Inspection on 19/09/07 for Josephine Butler

This inspection was carried out on 19th September 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Josephine Butler 20/04/10

Josephine Butler 04/02/10

Josephine Butler 25/03/09

Josephine Butler 10/07/08

Josephine Butler 17/05/06

Josephine Butler 20/01/06

Josephine Butler 27/07/05

Josephine Butler 15/12/04

Josephine Butler 23/09/04

Josephine Butler 14/04/04

Josephine Butler 17/06/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Josephine Butler 34 Alexandra Drive Liverpool Merseyside L17 8TE Lead Inspector Mr Mike Perry Unannounced Inspection 19th September 2007 10:00 Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Josephine Butler Address 34 Alexandra Drive Liverpool Merseyside L17 8TE 0151 727 7877 F/P 0151 727 7877 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) Mr Harold Smith Philip David Wade Care Home 21 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (21) of places Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Residents between ages of 16 - 64 years To accommodate one named service user over the age of 65 years Date of last inspection 8th January 2007 Brief Description of the Service: Josephine Butler House is a large detached property set in its own grounds in the Sefton Park area of Liverpool. It is short walk from Sefton Park, Lark Lane, shops, pubs and public transport. The home provides care and personal support to younger people between the ages of 18-65 years that have mental disorder. The accommodation is provided on three floors with the communal areas: lounge, dining room, conservatory, games room and quite room on the ground floor. All the service users’ accommodation is provided in single bedrooms. Service users are able to access the first and second floor by the passenger lift. The home is staffed twenty-four hours a day by a Registered Mental Nurse and support workers. The service users are encouraged by staff to access various community facilities and to maintain their independence. The manger for the service is Phil Wade and the Registered Provider is Mr Harold Smith. The weekly fee is currently £450 per week and service users are given written terms and conditions showing what is included in the weekly fee. Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that lasted nine hours over two days. During this time residents in the home were spoken to and members of staff on duty as well as the registered manager. The inspector also met with a representative of the Provider. A health care professional was also consulted. Prior to the visit the manager completed a pre inspection information document [AQAA], which provided evidence of the daily running of the home. Resident surveys were also completed and returned and comments from these assisted to provide further evidence regarding the standards in the home. A sample of service users care plans and risk assessments were inspected as well as staffing and other health and safety records. Also a tour of the building was made and all day areas and some [not all] resident’s bedrooms were seen. What the service does well: The nursing staff at the care home make an assessment of the service user needs both prior to admission and during the admission process to ensure that the facilities offered are suitable and staff have the necessary skills to meet the service user assessed needs. One resident described how he had first visited the home for the day and then a weekend and then a full week. Over this period the above assessments are completed. The residents have detailed care plans and risk assessments showing how their assessed needs would be met and how identified risks would be minimised. The plans are reviewed at regular intervals and these reviews are detailed enough to track the progress of the resident over that period. Observation during the inspection and discussion with service users and staff clearly showed that the service users make decisions over their daily lives. For example all of the service users manage their own finances to various degrees. Residents also make decisions about maintaining contact with their family and the frequency and choose level of participation in community activities or activities in the home. Resident’s spoken with enjoy this freedom and feel relaxed in the home. One said ‘it’s the best home I’ve been in – the staff are very friendly and help me’. Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 6 The general environment is very relaxed and sociable and this was observed throughout. Discussion with residents indicated that they are very happy with the food provided at the care home. There was evidence of a choice of meal being offered to service users. The chef consults the residents on a regular basis. One resident has current health needs in terms of a physical condition. The care plan details the needs and input from both health care professionals and carers in the home. Discussion with the resident conformed that staff are very supportive and are respectful and appropriate when carrying out personal care. The health professional involved from outside the home confirmed that the staff have been very proactive in referring the resident and in giving the ongoing support needed. Some of the residents continue to have additional support from the Community Psychiatric Nurse and have regular review of their medication and mental health needs by the psychiatrist. The home does seek out the views of the residents by holding regular resident meetings and the use of quarterly satisfaction surveys. One issue identified was the variety of the food and this has been dealt with by getting the chef to talk to residents on a regular basis about any changes or requests. What has improved since the last inspection? Residents are assessed appropriately before being fully admitted to the home so that they are assured that their care needs can be met. The care plans seen were detailed, personalised and easy to follow and had been reviewed on a regular basis. The reports from the residents and the meal time seen evidenced that the food in the home is of a good standard and is enjoyed by the residents. Staff have attended training courses on safeguarding adults and the reporting of abuse and staff spoken to were aware of the procedures involved. Both electrical and gas safety certificates were available for inspection and fire safety equipment has been tested and maintained. Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 7 What they could do better: Resident’s are responsible for maintaining their bedrooms with the support from their key worker to ensure that service user maintains daily living skills. On both days of the inspection there was limited staff available to maintain these. Some bedrooms were observed to be not clean evidencing that these residents require more support from care staff. Resident’s weekly activity sheets show that some access a range of community activities locally where they have the opportunity to meet others that do share the same disability. Currently, the service does not contribute towards service users holidays and this should be given some consideration. Discussion with some residents indicates that his would be important in terms of the overall quality of life. The nursing staff at the care home currently administers the service users medication. There was agreement that some development could be made here so that some residents could become more independent with self-medication. Inspection of resident’s medication records showed that medication records are not being maintained accurately as medication is not signed as given when administered. There were other anomalies with both the storage and recording of medicines that must be addressed so that the residents are assured of a safe and consistent service. The manager needs to develop a more thorough auditing process to ensure standards are maintained. There were a number of concerns around the ability of the provider to maintain the fabric of the building. There were also issues around safety and independence of residents with respect to the lighting in the home and the risk of scalds from hot water. For example: • Internally the building was very dark. There has been a programme of replacing normal light switches with ones that can only be turned on and off by staff using a key. This must cease and be reversed as it infringes on the independence of the residents in the home as well as being a risk factor. Although accessible to residents none of the bathrooms are fitted with thermostatic controls to control the water temperature at a safe level. There are risk assessments in place which state that residents are at risk from scalds and need staff supervision for bathing. From the perspective of both safety and promoting independence the water must be regulated at a safe temperature with thermostatic valves and routinely checked. There were signs that the maintenance programme in the home is not meeting needs in terms of maintaining standards. For example one room DS0000025114.V343826.R01.S.doc Version 5.2 Page 8 • • Josephine Butler had no ventilation, as the old sash window could not be kept open due to a broken sash cord [reported months previously]. At least two rooms were particularly in need of upgrading as the windows were in a very poor state of repair with flaking internal paintwork and decayed external frames. One room had wallpaper peeling off and plaster was cracked and exposing brickwork. Another bedroom [not currently used] on the top floor had a large damp / wet stain in one corner indicating problems with the roof / gutter outside [first reported 8 months ago]. • • Some bedrooms were not clean. For example windowsills and sinks that were stained and windows that were dirty [internally]. The management have installed CCTV in the home in communal areas. The manager reported that this was to observe staff but it also obviously monitors residents and is an invasion in terms of both privacy and dignity for people who consider Josephine Butler their home. They must be removed. It is a requirement that an improvement plan is formulated, which includes upgrading, and maintenance plans with realistic time scales for completion. The ongoing monitoring of the environment should be reviewed on a regular basis and should form part of the monthly auditing visits by the provider [Regulation 26 visits]. None of these reports were available. The staffing of the home has been inconsistent of late. During the inspection some staff did not turn in to work. The manager understands that consistency of staff is importance so that the continuity of the care is not disrupted. The ongoing recruitment of staff has been difficult and staff records inspected showed that the required checks to ensure staff are fit to work in the home are not being carried out prior to appointment and this must be addressed as it may put residents at risk from staff who are unsuited. Staff are attending basic training courses and there is an induction checklist for new staff but these need to be developed further through individual training plans and improving the induction programme so that it is more thorough and meets recommended standards. There is currently no external quality audits for the manager to gain any feedback about the service and the in-house audits are not thorough enough to be monitoring and improving standards in key areas [medication and environmental standards for example]. The Provider must fulfil the monthly auditing role [Regulation 26 visits] and produce a report for the manager as part of the overall quality processes in the home. Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 9 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. Josephine Butler DS0000025114.V343826.R01.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 Josephine Butler DS0000025114.V343826.R01.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): Standard 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission procedure at Josephine Butler would enable residents to be confident about the home being able to meet their needs. EVIDENCE: The nursing staff at the care home make an assessment of the residents’ needs both prior to admission and during the admission process to ensure that the facilities offered are suitable and staff have the necessary skills to meet the service user assessed needs. From the information obtained an initial service user plan and risk assessment is developed showing how the assessed needs of the resident’s would be met. One resident described how he had first visited the home for the day and then a weekend and then a full week. Over this period the above assessments are completed. Care files seen also contained assessments from referring agencies such as social services and this information is also used so that a full picture of the resident is built up. The manager stated that not all residents are visited prior to admission, as the above process is good at getting the assessment process completed. It would be recommended as good practice however as an initial assessment prior to Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 12 admission is important to reassure the prospective resident about the home as well as providing a useful first contact. Josephine Butler DS0000025114.V343826.R01.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): All key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are consulted and care planning is devised in order to maintain residents independence. EVIDENCE: The residents have detailed care plans and risk assessments showing how their assessed needs would be met and how identified risks would be minimised. The service user plans inspected showed that where possible the resident has been consulted about the content of the plan. The plans are reviewed at regular intervals and these reviews are detailed enough to track the progress of the resident over that period. There was some discussion with the manager regarding the inclusion of the resident at these reviews of the care plan and this could be evidenced in the documentation [for example a signature]. Observation during the inspection and discussion with resident’s and staff clearly showed that resident’s make decisions over their daily lives. There is a Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 14 weekly activity plan, which show activities that each resident would like to do and whether it actually took place. This includes activities that the service users engage independently or with staff. All of the resident’s manage their own finances to various degrees. One residents care plan details the management of personal allowance with the support of staff and these arrangements were seen on the inspection. Residents also make decisions about maintaining contact with their family and the frequency and choose level of participation in community activities or activities in the home. For example one resident discussed monthly trips to see a relative in another town. The registered manager organises monthly service users meetings so that residents can raise any issues in a group forum. All residents spoken to state that staff were approachable and would listen to their concerns. Staff support resident’s to take responsible risks as identified in their service user plan. Some residents have kettles in their bedroom for which risk assessments have been developed to minimise risks. At least two residents have risk assessments around the use of the bath due to risk of scalds from hot water although the introduction of thermostatic controls would lessen the need for staff intervention and promote more independence [see environment for further discussion]. Another resident is at risk from traffic when out of the home and a plan is in place to reduce any risk. Service users records are kept in a secure place and discussion with staff confirm that they understand the home’s policy on confidentiality of information. Josephine Butler DS0000025114.V343826.R01.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, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff support the residents to develop new skills and to maintain personal relationships although some aspects could be more consistent and some quality of life areas could be better developed. EVIDENCE: Resident’s are responsible for maintaining their bedrooms with the support from their key worker to encourage they maintain daily living skills. This also, includes being responsible for their laundry. On both days of the inspection there was limited staff available to maintain these programmes [see staffing] and the recent turnover of staff means that consistency of input is not always maintained. Some bedrooms were observed to be not clean evidencing that these residents require more support from care staff. Resident’s make decisions over all aspect of their daily lives, such as choosing to spend time on their own in their bedroom or in the communal areas with Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 16 other service users. Resident’s spoken with enjoy this freedom and feel relaxed in the home. One said ‘it’s the best home I’ve been in – the staff are very friendly and help me’. The general environment is very relaxed and sociable and this was observed throughout. Staff reported that some residents have attended college to improve their knowledge and skills. For example one resident has attended a computer course. Another resident discussed how she would like to start an art course and had a copy of available courses at the local college. This particular resident discussed some of the artwork she had produced. The service is located close to shops, pubs, library, etc. Observation during the inspection showed that service users access these regularly throughout the day. The service is close to a main road where service users could access a number of buses. Most service users have a bus pass. Resident’s weekly activity sheets show that some access a range of community activities locally where they have the opportunity to meet others that do share the same disability. Currently, the service does not contribute towards service users holidays and this should be given some consideration. Discussion with some residents indicates that this would be important in terms of the overall quality of life. One resident contacted the Commission some time ago with issues around the home supporting a relationship with a person from outside the home. The resident felt the home were not being supportive but during he inspection it became apparent that the relationship had been supported and appropriate risks had been addressed within the homes duty of care. There was constructive discussion with the manager who displayed a good understanding of the issues involved. All parts of the home are easily accessible,and there is good day space. The service has a large garden to the rear of the property and there is large tarmac area to the front of the property, which is used as a parking area for staff and visitors. Service users are provided with a key to their bedroom door to promote their privacy. Discussion with residents indicated that they are very happy with the food provided at the care home. There was evidence of a choice of meal being offered to service users. The chef consults the residents on a regular basis. Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 17 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): All key standards. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff monitor service users health to ensure that their health needs are met by accessing appropriate support and advice from other health professionals when necessary but there needs to be attention paid to standards around the recording and other medication standards to ensure a consistently safe service. EVIDENCE: Observation of residents showed that they require little assistance with personal care except for prompting and supervision as evidence in the inspection and the pre-inspection questionnaire [AQAA]. One resident has current health needs in terms of a physical condition. The care plan details the needs and input from both health care professionals and carers in the home. Discussion with the resident conformed that staff are very supportive and are respectful and appropriate when carrying out personal care. The health professional involved from outside the home confirmed that the staff have been very proactive in referring the resident and in giving the ongoing support needed. Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 18 Some residents continue to have additional support from the Community Psychiatric Nurse and have regular review of their medication and mental health needs by the psychiatrist. Where necessary staff from the care home would accompany residents to outpatient appointment and visit to the chiropodist, optician or dentist. The chiropodist visits the care home every two months. The nursing staff at the care home currently administers medication to the residents. Discussion with the manager was useful and there was agreement that some development could be made here so that some residents could become more independent with self-medication. There was no risk assessment tool for self medication. The home uses a monitored dosage system and records are kept of all medication received into the care home, administered and returned to the pharmacist. Inspection of service user medication records showed that medication records are not being maintained accurately as medication is not signed as given when administered as evidenced on one of the recording sheets. Staff could not explain why the medicine had not been given. The supplying pharmacist visits the home twice yearly but does not supply any written feedback and it is recommended that this be requested. The manager has started his own internal audit but this lacked depth and an example of an audit sheet was left. The medication recording charts [MAR] for two residents were seen. Sticky labels are being used on the MAR as a record of the medication prescribed. These are not permanent and can fall of over time. Staff should record any mid cycle changes by hand and get two signatures as appropriate to check accuracy. One resident is on fentinol patches [for pain relief] and these were monitored through the controlled drug register in the home but the amount received was not written on the MAR sheet and this is recommended as part of the auditing process. One medicine was very hard to read on the MAR chart and care should be taken to ensure that all medications can be easily read. At the time of the inspection there had been a delivery of medications and these were left in the office and accessible as the office door is managed on a key pad system and therefore accessible to anybody with the code. Suitable storage must be made available. This was required on the last inspection and has still not been addressed. Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 19 Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 20 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): Both Key Standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure and staff are aware of the procedures for reporting abuse so that residents feel they are listened to and are safe. EVIDENCE: The service has a complaint procedure, which is displayed in a prominent position. A suggestion box is available to enable stakeholders to raise their concerns or make comment about the service. The service has received no complaints in the last twelve months. All residents spoken to felt safe in the home and felt that staff would listen to their concerns. Survey forms also evidenced this. The service has various policies and procedures in place to protect service users and staff from all forms of abuse. The local safeguarding adults procedures are situated in the office in a cupboard [although these could be more immediately accessible]. There has been some training for staff on abuse awareness. The staff spoken to had knowledge of the procedures for reporting any allegations and also of the role of the statutory bodies such as social services and The Commission for Social Care Inspection [CSCI]. Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 21 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): All key standards. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are good advantages for residents in terms of the general layout and vicinity of the home but there needs to be better monitoring of the fabric of the building with respect to maintenance and some health and safety issues so that residents are assured of a safe and homely environment. EVIDENCE: All parts of the home are easily accessible to residents and the building was clean and free from unpleasant smells. The building is in keeping with the local community and the premises is well suited for the resident group as most of the bedrooms are very large and the home is within a short walking distance to the local shops and public transport. All accommodation is provided in single bedrooms. Many of the bedrooms are personalised with resident belongings that reflect their interests. There are a number of toilets and bathrooms, which are located near the bedrooms and the communal areas. The communal areas in Josephine Butler are large and Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 22 airy which could be used for a variety of purposes. There is a large lounge, a smoking lounge, conservatory, dining room and a games room. The laundry equipment is situated in the basement which is easily accessible toresidents . Policies and procedures are in place to minimise the spread of infection. From the inspection there were a number of concerns around the ability of the provider to maintain the fabric of the building, which is both large and old and there was some discussion with both the representative of the provider and the manager with respect to providing a realistic upgrading and maintenance plan for the home. There were also issues around safety and independence of residents with respect to the lighting in the home and the risk of scalds from hot water. Some of the observations are: • Internally the building was very dark. The manager explained that residents continually left lights on and this has meant large electricity bills. There has been a programme of replacing normal light switches with ones that can only be turned on and off by staff using a key. This must cease and be reversed as it infringes on the independence of the residents in the home as well as being a risk factor. One resident was showing the inspector along a corridor, which was extremely poorly lit, and stated that there have been instances of stumbling down the stairs. Although accessible to residents none of the bathrooms are fitted with thermostatic controls to control the water temperature at a safe level. There are risk assessments in place which state that residents are at risk from scalds and need staff supervision for bathing. From the perspective of both safety and promoting independence the water must be regulated at a safe temperature with thermostatic valves and routinely checked. There were signs that the maintenance programme in the home is not meeting needs in terms of maintaining standards. For example one room had no ventilation, as the old sash window could not be kept open due to a broken sash cord [reported months previously]. Many of the bedrooms had carpets that were badly stained, particularly around the sink area. At least two rooms were particularly in need of upgrading as the windows were in a very poor state of repair with flaking internal paintwork and decayed external frames. One room had wallpaper peeling off and plaster was cracked and exposing brickwork. Another bedroom [not currently used] on the top floor had a large damp / wet stain in one corner indicating problems with the roof / gutter outside [first reported 8 months ago]. Some bedrooms were not clean. For example windowsills and sinks that were stained and windows that were dirty [internally]. The key workers • • • Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 23 are responsible for maintaining bedrooms with residents and this needs to be monitored closely so that basic hygiene standards are met. • The management have installed CCTV in the home in communal areas. The manager reported that this was to observe staff but it also obviously monitors residents and is an invasion in terms of both privacy and dignity for people who consider Josephine Butler their home. They must be removed. Despite the advantages enjoyed by residents with the general facilities these issues must be addressed by the manager and provider. It is a requirement that an improvement plan is formulated, which includes upgrading, and maintenance plans with realistic time scales for completion. The ongoing monitoring of the environment should be reviewed on a regular basis and should form part of the monthly auditing visits by the provider [Regulation 26 visits]. None of these reports were vailable. Josephine Butler DS0000025114.V343826.R01.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): 32,33,34,35. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. staffing in the home is currently inconsistent and recruitment and training are areas that need improvement so that residents can be assured staff are fit and competent to meet their needs. EVIDENCE: On both days of the inspection the staffing numbers were depleted due to individual staff members not turning in for work. There is some flexibility apparent, as a representative of the provider was able to cover for some of this time. In discussion with the manager and provider it is apparent that currently staffing is inconsistent. The manager reported, ‘Staffing is an issue. Can’t send of for criminal record checks until we get the fee from the applicant. I’ve spoken to the owners as we will be short in a few weeks and we will have to use agency’. This is not good for continuity’. Input for residents on a daily basis is reliant on key workers who are permanent members of staff in order to develop the relationships with residents that are needed for this particular resident group. An example of the effect could be the lack of input to assist residents in maintaining their Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 25 bedrooms [see comments previously], which is reliant on the key worker relationship. Ancillary staff cover was present on both days with a domestic and somebody working in the kitchen up till 17:30 hours. Staff files were checked in terms of the recruitment process for the home. Of the three files inspected two did not have the required written references needed [one staff had no references] and all three had not received a clear Protection of Vulnerable Adults [POVA] check prior to starting work in the home. This puts residents at risk from staff that may not be fit to work. The manager confirmed these findings. On the pre inspection information form given by the manager there is a statement to the effect that more training for staff is needed. This was confirmed on the inspection visit. Staff spoken with have completed basic training in statutory issues such as health and safety and safeguarding adults but only 4 of the care staff currently working have an NVQ qualification [out of nine care staff]. The induction of new staff is currently very basic and both staff records and interviews confirm that the induction does not meet the induction standards set out by ‘skills for care’. This was discussed and the manager needs to audit the current induction checklist against these standards. The manager was unaware of the code of conduct that should be issued to all care staff from the General Social Care Council [GSCC] and this needs to be included in the induction package. There are seminars held by the manager for staff on mental health issues and this was evidenced in staff interviews. These are adhoc however and the manager needs to maintain better training records to evidence continuity of training for staff through supervision sessions, which are still inconsistent. The manager does not have a set budget for training and therefore has difficulty planning properly due to uncertainty about the financial constraints. The provider has not taken up the recommendation on previous inspection reports for the manager to be a given realistic budget. Staff spoken to during the inspection were enthusiastic about the home and had a demonstrated a clear interest in the resident group. All of the comments received from residents either verbally or through survey forms were positive about the staff although some comments reflected the findings above around continuity, ‘ some staff do not stay very long’. Josephine Butler DS0000025114.V343826.R01.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): Key standards Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is managed in the interests of residents but there needs to be more thorough and consistent management processes to ensure continued development. EVIDENCE: Phil Wade is the Homes Registered Manger. He has a nursing qualification in mental Health [RMN] and has had a long history for working in the private sector. He was manager of a care home prior to Josephine Butler. He was able to provide some evidence of managerial update over recent years by the completion of an eight-week management course [certificate seen]. Phil was doing an NVQ at level 4 management but has not completed this and it would still be recommended [manager has also identified this]. Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 27 The home does seek out the views of the residents by holding regular resident meetings and the use of quarterly satisfaction surveys. One issue identified was the variety of the food and this has been dealt with by getting the chef to talk to residents on a regular basis about any changes or requests. There is currently no external quality audits for the manager to gain any feedback about the service and the in-house audits are not thorough enough to be monitoring and improving standards in key areas [medication and environmental standards for example]. There was some discussion around this and examples of audits were reviewed. The Provider must fulfil the monthly auditing role [Regulation 26 visits] and produce a report for the manager as part of the overall quality processes in the home. The manager expresses a desire for the service to continue to improve and some of the requirements from the previous inspections have been met. The pre inspection information returned highlights some of the issues raised in this report and cites what are essentially financial constraints as the main barriers to improvements. Health and safety records were inspected. The pre inspection information states that all safety certificates are up to date and some of these [fire, electricity, gas safety] were checked on the inspection visit. Josephine Butler DS0000025114.V343826.R01.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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 29 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 YA20 Regulation 13(2) Requirement The registered person shall make arrangements for all medication received in to the home to be recorded accurately. [Last requirement date 30/01/07 not met] 2 YA20 13(2) The registered person shall make arrangements for all medication to be stored in a locked cupboard whilst in the home including any new medications and returns. [Last requirement date 30/01/07 not met] 3 YA24 23(2)(b) The registered person shall ensure the premises are of sound construction and kept in good state of repair externally and internally to provide a pleasant and safe environment in which residents can live. [Last requirement date 28/02/07 not met] There must be an improvement and maintenance schedule [written] that addresses the DS0000025114.V343826.R01.S.doc Timescale for action 15/10/07 15/10/07 30/10/07 Josephine Butler Version 5.2 Page 30 issues listed in the report under ‘environment’ and includes completion dates. 4 YA24 13[4] The safety of residents with 30/10/07 respect to bathing must be addressed and thermostatic controls fitted to baths to reduce risk of scalds as well as promote independence for residents. There must be a level of staff on 15/10/07 duty at all times to ensure that residents are needs are met with some consistency. The registered person shall not 15/10/07 employ any person to work at the care home unless all documentation detailed in Schedule 2 of the National Minimum Standards has been obtained including two satisfactory references and POVA clearance. [Last requirement date 20/02/07 not met] 7 YA35 18(1) c All staff must have an ongoing training programme appropriate to the work that they are to perform. Particular attention must be paid to ensuring that induction programmes meet recommended standards. The registered provider who is not in day to day charge of the home shall visit the care home at least once a month unannounced, and prepare a written report on the conduct of the home. [Last requirement date 28/02/07 not met] 30/11/07 5 YA33 18(1) a 6 YA34 19 8 YA39 26 30/10/07 Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 31 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 2 3 Refer to Standard YA2 YA16 YA14 Good Practice Recommendations It would be good practice for all prospective residents to be initially visited and assessed prior to coming into the home. The key worker support of residents in terms of maintaining the standard of cleanliness in their bedroom needs to be more targeted and consistent The planning and support of residents [including financial] to engage in a holiday should be seriously considered so that residents can experience and learn from social activity external to the home. All residents should be assessed in terms of ability to self medicate and a suitable risk assessment should be used for any resident who wishes to self medicate. All medicines administered should be signed for on the MAR chart. Any omissions should be recorded. It is recommended that some written feedback be requested from the supplying pharmacist when carrying out the auditing visits to the home. The use of the ‘sticky’ labels should be replaced wit permanent written records on the MAR sheet. All medicines prescribed need to be easily read on the MAR chart. The manager, on all medication standards, should carry out thorough routine internal audits. 5 YA24 The monthly auditing reports by the provider [Regulation 26 reports] should include an audit of the environment of the care home and any action needed addressed NVQ training in the home should continue and meet the standard of at least 50 care staff trained. A copy of the code of conduct issued by the General Social Care Council [GSCC] should be given to all care staff. The registered person should ensure that the registered DS0000025114.V343826.R01.S.doc Version 5.2 Page 32 4 YA20 6 7 8. YA32 YA34 YA35 Josephine Butler 9 10 YA37 YA39 manager has a training budget to enable them to prioritise staff training. The registered person should complete their NVQ level 4 Management qualifications to satisfy the National Minimum Standards of 2001. In the absence of any external quality audits there should be thorough internal audits [particularly around medicines and environmental standards] so that continued monitoring and improvement can be evidenced. Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Josephine Butler DS0000025114.V343826.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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