Inspection on 23/01/07 for Imber House

This inspection was carried out on 23rd January 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 14 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 22/11/07

Imber House 04/05/07

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 23rd January 2007 09:30 Imber House DS0000024558.V328869.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.V328869.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.V328869.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.V328869.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th September 2006 Brief Description of the Service: Imber House has undergone little change since the last service user 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 residents occupy the ground floor and first floor whilst the owner and family have bedroom accommodation on the second floor. The residents and the family share the kitchen, utility room and dining facilities. Three residents 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. Each service user has a contract, which is included in their own copy of the service users guide. The current fees charged by the home are £321 per week. Two service users receive additional direct payments to fund one to one day care, which range from 10 to 25 hours per week. Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced on a weekday lasting four hours. This was the second key inspection for 2006/7 undertaken by Anna Rogers, regulation manager and Deborah Kerr, regulation inspector. The inspection focused on the key standards relating to adults, aged 18-65 and the progress made to address the requirements set at the key inspection in September 2006 and the random inspection on 1st November 2006. Time was spent with the registered provider/ manager and an inspection of the environment was conducted. A number of records were reviewed including those relating to service users, staff, training and quality assurance. What the service does well: What has improved since the last inspection? Fourteen requirements were made at the key inspection 06/09/06. These were reviewed at the random inspection 01/11/06, where one requirement had been addressed. Today’s inspection recognises that there have been some improvements made regarding a review of care plans which now reflect agreed risk management strategies and interventions staff need to take to support and manage service users behaviour. The manager has leased a new washing machine with sluice cycle and a tumble dryer. Water outlets in hand basins, the bath and both showers checked confirmed that water temperature now meets safe recommended temperature near to 43 degrees centigrade. The manager provided information confirming they are in the process of obtaining feedback through satisfaction surveys, these have been sent to day care providers. Records showed that staff training, induction, regular supervision and appraisal is now taking place. A requirement made following the random inspection was for the home to provide sufficient baths and showers for the number of service users at the home. This has been addressed, the bath has been cleared and the upstairs shower repaired. Residents care plans and personal records are now held in a locked cupboard to prevent other residents and visitors having access to confidential information. Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 6 What they could do better: 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.V328869.R01.S.doc Version 5.2 Page 7 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.V328869.R01.S.doc Version 5.2 Page 8 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, Quality in this outcome area is good, however, information needs to be available in formats suitable for the people for whom the home is intended. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of these standards were reviewed at the previous inspections and were found to be met. However it is recommended that information provided about the home and service user contracts are available in formats suitable for the people for whom the home is intended, for example appropriate language, pictures and where possible photographs. The manager is currently liaising with Suffolk and Norfolk Social Services to reassess the current service user’s needs and current fees. The manager has requested these assessments as the individual needs of the service users have changed since the initial assessments were undertaken. Service users contracts confirm that the current fees are £321 per week, the manager commented that these no longer meet the cost for providing the level of care and support the service users require. Norfolk Social Services have agreed to increase funding for three service users. Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 9 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): 6,7,8,9,10, Quality in this outcome area is adequate. Service users can expect to be supported to take risks, which enable them to lead positive and fulfilling lives however information in care plan’s do not have individualised procedures for service users likely to be aggressive if lost, when out in the community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has rewritten two of the care plans. These cover all aspects of the service users health, personal and social care needs and identify the level of support they require to take control of their daily lives and routines. One service user has a history of behaviour that can be challenging to others. Generally the home manages the service users behaviour well, with very few incidents, these incidents are more frequent at their day care placement. A requirement was made at previous inspections for their care plan to include procedures for dealing with incidents of inappropriate behaviour. Their care plan now identifies the triggers likely to instigate the behaviour and sets out clear guidelines supported by a risk assessment which agrees the actions all people involved in their care, must follow where their behaviour becomes challenging. Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 10 These plans have been agreed with the service user and provide a consistent approach for managing incidents of inappropriate behaviour. However, a missing persons report for the same service user identified that they would become agitated and aggressive if they became lost. There were no recorded and agreed strategies to protect the safety of the service user and members of the general public should this happen. There has been considerable improvement to the written content of the care plans. Previously plans referred to managing behaviour on a reward system and the terminology used to describe the behaviour used words such as ‘temper tantrums’ and ‘outbursts’. Plans now have been reworded in a way that respect service users dignity and are age appropriate. However, their plan stated, ‘advise staff on challenging behaviour techniques to help the service user at times of distress’, there was no instructions recorded. Staff are scheduled to attend training about challenging behaviour on the 26th January to provide them with additional support, skills and knowledge to manage inappropriate behaviour’s presented by service users. Each of the service users has assessments in place identifying risks and hazards when undertaking daily routines such as using public transport, helping with domestic tasks and preparing meals. Evidence was seen that these had been reviewed and updated in the care plans to reflect any changes and terminology. The accident book reported one of the service users had ran into the road when getting out of the car outside the home. The missing persons reports also identify a service user would become anxious and agitated if lost. It was agreed that service users would benefit from personal safety training. The manger agreed to find out if service users can access this training through their local college. Service users have their own savings bank account into which their mobility, income support and personal allowance is paid. Each service user has their personal allowance each week for which they sign to say they have received. A record of all transactions is maintained on a weekly money sheet with all corresponding receipts. Three service users records were checked and all were found to be excess of the balance, up to a maximum of £1.23. Service users are offered opportunities to take part in making decisions about the home; the manager confirmed they had scheduled individual meetings with the service users for the coming week to discuss relevant issues. They have tried to have joint meetings, however from experience service users have agreed that individual meeting suit their needs better. Care plans, policies and procedures and other information relating to the service and service users are being stored in a cupboard in the dining room, which is now kept locked to maintain confidentiality of personal information. Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17, Quality in this outcome area is good. Service users can expect that they will have opportunities to take part in appropriate leisure activities within the local community, have their rights and choices respected and have the opportunity to mix with other adults. This judgement has been made using available evidence including a visit to this service. EVIDENCE: These standards were inspected at the last key inspection on 6th September 2006 and were found to be met to a good standard. The random inspection on the 1st November confirmed service users continue to be supported to access meaningful daytime activities of choice and take part in appropriate leisure activities within the local community. There is no additional evidence to suggest there have been changes to this outcome area. Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 12 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, Quality in this outcome area is adequate. Service users can expect to be supported to have access to health care professionals, however cannot expect to have the necessary equipment they need to maximise independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Imber House is a small business, which provides service users with consistency and continuity of care. Family and friends staff the home and have known the service users since it opened in 2002. All of the service users are able to look after their own personal care needs with guidance, support and encouragement from staff. They are enabled to 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 service users have access healthcare services. One service user care plan states they are being supported to access their general practitioner (GP) who is in the process of reviewing their medication to monitor their high blood pressure. The service users mobility has decreased; they can now only walk short distances with one to one support. Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 13 A risk assessment for the same service user identified they required a shower stool and handrails fitted in the shower room to enable to them to shower. The shower stool was rusting and the manager was advised at the previous inspection to replace the stool, it was noted during the tour of the environment that the stool had been removed and not replaced. The service users care plan identified that they have become unsteady on their feet and they must be supported by a member of staff to shower, this does not allow the service user to shower in privacy and with dignity. The manager explained they are currently sourcing support from an occupational therapist to assess the service user for a replacement shower stool and a wheelchair for the service user to use when out in the community and holidays. At the random inspection an entry had been made in one of the service users care plan that their medication had been changed; they were reducing the drug Clorapromazin and changing over to Rispairadone, however there was no information recorded in their care plan how, why and over what period this was to take place. This information has now been updated in the care plan. Another requirement made at the random inspection was for the safe keeping of all medicines. A blister pack containing paracetomol was seen lying on top of the microwave in the kitchen. Service users access the kitchen freely and were at risk because they could take the medication unnoticed. A check of the premises confirmed that no medication was seen lying around. The manager confirmed that all medication was locked in a cupboard in the kitchen; only staff have access to the key. The home has a policy for dealing with the death or dying of a resident. Requirements have been made at previous inspections for the wishes of the service user to be sought and recorded in their care plan so that their wishes would be respected if diagnosed with a terminal illness or at the time of their dying and death. Two of the service users have experienced recent bereavement of close family members; therefore the manager has not wished to raise this issue at a sensitive time. The manager informed the inspector they will discuss this issue with service users, social workers and their families at their next annual review. Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 14 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, Quality in this outcome area is adequate. The home has detailed policies and procedures for dealing with complaints and allegations of abuse, however service users safety cannot be fully protected until all staff have received up to date training in the protection of vulnerable adults. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has policies and procedures in place, which are clear and detailed of staff’s responsibility to report allegations or suspicions of abuse to the Local Authority Vulnerable Adult Protection Committee (VAPC) and informing the Commission for Social Care Inspection (CSCI). These procedure need to be developed in to a suitable format that service users can understand. To ensure service users are protected from abuse, neglect and self-harm, all staff have had a Protection of Vulnerable Adults (POVA) first and Criminal Records Bureau (CRB) check undertaken prior to taking up a post, however staff have not received current and up to date training in the protection of vulnerable adults. The manager explained that staff did not attend training for the Protection of Vulnerable Adults (POVA) as they were waiting for conformation of a date with a local training centre. They agreed to contact the training centre again to set a date. The manager provided evidence in revised care plans of individualised procedures in place, which have been discussed and agreed with the service user, staff and day care service for dealing with incidents of inappropriate behaviour. The plan consists of known triggers and actions to prevent situations so that all staff are consistent in their approach. Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 15 At the previous inspection service user financial records were unavailable for inspection, these were at a member of staffs home. A requirement was made for these to be retained at the home and kept safe and secure at all times to ensure the financial protection of service users. The service users records were provided and inspected on this occasion and were found to be accurate. Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 16 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): 24,26,27,30, Quality in this outcome area is poor. To protect service users health safety and welfare there needs to be a significant improvement to the maintenance and decoration throughout the home. The quality of some facilities such as hot water flow and foul linen management need to be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Accommodation comprises of three floors. The ground floor has a kitchen, a lounge with french doors leading out into the garden, a dining room, two single bedrooms which have a shared toilet and shower. The first floor has three bedrooms, a separate toilet and a bathroom with a bath, shower and toilet. The second floor is the manager’s private accommodation. Requirements were made at the key and random inspections for the manager to produce an action plan for an ongoing maintenance programme. This has not been provided and there has been little improvements made. Essential maintenance needs to be carried out on the home to ensure service users are living in a safe and comfortable environment. Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 17 The lounge has no door leading into the corridor; the manger acknowledged this needed replacing with a fire door. The Fire and Rescue Service visited the home on the 7th July 2006, making several recommendations for the home to comply with the Fire Precautions (Workplace) Regulations. The home is in the process of complying with these recommendations. The lounge was redecorated in Spring 2006, however the wall lights had not been fitted leaving bare wires showing. The wall lights have now been installed but have not been connected to the electricity supply and are purely decorative. The room only has one central light, which makes the room dull. French doors lead out into the garden, which also act as a fire exit. The doors need to be kept free of obstruction for access, in case of an emergency, however an armchair was seen blocking the exit. All rooms are single occupancy. Two service users rooms are on the ground floor leading off from the lounge, curtains separate the entrance to the corridor and both bedrooms. Supervision records confirmed that staff had a good understanding of practice issues respecting service users privacy and dignity by keeping curtains and doors to the shower and toilet closed preventing exposure to other service users. Both these bedrooms have large windows, which are not fitted with restrictors. The fire service has confirmed these are acceptable for the service users to use as fire escape routes. However, there is a concern that access could be obtained from the outside. Building materials were seen outside the window at the back of the house, which would prevent the service user getting out of the window safely in an emergency. Service users rooms’ varied in décor, one had basic furniture and fittings whereas the other rooms seen were personalised reflecting individual tastes. Service users duvets felt thin for the current winter temperatures and one service user appeared to be sleeping in tracksuit bottoms and a tee shirt. The central heating was not on for the duration of the inspection it was therefore not possible to check the temperature of the home. Not all service user rooms had the use of a bedside table lamp and some light bulbs were missing in the corridors. The inspectors were informed these had been removed as the lights on the landing were left on at night for one of the service users, if all the light bulbs were in situ they would be too bright, disturbing the other service users sleep. The curtain rail in one room was seen coming a way from the wall and the sash cord is broken on the right side of one of the windows, both of these require attention. All bedrooms are lockable and service users are given the choice of holding their own key. One room seen had tape over the door lock where the service user had broken their key in the lock. One of the recommendations from the fire officer was to replace all doors with fire doors; this will include a new lock and key for the service user. The same door also had a loose handle, which needs attention to prevent the service user being locked in or out of their room should the handle come off. Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 18 Towels in service users bedrooms were seen strewn over armchairs and lying screwed up on top of radiators. In one service users room a towel rail was seen fixed over a radiator providing somewhere to hang wet towels, these would be beneficial for use in the other service users bedrooms. At the random inspection conditions in the home had been made worse following a leak in the roof and flooding to rooms in the private family residence. As a result the personal belongings of the family member were being stored in the service users bathroom. These had been removed and staining and scum around the bath indicated it was being used. The condition of the bathroom is very poor. There are bare floorboards, with evidence of new tiles being stored ready to be laid. There are missing tiles around the bath. The tiles behind the radiator are coming away from the wall as is the radiator, presenting a health and safety issue. The fan heather on the wall works, but needs the dust removing. The shower has been repaired and is now working, however, the showerhead and the one from the downstairs shower would benefit from descaling. The toilet next door to the bathroom has been stripped of tiles and flooring ready for decoration. The glass in the window is still broken; this has been taped over and needs to be replaced. There are no hand washing facilities and the toilet would benefit from a good clean. The water temperatures of hand basins in bedrooms, the bath and both showers were checked and found to be with the recommended temperature of near to 43 degrees centigrade. The pressure and flow of water from taps in the hand basins and the bath remains an issue, the manager has been informed by a plumber they need to reposition or replace the water tank to resolve the problem. The stair lift is out of order. The manager confirmed a new one has been ordered with a battery back up in case of power failure. They have paid a deposit and will need to pay the balance before it is installed. None of the current residents use the stair lift, however this will be beneficial if the needs of service users living on the first floor change. The stair rail is broken half way up the stairs, and has been temporarily repaired with tape and requires action to make this safe to use. The kitchen leads through to the utility room. A requirement was made at the recent inspections for the manager to make suitable arrangements for dealing with soiled garments, which comply with the Department of Health Guidance for Infection Control. The manager has leased a washing machine with correct temperature to manage soiled bedding and clothing. They have as part of the lease obtained a new tumble dryer. There still remains an issue regarding the arrangements for taking soiled linen through the kitchen. The manager was informed that Environmental Heath Team would be contacted to visit the home to follow up on this issue. Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 19 The environment would benefit from a general de clutter and regular domestic hours to improve cleanliness and tidiness. Air fresheners are situated in majority of bedrooms and bathrooms on the first floor. The home has an enclosed courtyard garden which service users have access too; it was noted that there was a lot of dog excrement on the paths, which needs to be cleared. Imber House DS0000024558.V328869.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): 32,33,34,35,36, Quality in this outcome area is adequate. The current arrangements for recruitment and staffing are not sufficient to ensure the safety and welfare of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing structure does not allow the manager time to effectively manage the home. This has been discussed with the manager at previous inspections. As already mention, they are in the process of leasing with social services to increase service users fees to fund additional recruitment of staff. The current roster is covered by the manager and three staff who rotate their shifts across the week. Service users are out at various day care and work placements Monday to Friday between the hours of 9am to 4pm. The roster reflects two staff are available between the hours of 4 – 7pm weekdays with two staff on duty between 10am and 10pm at weekends. The rota confirmed the manager had one full day off a week, covered nights and worked almost every weekend. Between the hours of 7pm (10pm at weekends) and 9am there is only one member of staff providing support to five service users. Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 21 Two staff files checked confirmed that the necessary information required for the safe recruitment of staff had not been obtained. A requirement was made at the inspection in September 2006 for the two written references to be obtained for a member of staff that had commenced employment at the home. There was no evidence on their personnel file to confirm that these had been obtained. Both files reflected that the application forms did not have a record of continuous employment; the manager was informed that any gaps in employment must be explored to protect service users from suffering from abuse or being placed at risk of harm or abuse. Requirements were made at the previous inspections for staff to be adequately trained in understanding and managing challenging behaviour and adult protection. The manager confirmed they have purchased a training pack, Challenging Behaviour part 1 to provide in house training to all staff. A date has been scheduled for the 26th January 2007. The manager confirmed that protection of vulnerable adults training had not taken place and agreed to contact the training centre to arrange and confirm another date. One member of staff has commenced National Vocational Qualification in care, which does not meet the recommended National Minimum Standards ratio of 50 of staff delivering personal care hold a recognised qualification. All staff have commenced an induction programme for workers using the Common Induction Standards (CIS), Passport to Care. The programme is modular with five separate units. One staff’s workbook showed the learning outcomes they had covered so far in the first three modules, 1. Understanding the principles of care, which identified the staff, had a good understanding of resident’s rights to privacy, dignity, respect and choice. 2. Understanding the organisation and role of the worker and the use of policies and procedures and contact with relatives and 3. Confidentiality. The workbook also provided evidence that the staff had completed work on fire safety, supervision, values, equal opportunities and diversity, cultural and faith differences, for example diet, language and dealing with death. The manager has a master manual, providing evidence that staff’s work is being assessed. Supervisions and annual appraisals are taking place; two staff records were examined. Records show they are clear about the expectations and content of supervision. Topics discussed were task related issues, time keeping and appearance, with agreed outcomes and action plans. Appraisal forms are in pre printed format covering the roles and responsibilities of the staff. The completed appraisal of one member of staff had agreed actions they should take to improve care plans and risk assessments, daily report writing, domestic duties, untoward incidents and social and recreational care of residents. These need to be expanded to identify the training and development needs of the staff. Imber House DS0000024558.V328869.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): 37,39,42,43, Quality in this outcome area is poor. Service users welfare and safety is at risk due areas of poor management identified throughout the report with regards to staffing and risks to service users safety and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has 15 years experience working with people with learning disabilities and has obtained valuable experience working with people with mental health needs. They hold Registered Managers Award (RMA) and level 4 in management and care. Whilst it is recognised that the manager has worked hard to make improvements were required, service users do not currently benefit from a well managed home. Evidence gathered during this and previous inspections identify concerns about staffing levels, environmental issues and risks to the health, safety and welfare of the service users. Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 23 The Commission for Social Care Inspection (CSCI) has requested the manager to produce and a business and financial plan to assess the financial viability of the service. They are in the process of completing this with the help of their accountant. A copy is to be forwarded to the CSCI on completion. The manager is awaiting clarification of the increased fees to incorporate into the budget to identify how they intend to address and comply with outstanding requirements of the Care Standards Act and Regulations. A requirement was made at previous inspections for the manager to implement a quality assurance system, which is undertaken at least annually taking into account all persons connected with the home. The manager confirmed they have begun this process sending out questionnaires to the day care services and colleges that the service users attend. The accident book reported one of the service users had ran into the road when getting out of the car outside the home. The missing persons reports also identify service users would become anxious and agitated if lost. It was agreed that service users would benefit from personal safety training. The manger agreed to find out if service users can access this training through their local college. To protect service users health, safety and welfare there needs to be a significant improvement to the maintenance of the home. The quality of some facilities such as hot water flow and foul linen management need to be addressed. Risk assessments need to be undertaken to assess the security of the premises with regards to the windows being used as fire escapes on the ground floor. The home would benefit from a thorough clean to prevent the spread of infection and decluttering, for example items being stored in the cupboards on the landing on the second floor are a potential fire hazard. As previously mentioned the home have agreed with the fire service a time scale of 6 months to implement items identified in the fire services report in order to comply with the Fire Precautions (Workplace) Regulations. However this plan was agreed following their inspection in July 2006, the manager confirmed they have fire proofed the cellar. The manager agreed to forward a copy of the action plan to the CSCI to show the outstanding work to be completed. Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 24 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 3 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 3 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 1 27 1 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 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 2 3 3 2 2 X 3 X X 2 2 Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 25 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 YA6 Regulation 15 Requirement The registered person must update the missing person’s procedure in the service users care plan and record the agreed strategies to protect the safety of the service user and members of the general public. The registered person must ensure service users are provided with the technical aids and equipment they need to maximise independence and ensure they are kept in good working order. The registered person must record in service users care plans their end of life needs so that they are assured at the time of serious illness, death and dying staff will treat them and their relatives with care sensitivity and respect. This is a repeat requirement from 07/02/06 & 06/09/06 and 01/11/06 Timescale for action 23/02/07 2. YA18 23 (2) (c)(n) 23/02/07 3. YA21 12 (3) 23/02/07 Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 26 4. YA23 13 (6) The registered person must 23/02/07 ensure that all staff attends training to prevent residents from suffering abuse or placed at risk of harm or abuse. The registered person must provide an action plan of timescales to show planned maintenance and decoration of the premises. This is a repeat requirement from 06/09/06 and 01/11/06 23/02/07 5. YA24 23 2 (b) (d) 6. YA26 16 (2) (c) 23 (2) (p) The registered person must provide adequate bedding and fittings in service users rooms which are sufficient and suitable to meet their individual needs, for example a review of lighting throughout the home needs to be undertaken to ensure there is sufficient light for service users safety and check duvets meet service users needs as they felt thin for the current winter temperatures The registered person must provide toilet, hand washing and bathroom facilities, which are kept in a good sate of repair and which meet service users needs. The registered person must make suitable arrangements for the transport of soiled garments, which comply with the Department of Health Guidance for Infection Control. The registered person must make suitable arrangements to keep the premises clean and tidy to prevent the spread of infection. DS0000024558.V328869.R01.S.doc 23/02/07 7. YA27 23 (2) (b) (j) 23/02/07 8. YA30 13.3 23/02/07 9. YA30 13.3 23/02/07 Imber House Version 5.2 Page 27 10. YA33 18 1 (a) The registered person must ensure that there are sufficient numbers of staff employed in the home to appropriate to meet the health and welfare needs of the service users. This is a repeat requirement from 06/09/06 and 01/11/06 23/02/07 11. YA34 Schedule 2 (5) The registered person must make sure two written references must be obtained before staff commence employment and any gaps in employment history explored This is a repeat requirement from 07/02/06, 06/09/06 and 01/11/06. 23/02/07 12. YA37 12 (1) The registered person must ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of the service users. All parts of the home which service users have access must be free from hazards for their safety, and unnecessary risks identified and so far as possible eliminated. Two areas of concern identified are: 1. Implementation of items identified in the Fire and Rescue Service report must be carried out within the agreed time scale of 6 months to comply with the Fire Precautions (Workplace) Regulations. This is a repeat requirement from 06/09/06 and 01/11/06. 23/02/07 13. YA42 13, 4 (a) 23/02/07 Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 28 2. A risk assessment must be undertaken to assess the windows used as fire escapes on the ground floor with regards to security of the premises and safety of service users. 14. YA43 25 (2) The registered person must provide the Commission for Social Care Inspection (CSCI) with a business and financial plan to assess the financial viability of the service. 23/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 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. Service users should be provided with training about their personal safety to avoid limiting their preferred activity or choice. 50 of staff should achieve NVQ level 2 2. 3. YA9 YA32 Imber House DS0000024558.V328869.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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. 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