Inspection on 15/10/08 for Island Place

This inspection was carried out on 15th October 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Island Place 21/04/09

Island Place 21/05/08

Island Place 24/04/07

Island Place 05/06/06

Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

CARE HOME ADULTS 18-65 Island Place Gooding Avenue Braunstone Leicestershire LE3 1JS Lead Inspector Chris Wroe Unannounced Inspection 15th October 2008 09:30 Island Place DS0000066589.V372873.R02.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 Island Place DS0000066589.V372873.R02.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. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Island Place Address Gooding Avenue Braunstone Leicestershire LE3 1JS 0116 2855518 0116 2855518 islandplace@prime-life.co.uk info@prime-life.co.ukwww.prime-life.co.uk Prime Life Ltd 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) Jason Reece-Sumner Care Home 36 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (36) of places Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only – Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding learning disability or dementia – Code MD The maximum number of service users who can be accommodated is 36. 21st May 2008 Date of last inspection Brief Description of the Service: Island Place is registered for up to 36 people who have mental ill health, to live in one of ten apartments in the home. Island Place is part of the Prime Life Group. Car parking is available to the front of the home and it is a ten-minute bus journey to the town centre and the nearby shopping centre, Fosse Park. The living area is located over three floors, accessed through the main reception and entrance to the home. The office, staff room, the large communal lounge and kitchen are located on the ground floor. The upper floors are accessible via the stairs or the passenger lift. Each flat accommodates either three or four people, who have their own bedroom and share a communal lounge, kitchen and dining area and two shower/ toilet facilities. During our inspection visit we were told that fees charged in the home have not changed since the last inspection. Fees begin at £298.00 and increase where someone has been assessed as needing greater levels of care. Additional charges are made for one to one care. The maximum reported fee level when we inspected was £732.00, including additional one to one charges. There are also additional costs payable for things such as transport, activities and personal items. Island Place DS0000066589.V372873.R02.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 star. This means the people who use this service experience poor quality outcomes. This key inspection included a visit to the service. We visited the home on 15th and 16th October 2008. The registered manager, Jason Reece-Sumner, Prime Life’s regional manager and staff in the home helped us during the visit. The visit started at 9.15am on 15th October and lasted for a total of thirteen and a half hours. This inspection included a check of the home’s medication systems by one of our pharmacy inspectors. As part of our inspection, we sent out surveys to the home for people who live there to fill in if they wanted to, so they could tell us what they thought about the home. We did not receive any responses. We also sent out surveys to staff, and we received one response from a member of staff. They gave us positive responses to our questions, and told us they felt well supported by the manager. They suggested that the home could improve by having a minibus so staff could arrange more group activities and outings for people who live in the home. The main method of inspection we used was ‘case tracking’. This means looking at the care given to people in different ways. The ways this was done are: • talking to the people who live in the home • talking to staff and the manager • watching how people are given support • looking at written records. We also looked at the provider (owner’s) own assessment of the services they provide, which they sent to us (called the Annual Quality Assurance Assessment – or AQAA). We spoke with five people who live in the home during our visit. People told us that they generally felt staff were good and helped them. One person told us they really liked the day staff, but weren’t so keen on the night staff. They said if they had any problems they would either go to Jason (‘he’s brilliant’), or to a member of staff who helps them a lot. We spoke to three members of staff during our visit to the home, who told us about working in the home and gave us their views. They felt very positive about working in the home, and said they felt well supported. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 6 We checked all the standards that the Commission for Social Care Inspection has decided are ‘key’ standards during this inspection. Under some sections, we may have checked additional standards – this will be detailed in the main report. The information below is based only on what we checked in this inspection. We have kept details about individual people out of the report, to make sure it is kept confidential. We have recognised in our inspection that the manager and provider have begun work to make some positive changes within the home. This means that although we found some of the same areas of concern at this inspection as last time, we will not take enforcement action at this time, but are allowing the service to have more time to continue these improvements. What the service does well: We saw that staff were friendly with people who live in the home and treated them with respect. Staff talk sensitively about people’s needs – particularly in relation to mental health. Staff are non-judgemental of people’s lifestyles. We observed that staff were involving people who live in the home in activities while we visited. People are supported to manage their money, or if they are able to, they can have control over their finances. People are supported to maintain relationships with family and friends, and to develop new relationships if they choose to. We saw that staff helped people who live in the home to make choices regarding their personal care, and communicated with them respectfully. We found staff maintain good contact with health professionals to respond to a crisis or deterioration in health. Staff we spoke with showed that they understood how important it is to keep people safe. People who live in the home told us they feel able to speak out if they have a concern. Members of staff have had training in different aspects to help them to improve their skills, including moving and handling, medication training, and first aid. People we spoke to in the home told us they felt that staff work with them well. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 7 The manager has gathered people’s views about the home by giving out questionnaires about the service, which can then be used to help make improvements. What has improved since the last inspection? There is now a clear policy for people who live in the home, which describes the rules for drinking alcohol. This means that people can be clearer about their rights. The manager has started to make improvements to care plans, making them more accurate about what the needs of each person are. There is now someone employed in the home, who is focussing on developing more activities for people. We saw that there are some new activities, like a regular coffee morning. Staff are trying to involve people who live in the home in learning more skills, for example by having a regular morning where people can help staff to prepare a cooked breakfast. There have been some improvements made in how medication is given and recorded. There is a new medication policy, to tell staff how to give out medication. One member of staff is focussing more on improving how medication is given out, and there are regular checks done to make sure the systems are safe. The manager has now begun training for staff to increase their understanding about keeping people safe from abuse and harm. The provider has brought forward an audit of the home, so that improvements can be made to the living environment. We saw that immediate repairs that are needed are now carried out promptly by maintenance staff. The manager and regional manager are working to improve the training given to staff in key areas, and there has been some training given to address gaps in knowledge. Staff we spoke to said that they felt that things had improved in the home since the last inspection. They said they felt they had more time to spend with people, and the staff team are working better together. The provider has started to be more involved in trying to make improvements in the service. We found that the management of the home is more stable than it was, and that staff feel supported by the registered manager. One Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 8 person told us the registered manager ‘helps me understand and explains [things] to me…’ Residents meetings are taking place more regularly in the home, and some people’s ideas have been used to develop new activities. What they could do better: The service still needs to make improvements in the written information that is given to people who would like to come to live there. We found there is not enough information about the kind of service people can expect, and about how the home will meet their particular needs (especially in relation to their mental health). We found that for two new people who moved into the home, assessments had not been carried out to check whether island Place was right to meet their needs. One person told us they had not received any information at all about the home, either before moving in or since. As we found at the last inspection, care plans still do not always contain all the information they should about people and about their needs. They are not being reviewed after a serious incident to make sure they contain information about how people’s needs have changed. There are not always proper risk assessments in place, to detail how people will be supported to live their lives as they choose, but be kept safe in doing so. Staff did not always show a full understanding of people’s additional needs, and did not access resources in the community to assist this. There are still gaps in how much people are being involved in opportunities for education and development. We also found that people were not being helped to develop skills that they were identified in care plans as needing – for example budgeting and other skills to help move towards independent living. Staff have limited time to support people to develop their lifestyle choices, as they have other tasks to do, such as cooking and cleaning. Many people who live in this home have a range of complex mental health needs, and there doesn’t appear to be proper ongoing attention paid to these, or respond to how people’s needs may have changed. We found that there was a lack of training amongst staff of the links between mental health and drug dependency and how these can show in people’s behaviour, and what support should be given. We found that there are still some issues about how medication is given out, and how it is recorded. This could lead to risk to people’s health and wellbeing, and improvements must be made. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 9 The service is still not fully following up all issues of concern to make sure that any risks to people’s safety are removed. There are still some areas of the home, which need attention (repair or refurbishment), as we raised at our last inspection. We found that people are smoking in communal areas in the home, which is illegal and poses a risk to the health of others in the home. We found that a completed clear Criminal Records Bureau (CRB) check has not been received regarding one member of staff, and that this person was working without proper close supervision. This could potentially put people at serious risk of harm. We made an immediate requirement for action to be taken, and the home responded quickly. Training for all staff has still not been provided to address the gaps in staff’s knowledge about important issues relating to people’s mental health. There is also a lack of training and understanding of how a dual diagnosis of mental health and drug dependency can show itself in people’s behaviour and how staff can properly support people. We still have concerns about how much time staff have to support people, since there are still issues about the level of care and support given to people. The fire evacuation risk assessment relating to people who live in the home has not been updated to reflect that some individuals have left the home and new people have come to live there. This means that it does not cover all risks for people and how to keep them safe in the event of a fire. 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. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 10 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 Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People who come to live in the home are unlikely to receive enough information to help them to make an informed choice and cannot be confident that their needs will be met. EVIDENCE: At our last inspection, in May 2008, we found that there were some gaps in the information that is given to people who are thinking about moving into the home, to help them to make a proper choice. This time, we found that some work has begun in making changes to the Statement of Purpose and Service User Guide – (the written information that tells people about the home). We saw that the provider has made sure that there has been ongoing input into the home to improve standards, and other parts of the report will describe this more. However, the information to be given to people who move into the home has still not been improved enough. The Statement of Purpose still does not give enough detail about what kinds of needs the service can meet, how someone’s mental health needs will be met, nor about links with mental health services. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 12 There is not enough information to show how the provider has developed links with the wider community to ensure that people who live in the home can become part of the local community, without fear of prejudice. Within the home, people who need more support from staff and a greater input of care live in the ground floor and first floor flats, and mainly have all their meals cooked by staff. The second and third floor flats are for more independent residents who require less input from staff. This is still not set out in information in the Statement of Purpose or the Service User Guide. There was also nothing to show us, for new people who had come to live in the home since that last inspection, about what their decided level of staff support/independence was. The provider’s representative told us that the Statement of Purpose and Service User Guide would be completed within two weeks of our visit. At our last inspection, we found that some members of staff did not have a strong understanding about mental health and people’s needs in relation to this. We made a requirement that the home should provide more training for staff in mental health. We talked more with staff about their understanding of mental health this time. One member of staff was especially able to show us she had good understanding of people’s needs, and of what was important to them in relation to their mental health. We saw that an in-house lecture has also been given to four other members of staff, and that improvements have begun. However, given other issues highlighted elsewhere in this report, relating to people’s care, we have found that there is still a gap in training in mental health. We looked at care records, spoke with people who live in the home, and spoke with the manager and staff. We found that for two new people who have moved into the home, assessments had not been carried out, either before they moved into the home or since. Because of this, the home could not show how they had made sure that they were the right service to provide care and support for each of those people. One person we spoke to told us they felt the staff had given them good support on moving to Island Place and that they liked having a flat to themselves. Another person told us that they felt quite isolated in the home, although again they felt the staff were good. They told us they had not received any information about the home before they moved in, nor anything since. Since our last inspection, the home has brought in a new policy, which makes clear for people whether they are allowed to drink alcohol in the home, and sets out the rules relating to this. This is a good improvement. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People who live in this home are placed at risk through lack of appropriate care plans, risk assessments and inadequate care. EVIDENCE: We looked at care plans and risk assessments for people whose care we were tracking. In our last inspection, we found that while there were care plans, these had sometimes not been reviewed for a long time. This was mainly of concern to us where there had been serious incidents relating to individuals, which might change their care needs and what kind of support should be given. This time, we found that the home is starting to try to make improvements to care plans. The manager and regional manager told us how they are trying to focus more on what is important for each individual. They have begun writing new care plans for some people who live in the home, and this is the start of an improvement. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 14 However, these improvements have only just begun to happen and we found examples where there was still not a proper review of care plans. We found again that staff had not reviewed care plans when something had happened which was very significant to someone, and which could mean a change in their needs and in the way care was given to them. We also found again that there were not always risk assessments in place, even where issues of particular concern had been recognised. (Risk assessments tell about whether there are any issues of concern relating to people, and how the staff can keep them safe whilst still encouraging them to be independent.) Staff we spoke to told us that they have more time to spend with people who live in the home now, because there are some more staff working in the home. This is an improvement. However, we still found that people’s needs were not being properly met or monitored – and that in some cases this could put them at risk of their mental health deteriorating. The manager said that care staff still have to spend a lot of time doing cleaning and cooking, because there are no extra staff employed to do these jobs. He explained that he and the staff are trying to focus more on people’s needs, including those of people who are more independent. The manager acknowledged that people who are more independent still need help to develop skills, such as cooking, and budgeting, and he confirmed that staff still do not really have time to give this kind of support, because of the other tasks they have to do. We saw during our visit that staff were friendly with people who live in the home and treated people with respect. When we spoke to staff they also talked respectfully about people who live in the home, and about their needs, particularly relating to their mental health. We did find that there was not always a full understanding or awareness of how to give good support where an additional need was identified, such as gender identity. Staff had not accessed support from community resources, and we talked with the manager about ways this could be improved. However, staff did show sensitivity and were non-judgemental of people’s ways of living. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 15 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, 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. While there has been some improvement in the service offered, people who live in this home cannot yet expect to experience a good lifestyle, and lack sufficient support to participate in opportunities or develop skills. EVIDENCE: At our last inspection, we found that there was very little on offer to people in the way of activities and opportunities. This time we found there has been some improvement. One member of staff is now focussing some of her time specifically on organising more activities. After suggestions from people who live in the home, there is now a regular coffee morning for staff and people who live in the home to get together. Other events have been organised for people to get involved in. Staff are trying to involve people in developing skills – for example to take charge of making tea once a week (with staff support), and to join staff in preparing a cooked breakfast once a week. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 16 Members of staff told us about other activities that have been happening, for example, a trip to Rutland Water, and a fete. Staff did say that there are some limits about what can be offered because the home does not have its own transport. At the moment taxis are used, and staff told us they feel that if the home had its own transport they could be more spontaneous in offering activities to bigger groups of people. While we were visiting the home we saw that a game of cards was taking place in the communal lounge between staff and people who live in the home. This was relaxed and the people taking part in the game looked like they were enjoying themselves. We did find that there were still gaps in how much people are being involved in opportunities for education and development. We found that people were not being helped to develop skills that they were identified in care plans as needing – for example budgeting and other skills to help move towards independent living. There are different resources in the locality around the home that are not being accessed by people at the moment – such as libraries with internet access, and community and leisure centres, and staff could look at how to support people more in doing this. We also found that staff have limited understanding about how to support people in relation to diversity needs – and do not know about local resources where people could find support – which would then promote better mental health. There are no specific cooking or cleaning staff employed in the home, and care staff are do the cooking and cleaning. This means that they have limited time to look at people’s other needs. Staff told us that people who live in the home are able to have ongoing relationships with friends and family, and we saw information about this in written records too. People are also able to develop relationships within the home. We saw that there was an open and positive atmosphere in the home. One member of staff we spoke with said there had been a big improvement in the home since the last inspection. They said “staff have been working more together and people are getting on with each other.” We saw records to show how staff support people to look after their money in the home. Some people manage their own money, and some have allowances paid to them regularly. Staff keep receipts when they spend money on someone’s behalf. Whilst some people who live in the home are now having involvement in preparing some meals, care staff still do all of the cooking for people who do not cater for themselves. We found that staff are still not monitoring people’s diet where a concern has been identified in their care plans. There is not a focus on healthy eating – and staff have not had specific training about this (this is the kind of knowledge that is usually held by a cook in a care home). Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 17 This means that staff are not addressing the dietary needs of people who live in the home, particularly in relation to promoting their mental health and wellbeing. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People who live in this home cannot be confident that their health needs will be met in full, and may be at risk. EVIDENCE: We saw during our visit to the home that all staff were caring towards people living at Island Place, and respected their individual needs and wishes. We saw that they helped people to make choices and communicated with them respectfully. We found that there was some good practice in meeting people’s care needs in the home. We saw examples where staff alerted social workers, GPs and other health professionals where they noted that someone’s mental health was deteriorating. The manager told us that he felt the home has a good working relationship with other healthcare professionals. We saw that people were supported to attend appointments, and to maintain their health – for example being given support to get a flu vaccination. One person who lives in the home Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 19 told us about how they are supported by community nurses, who come in daily to the home. However, we did have concerns that in some cases, proper attention was not being given to people’s health needs. We saw at our last inspection that there was not always a proper review of care plans – and we found the same at this inspection. For example for one person, there had been quite significant changes in their mental health, and this had not been looked at in relation to the kind of care they might need and how staff should support them. This meant there was still an ongoing risk to their health and wellbeing. Also where care plans did state particular health needs, staff had not followed these up. Many people who live in this home have a range of complex mental health needs, and there doesn’t appear to be proper ongoing attention paid to these. In addition to this, there are some people who live in the home who have drug dependencies. We found that there was a lack of training amongst staff of the links between mental health and drug dependency and how these can show in people’s behaviour. For example, for one person, whilst there were some attempts to enable them to be safe in their drug use, there was nothing to show us that this was done with the support or authorisation of the wider care team (including social workers, GP, psychiatrist) or what the aims of the support were. Since our last key inspection, we have done two smaller inspections looking specifically at medication. Since the last time we visited, there have been some improvements made. The system for recording how much medication is in the home has improved. The homes medicine policy has been reviewed and up-dated. Monitoring sheets are completed daily for people who deal with their own medication. The amount of medication given to someone who is selfmedicating is recorded, with the date of handover. We spoke to someone who deals with their own medication, and they told us about safety checks that are in place. We found medicines were locked away as they should be. Every month, a detailed check of medication is done. There are now systems to help ensure that medicines are re-ordered in good time and are always in stock when needed by service users. The manager told us that their supplier chemist, Brennans, will be providing them with a controlled drugs storage cabinet which meets new legal requirements. Even though there were some improvements, we found some issues regarding medication. There are still improvements which need to be made, and we will take enforcement action if the home does not make more improvements before we next inspect. These are some of the issues we found: For one person whose care we looked at, we found they were dealing with one of their medicines themselves. But there was no written agreement about this and no risk assessment to make sure they were doing this safely. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 20 Some details of medicines prescribed were handwritten on recording sheets by staff at the home. But these handwritten entries were not signed by the member of staff - this is necessary to ensure accountability. In one case, this meant that the amount of medication being given, and stated on the bottle, was different to the handwritten information about how much should be given. This could create a risk to someone’s health. In two other cases, we found the dose of medication given was different to what was written on the records. Staff told us this was because changes had been requested by the consultant, or by the person themselves who took the medication. There was no written instruction about these changes, to show that the staff were giving the right amount of medication – again this could cause a risk to people. We also found that the medication policy did not include information about how to manage medicines which were to be given ‘as required’ for people who deal with their own medication. For one person who dealt with their own medication, they were given loose unlabelled strips of the medicines, which were for use ‘when required’. Some updating of information is needed to make sure it is current – such as staff signatures, and medical reference books. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who live in the home are partly protected from risk of harm. EVIDENCE: We found that there have been some improvements in this area since the last inspection. The manager has now begun training for staff to increase their understanding about keeping people safe from abuse and harm. Staff we spoke with showed that they understood how important it is to keep people safe, and understood how they should do this. People who live in the home told they feel able to speak to the manager or to staff if they have a concern. However, we did find that the home is still not fully following up all serious incidents concerning people who live in the home. An issue of concern was picked up by a health professional, who visited the home, and the local social services department is now investigating this. Even following this, staff have not put a risk assessment in place to make sure that all staff are aware of the risks and how to keep vulnerable people who live in the home safe from harm. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who live in this home are not guaranteed to be living in a comfortable and safe environment. EVIDENCE: There are ten flats in the home. Each flat has a living room, kitchen and shower rooms and toilets, and is shared by three or four people. Everyone who lives in the home has their own bedroom. We looked around at parts of the home, including two flats and two individual bedrooms, at people’s invitation. They told us that they felt they had what they needed in their rooms and were satisfied with them. We did not see everyone’s living accommodation during our visit. We saw that the home is spacious and bright and airy throughout. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 23 There were some issues we raised at our last inspection that had not been addressed. We saw that there are still some bad stains on the carpets in some shared areas, and some damaged furniture. But we learnt that the provider has brought forward the annual audit of the home environment, and would be doing it in the week following our visit to the home. The manager has requested that a number of items be replaced and repaired. As at our last inspection, we found that there are showers available to people who live in the home, but no baths. CCTV cameras are in place covering the entrance and surrounds of the building, and all staircases. Staff carry keys around for various parts of the building which are locked, such as the main kitchen, and offices, but people who live in the home are enabled to have free access into and out of the home. The manager told us that there are plans to put in a more secure entry system. The new smoking laws mean that the home has had to put in rules about where people may smoke. There is a covered area outside where people may smoke, and they may also smoke in their bedrooms. One person spoke to us about their concern that people smoke within communal areas in the home – and we found in one shared lounge that there were cigarette butts on the floor, showing that people had been smoking. This is illegal and a risk to health. We saw the laundry facilities in the home, which we found were satisfactory. Care staff keep keys to the laundry, which is kept locked. We learn that the fire service had carried out a fire safety inspection in the home in July 2008. Requirements were made at the inspection, and the Registered Manager said these had been actioned. We found that other safety checks have been carried out in the home since the last inspection. We also saw that any maintenance requirements are recorded in the maintenance logbook. These are dealt with on a weekly basis. There was one maintenance requirement in the book on the day we visited, and this was dealt with on the day, as the maintenance workers were at the service. The workers were respectful of the people living at the home, and checked that it was okay to go into the service user’s bedroom before entering. There is a 24-hour on-call system if there are emergencies. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People who live in this home are not sufficiently protected by the home’s staffing policies and practices EVIDENCE: We looked at the recruitment and training records for a sample of five members of staff who are employed to work in the home. We found that the required safety checks have been made for most staff. But we saw that a completed clear Criminal Records Bureau (CRB) check has not been received regarding one member of staff. CRB checks should be received before people start to work in the home. In exceptional circumstances, if this cannot be done, someone may start work, if they work with another member of staff alongside them at all times, and without access on their own to people who live in the home. We found that these sorts of safety arrangements had not been put in place. This could potentially put people at serious risk of harm. We made an immediate requirement for action to be taken, and the home responded quickly. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 25 We talked to staff about training and saw training certificates for staff. The staff records we checked showed that members of staff have had training in different aspects to help them to improve their skills, including moving and handling, medication training, and first aid. There has been some training provided since our last inspection, including a talk for two members of staff about mental health. But training has still not been provided to all staff, to address the gaps in staff’s knowledge about important issues relating to people’s mental health. Many people who live in the home have a range of complex mental health needs, and there does not appear to be training available to look at how these needs can be effectively managed. A significant minority of people living in the home have drug dependencies. Again there is a lack of training and understanding of how a dual diagnosis of mental health and drug dependency can show itself in people’s behaviour and how staff can properly support people. Staff we spoke to said that they felt that things had improved in the home since the last inspection. They said they felt they had more time to spend with people. One member of staff told us it was her responsibility to work mainly on improving systems on giving out and recording medication, since this was an important issue that needed looking at after the last inspection. Another member of staff has been given responsibility for organising more activities for people who live in the home. While this is an improvement, we found that there are still gaps in how staff follow care plans, to make sure people’s needs are met – and this means that we still question how much time staff have to support people. One member of staff told us they felt the relationships, which staff have with people who live in the home, are good. They said that the staff team work more together and people get on with each other more. People we spoke to, who live in the home, told us that they felt comfortable with the staff in the home. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who live in the home are beginning to benefit from some improvements in management. EVIDENCE: We found that since our last inspection, the provider has started to be more involved in trying to make improvements in the service. The regional manager comes out to the home regularly to check how things are going and to help to take improvements forward. We found that the management of the home is more stable than it was, and that staff feel supported by the registered manager. One person told us the registered manager ‘helps me understand and explains [things] to me…’ The manager and regional manager have taken Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 27 on board the issues raised at the last inspection, and have begun the process of change to provide a better service for people who live at the home. Residents meetings are taking place in the home, and some people’s ideas have been used to develop new activities. Staff meetings are also being held. The manager has given questionnaires to some people who live in the home to find out their views, and there are plans to do this more. We saw a poster on the wall from an old audit carried out by Prime Life (the provider), which could be misleading because it does not relate to the current service. We did not see a copy of our inspection report available for people to read. Staff are receiving training in different aspects to help them to work safely, including fire safety. Fire evacuations have been carried out since the last inspection, and records show that the alarms are tested once a month. The fire evacuation risk assessment relating to people who live in the home has not been updated to reflect that some individuals have left the home and new people have come to live there. This means that it does not cover all risks for people and how to keep them safe in the event of a fire. Checks are carried out to make sure equipment is safe. Training has begun in the home in topics such as infection control, but this still needs to be completed. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 28 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 1 2 2 3 X 4 1 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 3 X 3 X X 2 X Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 29 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 YA1 Regulation 4(1) Requirement The provider must ensure that the Statement of Purpose contains full information about the aims and objectives of the home and the facilities and services to be provided, in order that people can make a choice about where to live. This is an outstanding requirement since the last key inspection. The provider must ensure that an assessment is carried out for every person who comes to live in the home, so that a proper decision can be made about whether the home is able to meet people’s needs. The provider must ensure that the specialist mental health service offered by the home is based on good practice and reflects specialist and clinical guidance – and specifically that staff are trained in mental health. This is to ensure that people’s mental health needs are met. This is an outstanding DS0000066589.V372873.R02.S.doc Timescale for action 31/12/08 2. YA2 14(1) 10/12/08 3. YA3 12(1) 28/02/09 Island Place Version 5.2 Page 30 4. YA6 15(2) 5. YA7 12(1) 6. YA9 13(4) 7. YA20 13 (2) 8. YA34 19 (1) requirement since the last key inspection. The provider must ensure that individual care plans are updated to reflect changing needs, to ensure people are given the current care they need. This is an outstanding requirement since the last key inspection. The provider must ensure that care staff implement the actions identified in care plans to meet the needs of people who live in the home (including monitoring of physical and mental health) to promote their health and wellbeing. This is an outstanding requirement since the last key inspection. The provider must ensure that risk assessments are in place for each person living in the home, so that people are able to do things they would like to but are kept safe. This is an outstanding requirement since the last inspection. The provider must ensure that medication is administered according to the prescribers instructions, to manage individual health needs. The registered person must ensure that the homes systems of communication and documentation protect people taking medication. This is an outstanding requirement since the last inspection. The provider must not employ a person to work unsupervised in the home unless full Criminal Records Bureau enhanced disclosure has been obtained. DS0000066589.V372873.R02.S.doc 31/12/08 31/12/08 10/12/08 10/12/08 15/10/08 Island Place Version 5.2 Page 31 9. YA42 23(4) 10. YA42 13(4) The provider must ensure that there is a fire risk assessment in place, which relates to the current group of people who live in the home. The provider must ensure that the requirements of legislation relating to smoking in the home are properly enforced, to ensure the health and safety of people. 10/12/08 10/12/08 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 YA20 Good Practice Recommendations It is recommended that the provider makes the following improvements: Ask the pharmacy to include a description on the labels of MDS packs containing more than one medicine, so that each tablet or capsule can be identified. Obtain an up to date copy of the British National Formulary (BNF), which gives information about medication. Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Island Place DS0000066589.V372873.R02.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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