Inspection on 05/06/08 for Intelligent Care

This inspection was carried out on 5th June 2008.

CSCI found this care home to be providing an Poor service.

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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Intelligent Care 30/10/08

Intelligent Care 21/06/07

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Intelligent Care 102 Park Road Bolton Lancashire BL1 4RQ Lead Inspector Mike Murphy Unannounced Inspection 5th June 2008 09:30 Intelligent Care DS0000069171.V365439.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 Intelligent Care DS0000069171.V365439.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. Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Intelligent Care Address 102 Park Road Bolton Lancashire BL1 4RQ 01204 386186 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) Jamil Mohammed Miss Nusat Khan Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to service users of the following gender:Mixed Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 6 Date of last inspection 21st June 2007 Brief Description of the Service: Intelligent Care is a privately owned organisation that provides residential services in a care home called Queens Park View that is situated in a residential area of Bolton close to Bolton School. Queens Park View is a large three-storey Victorian style property with mature gardens to the front and back. The front of the property overlooks Queens Park which is a very popular landmark of Bolton with the home being located near to the town centre in a quiet residential road set back in an elevated position. The building has been fully refurbished with a large lounge, a further lounge/dining room and a kitchen. There are six bedrooms, two of which have en-suite facilities. The other bedrooms have washbasins with vanity units and all bedrooms have TV points. Toilets and showers are available on the ground and first floors. There is limited car parking to the front of the home and on street parking is also available. The Statement of Purpose says that the aim of Intelligent Care is to provide client centred rehabilitative care for people between 18 and 65 years of age who have mental health problems with the intention of enabling them to live independently or semi independently within the community. The home is currently registered for male and female service users. A Service User Guide, Statement of Purpose and a leaflet style brochure that describe the home’s services is available in the home and the provider gives other information about the home to new and prospective residents and their families verbally. Fees charged are individually assessed/negotiated by the home and placing authority. Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. This inspection which included 2 site visits that the home did not know was going to take place was carried out over an eleven and a half hour period on the 5th of June 2008 and the 2nd of July 2008 (1 inspector conducted the first visit and 2 inspectors the second). These visits were also supplemented by an unannounced inspection conducted by a CSCI pharmacy inspector on the 4th of July 2008. The process of inspection included observing what went on in the home, talking to residents, staff and the home’s owners, looking round the home, and examining some important records. Before the inspection, we also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home sees the service they provide the same way that we see the service. We felt this form was completed adequately. What the service does well: What has improved since the last inspection? What they could do better: There is an urgent need for a manager to be appointed to ensure the home is run properly. We found that a number of issues are in need of urgent attention to ensure residents at the home are being suitably supported and protected. Specifically improvements need to be made in respect of how care records are maintained, how residents medicines are managed, how staff are recruited, staffing numbers, staff training and the arrangements to maximise fire safety in the home. These issues are detailed throughout this report. What action the home’s owners need to take in respect of the issues is also detailed throughout Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 6 this report and in the requirement/recommendation sections at the end of the report. 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. Intelligent Care DS0000069171.V365439.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 Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are only admitted to the home on the basis of a full assessment of their care and support needs. EVIDENCE: The pre-admission assessment records of the six residents living at the home were looked at. Before residents are admitted to the home an assessment of their needs is carried out in consultation with the resident and their relatives by relevant health and social care professionals such as doctors (including psychiatrists and other mental health care professionals and social workers). The home also conducts a pre-admission assessment on all residents. The reason for such an assessment is to help the prospective resident decide how appropriate a placement at the home would be and enable the person conducting the assessment (currently one of the home owners) to determine if the home will be able to meet the prospective resident’s needs appropriately. The initial assessment helps to form the basis of the plan of care to be followed following admission to the home. The 6 residents care records inspected contained detailed pre-admission assessments. Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 9 Residents spoken to said they were actively supported by their care managers in the pre-admission process and that their views were important in the process. Trial visits to the home are regarded as an important part of the preadmission visits and enable prospective residents to meet residents and staff at the home before a choice is made about entering the home more permanently. Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 10 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 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst care plans and risk assessments have been developed for each resident by care managers prior to (and after admission) those produced by the home need to be improved. EVIDENCE: The care records of all 6 residents living at the home were inspected on this occasion. Detailed care plans and risk assessments had been developed as part of the care management process. These documents identify the care/rehabilitation and support requirements of residents and what actions/interventions need to be taken to enable them to lead a fulfilling life. In the case of 1 resident these care plans and risk assessments had been used by the home to generate care plans and risk assessments that detailed how this person was to be supported at the home and how they were supported to take risks as part of an independent lifestyle. However in the care records of Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 11 remaining residents care plans and risk assessments generated by the home lacked the detail referred to in the example above. It is required that the home develop care plans and risk assessments to the standard of this example to ensure staff at the home are fully aware of how residents are to be adequately supported whilst living at the home. (This was discussed in detail with the 2 registered owners at the time of inspection). Detailed daily progress notes were completed by staff and were dated, timed and signed appropriately. Residents spoken to expressed the view that staff do support them and seek to help them become independent. Staff also expressed this view. However staffing provision means that at times of the day/night when only 1 staff member is on duty staff are unable to support residents with pursuits/activities outside the home during these periods. (This was also discussed in detail with the 2 registered owners at the time of inspection). Information on how to contact advocacy services for people with metal health problems was prominently displayed in the home. Residents spoken to were aware who their care manager is and how to contact them. Resident’s placement at the home is subject to regular reviews by the care managers appointed by the placing authority. Residents are encouraged to manage their own finances. Where the home manages money on behalf of residents a written record is maintained – both staff and resident sign when money is given out and the balance is recorded. Where staff support residents by making purchases for them receipts are kept. Each resident has a secure place for the storage of money and other valuables. It is noted that at the time of this inspection there had been an issue relating to residents finances/contractual issues regarding supplementary charges for food provision at the home. The registered owners informed the inspectors that the practice of supplementary charges had ceased and the issue was being discussed with the relevant placing authorities of the residents concerned. Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst residents are encouraged to participate in the local community and pursue leisure activities staff find it difficult at times to support them in this important area. EVIDENCE: Residents have varying degrees of independence and are able to make individual choices about how they spend their day. Most go out regularly on their own or accompanied by staff to support them when necessary. However as identified in other areas of this report staffing provision means that at times of the day/night when only 1 staff member is on duty staff are unable to support residents with pursuits/activities outside the home during these periods. Staff time with, and support for residents outside the home needs to be flexibly provided to include mornings, evenings and weekends. Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 13 There is a need to record in the care plans generated by the home how staff support residents to become part of, and participate in, the local community in accordance with their assessed needs. Residents and staff at the home report no unreasonable restrictions to residents being able to receive visitors at the home. Discussion with residents and staff indicate that the daily routines and house rules generally encourage independence. However concern was expressed to us regarding residents not being able to access the main communal lounge and kitchen area between the hours of 11pm and around 7am. This is because the member of staff who is designated to be on duty at night is designated as a being on ‘sleep in duty’ and uses the main communal lounge area as a staff bedroom during these hours. This clearly impacts on the time residents can access this facilities and thus is a limitation of choice in respect of the daily routines at the home. This issue is in need of review by the home and was discussed at length with the registered owners during the inspection. Residents said that their privacy was respected by staff, that staff were kind and interacted with them well and that residents responsibilities for housekeeping tasks is shared with staff and clearly programmed as part of daily life in the home. The home has domestic style kitchen and dining area. Both were adequately equipped and furnished. Mealtimes were reported by residents flexible and reasonable. Menus were prominently displayed and residents said they reflected their choice of what to eat. Staff said they tried to encourage residents to eat healthy – particular in relation to the five a day recommendation regarding fruit and vegetables. Meals are provided 3 times a day – with the main meal of the day being taken in the evening. Residents said staff supported them to prepare and serve food. As referred to earlier in this report at the time of this inspection there had been an issue relating to residents finances/contractual issues regarding supplementary charges for food provision at the home. The registered owners informed the inspectors that the practice of supplementary charges had ceased and the issue was being discussed with the relevant placing authorities of the residents concerned. Clearly this issue needs to be fully resolved as soon as possible and clearly set out in the contractual arrangements between the home and placing authority. Residents appeared to be weighed reasonably regularly and their weight is recorded in their care records. Where individual residents have issues relating to the food provided these should be recorded in the care plans generated by the home and detail how management and staff are supporting residents to resolve the issues in accordance with their assessed needs and discussion with the resident and their care manager. Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of resident’s medicines in the home needs to be improved to ensure that residents are protected from risk of harm. EVIDENCE: Residents spoken to said staff supported them sensitively and respected their privacy and dignity. Times for getting up, going to bed, bathing/showers and mealtimes are flexible. However as stated previously in this report there is the issue of residents being able to access the communal lounge and kitchen at night and the view that when only 1 staff member is on duty staff are unable to support residents with pursuits/activities outside the home during these periods. Staff guide and support residents with regard to personal hygiene and this is documented in resident’s care records. Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 15 All residents are registered with a GP and are able to access specialist mental health services, chiropody, optical and other relevant health/social care services. Each resident has a care manager appointed by the relevant placing authority. As part of the inspection a specialist pharmacist inspector looked at how medicines were handled. We looked at the medicines stock and records and spoke with a member of staff, a resident and the manager. We found serious shortfalls in how medicines were recorded, of particular concern was the lack of records for medicines receipt and disposal, and this meant that we could not check whether medicines had been given to residents correctly. Medicines handling paperwork was handwritten and the general design of these did not help staff make accurate records. We found important ‘warning’ information missing and some records had several months administration doses recorded on them, this is not good practice as the records could easily become confused and unclear. Poor record keeping could result in mistakes when giving medicines to residents. We looked at how residents were supported when they looked after their own medicines. Two residents that were looking after some of their own medicines had not been formally risk assessed and so care plans had not been developed, this meant they might not receive the right amount of support to help them manage their medicines safely. We spoke with the manager and the carer on duty about how staff were trained to handle and administer medicines safely. They both said that no ‘formal’ training had been carried out and that the managers did not observe staff administering medicines to ensure they were competent. A written procedure was in place but this lacked important information such as how to manage homely remedies, self-medication and records of receipt and disposal. The manager also said that no formal audits (checks) on the medicines were carried out so if any mistakes had been made they would not necessarily know about it. We gave detailed advice to the manager at the end of the visit about how the necessary improvements could be made. Having formal training, regular supervision, good written procedures and regular audits help ensure staff are competent. Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The process used to recruit staff needs to be improved to ensure residents are safe and protected from potential abuse. EVIDENCE: Residents spoken to said they were aware how to raise any concerns with the staff – or their care manager if required. A formal complaints procedure was in place and accessible. No complaints have been recorded in the home’s complaints record since the last inspection. Staff working at the time of this inspection were aware of the need to ensure residents felt safe and were aware of safeguarding issues. No instances of a safeguarding nature have been reported by the home since the last inspection. The home has a safeguarding procedure in place and this is supplemented by the interagency safeguarding protocol operated in Bolton. Staff training information showed that some workers had completed training for topics such as the protection of vulnerable adults. It is important that staff who have not received such training are provided with such as soon as is practicable. Failures in safe staff recruitment means that residents may not be fully protected. There was no records of protection of vulnerable adults (‘POVA First’) checks and the registered owners told us during the inspection that they Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 17 did not know about POVA First. These checks are important in maximising the protection of vulnerable people. This was discussed at length with the registered owners and an immediate requirement was issued at the time of inspection in respect of this. Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home appears to be well maintained and provides residents with a suitable homely environment in which to live. EVIDENCE: The premises are suitable for its stated purpose and meets the collective and individual needs of residents in a comfortable and homely way. All areas of the home were very clean and free of offensive odours. Furnishings and fittings were of a good quality and domestic in nature. The home was decorated to a good standard throughout. Residents have their own bedroom – three of which were inspected (with the resident’s permission) on this occasion. These rooms were clean, warm, suitably ventilated, comfortably/appropriately furnished and personalised. Residents expressed satisfaction with their rooms and said staff respected their privacy. WC/shower areas were clean, suitably equipped and Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 19 provided privacy. A main lounge, dining room and kitchen are provided. These areas were suitably equipped, comfortably/appropriately furnished. However as referred to earlier in this report concern was expressed to us regarding residents not been able to access the main communal lounge and kitchen area between the hours of 11pm and around 7am. This is because the member of staff who is designated to be on duty at night is designated as a being on ‘sleep in duty’ and uses the main communal lounge area as a staff bedroom during these hours. This clearly impacts on the time residents can access these facilities and thus is a limitation of choice in respect of the daily routines at the home. This issue is in need of review by the home and as stated earlier in this report was discussed at length with the registered owners during the inspection. Residents who smoke are permitted to do so in the patio area at the back of the property. Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Arrangements for the provision, recruitment and training of staff are all in need of review and improvement, to ensure residents are supported and protected. EVIDENCE: Staff rotas for June 2008 were seen and shifts were 8/5, 5/10 and 10/4 or 8/5, 5/10 and 9/3 or 3/10, 8/5 and 10/8. Sleeping in cover was not always clear on the rota and it was evident that one staff member works alone (for long periods) to support 6 residents each day. One resident said that they had no friends outside the home and never goes out. They said that they would like to go out more. One staff member said that they would like to take this resident out to support them but when one staff member is on duty alone this is not possible. As stated earlier in this report, concern was expressed to us regarding residents not being able to access the main communal lounge and kitchen area between the hours of 11pm and around 7am. This is because the member of Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 21 staff who is designated to be on duty at night is designated as a being on ‘sleep in duty’ and uses the main communal lounge area as a staff bedroom during these hours. This clearly impacts on the time residents can access this facility and thus is a limitation of choice in respect of the daily routines at the home. This issue is in need of review by the home and was discussed at length with the registered owners during the inspection. We also discussed staffing at length with the registered owners of the home at the time of this inspection and informed them of staff’s expressed concerns regarding the safety issues and logistics of working alone and the impact of this on residents. One of the owners said that other people, including themselves (the owners) and a registered psychiatric nurse employed to provide advice were often at the home with staff but the owners agreed that this was not reflected on the Rotas. Clearly staffing arrangements, both day and night, were in need of urgent re-assessment by the registered owners and an immediate requirement was made in respect of this at the time of this inspection. Staff time with, and support for residents outside the home needs to be flexibly provided to include mornings, evenings and weekends. Inspection of staff personnel files revealed that the recruitment processes of the home were in need of urgent improvement. Failures in safe staff recruitment means that residents may not be fully protected. There was no records of protection of vulnerable adults (‘POVA First’) checks and the registered owners told us during the inspection that they did not know about POVA First. These checks are important in maximising the protection of vulnerable people. This was discussed at length with the registered owners and an immediate requirement was issued at the time of this inspection in respect of this. The staff training plan for 2008 is unclear. Entries against food hygiene, self harm, first aid and health and safety training state “TBA” (to be confirmed) or “date to be confirmed”. One of the registered owners stated that they can’t keep getting a trainer in for one person and that they need enough staff that needed training to set the training up. They also said that when staff have training from previous employers, they rely on this. The personal file for one staff member was used as an example of reliance on previous training with another employer (a domiciliary care agency). It was pointed out that this training would be specific to the role as a domiciliary care agency carer and did not encompass work in a residential setting with residents who have mental health needs. It was also noted that the same member of staff had not had a documented induction or any training recorded since they had commenced employment in November 2007. No staff-training plan was in place and there was no staff training needs analysis. The “staff training development profile” contained no dates when training was completed, just ticks against issues such as mental health awareness, first aid, fire safety, health and safety. The registered owners were Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 22 unable to provide evidence of the dates this training took place. Most staff had attended an abuse awareness training on 13/12/07. The entry for social care induction for some staff stated “completed on previous job”. The owners informed us that of the 7 regular staff, two have obtained a level 2 NVQ and two staff enrolled on it on 2/07/08. It is imperative that residents individual and joint needs are met by appropriately trained staff and that the home maintain adequate records (including the type of training and dates it is delivered) of training provided to staff. Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 23 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 and 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home was not being adequately managed at the time of this inspection. EVIDENCE: The person who was registered by the CSCI as the registered manager no longer fulfils this role. We have been informed that one of the registered owners of the home has recently completed the Registered Managers Award and is currently in the process of applying to the CSCI seeking registration as manager of the home. We are convinced that the wide range of issues of concern that are detailed in this report can only be effectively remedied when the home and staff are being adequately managed and monitored on a daily basis by a registered manager. Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 24 The quality assurance system operated at the home consisted of questionnaires to residents completed with the help of staff. Three of these were dated (April, May and June 08), but others were not dated. Staff confirmed that they asked the questions and recorded residents’ replies. A discussion regarding Quality Assurance was held with the registered owners at the time of this inspection. One example given was that a resident’s questionnaire noted that they were 60 satisfied with needs met. As the outcomes of questionnaires had not been collated and analysed, issues had not been noted and addressed. The owners stated they didn’t know that they had to be collated. They were referred to the National Minimum Standards (Care Homes for Adults (18-65)) for information and guidance regarding this and all the other issues identified during this inspection. In respect of staff meetings - Minutes were in place for 30/01/08 and 11/01/08, but meetings in February, March and April had been cancelled. The arrangements in respect of fire safety at the home were in need of urgent improvement. Specifically; the fire warning system (bells and zones) were checked on 6/03/08, then there was a gap until 1/4/08, then an entry on 8/04/08 then a gap to 8/5/08, then on a weekly basis until 5/6/08, then no more checks were recorded. There was no documented check of the means of escape. There were inadequate records in respect of fire drills – the last one was documented in November 2007 (precise date not specified), the previous one on 10/6/07. Drill records had first names of residents and initials of staff, Staff were not signing the record to denote involvement. It was therefore unclear who is involved, and in what capacity, also there were no details of the process recorded, no times and no staff response times. A fire risk assessment had been done, but this was not readily available – this document should be readily available for staff to refer to. The registered owners were advised to contact the local fire safety officer for fire risk assessment guidance and for further advice. An immediate requirement was issued in respect of fire safety at this inspection. Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable HOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 X 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 1 X 1 X 2 X x 1 x Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 26 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 Regulation 13(4)(b)(c) 15(1) Requirement Care plans and risk assessments generated by the home should detail how residents are to be supported in their daily life and how they are to be supported to take risks as part of an independent lifestyle. (Timescale of 20/08/07 not met) The home’s medication arrangements and policies and procedures must be reviewed so ensuring that the people living at the home are given their medicines as prescribed. (Timescale of 20/08/07 not met) Records of medicines received, administered and disposed of must be accurate and detailed so that all medicines can be fully accounted for. Care plans and risk DS0000069171.V365439.R01.S.doc Timescale for action 04/08/08 2. YA20 13 (2) 04/08/08 3. YA20 13(2) 04/08/08 4. YA20 13(4) (b) (c) 04/08/08 Version 5.2 Page 27 Intelligent Care assessments must be completed and regularly reviewed for residents that self medicate to help ensure they manage their medicines safely. 5. YA20 18(1) c (i) Care staff must have 04/08/08 ‘safe handling of medicines’ training and supervision to help ensure they are competent when handling medicines. That before any staff are 03/07/08 employed at the home a protection of vulnerable adults (POVA first) check must be obtained as part of the recruitment process operated by the home. Issued as an immediate requirement during the inspection of 2/7/08 That staffing provision at 03/07/08 the home is urgently reviewed to ensure resident’s needs are adequately and safely met. And that adequate and appropriate numbers of staff are on duty at the home at all times. Issued as an immediate requirement during the inspection of 2/7/08 That resident’s individual 04/08/08 and joint needs are met by appropriately trained staff and that the home maintain adequate records (including the type of training and DS0000069171.V365439.R01.S.doc Version 5.2 Page 28 6. YA34 19(1)(b) 7. YA33 18(1)(a) 8. YA35 18(1)c(i) Intelligent Care dates it is delivered) of training provided to staff. (Timescale of 31/08/07 not met) 9. YA42 23(4)(a)(b)(c)(d)(e) It is required that the arrangements to ensure fire safety at the home are urgently reviewed. Issued as an immediate requirement during the inspection of 2/7/08 Section 11 That action is taken to Care Standards Act ensure the home is 2000 appropriately managed by a person who is registered by the CSCI 24(1)(2)(3) That a system of quality assurance is established that at appropriate intervals reviews the quality of care/support provided at the home 03/07/08 10. YA37 04/08/08 11. YA39 04/09/08 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 YA16 Good Practice Recommendations That the arrangements for residents accessing the main lounge and kitchen areas overnight are reviewed and discussed with residents and their representatives in the context of residents being able to exercise choices and being able to access communal areas in the home. Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Intelligent Care DS0000069171.V365439.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!