Inspection on 22/11/07 for Imber House

This inspection was carried out on 22nd November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Imber House 20/11/08

Imber House 04/05/07

Imber House 23/01/07

Imber House 06/09/06

Imber House 07/02/06

Imber House 05/07/05

Imber House 03/03/05

Imber House 16/08/04

Imber House 15/03/04

Imber House 20/10/03

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 Imber House 412 London Road South Lowestoft Suffolk NR33 0BH Lead Inspector Deborah Kerr Unannounced Inspection 22nd November 2007 11:00 Imber House DS0000024558.V357169.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 Imber House DS0000024558.V357169.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. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Imber House Address 412 London Road South Lowestoft Suffolk NR33 0BH 01502 500448 F/P 01502 500448 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) Mrs Patricia Lesley Webb Mrs Patricia Lesley Webb Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th May 2007 Brief Description of the Service: Imber House has undergone little change since the last person moved in to the home in October 2004. It is a care home for five adults with learning disabilities. The home is situated on a main road in the south of Lowestoft, close to local shops, a bus route and five minutes from the beach. It is a semi-detached building with accommodation on three floors. The people using the service occupy the ground floor and first floor whilst the owner and family have bedroom accommodation on the second floor. The people living in the home and the family share the kitchen, utility room and dining facilities. Three people have bedrooms on the first floor and two on the ground floor. There is a garden and patio area for general use outside. The home has a statement of purpose and service users guide providing information for prospective service users, however this information is not in a format which all of the people using the service can understand. People have a contract, which is included in their own copy of the service users guide. Social Services fund the people using the service; three are funded by Norfolk and two by Suffolk. Fees are paid by Norfolk and Suffolk County Councils at a rate of £315.00 per person per week, Two people receive additional direct payments to fund one to one day care, which range from 10 to 25 hours per week. This was the information provided at the time of the key inspection, people considering moving to this home may wish to obtain more up to date information from the care home. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second key inspection visit for the inspection programme for 2007/8. The inspection focused on the core standards relating to adults, aged 18-65 and to review progress to meet the twelve requirements made at the key inspection on 4th May 2007. The inspection was unannounced on a weekday starting at 11am and lasted six hours. This report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from a selection of service users, relatives and staff ‘Have Your Say’ surveys and the Annual Quality Assurance Assessment (AQAA), issued by the Commission for Social Care Inspection (CSCI). This document gives providers the opportunity to inform the CSCI about their service and how well they are performing. Time was spent talking with four service users and the registered provider. Records relating to service users, staff and health and safety were examined and a tour of the premises was made. What the service does well: What has improved since the last inspection? Information provided in the AQAA and verified at the inspection confirmed that the registered provider, also the registered manager of the home, has taken steps to meet, or partially meet nine of the twelve requirements. Previous requirements were made to ensure that people living in the home were aware of the terms and conditions of residence. Examination of these records confirmed that the manager has sought the assistance of a family representative or an advocate to discuss and clarify the content of the individual contracts with each service user. Previous requirements have been for care plans to be person centred and developed in a format that the service user can understand. Care plans examined confirmed these are in the process of being updated. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 6 A section called ‘My Person Centred Social and Health Plan’ has been created, which focuses on the individual and will ensure that they receive person centred support that meets their needs, individual preferences and choices. The plans are being developed in consultation with the service user in a format appropriate to their needs, including words, photographs, pictures and symbols. The missing person’s procedure in service users’ care plans have been reviewed and amended and clearly reflect individual strategies to protect the safety and welfare of the individual and members of the general public. To ensure people using the service are safeguard from suffering abuse or being placed at risk of harm or abuse, all staff have received safeguarding adults training. Previous requirements have been made to ensure that there are sufficient numbers of staff working at the home to ensure peoples health, safety and welfare. Where previously, there was an identified risk of insufficient staff to cover a waking night shift to support a service user who wandered, the service users pattern of behaviour has changed and is therefore no longer a concern, however the manager is still pursuing additional funding to increase staffing levels. A previous requirement was made for the manager to explore any gaps in a potential staffs employment history before employing them. Examination of staff files confirmed that all recruitment checks are now in place. However, application forms need to be amended to make it clear where potential staff completing the form must record their employment history. Previous concerns relating to the safety of people living and working in the home have been addressed. Concerns had previously been raised about the security of two people occupying bedrooms on the ground floor, with low-level large windows. Both sets of windows have now been fitted with restrictors, preventing access from the outside. The Commission and the Fire and Rescue service has made repeated requirements for the manager to make improvements to fire safety within the home to comply with the Fire Precautions (Workplace) Regulations. The manager was issued with an enforcement notice by the Fire and Rescue service in July 2007 for the work to be completed by the 12th November 2007. This work has now been completed and the Fire and Rescue Service have returned to the home and are satisfied with the work undertaken. Where the manager has taken action to obtain advocacy support for service users, arrangements must now be made to discuss and record their wishes with regards to death and dying. This will ensure that service users have an agreed plan to support them as they grow older or require nursing care. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 7 What they could do better: The service users guide and other information about the home needs to be available in formats suitable for the people for who the home is intended, for example appropriate language, pictures and where possible photographs. Further work needs to be undertaken to ensure the care plans and risk assessments are person centred, up to date and clearly reflect the current needs of the individual. A record needs to be kept of all complaints made about the home with the details of any investigation, the action taken and the outcome. This should reflect if the complainant was satisfied with the response. Where the Adult Safeguarding Board (ASB) has replaced the interagency policy, Vulnerable Adult Protection Committee (VAPC) the home’s policies and procedures should be amended to reflect this change. The way in which the manager supports service users to manage their personal accounts must be urgently reviewed. This will ensure service users are protected from financial abuse and will protect the registered manager from further allegations of financial abuse of service users personal monies. There has been significant improvement to the maintenance and décor of the home, however action must be taken to replace/repair the stairs and landing carpet and to replace the missing light bulb and tiles in the bathroom. Persons employed to work in the care home must be suitably qualified and competent. Each member of staff must have a training and development programme, which includes induction, supervision and training appropriate to the work they are to perform. This will ensure they receive up to date training in line with new and / or updated legislation relating to safe working practices, for example, moving and handling. To ensure the safety and welfare of people living and working in the home, the Fire Safety Risk Assessment must be updated to reflect the improved fire safety procedures and installation of the new prevention and detecting equipment. Where radiators are exposed throughout the home the manager must assess the risks of burns from hot and uncovered surfaces to service users based on their needs and capabilities. The manager remains the primary carer, which does not allow them time to effectively manage the service. As the registered person they must carry on the care home in such a manner as is likely to ensure that the service is finically viable, which will ensure that the home can continue to operate as a business and provide a stable environment for the people currently living in the home. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5, People who use the service experience good quality outcomes in this area. People using this service will have their needs assessed and a contract, which clearly tells them about the service, they will receive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A previous recommendation for the service user’s guide and other information about the home to be made available in formats suitable for the people for whom the home is intended, for example appropriate language, pictures and photographs has not yet been completed. The group of service users have lived together for a long time. The last person to move into the home was in October 2004, a Suffolk County Council Individual Placement (IPC) assessment had been obtained and a pre admission assessment had been completed by the manager identifying the needs of the service user. There has been no new information to assess standard 2,3, and 4 further. A previous requirement was made to ensure that people living in the home were aware of the terms and conditions of residence. Examination of care plans confirmed that the manager has sought the assistance of a family representative or an advocate to discuss and clarify the content of the individual contracts with each service user. This ensures that both parties are aware of what the service provides and the rights and obligations of the service user. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, People who use the service experience good quality outcomes in this area. Individuals are being involved in planning the care and support they receive, however further work needs to be undertaken to ensure the care plans and risk assessments are up to date to ensure their needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two service users care plans examined confirmed that these are in the process of being updated. A section called ‘My Person Centred Social and Health Plan’ has been created, which focuses on the individual. These contain relevant information about the service user, including personal contacts, daily routines, likes and dislikes. The plans are being developed in a format that the service users can understand, and which reflects their individuality. A service user spoken with confirmed they have been working with the manager on the computer choosing pictures and symbols for their care plan. They clearly understood the relevance of the pictures in relation to their likes and dislikes and their personal preferences. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 12 The manager explained they have, with peoples’ agreement taken photographs of family members, friends and other people and places relevant to the service users, including day care facilities to support the information in the care plans. The written content of the care plans has improved, however, these need to be written in the first person to reflect that these have been discussed and agreed with the individual. Additionally, further work needs to be undertaken to ensure the care plans and risk assessments are up to date and clearly reflect the current needs of the individual. Requirements were made at the last three inspections, for the missing persons reports to be amended to reflect agreed strategies to protect the safety of the individuals and members of the general public, where the plans identify that the individual would become agitated and aggressive if they became lost. These have now been completed and provide good information, to be passed to relevant people, for example the police of the triggers to inappropriate behaviours and the best approach to support the individual. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17, People who use the service experience good quality outcomes in this area. People using the service are supported to make choices about their lifestyles and take part in appropriate social and leisure activities within the local community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: These standards were fully assessed at the previous key inspection in May 2007. The people using the service continue to be provided with opportunities to live ordinary and meaningful lives both in the home and the in the community. The Commission received, three relatives and four service users ‘Have your Say’ surveys. Analysis of this information reflects that people are generally happy with the service provided. Service users comments included, “this is a very nice home, I go out a lot” and “I am able to do what I want, day and night and go out at weekends”. Relative’s surveys, stated, “my relative is well cared for” and “the home gives all the love and support my relative needs”. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21, People who use the service experience good quality outcomes in this area. The health and personal care people receive is based on their individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: These standards were fully assessed in May 2007. All of the people using the service are able to look after their own personal care needs with guidance, support and encouragement from staff. They follow their own routines, for example when they choose go to bed, the clothes they wear and when they eat their meals. Information in care plans confirmed that people have access to healthcare services. One care plan had a detailed plan of post - operative care and steps to rehabilitation for an individual who had had recent heart surgery. Where assessed as competent people are encouraged and supported to manage their own medication. Service users unable to manage this aspect of their care, have their medication administered by staff. This is managed in accordance with the home’s policy and procedures. Repeated requirements have been made for the wishes of people living in the home to be sought with regards to terminal illness, death and dying. This is to ensure that in these circumstances service users will be treated with dignity Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 15 and respect and will know if the home will be able to continue to provide care and support as they grow older or require nursing care. These plans have not yet been implemented, however, the manager confirmed that they are in the process of sourcing an advocate to support each service user to make an informed decision about their future based on choice and their personal beliefs. In the interim, the manager has implemented a policy relating to ‘care of the dying’, which includes the arrangements for palliative care and managing pain relief. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23, People who use the service experience adequate quality outcomes in this area. People using this service are currently at risk of financial abuse until safe measures are introduced regarding the use of debit cards and pin numbers. People can expect their complaints to be responded to but cannot be assured that they will be recorded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager demonstrated that they listen, act and respond to concerns raised about the home. They had been sent a copy of a CSCI ‘Have your say survey’ completed by a relative, which was also received by the Commission, prior to the inspection. This raised a number of concerns, which the manager had responded to in line with the complaints procedure. However, examination of the complaints book reflected that the manager had not recorded the details of the complaint, the action taken and the outcome. The response was discussed with the manager, who needs to make sure this is recorded and ascertain if the relative is satisfied with the outcome. A recent adult safeguarding referral regarding the management of three service users contributions to Social Services has now been resolved. Norfolk Social Services have become the designated appointees for these three service users, Suffolk County Council, were already appointees for the other two. However, none of the service users have an understanding of financial matters or the value of money. Each person has their own savings bank account into which their Disability Living Allowance (DLA) and personal allowance is paid. For service users to access their money from the bank they use a debit card. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 17 The manager, although no longer the appointee for the service users, explained that they hold the debit cards and pin numbers for these accounts. This was discussed with the manager who was advised to contact the bank to make alternative arrangements, as this practice leaves the service users and the manager vulnerable to further allegations of financial abuse. The manager could not provide current bank statements for the service users, as these had not yet been received following revision of change of appointeeship. However, they did show the inspector the credit slips, which reflected the amount of DLA, and personal allowance that had been paid into each service users account. Each service user withdraws their personal allowance from the bank weekly. A record of these transactions is being kept on a balance sheet with two staff signatures against them. The service user also signs to reflect they have received their money. The balance sheets for each of the service users was checked and found to be accurate. A repeat requirement from January 2007 was for staff to attend up to date training for the protection of vulnerable adults. Staff files confirmed that all staff have now attended training. The manager has purchased a training DVD, through a distance learning company. Staff have watched the DVD, which included handouts and worksheets of signs and symptoms of abuse, whistle blowing and contacting the appropriate agencies for reporting allegations of abuse. The company has marked the test papers externally and have issued certificates to the staff. Imber House adult protection policy has clear guidance of the procedures staff must take to report allegations of abuse. These are in accordance with the Local Authority. However, the manager was advised that the Adult Safeguarding Board (ASB) has replaced the interagency policy, Vulnerable Adult Protection Committee (VAPC) and that they will need to amend the home’s policies and procedures to reflect this change. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 People who use the service experience adequate quality outcomes in this area. People can expect to live in a home that has been decorated to a satisfactory level and maintained, however to ensure they are provided with a safe environment, areas of risk need to be minimised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home confirmed that the manager has continued with the planned schedule of maintenance. Three service users’ rooms are in the process of being decorated and they have each been involved in choosing their new furniture. One service user was out at the time of the inspection with a family friend choosing a new carpet. The wallpaper in another service user’s room is torn exposing decaying plasterwork underneath. The manager advised they have obtained a quote to repair and plaster the wall and then redecorate the service user’s room after Christmas. All rooms throughout the home were found to be clean and tidy, however, there are a few missing wall tiles in the bathroom and a missing light bulb in the corridor outside the shower on the lower floor, which needs to be replaced. The stairs, landing and hallway carpet has not yet been replaced and remains a safety risk where it is not properly fixed to the floor. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 19 A previous requirement was made for the manager to assess the security of two people occupying bedrooms on the ground floor, which have low-level large windows. These had not been fitted with restrictors and raised concerns that access could be obtained from the outside. Both windows have now been fitted with restrictors. Where the fire service previously indicated these could be used as a means of escape in an emergency, both service users are able to safely evacuate via the escape route through the lounge, directly next to their rooms. Radiators throughout the home are not protected to prevent service users burning themselves on hot surfaces. The manager was advised to risk assess all radiators and record where action is required and /or is taken to address any significant risks to service users. There remains an ongoing issue with water pressure, which can only be rectified by moving or replacing the hot water tank, however this remains a cost implication. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, People who use the service experience adequate quality outcomes in this area. People using the service can expect to be well supported by the staff team, however they cannot be assured that staff have the skills and particular knowledge to meet the changing needs of the service user group. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three requirements were made previously relating to staffing. These included recruitment procedures, staffing levels and staff training. Six care staff (these figures include the manager) are employed at the home with one maintenance person. A seventh member of staff is in the process of being recruited. With the exception of the manager, care staff are employed part time, contracted hours. People using the service are out at various day care, college and work placements Monday to Friday between the hours of 9am to 4pm. Two staff are on duty between the hours of 4 – 7pm weekdays, with two staff between 10am and 10pm at weekends. Between the hours of 7pm (10pm at weekends) and 9am there is only one member of staff, who sleeps in, providing support to five people. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 21 The roster reflects that the manager continues to be the main carer covering the nights, early mornings and working almost every weekend. This does not allow the manager time to effectively manage the home. Concerns have previously been raised about no waking night staff and the risks for an individual who wanders at night. Their room is at the top of the stairs on the second floor. The manager advised that this behaviour has subsided, however, they are continuing to pursue an increase in the level of funding for all of the service users, to increase the staffing ratio, including a waking night member of staff. An audit of the staff files confirmed that all the necessary information required for the safe recruitment of staff has now been obtained. However, application forms need to make it clear that potential staff completing the form must record their employment history and where there are gaps the manager must ensure these are fully explored to protect service users being placed at risk of harm or abuse. Four staff surveys received reflect that staff felt that their recruitment had been undertaken fairly, receive training relevant to their role and are kept informed of issues about the running of the home and the service users. At the last inspection staff had commenced an induction programme using the Common Induction Standards (CIS), Passport to Care. Despite initial progress, examination of a selection of the workbooks confirmed that these have not yet been completed. Additionally, supervision and other training refreshers for moving and handling, fire safety, food hygiene and health and safety have fallen behind. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 42, 43, People who use the service experience adequate quality outcomes in this area. Service users can expect to be provided with a stable environment by the staff team who care for them, however to ensure the home continues to operate as a business, clear financial and budget monitoring are required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standard 39 was inspected at the previous key inspection in May 2007. The manager had developed a quality assurance policy, which states they hold 6 monthly reviews with each person using the service, their relatives and day care services and use the feedback to update the statement of purpose and service user’s guide annually. Questionnaires completed by the day care services were complimentary about the service provided by the home. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 23 A previous requirement was made for the manager to demonstrate that the service is financially viable. As a result of investigations undertaken as part of the adult safeguarding referral into the management of service users finances, it was identified that the manager had not been receiving full funding for three service users. Norfolk County Council agreed to backdate funding to cover this shortfall. The manager confirmed they had received the back dated fees, which had allowed them to complete the work required under regulation by the Fire and Rescue Service and the CSCI. They explained that they have contacted their local Member of Parliament (MP) to help raise their profile with Social Services to review and increase the current level of funding to ensure they have sufficient resources to continue running the business. The Commission has made repeated requirements for the manager to make improvements to fire safety within the home to comply with the Fire Precautions (Workplace) Regulations. These requirements were first identified in the Fire and Rescue teams report in July 2006. The fire service agreed a time scale of six months for the manager to complete the work, however, following further visits to the home, the Fire and Rescue service issued the manager with an enforcement notice on the 23rd July 2007 for the work to be completed by the 12th November 2007. The Fire and Rescue Service have returned to the home and are satisfied with the work undertaken. A tour of the premises confirmed that all the work identified in the Fire and Rescue team report has now been completed. Internal doors have been replaced with made to measure fire safety doors, these have been fitted with intrumescent strips, smoke seals and self-closing devices. A new fire alarm system has been installed, with new smoke detectors and call points. Emergency lighting has been fitted throughout the home. The manager demonstrated the alarm and all of the fire doors closed automatically when the alarm was raised. Fire doors to the outside, which are part of the escape route have been fitted with, thumb locks, which ensure security, but turn easily to provide easy exit in an emergency. Additional fire fighting equipment signage has been purchased and was seen displayed where extinguishers had been fitted to the wall. The cupboards on the landing, including the airing cupboard have been emptied and work is in progress to fire proof these. All of the cupboard doors are to be replaced and fire proofed and fitted with intrumescent strips. The fire logbook was checked. The logbook reflected that visual checks were being made of fire fighting equipment and weekly tests of the alarm system and emergency lighting are taking place. Certificates were in place confirming installation of the new system and that the fire-fighting equipment had been serviced in August 2007. Regular fire drills are taking place, which includes all of the people living in the home. However, the fire safety risk assessment needs to be updated to reflect the new systems, equipment and precautions implemented. The remaining Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 24 requirement of the fire and rescue report was for the electrical installation and electrical appliances to be checked. The manager informed the inspector that a date has been set in 2 weeks time for this to be completed. A copy of the certificate has been forwarded to the Commission confirming this work has been completed. A copy of the latest landlord’s gas safety certificate was seen in conjunction with paper work to reflect that the home are covered by a Home Care agreement with British Gas for servicing and repair of the central heating boiler and cooker. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 3 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 2 2 X X X X 2 2 Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA21 Regulation 12 (3) Requirement Where the manager has taken action to obtain advocacy support for service users, arrangements must now be made to discuss and record their wishes in their care plan which will ensure that service users have an agreed plan to support them as they grow older or require nursing care. The way in which the manager supports service users to manage their personal accounts must be reviewed. This will ensure that people are protected from the risk of financial abuse. Timescale for action 31/01/08 2. YA23 20 13 (6) 07/12/07 3 YA24 23 (2) (b) (d) There has been significant 20/12/07 improvement to the maintenance and décor of the home, however action must be taken to replace/repair the stairs and landing carpet and to replace the missing light bulb and tiles in the bathroom. This will ensure the safety of people living and working in the home. Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 27 4. YA32 18 (1) (c) (i) Persons employed to work in the 31/01/08 care home must have a training and development programme, which includes training appropriate to the work they are to perform. This will ensure staff are kept up to date with training to ensure safe working practices, for example, moving and handling. The manager must update the home’s Fire Safety Risk Assessment to reflect the improved fire safety procedures and installation of the new prevention and detecting equipment. This will ensure the safety and welfare of people living and working in the home. Where radiators are exposed throughout the home, the risks to service users must be assessed based on their needs and capabilities. This will protect service users safety and risks of burns from hot and uncovered surfaces. The registered person shall carry on the care home in such a manner as is likely to ensure that the service is financially viable. This will ensure that the home can continue to operate as a business and provide a stable environment for the people currently living in the home. This is a repeat requirement from 04/05/07 07/12/07 5. YA42 23 (4) (a) 6. YA42 YA24 13 (4) (a) (c) 07/12/07 7. YA43 YA37 25 23/11/07 Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 28 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 YA1 Good Practice Recommendations The service users guide and other information about the home are available in formats suitable for the people for whom the home is intended, for example appropriate language, pictures and where possible photographs. Further work needs to be undertaken to ensure the care plans and risk assessments are person centred, up to date and clearly reflect the current needs of the individual. A record is kept of all complaints made about the home with the details of any investigation, the action taken and the outcome. This should reflect if the complainant was satisfied with the response. Where the Adult Safeguarding Board (ASB) has replaced the interagency policy, Vulnerable Adult Protection Committee (VAPC) the home’s policies and procedures should be amended to reflect this change. Each member of staff should complete the Common Induction Standards (CIS), Passport to Care workbooks to ensure they have the skills and knowledge to meet the changing needs of the people using the service. 2. YA6 3. YA22 4. YA23 5. YA35 Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Imber House DS0000024558.V357169.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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