Inspection on 06/09/06 for Imber House

This inspection was carried out on 6th September 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 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 23/01/07

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 6th September 2006 10:30 Imber House DS0000024558.V303849.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.V303849.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.V303849.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 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.V303849.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 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.V303849.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 1:45pm and lasted seven hours. This was a key inspection, which focused on the core standards relating to adults, aged 18-65. The report has been written using accumulated evidence gathered prior to and during the inspection. The home’s Statement of Purpose and Service Users Guide were reviewed and a number of records held including those relating to service users, staff, training and health and safety records. Time was spent with all of the service users, the homes owner and manager and one member of staff. What the service does well: What has improved since the last inspection? What they could do better: Urgent consideration needs to be given to the staffing arrangements to ensure there are sufficient numbers of staff to meet the diverse needs and routines of the service users. Staff files seen indicated that all the necessary paperwork had been obtained for a new member of staff including a completed application form reflecting a continuous record of the person’s previous education and employment history, however references were not available for a recent new member of staff. None of the current service users are able to read printed literature therefore the home need to consider how they provide information to prospective and current service users. All information documents, including the service user guide, contract and how to make a complaint need to be developed and made available in formats that the service users are able to understand. Imber House DS0000024558.V303849.R01.S.doc Version 5.2 Page 6 Information in the care plans must be expanded to reflect agreed risk management strategies and the interventions staff need to take to support and manage service users behaviour. The homes procedures and practice must ensure that records are kept safe and secure at all times to ensure the financial protection of service users. Care plans are still being stored in a cupboard within the dining area and are accessible to other residents and relatives. To protect confidentiality of service users this needs to be kept locked. The residents lounge and dinning area have been decorated since the last inspection, however there must be significant improvements made to the maintenance and decoration of other parts of the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Imber House DS0000024558.V303849.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.V303849.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5, Quality in this outcome area is good. Prospective service users are provided with information about the home before making a decision about where they live, 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: The homes statement of purpose and service users guide contains information about the service and provides clear guidance on how the home deals with referrals and admissions. Service users can expect a three-month trial period with a review to discuss if Imber House is the right choice of home. The most recent service user to move into the home was in October 2004. It was therefore difficult to fully assess standards 2,3, and 4, however evidence was seen that a Suffolk County Council Individual Placement assessment had been obtained and a pre admission assessment had been completed by the manager identifying the needs of the service user. Each service user had a copy of the service user guide in their care plan, which contained a copy of their contract and terms and conditions of occupancy. However, all documents providing information to residents need to be in a format to meet the capacity and understanding of the service user, to include symbols, pictures and where possible photographs. Imber House DS0000024558.V303849.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10, Quality in this outcome area is adequate. Service users can expect to have care plans, which identify the personal needs but do not always reflect the level of support required to manage inappropriate behaviour. Information held about residents is easily accessible to others, including staff at their own homes and does not safeguard their confidences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans of two service users were seen which identified the level of support required to meet their individual needs and to take control over their daily routines. These covered all areas of daily living for example, personal hygiene, and participation in the preparation of food and communication needs. 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, the inspector was informed that these incidents are more frequent at their day care placement. The manager and a member of staff spoken with were clear of the actions they would take in these circumstances, but there was no agreed strategy recorded in the service users care plan or agreed with the day care service of how the service users behaviour was being managed. Imber House DS0000024558.V303849.R01.S.doc Version 5.2 Page 10 Each of the service users has an identified key worker; this was confirmed in discussion with one of the service users. Service users have their own savings bank account into which their mobility, income support and personal allowance is paid. A record of all transactions is maintained on a weekly money sheet with all corresponding receipts, however the inspector was unable to check these as a senior member of staff who looks after the record keeping had the paperwork at home to audit. All records must be kept securely at the home and available for inspection at all times. Each service users has their personal allowance each week for which they sign to say they have received. 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 were being updated on a regular basis. The assessment for one service user identified the risks for them to be involved in activities within the community. The assessment gave brief descriptions of the risk and the consequences, however, there was no agreed strategy with the service user of how this should be managed, other than a statement that they should be kept away from situations that cause them to loose their temper and calm situation before it gets out of hand. A missing persons report was seen in each of the care plans, which had a description of the resident and a recent photograph for identification. The report for the same service user identified that they would become agitated and aggressive if they became lost. Although the manager was able to describe how they would support the service user in both of these situations, there were no recorded strategies to protect the safety of the service user and members of the general public. One risk assessment identified that a service user liked to tamper with electrical appliances, sockets and switches. To minimise the risk of the service user being electrocuted, it was recorded that furniture should not be placed directly under light bulb sockets, however when the service user showed the inspector their room a desk and chair were directly beneath a low hanging bare light bulb. The manager removed the light bulb immediately; followed by the service user demonstrating to both the manager and the inspector they could reach the light and stuck their finger into the empty socket. The manager must address this issue immediately to protect the safety of the service user. Service users care plans are held in a cupboard in the dining room which all residents have access to, highlighting further concerns around confidentiality of information. This was discussed at the previous inspection and a requirement was made for the care plans to be kept in a secure place. The manager had discussed this with the service users and had instructed them not to access the cupboard, however service users were observed being naturally interested in documents during the inspection, wanting to look at care plans and other information. The manager agreed to fit a lock on the cupboard to ensure that service users confidences are kept. Imber House DS0000024558.V303849.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 at least once during a 12 month period. 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: Evidence was seen and obtained during discussion with service users that they are supported to lead full and stimulating lives. All service users were out when the inspector arrived and returned at various intervals late afternoon. Two service users attend Yarmouth College and Yarmouth Training Centre two days a week. One service user helps out at a local stable that offers work opportunities to people with learning disabilities; they help clean out the stables and groom the horses. The service user has recently started to have riding lessons and showed the inspector a picture of them one of the horses. Another service user works at a placement called Norwich Union where they receive payment for packaging of promotional and advertising information. Imber House DS0000024558.V303849.R01.S.doc Version 5.2 Page 12 At the last inspection in February 2006 one of the service users had told the inspector that their day care service was closing. They expressed their wish to go to Yarmouth College, however there were issues around funding. At today’s inspection the service user told the inspector they had started at the college for two days a week and had enrolled on a directions course. They showed the inspector the brochure which identified they would be working with tutors identifying and learning new skills. Direct payments have been obtained for two service users to have one to one care support for days they do not attend other placements. One service user has 10 hours per week and another has twenty-five to pursue activities of their choice, for example swimming, shopping, dancing, visiting the hairdressers and cooking. One of the service users was observed returning from a shopping trip during the inspection. Service users are supported to access the community for leisure activities and have the opportunity to attend local support groups, such as Gateway Club on Tuesday and Thursday evenings. Imber House is on the bus route into the town centre, with a stop out side the home on the other side of the road. 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 for the service users. Friday night is ‘residents night’ and they choose where they want to go. They choose between having a meal and play pool or snooker. Alternatively service users spend their time at home with a take away meal and can if they choose, listen to music, watch television or videos in the privacy of their own rooms or in the lounge. Each service user has a week’s holiday agreed as part of their contract. The service users choose to go away together for a group holiday, the manger explained that they have discussed with the service uses the option to have individual holidays but they prefer to go together. This year they have been to Cornwall and stayed in a rented cottage. This way they are able to cater for each individual’s interests, such as visiting zoos, trains and castles. With the exception of other service users bedrooms and private residence of the manager and their family service users are free to move around the home. During the inspection service users were observed going about their daily routines, watching television, having a shower and going to bed at their preferred time. Each of the service users have a key to their room, one of the service user was observed unlocking their door to invite the inspector into their room another service user had broken key in lock which had been taped over. The manager explained that they were in the process of replacing the door with a fire door following a visit from the fire officer. Evidence was seen that service users are supported to maintain links with their family and friends. A relative of one of the service users was due to visit at the weekend to celebrate their birthday. Imber House DS0000024558.V303849.R01.S.doc Version 5.2 Page 13 Service users take turns to help with the shopping and domestic chores around the home. Service users had agreed a menu for the week, which reflected that they were receiving a nutritious, varied and well-balanced diet. If on the day a service user decides 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. Service users were observed eating their evening meal outside, which consisted of different meals according to choice, two had pizza, another service user had chosen chicken nuggets and chips where as the others had opted for sandwiches. Service users are encouraged to help in the preparation of meals and hot drinks. Imber House DS0000024558.V303849.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. 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 access healthcare and to receive support to manage their own personal care needs. However they cannot expect to be treated with sensitivity and respect regarding ageing, illness and death until they have had the opportunity to discuss and record their wishes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users are supported and encouraged to follow their own routines, for example when they choose go to bed, the clothes they wear and when they eat their meals. Generally service users getting up time during the week was to enable them to attend college or day care, however weekends are more flexible to allow service users to have a lie-in if they choose. Imber House is a small business, which provides service users with consistency and continuity of care. It is mostly staffed by family and friends who have known the service users since it opened in 2002. Staff spoken with demonstrated that they had a good knowledge of the service users physical and emotional health, however terminology used in one service users care plan does not respect their dignity. Their behaviour is generally described as having a ‘temper tantrum’ or being ‘moody’. The care plan reflects that the home manage their behaviour on a reward system and describes that if they have no Imber House DS0000024558.V303849.R01.S.doc Version 5.2 Page 15 incidents of ‘temper tantrums, outbursts or swearing’ during their day care placement or at home they receive a reward. For example, if their behaviour had been in appropriate the service user would not go out shopping on their day for receiving one to one support. This does not encourage the service user to take responsibility for their actions or promote independence. Additional training is required to ensure staff have the skills and experience to support service user’s with behavioural needs. Two of the service users care plans seen identified communication needs, one has been referred to the speech and language therapist, however the manager informed the inspector they had been on the waiting list for two years, during which time there speech has improved. The other service user can verbalise words but needs to be encouraged to speak slowly to be understood, they also use makaton and sign language to support there speech. One of the service users mobility has deteriorated with age; they are finding it more difficult to walk long distances. The occupational therapist has referred them to a physiotherapist, however they have been on the waiting list for eight months for an appointment. They do have a scooter, which they use to go out and about in the community. A member of staff was observed administering medication to a service user following their evening meal. The medication was appropriately administered by the member of staff who signed the Medication Administration Record (MAR) after they had observed the service user take their medication. The home uses a Monitored Dosage System (MDS). Whilst checking through the rack of medication, the teatime dose for one service user was missing from their blister pack, the manager was able to demonstrate that the tablets had been soiled and had requested replacement medication from the surgery. The MAR charts for all five service users were seen, these were accurate and up to date. The monthly order of medication had been delivered to the home on the day of the inspection. The manager showed the inspector the system for ordering and receiving medication into the home, which was compliant with the homes policy and procedure. The home has a policy for dealing with the death or dying of a resident. A requirement was made at the previous inspection 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.V303849.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23, Quality in this outcome area is adequate. The home has policies and procedures in place for dealing with complaints and allegations of abuse, however to protect the service users rights and best interests there needs to be established procedures in place for dealing with incidents of inappropriate behaviour. All records relating to service users finances must be kept securely at the home and available for inspection at all times. The complaints procedure needs to be provided in a format service users can use and understand. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints procedure was seen which gives details on how to make a complaint and to expect a response with 72 hours. The complainant is assured that their complaint will be logged and resolved within 21 days. The procedure includes the contact details of the Commission for Social Care Inspection (CSCI), however the procedure needs to be developed in to a suitable format that service users can understand. There have been no complaints received by the home or the CSCI since 2000. The homes adult protection policy and procedure has been updated to reflect the Suffolk inter agency guidelines of June 2004 which includes the process of reporting all allegations of abuse to the Customer First team. The manager explained that staff are scheduled to attend training for the Protection of Vulnerable Adults (POVA) and that they are awaiting conformation of a date with a local training centre. Imber House DS0000024558.V303849.R01.S.doc Version 5.2 Page 17 One service user at the home is known to display behaviour that can challenge. Generally the home does manage the service users behaviour well; there have been very few incidents where their behaviour has impacted on the other service users. The manager was clear of the actions that they would take in these circumstances, but these were not recorded in their care plan. There needs to be established individualised procedures in place that have been discussed and agreed with the service user for dealing with incidents of inappropriate behaviour. These procedures must be recorded in a plan with clear guidelines as to what actions staff should take in each circumstance. The plan needs to consist of known triggers and actions to prevent situations so that all staff are consistent in their approach, including day care staff to avoid situations which trigger verbal or aggressive behaviour. It was not acceptable that financial records were at a member of staffs home, as they need to be retained at the registered home. The homes procedures and practice must ensure that records are kept safe and secure at all times to ensure the financial protection of service users. Imber House DS0000024558.V303849.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,27,28,30, Quality in this outcome area is adequate. Service users can expect to live in a non institutionalised environment that is family orientated, which has a relaxed and friendly atmosphere, however 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 to be more effective for service users and staff. 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 (which residents use under supervision) a lounge with patio doors leading out into the garden, a dining room, two single bedrooms with sinks and a shared toilet and shower. The first floor has three bedrooms, a separate toilet and a bathroom with a bath, shower and toilet. The third floor is the manager’s private accommodation. Service users individually invited the inspector to see their bedrooms. These were nicely decorated and reflected their personalities. At the last inspection in February the manager informed the inspector that the washbasin in one service users bedroom had developed a slow leak. This leak had been repaired and new floorboards had been fitted. The manager is waiting for the joists to dry out, before they can decorate the room. Once this has happened a new carpet and bedroom furniture will be ordered. Imber House DS0000024558.V303849.R01.S.doc Version 5.2 Page 19 All service users rooms seen were well furnished and fitted with television points and a washbasin. Service users rooms are lockable and they are given the choice of holding their own key. One of the services users rooms seen had tape over the door lock where they had broken their key in the lock. At a recent visit by the Fire and Rescue Officer the manager has been instructed to replace all doors with fire doors, this will include a new lock and key for the service user. Generally the home was seen to be clean, warm and free from offensive odours. However the décor throughout the home is looking very tired and worn. The manager is aware that there a several areas that need urgent attention, for example the tiles on the floor in the upstairs bathroom are lifting following a leak and the glass in the window has been broken, this has been taped over and needs to be replaced. The stair carpet is very worn and frayed which needs replacing. The manager has purchased a piece of carpet to replace the stair carpet and assured the inspector, the hall and landing, are scheduled for redecoration next June when all service users are away on holiday. The lounge has been decorated and a new carpet has been laid since the inspection in February, however the wall lights still need to fitted. The families of the service users have provided pictures to be put up in the lounge and a service user showed the inspector a group holiday photograph, which was standing on the mantelpiece. The stair lift is currently out of order. The manager confirmed a new one has been ordered with a battery back up in case of power failure. The manager informed the inspector they are paying for the lift in instalments before it can be installed. None of the current residents use the stair lift. The first floor shower is not working properly, the manager advised the inspector a plumber has been arranged to visit the home to make the necessary repairs. The bath is useable however it takes at least half an hour to run enough water for a bath; this is due to water pressure problems. The manager informed the inspector that a plumber has told them that they need to replace or reposition the tank, to solve the problem. The home has separate washing machines and tumble driers for service users and the families own laundry. All clothing is washed separately and was seen folded into individual piles. The homes process for managing soiled linen was discussed with the manager; they explained it is rarely an issue and that they have an occasional incident with one service user. The current system of dealing with soiled garments does not comply with the Department of Health Guidance for Infection Control. The manager was shown a copy of the guidance; they informed the inspector they would look into hiring a washing machine with a sluicing element. Imber House DS0000024558.V303849.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36, Quality in this outcome area is adequate. Whilst observation and feedback from the service users was positive about the support they receive, 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 home is staffed by a team made up of family members and friends, whom are well known to the manager. This provides service users with consistency, which was evident during the inspection, as they appeared relaxed, happy and comfortable with the staff, this was confirmed in discussions held with the service users. However, the staffing structure does not allow the manager time to effectively manage the home, they appeared to be tired and stressed. This was discussed in depth with the manager who agreed that they were feeling under pressure. They were extremely concerned about the welfare of a member of staff on long-term sick leave. Although an additional member of staff had been employed to help cover sick leave the manager is working shifts and trying to run the home at the same time. Staffing levels were discussed in more detail; the roster is covered by the manager and three staff who rotate their shifts across the week. The roster reflected that two staff are available between the hours of 4 – 7pm weekdays with two staff on duty between 10am and 10pm at weekends. The service users are out at various day care and work placements Monday to Friday between the hours of 9am to 4pm. The Imber House DS0000024558.V303849.R01.S.doc Version 5.2 Page 21 rota showed that 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. Although the service users are reasonably independent, risks to their safety have been identified in their care plans. For example, a service user who likes to interfere with electrical appliances could, if left unsupervised electrocute themselves. There would be insufficient staff to deal with the incident and provide support to the other service users. A review of staffing levels was discussed with the manager to ensure that are sufficient staff available at all times to meet the assessed needs of the service users and to manage the home. One of the full time care staff is reducing their care hours. It has been arranged that they will continue to provide support for one service user who has additional funding for twenty-five hours per week for one to one activities. The manager has recruited a friend to take on some of their hours. Evidence was seen that all the necessary paper work had been obtained prior to the person commencing employment and that they had experience of working with people with learning difficulties. In total three staff files were seen, necessary paperwork, job descriptions reflecting the employees education and employment history plus Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks had been obtained prior to them commencing employment. However there was no evidence of two satisfactory references being obtained on file for another member of staff recently recruited. The files reflected that staff had been issued with job descriptions. A member of staff spoken with was clear about their role and duties required. Whilst working their shift they demonstrated that they had good understanding of the service users needs. Supervisions and annual appraisals are taking place, however supervision was not being completed as frequently as stated in the homes supervision policy. The manager showed the inspector agenda’s they had prepared for forthcoming supervisions with staff. A recommendation from the last inspection was for training records to be consolidated to give an overview of training needs and updates. This has not yet been completed, however the manager has located a company that can provide the materials required for staff to complete training, which covers mandatory areas of safe working practices. Evidence was seen that staff had undertaken some training in fire safety and administration of medication and one member of staff has enrolled to undertake National Vocational Qualification (NVQ) in care. A date is to be agreed with a local training centre for staff to access protection of vulnerable adults training. None of the staff have completed the Skills for Care Induction Standards (CIS). The manager informed the inspector that all staff, including themselves are to commence the induction workbooks to ensure they all have an understanding of the principles of care, safe working practices, and experiences and particular needs of the service users. Training needs to be provided to ensure that all staff are adequately trained in managing challenging behaviour. Imber House DS0000024558.V303849.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41,42, 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, record keeping and risks to service users personal safety. 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 valuable experience of working in Northgate Hospital on geriatric and psychiatric wards. They have completed the Registered Managers Award (RMA) at National Vocational Qualification (NVQ) level 4 in management and care. However, service users do not currently benefit from a well managed home, evidence gathered during the inspection is reflected throughout this report which identifies there are concerns around the current staffing levels of the home, inappropriate management of service users records which do not safeguard their rights and best interests and insufficient measures taken to minimise risks to service users personal safety. Imber House DS0000024558.V303849.R01.S.doc Version 5.2 Page 23 Evidence was seen that the manager has necessary certificates in place, which allow them to operate as a registered service, insurance documents were also seen ensuring the home for employees, public, and products liability, The certificate expires in March 2007. The manager also provided a certificate to reflect that the gas boiler had been serviced in March 2006. Evidence was seen that the manager was keeping a record of water temperatures, however the water temperatures in service users rooms were checked and were found to be variable and above the required temperature of 43 degrees centigrade. Imber House has a quality monitoring system in place, however the last survey was conducted in May 2005. Examples of comments seen on feedback sheets completed by the day care service were very positive about the care provided at the home “service users appear happy and well groomed” and “carers are good at communicating”. The feedback from one of the service users relatives was seen and had very positive comments about the residents care “My relative is very happy and settled at Imber House”, “their overall behaviour and disposition is very good”, “thank you to every one at the home”. However, quality assurance and quality monitoring systems need to completed at least annually and based on views of the service users, family, friends and other professionals associated with the home such as the general practitioner (GP) to ascertain how the home is meeting the needs of the service users. The home was inspected by the Fire and Rescue service on the 7th July 2006. A copy of the report was forwarded to the Commission for Social Care Inspection (CSCI), which identifies a number of items to be addressed for the home to comply with the Fire Precautions (Workplace) Regulations 1997. The manager has produced an action plan in conjunction with the Fire and Rescue Service to make the necessary improvements over a period of six months. These include upgrading insufficient fire detection and warning in case of fire, emergency routes and exits (to include replacing existing doors at ground and first floor level including a range of cupboards on the upstairs landing with fire doors). The report also identifies that staff must be trained to understand fire precautions and action to take in the event of a fire. A record of the training and instruction must be recorded and a log kept detailing the result of all fire drills, tests and maintenance of equipment. The fire risk assessment needs to be amended and updated which identifies the hazards identified in the report and the actions to be taken to minimise the risks to service users and staff. The existing fire logbook was seen and which reflected that fire drills were taking place which included the service users, the manager also informed the inspector that weekly fire alarm tests and testing of emergency lighting was being done, however these were not being recorded. Evidence was seen in the log that a service of the existing fire alarms and fire fighting equipment had taken place in August 2007. Imber House DS0000024558.V303849.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 3 4 3 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 2 25 X 26 3 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 3 32 3 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 1 2 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 1 X 2 X 1 1 X Imber House DS0000024558.V303849.R01.S.doc Version 5.2 Page 25 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 YA6 YA23 Regulation 15 Requirement Timescale for action 27/10/06 2. YA9 13 (4) (a)(b) (c) 3. YA10 17 (1) (b) Care plans must establish individualised procedures, which have been discussed and agreed with the service user and day care service for dealing with incidents of inappropriate behaviour. These procedures must be recorded in a plan with clear guidelines as to what actions staff should take in each circumstance to protect the rights and best interests of the service user All parts of the home which 06/09/06 service users have access are free from hazards to their safety, ensure any activities in which the service user participates are so far as practicable free from avoidable risks and unnecessary risks are identified and so far as possible eliminated. Residents care plans must be in 27/10/06 a secure place to prevent other residents and visitors having access to confidential information. This is a repeat requirement from 07/02/06 Imber House DS0000024558.V303849.R01.S.doc Version 5.2 Page 26 4. YA18 12 5. YA21 12 (3) Terminology in service users care plans must respect their dignity and have agreed interventions to manage their behaviour (see also Requirement N0 1) A record of resident’s wishes and feelings must be made in their care plan and taken into account at the time of their death. This is a repeat requirement from 07/02/06 The homes procedures and practice must ensure that records are kept safe and secure at all times to ensure the financial protection of service users. The manager must provide an action plan of timescales to show planned maintenance and decoration of the premises (see text in environment section of the report) for details. Suitable arrangements must be made for dealing with soiled garments, which comply with the Department of Health Guidance for Infection Control. The manager 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. Two written references must be obtained before staff commence employment. 27/10/06 27/10/06 6. YA23 YA41 17 (2) Sch 4 (9) 27/10/06 7. YA24 23 2 (b) (d) 27/10/06 8. YA30 13.3 27/10/06 9. YA33 18 1 (a) 27/10/06 10. YA34 Schedule 2 (5) 27/10/06 11. YA35 18 (1) (c ) The manager must ensure that staff are adequately trained in managing challenging behaviour. 22/12/06 Imber House DS0000024558.V303849.R01.S.doc Version 5.2 Page 27 12. YA39 24 13. YA42 13, 4 (a) The home’s quality assurance 22/12/06 (QA) system must be taken at least annually taking into account all persons connected with the home. A copy of the report made available to service users, staff and a copy sent to the CSCI, to reflect how information is used to improve the service. All parts of the home which 06/02/07 service users have access must be free from hazards to their safety, and unnecessary risks are 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. 14. YA42 13, 4 (a) 2. To control the risk of service users being scolded, the hot water supply in service users rooms must be close to the recommended 43 degrees centigrade. 06/09/06 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. DS0000024558.V303849.R01.S.doc Version 5.2 Page 28 Imber House 2. YA35 3. YA36 Staff training records should be completed to reflect an overview of training that has taken place, training needs and training due. Copies of certificates for training undertaken outside of the home should be obtained and held on staffs file to provide an overall picture of training they have undertaken. This is a repeat recommendation from 07/02/06 Evidence was seen that supervision takes place, however the frequency should meet the recommended six supervisions a year. Imber House DS0000024558.V303849.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: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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