A new contract had recently been agreed with another local pharmacy for medication supplies to commence 1st May 2006. Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 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 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. The complaints management in the home was poor, with no information available to service users. Adult protection in the home is poor with the lack of staff training and policies and procedures to guide staff. EVIDENCE: A complaints procedure was in place, which although basic, includes all the elements required. However, in view of the recent concern raised by a Social Worker and other concerns expressed by service users it is difficult to see how the home is operating in an open responsive manner to concerns as outlined by that procedure. Records and outcomes of service user consultation were not evident. The home had taken some steps to address concerns previously raised in respect of the homes culture and practice in promoting and protecting the safety of vulnerable adults from abuse. Essex Vulnerable Adult Committee documents were on site but there continued to be a lack of a robust internal policy with links to Local Authority policy and guidance, for staff. Some training had taken place for some staff, regarding this issue. Following discussion, Mr Hussein was advised to familiarise himself with the content of the documents and to ensure that an internal procedure exists to adequately respond to a disclosure or allegation of abuse. Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 20 The CSCI is aware of one ongoing Protection of Vulnerable Adults (POVA) issue in relation to this service and one other POVA related issue raised with regard to financial mismanagement of service users funds, since the last inspection. Staff are managing challenging behaviour without appropriate training, which has the potential to be harmful to service users health, safety and welfare. Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 21 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, 25, 26, 27, 28 & 30 Quality in this outcome area is adequate. The home does not fully maintain an unobtrusive and ordinary living environment. The home does not fully maintain a safe environment for service users. EVIDENCE: Some improvements had been made to the home, which included an additional bathroom with shower facilities, and redecoration and refurbishment to the lounge and dining room. A programme of redecoration was continuing. The home provided a clean, comfortable and homely atmosphere for most parts, although the current practice of maintaining locked cupboards for finances and medication, a freezer and a Health and Safety poster on the wall in the dining room detracted from this. No action had been taken since the last inspection to replace the fluorescent light fittings in the lounge, which remained unprotected and were potentially a hazard, especially where service users have behavioural disturbances. Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 22 Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 23 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. 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. The home was unable to evidence that all staff were adequately trained and competent to do their jobs. Service users did not always benefit from a cohesive effective staff team deployed in adequate numbers to meet all their assessed needs. Staff training is not provided in a planned way to ensure mandatory requirements are met. 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. Residents do not benefit from staff trained in specialised areas pertinent to their needs. Staff were not appropriately supervised to enable them to reflect and develop own practice and have a stronger link to care practice issues. Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 24 EVIDENCE: At the time of this inspection long term sick leave and a number of staff resigning adversely affected the staffing numbers of the home. This situation has a detrimental impact on the standard and consistency of care offered within the home. The ratio of staff deployment had not been calculated according to the service users assessed needs and the weekly staffing hours was considerably lower than expected for the purpose of the service, taking into consideration the absence of domestic staff and a cook. One new member of staff, although recently commenced National Vocational Qualification (NVQ) level 2 and Learning Disability Award Framework (LDAF), is relatively inexperienced within the caring industry and was not supervised by experienced staff who had received supervisory training. There was no evidence that new or existing staff had commenced Skills for Care, Common Induction and Foundation Standards. At the time of inspection, the service had not yet achieved an adequate proportion of carers having attained or commenced a NVQ 2, or a date by which this will be achieved. The practice of staff recruitment did not meet with National Minimum Standards or regulatory requirements at the previous two inspections and little progress had been made on this occasion, potentially placing service users at risk. A sample of three staff files were examined, and although they had improved in an organised way, they continue to fail to meet requirements due to shortfalls in information held in relation to application form, two written references and previous employment records. None of the records indicated that staff had received equal opportunities training or confirmation that staff had received a General Social Care Code of Conduct, EVAC POVA booklet, as indicated in the providers action plan, or a copy of the homes’ grievance procedure. Whilst there is no identifiable training budget, some limited training had been undertaken by some staff since the last inspection, including POVA, Moving and Handling, Health & Safety, Food Hygiene and Epilepsy. Mandatory training continued to fall short in areas such as First Aid, Infection Control and Fire Safety awareness. The Action Plan submitted indicated fire safety awareness training had taken place in response to an Immediate Requirement although there was no evidence available to confirm this. Mr Hussein is yet to undertake training needs assessment for the staff group as a whole, or an individual assessment and profile of care staff to identify any training needs or gaps in knowledge and skills. Staff files did not provide Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 25 evidence of training undertaken in areas of challenging behaviour, assessment of risk, care planning, key working, accredited medication administration assessment or any other essential aspects of care provision for service users accommodated. No further action had been taken to ensure regular formal supervision was in place to support staff to assess their own levels of skill and competence, focusing on service users needs and their care outcomes. The sample of staff files indicated that formal supervisions were irregular; one file indicated three supervisions carried out in three years, the second indicated one in three months for a relatively new employee and the third indicated two supervisions in two years. Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 26 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, 40, 41, 42 & 43 Quality in this outcome area is poor. Service users do not benefit from a service managed by a 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. The extent to which the Registered Person is maintaining regulatory required records remains in need of considerable improvement within all groups of National Minimum Standards and currently does not protect service users rights and best interests. Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 27 EVIDENCE: The Registered Managers position has remained vacant since the sudden departure of the previous Manager in September 2005. Apart from a short period of temporary cover by an acting manager provided by an agency, the service has not benefited from demonstrable, consistent and competent management, resulting in an absence of structure to working practice and care management. This was considered by the inspectors to be a contributing factor to the slow progress being made. There was no evidence to indicate that the home has a quality assurance and monitoring approach although some discussion around this was undertaken with the consultant who is intending to develop this area. Policies and procedures remain in need of improvement with regard to content. Several have been rewritten and amended, however the inspection process found little evidence that these were being followed in practice. Following the previous inspection, Mr Hussein was requested to provide records associated with the running of the business element of the home. A ‘profit and loss’ statement for the year ending 2004 was submitted to the CSCI. In discussion during the inspection, with Mr Hussein regarding this NMS, he advised that no business plan, cash flow projections, statements or budgetary system or transaction audits were in existence other than the statement submitted via his accountant. The statement did not provide information regarding the cost of items such as food, staff training and recruitment, service user activities, holidays or service users’ contributions to fees. Mr Hussein indicated that no financial records were kept in the home and all documentation including receipts, are sent weekly to the accountant. Concerns were recently raised by a Social Worker relating to three substantial amounts of money withdrawn from a service users account in a three-week period. The Social Worker was informed that the money related to underpayment of contributions to fees. Mr Hussein was unable to provide financial records of evidence to support this. Based upon entries noted within the petty cash book regarding receipt of income received from a service user, a practice recently commenced, the financial management approach in the home is in need of considerable review. Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 28 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 1 2 1 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 N/A 30 3 STAFFING Standard No Score 31 2 32 1 33 2 34 1 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 1 1 LIFESTYLES Standard No Score 11 1 12 2 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 2 1 1 1 1 1 2 1 Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 29 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 YA1YA8YA22 Regulation 4,5,6,24 & Schedule 1. Timescale for action The Responsible Person must 21/06/06 ensure that a Statement of Purpose and Service User Guide is produced that complies with regulatory requirements and NMS and service users are provided with accessible, comprehensive and up to date information. A fourth repeat requirement not met within the previous given timescales,30th May 2005,1st October 2005 & 1st April 2006. The Registered Manager 21/06/06 must demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. A second repeat requirement not addressed within the given timescale of 1st October 2005 & 1st April Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 30 Requirement 2. YA2YA3 12 2006 . 3. YA5 5(c) The Responsible Person must ensure a contract is agreed specifying all arrangements as detailed in NMS 5.2 and provide the individual wth a copy. A second repeat requirement not met within the given timescale 1st October 2005 & 1st April 2006. The Responsible Person must ensure an individualised care plan is developed and agreed with each service user, setting out how all assessed needs will be met through positive planned interventions and programmes, reviewed within the agreed times and updated to reflect changing needs and/or outcomes for the service user. A second repeat requirement not met within previous given timescales of 30th May 2005, 1st September 2005 & 1st April 2006. The Responsible Person must respect and support service users rights to make decisions, and that right is limited only through an assessment process, involving the service user, and as recorded within the individual plan. This a repeat requirement not met within given timescales – 1st April 2006. The Responsible Person must ensure that the service operates within a clear risk management framework DS0000017926.V292602.R01.S.doc 21/06/06 4. YA6 15 21/06/06 5. YA7 12(2,3), 15(1) 21/06/06 6 YA9 13(4)(c) 21/06/06 Sandford House Version 5.1 Page 31 7. YA10 17 8. YA11 16(2)(m,n) 9. YA12YA13YA14 16 (2)(m,n) 10. YA16YA20 12 (4)(a) approach. This is a repeat requirement not met within given timescales – 1st April 2006 The Responsible Person must ensure all information relating to service users is confidential, appropriately recorded and stored securely. A repeat requirement not met within given st timescale – 1 April 2006. The Responsible Person must ensure consultation with service users is carried out and that opportunities and support is provided to maintain and develop social, emotional and life skills and service users participate in a valued and fulfilling lifestyle. A second repeat requirement not met within given timescale 1st Sept 2005 & 1st April 2006. The Responsible Person must consult with service users about the programme of activities arranged by or on behalf of the care home, and having regard to the needs of the service users provide appropriate activities in relation to recreation, education, training or work experience. The Responsible Person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of the service user. 21/06/06 21/06/06 21/06/06 21/06/06 Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 32 11. YA17 17(2) Schedule 4 (13) 12. YA18YA21 13. YA19 14. YA20 15. YA22 16. YA23 The Responsible Person must ensure a record of food provided for service users is maintained in sufficient detail. 12 (3) The Responsible Person must make proper provision for the health and welfare of the service users and take into account their wishes and feelings. 17 (1)(a) The Responsible Person must Schedule 3 ensure details of any plan (3)(a) relating to the service user in respect of medication, 12(1)(a)(b) nursing, specialist health care or nutrition is maintained, monitored and reviewed. 18 (1) The Responsible Person ( c)(i) should ensure staff receive accredited medication training and ensure assessed competence of staff in the administration and understanding of medication use and side effects. 22(3) The Responsible Person must ensure the complaints procedure is followed and any complaint is fully and effectively investigated to ensure positive outcome. 13 The Registered Manager must safeguard service users from all types of abuse by ensuring robust policies and procedures are in place and carried out. The Registered Person must ensure all staff receive appropriate training in the areas of protecting vulnerable adults. This is a third repeat requirement not met within timescales 30th April 2005, 1st Sept 21/06/06 21/06/06 21/06/06 21/06/06 21/06/06 21/06/06 Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 33 2005 & 1st April 2006. 17. YA24 16 The Responsible Person must ensure the premises are safe and well maintained this relates to providing safe lighting in the lounge. A second repeat requirement not met within given timescale 1st Sept. 2005 & 1st April 2006. The Responsible Person shall make arrangements for providing persons who work at the home with appropriate information about the General Social Care Council Code of Conduct and ensure that staff clearly understand their roles and responsibilities. The Responsible Person must ensure that all staff have the knowledge, skills and experience necessary for supporting and meeting the needs of the service users particularly with regard to NVQ and mental health awareness. A second repeat requirement not met within given timescale 1st October 2005 & 1st April 2006. The Responsible Person must ensure that the home has an effective staff team, with sufficient numbers to support the service users assessed needs at all times. The Responsible Person must operate a robust and thorough recruitment procedure in accordance with regulatory requirements. This is a fourth repeat requirement not met DS0000017926.V292602.R01.S.doc 21/06/06 18. YA31 18 (4) 21/06/06 19. YA32 18, 19 21/06/06 20. YA33 18 21/06/06 21. YA34 19 21/06/06 Sandford House Version 5.1 Page 34 22. YA35 18 23. YA36 12,18 24. YA37 8 25. YA38 9 26. YA39YA8 24 within agreed timescales 31st April 2005, 1st September 2005, and 1st April 2006. The Responsible Person must ensure that the home has a training and development plan, and that all staff receives at least five paid training and development days. The Registered Person must ensure staff receive structured induction and foundation training to Skills for Care specification. A second repeat requirement not met within timescale of 1st October 2005 & 1st April 2006. The Responsible Person must ensure that staff receive regular and formal supervision to support and inform care practice and receive feedback on their conduct and performance. This is a repeat requirement not met within given timescale 1st April 2006. The Registered Person must ensure that service users live in a home which is run and managed by a person who is fit to be in charge and able to discharge their responsibilities fully. The Registered Person must ensure that service users benefit from the ethos, leadership and management approach of the home. The Registered Person must establish and maintain a system for reviewing the care within the home and DS0000017926.V292602.R01.S.doc 21/06/06 21/06/06 21/06/06 21/06/06 21/06/06 Sandford House Version 5.1 Page 35 27. YA41 17 28. YA42 12,13 &23 29. YA43 25 ensure the home is run in the best interests of the service users. This is a second repeat requirement not met within given timescales of 30th April 2005, 1st September 2005 & 1st April 2006. The Registered Person must 21/06/06 ensure that records required by regulation are appropriately maintained and available for inspection purposes. This is a repeat requirement not met within given timescale – 1st April 2006 The Registered Person must 21/06/06 ensure that unecessary risks to service users are identified and so far as possible eliminated. The Registered Persn must ensure suitable training is provided for staff to ensure the health, safety and welfare of service users. This is a second repeat requirement not met within given timescale of 1st October 2005 & 1st April 2006. The Responsible Person must 21/06/06 ensure the overall management of the service ensures effectiveness, financial viability and accountability of the home and meets all statutory requirements within given timescales. This is a repeat requirement not met within given timescale 1st April 2006. The Registered Person must Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 36 ensure there is a business plan and financial plan for the home and the service, open to CSCI inspection and reviewed annually. The Registered Person must ensure there are systems in place to ensure financial planning, budget monitoring and financial control and audit and quality assurance. 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 YA20 YA40 Good Practice Recommendations The Responsible Person should ensure that the practice of medication administration is individualised promoting independence and dignity. The Responsible Person should ensure policies and procedures are developed covering the topics set out in Appendix 2 of NMS YA, which comply with current legislation and professional guidelines and ensure staff understand and implement policies and procedures to support the main aims of the service. Sandford House DS0000017926.V292602.R01.S.doc Version 5.1 Page 37 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. 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