Inspection on 04/05/07 for Imber House

This inspection was carried out on 4th May 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 13 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 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 4th May 2007 09:45 Imber House DS0000024558.V339756.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.V339756.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.V339756.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.V339756.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd January 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. Funding for the people from Norfolk is paid at a rate of £282.00 per person per week, Suffolk are paying £331.00 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. Imber House DS0000024558.V339756.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 starting at 9:45pm and lasted eight hours. This was a key inspection, which focused on the core standards relating to adults, aged 18-65 and to review progress of the 14 requirements made at the last key inspection on the 23rd January 2007. The report has been written using accumulated evidence gathered prior to and during the inspection, which included a pre inspection questionnaire and 4 ‘Have your say’ comment cards completed by staff with the people living in the home. A representative of the fifth person had completed a comment card on their behalf. A number of records were reviewed including those relating to people using the service, staff, training and health and safety records. Time was spent with all five people living in the home, the home’s owner/manager and four members of staff. What the service does well: What has improved since the last inspection? Concerns were raised at the previous inspection including the financial viability of the home. Fourteen requirements were made following the inspection to address the welfare and safety of the people using the service, which included staffing arrangements, improvements to the environment’s maintenance, décor, cleanliness and management of soiled linen. To address the financial viability of the home the manager contacted Suffolk and Norfolk County Councils for a review of each the service users fees. A programme of redecoration and maintenance has taken place, which has significantly improved the environment and created a more comfortable environment for the people living in the home. Following advice from the Environmental Health Officer (EHO) there has been significant improvements made to the management of soiled linen and cleanliness of the home to control the risk of spreading infection. Thermostatic valves on hot water taps are in the process of being upgraded to ensure water is close to the recommended temperature of 43 degrees centigrade. Where rooms were not well lit, limiting visibility additional lighting has been installed using low energy light bulbs. Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 6 Where required, aids and equipment have been provided to encourage individuals to maintain their independence to continue to meet their own personal care needs. To protect their safety whilst accessing activities of their choice in the community, each of the people using the service has had access to training on personal safety. Training has been arranged to ensure the home complies with the National Minimum Standard of 50 of care staff are trained to achieve a National Vocational Qualification. Two staff have been enrolled to undertake level 2 in care, and a third is scheduled to complete top up training to upgrade their GNVQ obtained at college prior to commencing work at Imber House. The manager has made a start to introduce a quality assurance and monitoring system. Questionnaires have been circulated to the individuals’ day care placements and colleges who have regular contact with the people using the service and the home. Feedback seen was mostly positive. What they could do better: The service users guide and other information about the home need to made available in formats suitable for the people for who the home is intended, for example appropriate language, pictures and where possible photographs. Care plans, although improved need, further modification to ensure they are person centred and contain updated information relating to the individual’s needs. For example where identified at risk, the missing person’s procedure must reflect the agreed strategies to protect the safety of the individual and members of the general public. Care plans must also record the end of life needs of each person 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 in accordance with their wishes and personal beliefs. The contracts agreeing the terms and conditions of residence between the individual and the home have been amended to reflect current fees, however these need to be signed, agreed and dated. Where there are concerns relating to the capacity of the individual to understand the content of the contract support from family or an independent advocate must be obtained to act in their best interests. The manager must ensure that there are sufficient numbers of staff employed in the home to meet the health and welfare needs of the people using the service. They must also ensure that two written references are obtained before staff commence employment and any gaps in employment history explored. The welfare and safety of people living in the home is still at risk until all staff attend training to prevent residents from suffering abuse or being placed at risk of harm or abuse. The manager has not implemented the items identified in the Fire and Rescue Service report dated for the home to comply with the Fire Precautions (Workplace) Regulations. Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 7 Until risk assessments have been completed and advice sought from the Fire and Rescue team there continues to be a risk to security of the premises where windows on the ground floor in two peoples bedrooms are used as fire escapes. Although there has been a significant improvement to the décor the manager must ensure that there is a plan of continued maintenance and decoration of the premises. A POVA referral is currently being investigated by the Adult Safe Guarding Locality Committee (ASLC) relating to the appropriateness of the manager remaining the appointee for people using the service. Two of the individuals are in arrears with their contribution to social services. Having reviewed the home’s business and financial plan it is evident that the systems in place, do not effectively monitor financial control of the business. The Commission for Social Care Inspection are concerned about the management and financial viability of the home. The manager/owner needs to demonstrate how they intend to deal with these concerns. 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.V339756.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5, People who use the service experience adequate quality outcomes in this area. Prospective service users would not be able to make an informed choice based on the current information formats used by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of these standards have been reviewed at previous inspections and were found to be met. As there have been no new people moving into the home, there is no new information to assess the standards further. A previous recommendation identified the need to provide information about the home and peoples contracts in formats suitable for the people for whom the home is intended, for example appropriate language, pictures and where possible photographs. The manager confirmed they have been researching different types of symbols and formats on the Internet, but have not yet stated the process. The care plans identified that review meetings with Suffolk and Norfolk Social Services have taken place for each person living in the home. The manager requested these assessments as the needs of the people using the service have changed since their initial assessments were undertaken and the funding no longer covers the costs for providing the level of care and support they need. Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 10 Each person is provided with contract, stating the terms and conditions of occupancy. However, these had not been signed and dated, by the individual and the manager. Where the individual is deemed to lack the capacity to agree and sign the terms and conditions between themselves and the home, support from family or an independent advocate must be obtained to act in their best interests. Imber House DS0000024558.V339756.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 adequate quality outcomes in this area. People are supported to take risks, which enables them to lead positive and fulfilling lives however they cannot expect their care plans to detail their changing needs and personal goals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been considerable improvement to the written content of the care plans, these have been reworded in a way that respect people’s dignity and are age appropriate. They contain information necessary to deliver the persons care, however these are not person centred. The plans need to be written in the first person to indicate that these have been discussed and agreed with the individual, written in a format they understand so that it becomes a working document reflecting the individual’s preferences, choices and changing needs. Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 12 Requirements were made at the last two inspections, for the missing persons reports to be amended. These need 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. This has not happened. Staff watched a training video about challenging behaviour to provide them with information, skills and knowledge to manage incidents where individual’s behaviour becomes challenging or inappropriate. Procedures have been developed and recorded in the individuals care plans, which gives guidance for staff to manage these situations, which also provides a consistent approach to support the individual. The home recognises the rights of the individuals to make decisions and choices about their lives. People using the service were observed leading ordinary and meaningful lives, contributing to the daily routines of the home, accessing the community for leisure, day activities and work placements. Assessments are in place, which identify the hazards and support the individuals need to maximise their independence when involved in using public transport, crossing the road, helping with domestic tasks and preparing meals. These are being reviewed on a regular basis. Since the last inspection people using the service have been involved in personal safety training through their local college and day care placements. Each person has their own savings bank account into which their mobility, income support and personal allowance is paid. The manager is currently appointee for three of the people at the home. None of the people have understanding of financial matters and the value of money and are vulnerable to financial abuse. Concerns have been raised about the appropriateness of the manger remaining the appointee as two of the individuals are in arrears with their contribution to social services. Action is currently being taken to resolve this issue. Each individual has their personal allowance weekly for which they sign to say they have received. A record of these transactions is being kept. Imber House DS0000024558.V339756.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: Despite the concerns raised about the environment, staffing and the future financial viability of the service, the outcomes for people living in the home continue to be good. The majority of the people have lived together since the home opened in 1999, (the most recent person moved into the home in October 2004), and look upon each other as ‘family’. A small team made up of friends and family members staff the home, providing consistency and style of living that the people are familiar with and trust. Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 14 On return form their various day activities the people using the service were observed moving freely around the home, making cups of tea and preparing to go out for the evening. Friday night is ‘residents night’, where they collectively decide their activity of choice. The result of the discussions between the individuals was a unanimous vote for fish and chips and then a trip to the local pub to play snooker. Imber House is on the bus route into the town centre. There is a bus stop out side the home on the other side of the road. People living in the home use public transport with staff support, however, one individual was able to tell the inspector the number of the bus which goes into town and spoke of using the service independently, but explained due to current health problems they now need support to use the bus. There are four pubs within walking distance providing a choice of food and opportunities to play pool or darts. There is also a fish and chip shop, two local shops, a bowling alley and sports centre providing a range of facilities. Conversations with the individuals confirmed that they continue to access meaningful activities with in the wider community. These include Yarmouth College, Yarmouth Training Centre and a works placement called Norwich Union where the people receive payment for packaging of promotional and advertising information. Care plans contained certificates of achievement obtained through the college covering life and living skills, group work and introduction to drama, communication and performance techniques. One individual has the opportunity to help out at a local stable that offers work opportunities to people with learning disabilities and another attends the Suffolk Befriending Scheme where they can socialise with people know from the community. Direct payments have been obtained for two individual to have one to one care support for days they do not attend other placements. One person has 10 hours per week and another has twenty-five to pursue activities of their choice. A recent Social Services review has identified a need for a third person who would benefit from one to one support to enable them to access day care services. Additional funding is being requested for a trail period. The cost of a week’s holiday is agreed as part of the individuals contract. The manger explained that they have discussed with each person the option to have individual holidays but they prefer to go together. A deposit has been paid for a holiday in June in a cottage in Cornwall. One individual produced photographs of themselves at their relatives wedding indicating that people are being supported to maintain links with their family and friends. The recent Social Services assessments identify that two of the people have minimal contact with their relatives; through discussion with the manager they confirmed that these people are supported to visit their relatives at home. Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 15 However, the distance involved and the staffing hours limit the frequency of these visits to once a month. All of the people have access to a private telephone to maintain regular contact. A menu is agreed with the individuals for the coming week. If on the day they decide they do not want what is on offer the manager explained there are supplies of other foods. The fridge and cupboards are well stocked with a variety of fresh and pre packed foods. People are encouraged to help in the preparation of meals and hot drinks. The Environmental Health Officer made recommendations for the home to make better use of the safer food, better business pack. This was seen in use at the inspection monitoring cleaning schedules, peoples diet and generally as a communication tool amongst staff. Hygiene has improved, the household pets are being discouraged from the kitchen and the room in general looks less cluttered, cleaner and tidier. However, the formica on the kitchen work surface and edging are worn through to the wood underneath, which could cause bacteria to collect and become a source of cross infection. Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 16 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 that people receive is based on their individual needs, however the ageing, illness and death of the individuals need to be discussed with relatives and/or representatives to ensure these issues are handled with dignity and respect and in accordance with the individuals wishes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 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 was seen in care plans, which confirmed that people have access to healthcare services. These included regular check ups with the dentist, optician and chiropodist. One person is being monitored by their general practitioner (GP) for high blood pressure, slow heat rate and breathlessness. A letter arrived that date confirming an appointment at the hospital for a physical examination. A physiotherapist has recommended a healthy eating plan and developed gentle exercises to help the individual maintain their mobility and a healthy weight. Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 17 A previous requirement was made for the provision of technical aids and equipment needed to maximise people’s independence, privacy and dignity. A tour of the environment confirmed that a new shower stool has been purchased and grab rails fitted into the shower room to enable individuals who are unsteady on their feet to be able to shower in private with out staff support. Where assessed as competent people are supported to manage their own medication, for the other individuals medication is administered by staff in accordance with the homes policy and procedures. They use a well-known local pharmacy’s Monitored Dosage System (MDS). The Medication Administration Record (MAR) charts were seen, these were accurate and up to date. Where individuals had been administered PRN (as required) medication the reason and dose had been recorded on the reverse of the MAR chart. A member of staff was observed administering medication to an individual following their evening meal. The medication was appropriately administered by the member of staff who signed the MAR after they had observed the person take their medication. Repeated requirements have been made for the wishes of the people using the service to be sought with regards to the terminal illness, dying and death. Although this is a sensitive subject this information needs to be ascertained and agreed with the individual and /or their relatives to ensure that in these circumstances the individual will be treated with dignity and respect and in accordance with the individuals wishes and if they will be able to remain in the home as they grow older or require nursing care. Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 18 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 poor quality outcomes in this area. The home has detailed policies and procedures for dealing with complaints and allegations of abuse, however peoples’ 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 a detailed complaints procedure, however this needs to be developed in to a suitable format that people using the service can understand. There are clear policies and procedures in place, which provided detailed guidance for staff outlining their responsibility to report allegations or suspicions of abuse to the Social Services, Customer First team and to inform the Commission for Social Care Inspection (CSCI). To ensure people are protected from abuse, neglect and self-harm, all staff have a Protection of Vulnerable Adults (POVA) first and Criminal Records Bureau (CRB) check undertaken prior to taking up a post. However repeated requirements have been made for staff to attend current and up to date training in the protection of vulnerable adults. The manager explained that due to their current financial circumstances this training has not taken place. A POVA referral has been received by the Customer First team and referred to the Adult Safe Guarding Locality Committee (ASLC) with regards to an allegation of financial abuse within the home. This is currently being investigated. Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 19 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. Significant improvements have been made to the maintenance and décor of the home however they cannot expect to live in a safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Imber House provides a non-institutionalised environment that is family orientated, with a relaxed and friendly atmosphere. However there have been previous concerns about the general cleanliness, décor and maintenance of the premises. Requirements were made for essential maintenance and decoration of the home to ensure people are living in a safe and comfortable environment. A tour of the home confirmed that the manager has made significant improvements. The home has been de cluttered and thoroughly cleaned. Staff are now undertaking regular domestic duties to maintain the cleanliness and tidiness of the home. Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 20 Air fresheners are situated in majority of bedrooms and bathrooms on the first floor, providing a fresh smell throughout the home. The French doors leading out into the garden also provide emergency exit in the event of a fire, however at the previous inspection an armchair had obstructed these. The armchair has been moved to ensure there is a clear access through the fire doors. All rooms are single occupancy. Two people’s rooms are on the ground floor leading off from the lounge, curtains separate the entrance to the corridor and both bedrooms. Staff confirmed that they have a good understanding of practice issues respecting people’s privacy and dignity by keeping curtains and doors to the shower and toilet closed preventing exposure to other people in the home. Both bedrooms on the ground have large windows, which are not fitted with restrictors. The fire service has confirmed these are acceptable for the individuals to use as fire escape routes. However, there is a concern that access could be obtained from the outside. The manger was advised to complete risk assessments to assess the security of the individuals occupying these rooms and to consult with the fire officer about and safety of using these windows. This has not happened. Building materials previously seen outside the window at the back of the house, which would have prevented one of the people getting out of their window safely in an emergency, have been moved. People’s room’s varied in décor and are personalised reflecting individual tastes. Concerns were raised following the previous inspection regarding the suitability of duvets. The person this related too chooses to wear tracksuit bottoms for comfort and not because their duvet is insufficient to keep them warm, they have been provided with a blanket however, in case they are cold. The curtain rail in one room coming a way from the wall has been repaired, however the sash cord in one of the windows still needs to be repaired. All bedrooms are lockable and individuals are given the choice of holding their own key. The door lock to one person’s room is not working as they have broken their key in the lock. A new lock and key is required. Previously towels in people’s bedrooms were seen strewn over armchairs and lying screwed up on top of radiators. Towel rail’s, which slot over radiators, have been purchased for all peoples rooms providing somewhere to hang wet towels. Previous concerns were raised about insufficient light throughout the home. The lounge only has a central light, which makes the room very dull. A standard lamp has been purchased providing additional light. The inspectors were informed at the previous inspection that the lights on the landing were left on at night for one of the individuals, if all the light bulbs were in situ they would be too bright, disturbing the other people’s sleep. The missing light bulbs have been replaced with low energy bulbs, which create sufficient light for the individual if they come out of their room with out affecting the other occupants. Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 21 The leak in the roof causing flooding to rooms in the private family residence has been repaired under the home’s insurance and the hall and landing on the first floor leading up to the private residence have been redecorated as part of the insurance claim. The manager has purchased new furniture where required, including a new table and chairs for the dining room and a new larger bed for one of the people living in the home. The bathroom on the first floor has been tiled and carpeted. The maintenance person was seen replacing missing wall tiles and fitting a new bath panel. The radiator, which was previously comming away from the wall, has been removed and tiles fixed to the wall. The bathroom has an additional heated towel rail providing adequate heat to keep the bathroom warm. The fan heater on the wall has been cleaned. The shower has been repaired and is now working and the showerhead has been descaled. The toilet next door to the bathroom has been redecorated and thoroughly cleaned. The glass in the window has been repaired. The water temperatures of hand basins in bedrooms, the bath and both showers were checked and found to be within the recommended temperature of near to 43 degrees centigrade. A plumber has replaced some of the thermostatic valves, which were blocked with lime scale, which has improved the flow of water from taps. There remains an issue with the water pressure, to address this issue the manager has been advised that the water tank needs to be repositioned or replaced. The kitchen leads through to the utility room. The issue regarding the arrangements for taking soiled linen through the kitchen were discussed with the manager at the previous inspection. They were advised that the Commission for Social Care Inspection (CSCI) would contact the Environmental Heath Team to visit the home to follow up on this issue. Following their visit on the 23rd January they made several requirements to have electrical and gas equipment inspected and tested, improve lighting, management of foul linen, and thorough cleaning and repairs to walls and work surfaces which permits wet cleaning. There are now 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. The home has an enclosed courtyard garden which all people in the home have access too; at the previous inspection it was noted that there was a lot of dog excrement on the paths. Inspection of the premises confirmed that the pets of the household were being discouraged from entering the kitchen area and the courtyard was clean and tidy. An awning has been erected in the garden providing a sheltered space for people to eat outside in the better weather. Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 22 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, People who use the service experience adequate quality outcomes in this area. The current arrangements for recruitment and staffing are not sufficient to ensure the safety and welfare of the people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs six regular staff that work part time hours and one maintenance person. The manager has completed recruitment checks on another person who is prepared to help out as a bank member of staff. However, this does not increase the staff numbers. The roster continues to be covered by the manager and three staff who rotate their shifts across the week. This does not allow the manager time to effectively manage the home. People using the service 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. Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 23 The rota confirmed the manager has two full days off a week, covered the 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 people. Staff files checked confirmed that the necessary information required for the safe recruitment of staff had not been obtained. One person’s file reflected that their application form did not have a record of continuous employment and another had been partially completed. 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. Staff have watched a video as part of a training pack for managing Challenging Behaviour and fire safety, however protection of vulnerable adults training has not taken place. Certificates seen on staff files reflect that they have received some recent training, one person had completed the care of medicines course and another had been on a unisafe course for the management of challenging behaviour. The manger received confirmation that two staff have been enrolled on National Vocational Qualification training at level 2 in care. Another member of staff has completed NVQ level 2 and is working to achieve level 3. A more recent member of staff completed GNVQ 2 at college and the manager has been advised that they only need to fund top up training for the individual to achieve NVQ level 2. The home now meets the National Minimum Standard ratio of 50 of staff delivering personal care hold a recognised qualification. At the last inspection staff had commenced an induction programme for workers using the Common Induction Standards (CIS), Passport to Care. Despite initial progress, examination of a selection of the workbooks confirmed that no further sections have been completed. Conversations with staff confirmed that they are very happy working at the home. One person commented “We are one big happy family, I love working with the group, the interaction is good”. Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 24 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, People who use the service experience poor quality outcomes in this area. Current financial difficulties of the service do not ensure the future viability of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is well qualified and has a lot of experience working with people with learning disabilities and people with mental health needs. Whilst it is recognised that the manager has worked hard to make improvements where required, people using the service do not currently benefit from a well managed home. Evidence gathered during this and previous inspections and a recent Protection Of Vulnerable Adults referral identifies serious concerns about risks to the welfare of the people living in the home, staffing levels and the future financial viability of the business. Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 25 The manager has produced a business and financial plan, setting out the financial viability of the service, however their plan has been based on projected funding increases, with no contingency plans if funding is refused. Their current outgoings exceed their income. The manger talked at length of their current financial difficulties and that they are struggling to deliver the service and meet the requirements of the Environmental Health, Fire Service and the CSCI. The manager has contacted both Suffolk and Norfolk Social Services requesting a review of the funding for each of the people using the service. This has raised concerns about the manager remaining the appointee for three of the individuals who because of the financial difficulties of the home are in arrears with their contributions to social services. Social Services view is that the people living in the home are appropriately funded for their assessed needs. The manager has spent their own savings to keep the service running and unless they receive increased funding for all five people using the service they indicated they may have no option other to consider closing the home. Previous requirements were made for the manager to implement a quality assurance system. The manager has 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 users guide annually. They had sent questionnaires to the day care services of each person and the questionnaires returned were complimentary about the service provided by the home. Comments included, “the people using the service always appear well presented, clean and tidy” and “we are always kept informed of any changes relating to the individual”. Comments made about the managers performance included “good communication between the home and day care” and “there is a good working relationship between the manager, staff and the college, the manager is very informative and honest in any situation”. To obtain a broader picture of how the home meets their aims and objectives as stated in the statement of purpose, questionnaires should be distributed to relatives and health professionals connected with the home. To protect service users health, safety and welfare requirements were made to rectify the problems with the hot water flow and foul linen management. Whilst the immediate concerns have been addressed, there remains an issue with the cost of moving or replacing the hot water tank and the risk assessments need to be undertaken to assess the security of the premises with regards to the windows on the ground floor. The fire service agreed a time scale of 6 months to implement items identified in the fire services report to comply with the Fire Precautions (Workplace) Regulations in July 2006. The manager provided the inspector with a copy of the plan showing the outstanding work to be completed, they confirmed they have fire proofed the cellar, but the remaining work still needs to be carried out. Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 26 They have obtained two quotes for the work to be undertaken to meet the recommendations, however this involves significant expenditure, which the manger confirmed that their current financial problems cannot sustain. The fire and rescue service visited the home in February 2007 to check on the progress to meet their recommendations. The manager informed the inspector they have agreed interim risk assessments until the manager is able to complete the necessary work. The fire logbook was checked, which contained a series of risk assessments to safeguard people from the risk of fire, covering regular checks of appliances, ensuring no one smokes alone in their room and that all electrical appliances are unplugged at night. They also include checking batteries in household smoke detectors, which have been placed in each person’s room as an interim measure until they can afford to fit a new alarm system. The logbook reflected that visual checks were being made of fire fighting equipment and weekly tests of the existing alarm system and emergency lighting. Regular fire drills are taking place, which includes all of the people living in the home. Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 3 4 X 5 2 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 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 3 X X 2 2 Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 28 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 YA5 Regulation 5 (b) Requirement Each of the people using the service has a contract between them and the home. Where an individual lacks the capacity to agree and sign the terms and conditions of residence support from family or an independent advocate must be obtained to act in their best interests. This will ensure that people know what the service provides and what they must do. All people using the service must have an up to date, detailed care plan, which are person centred. This will ensure that they receive person centred support that meets their needs, individual preferences and choices. The missing person’s procedure in peoples care plan must reflect the individual strategies to protect their safety. This will ensure the safety and welfare of the individual and members of the general public. This is a repeat requirement from 23/01/07 DS0000024558.V339756.R01.S.doc Timescale for action 01/07/07 2. YA6 15 01/08/07 3. YA6 15 01/07/07 Imber House Version 5.2 Page 29 4. YA7 YA23 20 13 (6) The way in which the manager manages the money of people who live in the home must be reviewed to be more transparent. This will ensure that people are protected from financial abuse. The ageing, illness and death of the individuals need to be discussed with relatives and/or representatives. This will ensure that these issues are handled with dignity and respect and in accordance with the individual’s wishes and establish if they will be able to remain in the home as they grow older or require nursing care. This is a repeat requirement from 07/02/06, 06/09/06, 01/11/06 and 23/01/07 All staff must attend adult protection training. This is to ensure that people using the service will safeguard form from suffering abuse or being placed at risk of harm or abuse. This is a repeat requirement from 23/01/07 Although there has been a significant improvement to the décor the manager must ensure that there is a plan of continued maintenance and decoration of the premises. This will ensure the welfare and safety of the people using the service. The manager must ensure that at all times there are suitably qualified, competent and experienced persons working at the home in sufficient numbers to ensure peoples health, safety and welfare needs are met. DS0000024558.V339756.R01.S.doc 01/07/07 5. YA21 12 (3) 01/08/07 6. YA23 13 (6) 01/07/07 7. YA24 23 (2)(b) (d) 05/05/07 8. YA33 18 1 (a) 05/05/07 Imber House Version 5.2 Page 30 9. YA34 Schedule 2 (5) 10. YA37 12 (1) 11. YA42 13, 4 (a) This is a repeat requirement from 06/09/06, 01/11/06 and 23/01/07 The manager must ensure that before they employ a person at the home any gaps in employment history must be explored. This will protect the people living in the home from the risk of suffering from abuse or being placed at risk of harm or abuse. This is a repeat requirement from 23/01/07 The registered person must ensure they conduct their business to make proper provision of services, which protect people’s health, safety and welfare. This is a repeat requirement from 23/01/07 All parts of the home which people have access must be free from hazards for their safety, and unnecessary risks identified and so far as possible eliminated. Two areas of concern still remain: 1. Implementation of items identified in the Fire and Rescue Service report must be carried out to comply with the Fire Precautions (Workplace) Regulations. This is a repeat requirement from 06/09/06 and 01/11/06 and 23/01/07 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. This is a repeat requirement from 23/01/07. 05/05/07 05/05/07 01/08/07 Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 31 12. YA43 25 The registered person shall carry 05/05/07 on the care home in such a manner as is likely to ensure that the service is finically 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. 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. This is a repeat recommendation from 23/01/07 Each member of staff should have a training and development programme which includes completion of 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. YA35 Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 32 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. Extracts may not be used or reproduced without the express permission of CSCI Imber House DS0000024558.V339756.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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