Inspection on 21/05/08 for Island Place

This inspection was carried out on 21st May 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 23 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 15/10/08

Island Place 24/04/07

Island Place 05/06/06

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOME ADULTS 18-65 Island Place Gooding Avenue Braunstone Leicestershire LE3 1JS Lead Inspector Chris Wroe Unannounced Inspection 21st May 2008 12:30 Island Place DS0000066589.V364833.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.V364833.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.V364833.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.V364833.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. 24th April 2007 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 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.V364833.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 21st May 2008, 27th May 2008 and 28th May 2008. The registered manager, Jason Reece-Sumner, and staff in the home helped us during the visit. The visit started at 12.30pm on 21st May and lasted in total for seventeen and a half hours. This inspection included an audit of the home’s medication systems by one of our pharmacy inspectors. As part of our inspection, we sent out surveys to a sample of ten people who live in the home, to get their views about the home. We received four completed surveys. Their comments were mostly positive. One person said they felt they were: “well looked after. Come and go as I please.” People stated that they were able to do what they want to, and that the staff treat them well. We also sent out surveys to staff, and received two responses from members of staff. They gave us mostly positive responses to our questions, telling us they received training (although one told us their National Vocational Qualification training was ‘on hold’), and that they got support from the manager. They both suggested that the home could improve by arranging more activities and outings for people who live in the home. One also said that communication between staff could improve, but that they were working on that. We sent surveys to other professionals involved with the home, like GPs, consultants and social workers. We received one reply. That person gave us mostly positive answers to our questions about the home. In response to our question about how the service responded if they raised concerns about someone’s care, they commented: “I feel that this is one of the strengths of the home/staff”. They also commented: “I think the staff manage and monitor the residents well… I think the staff at island Place do an excellent job… I would use their service/home again if ever I needed to.” They did suggest some improvement: “I think that the new members of staff (plus some of the existing ones) should be encouraged to attend training events/courses” 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 Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 6 • 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 nine people who live in the home during our visit. We got some different views about the home to the things we were told in the surveys. One person told us they like living in the home and they “would be happy to live here till I die”. Three other people told us briefly that the home was okay for them. But other people had different views. One person said “I hate it here. It’s just boring. There’s nothing to do.” Another person expressed the same view, that there was nothing to do, and said that they did not feel safe in the home. There was a general view, expressed by people we spoke to, that staff did not have time to spend with them or do things with them. Another person said that they did not like it when people ‘kick off’ in the home, and that they did not feel safe. We spoke to four members of staff during our visit to the home, who told us about working in the home and gave us their views – some of the things they told us gave us some cause for concern. Their comments are included below in the summary and in the main report. 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. What the service does well: The service has prepared some information about the home for people who would like to live there. It is written in plain language, with pictures and gives information about the Prime Life group of homes. People who come to live in the home are able to come on a trial basis, to see if the home meets their needs. People who live in the home told us that staff are caring and mostly treat them well. We saw that staff were friendly and supportive towards people who live in the home. Staff keep daily records about how people are in the home. People were able to be independent in the home and to come and go as they please. Some people have control over their own money. For some people, Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 7 the home handles their benefits for them, and people are then able to have choice about how they spend their money. Staff cater for some people who live in the home, whilst others do most of their cooking for themselves. Those who self-cater are given an allowance for food each week, and may also have other supplies of staple items from the main kitchen. Staff assist people who need support with attending appointments. Staff have involvement with other professionals who are involved with people’s care, such as social workers or GPs. Medication trolleys were well kept and we saw that staff mainly gave medication to people in a dignified way. People told us they felt able to raise any concerns or complaints they have with staff or with the manager. The home is generally spacious, bright and airy. Each person has their own bedroom and is able to personalise it. Staff recruitment is mainly good; with proper checks carried out to make sure staff are employed who have the right skills or experience. People told us that they found the manager to be approachable. What has improved since the last inspection? What they could do better: We found that there were some aspects of the service, which have declined since our last inspection. During our visit, we had to make some immediate requirements for action by the Manager relating to four issues we found, and to make referrals to the local Social Services department to safeguard people living in the home. There are quite a number of areas in which the service could do better, including the following: There is not enough information provided to people who are coming to live in the home about the home itself – mainly about the kind of service people can Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 8 expect, and about how the home will meet their particular needs (especially in relation to their mental health). Some of the rules of living in the home are not made clear in the terms and conditions. Although there are care plans, these do not always contain all the information they should about people and about their needs. They are not being reviewed regularly enough to be sure that they are current. There are not 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. Sometimes this means that people are put at risk. One member of staff told us “Some people need more than what they’re getting here – one to one, more personal care – it’s not set out enough what you need to do for people.” Whilst people are left to make their own choices and do what they want to do, this is not always what they need. Most people we talked to said that although staff treated them well, they did not have time to support them properly or do things with them – and the main explanation given was because staff spend their time cooking and cleaning. Staff also said to us that they had little time to spend with people, because they were so busy with other tasks. This meant that we found that people have a poor lifestyle in the home. We found that there was little monitoring of people’s physical and mental health needs as was set out in care plans. Sometimes there was a lack of information being passed on to other professionals who were involved in people’s care. In other instances, we found that staff were doing things differently to what had been set out by other professionals. There were a number of serious issues relating to the administration of medication, which could put people at risk of harm. The service must report to the Commission for Social Care Inspection about serious issues, which could affect the welfare of people living in the home, and we found that this was not being done. Staff had not all been trained in how to protect people from harm, and one member of staff spoke themselves about feeling unsafe. We were told by people who live in the home and by staff and the manager, about lack of safety in the local neighbourhood and incidents and an assault, which had taken place against people living in the home. Staff expressed concern that the home was not as secure as it should be. One member of staff told us: “Security-wise it is difficult, people come and go as they please, people come in to see people, we don’t know who they are”. All this contributed to our view that people living in the home are not fully safeguarded from potential harm or abuse. There are a number of repairs and improvements, which could be made to the home, which would improve the environment for people who live there, and so benefit their health and wellbeing. We found that there were some crucial gaps in staff training, which meant that staff were not able to fully meet the needs of people living in the home, or keep them safe: not all staff had receive fire safety training, nor were aware of Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 9 procedures. Whilst staff have received a booklet about mental health to give them some training about the subject, they were not aware of key issues of importance in caring for people who have mental ill health. Staff have a lot of additional tasks to do as well as caring for people who live in the home. The service was unable to provide us with evidence that a Criminal Records Bureau check had been carried out for one member of staff – this is one of the main ways in which the safety of staff in care services is checked. Because the staff in the home are not properly trained in all relevant aspects (particularly mental health) and the systems are not in place to ensure the safety of service users or the proper support of staff and the manager, we have to find that the overall management of the home does not provide a well run home for people who live there. 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.V364833.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.V364833.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, 3, 4, 5 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: We saw the home’s Statement of Purpose, which gives information about the home and staff. We also saw the Service User Guide, which is information that is given to people who want to come and live in the home. This is written in plain English, with pictures, making it attractive and easy to read, which is helpful. But the Service User Guide is more about the Prime Life group of homes generally, rather than Island Place, and it did not contain some important information specifically about living in this home. The Statement of Purpose should contain information to help people understand what the service offers and make an informed choice about whether they want to live in the home. We found that the Statement of Purpose 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 local community mental health teams, and other mental health services. Island Place DS0000066589.V364833.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. We were told by members of staff and by people who live in the home, that the local neighbourhood is not friendly towards the home. One staff member said ‘the local area is not good… the people who live here are afraid of outsiders – sometimes we have to escort some of them’. We were told about some bad experiences people who live in the home had had in the neighbourhood. The Statement of Purpose or Service User Guide do not describe how the provider works with the neighbouring community to provide a safe environment for people who live in the home. The manager told us about the set-up within the home – that 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 much less input from staff. Again, this is not set out at all in information in the Statement of Purpose or the Service User Guide. There was nothing to show us, in assessments or in care plans for people who live in the home, about what their decided level of staff support/independence was, and no evidence in the terms and conditions held in their files. In the surveys we received from people, two people said they had received enough information about the home before they moved in, and two said they could not remember. One person we spoke to during our visit said they had not received any information about the home before they moved in, and had not received anything since. People can come to stay for a trial period, to see whether the home is right for them. During our visit to the home we saw that one person was having an assessment for a move to a different home, because Island Place was found to be not right for their needs during their three-month trial period. We saw written assessments, which were done when people came to live in the home. The manager carries out assessments for people who might like to come and live in the home, to find out about their care needs and whether the staff will be able to support them. We found that assessments did not always contain all information that would be relevant relating to someone’s care needs or any risks to them or others. We saw that information from other professionals was available – such as assessments by Social Services and Care Programme Approach (multi agency mental health support) records. We saw training records and talked to staff. Staff have some training to help them to learn how to support people who live in the home in the ways they might need – examples include first aid, moving and handling, medication training. But staff have had limited training in mental health and how to support people who experience mental illness. Members of staff told us they Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 13 received a booklet about mental health, to work through on their own. Whilst some staff said this was helpful, one member of staff said it would have been helpful to have gone through the booklet with a manager. When we talked with staff, they did not have an understanding of some important aspects of mental health legislation and practice, which impact on the care of people who live in the home, such as aftercare under section 117 of the Mental Health Act 1983 or the important elements of the Mental Capacity Act 2005. There is also no mention of these important aspects in the Statement of Purpose or Service User Guide. Given the outcomes for people who use this service, as detailed further in this report, the lack of training for staff is a concern. We saw only blank unsigned copies of contracts in the care files of each person who we case tracked. The manager was not able to tell us whether there were signed copies held anywhere. The provider contacted us following the inspection to explain that the manager keeps sample documents for people who live in the home to show them the nature of the terms and conditions, because sometimes the authorities are slow in producing people’s contracts of occupancy. The provider explained that once the placements have been agreed, the person living in the home does get a copy. We found that the terms and conditions contradicted working practices within the home regarding the drinking of alcohol. For example, the terms and conditions stated: ‘Residents have the right to choose whether and how much alcohol they may consume with consideration to their medication and other residents within the home.’ However, we learnt from the manager and staff that the current rule in the home is that no alcohol is allowed on premises, and that residents may drink only up to two units per day in the garden (this is not contained within individual care plans or risk assessments, nor in the Statement of Purpose or Service User Guide). Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 14 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 the people whose care we were tracking. We found that while there were care plans, these had not been reviewed since the end of 2007 (and in some cases earlier), even where there had been serious incidents of concern relating to individuals, which impacted on their care needs. There was no evidence to show that people were involved in preparing their own care plans or were given a choice about this – although one person we talked to said they were aware of their care plans and that daily records were written about them, and that they did not want to be involved. Care staff do write daily records about people who live in the home, although these do not always tie in with care plans. A number of entries for two files we looked at said that the individuals had ‘not been seen’ for whole days – which Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 15 went against instructions in care plans to monitor their well-being (and one of these related to someone who staff were supposed to be checking at night, due to a serious incident which had just happened affecting their health and wellbeing). Care staff record any incidents that happen which affect people who live in the home – although in one case we saw that there was quite a serious contradiction in the account written by two different members of staff of an incident concerning someone living in the home, and that the manager had not looked into this further – nor at the potential risks involved. We looked at risk assessments, which tell about whether there are any issues of concern relating to people and how the staff can keep them safe whilst still encouraging independence. We saw that there were some risk assessments in some cases, but that there were not risk assessments for some people regarding aspects which were of particular concern – for example risk of self harm or suicide, risk of harm from others or harm to other people. We became aware during the inspection that there were ongoing serious concerns affecting the safety of some people living in the home, so we made an immediate requirement for action, and made a referral to the Social Services Department under safeguarding procedures. After the inspection, these issues were addressed by the provider without delay. In the surveys we received, people indicated that they felt the staff treated them well, and that they could choose what they wanted to do. One person said they felt “well looked after”. People are enabled to have independence, in that they can come and go as they wish, and do what they want in the day. However this does always not tie in with their care needs or with particular aspects of risk. People we talked to who live in the home told us that staff do not have enough time to spend with them to support them. One person said: “Staff don’t do things with me because they are too busy”. Another person said: “The care staff are really good – only problem is that they don’t have enough time to spend with us”. We saw during our visit that staff were friendly with people who live in the home and were aiming to be supportive. Staff we spoke with also told us that they did not have enough time to spend with people to support them, and said this was mainly because they have to do cleaning and cooking also. (There are no cooks or cleaners employed in the home). One member of staff told us they felt that people who live in the home were not well supported: “Some people need more than what they’re getting here – one to one, more personal care – it’s not set out enough what you need to do for people.” Two members of staff we spoke with were not very clear about the specific mental health needs of individuals and what kind of support they needed as a result. Whilst care plans referred to one individual needing support to make sure they ate a healthy diet, and another needing staff to monitor their alcohol intake, there was nothing to show us that these issues were being followed up by staff. On the other hand, staff showed good awareness of some aspects relating to Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 16 people’s needs and risks to their safety, which were then not fully detailed in care plans and risk assessments. Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 17 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 poor This judgement has been made using available evidence including a visit to this service. People who live in this home do not experience a good lifestyle and lack sufficient support to participate in activities or develop skills. EVIDENCE: During our inspection, we heard mixed views about the home. One person told us they wanted to stay there forever, and we heard from others that they were satisfied with the home. But we did keep hearing the same thing from people we talked to – that they would like more involvement of staff, but staff do not have time. One person said: “I go out to town, go for a bevy, staff come occasionally but not often, no time”. One person showed us some paintings that they had done while in hospital. They said to us: “They do nothing here. Tell them to do something – painting or things with hands.” Another told us that one carer bought them a craft to do. They told us the member of staff said they “will do it sometime - but they’re so busy doing Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 18 cooking and cleaning, [I] don’t know when they will have time”. One other person told us “I hate it here. It’s just boring, there’s nothing to do.” When we looked at care plans we did not find evidence of specific activities to engage service users in, nor interests. There was no evidence, regarding those people whose care we tracked, of people being involved in employment or voluntary opportunities, hobbies, or college courses. Staff we talked to also told us that people living in the home could benefit from more activities, and two members of staff who filled in our surveys said this too. One person told us they get £20 a week, and told us about their favourite fast food place where they like to eat. They told us they catch the bus to town and back. We saw from records that people get visitors in the home or can go out to see friends and family. People are able to go to church or worship as they choose. People have keys to their own bedrooms. In the home there is a pool table, football table and games. A fete has been held at the home, but otherwise we were told that there are few activities or outings, and no holidays. We were told that people may see visitors in their own flats – although we then saw in someone’s care file about a rule in the home that people may not have members of the opposite sex in their bedrooms. This is again not written in the Statement of Purpose, or Service User Guide, and is not based on individual risk assessments for each person. It also makes assumptions that relationships and/or risks to safety only come with regard to the opposite sex. Some people who live in the home manage their money independently. Some people have their benefits given out to them on a weekly basis by staff at the home. We saw records to show monies coming in and out of the home for people. We found that independence is enabled in the home, in that people are left to their own devices - but saw also that this does not always reflect the risks to them. We saw that people have free access into and out of the home. One member of staff told us: “Security-wise it is difficult, people come and go as they please, people come in to see people, we don’t know who they are”. The manager, staff and people living in the home told us about some problems in the neighbourhood from locals – and said that sometimes the local area is not very safe for people who live in the home. This is not detailed in care plans or risk assessments. Alcohol dependency is an issue for some people in the home – and there is currently a blanket ban on alcohol in the home – but people are not monitored or supported as care plans would require. The home receives additional funding for some people to have individual one to one support for a number of hours per week. Staff told us there is less time Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 19 for individual support for people generally, because they have to do cooking and cleaning and give out medication. Some people who live in the home cook for themselves. Care staff do the cooking in the home for those who do not self-cater, and one member of staff told us that on Sundays, they cook for everyone in the home. People we spoke with said the food that staff cook is good, and we saw that portions were a good size. People who do their own cooking get £21 per week from Prime Life – this is paid to them weekly - and they are also able to freely access, from the main kitchen, potatoes, pasta, rice, vegetables, sugar, tea, coffee, milk, bread, margarine, and fresh fruit. Whilst care plans for some people living in the home indicate that their diet should be monitored, staff told us and we saw from records that this is not carried out. Regarding one person, who has their meals provided, their care plan said “Staff to ensure [person] has a healthy diet and choice”. However, one member of staff told us that this person “orders burgers, fried eggs, fried food every day – if [they] ask for it we cook it… I think it is not a healthy diet”. For those people who cater for themselves, staff said they do not check what they have eaten – which again contradicts care plans, in which it says that staff are to monitor healthy eating and support people to prepare healthy meals. We found a lack of certainty about cultural needs – one staff member was unsure about whether people had particular dietary wishes or requirements, where they were known to hold religious beliefs. Staff confirmed that they do cater for vegetarian and dairy-free diets. Staff told us that sharp knives are not allowed in individual kitchens. If anyone wants to use a sharp knife to prepare something, they have to bring the food to the main kitchen and cut it there. We only found a risk assessment relating to this for one person, and this restriction is not mentioned in the Service User Guide. Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 20 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. The personal and healthcare support needs of people who live in the home are not sufficiently met, and medication practices and processes are unsafe, putting people at risk. EVIDENCE: We saw from care records and learnt from discussion with care staff and people who live in the home, that people are supported to make health appointments if they need to. Staff attend appointments with people if they wish it. We saw from care records that the home works alongside other professionals to support people. One professional person who filled in one of our surveys commented, in response to a question about how well the home follow up any concerns raised with them: “I feel that this is one of the strengths of the home/staff”. A community psychiatric nurse was visiting one person on the day we inspected, as part of their Care Programme Approach (CPA) and aftercare from hospital. We saw records from CPA meetings and reviews. We Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 21 also saw records in care plans showing that staff did communicate with social workers and other professionals. However, we were concerned that some decisions from CPA reviews were not being followed, and that information was not being fully passed back by the home to other agencies. We made an immediate requirement for action by the home and a safeguarding referral to the Social Services department regarding one issue of concern. The provider reported to us that this was followed up promptly. One person’s physical health care plan stated ‘does not eat well – missing meals’ – and noted that staff were to weigh the person monthly. We saw from records that this care plan instruction was not followed consistently - there were gaps in recording weight, and nothing to show whether there was any follow-up where weight loss was noted, or to say whether it was significant. We found there was a lack of monitoring of other highlighted issues, such as alcohol intake, emotional/mental health and use of drugs. During the medication audit carried out by our pharmacy inspector, we looked at the care plans for the people we “case tracked,” we saw where medicines are kept and looked at what medicines are left for people in the home to selfadminister. Medicines kept in the medicine rooms and trolleys were generally clean and tidy. We observed how medication was given out during the medicines round, which was done well, with staff taking time to administer medicines with a drink in a dignified way. However, we found a number of concerns relating to medication, including the following: We found that one person was administering their own medication and keeping it in their room, without a risk assessment being in place, and despite recent related concerns about their health and safety. This person was telling us themselves that they felt this was a danger to them. We made an immediate requirement for action regarding this, and the provider took prompt action to put this right. We found further examples where there were not satisfactory risk assessments in place and people were left to manage their own medication without proper attention to the risks to them. We found that there was not consistent practice relating to medication for occasional use ‘when required’. Staff told us that these medicines are normally kept in the trolley and given by staff when needed. However, for one person, we could not find the ‘when required’ medication. We were informed by staff and by the person themselves that a full supply of a medicine had been given to them to take when required. The person told us that they had finished the tablets ages ago. In another instance, there was not a clear account in records about why someone had been given ‘when required’ sedating medicine to calm them down – in fact, we saw that daily records indicated on two occasions that the person was fine. Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 22 When we were invited to see the bedrooms of two people who live in the home, we found medication lying around, unsecured. This is a safety risk. We made an immediate requirement for action regarding this. The provider told us that staff acted quickly to put things right. We observed other instances in which medicines were kept in the rooms of people in an unsafe manner. Staff were not aware of any system about when and how ensure that people were taking their medicines safely. We saw some examples of medication cassettes where we found that blister seals for medicines, due to be taken later that night and the next day, had already been popped open. Other people had taken medicines before their due time. We also found medicine stored in the drug trolley, when the record had been signed by staff to say that the person had received it. We found that there were homely remedies in use (medicines which can be taken without prescription), but no policy relating to their use, or their safety for different individuals. We saw a member of staff giving medication to someone who lives in the home to calm her, but the member of staff did not watch the person take it, or write it down on a record, thereby creating a risk. We told the member of staff what we had seen and they corrected it straight away. We found that handwritten instructions on record sheets were not complete, and did not give full details about how medication should be taken. Instructions from the GP were not clear in all cases, and there was insufficient detail about people’s allergies. We saw that one person who was to receive antipsychotic injections every two weeks was overdue their appointment. We also found that controlled drugs were not being stored securely enough, according to new regulations. The manager and staff were not able to find policies and protocols, relating to the administration of medication, which are documents that they should have to tell them about how to give out medication safely. Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 23 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): 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 the home are not sufficiently protected from the risk of harm. EVIDENCE: There is a complaints procedure within the home. We have received one complaint since the last inspection, which was referred to the police and social services to investigate under adult safeguarding procedures (which are used to protect people from the risk of harm). The home has reported to us that they have received ten complaints over the last twelve months, none of which were upheld. Four people who live in the home, who filled in our surveys said that they felt able to talk to staff if they had any concerns or complaints. One person who lives in the home told us that they get worried in the home when people ‘kick off’. One person said that they do not feel very safe, and another told us that there had been problems within the local neighbourhood, such as people throwing stones. Staff and the manager agreed that there were some risks from some people in the local community. We did not find anything to show us that any action was being taken by the provider to try and address this. We spoke with staff about safeguarding people who live in the home, and looked at training records. Staff were able to tell us about what action they would take to ensure people were protected from harm. One member of staff had received training at the home about protecting people from harm and Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 24 about procedures that should be followed where abuse is suspected – another member of staff had training at another Prime Life home. Two members of staff said that they have not received training about safeguarding/protection from abuse. One told us about a serious incident, which had taken place recently in the home. The member of staff felt that not enough had been done, and said they felt unsafe working in the home. We found that there have been at least two incidents that have occurred in the home relating to the safety and welfare of people who live there, which should properly have been referred under safeguarding procedures, but which were not. Care services have to report any serious incidents to us, which could affect the safety and welfare of people who use the service, under Regulation 37 of the Care Homes Regulations 2001. We found records in care files of a number of serious incidents, which had not been reported to us. We left an immediate requirement for action to be taken by the home to correct this, and the home has been reporting incidents more regularly since this time. The home does have links with other people who are involved in the care of people living in the home, like community psychiatric nurses (CPNs) and social workers, but we found that not all information is passed on as it should be – for example we found a difference in what staff told us and what a visiting CPN was aware of regarding someone’s care needs. Staff have received training in handling difficult situations and the proper use of restraint. Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 25 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 homely, comfortable, clean and safe environment. EVIDENCE: We looked around at parts of the premises, including a sample of flats and three bedrooms, at people’s invitation. We did not see everyone’s living accommodation during our visit. In the surveys that people who live in the home returned to us, two people said the home was always fresh and clean, two people said it was sometimes so. Each flat has a living room, kitchen and shower rooms and toilets, and is shared by three or four people. Every person has their own bedroom. We found that generally the home is spacious and bright and airy throughout. However, we saw that there were some very bad stains on the carpets in some shared areas, and some damaged furniture – for example, we saw a table with Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 26 burn marks on it. One staff member suggested to us in one of our surveys that it might be good if the carpets could be replaced in some areas with flooring to enable staff to keep the home cleaner. There are showers available to people who live in the home, but no baths. Some people we spoke with, and staff, said that it would be good if there were baths so that people could have a choice. One person said to us “It would be better to have a bath – bath is better, sometimes it’s hard to stand up for a long time in the shower, I’m shaky.” The bedrooms we saw showed that people had their own individual style and preference about furniture and possessions, although one person said they did not like the colour of their bedroom, which had been decorated before they moved into it, and they would prefer a different colour (this individual preference was discussed with the manager). In one bedroom we saw a hole in the ceiling, which the person to whom it belonged told me that water had come through. The manager confirmed that it had been repaired, but agreed it did not create a homely environment to have a hole gaping in the bedroom ceiling looking to the roofspace above. We saw one shared kitchen, and found that the standard of cleanliness was not high and there was a pile of flour spilt on the floor. Whilst people who live in the home may help to keep areas clean if they choose to (particularly their own bedrooms), care staff in the home told us that they are responsible for cleaning both the main kitchen and lounge area, and the kitchens, lounges, toilets and bathrooms in each of the ten flats, in addition to all communal spaces, such as staircases. CCTV cameras are in place covering the entrance and surrounds of the building. There is a broken window in the office, which staff told us has not been replaced for some time. Staff carry keys around for various parts of the building which are locked, such as the main kitchen, offices, and laundry, but people who live in the home are enabled to have free access into and out of the home. There is a courtyard, where staff have put a gazebo, which provides a covered smoking area for service users. This is also the area where people may drink alcohol, since it is not allowed inside the home. People may also smoke in their own bedrooms. We saw the laundry facilities in the home. There is a laundry, which is kept locked by staff. Care staff assist people who need help to do their laundry, but encourage those who are more independent to do it themselves. Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 27 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, 33, 35 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 put at risk by insufficient staff time to meet their needs, and by gaps in staff training. EVIDENCE: We looked at the recruitment and training records for a sample of four members of staff who are employed to work in the home. We saw application forms, two written references, and evidence of relevant safety checks in place for three members of staff. The manager was unable to locate proof of a Criminal Records Bureau check for one member of staff and contacted head office who hold records centrally. We did not see this evidence during our visit to the home. (Following our inspection, we were told that there had been a mistake made concerning this person’s CRB check and a new one would have to be requested – the member of staff was to be kept off shift until relevant checks were confirmed). We have separately inspected the central recruitment systems of Prime Life and found these to meet our standards. Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 28 We talked to staff about training and saw training certificates for staff. Staff have had training in different aspects to help them to improve their skills, including food hygiene, medication training, and first aid. As described in other sections of this report, not all staff have had training in key areas needed. One member of staff has achieved National Vocational Qualification (NVQ) level 2 in care, at a previous home they worked at. One member of staff told us in their survey response that a ‘hold’ has been put on their NVQ 3 training – although they gave no explanation as to why. The home’s AQAA stated that eight out of nineteen members of staff have achieved NVQ level 2 or above. Further information provided by the home told us that sixteen members of staff have left the home in the last twelve months. One member of staff said that they had not received a proper induction when they came to work at the home, but felt they had been ‘thrown straight into the job’. We saw no evidence of induction records in their file. There is a mix of race, gender and age in the staff group, which reflects the range of people who live in the home. People we spoke with mainly said that the staff in the home were good, but that they had little time to spend with them. We observed one person who had asked for a member of staff to come to see them to help them with something: it took about forty minutes for the member of staff to come to them, during which time they were left without proper explanation for the delay. We saw that the person became quite distressed at being left for so long. Some members of staff support some people who live in the home on a one to one basis for a number of hours each week, and the provider gets additional funding for this. Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 29 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 poor. This judgement has been made using available evidence including a visit to this service. The welfare of people who live in the home is put at risk by lack of properly supported management of the home. EVIDENCE: The manager has remained in post since the last inspection and is now registered with us. Staff told us that the manager is approachable. However, because the staff in the home are not properly trained in all relevant aspects (particularly mental health) and the systems are not in place to ensure the safety of service users or the proper support of staff and the manager, we have to find that the overall management of the home does not provide a well run home for people who live there. Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 30 We saw records of resident meetings and staff meetings – the last dated was in 2007, although one member of staff said they recalled the last staff meeting as being about two months previous. The member of staff said they felt able to contribute ideas about the running of the home. The provider told us about their quality assurance system, and about how they gain the views of people who live in the home from time to time. During our inspection, the fire alarm went off on two occasions (not practices), and the building was evacuated. We observed the manager taking control, and the process was carried out without panic. We learnt that one member of staff has not had training in fire safety since starting to work in the home, and they described to us their concerns about how they would evacuate people safely. Staff have had training in first aid and food hygiene. We did not see evidence that all staff have had training in infection control, and one member of staff told us that she had not. Given the different roles that staff are carrying out, this is particularly important. Information we have received from the provider showed us that most equipment was last checked in 2007. However, gas appliances were last checked in 2006, which is outside the required annual check time. Again, information given to us by the provider told us that policies in the home, including those relating to safe working practices, have not been reviewed since 2006. Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 31 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 1 4 3 5 2 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 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 2 35 1 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 1 14 X 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 2 X 3 X X 2 X Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 32 No 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 Timescale for action 31/07/08 2 YA2 14 (1) 3 YA3 12 (1) 4 YA5 5 (1) 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 an informed choice about where to live. The provider must ensure that 31/07/08 assessments contain all relevant information provided to the service, including information about risks, so that a proper decision can be made about meeting an individual’s needs. The provider must ensure that 31/08/08 the specialist mental health service offered by the home is based on current good practice and reflects specialist and clinical guidance – and specifically that staff are properly trained in mental health. This is to ensure that people’s mental health needs will be met. The provider must ensure that 31/07/08 terms and conditions correctly state any policies or rules, which may limit personal freedom in DS0000066589.V364833.R02.S.doc Version 5.2 Island Place Page 33 5 YA6 15 (2) 6 YA7 12 (1) 7 YA9 13 (4) 8 YA12 16 (1) 9 YA13 16 (1) 10 YA19 13 (4) 11 YA20 13 (4) the home, so that people who live in the home know what their rights are. The provider must ensure that individual care plans are updated to reflect changing needs, to ensure that people are given the current care they need. 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. The provider must ensure that risk assessments are in place for each person living in the home, so that people who live in the home are able to do things they would like to, but are kept safe. The provider must ensure that people are supported to take part in appropriate and relevant activities of their choice, to improve their lifestyle. The provider must ensure that people who live in the home are properly supported to safely participate in their local community, to improve their lifestyle. The provider must carry out a risk assessment (relating to confidential issues regarding two people who live in the home – detailed separately to provider) and inform Social Services in a safeguarding referral of all relevant issues and incidents, in order that the risks can be properly ascertained and managed. The provider must ensure that there is a proper assessment in place for people who are enabled to administer their own DS0000066589.V364833.R02.S.doc 31/08/08 31/07/08 31/07/08 30/09/08 31/08/08 28/05/08 30/06/08 Island Place Version 5.2 Page 34 12 YA20 13 (2) 13 YA20 13 (2) 14 YA20 13 (2) 15 YA20 13 (2) 16 YA20 13 (2) 17 YA20 13 (2) medication, to include all potential risks and how these will be minimised – including written evidence of any instruction from GP/Community Psychiatric Nurse. This is to ensure the safety of people who live in the home. The provider must ensure that medication is stored safely in the home, within a risk management framework. The provider must put in a system to regularly monitor compliance for everyone who has been risk assessed as able to self administer their own medication, to ensure that they are taking their medication properly and safely. The provider must ensure that medication is administered safely and correctly by each responsible staff member, in accordance with policies and required practice. The provider must ensure that suitable provision is made for the safe storage of controlled drugs under the Misuse of Drugs (Safe storage) Regulations 1973 (as amended), to safely store all controlled drugs on the premises. The provider must ensure that all homely remedies have a supporting policy to administer them against. This is to ensure that certain remedies are administered, for certain conditions only and for a certain length of time before referral to a doctor. The provider must ensure that there are medication polices readily available, which reflect good practice and are regularly reviewed. DS0000066589.V364833.R02.S.doc 22/05/08 01/07/08 01/07/08 31/08/08 31/07/08 31/07/08 Island Place Version 5.2 Page 35 18 YA23 13 (6) 19 YA23 13 (6) 20 YA33 18 (1) 21 YA35 18 (1) 22 YA35 18 (1) 23 YA42 23 (4) The provider must notify the CSCI of any serious incidents affecting the welfare of service users as specified in Regulation 37, in order to safeguard people who live in the home. The provider must ensure that there are robust procedures for responding to suspicion or evidence of abuse or harm, including staff knowing how to follow them, so that people are kept safe from harm. The provider must ensure that there are enough staff on duty to meet the assessed needs of people who live in the home. The provider must ensure that all staff receive structured induction training within six weeks of commencing work in the home, to ensure that people who live in the home receive good care from staff. The provider must ensure that all staff receive the training they need to carry out their role effectively (and particularly safeguarding, and infection control), so that people who live in the home can have confidence in staff. The provider must ensure that staff know the needs of every individual in relation to fire safety and that they are trained to evacuate anyone who needs help, so that everyone who lives in the home can be kept safe. 27/05/08 31/08/08 31/07/08 31/07/08 30/09/08 11/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 36 No. 1 Refer to Standard YA20 Good Practice Recommendations It is recommended that the provider ensures that all ‘when required’ occasional-use medicines have supporting protocols to administer them against, to ensure they are administered as the doctor intended, endorsed by a clinician. It is recommended that the provider ensures that any known allergies are recorded on the Medication Administration Record, or ‘nil known’ where appropriate. Also, to liaise with the supplying pharmacist to include above details, GP name and all current medication prescribed. It is recommended that the provider replaces stained carpets, to provide a better environment for people who live in the home, which will contribute to their health and wellbeing. It is recommended that the provider reviews whether and how it might be possible to provide baths in home, so that people can have a greater choice about personal care, in relation to their needs. It is recommended that the provider carries out immediate repairs to the hole identified in one person’s bedroom ceiling, to ensure they feel safer and more comfortable in their own environment. It is recommended that the provider carries out repairs to the broken window in the office, to ensure people are safe. It is recommended that the provider carries out an audit of the environment to see what other repairs/action needs to be taken to create a homely living environment, to promote the good health and wellbeing of people who live there. It is recommended that the provider reviews all policies in the home, to ensure that they fit with best current practice in meeting the needs of people who live in the home. It is recommended that the provider has a safety check carried out on the gas boiler without delay. 2 YA20 3 YA24 4 YA24 5 YA24 6 7 YA24 YA24 8 9 YA42 YA42 Island Place DS0000066589.V364833.R02.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Cambridge LO CPC1 Capital Business 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.V364833.R02.S.doc Version 5.2 Page 38 - 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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